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Thomas J, Crowe R, Schulz K, Wang HE, De Oliveira Otto MC, Karfunkle B, Boerwinkle E, Huebinger R. Association Between Emergency Medical Service Agency Intubation Rate and Intubation Success. Ann Emerg Med 2024; 84:1-8. [PMID: 38180402 DOI: 10.1016/j.annemergmed.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/10/2023] [Accepted: 11/03/2023] [Indexed: 01/06/2024]
Abstract
STUDY OBJECTIVE Airway management is a crucial part of out-of-hospital care. It is not known if the rate of overall agency intubation attempts is associated with intubation success. We sought to evaluate the association between agency intubation attempt rate and intubation success using a national out-of-hospital database. METHODS We conducted a retrospective secondary analysis of the ESO Data Collaborative from 2018 to 2019, and included all adult cases with an endotracheal intubation attempt. We calculated the number of intubations attempted per 100 responses, advanced life support responses, and transports for each agency. We excluded cases originating at health care facilities and outliers. We used multivariable logistic regression to evaluate the association between agency intubation attempt rate and 1) intubation success and 2) first-pass success. We adjusted for confounders. RESULTS We included 1,005 agencies attempting 58,509 intubations. Overall, the intubation success rate was 78.8%, and the first-pass success rate was 68.5%. Per agency, the median rate of intubation attempts per 100 emergency medical service responses was 0.8 (interquartile range 0.6 to 1.1). Rates of intubation attempts per 100 responses (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI] 1.6 to 1.8), advanced life support responses (aOR 1.18; 95% CI 1.16 to 1.20), and transports (aOR 1.21; 95% CI 1.18 to 1.22) were all associated with intubation success. These relationships were similar for first-pass success but with smaller effect sizes. CONCLUSION Higher agency rates of intubation attempts were associated with increased rates of intubation success and first-pass success.
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Affiliation(s)
- Jordan Thomas
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | | | - Kevin Schulz
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX; Texas Emergency Medicine Research Center, McGovern Medical School, University of Texas Health Science Center, Houston, TX; Houston Fire Department, Houston, TX
| | - Henry E Wang
- Department of Emergency Medicine, the Ohio State University, Columbus, OH
| | | | - Bejamin Karfunkle
- Texas Emergency Medicine Research Center, McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | | | - Ryan Huebinger
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX; Texas Emergency Medicine Research Center, McGovern Medical School, University of Texas Health Science Center, Houston, TX; Department of Emergency Medicine (Huebinger), University of New Mexico, Albuquerque, NM.
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Harris TR, Bhutta ZA, Qureshi I, Kharma N, Raza T, Hssain AA, Pathare AS, D'Silva A, Khatib MY, Mohamedali MGH, Macineira IMG, Garcia Hernandez VR, Garcia JR, Thomas SH, Pathan SA. A randomised clinical trial of awake prone positioning in COVID-19 suspects with acute hypoxemic respiratory failure. Contemp Clin Trials Commun 2024; 39:101295. [PMID: 38689829 PMCID: PMC11059337 DOI: 10.1016/j.conctc.2024.101295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/22/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
Background Awake prone position (APP) has been reported to improve oxygenation in patients with COVID-19 disease and to reduce the requirement for invasive mechanical ventilation for patients requiring support with high flow nasal cannula. There is conflicting data for patients requiring lower-level oxygen support. Research question Does APP reduce escalation of oxygen support in COVID-19 patients requiring supplementary oxygen?The primary outcome was defined as an escalation of oxygen support from simple supplementary oxygen (NP, HM, NRB) to NIV (CPAP or BiPAP), HFNC or IMV; OR from NIV (CPAP or BiPAP) or HFNC to IMV by day30. Study design Two center, prospective, non-blind, randomised controlled trial. Patients with confirmed or suspected COVID-19 pneumonia requiring ≥ 5 liters/min oxygen to maintain saturations ≥ 94 % were randomised to either APP or control group. The APP group received a 3-h APP session three times per day for three days. Results Between 9 May and July 13, 2021, 89 adults were screened and 61 enrolled, 31 to awake prone position and 30 controls. There was no difference in the primary outcome, 7 (22.6 %) patients randomised to APP and 9 (30.0 %) controls required escalation of oxygen support (OR 0.68 (0.22-2.14), P = 0.51). There were no differences in any secondary outcomes, in APP did not improve oxygenation. Interpretation In COVID-19 patients, the use of APP did not prevent escalation of oxygen support from supplementary to invasive or non-invasive ventilation or improve patient respiratory physiology. Trial registration NCT04853979 (clinicaltrials.gov).
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Affiliation(s)
- Tim R.E. Harris
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Qatar
- Queen Mary University London, United Kingdom
| | - Zain A. Bhutta
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Qatar
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Isma Qureshi
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nadir Kharma
- Corporate Department Medical Intensive Care, Hamad General Hospital, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Tasleem Raza
- Corporate Department Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| | - Ali Ait Hssain
- Corporate Department Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| | - Ankush Suresh Pathare
- Corporate Department of Emergency Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ashwin D'Silva
- Corporate Department of Emergency Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad Yahya Khatib
- Corporate Medical Intensive Care, Head of Unit, Hazm Mebaireek General Hospital, Doha, Qatar
| | - Mohamed Gafar Hussein Mohamedali
- Corporate Department Internal Medicine, Head of Unit, Hazm Mebaireek General Hospital, Doha, Qatar
- Instructor in Clinical Medicine, Weill Cornell Medicine, Qatar
| | | | | | - Jorge Rosales Garcia
- Corporate Department Medical Intensive Care, The Cuban Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H. Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
- Queen Mary University London, United Kingdom
| | - Sameer A. Pathan
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Qatar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Cabrera JM, Lagos-Villaseca A, Fuentes-López E, Rosenbaum A, Willson M, Palma S, Kattan E, Vera M, Aquevedo A, Napolitano C, Cabello P. Role of Prolonged Intubation in Vocal Fold Motion Impairment in Critically Ill Patients. J Voice 2024:S0892-1997(24)00149-8. [PMID: 38806325 DOI: 10.1016/j.jvoice.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE COVID-19 upsurge in orotracheal intubation (OTI) has opened a new opportunity for studying associated complications. Vocal fold motion impairment (VFMI) is a known complication of OTI. The present study sought to determine the impact of OTI and prolonged OTI on the risk of developing VFMI; to identify both risk and protective factors associated with it. STUDY DESIGN Retrospective cohort study. SETTING Multicenter. METHODS Medical charts were reviewed for all patients that received invasive mechanical ventilation with a subsequent flexible laryngoscopic assessment between March 2020 and March 2022. The main outcomes were the presence of VFMI, including immobility (VFI) and hypomobility (VFH). RESULTS A total of 155 patients were included, 119 (76.8%) COVID-19 and 36 (23.2%) non-COVID-19 patients; overall 82 (52.9%) were diagnosed with VFMI. Eighty (52.3%) patients underwent a tracheostomy. The median (IQR) intubation duration was 18 (11-24.25) days, while the median (IQR) time to tracheostomy was 22 (16-29). In the adjusted model, we observed there was a 68% increased risk for VFMI from day 21 of intubation (RR: 1.68; 95% CI 1.07-2.65; P = 0.025). CONCLUSIONS VFMI is a frequent complication in severely ill patients that undergo intubation. A prolonged OTI was associated with an increased risk of VFMI, highlighting the importance of timely tracheostomy. Further research is needed to confirm these findings in other subsets of critically ill patients.
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Affiliation(s)
- José María Cabrera
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonia Lagos-Villaseca
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Departamento de Ciencias de la Salud, Carrera de Fonoaudiología, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Rosenbaum
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Matías Willson
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Otolaryngology Service, Hospital Padre Hurtado, Santiago, Chile
| | - Soledad Palma
- Otolaryngology Service, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Eduardo Kattan
- Intensive Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Magdalena Vera
- Intensive Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Aquevedo
- Intensive Care Service, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Carla Napolitano
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Cabello
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Otolaryngology Service, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile.
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Maldonado A, Endara P, Abril P, Carrión H, Largo C, Benavides P. ROX Index Variation as a Predictor of Outcomes in COVID-19 Patients. J Clin Med 2024; 13:3025. [PMID: 38892736 PMCID: PMC11172455 DOI: 10.3390/jcm13113025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 06/21/2024] Open
Abstract
Background: During the COVID-19 pandemic, emergency departments were overcrowded with critically ill patients, and many providers were confronted with ethical dilemmas in assigning respiratory support to them due to scarce resources. Quick tools for evaluating patients upon admission were necessary, as many existing scores proved inaccurate in predicting outcomes. The ROX Index (RI), a rapid and straightforward scoring system reflecting respiratory status in acute respiratory failure patients, has shown promise in predicting outcomes for COVID-19 patients. The 24 h difference in the RI accurately gauges mortality and the need for invasive mechanical ventilation (IMV) among patients with COVID-19. Methods: Study design: Prospective cohort study. A total of 204 patients were admitted to the emergency department from May to August 2020. Data were collected from the clinical records. The RI was calculated at admission and 24 h later, and the difference was used to predict the association with mortality and the need for IMV, a logistic regression model was used to adjust for age, sex, presence of comorbidities, and disease severity. Finally, the data were analyzed using ROC. Results: The difference in respiratory RI between admission and 24 h is a good predictor for death (AUC 0.92) and for mechanic ventilation (AUC: 0.75). Each one-unit decrease in the RI difference at 24 h was associated with an odds ratio of 1.48 for the risk of death (95%CI: 1.31-1.67) and an odds ratio of 1.16 for IMV (95% IC: 1.1-1.23). Conclusions: The 24 h variation of RI is a good prediction tool to allow healthcare professionals to identify the patients who will benefit from invasive treatment, especially in low-resource settings.
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Affiliation(s)
- Augusto Maldonado
- School of Medicine, Universidad San Francisco de Quito, Quito 170901, Ecuador; (P.E.); (H.C.)
- Hospital General Docente de Calderón, Quito 170201, Ecuador; (P.A.); (C.L.); (P.B.)
| | - Pablo Endara
- School of Medicine, Universidad San Francisco de Quito, Quito 170901, Ecuador; (P.E.); (H.C.)
| | - Patricio Abril
- Hospital General Docente de Calderón, Quito 170201, Ecuador; (P.A.); (C.L.); (P.B.)
| | - Henry Carrión
- School of Medicine, Universidad San Francisco de Quito, Quito 170901, Ecuador; (P.E.); (H.C.)
- Hospital General Docente de Calderón, Quito 170201, Ecuador; (P.A.); (C.L.); (P.B.)
| | - Carolina Largo
- Hospital General Docente de Calderón, Quito 170201, Ecuador; (P.A.); (C.L.); (P.B.)
| | - Patricia Benavides
- Hospital General Docente de Calderón, Quito 170201, Ecuador; (P.A.); (C.L.); (P.B.)
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Melkonian AK, Hakobyan GV. Evaluation of the therapeutic action of original antiviral drug in SARS-CoV-2. Biotechnol Appl Biochem 2024. [PMID: 38710664 DOI: 10.1002/bab.2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
Purpose of this article is to study the possible direct antiviral effect of "Armenikum" on SARS-CoV-2, conduct an in vitro study on the SARS-CoV-2 encephalomocarditis virus, and an in vivo study on the Syrian hamster model. Human coronavirus SARS-CoV-2 (delta strain) was used as the virus. Two groups of four-specimen hamsters were used to study the therapeutic activity of the drug during 48 h after infecting. One group of hamsters served as positive control and was infected with the virus at a similar dose as experimental one and was used as a control of pathology induced by the viral infection till the end of the experiment. Another group of hamsters (four of them) was injected physiological solution and was used as a control. The Syrian hamsters underwent a clinical blood test and computed tomography. "Armenikum" in the form of an injection has a significant antiviral effect on the human coronavirus SARS-CoV-2, credibly reducing the titers of the virus and the time of its elimination from the Syrian hamsters, significantly mitigating the viral infection. "Armenikum" in the form of an injection drug almost completely removes the pathological effect of the virus in the lungs of the hamsters.
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Affiliation(s)
| | - Gagik V Hakobyan
- Department of Oral and Maxillofacial Surgery, University of Yerevan State Medical University, Yerevan, Armenia
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Cain MT, Taylor LJ, Colborn K, Teman NR, Hoffman J, Mayer KP, Etchill EW, Sevin CM, Jaishankar S, Ramanan R, Enfield K, Zwischenberger JB, Jolley SE, Rove JY. Worse survival in patients with right ventricular dysfunction and COVID-19-associated acute respiratory distress requiring extracorporeal membrane oxygenation: A multicenter study from the ORACLE Group. J Thorac Cardiovasc Surg 2024; 167:1833-1841.e2. [PMID: 36717346 PMCID: PMC9767877 DOI: 10.1016/j.jtcvs.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We sought to determine the impact of right ventricular dysfunction on the outcomes of mechanically ventilated patients with COVID-19 requiring veno-venous extracorporeal membrane oxygenation. METHODS Six academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 stratified by support with veno-venous extracorporeal membrane oxygenation during the first wave of the pandemic (March to August 2020). Echocardiograms performed for clinical indications were reviewed for right and left ventricular function. Baseline characteristics, hospitalization characteristics, and survival were compared. RESULTS The cohort included 424 mechanically ventilated patients with COVID-19, 126 of whom were cannulated for veno-venous extracorporeal membrane oxygenation. Right ventricular dysfunction was observed in 38.1% of patients who received extracorporeal membrane oxygenation and 27.4% of patients who did not receive extracorporeal membrane oxygenation with an echocardiogram. Biventricular dysfunction was observed in 5.5% of patients who received extracorporeal membrane oxygenation. Baseline patient characteristics were similar in both the extracorporeal membrane oxygenation and non-extracorporeal membrane oxygenation cohorts stratified by the presence of right ventricular dysfunction. In the extracorporeal membrane oxygenation cohort, right ventricular dysfunction was associated with increased inotrope use (66.7% vs 24.4%, P < .001), bleeding complications (77.1% vs 53.8%, P = .015), and worse survival independent of left ventricular dysfunction (39.6% vs 64.1%, P = .012). There was no significant difference in days ventilated before extracorporeal membrane oxygenation, length of hospital stay, hours on extracorporeal membrane oxygenation, duration of mechanical ventilation, vasopressor use, inhaled pulmonary vasodilator use, infectious complications, clotting complications, or stroke. The cohort without extracorporeal membrane oxygenation cohort demonstrated no statistically significant differences in in-hospital outcomes. CONCLUSIONS The presence of right ventricular dysfunction in patients with COVID-19-related acute respiratory distress syndrome supported with veno-venous extracorporeal membrane oxygenation was associated with increased in-hospital mortality. Additional studies are required to determine if mitigating right ventricular dysfunction in patients requiring veno-venous extracorporeal membrane oxygenation improves mortality.
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Affiliation(s)
- Michael T Cain
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Lauren J Taylor
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Kathryn Colborn
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Nicholas R Teman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Jordan Hoffman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Kirby P Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Ky
| | - Eric W Etchill
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md
| | - Carla M Sevin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, Tenn
| | | | - Raj Ramanan
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Kyle Enfield
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, Va
| | - Joseph B Zwischenberger
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Ky
| | - Sarah E Jolley
- Division of Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo.
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da Cruz AP, Martins G, Martins CM, Marques V, Christovam S, Battaglini D, Robba C, Pelosi P, Rocco PRM, Cruz FF, Dos Santos Samary C, Silva PL. Comparison between high-flow nasal oxygen (HFNO) alternated with non-invasive ventilation (NIV) and HFNO and NIV alone in patients with COVID-19: a retrospective cohort study. Eur J Med Res 2024; 29:248. [PMID: 38649940 PMCID: PMC11036698 DOI: 10.1186/s40001-024-01826-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Non-invasive respiratory support (conventional oxygen therapy [COT], non-invasive ventilation [NIV], high-flow nasal oxygen [HFNO], and NIV alternated with HFNO [NIV + HFNO] may reduce the need for invasive mechanical ventilation (IMV) in patients with COVID-19. The outcome of patients treated non-invasively depends on clinical severity at admission. We assessed the need for IMV according to NIV, HFNO, and NIV + HFNO in patients with COVID-19 according to disease severity and evaluated in-hospital survival rates and hospital and intensive care unit (ICU) lengths of stay. METHODS This cohort study was conducted using data collected between March 2020 and July 2021. Patients ≥ 18 years admitted to the ICU with a diagnosis of COVID-19 were included. Patients hospitalized for < 3 days, receiving therapy (COT, NIV, HFNO, or NIV + HFNO) for < 48 h, pregnant, and with no primary outcome data were excluded. The COT group was used as reference for multivariate Cox regression model adjustment. RESULTS Of 1371 patients screened, 958 were eligible: 692 (72.2%) on COT, 92 (9.6%) on NIV, 31 (3.2%) on HFNO, and 143 (14.9%) on NIV + HFNO. The results for the patients in each group were as follows: median age (interquartile range): NIV (64 [49-79] years), HFNO (62 [55-70] years), NIV + HFNO (62 [48-72] years) (p = 0.615); heart failure: NIV (54.5%), HFNO (36.3%), NIV + HFNO (9%) (p = 0.003); diabetes mellitus: HFNO (17.6%), NIV + HFNO (44.7%) (p = 0.048). > 50% lung damage on chest computed tomography (CT): NIV (13.3%), HFNO (15%), NIV + HFNO (71.6%) (p = 0.038); SpO2/FiO2: NIV (271 [118-365] mmHg), HFNO (317 [254-420] mmHg), NIV + HFNO (229 [102-317] mmHg) (p = 0.001); rate of IMV: NIV (26.1%, p = 0.002), HFNO (22.6%, p = 0.023), NIV + HFNO (46.8%); survival rate: HFNO (83.9%), NIV + HFNO (63.6%) (p = 0.027); ICU length of stay: NIV (8.5 [5-14] days), NIV + HFNO (15 [10-25] days (p < 0.001); hospital length of stay: NIV (13 [10-21] days), NIV + HFNO (20 [15-30] days) (p < 0.001). After adjusting for comorbidities, chest CT score and SpO2/FiO2, the risk of IMV in patients on NIV + HFNO remained high (hazard ratio, 1.88; 95% confidence interval, 1.17-3.04). CONCLUSIONS In patients with COVID-19, NIV alternating with HFNO was associated with a higher rate of IMV independent of the presence of comorbidities, chest CT score and SpO2/FiO2. Trial registration ClinicalTrials.gov identifier: NCT05579080.
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Affiliation(s)
- Amanda Pereira da Cruz
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Gloria Martins
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
- D'or Institute of Research and Teaching, Barra D'or Hospital, Rio de Janeiro, Brazil
| | | | - Victoria Marques
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Samantha Christovam
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Chiara Robba
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Fernanda Ferreira Cruz
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Cynthia Dos Santos Samary
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil.
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Jagtiani P, Young T, Ahmed W, Devarajan A, Hickman ZL, Jones S. Prevalence of Acute Alcohol Use in Traumatic Brain Injury Patients During the COVID-19 Pandemic: A Retrospective Analysis From Queens, New York. Cureus 2024; 16:e58928. [PMID: 38800166 PMCID: PMC11122664 DOI: 10.7759/cureus.58928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Background This study investigates the impact of New York's relaxed alcohol consumption policies during the coronavirus disease (COVID-19) pandemic on alcohol-related traumatic brain injuries (TBIs) among patients admitted to a Level 1 trauma center in Queens. Given the limited research available, this study critically explores the link between public health policies and trauma care. It aims to address a significant gap in the literature and highlight the implications of alcohol regulations during global health emergencies. Methodology A retrospective analysis was conducted among trauma patients from 2019 to 2021. The study period was divided into the following three periods: pre-lockdown (March 7, 2019, to July 31, 2019), lockdown (March 7, 2020, to July 31, 2020), and post-lockdown (March 7, 2021, to July 31, 2021). Data on demographics, injury severity, comorbidities, and outcomes were collected. The study focused on assessing the correlation between New York's alcohol policies and alcohol-related TBI admissions during these periods. Results A total of 1,074 admissions were analyzed. The study found no significant changes in alcohol-positive patients over the full calendar years of 2019, 2020, and 2021 (42.65%, 38.91%, and 31.16% respectively; p = 0.08711). Specifically, during the lockdown period, rates of alcohol-positive TBI patients remained unchanged, despite the relaxed alcohol policies. There was a decrease in alcohol-related TBI admissions in 2021 compared to 2020 during the lockdown period. Conclusions Our study concludes that New York's specific alcohol policies during the COVID-19 pandemic were not correlated with an increase in alcohol-related TBI admissions. Despite the relaxation of alcohol consumption laws, there was no increase in alcohol positivity among TBI patients. The findings suggest a complex relationship between public policies, alcohol use, and trauma during pandemic conditions, indicating that factors other than policy relaxation might influence alcohol-related trauma incidences.
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Affiliation(s)
- Pemla Jagtiani
- School of Medicine, State University of New York Downstate Health Sciences University, Queens, USA
| | - Tirone Young
- Medical School, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Wasil Ahmed
- Medical School, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alex Devarajan
- Medical School, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Zachary L Hickman
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Salazar Jones
- Neurological Surgery, Mount Sinai Hospital, New York, USA
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Perez-Garzon M, Poveda-Henao C, Bastidas-Goyes A, Robayo-Amortegui H. Oxygen Debt as Predictor of Mortality and Multiple Organ Dysfunction Syndrome in Severe COVID-19 Patients: A Retrospective Study. J Intensive Care Med 2024; 39:358-367. [PMID: 37876236 DOI: 10.1177/08850666231208433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Background: Oxygen debt (DEOx) represents the disparity between resting and shock oxygen consumption (VO2) and is associated with metabolic insufficiency, acidosis, severity, and mortality. This study aimed to assess the reliability of DEOx as an indirect quantitative measure for predicting multiple organ dysfunction syndrome (MODS) and 28-day mortality in patients admitted to the intensive care unit (ICU) with respiratory syndrome severe acute coronavirus type 2 (SARS-CoV-2) infection, in comparison to the Acute Physiology and Chronic Health Evaluation II (APACHE II), sepsis-related organ failure assessment (SOFA), and 4C scores. Methods: A retrospective cohort study was conducted, including ICU patients with SARS-CoV-2 infection between 2020 and 2021. Clinical data were extracted from the EPIMED Monitor Database®. APACHE II, SOFA, and 4C scores were calculated upon ICU admission, and their accuracy in predicting 28-day mortality and MODS was compared to DEOx. Multivariate logistic regression analysis was performed to analyze the outcome variables. Results: 708 patients were included, with a mortality rate of 44.4%. DEOx value was 11.16 ml O2/kg. The mean age was 58.7 years. Multivariate analysis showed that DEOx was independently associated with mortality, intubation, and renal injury. Each point increase in creatinine was associated with a higher risk of MODS. To determine the precision of the scores, area under the receiver operating characteristic curves (AUROC) analysis was performed with weak discrimination and similar behavior for the primary outcomes. The most accurate scale for mortality and MODS was 4C with an AUC of 0.683 and APACHE II with an AUC of 0.814, while that of the AUROC of DEOx was 0.612 and 0.646, respectively. Conclusions: DEOx showed similar predictive value to established scoring systems in critically ill patients with SARS-CoV-2 infection. The correlation of DEOx with these scores may facilitate early intervention in critically ill patients.
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Affiliation(s)
- Michel Perez-Garzon
- Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
- Critical Medicine and Intensive Care, Msc Mechanical Ventilation and Respiratory Support, Department of Investigation, Fundación Clínica Shaio. Bogota DC. Colombia
| | - Claudia Poveda-Henao
- Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
- Critical Medicine and Intensive Care, Msc Mechanical Ventilation and Respiratory Support, Department of Investigation, Fundación Clínica Shaio. Bogota DC. Colombia
- Clinical Cardiology, Intensive Care Department, Shaio Clinic Foundation. Bogota DC. Colombia
| | - Alirio Bastidas-Goyes
- Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
| | - Henry Robayo-Amortegui
- Critical Care Resident, Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
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10
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Michel PG, Claudia PH, Andrea RS, Maria DA, Henry RA. Oxygen debt as a predictor of high-flow nasal cannula therapy failure in SARS-CoV-2 patients with acute respiratory failure: A retrospective cohort study. Heart Lung 2024; 64:176-181. [PMID: 38278127 DOI: 10.1016/j.hrtlng.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/20/2023] [Accepted: 10/23/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is known for its rapid progression to acute hypoxemic respiratory failure (AHRF). The increased use of oxygen therapy during the pandemic and the progression of AHRF have highlighted the need to promptly determine the need for orotracheal intubation (OTI). OBJETIVE To determine the validity of quantitative measurement of oxygen debt (DEOx) according to arterial gases compared to the use of iROX in patients with high-flow nasal cannula (HFNC) therapy requirement, presenting with acute respiratory failure as a consequence of SARS-CoV-2 infection. In addition, we aimed to identify the factors associated with the need for orotracheal intubation (OTI). METHODS A retrospective observational cohort study of a database collected from patients with SARS-CoV-2 infection admitted to intensive care units with AHRF and had received HFNC upon admission during the Covid-19 pandemic (March 23, 2020 through August 02, 2021). The variables of interest were factors determining the predictive ability of DEOx and iROX. We used a multiple logarithmic regression model to correct for confounding and mixed-effects variables, and validated for OTI in patients treated with HFNC. RESULTS From a total of 373 patients treated with HFNC, 317 patients (84.9%) required invasive mechanical ventilation. APACHE II (AOR 1.44; 95% CI: 1.14-1.83, p 0,032), vasopressor use (AOR 27.7; 95% CI: 1.83 - 420,63, p 0,017), and DEOx (AOR 1.26; 95% CI: 1.10 - 1.44, p 0,001) were associated with the need for intubation. The predictive model between iROX and DEOx evidenced an AUC of 0.535 vs. 0.606, respectively, with a DEOx cut off point of 7.14 (±10.16, p < 0.01). DEOx as an independent factor of OTI presents an OR 2,48 with cut point 4.5 mlO2/kg (AUC 0.780, CI 95%, 0.753 - 0.808, p < 0.01). CONCLUSIONS DEOx is a valuable measurment to identify the need for OTI in patients with SARS-CoV-2 who were under management with HFNC with a predictive value superior to iROX, being a reproducible and valid quantitative method for the need OTI that can be implemented in other critically illconditions. Further studies are required to characterize the usefulness of DEOx more precisely.
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Affiliation(s)
- Perez-Garzon Michel
- Critical Medicine and Intensive Care, Fundación Clínica Shaio, Bogota DC, Colombia; Msc Mechanical Ventilation and Respiratory Support, Department of Investigation, Fundación Clínica Shaio, Bogota DC, Colombia; Msc Clinical Epidemiology, Department of Intensive Care and Research, Fundación Clínica Shaio, Bogota DC, Colombia.
| | - Poveda-Henao Claudia
- Critical Medicine and Intensive Care, Fundación Clínica Shaio, Bogota DC, Colombia; Msc Mechanical Ventilation and Respiratory Support, Department of Investigation, Fundación Clínica Shaio, Bogota DC, Colombia; Clinical Cardiology, Intensive Care Department, Fundación Clínica Shaio, Bogota DC, Colombia
| | - Rozo-Salinas Andrea
- Critical Medicine and Intensive Care, Fundación Clínica Shaio, Bogota DC, Colombia
| | - Diaz-Ardila Maria
- Physiotherapist, Clinical Epidemiology, Physiotherapy Department, Fundación Clínica Shaio, Bogotá DC, Colombia
| | - Robayo-Amortegui Henry
- Critical Care Resident, Department of Medicine, Universidad de La Sabana, Chia Cundinamarca, Colombia
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11
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Suttapanit K, Lerdpaisarn P, Sanguanwit P, Supatanakij P. Predictive Factors of Oxygen Therapy Failure in Patients with COVID-19 in the Emergency Department. Open Access Emerg Med 2023; 15:355-365. [PMID: 37818445 PMCID: PMC10560766 DOI: 10.2147/oaem.s430600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/18/2023] [Indexed: 10/12/2023] Open
Abstract
Background Most patients with coronavirus disease 2019 (COVID-19) pneumonia require oxygen therapy, including standard oxygen therapy and a high-flow nasal cannula (HFNC), in the Emergency Department (ED), and some patients develop respiratory failure. In the COVID-19 pandemic, the intensive care unit (ICU) was overburdening. Therefore, prioritizing patients who require intensive care is important. This study aimed to find predictors and develop a model to predict patients at risk of requiring an invasive mechanical ventilator (IMV) in the ED. Methods We performed a retrospective, single-center, observational study. Patients aged ≥18 years who were diagnosed with COVID-19 and required oxygen therapy in the ED were enrolled. Cox regression and Harrell's C-statistic were used to identifying predictors of requiring IMV. The predictive model was developed by calculated coefficients and the ventilator-free survival probability. The predictive model was internally validated using the bootstrapping method. Results We enrolled 333 patients, and 97 (29.1%) had required IMV. Most 66 (68.0%) failure cases were initial oxygen therapy with HFNC. Respiratory rate-oxygenation (ROX) index, interleukin-6 (IL-6) concentrations ≥20 pg/mL, the SOFA (Sequential Organ Failure Assessment) score without a respiratory score, and the patient's age were independent risk factors of requiring IMV. These factors were used to develop the predictive model. ROX index and the predictive model at 2 hours showed a good performance to predict oxygen therapy failure; the c-statistic was 0.814 (95% confidence level [CI] 0.767-0.861) and 0.901 (95% CI 0.873-0.928), respectively. ROX index ≤5.1 and the predictive model score ≥8 indicated a high probability of requiring IMV. Conclusion The COVID-19 pandemic was limited resources, ROX index, IL-6 ≥20 pg/mL, the SOFA score without a respiratory score, and the patient's age can be used to predict oxygen therapy failure. Moreover, the predictive model is good at discriminating patients at risk of requiring IMV and close monitoring.
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Affiliation(s)
- Karn Suttapanit
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Peeraya Lerdpaisarn
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pitsucha Sanguanwit
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Praphaphorn Supatanakij
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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12
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Shiao CC, Wu JT, Chu YC, Tang YH, Huang L, Lai HY. Bibliometric analysis of the top 100 most-cited articles on video laryngoscope from 2011 to 2022. J Chin Med Assoc 2023; 86:902-910. [PMID: 37683127 DOI: 10.1097/jcma.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The popularity of video laryngoscope (VL) has increased rapidly since its introduction in the late 1990s. However, a comprehensive overview of VLs evolution and impact is lacking, which merits further investigation. METHODS We conducted a bibliometric analysis of the top 100 most-cited articles on VL (Top100VL) published between 2011 and 2022 and retrieved from the PubMed and Web of Science databases. Using social network analysis, we identified the subject terms and subject categories of the Top100VL and compared their citation counts across individual subject terms and categories via one-way analysis of variance (ANOVA). Then, we employed the Medical Query Expert software to assess the practical applications of VL. RESULTS The Top100VL included 65 subjects across nine subject categories, with "anesthesiology" being the most frequently represented category and "coronavirus infections" with the highest impact factor. The citation counts inferred by subject categories significantly correlated with the actual citation counts (Pearson's R = 0.4; p < 0.01). For enhanced visualization, we employed network visualization and Sankey diagrams to display the article characteristics. We highlighted the clinical advantages of VL, including its usefulness in difficult intubations, wider angle of view, and management of pediatric emergencies, as well as its teaching benefits, such as facilitating training programs and a lower learning curve. CONCLUSION By using bibliometric analysis and natural language processing methods, we effectively summarized the applications of VL in both clinical and teaching settings, particularly in reducing the risk of cross-infection during the Coronavirus Disease 2019 pandemic.
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Affiliation(s)
- Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, Yilan, Taiwan, ROC
| | - Jui-Teng Wu
- Department of Surgery, Camillian Saint Mary's Hospital Luodong, Yilan, Taiwan, ROC
| | - Ya-Chun Chu
- Department of Anesthesiology, Taipei Veterans General Hospital, and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Hsuan Tang
- School of Life Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | | | - Hsien-Yung Lai
- Department of Anesthesiology, Mennonite Christian Hospital, Hualien, Taiwan, ROC
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13
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Alhoufie ST, Mumena WA, Alsharif N, Makhdoom HM, Almutawif YA, Alfarouk KO, Alharbi MZ, Aljabri K, Aljifri A. Epidemiological Characteristics and Outcomes Predictors for Intensive Care Unit COVID-19 Patients in Al-Madinah, Saudi Arabia. Retrospective Cohort Study. Infect Drug Resist 2023; 16:5573-5586. [PMID: 37645558 PMCID: PMC10461755 DOI: 10.2147/idr.s419724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction The global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) increased the demand for intensive care unit (ICU) services. Mortality and morbidity rates among ICU COVID-19 patients are affected by several factors, such as severity, comorbidities, and coinfections. In this study, we describe the demographic characteristics of COVID-19 patients admitted to an ICU in Saudi Arabia, and we determined the predictors for mortality and prolonged ICU length of stay. Additionally, we determined the prevalence of bacterial coinfection and its effect on the outcomes for ICU COVID-19 patients. Methods We retrospectively studied the medical records of 142 COVID-19 patients admitted to the ICU at a tertiary hospital in Madinah, Saudi Arabia. Data on demographics, medical history, mortality, length of stay, and presence of coinfection were collected for each patient. Results Neutrophil-to-Lymphocyte ratio (NLR) and intubation were reliable predictors of mortality and ICU length of stay among these ICU COVID-19 patients. Moreover, bacterial coinfections were detected in 23.2% of the patients and significantly (p < 0.001) prolonged their ICU length of stay, explaining the 10% increase in the length of stay for these patients. Furthermore, mortality reached 70% among the coinfected patients, and 60.8% of the isolated coinfecting pathogens were multidrug-resistant (MDR) strains of Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus. Conclusion Increased NLR and intubation are predictors of mortality and prolonged length of stay in COVID-19 patients admitted to the ICU. Coinfection with MDR bacterial strains potentially results in complications and is a high-risk factor for prolonged ICU length of stay.
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Affiliation(s)
- Sari T Alhoufie
- Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munwarah, Saudi Arabia
| | - Walaa A Mumena
- Department of Clinical Nutrition, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munwarah, Saudi Arabia
| | - Naif Alsharif
- King Salman Medical City, Al-Madinah General Hospital, Al-Madinah Al-Munwarah, Saudi Arabia
| | - Hatim M Makhdoom
- Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munwarah, Saudi Arabia
| | - Yahya A Almutawif
- Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munwarah, Saudi Arabia
| | | | - Mohammed Z Alharbi
- King Salman Medical City, Al-Madinah General Hospital, Al-Madinah Al-Munwarah, Saudi Arabia
| | - Khaled Aljabri
- King Salman Medical City, Al-Madinah General Hospital, Al-Madinah Al-Munwarah, Saudi Arabia
| | - Alanoud Aljifri
- Al-Madinah Health Cluster, Ministry of Health, Al-Madinah Al-Munwarah, Saudi Arabia
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14
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Zhu Y, Sharma L, Chang D. Pathophysiology and clinical management of coronavirus disease (COVID-19): a mini-review. Front Immunol 2023; 14:1116131. [PMID: 37646038 PMCID: PMC10461092 DOI: 10.3389/fimmu.2023.1116131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/24/2023] [Indexed: 09/01/2023] Open
Abstract
An unprecedented global pandemic caused by a novel coronavirus named SARS-CoV-2 has created a severe healthcare threat and become one of the biggest challenges to human health and the global economy. As of July 2023, over 767 million confirmed cases of COVID-19 have been diagnosed, including more than 6.95 million deaths. The S protein of this novel coronavirus binds to the ACE2 receptor to enter the host cells with the help of another transmembrane protease TMPRSS2. Infected subjects that can mount an appropriate host immune response can quickly inhibit the spread of infection into the lower respiratory system and the disease may remain asymptomatic or a mild infection. The inability to mount a strong initial response can allow the virus to replicate unchecked and manifest as severe acute pneumonia or prolonged disease that may manifest as systemic disease manifested as viremia, excessive inflammation, multiple organ failure, and secondary bacterial infection among others, leading to delayed recovery, hospitalization, and even life-threatening consequences. The clinical management should be targeted to specific pathogenic mechanisms present at the specific phase of the disease. Here we summarize distinct phases of COVID-19 pathogenesis and appropriate therapeutic paradigms associated with the specific phase of COVID-19.
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Affiliation(s)
- Ying Zhu
- College of Pulmonary and Critical Care Medicine, 8th Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, 7th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lokesh Sharma
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - De Chang
- College of Pulmonary and Critical Care Medicine, 8th Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, 7th Medical Center of Chinese PLA General Hospital, Beijing, China
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15
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Maguire S, Schmitt PR, Sternlicht E, Kofron CM. Endotracheal Intubation of Difficult Airways in Emergency Settings: A Guide for Innovators. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2023; 16:183-199. [PMID: 37483393 PMCID: PMC10362894 DOI: 10.2147/mder.s419715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023] Open
Abstract
Over 400,000 Americans are intubated in emergency settings annually, with indications ranging from respiratory failure to airway obstructions to anaphylaxis. About 12.7% of emergency intubations are unsuccessful on the first attempt. Failure to intubate on the first attempt is associated with a higher likelihood of adverse events, including oxygen desaturation, aspiration, trauma to soft tissue, dysrhythmia, hypotension, and cardiac arrest. Difficult airways, as classified on an established clinical scale, are found in up to 30% of emergency department (ED) patients and are a significant contributor to failure to intubate. Difficult intubations have been associated with longer lengths of stay and significantly greater costs than standard intubations. There exists a wide range of airway management devices, both invasive and noninvasive, which are available in the emergency setting to accommodate difficult airways. Yet, first-pass success rates remain variable and leave room for improvement. In this article, we review the disease states most correlated with intubation, the current landscape of emergency airway management technologies, and the market potential for innovation. The aim of this review is to inspire new technologies to assist difficult airway management, given the substantial opportunity for translation due to two key-value signposts of medical innovation: the potential to decrease cost and the potential to improve clinical outcomes.
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Affiliation(s)
- Samantha Maguire
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, RI, USA
| | - Phillip R Schmitt
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, RI, USA
| | - Eliza Sternlicht
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, RI, USA
| | - Celinda M Kofron
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, RI, USA
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16
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McGowran P, Johns H, Raju E, Ayeb-Karlsson S. The making of India's COVID-19 disaster: A Disaster Risk Management (DRM) Assemblage analysis. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2023; 93:103797. [PMID: 37324932 PMCID: PMC10259166 DOI: 10.1016/j.ijdrr.2023.103797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 05/31/2023] [Accepted: 06/10/2023] [Indexed: 06/17/2023]
Abstract
This article analyses the suite of policies and measures enacted by the Indian Union Government in response to the COVID-19 pandemic through apparatuses of disaster management. We focus on the period from the onset of the pandemic in early 2020, until mid-2021. This holistic review adopts a Disaster Risk Management (DRM) Assemblage conceptual approach to make sense of how the COVID-19 disaster was made possible and importantly how it was responded to, managed, exacerbated, and experienced as it continued to emerge. This approach is grounded in literature from critical disaster studies and geography. The analysis also draws on a wide range of other disciplines, ranging from epidemiology to anthropology and political science, as well as grey literature, newspaper reports, and official policy documents. The article is structured into three sections that investigate in turn and at different junctures the role of governmentality and disaster politics; scientific knowledge and expert advice, and socially and spatially differentiated disaster vulnerabilities in shaping the COVID-19 disaster in India. We put forward two main arguments on the basis of the literature reviewed. One is that both the impacts of the virus spread and the lockdown-responses to it affected already marginalised groups disproportionately. The other is that managing the COVID-19 pandemic through disaster management assemblage/apparatuses served to extend centralised executive authority in India. These two processes are demonstrated to be continuations of pre-pandemic trends. We conclude that evidence of a paradigm shift in India's approach to disaster management remains thin on the ground.
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Affiliation(s)
- Peter McGowran
- United Nations University - Institute for Environment and Human Security, UN Campus, Platz der Vereinten Nationen 1, D-53113, Bonn, Germany
- School of Social Sciences, Oxford Brookes University, Gibbs Building, Oxford Brookes Headington Campus, Headington Road, Oxford, OX3 0BP, UK
| | - Hannah Johns
- United Nations University - Institute for Environment and Human Security, UN Campus, Platz der Vereinten Nationen 1, D-53113, Bonn, Germany
| | - Emmanuel Raju
- Global Health Section, Department of Public Health & Copenhagen Centre for Disaster Research, University of Copenhagen, CSS, Øster Farimagsgade 5, 1014, København K, Denmark
- African Centre for Disaster Studies, North-West University, Private Bag X6001, Potchefstroom, North West Province, 2520, South Africa
| | - Sonja Ayeb-Karlsson
- United Nations University - Institute for Environment and Human Security, UN Campus, Platz der Vereinten Nationen 1, D-53113, Bonn, Germany
- Institute for Risk and Disaster Reduction, University College London, London, UK
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17
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Shamim F, Sohaib M, Samad K, Khan MF, Manji AA, Latif A. Ease of Intubation with McGrath Videolaryngoscope and Incidence of Adverse Events During Tracheal Intubation in COVID-19 Patients: A Prospective Observational Study. J Crit Care Med (Targu Mures) 2023; 9:162-169. [PMID: 37588180 PMCID: PMC10425925 DOI: 10.2478/jccm-2023-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023] Open
Abstract
Background Tracheal intubation in critically ill patients remains high-risk despite advances in equipment, technique, and clinical guidelines. Many patients with COVID-19 were in respiratory distress and required intubation that is considered an aerosol-generating procedure (AGP). The transition to videolaryngoscopy as a routine first line option throughout anesthetic and ICU practice has been reported. We evaluated the ease of intubation, success rate, use of accessory maneuvers and adverse outcomes during and 24 hours after intubation with the McGrath videolaryngoscope. Methods This was a prospective, observational single center study conducted at non-operating room locations that included all adults (>18 years old) with suspected or confirmed COVID-19 infection and were intubated by McGrath videolaryngoscope. The anesthesiologist performed tracheal intubation were requested to fill online data collection form. A co-investigator was responsible to coordinate daily with assigned consultants for COVID intubation and follow up of patients at 24 hours after intubation. Results A total of 105 patients were included in our study. Patients were predominantly male (n=78; 74.3%), their COVID status was either confirmed (n=97, 92.4%) or suspected (n=8, 7.6%). Most were intubated in the COVID ward (n=59, 56.2%) or COVID ICU (n=23, 21.9%). The overall success rate of intubation with McGrath in the first attempt was 82.9%. The glottic view was either full (n=85, 80.95%), partial (n=16, 15.24%) or none (n=4, 3.81%). During intubation, hypoxemia occurred in 18.1% and hypotension in 16.2% patients. Within 24 hours of intubation, pneumothorax occurred in 1.9%, cardiac arrest and return of spontaneous circulation in 6.7% and mortality in 13.3% of patients. Conclusion These results illustrate the ease and utility of the McGrath videolaryngoscope for tracheal intubation in COVID-19 patients. Its disposable blade is of significant value in protectin during tracheal intubation.
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Affiliation(s)
| | | | | | | | | | - Asad Latif
- Aga Khan University Hospital, Karachi, Pakistan
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18
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Shetabi H, Nazemroaya B, Mahjobipoor H, Majidi S. Comparative study of the effect of two different doses of intravenous labetalol on the cardiovascular response to endotracheal extubation. J Cardiovasc Thorac Res 2023; 15:98-105. [PMID: 37654815 PMCID: PMC10466463 DOI: 10.34172/jcvtr.2023.31623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 05/25/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Providing a stable hemodynamic in extubation is important. We aimed to compare the effect of two different doses of intravenous labetalol on the cardiovascular response to endotracheal extubation. Methods This double-blind randomized trial was performed in 2019-2020 in Isfahan on 72 patients under general anesthesia. Patients using Random Allocation software were divided into three groups and received 0.1 mg/ kg or 0.2 mg/kg labetalol and normal saline intravenously 10 min before extubation. Hemodynamic variables including heart rate (HR), Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and peripheral blood oxygen saturation(SPO2) was measured for each patient before induction of anesthesia and 1, 3, 5 and 10 minutes after extubation. Results SBP changes were significantly different between the three groups at 1, 3, 5 minutes after extubation (P=0.036, P=0.009, P=0.005 respectively) unlike the other two groups, patients who received 0.2 mg/kg labetalol did not have an increase in DBP after extubation (P>0.05). DBP was significantly different between the three groups one minute after extubation (P=0.03). At minutes 1 and 3 following extubation, there was a significant difference in the MAP between the three groups. (P=0.029 and P=0.012 respectively). There was no significant difference between the three groups regarding heart rate (P>0.05). Conclusion Tracheal extubation is usually associated with an increase in hemodynamic variables. Both doses of labetalol attenuate the hemodynamic response accompanying tracheal extubation. But labetalol 0.2 mg/kg in reducing hemodynamic response to extubation acted more effectively than labetalol 0.1mg/kg.
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Affiliation(s)
- Hamidreza Shetabi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Nazemroaya
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hosein Mahjobipoor
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sanaz Majidi
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Fazel P, Sedighian H, Behzadi E, Kachuei R, Imani Fooladi AA. Interaction Between SARS-CoV-2 and Pathogenic Bacteria. Curr Microbiol 2023; 80:223. [PMID: 37222840 DOI: 10.1007/s00284-023-03315-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/28/2023] [Indexed: 05/25/2023]
Abstract
The novel human coronavirus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which results in the coronavirus disease 2019 (COVID-19), has caused a serious threat to global public health. Therefore, many studies are performed on the causes and prevalence of this disease and the possible co-occurrence of the infection with other viral and bacterial pathogens is investigated. Respiratory infections predispose patients to co-infections and these lead to increased disease severity and mortality. Numerous types of antibiotics have been employed for the prevention and treatment of bacterial co-infection and secondary bacterial infections in patients with a SARS-CoV-2 infection. Although antibiotics do not directly affect SARS-CoV-2, viral respiratory infections often result in bacterial pneumonia. It is possible that some patients die from bacterial co-infection rather than virus itself. Therefore, bacterial co-infection and secondary bacterial infection are considered critical risk factors for the severity and mortality rates of COVID-19. In this review, we will summarize the bacterial co-infection and secondary bacterial infection in some featured respiratory viral infections, especially COVID-19.
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Affiliation(s)
- Parvindokht Fazel
- Department of Microbiology, Fars Science and Research Branch, Islamic Azad University, Eqlid, Fars, Iran
- Department of Microbiology, Shiraz Branch, Islamic Azad University, Shiraz, Iran
| | - Hamid Sedighian
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Vanak Sq, Mollasadra St, P.O. Box 19395-5487, Tehran, Iran
| | - Elham Behzadi
- Academy of Medical Sciences of the I.R. of Iran, Tehran, Iran
| | - Reza Kachuei
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ali Imani Fooladi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Vanak Sq, Mollasadra St, P.O. Box 19395-5487, Tehran, Iran.
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20
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Muñoz-Leyva F, Perlas A, Chin KJ, Soheili M, Li Q, Huszti E, Chan V. A hood shield reduces postdoffing contamination during simulated COVID-19 airway management: an exploratory, simulation-based randomized study. Can J Anaesth 2023; 70:869-877. [PMID: 37020172 PMCID: PMC10075501 DOI: 10.1007/s12630-023-02400-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 04/07/2023] Open
Abstract
PURPOSE SARS-CoV-2 poses a significant occupational health threat to health care workers performing aerosol-generating medical procedures, with a threefold increased risk of a positive test and predicted infection compared with the general population. Nevertheless, the personal protective equipment (PPE) configuration that provides better protection with lower contamination rates is still unknown. METHODS We enrolled 40 practitioners with airway management training (anesthesiologists, anesthesia assistants/nurses) in an exploratory, simulation-based randomized study. We evaluated the performance of a novel, locally designed hood (n = 20) in terms of protection from surrogate contamination using an ultraviolet (UV) marker during a standardized urgent intubation procedure and a simulated episode of coughing in a high-fidelity simulation setting compared with standard PPE (n = 20). The primary outcome was the presence of residual UV fluorescent contamination on any base clothing or exposed skin of the upper body after doffing PPE assessed by a blinded evaluator. RESULTS The proportion of participants with residual contamination on any base clothing or exposed skin of the upper body after doffing was less than half in the hood PPE group compared with the standard PPE group (8/20 [40%] vs 18/20 [90%], respectively; P = 0.002). CONCLUSIONS Compared with standard PPE, enhanced PPE with a locally designed prototype hood was associated with reduced contamination of the upper torso and fewer body areas being exposed to droplets after a simulated aerosol-generating scenario without designed airflow. STUDY REGISTRATION ClinicalTrials.gov (NCT04373096); registered 4 May 2020.
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Affiliation(s)
- Felipe Muñoz-Leyva
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst St., Mc Laughlin Pavilion, 2-405, Toronto, ON, M5T 2S8, Canada
- Hospital Universitario Mayor, Méderi, Bogotá, Colombia
- Faculty of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Anahi Perlas
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst St., Mc Laughlin Pavilion, 2-405, Toronto, ON, M5T 2S8, Canada.
| | - Ki Jinn Chin
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst St., Mc Laughlin Pavilion, 2-405, Toronto, ON, M5T 2S8, Canada
| | - Mehdi Soheili
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst St., Mc Laughlin Pavilion, 2-405, Toronto, ON, M5T 2S8, Canada
| | - Qixuan Li
- Biostatistics Research Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vincent Chan
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst St., Mc Laughlin Pavilion, 2-405, Toronto, ON, M5T 2S8, Canada
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21
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Obiefuna EC, Ojonta OI, Ogbuabor JE. The influence of COVID-19 pandemic and coping strategies on work operation of nonfarm household enterprises in Nigeria. ENVIRONMENT, DEVELOPMENT AND SUSTAINABILITY 2023:1-16. [PMID: 37363036 PMCID: PMC10066960 DOI: 10.1007/s10668-023-03185-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 03/20/2023] [Indexed: 06/28/2023]
Abstract
The purpose of this study is to investigate how COVID-19 pandemic including some coping strategies such as hand wash with soap and food consumption influences work operation or performance of nonfarm household enterprises (NHEs) in Nigeria using 2020 Living Standard Measurement Survey data of 1728 sample size. This study departs from existing study in two ways: first, the study employs multinomial logistic regression technique to ascertain the determinants of work performance of nonfarm household enterprises in Nigeria. Second, the study focuses on nonfarm enterprises such as petty trade, road side automobile and cab drivers. The results show that COVID-19 pandemic is significant with negative influence on the work operation of NHEs in Nigeria. The result of the study also reveals that coping strategy such as hand wash with soap during the pandemic is an important driver of work performance or operation of NHEs in Nigeria. Another coping strategy like food consumption by nonfarm household enterprises shows insignificant influence on work operation which implies that there is no relationship between food consumption and work operation by NHEs in Nigeria. The policy recommendation of this study, among others, is that policies should focus on procurement of sanitary material for public use. This can be achieved through public sensitisation in terms of organising workshops and conferences.
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Affiliation(s)
| | - Obed I. Ojonta
- Department of Economics, University of Nigeria, Nsukka, Nigeria
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22
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Chaudhary K, Goyal S, Dixit A, Dixit SG, Sharma V, Nair NP, Sharma A, Kothari N, Bhatia P, Goyal A, Misra S. Assessment of the use and Safety of Protection Box for Intubation and Extubation Among Anaesthesiologists During COVID-19 Pandemic- A Cross-sectional Survey. Indian J Otolaryngol Head Neck Surg 2023. [PMCID: PMC10031719 DOI: 10.1007/s12070-023-03692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
Introduction Covid 19 epidemic has affected the people making them undergo emergency procedures requiring intubation. A protective box was innovated at our tertiary care centre to safeguard the HCW during intubation and/or extubation and the study was planned to assess its use and safety among the anaesthesiologists. Methods A cross sectional, questionnaire base survey was done among anaesthesiologists in various strata of residency. The intubation box was used on the patient for intubation and extubation. The experience of participants was recorded via a Google Form and one response per participant was restricted. Participants were divided into two groups, Group 1(1stand 2nd year junior residents) and Group 2 (Senior resident and 3rd year junior resident). A valid response, was received from 25 anaesthesiologists who were either performing or assisting the intubation. The residents were evaluated based on the ease of use and safety features of the box. Results There was a significant difference in the time taken to intubate between the two groups (p = 0.048) and it was found that Group 2 with more experience took less time to intubate than Group 1. Also, more respondents in Group 2 found it easier to manoeuvre the hands to handle instruments than Group 1(p = 0.024). Conclusion We recommend that usage of intubation box during intubation or extubation is a non-harmful and necessary compromise that we must make to protect the /safeguard the well-being of Health Care Worker without affecting patient care in our fight with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03692-7.
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Affiliation(s)
- Kriti Chaudhary
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bilaspur, India
| | - Shilpa Goyal
- Department of Anaesthesiology and Critical care, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhinav Dixit
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Email India
| | - Shilpi Gupta Dixit
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, India
| | - Vidhu Sharma
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Nithin Prakasan Nair
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Ankur Sharma
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Jodhpur, India
| | - Nikhil Kothari
- Department of Anaesthesiology and Critical care, All India Institute of Medical Sciences, Jodhpur, India
| | - Pradeep Bhatia
- Department of Anaesthesiology and Critical care, All India Institute of Medical Sciences, Jodhpur, India
| | - Amit Goyal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjeev Misra
- Director & CEO, Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
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23
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Management of the Normal and Difficult Pediatric Airway: Unique Challenges in the Time of COVID-19. CURRENT SURGERY REPORTS 2023; 11:144-153. [PMID: 37125393 PMCID: PMC9984748 DOI: 10.1007/s40137-023-00359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 03/07/2023]
Abstract
Purpose of Review This review focuses on the challenges faced by acute care healthcare workers in the management of the normal and difficult pediatric airway during the COVID-19 pandemic and how these protocols and practices evolved during the pandemic. The current state of knowledge on timing of surgery and anesthesia is also discussed. Recent Findings In the early days of the pandemic, information about the SARS-CoV-2 virus and disease process was scarce. Governmental, healthcare, and professional organizations created several guidelines to protect invaluable healthcare workers from the contagious virus while also delivering appropriate care to children with COVID-19. With the emergence of new studies and the deployment of new life-saving COVID-19 vaccines and other therapies, these guidelines evolved. The use of aerosol containment devices such as aerosol boxes and flexible barrier techniques was found to be ineffective in reliably containing virus particles while posing potential harm to both healthcare workers and patients. Also, the definition of aerosol-generating and dispersing medical procedures was vastly broadened. To date, use of appropriate personal protection equipment and COVID-19 vaccination are the most effective ways to protect healthcare workers and safely manage children infected with SARS-CoV-2 who require airway intervention. Summary Evidence-based public health measures and appropriate personal protective equipment remain the best way to protect both healthcare workers and patients. As the virus and population evolve and COVID-19 vaccines become more widely available, clinicians must be willing to adapt to the emerging evidence of their impact on how safe pediatric perioperative care is delivered.
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24
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Asim M, Rahatullah A, Wahid K, Wahid F. Investigating the interrelatedness of clinical and non-clinical parameters affecting outcomes in COVID-19 patients: a retrospective study. Pathog Glob Health 2023; 117:212-218. [PMID: 35469550 PMCID: PMC9970242 DOI: 10.1080/20477724.2022.2064796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The COVID-19 pandemic has affected millions globally. Several studies have been carried out to uncover factors affecting the severity of the resulting infection. Available location-specific data concerning the affective demographics as well as clinical aspect of the disease remains limited. In this study, a number of non-clinical as well as the clinical parameters were investigated for their role in adverse progression of the disease in patients admitted to intensive care unit (ICU) in a private tertiary hospital in Peshawar. The prevalence of comorbidities hypertension and diabetes as well as mortality was higher in age group of 70-79 years. Dyspnea was significantly linked to sepsis, invasive ventilation, and mortality; its late presentation, i.e. 15 to 20 days was significantly associated with mortality (p-value < 0.02). Acute kidney injury and acute respiratory distress syndrome were found to be the most strongly associated with sepsis and septic shock. Neither remdesivir nor tocilizumab was effective in preventing the infection-related complications, invasive ventilation, and mortality. Overall, dyspnea was found to be an indicator of the worst progression of the disease. Furthermore, while some parameters were closely linked, others were not.
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Affiliation(s)
- Mohammad Asim
- Department of Medicine, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Arslan Rahatullah
- Department of Medicine, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Khatira Wahid
- Department of Medicine, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Fakhria Wahid
- Department of Medicine, North West General Hospital and Research Center, Peshawar, Pakistan.,Department of Medicine, Institute of Environmental Sciences and Engineering (IESE), National University of Sciences and Technology (NUST), Islamabad, Pakistan
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25
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Cattin L, Ferrari F, Mongodi S, Pariani E, Bettini G, Daverio F, Donadello K, Polati E, Mojoli F, Danzi V, De Rosa S. Airways management in SARS-COV-2 acute respiratory failure: A prospective observational multi-center study. Med Intensiva 2023; 47:131-139. [PMID: 36155747 PMCID: PMC9359672 DOI: 10.1016/j.medine.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest. SETTING Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021. PATIENTS Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management. INTERVENTIONS Endotracheal Intubation Adverse Events. MAIN VARIABLES OF INTERESTS The primary endpoint was to determine the occurrence of at least 1 of the following events within 30 minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%; hemodynamic instability defined as a SBP 65 mmHg recoded at least once or SBP < 90 mmHg for 30 minutes, a new requirement or increase of vasopressors, fluid bolus >15 mL/kg to maintain the target blood pressure; cardiac arrest. RESULTS Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest. CONCLUSION In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent. CLINICAL TRIAL REGISTRATION www. CLINICALTRIALS gov identifier: NCT04909476.
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Affiliation(s)
- L Cattin
- Department of Anesthesia and Intensive Care Unit, St. Bortolo Hospital, Vicenza, Italy; Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy
| | - F Ferrari
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Mongodi
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Pariani
- Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
| | - G Bettini
- Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
| | - F Daverio
- Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
| | - K Donadello
- Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy
| | - E Polati
- Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy
| | - F Mojoli
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
| | - V Danzi
- Department of Anesthesia and Intensive Care Unit, St. Bortolo Hospital, Vicenza, Italy
| | - S De Rosa
- Department of Anesthesia and Intensive Care Unit, St. Bortolo Hospital, Vicenza, Italy.
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26
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Airways management in SARS-COV-2 acute respiratory failure: A prospective observational multi-center study. Med Intensiva 2023; 47:131-139. [PMID: 36855737 PMCID: PMC9950782 DOI: 10.1016/j.medin.2022.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/06/2022] [Indexed: 02/26/2023]
Abstract
Objective Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest. Setting Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021. Patients Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management. Interventions Endotracheal Intubation Adverse Events. Main variables of interests The primary endpoint was to determine the occurrence of at least 1 of the following events within 30 minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%; hemodynamic instability defined as a SBP 65 mmHg recoded at least once or SBP < 90 mmHg for 30 minutes, a new requirement or increase of vasopressors, fluid bolus >15 mL/kg to maintain the target blood pressure; cardiac arrest. Results Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest. Conclusion In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent. Clinical Trial registration www.clinicaltrials.gov identifier: NCT04909476.
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Key Words
- ARDS, acute respiratory distress syndrome
- Airway management
- CI, confidence interval
- COVID-19, Coronavirus disease 2019
- CPAP, continuous positive airways pressure
- Critical care
- DBP, diastolic blood pressure
- ECG, electrocardiography
- ETT, Emergency Endotracheal intubation
- EtCO2, end-tidal carbon dioxide
- HFNO, High flow nasal oxygen
- HR, heart rate
- ICU, intensive care unit
- NIV, noninvasive ventilation
- OR, odds ratio
- PCR, polymerase chain reaction
- PaO2/FiO2, arterial partial oxygen pressure / fraction of inspired oxygen
- RR, respiratory rate
- Respiratory failure
- SARS-CoV infection
- SARS-Cov2, severe acute respiratory syndrome coronavirus 2
- SBP, systolic blood pressure
- SpO2, Peripheral oxygen saturation
- Tracheal intubation
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Pena M, Neu DT, Feng HA, Hammond DR, Mead KR, Banerjee RK. Use of a Negative Pressure Containment Pod Within Ambulance-Workspace During Pandemic Response. J Med Device 2023; 17:011009. [PMID: 36890857 PMCID: PMC9987460 DOI: 10.1115/1.4056694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/02/2022] [Indexed: 01/17/2023] Open
Abstract
Emergency medical service (EMS) providers have a higher potential exposure to infectious agents than the general public (Nguyen et al., 2020, "Risk of COVID-19 Among Frontline Healthcare Workers and the General Community: A Prospective Cohort Study," Lancet Pub. Health, 5(9), pp. e475-e483; Brown et al., 2021, "Risk for Acquiring Coronavirus Disease Illness Among Emergency Medical Service Personnel Exposed to Aerosol-Generating Procedures," Emer. Infect. Disease J., 27(9), p. 2340). The use of protective equipment may reduce, but does not eliminate their risk of becoming infected as a result of these exposures. Prehospital environments have a high risk of disease transmission exposing EMS providers to bioaerosols and droplets from infectious patients. Field intubation procedures may be performed causing the generation of bioaerosols, thereby increasing the exposure of EMS workers to pathogens. Additionally, ambulances have a reduced volume compared to a hospital treatment space, often without an air filtration system, and no control mechanism to reduce exposure. This study evaluated a containment plus filtration intervention for reducing aerosol concentrations in the patient module of an ambulance. Aerosol concentration measurements were taken in an unoccupied research ambulance at National Institute for Occupational Safety and Health (NIOSH) Cincinnati using a tracer aerosol and optical particle counters (OPCs). The evaluated filtration intervention was a containment pod with a high efficiency particulate air (HEPA)-filtered extraction system that was developed and tested based on its ability to contain, capture, and remove aerosols during the intubation procedure. Three conditions were tested (1) baseline (without intervention), (2) containment pod with HEPA-1, and (3) containment pod with HEPA-2. The containment pod with HEPA-filtered extraction intervention provided containment of 95% of the total generated particle concentration during aerosol generation relative to the baseline condition, followed by rapid air cleaning within the containment pod. This intervention can help reduce aerosol concentrations within ambulance patient modules while performing aerosol-generating procedures.
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Affiliation(s)
- Mirle Pena
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221
| | - Dylan T. Neu
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226
| | - H. Amy Feng
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226
| | - Duane R. Hammond
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226
| | - Kenneth R. Mead
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226
| | - Rupak K. Banerjee
- Department of Mechanical and Biomedical Engineering, University of Cincinnati, 593 Rhodes Hall, 2600 Clifton Ave, Cincinnati, OH 45221
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28
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Moein N, Dehqan A, Scherer RC. Chronic voice disorder after coronavirus disease 2019 infection and its treatment using the cricothyroid visor maneuver: a case report. J Med Case Rep 2023; 17:67. [PMID: 36841775 PMCID: PMC9968215 DOI: 10.1186/s13256-023-03780-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/16/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Regarding human coronavirus, the severe acute respiratory syndrome coronavirus 2 pandemic, the novelty of disease, and consequently the lack of studies, the etiology of dysphonia in patients with coronavirus disease 2019 is still unknown and needs to be investigated. The purpose of the current study is to investigate the effect of a new manual therapy technique, cricothyroid visor maneuver, on muscle tension dysphonia symptoms for a patient who had experienced dysphonia symptoms due to the coronavirus disease 2019 infection. CASE PRESENTATION A 55-year-old retired Iranian teacher who was diagnosed with muscle tension dysphonia by an otolaryngologist participated in this study. Fifty days before being referred to an otolaryngologist, he was diagnosed with coronavirus disease 2019 on the basis of the results of a standard laboratory test, namely real-time polymerase chain reaction. Treatment was provided in ten sessions. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted for auditory perceptual and acoustic analysis to assess the effects of the treatment program. Also, videolaryngostroboscopy voice quality perceptions by the patient, both before and after therapy, were assessed. The reduction in all features of the Consensus Auditory-Perceptual Evaluation of Voice was observed. The results of acoustic assessment showed that jitter (35.13%) and shimmer (20.48%) decreased; moreover, the harmonics-to-noise ratio (1.17%), cepstral peak prominence smoothed (28.53%) and maximum phonation time (15.5%) increased after treatment sessions. The scores of four parameters of Stroboscopy Examination Rating Form (SERF) form changed after cricothyroid visor maneuver therapy. Also, the visual analog scales score at the pre-treatment assessment was 40, and increased to 90 at the post-treatment assessment. CONCLUSIONS The effectiveness of cricothyroid visor maneuver therapy on dysphonia associated with coronavirus disease 2019 was investigated in the current study. This case study has highlighted chronic dysphonia after coronavirus disease 2019 infection, and suggests that the cricothyroid visor maneuver therapy approach may have positive outcomes for patients with muscle tension dysphonia with this background.
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Affiliation(s)
- Narges Moein
- grid.411746.10000 0004 4911 7066Department of Speech Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St., Shahnazari Ave., Mirdamad Blvd., Madar Sq., Tehran, Iran
| | - Ali Dehqan
- Rehabilitation Sciences Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Ronald C. Scherer
- grid.253248.a0000 0001 0661 0035Department of Communication Disorders, Bowling Green State University, Bowling Green, OH USA
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Validation of Sequential ROX-Index Score Beyond 12 Hours in Predicting Treatment Failure and Mortality in COVID-19 Patients Receiving Oxygen via High-Flow Nasal Cannula. Can Respir J 2023; 2023:7474564. [PMID: 36817550 PMCID: PMC9931457 DOI: 10.1155/2023/7474564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/25/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
Background High-flow nasal cannula (HFNC) is an oxygen delivery method shown to reduce the risk of intubation and mortality in patients with type 1 respiratory failure. The ROX-index score can predict HFNC failure. This study aims to evaluate sequential ROX-index assessments as predictors of HFNC failure and mortality. Methods Prospective observational single-center study including all adult patients with positive SARS-CoV-2 PCR placed under HFNC from 1st November 2020 to 31st May 2021, and patients with hemodynamic instability or unable to tolerate HFNC were excluded. The primary endpoint was successful HFNC de-escalation. Results In univariate analysis, HFNC de-escalation was associated with younger age (59.2 ± 14 vs. 67.7 ± 10.5 and p < 0.001), lower levels of serum lactate (1.1 vs. 1.5 and p=0.013), and higher ROX-index at 12 hrs (5.09 vs. 4.13 and p < 0.001). ROC curve analysis of ROX-index at 12 hrs yielded a c-statistic of 71.2% (95% CI 61.6-80.9 and p < 0.001). ROX-index at 12 hrs and age retained significance in multivariate analysis. Using an optimal cutoff point of 4.43, we calculated a sensitivity of 64.5% and specificity of 69.6%. In univariate survival analysis, older age (68.8 ± 9.7 vs. 58.9 ± 13.9 and p < 0.001), greater creatinine values (0.96 vs. 0.84 and p=0.022), greater SOFA score (p=0.039), and a lower 12 hrs ROX-index (4.22 vs. 4.95 and p=0.02) were associated with hospital mortality. The SOFA score and age retained significance in multivariate survival analysis. Conclusion ROX-index is proven to be a valuable and easy-to-use tool for clinicians in the assessment of COVID-19 patients under HFNC.
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Eisa M, Omer E. Challenges of Gastric Versus Post-pyloric Feeding in COVID-19 Disease. CURRENT SURGERY REPORTS 2023; 11:39-41. [PMID: 36588861 PMCID: PMC9791629 DOI: 10.1007/s40137-022-00343-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/27/2022]
Abstract
Purpose of the Review The COVID-19 pandemic has had an unprecedented challenge to the critical care providers caring for those patients, including the delivery of nutrition. This review will address the challenges of gastric versus post gastric feeding in patients in COVID-19 disease. Recent Recommendations Many societies, including American, British, and Australian recommend initiating of enteral feeding in COVID-19 patients as soon as 24 h of ICU admission or within 12 h after intubation. Consideration for post-pyloric feeding if there is evidence of intolerance to gastric feeding. Summary The same principle for non-COVID-19 critically ill patients applies to COVID-19 patients when it comes to the route of nutritional delivery. Gastric feeding should be initiated as soon as 24 h of admission to the ICU, and post gastric feeding should be reserved to patients who demonstrate gastric feeding intolerance.
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Affiliation(s)
- Mohamed Eisa
- grid.417046.00000 0004 0454 5075Allegheny Center for Digestive Health, Allegheny Health Network, Pittsburgh, PA USA ,grid.266623.50000 0001 2113 1622Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, KY USA ,grid.417046.00000 0004 0454 5075Allegheny Center for Digestive Health, Allegheny Health Network, 1307 Federal St Suite B301, Pittsburgh, PA 15212 USA
| | - Endashaw Omer
- grid.417046.00000 0004 0454 5075Allegheny Center for Digestive Health, Allegheny Health Network, Pittsburgh, PA USA ,grid.266623.50000 0001 2113 1622Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, KY USA
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Cheng ZJ, Zhan Z, Xue M, Zheng P, Lyu J, Ma J, Zhang XD, Luo W, Huang H, Zhang Y, Wang H, Zhong N, Sun B. Public Health Measures and the Control of COVID-19 in China. Clin Rev Allergy Immunol 2023; 64:1-16. [PMID: 34536214 PMCID: PMC8449219 DOI: 10.1007/s12016-021-08900-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 01/26/2023]
Abstract
In December 2019, the COVID-19 pandemic quickly spread throughout China and beyond, posing enormous global challenges. With prompt, vigorous, and coordinated control measures, mainland China contained the spread of the epidemic within two months and halted the epidemic in three months. Aggressive containment strategy, hierarchical management, rational reallocation of resources, efficient contact tracing, and voluntary cooperation of Chinese citizens contributed to the rapid and efficient control of the epidemic, thus promoting the rapid recovery of the Chinese economy. This review summarizes China's prevention and control strategies and other public health measures, which may provide a reference for the epidemic control in other countries.
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Affiliation(s)
- Zhangkai Jason Cheng
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiqing Zhan
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China ,Guangzhou Medical University, Guangzhou, China
| | - Mingshan Xue
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Peiyan Zheng
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiali Lyu
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Ma
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Wenting Luo
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huimin Huang
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yong Zhang
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongman Wang
- The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China
| | - Nanshan Zhong
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Yin X, Büyüktahtakın IE, Patel BP. COVID-19: Data-Driven optimal allocation of ventilator supply under uncertainty and risk. EUROPEAN JOURNAL OF OPERATIONAL RESEARCH 2023; 304:255-275. [PMID: 34866765 PMCID: PMC8632406 DOI: 10.1016/j.ejor.2021.11.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/26/2021] [Indexed: 05/06/2023]
Abstract
This study presents a new risk-averse multi-stage stochastic epidemics-ventilator-logistics compartmental model to address the resource allocation challenges of mitigating COVID-19. This epidemiological logistics model involves the uncertainty of untested asymptomatic infections and incorporates short-term human migration. Disease transmission is also forecasted through a new formulation of transmission rates that evolve over space and time with respect to various non-pharmaceutical interventions, such as wearing masks, social distancing, and lockdown. The proposed multi-stage stochastic model overviews different scenarios on the number of asymptomatic individuals while optimizing the distribution of resources, such as ventilators, to minimize the total expected number of newly infected and deceased people. The Conditional Value at Risk (CVaR) is also incorporated into the multi-stage mean-risk model to allow for a trade-off between the weighted expected loss due to the outbreak and the expected risks associated with experiencing disastrous pandemic scenarios. We apply our multi-stage mean-risk epidemics-ventilator-logistics model to the case of controlling COVID-19 in highly-impacted counties of New York and New Jersey. We calibrate, validate, and test our model using actual infection, population, and migration data. We also define a new region-based sub-problem and bounds on the problem and then show their computational benefits in terms of the optimality and relaxation gaps. The computational results indicate that short-term migration influences the transmission of the disease significantly. The optimal number of ventilators allocated to each region depends on various factors, including the number of initial infections, disease transmission rates, initial ICU capacity, the population of a geographical location, and the availability of ventilator supply. Our data-driven modeling framework can be adapted to study the disease transmission dynamics and logistics of other similar epidemics and pandemics.
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Affiliation(s)
- Xuecheng Yin
- Yale School of Public Health, New Haven, CT, United States
| | - I Esra Büyüktahtakın
- Systems Optimization and Data Analytics Lab (SODAL), Department of Mechanical and Industrial Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Bhumi P Patel
- Systems Optimization and Data Analytics Lab (SODAL), Department of Mechanical and Industrial Engineering, New Jersey Institute of Technology, Newark, NJ, United States
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Panda CK, Singha SK, Karim HMR, Mishra M. Practices During Intubation in COVID-19 Intensive Care Units in India: A Cross-Sectional Questionnaire-Based Survey. Cureus 2023; 15:e34424. [PMID: 36874758 PMCID: PMC9981221 DOI: 10.7759/cureus.34424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
Background Healthcare workers are committed to learning from each other's experience to safely optimize patient management of COVID-19. Acute hypoxemic failure is common in COVID-19 patients, and nearly 3.2% may require intubation. Intubation is an aerosol-generating procedure (AGP) that might predispose the performer to COVID-19 infection. This survey was intended to evaluate the practices during tracheal intubation in COVID-19 intensive care units (ICUs) and analyze them against the recommendations of the All India Difficult Airway Association (AIDAA) for safe practice. Methodology It was a web-based, multicentric cross-sectional survey. The choices in the questions were based on guidelines for airway management in COVID-19. Survey questions were divided into two parts - the first part consisted of demographics and general information, and the second part focused on safe intubation practices. Results A total of 230 responses were obtained from physicians all over India, presuming their active involvement in COVID-19 cases, of which 226 responses were taken into account. Two-thirds of responders did not receive any training before ICU posting. The Indian Council of Medical Research (ICMR) guideline was followed by 89% of responders for personal protective equipment use. Intubation in COVID-19 patients was predominantly conducted by a senior anesthesiologist/intensivist in the team and a senior resident (37.2%). Rapid sequence intubation (RSI) and modified RSI were preferable among the responder's hospitals (46.5% vs. 33.6%). In most centers, responders used direct laryngoscope for intubation (62.8%), whereas video laryngoscope was used by 34%. Most responders confirmed the endotracheal tube (ETT) position by visual inspection (66.3%) over end-tidal carbon dioxide (EtCO2) concentration tracing (53.9%). Conclusions Safe intubation practices were followed in most of the centers across India. However, teaching and training, preoxygenation methods, alternative ventilation strategies, and confirmation of intubation pertinent to COVID-19 airway management need more attention.
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Affiliation(s)
- Chinmaya K Panda
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, IND
| | - Subrata K Singha
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, IND
| | - Habib Md R Karim
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, IND
| | - Meghana Mishra
- Anesthesiology and Critical Care, DKS Super Specialty Hospital, Raipur, IND
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Emergency endotracheal intubation in critically ill patients with COVID-19: management and clinical characteristics. ANESTHESIOLOGY AND PERIOPERATIVE SCIENCE 2023; 1:7. [PMCID: PMC10008717 DOI: 10.1007/s44254-023-00003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Purposes SARS-CoV-2 have become widespread worldwide since the outbreak. Respiratory function deteriorates rapidly in critically ill patients infected with SARS-CoV-2. Endotracheal intubation is an indispensable therapeutic measure during the development of the disease. This study was intended to describe the experience of endotracheal intubation from front-line anesthesiologists and clinical prognosis of patients infected with Coronavirus disease-19 (COVID-19). Methods Fourteen critical patients infected with COVID-19 who underwent endotracheal intubation were included in this study. We collate and analyze the blood gas results before and after tracheal intubation of patients and clinical prognostic indicators such as length of stay and. mortality. The experience of anesthesiologists who intubated patients has also been recorded in detail. Results Patients had a mean time of 10.6 days from initial symptoms to endotracheal intubation. Most intubated patients had one or more underlying conditions: hypertension (8, 57.14%), diabetes (5, 35.71%), and cardiovascular and cerebrovascular diseases (2, 14.29%). The oxygenation index increased significantly after intubation compared with before intubation (148.80 ± 42.25 vs 284.43 ± 60.17 p < 0.001). 85.72% of patients required extra-corporeal membrane oxygenation (ECMO) due to inability to maintain oxygen saturation with standard therapeutic measures. Two patients underwent lung transplantation because their lungs were essentially nonfunctional, and they recovered well after surgery. As of this writing, all patients were discharged after satisfactory recovery. Conclusions Reasonable selection of intubation timing is particularly important. It is crucial to increase the patient's oxygen supply and reduce oxygen consumption as much as possible during endotracheal intubation. In addition, the personal protective measures of medical personnel participating in treatment should be scientific and standardized. Graphical Abstract ![]()
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Alihodzic-Pasalic A, Pilav I, Maric V, Kadic K, Dapcevic M, Hadzismailovic A, Pilav A, Ademovic E, Custovic O. A Single-Center Experience on the Treatment Outcomes of Patients with COVID-19-Pleural Disorders: Lessons for the Future. Med Arch 2023; 77:345-349. [PMID: 38299086 PMCID: PMC10825738 DOI: 10.5455/medarh.2023.77.345-349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/15/2023] [Indexed: 02/02/2024] Open
Abstract
Background Pleural disorders in novel coronavirus disease 2019 (COVID-19), responsible for the deaths of more than 6.7 million people worldwide, are relatively uncommon and underappreciated findings. The severity of the pleural disease in these patients correlates with the treatment outcome and overall prognosis. Objective We aim to review our experience with treatment modalities and prognosis in 45 patients with COVID-19, who were treated at our Clinic between April 2020 and October 2021. Methods We conducted a retrospective, single-center, cross-sectional study. Demographic data, the type of thoracosurgical intervention(s), and treatment outcome for 45 patients included in this study were recorded for every patient. We analyzed the type and number of treatment modalities according to the pleural disorder, and the outcome of the treatment. Results Pneumothorax was the most common COVID-19-related pleural disorder, followed by the pleural effusion. Tube thoracostomy was the mainstay of treatment, performed in 84.4% of patients with unilateral pleural complications. In total, 20% of our patients were on mechanical ventilation, and all of them had a fatal outcome. We found statistical significance in comparison to the percentage of fatal outcomes between patients treated with and without mechanical ventilation (p=0.000). Conclusion COVID-19-related pleural disorders are prognostic markers of disease progression. Mechanically ventilated patients who require tube thoracostomy have an unfavorable prognosis.
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Affiliation(s)
- Alma Alihodzic-Pasalic
- Clinic of Thoracic Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ilijaz Pilav
- Clinic of Thoracic Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Veljko Maric
- Department of Surgery, Faculty of Medicine Foca, University of East Sarajevo, Foca, Bosnia and Herzegovina
| | - Kenan Kadic
- Clinic of Thoracic Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Meho Dapcevic
- Clinic of Thoracic Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ademir Hadzismailovic
- Clinic of Thoracic Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Alen Pilav
- Clinic of Thoracic Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Enisa Ademovic
- Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Sarajevo,, Sarajevo, Bosnia and Herzegovina
| | - Orhan Custovic
- Clinic of Thoracic Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Yarahmadi S, Ebrahimzadeh F, Mohamadipour F, Cheraghian T, Eskini M. Effect of Prone Position on Clinical Outcomes of Non-Intubated Patients with Covid-19: A Randomized Clinical Trial. Collegian 2022; 30:449-456. [PMID: 36591534 PMCID: PMC9792421 DOI: 10.1016/j.colegn.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Background Prone positioning (PP) is a well-known respiratory support approach. Limited data are available for the use of PP in non-intubated patients with COVID-19. Aim This study aims to investigate the effect of PP on the clinical outcomes of patients with COVID-19 pneumonia. Methods In This clinical trial, the participants in the PP group (n=41) were asked to lie comfortably in a prone position for 90 minutes. In the supine position (SP) group (n=41), the participants were asked to lie comfortably in a supine position for 90 minutes. Clinical data such as oxygen saturation, respiratory rate, the severity of dyspnea, mean arterial pressure, and pulse rate were assessed at 0 (immediately before), 30, 60, 90 minutes after the start of the intervention and 30 min after resuming the supine position. The participants in the PP group were then asked to intermittently stay in a prone position for a total of eight hours per 24 hours of hospitalization. The participants in the control group were asked to remain in their usual positions during the hospital stay. Finally, the length of hospital stay, intubation rate, and survival assessed. Findings Prone positioning was associated with significant improvement in oxygen saturation (P = 0.001), respiratory rate (P=0.004), the severity of dyspnea (P=0.014), and mean arterial pressure (P=0.027). There was no significant difference between the two groups in terms of pulse rate (P=0.890), hospital stay (P=0.994), intubation rate (P=0.324), and survival (P=0.091). Discussion Our results demonstrated that prone positioning showed marked improvement in some short-term clinical outcomes in non-intubated patients with COVID-19. Conclusion Prone positioning can be considered an inexpensive, accessible, and simple measure in awake non-intubated patients with COVID-19.
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Affiliation(s)
- Sajad Yarahmadi
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran,Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran,Correspondence to: Environmental Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farzad Ebrahimzadeh
- Nutritional Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Mohamadipour
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Tayebeh Cheraghian
- Cardiovascular Research Center, Shahid Rahimi Hospital, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mahtab Eskini
- Social Determinants of Health Research Center, Shohadaye Ashayer Hospital, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
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Zalyalova ZA, Munasipova SE, Khasanova DM, Ilyina GR, Khayatova ZG, Bagdanova NI. A “new” role of amantadines in COVID-19 in patients with Parkinson’s disease: results of own comparative study. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-6-40-48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Z. A. Zalyalova
- Kazan State Medical University, Ministry of Health of Russia; Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Ministry of Health of the Republic of Tatarstan; Hospital for War Veterans; Clinical Hospital “Railway Medicine“
| | - S. E. Munasipova
- Kazan State Medical University, Ministry of Health of Russia; Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Ministry of Health of the Republic of Tatarstan; Hospital for War Veterans
| | - D. M. Khasanova
- Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Ministry of Health of the Republic of Tatarstan; Hospital for War Veterans
| | - G. R. Ilyina
- Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Ministry of Health of the Republic of Tatarstan; Hospital for War Veterans
| | | | - N. I. Bagdanova
- Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Ministry of Health of the Republic of Tatarstan; Hospital for War Veterans
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Dierckx W, De Backer W, Lins M, De Meyer Y, Ides K, Vandevenne J, De Backer J, Franck E, Lavon BR, Lanclus M, Thillai M. CT-derived measurements of pulmonary blood volume in small vessels and the need for supplemental oxygen in COVID-19 patients. J Appl Physiol (1985) 2022; 133:1295-1299. [PMID: 36269576 DOI: 10.1152/japplphysiol.00458.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Throughout the COVID-19 pandemic, a portion of those affected have evolved toward acute hypoxic respiratory failure. Initially, this was hypothesized to result from acute lung injury leading to acute respiratory distress syndrome (ARDS). In previous research, a novel quantitative CT post-processing technique was described to quantify the volume of blood contained within pulmonary blood vessels of a given size. We hypothesized that patients with lower BV5 blood flow would have higher supplemental oxygen needs and less favorable arterial blood gas profiles. From the initial data analysis, 111 hospitalized COVID-19 patients were retrospectively selected based on the availability of CT scans of the lungs with a slice thickness of 1.5 mm or less, as well as PCR-confirmed SARS-CoV2 infection. Three-dimensional (3-D) reconstructions of the lungs and pulmonary vasculature were created. Further analysis was performed on 50 patients. Patients were divided into groups based on their need for oxygen at the time of CT scan acquisition. Eighteen out of 50 patients needed >2 L/min supplemental oxygen and this group demonstrated a significantly lower median percentage of total blood flow in the BV5 vessels compared with the 32 patients who needed <2 L/min supplemental oxygen (41.61% vs. 46.89%, P = 0.023). Both groups had significantly less blood as a proportion in BV5 vessels compared with healthy volunteers. These data are consistent with the hypothesis that reduced blood volume within small (BV5) pulmonary vessels is associated with higher needs for supplemental oxygen and more severe gas exchange anomalies in COVID-19 infections.NEW & NOTEWORTHY This research provides, by using new imaging analysis on CT imaging, an insight into the pathophysiology of patients with COVID-19 infection. By visualizing and quantifying the blood in small vessels in the lung, we can link these results to the clinical need for oxygen in patients with COVID-19 infection.
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Affiliation(s)
- Wendel Dierckx
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium.,Fluidda NV, Kontich, Belgium.,Multidisciplinary praxis Medimprove, Kontich, Belgium
| | - Wilfried De Backer
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium.,Multidisciplinary praxis Medimprove, Kontich, Belgium
| | - Muriel Lins
- General Hospital Sint-Maarten, Mechelen, Belgium
| | - Yinka De Meyer
- Fluidda NV, Kontich, Belgium.,Multidisciplinary praxis Medimprove, Kontich, Belgium
| | - Kris Ides
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium.,Department of Engineering, Cosys Labs, University of Antwerp, Antwerp, Belgium.,Multidisciplinary praxis Medimprove, Kontich, Belgium
| | - Jan Vandevenne
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine, University of Hasselt, Diepenbeek, Belgium
| | | | - Erik Franck
- Centre for Research and Innovation in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | | | - Muhunthan Thillai
- Interstitial Lung Disease Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.,Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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Chua EX, Wong ZZ, Hasan MS, Atan R, Yunos NM, Yip HW, Teoh WY, Ramli MAS, Ng KT. Prone ventilation in intubated COVID-19 patients: a systematic review and meta-analysis. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2022; 72:780-789. [PMID: 35809681 PMCID: PMC9259191 DOI: 10.1016/j.bjane.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND The efficacy and safety profiles of prone ventilation among intubated Coronavirus Disease 2019 (COVID-19) patients remain unclear. The primary objective was to examine the effect of prone ventilation on the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) in intubated COVID-19 patients. METHODS Databases of MEDLINE, EMBASE and CENTRAL were systematically searched from inception until March 2021. Case reports and case series were excluded. RESULTS Eleven studies (n = 606 patients) were eligible. Prone ventilation significantly improved PaO2/FiO2 ratio (studies: 8, n = 579, mean difference 46.75, 95% CI 33.35‒60.15, p < 0.00001; evidence: very low) and peripheral oxygen saturation (SpO2) (studies: 3, n = 432, mean difference 1.67, 95% CI 1.08‒2.26, p < 0.00001; evidence: ow), but not the arterial partial pressure of carbon dioxide (PaCO2) (studies: 5, n = 396, mean difference 2.45, 95% CI 2.39‒7.30, p = 0.32; evidence: very low), mortality rate (studies: 1, n = 215, Odds Ratio 0.66, 95% CI 0.32‒1.33, p = 0.24; evidence: very low), or number of patients discharged alive (studies: 1, n = 43, Odds Ratio 1.49, 95% CI 0.72‒3.08, p = 0.28; evidence: very low). CONCLUSION Prone ventilation improved PaO2/FiO2 ratio and SpO2 in intubated COVID-19 patients. Given the substantial heterogeneity and low level of evidence, more randomized- controlled trials are warranted to improve the certainty of evidence, and to examine the adverse events of prone ventilation.
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Affiliation(s)
- Ee Xin Chua
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia
| | - Zhen Zhe Wong
- International Medical University, School of Medicine, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia
| | - Rafidah Atan
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia
| | - Nor'azim Mohd Yunos
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia
| | - Hing Wa Yip
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia
| | - Wan Yi Teoh
- University of Liverpool, Faculty of Medicine, Liverpool L69 3BX, United Kingdom
| | - Mohd Afiq Syahmi Ramli
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia
| | - Ka Ting Ng
- Universiti Malaya, Faculty of Medicine, Department of Anesthesiology, Kuala Lumpur, Malaysia.
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Jakhotia Y, Mitra K, Onkar P, Dhok A. Interobserver Variability in CT Severity Scoring System in COVID-19 Positive Patients. Cureus 2022; 14:e30193. [PMID: 36397905 PMCID: PMC9648989 DOI: 10.7759/cureus.30193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Chest CT scans are done in cases of coronavirus disease 2019 (COVID-19)-positive patients to understand the severity of the disease and plan treatment accordingly. Severity is determined according to a 25-point scoring system, however, there could be interobserver variability in using this scoring system thus leading to the different categorization of patients. We tried to look for this interobserver variability and thus find out its reliability. Methods: The study was retrospective and was done in a designated COVID center. Some 100 patients were involved in the study who tested positive for COVID-19 disease. The research was conducted over six months (January 2021 to June 2021). Images were given to three radiologists with a minimum of 10 years of experience in thoracic imaging working in different setups at different places for interpretation and scoring further and their scores were compared. Before the study, the local ethics committee granted its approval. Results: There was no significant variability in the interobserver scoring system thus proving its reliability. The standard deviation between different observers was less than three. There was almost perfect agreement amongst all the observers (Fleiss’ K=0.99 [95% confidence interval, CI: 0.995-0.998]). Maximum variations were observed in the moderate class. Conclusion: There was minimum inter-observer variability in the 25-point scoring system thus proving its reliability in categorizing patients according to severity. There was no change in the class of the patient according to its severity. A 25-point scoring system hence can be used by clinicians to plan treatment and thus improve a patient's prognosis.
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Rehman S, Shahiman MA, Khaleel MA, Holý O. Does the intubation timeline affect the in-hospital mortality of COVID-19 patients? A retrospective cohort study. Front Med (Lausanne) 2022; 9:1023229. [PMID: 36275820 PMCID: PMC9582598 DOI: 10.3389/fmed.2022.1023229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Effective strategies for managing coronavirus disease 19 (COVID-19) patients suffering from acute respiratory distress are constantly evolving. The timeline and threshold for transitioning from non-invasive ventilation to intermittent mandatory ventilation in critical cases who develop COVID-19-related respiratory distress are undetermined. The present research intends to investigate if emergency room intubations in COVID-19 patients affect mortality. Methods Between January 1, 2021 and June 30, 2021, we retrospectively reviewed chart analysis on all patients with confirmed positive COVID-19 screening and who underwent endotracheal intubation. Depending on when the intubation was performed; early in the emergency room or delayed outside the emergency room, patients were separated into two cohorts. In addition to comorbid clinical manifestations, the quick sequential organ failure assessment (qSOFA) score, and in-hospital mortality were all recorded as demographic and clinical information. Results Fifty-eight of the 224 corona-positive patients who underwent intubation had their intubations performed in the emergency room. Age, sex, alcohol use, and smoking status did not significantly differ between the two categories at the baseline. The mean qSOFA score was higher in the early intubation cohort (3.5; p < 0.000) along with more underlying comorbidities (3.0; p < 0.000). When compared to the late intubation cohort (45.78%), patients treated with early intubation had a significantly greater death rate (67.24%). Conclusion In summary, we discovered that patients who underwent intubation in the emergency units exhibited a high quick SOFA score as well as maximum co-morbid conditions than patients intubated somewhere else in the hospital. The findings of our investigation imply that intubating patients too early might be risky.
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Affiliation(s)
- Shazia Rehman
- Department of Biomedical Sciences, Pak-Austria Fachhochschule, Institute of Applied Sciences and Technology, Haripur, Pakistan
| | - Muhammad Ali Shahiman
- Department of Urology, and Renal Transplantation, Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Mundher A. Khaleel
- Department of Mathematics, College of Computer Science and Mathematics, Tikrit University, Tikrit, Iraq
| | - Ondřej Holý
- Science and Research Center, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czechia,*Correspondence: Ondřej Holý
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Abstract
Background: Tracheal intubation is a high-risk intervention for exposure to airborne infective pathogens, including the novel coronavirus disease 2019 (COVID-19). During the recent pandemic, personal protective equipment (PPE) was essential to protect staff during intubation but is recognized to make the practical conduct of anesthesia and intubation more difficult. In the early phase of the coronavirus pandemic, some simple alterations were made to the emergency anesthesia standard operating procedure (SOP) of a prehospital critical care service to attempt to maintain high intubation success rates despite the challenges posed by wearing PPE. This retrospective observational cohort study aims to compare first-pass intubation success rates before and after the introduction of PPE and an altered SOP. Methodology: A retrospective observational cohort study was conducted from January 1, 2019 through August 30, 2021. The retrospective analysis used prospectively collected data using prehospital electronic patient records. Anonymized data were held in Excel (v16.54) and analyzed using IBM SPSS Statistics (v28). Patient inclusion criteria were those of all ages who received a primary tracheal intubation attempt outside the hospital by critical care teams. March 27, 2020 was the date from which the SOP changed to mandatory COVID-19 SOP including Level 3 PPE – this date is used to separate the cohort groups. Results: Data were analyzed from 1,266 patients who received primary intubations by the service. The overall first-pass intubation success rate was 89.7% and the overall intubation success rate was 99.9%. There was no statistically significant difference in first-pass success rate between the two groups: 90.3% in the pre-COVID-19 group (n = 546) and 89.3% in the COVID-19 group (n = 720); Pearson chi-square 0.329; P = .566. In addition, there was no statistical difference in overall intubation success rate between groups: 99.8% in the pre-COVID-19 group and 100.0% in the COVID-19 group; Pearson chi-square 1.32; P = .251. Non-drug-assisted intubations were more than twice as likely to require multiple attempts in both the pre-COVID-19 group (n = 546; OR = 2.15; 95% CI, 1.19-3.90; P = .01) and in the COVID-19 group (n = 720; OR = 2.5; 95% CI, 1.5-4.1; P = <.001). Conclusion: This study presents simple changes to a prehospital intubation SOP in response to COVID-19 which included mandatory use of PPE, the first intubator always being the most experienced clinician, and routine first use of video laryngoscopy (VL). These changes allowed protection of the clinical team while successfully maintaining the first-pass and overall success rates for prehospital tracheal intubation.
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Abstract
The COVID-19 pandemic has resulted in unprecedented numbers of critically ill patients. Critical care providers have been challenged to increase the capacity for critical care, prevent the spread of syndrome coronavirus 2 in hospitals, determine the optimal treatment approaches for patients with critical COVID-19, and to design and implement systems for fair allocation of scarce life-saving resources when capacity is exhausted. The global burden of COVID-19 highlighted disparities, across geographic regions and among minority patient populations. Faced with a novel pathogen, critical care providers grappled with the extent to which conventional supportive critical care practices should be followed versus adapted to treat patients with COVID-19. Fiercely debated practices included the use of awake prone positioning, the timing of intubation, and optimal approach to sedation. Advances in clinical trial design were necessary to rapidly identify appropriate therapeutics for the critically ill patient with COVID-19. In this article, we review the epidemiology, outcomes, and treatments for the critically ill patient with COVID-19.
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Affiliation(s)
- Matthew K Hensley
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh Medical Center, 5200 Centre Avenue, Suite 610, Pittsburgh, PA 15232, USA.
| | - Hallie C Prescott
- Department of Internal Medicine, University of Michigan, NCRC Building 16, Room 341E / 2800 Plymouth Road, Ann Arbor, MI 48109-2800, USA; VA Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, MI, USA. https://twitter.com/HalliePrescott
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Chen S, Qiu X, Tan X, Fang Z, Jin Y. A model-based hybrid soft actor-critic deep reinforcement learning algorithm for optimal ventilator settings. Inf Sci (N Y) 2022. [DOI: 10.1016/j.ins.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Shang Y, Wu J, Liu J, Long Y, Xie J, Zhang D, Hu B, Zong Y, Liao X, Shang X, Ding R, Kang K, Liu J, Pan A, Xu Y, Wang C, Xu Q, Zhang X, Zhang J, Liu L, Zhang J, Yang Y, Yu K, Guan X, Chen D. Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019 (COVID-19). JOURNAL OF INTENSIVE MEDICINE 2022; 2:199-222. [PMID: 36785648 PMCID: PMC9411033 DOI: 10.1016/j.jointm.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 12/16/2022]
Affiliation(s)
- You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Jianfeng Wu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510010, China
| | - Jinglun Liu
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China
| | - Jianfeng Xie
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Dong Zhang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Bo Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Yuan Zong
- Department of Critical Care Medicine, Shaanxi Provincial Hospital, Xi'an, Shannxi 710068, China
| | - Xuelian Liao
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiuling Shang
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fuzhou, Fujian 350001, China
| | - Renyu Ding
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Kai Kang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Jiao Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Aijun Pan
- Department of Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Yonghao Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Changsong Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150001, China
| | - Qianghong Xu
- Department of Critical Care Medicine, Zhejiang Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang 310013, China
| | - Xijing Zhang
- Department of Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi 710032, China
| | - Jicheng Zhang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Ling Liu
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Jiancheng Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Yi Yang
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
- Corresponding authors: Dechang Chen, Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Xiangdong Guan, Department of Critical Care Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China. Kaijiang Yu, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
| | - Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510010, China
- Corresponding authors: Dechang Chen, Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Xiangdong Guan, Department of Critical Care Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China. Kaijiang Yu, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Corresponding authors: Dechang Chen, Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Xiangdong Guan, Department of Critical Care Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China. Kaijiang Yu, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
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Gang J, Wang H, Xue X, Zhang S. Microbiota and COVID-19: Long-term and complex influencing factors. Front Microbiol 2022; 13:963488. [PMID: 36033885 PMCID: PMC9417543 DOI: 10.3389/fmicb.2022.963488] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/25/2022] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). According to the World Health Organization statistics, more than 500 million individuals have been infected and more than 6 million deaths have resulted worldwide. Although COVID-19 mainly affects the respiratory system, considerable evidence shows that the digestive, cardiovascular, nervous, and reproductive systems can all be involved. Angiotensin-converting enzyme 2 (AEC2), the target of SARS-CoV-2 invasion of the host is mainly distributed in the respiratory and gastrointestinal tract. Studies found that microbiota contributes to the onset and progression of many diseases, including COVID-19. Here, we firstly conclude the characterization of respiratory, gut, and oral microbial dysbiosis, including bacteria, fungi, and viruses. Then we explore the potential mechanisms of microbial involvement in COVID-19. Microbial dysbiosis could influence COVID-19 by complex interactions with SARS-CoV-2 and host immunity. Moreover, microbiota may have an impact on COVID-19 through their metabolites or modulation of ACE2 expression. Subsequently, we generalize the potential of microbiota as diagnostic markers for COVID-19 patients and its possible association with post-acute COVID-19 syndrome (PACS) and relapse after recovery. Finally, we proposed directed microbiota-targeted treatments from the perspective of gut microecology such as probiotics and prebiotics, fecal transplantation and antibiotics, and other interventions such as traditional Chinese medicine, COVID-19 vaccines, and ACE2-based treatments.
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Affiliation(s)
- Jiaqi Gang
- Department of Emergency, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Oncology, Xiuwu County People’s Hospital, Jiaozuo, China
| | - Haiyu Wang
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangsheng Xue
- Department of Oncology, Xiuwu County People’s Hospital, Jiaozuo, China
| | - Shu Zhang
- Department of Emergency, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Chavez S, Brady WJ, Gottlieb M, Carius BM, Liang SY, Koyfman A, Long B. Clinical update on COVID-19 for the emergency clinician: Airway and resuscitation. Am J Emerg Med 2022; 58:43-51. [PMID: 35636042 PMCID: PMC9106422 DOI: 10.1016/j.ajem.2022.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. OBJECTIVE This narrative review provides emergency clinicians with a focused update of the resuscitation and airway management of COVID-19. DISCUSSION Patients with COVID-19 and septic shock should be resuscitated with buffered/balanced crystalloids. If hypotension is present despite intravenous fluids, vasopressors including norepinephrine should be initiated. Stress dose steroids are recommended for patients with severe or refractory septic shock. Airway management is the mainstay of initial resuscitation in patients with COVID-19. Patients with COVID-19 and ARDS should be managed similarly to those ARDS patients without COVID-19. Clinicians should not delay intubation if indicated. In patients who are more clinically stable, physicians can consider a step-wise approach as patients' oxygenation needs escalate. High-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) are recommended over elective intubation. Prone positioning, even in awake patients, has been shown to lower intubation rates and improve oxygenation. Strategies consistent with ARDSnet can be implemented in this patient population, with a goal tidal volume of 4-8 mL/kg of predicted body weight and targeted plateau pressures <30 cm H2O. Limited data support the use of neuromuscular blocking agents (NBMA), recruitment maneuvers, inhaled pulmonary vasodilators, and extracorporeal membrane oxygenation (ECMO). CONCLUSION This review presents a concise update of the resuscitation strategies and airway management techniques in patients with COVID-19 for emergency medicine clinicians.
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Affiliation(s)
- Summer Chavez
- The University of Texas at Houston Health Science Center, Department of Emergency Medicine, 6431 Fannin, 2nd Floor JJL, Houston, TX 77030, United States of America
| | - William J. Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | | | - Stephen Y. Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, United States of America,Corresponding author at: 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States of America
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Zacchetti L, Longhi L, Bianchi I, Di Matteo M, Russo F, Gandini L, Manesso L, Monti M, Cosentini R, Di Marco F, Fagiuoli S, Grazioli L, Gritti P, Previdi F, Senni M, Ranieri M, Lorini L. Characterization of compliance phenotypes in COVID-19 acute respiratory distress syndrome. BMC Pulm Med 2022; 22:296. [PMID: 35915487 PMCID: PMC9341412 DOI: 10.1186/s12890-022-02087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) seems to differ from the "classic ARDS", showing initial significant hypoxemia in the face of relatively preserved compliance and evolving later in a scenario of poorly compliant lungs. We tested the hypothesis that in patients with COVID-19 ARDS, the initial value of static compliance of respiratory system (Crs) (1) depends on the previous duration of the disease (i.e., the fewer days of illness, the higher the Crs and vice versa) and (2) identifies different lung patterns of time evolution and response to prone positioning. METHODS This was a single-center prospective observational study. We enrolled consecutive mechanically ventilated patients with a diagnosis of COVID-19 who met ARDS criteria, admitted to intensive care unit (ICU). Patients were divided in four groups based on quartiles of initial Crs. Relationship between Crs and the previous duration of the disease was evaluated. Respiratory parameters collected once a day and during prone positioning were compared between groups. RESULTS We evaluated 110 mechanically ventilated patients with a diagnosis of COVID-19 who met ARDS criteria admitted to our ICUs. Patients were divided in groups based on quartiles of initial Crs. The median initial Crs was 41 (32-47) ml/cmH2O. No association was found between the previous duration of the disease and the initial Crs. The Crs did not change significantly over time within each quartile. Positive end-expiratory pressure (PEEP) and driving pressure were respectively lower and greater in patients with lower Crs. Prone positioning significantly improved PaO2/FiO2 in the 4 groups, however it increased the Crs significantly only in patients in lower quartile of Crs. CONCLUSIONS In our cohort, the initial Crs is not dependent on the previous duration of COVID-19 disease. Prone positioning improves oxygenation irrespective to initial Crs, but it ameliorates respiratory mechanics only in patients with lower Crs.
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Affiliation(s)
- Lucia Zacchetti
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.
| | - Luca Longhi
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Isabella Bianchi
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Maria Di Matteo
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Filippo Russo
- Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Lucia Gandini
- Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Leonardo Manesso
- Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Martina Monti
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.,Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Roberto Cosentini
- Emergency Medicine Department, Papa Giovanni XIII Hospital, Bergamo, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Milan, Italy.,Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.,Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Lorenzo Grazioli
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Paolo Gritti
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Fabio Previdi
- Department of Bioengineering, University of Bergamo, Bergamo, Italy
| | - Michele Senni
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Ranieri
- Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Lorini
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.,Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
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Vigouroux M, Amja K, Bertolizio G, Ingelmo P, Hovey R. Reflecting back to move forward: Lessons learned about COVID-19 safety protocols from pediatric anesthesiologists. Paediatr Anaesth 2022; 32:1138-1143. [PMID: 35852924 PMCID: PMC9349821 DOI: 10.1111/pan.14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 06/17/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic brought about the immediate need for enhanced safety protocols in health care centers. These protocols had to evolve as knowledge and understanding of the disease quickly broadened. AIMS Through this study, the researchers aimed to understand the experiences of pediatric anesthesiologists at the Montreal Children's Hospital and the Shriners' Hospital Canada as they navigated the first wave of COVID-19 at their institutions. METHODS Nine participants from the Montreal Children's Hospital and the Shriners' Hospital were interviewed. Interviews were recorded, transcribed verbatim, and then analyzed using an applied philosophical hermeneutics approach. FINDINGS Participants expressed their wish for simple and easy-to-apply protocols while recognizing the challenge of keeping up with evolving knowledge on the disease and its transmission. They pointed to some limitations and unintended consequences of the safety protocols and the system-wide flaws that the COVID-19 pandemic helped bring to light. They described their frustrations with some aspects of the safety protocols, which they at times felt could be more efficient or better suited for their daily practice. CONCLUSIONS The findings of this study highlighted the importance of listening to and empowering anesthesiology staff working in the field during crises, the implications of shifting from patient-centered care to community-centered care, and the fine line between sharing as much emerging information as possible and overwhelming staff with information.
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Affiliation(s)
- Marie Vigouroux
- Faculty of Dental Medicine and Oral Health SciencesMcGill UniversityMontrealQuebecCanada,Edwards Family Interdisciplinary Centre for Complex PainMontreal Children's HospitalMontrealQuebecCanada
| | - Kristina Amja
- Faculty of Dental Medicine and Oral Health SciencesMcGill UniversityMontrealQuebecCanada
| | - Gianluca Bertolizio
- Department of AnesthesiaMontreal Children's HospitalMontrealQuebecCanada,Department of Anesthesia, Faculty of Medicine and Health SciencesMcGill UniversityMontrealQuebecCanada
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Centre for Complex PainMontreal Children's HospitalMontrealQuebecCanada,Department of Anesthesia, Faculty of Medicine and Health SciencesMcGill UniversityMontrealQuebecCanada
| | - Richard Hovey
- Faculty of Dental Medicine and Oral Health SciencesMcGill UniversityMontrealQuebecCanada
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Deng M, Zou W. Commentary: Lung Recruitment, Individualized PEEP, and Prone Position Ventilation for COVID-19-Associated Severe ARDS: A Single Center Observational Study. Front Med (Lausanne) 2022; 9:884942. [PMID: 35685414 PMCID: PMC9171037 DOI: 10.3389/fmed.2022.884942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Meiling Deng
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Wangyuan Zou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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