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Mirfazeli FS, Faiz SHR, Shariati B, Rahimzadeh P, Kalantari S. Mental health care for hospitalized COVID-19 patients; an experience from Iran. Med J Islam Repub Iran 2020; 34:162. [PMID: 33816361 PMCID: PMC8004565 DOI: 10.47176/mjiri.34.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Seyed Hamid Reza Faiz
- Rasoul Akram Hospital Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Shariati
- Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Poupak Rahimzadeh
- Rasoul Akram Hospital Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Kalantari
- Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, Iran
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Naunheim MR, Zhou AS, Puka E, Franco RA, Carroll TL, Teng SE, Mallur PS, Song PC. Laryngeal complications of COVID-19. Laryngoscope Investig Otolaryngol 2020; 5:1117-1124. [PMID: 33364402 PMCID: PMC7752067 DOI: 10.1002/lio2.484] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To describe and visually depict laryngeal complications in patients recovering from coronavirus disease 2019 (COVID-19) infection along with associated patient characteristics. STUDY DESIGN Prospective patient series. SETTING Tertiary laryngology care centers. SUBJECTS AND METHODS Twenty consecutive patients aged 18 years or older presenting with laryngological complaints following recent COVID-19 infection were included. Patient demographics, comorbid medical conditions, COVID-19 diagnosis dates, symptoms, intubation, and tracheostomy status, along with subsequent laryngological symptoms related to voice, airway, and swallowing were collected. Findings on laryngoscopy and stroboscopy were included, if performed. RESULTS Of the 20 patients enrolled, 65% had been intubated for an average duration of 21.8 days and 69.2% requiring prone-position mechanical ventilation. Voice-related complaints were the most common presenting symptom, followed by those related to swallowing and breathing. All patients who underwent flexible laryngoscopy demonstrated laryngeal abnormalities, most frequently in the glottis (93.8%), and those who underwent stroboscopy had abnormalities in mucosal wave (87.5%), periodicity (75%), closure (50%), and symmetry (50%). Unilateral vocal fold immobility was the most common diagnosis (40%), along with posterior glottic (15%) and subglottic (10%) stenoses. 45% of patients underwent further procedural intervention in the operating room or office. Many findings were suggestive of intubation-related injury. CONCLUSION Prolonged intubation with prone-positioning commonly employed in COVID-19 respiratory failure can lead to significant laryngeal complications with associated difficulties in voice, airway, and swallowing. The high percentage of glottic injuries underscores the importance of stroboscopic examination. Otolaryngologists must be prepared to manage these complications in patients recovering from COVID-19. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthew R. Naunheim
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Allen S. Zhou
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Elefteria Puka
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Ramon A. Franco
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Thomas L. Carroll
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Division of OtolaryngologyBrigham and Womens HospitalBostonMAUSA
| | - Stephanie E. Teng
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Division of OtolaryngologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Pavan S. Mallur
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Division of OtolaryngologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Phillip C. Song
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
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Shrikhande SV, Chaudhary A, Krishnamurthy A, Rao GV, Chaturvedi H, Kar M, Deo SVS, Chaudhari V, Somashekhar S. Surgical Oncology Practice in the Wake of COVID-19 Crisis. Indian J Surg Oncol 2020; 11:762-768. [PMID: 33191994 PMCID: PMC7648662 DOI: 10.1007/s13193-020-01240-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome (SARS-CoV-2) outbreak has placed unprecedented challenges globally dismantling healthcare systems and forcing rapid transformations of healthcare services. In patients with cancer, these changes are having profound effects on vital aspects of their care. It has been advised that hospitals discontinue elective surgery and work on triage of nonemergent surgical procedures during the pandemic. The purpose of this article is to highlight the recommendations and adapted workflow from the private and public tertiary level hospitals in India advising on the best practices and views on better patient management, redesigning of SOPs for OR, surgeon, and staff safety and resumption of cancer care especially from surgical perspective. Different concerns are addressed that are necessary to optimize the quality of care provided to COVID-19 patients and to reduce the risk of viral transmission to other patients or healthcare workers.
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Affiliation(s)
- Shailesh V. Shrikhande
- Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Adarsh Chaudhary
- Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medcity, Delhi, India
| | | | - G. V. Rao
- Asian Institute of Gastroenterology, Hyderabad, Telangana India
| | - Harit Chaturvedi
- Max Institute of Cancer Care, Max Group of Hospitals, Delhi, India
| | | | - S. V. S. Deo
- Department of Surgical Oncology, AIIMS (ICRH and NCI), Delhi, India
| | - Vikram Chaudhari
- Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra India
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Fernandez CE, Franz CK, Ko JH, Walter JM, Koralnik IJ, Ahlawat S, Deshmukh S. Imaging Review of Peripheral Nerve Injuries in Patients with COVID-19. Radiology 2020; 298:E117-E130. [PMID: 33258748 PMCID: PMC7709352 DOI: 10.1148/radiol.2020203116] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With surging numbers of patients with coronavirus disease 2019 (COVID-19) throughout the world, neuromuscular complications and rehabilitation concerns are becoming more apparent. Peripheral nerve injury can occur in patients with COVID-19 secondary to postinfectious inflammatory neuropathy, prone positioning-related stretch and/or compression injury, systemic neuropathy, or nerve entrapment from hematoma. Imaging of peripheral nerves in patients with COVID-19 may help to characterize nerve abnormality, to identify site and severity of nerve damage, and to potentially elucidate mechanisms of injury, thereby aiding the medical diagnosis and decision-making process. This review article aims to provide a first comprehensive summary of the current knowledge of COVID-19 and peripheral nerve imaging.
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Affiliation(s)
- Claire E Fernandez
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
| | - Colin K Franz
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
| | - Jason H Ko
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
| | - James M Walter
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
| | - Igor J Koralnik
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
| | - Shivani Ahlawat
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
| | - Swati Deshmukh
- From the Department of Radiology (C.E.F., S.D.), Department of Physical Medicine and Rehabilitation (C.K.F.), Department of Neurology (C.K.F., I.J.K.), Division of Plastic and Reconstructive Surgery (J.H.K.), and Division of Pulmonary and Critical Care, Department of Medicine (J.M.W.), Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611; Shirley Ryan Ability Laboratory (formerly the Rehabilitation Institute of Chicago), Chicago, Ill (C.K.F.); and Department of Radiology, Johns Hopkins Hospital, Baltimore, Md (S.A.)
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205
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Masks or N95 Respirators During COVID-19 Pandemic-Which One Should I Wear? J Oral Maxillofac Surg 2020; 78:2114-2127. [PMID: 32926868 PMCID: PMC7451003 DOI: 10.1016/j.joms.2020.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/23/2020] [Accepted: 08/23/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Coronavirus Disease 2019 (COVID-19) has caused suffering and death around the world. Careful selection of facial protection is paramount for preventing virus spread among healthcare workers and preserving mask and N95 respirator supplies. METHODS This paper is a comprehensive review of literature written in English and available on Pubmed comparing the risk of viral respiratory infections when wearing masks and N95 respirators. Current international oral and maxillofacial surgery guidelines for mask and N95 respirator use, patient COVID-19 disease status, aerosol producing procedures were also collected and incorporated into a workflow for selecting appropriate facial protection for oral and maxillofacial surgery procedures during the current pandemic. RESULTS Most studies suggest N95 respirators and masks are equally protective against respiratory viruses. Some evidence favors N95 respirators, which are preferred for high-risk procedures when aerosol production is likely or when the COVID-19 status of a patient is positive or unknown. N95 respirators may also be used for multiple patients or reused depending on the type of procedure and condition of the respirator after each patient encounter. CONCLUSION N95 respirators are preferred over masks against viral respiratory pathogens, especially during aerosol-generating procedures or when a patient's COVID-19 status is positive or unknown.
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206
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Dabbagh A, Ahmadizadeh SN, Asgari S, Fani K, Massoudi N, Moshari M, Sezari P, Shokrollahi S, Tabashi S, Tajbakhsh A, Vosoughian M. Attitudes of the Third-Year Clinical Anesthesiology Residents Toward an Independent Clinical Practice Rotation in COVID-19 Pandemic in Iran. Anesth Pain Med 2020; 10:e110755. [PMID: 34150579 PMCID: PMC8207852 DOI: 10.5812/aapm.110755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND COVID-19 was a worldwide pandemic with international health emergencies and great challenges; health care personnel shortage and physician burnout is a potential major challenge that should be planned and managed; especially in those countries with a high COVID-19 occurrence. OBJECTIVES This study was designed to assess the attitudes of 3rd-year anesthesiology residents toward an independent one month-length clinical care course for patients with COVID-19. METHODS A closed self-administered questionnaire was developed to assess the attitudes of 3rd-year clinical anesthesiology residents. A self-administered closed questionnaire was developed. Cronbach's alpha was calculated to measure the reliability of the questionnaire; added with a factor analysis process. RESULTS All 19 clinical anesthesiology residents took part in the study, with a 100% response rate. Cronbach's alpha for the reliability of the questionnaire was 0.678. The eigenvalue for 8 factors was equal to 1; however, further assessment led us to 7 factors. CONCLUSIONS This one-month period could improve the competencies of the 3rd year clinical anesthesiology residents based on their viewpoints. Since the COVID-19 pandemic is ongoing health and social problem worldwide, 3rd-year anesthesiology residents could help the health system to recover health care delivery faults regarding manpower; a promising point for crisis preparedness in the COVID-19 pandemic. Besides, there were many constructive results for the clinical anesthesiology residents regarding their training and clinical service delivery.
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Affiliation(s)
- Ali Dabbagh
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sogol Asgari
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamal Fani
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nilofar Massoudi
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Moshari
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parissa Sezari
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Shokrollahi
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soodeh Tabashi
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ardeshir Tajbakhsh
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Vosoughian
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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207
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Clouston SAP, Natale G, Link BG. Socioeconomic inequalities in the spread of coronavirus-19 in the United States: A examination of the emergence of social inequalities. Soc Sci Med 2020; 268:113554. [PMID: 33308911 PMCID: PMC7703549 DOI: 10.1016/j.socscimed.2020.113554] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
Objectives To quantify the contribution variation in socioeconomic status in predicting the distribution of COVID-19 cases and deaths. Methods Analyses used incidence data on daily COVID + case counts from all counties from the initial wave of infections, merged with data from the U.S. census data to measure county-level SES and confounders. Multivariable analyses relied on survival analyses and Poisson regression to examine timing of county-level index cases and of COVID-19 incidence and mortality in infected counties to examine the spread and severity of COVID-19 while adjusting for adjusted for Black race, Hispanic ethnicity, age, gender, and urbanicity. Effect moderation by social distancing parameters was examined. Results Results indicate that higher SES was associated with earlier incidence of index cases, but that as social distancing took place inequalities in SES inverted so that growth in incidence was slower in higher SES counties, where case-fatality rates were lower. Conclusions This study is the first to date to show what happens when an opportunistic disease that could affect anyone meets the American system of inequality and is powerfully shaped by it. Socioeconomic inequalities in health emerge and change predictably as they infect communities. This study found that higher socioeconomic status was associated with earlier COVID-19 exposure. Lower socioeconomic status was associated with higher incidence and mortality rates. Despite being a new disease, social inequalities emerged alongside prevention implementation.
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Affiliation(s)
- Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA.
| | - Ginny Natale
- Program in Public Health, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA.
| | - Bruce G Link
- Department of Sociology and Public Policy, University of California at Riverside, Riverside, CA, USA.
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Arvind V, Kim JS, Cho BH, Geng E, Cho SK. Development of a machine learning algorithm to predict intubation among hospitalized patients with COVID-19. J Crit Care 2020; 62:25-30. [PMID: 33238219 PMCID: PMC7669246 DOI: 10.1016/j.jcrc.2020.10.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/17/2020] [Accepted: 10/27/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of this study is to develop a machine learning algorithm to predict future intubation among patients diagnosed or suspected with COVID-19. MATERIALS AND METHODS This is a retrospective cohort study of patients diagnosed or under investigation for COVID-19. A machine learning algorithm was trained to predict future presence of intubation based on prior vitals, laboratory, and demographic data. Model performance was compared to ROX index, a validated prognostic tool for prediction of mechanical ventilation. RESULTS 4087 patients admitted to five hospitals between February 2020 and April 2020 were included. 11.03% of patients were intubated. The machine learning model outperformed the ROX-index, demonstrating an area under the receiver characteristic curve (AUC) of 0.84 and 0.64, and area under the precision-recall curve (AUPRC) of 0.30 and 0.13, respectively. In the Kaplan-Meier analysis, patients alerted by the model were more likely to require intubation during their admission (p < 0.0001). CONCLUSION In patients diagnosed or under investigation for COVID-19, machine learning can be used to predict future risk of intubation based on clinical data which are routinely collected and available in clinical setting. Such an approach may facilitate identification of high-risk patients to assist in clinical care.
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Affiliation(s)
- Varun Arvind
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Jun S Kim
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Brian H Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Eric Geng
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Samuel K Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
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Ribeiro dos Santos Miggiolaro AF, da Silva Motta Junior J, Busatta Vaz de Paula C, Nagashima S, Alessandra Scaranello Malaquias M, Baena Carstens L, N Moreno-Amaral A, Pellegrino Baena C, de Noronha L. Covid-19 cytokine storm in pulmonary tissue: Anatomopathological and immunohistochemical findings. Respir Med Case Rep 2020; 31:101292. [PMID: 33200067 PMCID: PMC7658564 DOI: 10.1016/j.rmcr.2020.101292] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/21/2020] [Accepted: 11/07/2020] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic is a worldwide threat, and information on physiopathological aspects of the disease is limited. Despite efforts in searching treatment options, a better understanding of the SARS-CoV-2 pathways can contribute to managing severe cases. In this study, we aim to describe pathological and immunopathogenic findings of two different cases, both in the high-risk group. Post-mortem lung biopsies were analyzed by traditional and immunohistochemical methods. Tissue expression of innate and adaptive immune response biomarkers was tested. We observed a higher innate response in case 1 with an abundance of mast cells, scarce CD8+ lymphocytes, high expression of TNF-alpha, and almost absent adaptative immune response. In case 2, the adaptative immune response was present, with numerous CD8+ lymphocytes and higher levels of IL-4 and TGF-beta. Both cases converged to a prothrombotic state expressing high IL-6, followed by ICAM-1 expression and endotheliites leading to systemic inflammatory response syndrome. In conclusion, differences in age and comorbidities and immune response described here may be related to the SARS-CoV-2 delay in the adaptative immune response, evolution stage of diffuse alveolar damage, and progression for systemic inflammatory response syndrome.
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Affiliation(s)
- Anna Flavia Ribeiro dos Santos Miggiolaro
- Postgraduate Program of Health Sciences - School of Medicine, Hospital Marcelino Champagnat, Pontifícia Universidade Católica Do Paraná - PUCPR, R. Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, Brazil
| | - Jarbas da Silva Motta Junior
- Postgraduate Program of Health Sciences - School of Medicine, Hospital Marcelino Champagnat, Pontifícia Universidade Católica Do Paraná - PUCPR, R. Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, Brazil
| | - Caroline Busatta Vaz de Paula
- Postgraduate Program of Health Sciences - School of Medicine, Hospital Marcelino Champagnat, Pontifícia Universidade Católica Do Paraná - PUCPR, R. Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, Brazil
| | - Seigo Nagashima
- Postgraduate Program of Health Sciences - School of Medicine, Hospital Marcelino Champagnat, Pontifícia Universidade Católica Do Paraná - PUCPR, R. Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, Brazil
| | - Mineia Alessandra Scaranello Malaquias
- Postgraduate Program of Health Sciences - School of Medicine, Hospital Marcelino Champagnat, Pontifícia Universidade Católica Do Paraná - PUCPR, R. Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, Brazil
| | - Lucas Baena Carstens
- School of Medicine, Pontifícia Universidade Católica Do Paraná – PUCPR, R. Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, Brazil
| | - Andrea N Moreno-Amaral
- Laboratory Anemia and Immunology Research (LabAIRe) - School of Medicine, Pontifícia Universidade Católica do Paraná – PUCPR, R. Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, Brazil
| | - Cristina Pellegrino Baena
- Postgraduate Program of Health Sciences - School of Medicine, Center of Education, Research and Innovation –Hospital Marcelino Champagnat, Pontifícia Universidade Católica Do Paraná –R. Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, Brazil
| | - Lucia de Noronha
- Laboratory of Experimental Pathology - School of Medicine, Pontifícia Universidade Católica Do Paraná – PUCPR, R. Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, Brazil
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Ferrari D, Milic J, Tonelli R, Ghinelli F, Meschiari M, Volpi S, Faltoni M, Franceschi G, Iadisernia V, Yaacoub D, Ciusa G, Bacca E, Rogati C, Tutone M, Burastero G, Raimondi A, Menozzi M, Franceschini E, Cuomo G, Corradi L, Orlando G, Santoro A, Digaetano M, Puzzolante C, Carli F, Borghi V, Bedini A, Fantini R, Tabbì L, Castaniere I, Busani S, Clini E, Girardis M, Sarti M, Cossarizza A, Mussini C, Mandreoli F, Missier P, Guaraldi G. Machine learning in predicting respiratory failure in patients with COVID-19 pneumonia-Challenges, strengths, and opportunities in a global health emergency. PLoS One 2020; 15:e0239172. [PMID: 33180787 PMCID: PMC7660476 DOI: 10.1371/journal.pone.0239172] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/02/2020] [Indexed: 01/15/2023] Open
Abstract
AIMS The aim of this study was to estimate a 48 hour prediction of moderate to severe respiratory failure, requiring mechanical ventilation, in hospitalized patients with COVID-19 pneumonia. METHODS This was an observational prospective study that comprised consecutive patients with COVID-19 pneumonia admitted to hospital from 21 February to 6 April 2020. The patients' medical history, demographic, epidemiologic and clinical data were collected in an electronic patient chart. The dataset was used to train predictive models using an established machine learning framework leveraging a hybrid approach where clinical expertise is applied alongside a data-driven analysis. The study outcome was the onset of moderate to severe respiratory failure defined as PaO2/FiO2 ratio <150 mmHg in at least one of two consecutive arterial blood gas analyses in the following 48 hours. Shapley Additive exPlanations values were used to quantify the positive or negative impact of each variable included in each model on the predicted outcome. RESULTS A total of 198 patients contributed to generate 1068 usable observations which allowed to build 3 predictive models based respectively on 31-variables signs and symptoms, 39-variables laboratory biomarkers and 91-variables as a composition of the two. A fourth "boosted mixed model" included 20 variables was selected from the model 3, achieved the best predictive performance (AUC = 0.84) without worsening the FN rate. Its clinical performance was applied in a narrative case report as an example. CONCLUSION This study developed a machine model with 84% prediction accuracy, which is able to assist clinicians in decision making process and contribute to develop new analytics to improve care at high technology readiness levels.
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Affiliation(s)
- Davide Ferrari
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Physical, Computer and Mathematical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Tonelli
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Francesco Ghinelli
- Department of Physical, Computer and Mathematical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Sara Volpi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Matteo Faltoni
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Giacomo Franceschi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Vittorio Iadisernia
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Dina Yaacoub
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Giacomo Ciusa
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Erica Bacca
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Carlotta Rogati
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Marco Tutone
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Giulia Burastero
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Alessandro Raimondi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Gianluca Cuomo
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Luca Corradi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Gabriella Orlando
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Antonella Santoro
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Margherita Digaetano
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Cinzia Puzzolante
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Federica Carli
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Vanni Borghi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Andrea Bedini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Riccardo Fantini
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Luca Tabbì
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Ivana Castaniere
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Stefano Busani
- Department of Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Girardis
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Mario Sarti
- Clinical Microbiology, Ospedale Civile di Baggiovara, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Federica Mandreoli
- Department of Physical, Computer and Mathematical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Missier
- School of Computing, Newcastle University, Newcastle upon Tyne, United kingdom
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
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211
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Wei H, Jiang B, Behringer EC, Hofmeyr R, Myatra SN, Wong DT, Sullivan EPO, Hagberg CA, McGuire B, Baker PA, Li J, Pylypenko M, Ma W, Zuo M, Senturk NM, Klein U. Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations. Br J Anaesth 2020; 126:361-366. [PMID: 33256990 PMCID: PMC7836532 DOI: 10.1016/j.bja.2020.10.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Huafeng Wei
- Department of Anaesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
| | - Bailin Jiang
- Department of Anaesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Department of Anaesthesiology, Peking University People's Hospital, Beijing, China
| | - Elizabeth C Behringer
- Division of Cardiovascular Surgery & Critical Care, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Ross Hofmeyr
- Department of Anaesthesia & Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Sheila N Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - David T Wong
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ellen P O' Sullivan
- Department of Anaesthesia and Intensive Care Medicine, St James's Hospital, Dublin, Ireland
| | - Carin A Hagberg
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barry McGuire
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK
| | - Paul A Baker
- Department of Anaesthesia, Starship Children's Health, Auckland, New Zealand
| | - Jane Li
- Department of Anaesthesia and Pain Management, Central Coast Local Health District, NSW, Australia
| | - Maksym Pylypenko
- Department of Anesthesiology and Intensive Care, Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingzhang Zuo
- Department of Anaesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Nuzhet M Senturk
- Istanbul Universitesi, Istanbul Tıp Fakültesi, Anesteziyoloji AD, Istanbul, Turkey
| | - Uwe Klein
- Südharz-Klinikum Nordhausen, Nordhausen, Germany
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212
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Wozniak DR, Rubino A, Tan ALW, Jones NL, Webb ST, Vuylsteke A, Palas E, Quinnell TG, Smith IE, Davies MG. Positive role of continuous positive airway pressure for intensive care unit patients with severe hypoxaemic respiratory failure due to COVID-19 pneumonia: A single centre experience. J Intensive Care Soc 2020; 23:27-33. [PMID: 35194462 PMCID: PMC8855222 DOI: 10.1177/1751143720971543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objectives Continuous positive airway pressure (CPAP) may be a useful treatment strategy
for patients with severe COVID-19 pneumonia but its effectiveness in
preventing mechanical ventilation is unknown. We aimed to evaluate the
outcomes of COVID-19 patients treated with CPAP and determine predictors of
CPAP response. Design This was a retrospective observational cohort study. Setting The study took place in the intensive care unit (ICU) at Royal Papworth
Hospital (RPH) in Cambridge, UK. Patients We included all consecutive patients with confirmed COVID-19 pneumonia who
were transferred from neighbouring hospitals between 14th March and 6th May,
2020 for consideration of ventilatory support. Intervention We instituted the use of CPAP for all patients who arrived in RPH not
intubated and were not making satisfactory progress on supplemental oxygen
alone. Measurements and main results Of 33 self-ventilating patients included in this study, 22 (66.7%) were male
and the mean age was 54 ± 13.23 patients received CPAP. They were more
hypoxaemic than those treated with oxygen alone
(PaO2/FiO2 ratio; 84.3 ± 19.0 vs
170.0 ± 46.0 mmHg, p = 0.001). There was a significant improvement in
PaO2/FiO2 ratio 1–2 hours after CPAP initiation
(167.4 ± 49.0 from 84.3 ± 19.0 mmHg, p = 0.001). 14 (61%) patients responded
to CPAP and 9 required intubation. There was no difference between these two
groups in terms of the severity of baseline hypoxaemia
(PaO2/FiO2 ratio; 84.5 ± 16.0 vs 83.9 ± 23.0 mmHg,
p = 0.94) but CPAP responders had significantly lower C-reactive protein
(CRP) (176 ± 83 vs 274 ± 63 mg/L, p = 0.007), interleukin-6 (IL-6) (30 ± 47
vs 139 ± 148 pg/mL, p = 0.037), and D-dimer (321 ± 267 vs 941 + 1990 ng/mL,
p = 0.003). CT pulmonary angiogram was performed in 6 out of 9 intubated
patients and demonstrated pulmonary emboli in 5 of them. All patients were
discharged from ICU and there were no fatalities. Conclusions In this cohort, CPAP was an effective treatment modality to improve
hypoxaemia and prevent invasive ventilation in a substantial proportion of
patients with severe respiratory failure. Accepting the small sample size,
we also found raised biomarkers of inflammation (CRP and IL-6) and
coagulopathy (D-Dimer) to be more useful predictors of CPAP responsiveness
than the severity of hypoxaemia, and could help to guide intubation
decisions in this clinical setting.
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Affiliation(s)
- Dariusz R Wozniak
- Respiratory Support and Sleep Centre, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Antonio Rubino
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Aileen LW Tan
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicola L Jones
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Stephen T Webb
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Alain Vuylsteke
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Earl Palas
- Respiratory Support and Sleep Centre, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Timothy G Quinnell
- Respiratory Support and Sleep Centre, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Ian E Smith
- Respiratory Support and Sleep Centre, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Michael G Davies
- Respiratory Support and Sleep Centre, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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213
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Lari A, Alherz M, Nouri A, Botras L, Taqi S. Caution against precaution: A case report on silent hypoxia in COVID-19. Ann Med Surg (Lond) 2020; 60:301-303. [PMID: 33169089 PMCID: PMC7640922 DOI: 10.1016/j.amsu.2020.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Silent hypoxia is an entity that has been described in patients diagnosed with COVID-19. It is typically described as objective hypoxia in the absence of proportional respiratory distress. The physiological basis for this phenomenon is controversial, and its prognostic value is unclear. We present a case below, of a 66-year-old female presenting with severe hypoxia that was managed without mechanical ventilation. Presentation of case A 66 year old female with multiple comorbidities initially presented with a cough, fever and an oxygen saturation of 70% on room air in the absence of respiratory distress or altered mentation. She subsequently tested positive for COVID-19 and was admitted to the intensive care unit; received oxygen via high flow nasal cannula and continuous positive pressure mask. The patient remained in the intensive care unit for 40 days under close observation and exhibited multiple episodes of silent hypoxia on weaning oxygen. She was discharged on room air with an oxygen saturation >90% after 56 days. The patient was not intubated during her stay. Discussion and conclusion Clinicians face a clinical dilemma on whether to intubate a “silently hypoxemic” patient, who displays hypoxia out of proportion to clinical examination. The decision is confounded by a lack of clear evidence on whether the benefits of precautionary intubation outweighs the risks, especially in the current COVID-19 pandemic. A recent paradigm shift that recommends delaying intubation further displays the need for clearer analysis of the situation. Our case demonstrates a favorable outcome of the latter approach, yet emphasizes a case-by-case approach until clearer recommendations are available. COVID-19 may cause severe hypoxia in the absence of respiratory distress. The recommendations for intubating silently hypoxemic patients are unclear. Pre-emptive intubation versus close observation is currently debatable. The benefit to risk ratio of intubation should be considered carefully when determining management.
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Affiliation(s)
- Ali Lari
- Intensive Care Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait
| | - Mohammad Alherz
- Intensive Care Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait
| | - Abdullah Nouri
- Intensive Care Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait
| | - Lotfi Botras
- Intensive Care Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait
| | - Salah Taqi
- Intensive Care Department, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait
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214
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Saracoglu KT, Saracoglu A, Demirhan R. Airway management strategies for the Covid 19 patients: A brief narrative review. J Clin Anesth 2020; 66:109954. [PMID: 32599509 PMCID: PMC7262502 DOI: 10.1016/j.jclinane.2020.109954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Kemal T Saracoglu
- Department of Anesthesiology and Intensive Care, Health Sciences University Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
| | - Ayten Saracoglu
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Recep Demirhan
- Department of Thoracic Surgery, Health Sciences University Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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215
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Jallali N, Hunter JE, Henry FP, Wood SH, Hogben K, Almufti R, Hadjiminas D, Dunne J, Thiruchelvam PT, Leff DR. The feasibility and safety of immediate breast reconstruction in the COVID-19 era. J Plast Reconstr Aesthet Surg 2020; 73:1917-1923. [PMID: 32948493 PMCID: PMC7443097 DOI: 10.1016/j.bjps.2020.08.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/18/2020] [Indexed: 12/30/2022]
Abstract
The coronavirus disease-2019 pandemic has had a significant impact on the delivery of surgical services, particularly reconstructive surgery. This article examines the current evidence to assess the feasibility of recommencing immediate breast reconstruction services during the pandemic and highlights considerations required to ensure patient safety.
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Affiliation(s)
- Navid Jallali
- Department of Plastic and Reconstructive Surgery, Charing Cross Hospital Campus, Imperial College Healthcare NHS Trust, Fulham Palace Rd, London W6 8RF, UK.
| | - Judith E. Hunter
- Department of Plastic and Reconstructive Surgery, Charing Cross Hospital Campus, Imperial College Healthcare NHS Trust, Fulham Palace Rd, London W6 8RF, UK
| | - Francis P. Henry
- Department of Plastic and Reconstructive Surgery, Charing Cross Hospital Campus, Imperial College Healthcare NHS Trust, Fulham Palace Rd, London W6 8RF, UK
| | - Simon H. Wood
- Department of Plastic and Reconstructive Surgery, Charing Cross Hospital Campus, Imperial College Healthcare NHS Trust, Fulham Palace Rd, London W6 8RF, UK
| | - Katy Hogben
- Department of Breast Surgery, Charing Cross Hospital Campus, Imperial College Healthcare NHS Trust, London, UK
| | - Ragheed Almufti
- Department of Breast Surgery, Charing Cross Hospital Campus, Imperial College Healthcare NHS Trust, London, UK
| | - Dimitri Hadjiminas
- Department of Breast Surgery, Charing Cross Hospital Campus, Imperial College Healthcare NHS Trust, London, UK
| | - Jonathan Dunne
- Department of Plastic and Reconstructive Surgery, Charing Cross Hospital Campus, Imperial College Healthcare NHS Trust, Fulham Palace Rd, London W6 8RF, UK
| | - Paul T.R. Thiruchelvam
- Department of Breast Surgery, Charing Cross Hospital Campus, Imperial College Healthcare NHS Trust, London, UK
| | - Daniel R. Leff
- Department of Breast Surgery, Charing Cross Hospital Campus, Imperial College Healthcare NHS Trust, London, UK,Department of Surgery and Cancer, Imperial College London, UK
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216
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Deitrick K, Adams J, Davis J. Emergency Nursing Care of Patients With Novel Coronavirus Disease 2019. J Emerg Nurs 2020; 46:748-759. [PMID: 32972766 PMCID: PMC7368907 DOI: 10.1016/j.jen.2020.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022]
Abstract
Novel coronavirus disease 2019 is the disease caused by the novel coronavirus originally from Wuhan, China. Its pathophysiology is poorly understood, but it is known to be contagious and deadly. Multiple symptoms and complications from the disease have been described, with the most common complaints being respiratory. Nursing care of patients with novel coronavirus disease 2019 is largely supportive, but it should include a strong focus on mitigating the spread of infection to staff, other patients, and the community.
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217
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Sahoo S, Hansda U, Mohanty CR, Mishra N. Modified aerosol box for endotracheal intubation: A safeguard for the frontline healthcare workers during COVID pandemic. J Family Med Prim Care 2020; 9:5802-5803. [PMID: 33532441 PMCID: PMC7842474 DOI: 10.4103/jfmpc.jfmpc_1235_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/08/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- Sangeeta Sahoo
- Department of Trauma and Emergency, AIIMS Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, AIIMS Bhubaneswar, Odisha, India
| | | | - Nitasha Mishra
- Department of Anaesthesiology and Intensive Care, AIIMS Bhubaneswar, Odisha, India
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218
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Majid A, Ayala A, Uribe JP, Abdelghani R, Patel P, Chee A, Parikh M, Kheir F. Protective Strategies in a Simulated Model When Performing Percutaneous Tracheostomies in the COVID-19 Era. Ann Am Thorac Soc 2020; 17:1486-1488. [PMID: 32609553 PMCID: PMC7640727 DOI: 10.1513/annalsats.202004-372rl] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Adnan Majid
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Alvaro Ayala
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | | | | | - Priya Patel
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Alex Chee
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Mihir Parikh
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Fayez Kheir
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
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219
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Soffin EM, Reisener MJ, Sama AA, Beckman JD, Liguori GA, Lebl DR, Girardi FP, Cammisa FP, Hughes AP. Essential Spine Surgery During the COVID-19 Pandemic: A Comprehensive Framework for Clinical Practice from a Specialty Orthopedic Hospital in New York City. HSS J 2020; 16:29-35. [PMID: 32929320 PMCID: PMC7482371 DOI: 10.1007/s11420-020-09786-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Ellen M. Soffin
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Marie-Jacqueline Reisener
- Department of Orthopedic Surgery, Spine Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Andrew A. Sama
- Department of Orthopedic Surgery, Spine Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - James D. Beckman
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Gregory A. Liguori
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Darren R. Lebl
- Department of Orthopedic Surgery, Spine Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Federico P. Girardi
- Department of Orthopedic Surgery, Spine Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Frank P. Cammisa
- Department of Orthopedic Surgery, Spine Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Alexander P. Hughes
- Department of Orthopedic Surgery, Spine Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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220
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Mehta CK, Malaisrie SC, Budd AN, Okita Y, Matsuda H, Fleischman F, Ueda Y, Bavaria JE, Moon MR. Triage and management of aortic emergencies during the coronavirus disease 2019 (COVID-19) pandemic: A consensus document supported by the American Association for Thoracic Surgery (AATS) and Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS). Asian Cardiovasc Thorac Ann 2020:218492320974505. [PMID: 33124438 DOI: 10.1177/0218492320974505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Ashley N Budd
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Fernando Fleischman
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Yuichi Ueda
- Department of Cardiovascular Surgery, Nara Prefecture General Medical Center, Nara Prefectural Hospital Organization, Nara, Japan
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo
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221
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Mehta CK, Malaisrie SC, Budd AN, Okita Y, Matsuda H, Fleischman F, Ueda Y, Bavaria JE, Moon MR. Triage and management of aortic emergencies during the coronavirus disease 2019 (COVID-19) pandemic: A consensus document supported by the American Association for Thoracic Surgery (AATS) and Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS). J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)31326-X. [PMID: 33139061 PMCID: PMC7597972 DOI: 10.1016/j.jtcvs.2020.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Christopher K Mehta
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Ashley N Budd
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Fernando Fleischman
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Yuichi Ueda
- Department of Cardiovascular Surgery, Nara Prefecture General Medical Center, Nara Prefectural Hospital Organization, Nara, Japan
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo
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222
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Botti C, Lusetti F, Neri T, Peroni S, Castellucci A, Salsi P, Ghidini A. Comparison of percutaneous dilatational tracheotomy versus open surgical technique in severe COVID-19: Complication rates, relative risks and benefits. Auris Nasus Larynx 2020; 48:511-517. [PMID: 33143935 PMCID: PMC7598348 DOI: 10.1016/j.anl.2020.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/29/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023]
Abstract
Objective Patients with acute respiratory failure due to COVID-19 have a high likelihood of needing prolonged intubation and may subsequently require tracheotomy. Usually, the choice of technique (percutaneous dilatational tracheotomy [PDT] versus open surgical tracheotomy [OST]) depends on the preference of surgeons and patient-related factors. In case of COVID-19, airborne spread of viral particles and limited time of apnea must be considered in the choice of the safest technique. The aim of this study is to compare the complication rates and offer an assessment of relative risks and benefits of PDT versus OST in patients with severe COVID-19. Methods We performed a retrospective study considering 47 consecutive patients affected by severe acute respiratory distress syndrome due to SARS-CoV-2 infection, needing invasive mechanical ventilation and subsequent tracheostomy. This study was performed at the Intensive Care Unit of our tertiary referral center. Complication rates were analyzed. Results Seventeen patients underwent PDT and 30 patients were submitted to OST. Twenty-six patients (55.3%) had post-operative complications (local infection, hemorrhage, subcutaneous emphysema) with no significant difference between PDT and OST. Conclusion PDT and OST are characterized by similar postoperative complication rates in severe COVID-19 patients. These findings suggest that OST might be preferred if expert ENT surgeons are available, as PDT could result in longer apnea and exposure to generated aerosol. However, authors recommend considering either OST or PDT at the discretion of the medical staff involved, according to the personal experience of the operators performing the procedure.
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Affiliation(s)
- Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Francesca Lusetti
- Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Tommaso Neri
- Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Peroni
- Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Castellucci
- Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Pierpaolo Salsi
- Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy
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223
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Bajwa SJS, Kurdi M, Malhotra N. Combating the COVID-19 battle with personal protective equipment (PPE) armamentarium. J Anaesthesiol Clin Pharmacol 2020; 36:S133-S136. [PMID: 33100663 PMCID: PMC7573982 DOI: 10.4103/joacp.joacp_324_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
| | - Madhuri Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Naveen Malhotra
- Anaesthesiology and In Charge Pain Management Centre, Pt BDS PGIMS Rohtak, Haryana, India
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224
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Qadri SK, Ng P, Toh TSW, Loh SW, Tan HL, Lin CB, Fan E, Lee JH. Critically Ill Patients with COVID-19: A Narrative Review on Prone Position. Pulm Ther 2020; 6:233-246. [PMID: 33085052 PMCID: PMC7575418 DOI: 10.1007/s41030-020-00135-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/26/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Prone position is known to improve mortality in patients with acute respiratory distress syndrome (ARDS). The impact of prone position in critically ill patients with coronavirus disease of 2019 (COVID-19) remains to be determined. In this review, we describe the mechanisms of action of prone position, systematically appraise the current experience of prone position in COVID-19 patients, and highlight unique considerations for prone position practices during this pandemic. METHODS For our systematic review, we searched PubMed, Scopus and EMBASE from January 1, 2020, to April 16, 2020. After completion of our search, we became aware of four relevant publications during article preparation that were published in May and June 2020, and these studies were reviewed for eligibility and inclusion. We included all studies reporting clinical characteristics of patients admitted to the hospital with COVID-19 disease who received respiratory support with high-flow nasal cannula, or noninvasive or mechanical ventilation and reported the use of prone position. The full text of eligible articles was reviewed, and data regarding study design, patient characteristics, interventions and outcomes were extracted. RESULTS We found seven studies (total 1899 patients) describing prone position in COVID-19. Prone position has been increasingly used in non-intubated patients with COVID-19; studies show high tolerance and improvement in oxygenation and lung recruitment. Published studies lacked a description of important clinical outcomes (e.g., mortality, duration of mechanical ventilation). CONCLUSIONS Based on the findings of our review, we recommend prone position in patients with moderate to severe COVID-19 ARDS as per existing guidelines. A trial of prone position should be considered for non-intubated COVID-19 patients with hypoxemic respiratory failure, as long as this does not result in a delay in intubation.
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Affiliation(s)
- Syeda Kashfi Qadri
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. .,Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Priscilla Ng
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Theresa Shu Wen Toh
- Department of Pediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Sin Wee Loh
- Department of Pediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Herng Lee Tan
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Cheryl Bin Lin
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, 204 Victoria Street, 4th Floor, Room 411, Toronto, ON, M5B1T8, Canada
| | - Jan Hau Lee
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore
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Volatile Isoflurane in Critically Ill Coronavirus Disease 2019 Patients-A Case Series and Systematic Review. Crit Care Explor 2020; 2:e0256. [PMID: 33134946 PMCID: PMC7587445 DOI: 10.1097/cce.0000000000000256] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objectives: The ongoing coronavirus pandemic is challenging, especially in severely affected patients who require intubation and sedation. Although the potential benefits of sedation with volatile anesthetics in coronavirus disease 2019 patients are currently being discussed, the use of isoflurane in patients with coronavirus disease 2019–induced acute respiratory distress syndrome has not yet been reported. Design: We performed a retrospective analysis of critically ill patients with hypoxemic respiratory failure requiring mechanical ventilation. Setting: The study was conducted with patients admitted between April 4 and May 15, 2020 to our ICU. Patients: We included five patients who were previously diagnosed with severe acute respiratory syndrome coronavirus 2 infection. Intervention: Even with high doses of several IV sedatives, the targeted level of sedation could not be achieved. Therefore, the sedation regimen was switched to inhalational isoflurane. Clinical data were recorded using a patient data management system. We recorded demographical data, laboratory results, ventilation variables, sedative dosages, sedation level, prone positioning, duration of volatile sedation and outcomes. Measurements & Main Results: Mean age (four men, one women) was 53.0 (± 12.7) years. The mean duration of isoflurane sedation was 103.2 (± 66.2) hours. Our data demonstrate a substantial improvement in the oxygenation ratio when using isoflurane sedation. Deep sedation as assessed by the Richmond Agitation and Sedation Scale was rapidly and closely controlled in all patients, and the subsequent discontinuation of IV sedation was possible within the first 30 minutes. No adverse events were detected. Conclusions: Our findings demonstrate the feasibility of isoflurane sedation in five patients suffering from severe coronavirus disease 2019 infection. Volatile isoflurane was able to achieve the required deep sedation and reduced the need for IV sedation.
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Castro de Oliveira BM, de Souza RLP. Advantages of Delayed Sequence Intubation in Selected Patients With COVID-19. Anesth Analg 2020; 131:e133-e134. [PMID: 32412923 DOI: 10.1213/ane.0000000000004977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Renato Lucas Passos de Souza
- Departmento de Anestesiologia, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
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227
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Determination of Length of Time for "Postaerosol Pause" for Patients Under Investigation or Positive for COVID-19. Anesth Analg 2020; 131:e94-e96. [PMID: 32345854 PMCID: PMC7202114 DOI: 10.1213/ane.0000000000004921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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228
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Cobre ADF, Böger B, Vilhena RDO, Fachi MM, dos Santos JMMF, Tonin FS. A multivariate analysis of risk factors associated with death by Covid-19 in the USA, Italy, Spain, and Germany. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2020; 30:1189-1195. [PMID: 33101840 PMCID: PMC7572154 DOI: 10.1007/s10389-020-01397-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022]
Abstract
Aim Our aim was to investigate the risk factors associated with death from COVID-19 in four countries: The USA, Italy, Spain, and Germany. Subject and methods We used data from the Institute for Health Metrics and Evaluation with projection information from January–August 2020. A multivariate analysis of logistic regression was performed. The following factors were analyzed (per day): number of beds needed for the hospital services, number of intensive care units (ICU) beds required, number of ventilation devices, number of both hospital and ICU admissions due to COVID-19. Nagelkerke’s R2 coefficient of determination was used to evaluate the model’s predictive ability. The quality of the model’s fit was assessed by the Hosmer–Lemeshow and the chi-square tests. Results Among the evaluated countries, Italy presented greater need for ICU beds/day (≤ 98; OR = 2315.122; CI 95% [334.767–16,503.502]; p < 0.001) and daily ventilation devices (≤ 118; OR = 1784.168; CI 95% [250.217–12,721.995]; p < 0.001). It is expected that both Italy and Spain have a higher ICU admission rate due to COVID-19 (n = 14/day). Spain will need more beds/day (≤ 357; OR = 146.838; CI 95% [113.242–190.402]; p < 0.001) and probably will have a higher number of daily hospital admissions (n = 48/day). All the above-mentioned factors have an important impact on patients’ mortality due to COVID-19 in all four countries. Conclusions Further investments in hospitals’ infrastructure, as well as the development of innovative devices for patient’s ventilation, are paramount to fight the pandemic in the USA, Italy, Spain, and Germany.
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Affiliation(s)
| | - Beatriz Böger
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil
| | - Raquel de Oliveira Vilhena
- Department of Pharmacy, Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Av. Lothário Meissner, 632, Paraná, Curitiba 80210-170 Brazil
| | - Mariana Millan Fachi
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil
| | | | - Fernanda Stumpf Tonin
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil
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Ip V, Özelsel TJP, Sondekoppam RV, Tsui BCH. COVID-19 Pandemic: Greater Protection for Health Care Providers in the Hospital "Hot Zones"? Anesth Analg 2020; 131:e37-e38. [PMID: 33035019 PMCID: PMC7179064 DOI: 10.1213/ane.0000000000004880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Vivian Ip
- Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada Department of Anesthesia, University of Iowa Hospital, Iowa City, Iowa Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
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Shrestha A, Shrestha A, Sonnenberg T, Shrestha R. COVID-19 Emergency Department Protocols: Experience of Protocol Implementation Through in-situ Simulation. Open Access Emerg Med 2020; 12:293-303. [PMID: 33116965 PMCID: PMC7584514 DOI: 10.2147/oaem.s266702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/07/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE During the outbreak of Coronavirus disease of 2019 (COVID-19), the preparedness of emergency departments (EDs) for triaging of the patients and safety of staff is of utmost importance. The aim of our study was to develop and implement COVID-19 ED triage and protected intubation protocols for COVID-19 patients with in-situ simulation (ISS) training. The latent safety threats (LST) detection also served as a platform to test new system amendments and refine the protocols and workflows with infection control issues. We also explored the effectiveness of this approach based on Kirkpatrick's model of evaluating training outcomes. PARTICIPANTS AND METHODS The protocols and simulation scenarios were developed and validated. A total of 22 triage and 13 intubation simulation sessions were conducted in the ED with multidisciplinary staff (physicians=18, nurses=20) during a period of four months. Each simulation was followed by a debriefing session to discuss the team performance. Pre- and post-simulation performances were compared. LSTs were identified and remediated. An online voluntary feedback was collected from the participants to explore the opinion about the ISS sessions and confidence level using a 5-point Likert scale. RESULTS There was a significant improvement in triage knowledge score after ISS [5.5/10 (IQR 4-6) versus 8.5/10 (IQR 8-9), p<0.001]. There was a desirable proportion of correct responses (>75%) following the ISS for triage case scenarios. A pre-designed checklist was used during protective intubation simulations. Some important LSTs were missing medications, lack of mechanism to deliver patient samples to lab and faulty airway maneuvers. The participants' feedback on ISS showed increased skills and confidence level on triaging and protected intubation (p<0.001). They found the protocols easy to follow and they recommended for more such modules in future. CONCLUSION ISS is a quick and efficient tool to implement the ED protocols for preparation of outbreaks like COVID-19. It helps the ED staff to triage and manage the airway safely. We recommend such an approach to train the multidisciplinary staff and continue to improve ourselves through ISS addressing the changing nature of the pandemic.
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Affiliation(s)
- Anmol Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Taylor Sonnenberg
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Roshana Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
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Zheng H, Li S, Sun R, Yang H, Chi X, Chen M, Xu L, Deng Q, Li X, Yu J, Wan L, Luo A. Clinical experience with emergency endotracheal intubation in COVID-19 patients in the intensive care units: a single-centered, retrospective, descriptive study. Am J Transl Res 2020; 12:6655-6664. [PMID: 33194062 PMCID: PMC7653591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/08/2020] [Indexed: 06/11/2023]
Abstract
Few studies have reported the implications of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units (ICUs). Therefore, this study aimed to summarize the outcomes of COVID-19 patients in the ICU following endotracheal intubation and provide a clinical reference for the high-risk procedure. From February 1 to February 18, 2020, we enrolled 59 critically ill COVID-19 patients who received emergency endotracheal intubation in the ICUs of Tongji Hospital. We recorded demographic information, laboratory parameters, comorbidities, changes in vital signs pre- and post-intubation, the airway grade, intubation success rate using three types of laryngoscopes, and the experience of intubators. Follow-up evaluations were performed for all proceduralists to monitor nosocomial infections. The majority of the patients requiring intubation were elderly and had at least one comorbidity. Of the patients, 86.4% developed hypoxia before intubation. The first and second attempts of successful endotracheal intubation with the Macintosh laryngoscope (70.0% and 83.3%), Airtraq videolaryngoscope (93.5% and 80%), and UE videolaryngoscope (88.9% and 100%) were performed. Notably, SpO2 <93% and hypotension were observed 3 min after intubation in 32.2% and 39% patients, respectively. With the proper use of personal protective equipment (PPE), no nosocomial infections were observed among proceduralists. Full PPE increased the occurrence of fogging on goggles and myopia glasses. Overall, a higher success rate of intubation was achieved by senior intubators using a videolaryngoscope. Although inconvenient, appropriate ensembles of PPE could prevent nosocomial infections.
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Affiliation(s)
- Hongbo Zheng
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Shiyong Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Rao Sun
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Hui Yang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Xiaohui Chi
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Mingbing Chen
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Li Xu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Qingzhu Deng
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Xinhua Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Jie Yu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Li Wan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Ailin Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
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Montrief T, Ramzy M, Long B, Gottlieb M, Hercz D. COVID-19 respiratory support in the emergency department setting. Am J Emerg Med 2020; 38:2160-2168. [PMID: 33046288 PMCID: PMC7413866 DOI: 10.1016/j.ajem.2020.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/26/2020] [Accepted: 08/01/2020] [Indexed: 01/25/2023] Open
Abstract
Introduction Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19), may result in severe complications, multiorgan dysfunction, acute respiratory failure, and death. SARS-CoV-2 is highly contagious and places healthcare workers at significant risk, especially during aerosol-generating procedures, including airway management. Objective This narrative review outlines the underlying respiratory pathophysiology of patients with COVID-19 and discusses approaches to airway management in the emergency department (ED) based on current literature. Discussion Patients presenting with SARS-CoV-2 infection are at high risk for acute respiratory failure requiring airway management. Among hospitalized patients, 10–20% require intensive care unit admission, and 3–10% require intubation and mechanical ventilation. While providing respiratory support for these patients, proper infection control measures, including adherence to personal protective equipment policies, are necessary to prevent nosocomial transmission to healthcare workers. A structured approach to respiratory failure in these patients includes the use of exogenous oxygen via nasal cannula or non-rebreather, as well as titrated high-flow nasal cannula and non-invasive ventilation. This review offers several guiding principles and resources designed to be adapted in conjunction with local workplace policies for patients requiring respiratory support. Conclusions While the fundamental principles of acute respiratory failure management are similar between COVID-19 and non-COVID-19 patients, there are some notable differences, including a focus on provider safety. This review provides an approach to airway management and respiratory support in the patient with COVID-19.
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Affiliation(s)
- Tim Montrief
- Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, United States of America
| | - Mark Ramzy
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, United States of America
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, United States of America.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Dan Hercz
- Department of Emergency Medicine, Jackson Memorial Hospital, Miami, FL, United States of America
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233
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Aksu C, Cesur S, Kuş A, Toker K. General Anesthesia Practices During the COVID-19 Pandemic in Turkey: A Cohort Study With a National Survey. Cureus 2020; 12:e10910. [PMID: 33194477 PMCID: PMC7657308 DOI: 10.7759/cureus.10910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction This study aimed to examine the anesthesia practices applied to the cases during the pandemic, to analyze the rate of the precautions taken in emergency/elective operations in non-COVID patients, what precautions were taken, what resources the clinics had, and the patient management in the perioperative period by organizing a survey among anesthesiologist in Turkey. Methods After obtaining approval from the Turkish Ministry of Health (2020-05-04T09_30_03) and the local ethics committee (GOKAEK-2020/10.09), a survey consisting of 21 questions was formed over the online survey inquiry (surveymonkey.com). The survey was conducted in Turkish. Results The survey aimed at reaching the anesthesiologists, who were Turkish Anesthesiology and Reanimation Society (TARD) members, by e-mail, and it was seen that 120 people out of approximately 2700 members who had received our e-mail participated in the survey. After the first case was reported in our country, it was understood that 62.1% of the participants stopped accepting elective cases in their institutions. The anesthesia method preferred in this period was general anesthesia by 47.6%, regional anesthesia by 52.1%, and sedation by 0.3%. The arrival time of coronavirus disease COVID-19 tests (PCR and/or rapid diagnostic kits showing antibodies) to the hospital was questioned; seven people (5.83%) stated that tests were not performed at their hospitals. It was observed that tests arrived and were applied at the hospitals of the remaining participants in an average of 2.7 ± 1.6 weeks. It was determined that 59.32% of the participants avoided positive pressure ventilation after induction, 5.98% of the intubation on the patients were performed by anesthesia technicians, 66.67% by anesthesiologists, 25.64% by senior resident doctors with at least two years of experience, and 1.71% by junior anesthesia assistants with less than two years of experience. The use of personal protective equipment (PPE) is applied by 95% of the participants. 22.69% of the participants stated that they preferred to use supraglottic airway (SGA) devices during this period. While 45.06% of the participants stated that they provided oxygen support to the patient with the mask belonging to the circuit after extubation, 14.8% preferred the nasal cannula, and 33.1% used an oxygen mask. Our results showed that 90% of additional precautions were taken in our country's clinics, and 95% of PPE was used. Also, the use of video laryngoscope (VL) was 75% in this period. Finally, it was found that 50.85% of the patients were taken to the recovery unit after being extubated, and 49.15% were sent directly to the service. Conclusion We can reveal that each clinic made arrangements according to its own conditions. We think that plans should be made to standardize clinical facilities and algorithms throughout the country. Apart from technological and financial facilities, we believe that the continuity of the training organized by national and international associations should be ensured so that anesthesiologists' knowledge, skills, and experience who manage this process can remain at the highest level.
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Affiliation(s)
- Can Aksu
- Anesthesiology, Kocaeli University, Kocaeli, TUR
| | - Sevim Cesur
- Anesthesiology, Kocaeli University School of Medicine, Kocaeli, TUR
| | - Alparslan Kuş
- Anesthesiology and Reanimation, Kocaeli University, Kocaeli, TUR
| | - Kamil Toker
- Anesthesiology and Reanimation, Istinye University, Istanbul, TUR
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Arshid MA, Mumtaz M, Nazir R. Unforeseen challenges to global health system, in particular context to COVID-19 pandemic and health care personnel. ARAB JOURNAL OF BASIC AND APPLIED SCIENCES 2020. [DOI: 10.1080/25765299.2020.1824395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Muhammad Awais Arshid
- Department of Biological & Biomedical Sciences, Faculty of Health Sciences in Medical College of Aga Khan University, Karachi, Pakistan
| | - Maha Mumtaz
- RAK College of Medical Sciences, Ras al Khaimah (RAK) Medical and Health Sciences University, Al Qusaidat, Ras Al Khaimah, United Arab Emirates
| | - Rashid Nazir
- Department of Environmental Sciences, COMSATS University Islamabad (CUI) – Abbottabad Campus, Abbottabad, KPK, Pakistan
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Botti C, Lusetti F, Peroni S, Neri T, Castellucci A, Salsi P, Ghidini A. The Role of Tracheotomy and Timing of Weaning and Decannulation in Patients Affected by Severe COVID-19. EAR, NOSE & THROAT JOURNAL 2020; 100:116S-119S. [PMID: 33035129 PMCID: PMC7548540 DOI: 10.1177/0145561320965196] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: Patients with acute respiratory failure due to coronavirus disease 2019
(COVID-19) have a high likelihood of needing prolonged intubation and may
subsequently require tracheotomy. Indications and timing for performing
tracheotomy in patients affected by severe COVID-19 pneumonia are still
elusive. The aim of this study is to analyze the role of tracheotomy in the
context of this pandemic. Moreover, we report the timing of the procedure
and the time needed to complete weaning and decannulation in our center. Methods: This retrospective, observational cohort study included adults (≥18 years)
with severe COVID-19 pneumonia who were admitted to the intensive care unit
(ICU) of the tertiary care center of Reggio Emilia (Italy). All patients
underwent orotracheal intubation with invasive mechanical ventilation,
followed by percutaneous or open surgical tracheotomy. Indications, timing
of the procedure, and time needed to complete weaning and decannulation were
reported. Results: Forty-four patients were included in the analysis. Median time from
orotracheal intubation to surgery was 7 (range 2-17) days. Fifteen (34.1%)
patients died during the follow-up period (median 22 days, range 8-68) after
the intubation. Weaning from the ventilator was first attempted on median
25th day (range 13-43) from orotracheal intubation. A median of 35 (range
18-79) days was required to complete weaning. Median duration of ICU stay
was 22 (range 10-67) days. Mean decannulation time was 36 (range 10-77) days
from surgery. Conclusions: Since it is not possible to establish an optimal timing for performing
tracheotomy, decision-making should be made on case-by-case basis. It should
be adapted to the context of the pandemic, taking into account the
availability of intensive care resources, potential risks for health care
workers, and benefits for the individual patient.
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Affiliation(s)
- Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, 208968University of Modena and Reggio Emilia, Reggio Emilia, Italy.,Otolaryngology Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | | | - Stefano Peroni
- Intensive Care Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | - Tommaso Neri
- Intensive Care Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | | | - Pierpaolo Salsi
- Intensive Care Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
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Channick CL, Garrison G, Huie TJ, Narewski E, Caplan-Shaw C, Cho J, Rafeq S, Alalawi R, Alashram R, Bailey KL, Carmona EM, Habib N, Kapolka R, Krishnan A, Lammi MR, Peck T, Pennington KM, Rali P, Small BL, Swenson C, Witkin A, Hayes MM. ATS Core Curriculum 2020. Adult Pulmonary Medicine. ATS Sch 2020; 1:416-435. [PMID: 33870311 PMCID: PMC8015759 DOI: 10.34197/ats-scholar.2020-0016re] [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: 02/06/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023] Open
Abstract
The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine in a 3- to 4-year recurring cycle of topics. The topics of the 2020 Pulmonary Core Curriculum include pulmonary vascular disease (submassive pulmonary embolism, chronic thromboembolic pulmonary hypertension, and pulmonary hypertension) and pulmonary infections (community-acquired pneumonia, pulmonary nontuberculous mycobacteria, opportunistic infections in immunocompromised hosts, and coronavirus disease [COVID-19]).
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Affiliation(s)
- Colleen L. Channick
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Garth Garrison
- Division of Pulmonary Disease and Critical Care Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Tristan J. Huie
- Division of Pulmonary Sciences and Critical Care Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Erin Narewski
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Caralee Caplan-Shaw
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, New York University, New York, New York
| | - Josalyn Cho
- Division of Pulmonary, Critical Care, and Occupational Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Samaan Rafeq
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, New York University, New York, New York
| | - Raed Alalawi
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Arizona, Phoenix, Phoenix, Arizona
| | - Rami Alashram
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Kristina L. Bailey
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska
| | - Eva M. Carmona
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Naomi Habib
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Arizona, Phoenix, Phoenix, Arizona
| | - Rebecca Kapolka
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, Georgia
| | - Amita Krishnan
- Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University Health Sciences Center, Louisiana State University, New Orleans, Louisiana
| | - Matthew R. Lammi
- Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University Health Sciences Center, Louisiana State University, New Orleans, Louisiana
| | - Tyler Peck
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Kelly M. Pennington
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Bronwyn L. Small
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska
| | - Colin Swenson
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, Georgia
| | - Alison Witkin
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Margaret M. Hayes
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center–Harvard Medical School, Harvard University, Boston, Massachusetts
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Abdelzaher H, Saleh BM, Ismail HA, Hafiz M, Gabal MA, Mahmoud M, Hashish S, Gawad RMA, Gharieb RY, Abdelnaser A. COVID-19 Genetic and Environmental Risk Factors: A Look at the Evidence. Front Pharmacol 2020; 11:579415. [PMID: 33117174 PMCID: PMC7577231 DOI: 10.3389/fphar.2020.579415] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Abstract
The Covid-19 pandemic is with no doubt the biggest health crisis of the 21st century. The disease is caused by a virus of the Coronaviridae family and is closely related to the virus responsible for the severe acute respiratory Syndrome (SARS). Since December 2019, the virus has continued to spread way beyond the location of the first recorded cases (Wuhan, China). As of now, over 5 million cases have been diagnosed with the disease worldwide and over 300 thousand have died. COVID-19 patients suffer from respiratory symptoms that can rapidly turn into potentially fatal acute respiratory distress syndrome (ARDS) in a portion of patients. Although many drugs and vaccines are currently under clinical trials, there is no currently approved treatment or vaccine. It is therefore critical to correctly identify risk factors that lead to the exacerbation of symptoms in highly susceptible groups. Groups that are at high risk include those aged 55 or older especially those with underlying conditions such as cardiovascular diseases. Certain ethnicities such as African-Americans have been found to be at a higher risk and males seem to be higher both in numbers as well as severity of cases. It is hypothesized that these groups are at risk as their molecular landscape is more permissive of viral infection and growth. Different occupations, especially those related to health-care as well as populations that do not cultivate a mask-wearing culture are at higher risk due to environmental exposure. In this article, we examine the evidence regarding different groups that are more sensitive to the disease and review hypotheses pertaining to COVID-19 infection and prognosis. Risk factors that can be related to the molecular landscape of COVID-19 infection as well as those related to environmental and occupational conditions are discussed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Anwar Abdelnaser
- School of Science and Engineering, Institute of Global Health and Human Ecology, The American University in Cairo, Cairo, Egypt
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238
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Aodeng S, Wang W, Chen Y, Feng G, Wang J, Lv W, Yang H, Ding X, Song K, Zhao S, Liu J, Zhang S, Gao Z. Safety and efficacy of tracheotomy for critically ill patients with coronavirus disease 2019 (COVID-19) in Wuhan: a case series of 14 patients. Eur J Cardiothorac Surg 2020; 58:745-751. [PMID: 32951058 PMCID: PMC7543369 DOI: 10.1093/ejcts/ezaa312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/08/2020] [Accepted: 07/18/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19) is a global pandemic. Critically ill patients often require prolonged intubation for mechanical ventilation to support breathing; thus, the artificial airway must be managed by tracheotomy. Therefore, studies exploring appropriate and safe methods for tracheotomy that minimize the risks of nosocomial transmission are important. METHODS A retrospective analysis of the clinical characteristics of 14 critically ill patients with COVID-19, who underwent bedside tracheotomy from March to April 2020 was conducted to summarize the indications for tracheotomy and key points related to personal protective equipment and surgical procedures. RESULTS All 14 patients were diagnosed with COVID-19 and were critically ill. All tracheotomies were performed in the late phase of the infection course. The interval between the infection and tracheotomy was 33 days, and the median interval between intubation and tracheotomy was 25.5 days. The reverse transcription-polymerase chain reaction results of secretions from the operative incision and inside the tracheotomy tube were negative. Twelve patients improved after tracheotomy, with SpO2 levels maintained above 96%. One patient died of progressive respiratory failure; another patient died of uncontrolled septic shock. No medical staff who participated in the tracheotomy was infected. CONCLUSIONS Tracheotomy in critically ill patients with COVID-19 who meet the indications for tracheotomy potentially represents a safer approach to manage the airway and help improve the treatment outcomes. A tracheotomy performed in the late phase of the disease has a relatively low risk of infection. Adherence to key steps in the tracheotomy procedure and donning adequate personal protection will help medical staff avoid infection.
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Affiliation(s)
- Surita Aodeng
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiqing Wang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Chen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guodong Feng
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Wang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Lv
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hua Yang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Ding
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kaicheng Song
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sirui Zhao
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiazhen Liu
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiqiang Gao
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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239
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Meng M, Zhang S, Zhai CJ, Chen DC. Rapidly organize redeployed medical staff in coronavirus disease 2019 pandemic: what we should do. Chin Med J (Engl) 2020; 133:2143-2145. [PMID: 32804735 PMCID: PMC7508438 DOI: 10.1097/cm9.0000000000001033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Mei Meng
- Department of Critical Care Medicine, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China
| | - Sheng Zhang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Chun-Juan Zhai
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - De-Chang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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240
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Wang Y, Ma WH. Esophageal detection method may be a good choice to confirm endotracheal tube placement for patients with COVID-19 infection. Minerva Anestesiol 2020; 86:1113-1115. [DOI: 10.23736/s0375-9393.20.14618-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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241
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Poe FL, Corn J. N-Acetylcysteine: A potential therapeutic agent for SARS-CoV-2. Med Hypotheses 2020; 143:109862. [PMID: 32504923 PMCID: PMC7261085 DOI: 10.1016/j.mehy.2020.109862] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/07/2020] [Accepted: 05/21/2020] [Indexed: 02/08/2023]
Abstract
COVID-19, a respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to spread across the globe. Predisposing factors such as age, diabetes, cardiovascular disease, and lowered immune function increase the risk of disease severity. T cell exhaustion, high viral load, and high levels of TNF-ɑ, IL1β, IL6, IL10 have been associated with severe SARS-CoV-2. Cytokine and antigen overstimulation are potentially responsible for poor humoral response to the virus. Lower cellular redox status, which leads to pro-inflammatory states mediated by TNF-ɑ is also potentially implicated. In vivo, in vitro, and human clinical trials have demonstrated N-acetylcysteine (NAC) as an effective method of improving redox status, especially when under oxidative stress. In human clinical trials, NAC has been used to replenish glutathione stores and increase the proliferative response of T cells. NAC has also been shown to inhibit the NLRP3 inflammasome pathway (IL1β and IL18) in vitro, and decrease plasma TNF-ɑ in human clinical trials. Mediation of the viral load could occur through NAC's ability to increase cellular redox status via maximizing the rate limiting step of glutathione synthesis, and thereby potentially decreasing the effects of virally induced oxidative stress and cell death. We hypothesize that NAC could act as a potential therapeutic agent in the treatment of COVID-19 through a variety of potential mechanisms, including increasing glutathione, improving T cell response, and modulating inflammation. In this article, we present evidence to support the use of NAC as a potential therapeutic agent in the treatment of COVID-19.
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Affiliation(s)
- Francis L Poe
- Whole Systems Research Institute, 1020 SW Taylor St Ste. 340, Portland, OR 97239, United States.
| | - Joshua Corn
- Whole Systems Research Institute, 1020 SW Taylor St Ste. 340, Portland, OR 97239, United States
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242
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Thomas V, Maillard C, Barnard A, Snyman L, Chrysostomou A, Shimange-Matsose L, Van Herendael B. International Society for Gynecologic Endoscopy (ISGE) guidelines and recommendations on gynecological endoscopy during the evolutionary phases of the SARS-CoV-2 pandemic. Eur J Obstet Gynecol Reprod Biol 2020; 253:133-140. [PMID: 32866856 PMCID: PMC7448735 DOI: 10.1016/j.ejogrb.2020.08.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised some important interrogations on minimally invasive gynaecological surgery. The International Society for Gynecologic Endoscopy (ISGE) has taken upon itself the task of providing guidance and best practice policies for all practicing gynaecological endoscopists. Factors affecting decision making processes in minimal invasive surgery (MIS) vary depending on factors such as the phase of the pandemic, policies on control and prevention, expertise and existing infrastructure. Our responsibility remains ensuring the safety of all health care providers, ancillary staff and patients during this unusual period. We reviewed the current literature related to gynecological and endoscopic surgery during the Coronavirus Disease 19 (COVID-19) crisis. Regarding elective surgery, universal testing for SARS-CoV-2 infection should be carried out wherever possible 40 h prior to surgery. In case of confirmed positive case of SARS-CoV-2, surgery should be delayed. Priority should be given to relatively urgent cases such as malignancies. ISGE supports medical optimization and delaying surgery for benign non-life-threatening surgeries. When possible, we recommend to perform cases by laparoscopy and to allow early discharges. Any procedure with risk of bowel involvement should be performed by open surgery as studies have found a high amount of viral RNA (ribonucleic acid) in stool. Regarding urgent surgery, each unit should create a risk assessment flow chart based on capacity. Patients should be screened for symptoms and symptomatic patients must be tested. In the event that a confirmed case of SARS-CoV-2 is found, every attempt should be made to optimize medical management and defer surgery until the patient has recovered and only emergency or life-threatening surgery should be performed in these cases. We recommend to avoid intubation and ventilation in SARS-CoV-2 positive patients and if at all possible local or regional anesthesia should be utilized. Patients who screen or test negative may have general anesthesia and laparoscopic surgery while strict protocols of infection control are upheld. Surgery in screen-positive as well as SARS-CoV-2 positive patients that cannot be safely postponed should be undertaken with full PPE with ensuring that only essential personnel are exposed. If available, negative pressure theatres should be used for patients who are positive or screen high risk. During open and vaginal procedures, suction can be used to minimize droplet and bioaerosol spread. In a patient who screens low risk or tests negative, although carrier and false negatives cannot be excluded, laparoscopy should be strongly considered. We recommend, during minimal access surgeries, to use strategies to reduce production of bioaerosols (such as minimal use of energy, experienced surgeon), to reduce leakage of smoke aerosols (for example, minimizing the number of ports used and size of incisions, as well as reducing the operating pressures) and to promote safe elimination of smoke during surgery and during the ports' closure (such as using gas filters and smoke evacuation systems). During the post-peak period of pandemic, debriefing and mental health screening for staff is recommended. Psychological support should be provided as needed. In conclusion, based on the existent evidence, ISGE largely supports the current international trends favoring laparoscopy over laparotomy on a case by case risk evaluation basis, recognizing the different levels of skill and access to minimally invasive procedures across various countries.
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Affiliation(s)
- Viju Thomas
- Department of Obstetrics and Gynecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Charlotte Maillard
- Department of Obstetrics and Gynecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa; Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), 1200 Brussels, Belgium.
| | - Annelize Barnard
- Department of Obstetrics and Gynecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Leon Snyman
- Department of Obstetrics and Gynecology, Kalafong Tertiary Hospital, University of Pretoria, Pretoria, South Africa
| | - Andreas Chrysostomou
- Department of Obstetrics and Gynecology, Charlotte Maxeke Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Lusandolwethu Shimange-Matsose
- Department of Obstetrics and Gynecology, Charlotte Maxeke Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Bruno Van Herendael
- Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium,Università degli Studi dell’Insubria, Varese, Italy
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243
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Zhao S, Lin Y, Zhou C, Wang L, Chen X, Clifford SP, Akca O, Huang J, Chen X. Short-Term Outcomes of Patients With COVID-19 Undergoing Invasive Mechanical Ventilation: A Retrospective Observational Study From Wuhan, China. Front Med (Lausanne) 2020; 7:571542. [PMID: 33117833 PMCID: PMC7553072 DOI: 10.3389/fmed.2020.571542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/04/2020] [Indexed: 02/05/2023] Open
Abstract
Background: COVID-19 has spread rapidly worldwide. Many patients require mechanical ventilation. The goal of this study was to investigate the clinical course and outcomes of patients with COVID-19 undergoing mechanical ventilation and identify factors associated with death. Methods: Eighty-three consecutive critically ill patients with confirmed COVID-19 undergoing invasive mechanical ventilation were included in this retrospective, single-center, observational study from January 31 to March 15, 2020. Demographic, clinical, laboratory, radiological, and mechanical ventilation data were collected and analyzed. The primary outcome was 28-day mortality after endotracheal intubation. The secondary outcomes included the incidences of SARS-CoV-2-related cardiac, liver, and kidney injury. Results: Seventy-four out of 83 (89.2%) patients achieved oxygen saturation above 93% after intubation. Forty-nine out of 83 (59%) patients died and 34 (41%) patients survived after 28 days of observation. Multivariable regression showed increasing odds of death associated with cardiac injury (odds ratio 15.60, 95% CI 4.20–74.43), liver injury (5.40, 1.46–23.56), and kidney injury (8.39, 1.63–61.41), and decreasing odds of death associated with the higher PaO2/FiO2 ratio before intubation (0.97, 0.95–0.99). PaO2/FiO2 ratio before intubation demonstrated a positive linear correlation with platelet count (r = 0.424, P = 0.001), and negative linear correlation with troponin I (r = −0.395, P = 0.008). Conclusions: Cardiac, liver, and kidney injury may be associated with death for critically ill patients with COVID-19 undergoing invasive mechanical ventilation. The severity of pre-intubation hypoxia may be associated with a poorer outcome of patients with COVID-19 undergoing invasive mechanical ventilation. Larger, multi-institutional, prospective studies should be conducted to confirm these preliminary results.
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Affiliation(s)
- Shuai Zhao
- Department of Anesthesiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Lin
- Department of Anesthesiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Cheng Zhou
- Laboratory of Anesthesia and Critical Care Medicine, Department of Anesthesiology, Translational Neuroscience Center, West China Hospital of Sichuan University, Chengdu, China
| | - Li Wang
- Department of Anesthesiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xueyin Chen
- Department of Anesthesiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Sean P Clifford
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, United States
| | - Ozan Akca
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, United States
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, United States
| | - Xiangdong Chen
- Department of Anesthesiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
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244
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Seger CD, Wang L, Dong X, Tebon P, Kwon S, Liew EC, Marijic J, Umar S, Hoftman NN. A Novel Negative Pressure Isolation Device for Aerosol Transmissible COVID-19. Anesth Analg 2020; 131:664-668. [PMID: 32541251 PMCID: PMC7302060 DOI: 10.1213/ane.0000000000005052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic creates a need to protect health care workers (HCWs) from patients undergoing aerosol-generating procedures which may transmit the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Existing personal containment devices (PCDs) may protect HCWs from respiratory droplets but not from potentially dangerous respiratory-generated aerosols. We describe a new PCD and its aerosol containment capabilities. The device ships flat and folds into a chamber. With its torso drape and protective arm sleeves mounted, it provides contact, droplet, and aerosol isolation during intubation and cardiopulmonary resuscitation (CPR). Significantly improved ergonomics, single-use workflow, and ease of removal distinguish this device from previously published designs.
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Affiliation(s)
- Christian D Seger
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California
| | - Libing Wang
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California
| | - Xuezhi Dong
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California
| | - Peyton Tebon
- Department of Bioengineering, Samueli School of Engineering and Applied Sciences, University of California Los Angeles (UCLA), Los Angeles, California
| | - Sebastian Kwon
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California
| | - Elaine C Liew
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California
| | - Jure Marijic
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California
| | - Soban Umar
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California
| | - Nir N Hoftman
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California
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Demonstration and Mitigation of Aerosol and Particle Dispersion During Mastoidectomy Relevant to the COVID-19 Era. Otol Neurotol 2020; 41:1230-1239. [PMID: 32925848 PMCID: PMC7497894 DOI: 10.1097/mao.0000000000002765] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Supplemental Digital Content is available in the text Background: COVID-19 has become a global pandemic with a dramatic impact on healthcare systems. Concern for viral transmission necessitates the investigation of otologic procedures that use high-speed drilling instruments, including mastoidectomy, which we hypothesized to be an aerosol-generating procedure. Methods: Mastoidectomy with a high-speed drill was simulated using fresh-frozen cadaveric heads with fluorescein solution injected into the mastoid air cells. Specimens were drilled for 1-minute durations in test conditions with and without a microscope. A barrier drape was fashioned from a commercially available drape (the OtoTent). Dispersed particulate matter was quantified in segments of an octagonal test grid measuring 60 cm in radius. Results: Drilling without a microscope dispersed fluorescent particles 360 degrees, with the areas of highest density in quadrants near the surgeon and close to the surgical site. Using a microscope or varying irrigation rates did not significantly reduce particle density or percent surface area with particulate. Using the OtoTent significantly reduced particle density and percent surface area with particulate across the segments of the test grid beyond 30 cm (which marked the boundary of the OtoTent) compared with the microscope only and no microscope test conditions (Kruskall–Wallis test, p = 0.0066). Conclusions: Mastoidectomy with a high-speed drill is an aerosol-generating procedure, a designation that connotes the potential high risk of viral transmission and need for higher levels of personal protective equipment. A simple barrier drape significantly reduced particulate dispersion in this study and could be an effective mitigation strategy in addition to appropriate personal protective equipment.
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Simpson AI, Vaghela KR, Brown H, Adams K, Sinisi M, Fox M, Quick T. Reducing the Risk and Impact of Brachial Plexus Injury Sustained From Prone Positioning-A Clinical Commentary. J Intensive Care Med 2020; 35:1576-1582. [PMID: 32959717 DOI: 10.1177/0885066620954787] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Prone positioning is deployed as a critical treatment for improving oxygenation in patients with Acute Respiratory Distress Syndrome. This regimen is currently highly prevalent in the COVID-19 pandemic. The pandemic has brought about increased concern about how best to safely avoid brachial plexus injuries when caring for unconscious proned patients. METHODS A review of the published literature on brachial plexus injuries secondary to proning ventilated patients was performed. This was combined with a review of available international critical care guidelines in order to produce a succinct set of guidelines to aid critical care departments in reducing brachial plexus injuries during these challenging times. DISCUSSION There is no one manner in which prone positioning an unconscious patient can be made universally safe. This paper provides 6 key steps to reducing the incidence of brachial plexus injuries while proning and suggests a safe and sensible management and referral pathway for the conscious patient in which a brachial plexus injury is identified. CONCLUSION There is in truth no completely safe position for every patient and certainly there will be anomalies in anatomy that will predispose certain individuals to nerve injury. Thus the injury rate cannot be reduced to zero but an understanding of the principles of protection will inform those undertaking positioning.
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Affiliation(s)
- Ashley I Simpson
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | - Kalpesh R Vaghela
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | - Hazel Brown
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom.,UCL Centre for Nerve Engineering, Gower Street, London, United Kingdom
| | - Kate Adams
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | - Marco Sinisi
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | - Michael Fox
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | - Tom Quick
- Peripheral Nerve Injuries Unit, 159096Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom.,UCL Centre for Nerve Engineering, Gower Street, London, United Kingdom
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Correspondence. Retina 2020; 40:e62-e63. [PMID: 32956216 DOI: 10.1097/iae.0000000000002920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Sanjan A, Krishnan VS, Balakrishnan JM, Stawicki SP, Sirur FM, Lateef F, Goncalves RV, Galwankar S. What's New in Critical Illness and Injury Science?: In situ simulation for airway management during COVID-19 in the emergency department, KMC, Manipal. Int J Crit Illn Inj Sci 2020; 10:105-108. [PMID: 33409124 PMCID: PMC7771625 DOI: 10.4103/ijciis.ijciis_114_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/17/2020] [Accepted: 08/01/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- A Sanjan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vimal S Krishnan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jayaraj Mymbilly Balakrishnan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Stanislaw P Stawicki
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Freston Marc Sirur
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Fatimah Lateef
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Rose V Goncalves
- Department of Emergency Medicine, Florida State University, Sarasota Memorial Hospital, Sarasota, Florida, USA
| | - Sagar Galwankar
- Department of Emergency Medicine, Florida State University, Sarasota Memorial Hospital, Sarasota, Florida, USA
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Sleiwah A, Nair G, Mughal M, Lancaster K, Ahmad I. Perioral pressure ulcers in patients with COVID-19 requiring invasive mechanical ventilation. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020; 43:727-732. [PMID: 32952306 PMCID: PMC7490473 DOI: 10.1007/s00238-020-01737-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/01/2020] [Indexed: 12/13/2022]
Abstract
Background Facial pressure ulcers are a rare yet significant complication. National Institute for Health and Care Excellence (NICE) guidelines recommend that patients should be risk-assessed for pressure ulcers and measures instated to prevent such complication. In this study, we report case series of perioral pressure ulcers developed following the use of two devices to secure endotracheal tubes in COVID-19 positive patients managed in the intensive care setting. Methods A retrospective analysis was conducted on sixteen patients identified to have perioral pressure ulcers by using the institutional risk management system. Data parameters included patient demographics (age, gender, comorbidities, smoking history and body mass index (BMI)). Data collection included the indication of admission to ITU, duration of intubation, types of medical devices utilised to secure the endotracheal tube, requirement of vasopressor agents and renal replacement therapy, presence of other associated ulcers, duration of proning and mortality. Results Sixteen patients developed different patterns of perioral pressure ulcers related to the use of two medical devices (Insight, AnchorFast). The mean age was 58.6 years. The average length of intubation was 18.8 days. Fourteen patients required proning, with an average duration of 5.2 days. Conclusions The two devices utilised to secure endotracheal tubes are associated with unique patterns of facial pressure ulcers. Measures should be taken to assess the skin regularly and avoid utilising devices that are associated with a high risk of facial pressure ulcers. Awareness and training should be provided to prevent such significant complication. Level of evidence: Level IV, risk/prognostic study.
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Affiliation(s)
- Aseel Sleiwah
- Department of Plastic Surgery, Guy's & St. Thomas' Hospital, 3rd Floor, Lambeth Wing, Westminster Bridge, London, SE1 7EH UK
| | | | - Maleeha Mughal
- Department of Plastic Surgery, Guy's & St. Thomas' Hospital, 3rd Floor, Lambeth Wing, Westminster Bridge, London, SE1 7EH UK
| | - Katie Lancaster
- Department of Plastic Surgery, Guy's & St. Thomas' Hospital, 3rd Floor, Lambeth Wing, Westminster Bridge, London, SE1 7EH UK
| | - Imran Ahmad
- Department of Plastic Surgery, Guy's & St. Thomas' Hospital, London, UK.,King's College London, London, UK
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Minnelli N, Gibbs L, Larrivee J, Sahu KK. Challenges of Maintaining Optimal Nutrition Status in COVID-19 Patients in Intensive Care Settings. JPEN J Parenter Enteral Nutr 2020; 44:1439-1446. [PMID: 32799322 PMCID: PMC7461277 DOI: 10.1002/jpen.1996] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/07/2020] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 (COVID‐19) pandemic has threatened patients, healthcare systems, and all countries across the globe with unprecedented challenges and uncertainties. According to the latest literature, most patients with COVID‐19 have mild symptoms that do not require hospital admissions, and only a small percentage of those hospitalized require intensive care. In the intensive care unit (ICU), a registered dietitian nutritionist (RDN) assists the critical care team by formulating, executing, and monitoring the nutrition strategies and interventions to meet the unique requirements of extremely sick patients. However, because of the novelty of COVID‐19, the situation is fluid and guidelines continue to be developed and updated. This article discusses the interim guidelines available for the nutrition support of ICU COVID‐19 patients and the challenges the critical care team and RDN may face from a nutrition standpoint.
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Affiliation(s)
- Nicole Minnelli
- Department of Food and Nutrition, Morrison Healthcare, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Lisa Gibbs
- Department of Food and Nutrition, Morrison Healthcare, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Jennifer Larrivee
- Department of Food and Nutrition, Morrison Healthcare, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
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