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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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Kakkar K, Gupta B. Is the use of automated artificial manual breathing unit resuscitators justified during a pandemic mechanical ventilator crisis? Acute Crit Care 2020; 35:220-222. [PMID: 32907312 PMCID: PMC7483006 DOI: 10.4266/acc.2020.00311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/09/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Kamna Kakkar
- Department of Anaesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Bhavna Gupta
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, India
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253
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Ogunleye OO, Basu D, Mueller D, Sneddon J, Seaton RA, Yinka-Ogunleye AF, Wamboga J, Miljković N, Mwita JC, Rwegerera GM, Massele A, Patrick O, Niba LL, Nsaikila M, Rashed WM, Hussein MA, Hegazy R, Amu AA, Boahen-Boaten BB, Matsebula Z, Gwebu P, Chirigo B, Mkhabela N, Dlamini T, Sithole S, Malaza S, Dlamini S, Afriyie D, Asare GA, Amponsah SK, Sefah I, Oluka M, Guantai AN, Opanga SA, Sarele TV, Mafisa RK, Chikowe I, Khuluza F, Kibuule D, Kalemeera F, Mubita M, Fadare J, Sibomana L, Ramokgopa GM, Whyte C, Maimela T, Hugo J, Meyer JC, Schellack N, Rampamba EM, Visser A, Alfadl A, Malik EM, Malande OO, Kalungia AC, Mwila C, Zaranyika T, Chaibva BV, Olaru ID, Masuka N, Wale J, Hwenda L, Kamoga R, Hill R, Barbui C, Bochenek T, Kurdi A, Campbell S, Martin AP, Phuong TNT, Thanh BN, Godman B. Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future. Front Pharmacol 2020; 11:1205. [PMID: 33071775 PMCID: PMC7533592 DOI: 10.3389/fphar.2020.01205] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. OBJECTIVE Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. OUR APPROACH Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. ONGOING ACTIVITIES Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. CONCLUSION There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other.
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Affiliation(s)
- Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Debjani Mueller
- Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | | | - R. Andrew Seaton
- Healthcare Improvement Scotland, Glasgow, United Kingdom
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
- University of Glasgow, Glasgow, United Kingdom
| | | | - Joshua Wamboga
- Uganda Alliance of Patients’ Organizations (UAPO), Kampala, Uganda
| | - Nenad Miljković
- Institute of Orthopaedic Surgery “Banjica”, University of Belgrade, Belgrade, Serbia
| | - Julius C. Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, University of Botswana and Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Okwen Patrick
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon
- Faculty of Health and Medical Sciences, Adelaide University, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon
- Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | | | | | - Rehab Hegazy
- Pharmacology Department, Medical Division, National Research Centre, Giza, Egypt
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | | | | | | | | | | | | | | | | | - Daniel Afriyie
- Pharmacy Department, Ghana Police Hospital, Accra, Ghana
| | - George Awuku Asare
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Seth Kwabena Amponsah
- Department of Medical Pharmacology, University of Ghana Medical School, Accra, Ghana
| | - Israel Sefah
- Ghana Health Service, Pharmacy Department, Keta Municipal Hospital, Keta-Dzelukope, Ghana
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Hohoe, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N. Guantai
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia A. Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Tebello Violet Sarele
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville-campus, Durban, South Africa
| | | | - Ibrahim Chikowe
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University , Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Laurien Sibomana
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gwendoline Malegwale Ramokgopa
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Carmen Whyte
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Tshegofatso Maimela
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Johannes Hugo
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
- Department of Family Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Enos M. Rampamba
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacy, Tshilidzini Hospital, Shayandima, South Africa
| | - Adel Visser
- Eugene Marais Hospital, Pretoria, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Elfatih M. Malik
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- Community Medicine Council, SMSB, Khartoum, Sudan
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Kampala, Uganda
| | | | - Chiluba Mwila
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Ioana D. Olaru
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nyasha Masuka
- Zimbabwe College of Public Health Physicians, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | | | - Regina Kamoga
- Uganda Alliance of Patients’ Organizations (UAPO), Kampala, Uganda
- Community Health and Information Network (CHAIN), Kampala, Uganda
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tomasz Bochenek
- Department of Nutrition and Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Antony P. Martin
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- HCD Economics, The Innovation Centre, Daresbury, United Kingdom
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Binh Nguyen Thanh
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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254
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Luo M, Cao S, Wei L, Zhao X, Gao F, Li S, Meng L, Wang Y. Intubation, mortality, and risk factors in critically ill Covid-19 patients: A pilot study. J Clin Anesth 2020; 67:110039. [PMID: 32920347 PMCID: PMC7476450 DOI: 10.1016/j.jclinane.2020.110039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/14/2020] [Accepted: 09/05/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Mengqiang Luo
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shumei Cao
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Liqun Wei
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Zhao
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Feng Gao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengqing Li
- Department of Pulmonary Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lingzhong Meng
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
| | - Yingwei Wang
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
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255
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Xu S, Chen Z, Ge L, Chen A, Zhang W, Sun Z, Yu T, Shi S, Zhou L. A comprehensive review of diagnosis and treatment in critically ill adults with COVID-19. TRADITIONAL MEDICINE AND MODERN MEDICINE 2020. [DOI: 10.1142/s2575900020300015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The highly infectious coronavirus disease 2019 (COVID-19) that emerged in Wuhan, China, was caused by a novel strain of coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Subsequently, it was considered as one of the serious potential threats to global public health due to rapid spread worldwide. The purpose of this paper is to describe the characteristics of epidemiology, clinical manifestations, diagnosis, differential diagnosis, and treatment of traditional Chinese medicine and modern medicine in critically ill adults with COVID-19. We searched the related papers published up to April 20, 2020 on the PubMed and the China National Knowledge Infrastructure database. The findings will improve the potential recognition of COVID-19 among clinicians and the general public, and presumably contribute to the reduction of mortality.
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Affiliation(s)
- Shuanglan Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, P. R. China
| | - Zi Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, P. R. China
| | - Linyang Ge
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, P. R. China
| | - Aiping Chen
- Department of Radiology, The First Affiliated Hospital, Nanjing Medical University Nanjing 210029, P. R. China
| | - Wei Zhang
- Department of Radiology, The First Affiliated Hospital, Nanjing Medical University Nanjing 210029, P. R. China
| | - Zikai Sun
- Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, P. R. China
| | - Tongfu Yu
- Department of Radiology, The First Affiliated Hospital, Nanjing Medical University Nanjing 210029, P. R. China
| | - Suofang Shi
- Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, P. R. China
| | - Linfu Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, P. R. China
- Institute of Integrative Medicine, Nanjing Medical University, Nanjing 210029, P. R. China
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256
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Ing RJ, Barrett C, Chatterjee D, Twite M, Whitney GM. Perioperative Preparations for COVID-19: The Pediatric Cardiac Team Perspective. J Cardiothorac Vasc Anesth 2020; 34:2307-2311. [PMID: 32451272 PMCID: PMC7187810 DOI: 10.1053/j.jvca.2020.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Richard J Ing
- Department of Anesthesiology; University of Colorado School of Medicine
| | - Cindy Barrett
- University of Colorado School of Medicine; Department of Cardiology, Children's Hospital Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Mark Twite
- Department of Anesthesiology; University of Colorado School of Medicine
| | - Gina M Whitney
- Department of Anesthesiology; University of Colorado School of Medicine
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257
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Munro CL, Hope AA. Meeting Today's Challenges: All In. Am J Crit Care 2020; 29:334-336. [PMID: 32666071 DOI: 10.4037/ajcc2020139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Cindy L. Munro
- Cindy L. Munro is coeditor in chief of the American Journal of Critical Care. She is dean and professor, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| | - Aluko A. Hope
- Aluko A. Hope is coeditor in chief of the American Journal of Critical Care. He is an associate professor at Albert Einstein College of Medicine and an intensivist and assistant bioethics consultant at Montefiore Medical Center, both in New York City
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258
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Smith D, Montagne J, Raices M, Dietrich A, Bisso IC, Las Heras M, San Román JE, García Fornari G, Figari M. Tracheostomy in the intensive care unit: Guidelines during COVID-19 worldwide pandemic. Am J Otolaryngol 2020; 41:102578. [PMID: 32505993 PMCID: PMC7832100 DOI: 10.1016/j.amjoto.2020.102578] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE COVID-19 has become a pandemic with significant consequences worldwide. About 3.2% of patients with COVID-19 will require intubation and invasive ventilation. Moreover, there will be an increase in the number of critically ill patients, hospitalized and intubated due to unrelated acute pathology, who will present underlying asymptomatic or mild forms of COVID-19. Tracheostomy is one of the procedures associated with an increased production of aerosols and higher risk of transmission of the virus to the health personnel. The aim of this paper is to describe indications and recommended technique of tracheostomy in COVID-19 patients, emphasizing the safety of the patient but also the medical team involved. MATERIALS AND METHODS A multidisciplinary group made up of surgeons with privileges to perform tracheostomies, intensive care physicians, infectious diseases specialists and intensive pulmonologists was created to update previous knowledge on performing a tracheostomy in critically ill adult patients (>18 years) amidst the SARS-CoV-2 pandemic in a high-volume referral center. Published evidence was collected using a systematic search and review of published studies. RESULTS A guideline comprising indications, surgical technique, ventilator settings, personal protective equipment and timing of tracheostomy in COVID-19 patients was developed. CONCLUSIONS A safe approach to performing percutaneous dilational bedside tracheostomy with bronchoscopic guidance is feasible in COVID-19 patients of appropriate security measures are taken and a strict protocol is followed. Instruction of all the health care personnel involves is key to ensure their safety and the patient's favorable recovery.
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Affiliation(s)
- David Smith
- Department of Thoracic Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Juan Montagne
- Department of Thoracic Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Micaela Raices
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina.
| | - Agustín Dietrich
- Department of Thoracic Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Indalecio Carboni Bisso
- Department of Intensive Care Medicine and Critical Pulmonology, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Marcos Las Heras
- Department of Intensive Care Medicine and Critical Pulmonology, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Juan E San Román
- Department of Intensive Care Medicine and Critical Pulmonology, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Gustavo García Fornari
- Department of Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Marcelo Figari
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
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259
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Shao JM, Ayuso SA, Deerenberg EB, Elhage SA, Augenstein VA, Heniford BT. A systematic review of CT chest in COVID-19 diagnosis and its potential application in a surgical setting. Colorectal Dis 2020; 22:993-1001. [PMID: 32644268 PMCID: PMC7361755 DOI: 10.1111/codi.15252] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/24/2020] [Indexed: 12/24/2022]
Abstract
AIM The aim of this work was to investigate the sensitivity and utility of CT of the chest in diagnosing active SARS-Cov-2 (COVID-19) infection, and its potential application to the surgical setting. METHOD A literature review was conducted using Google Scholar® and MEDLINE®/PubMed® to identify current available evidence regarding the sensitivity of CT chest compared with RT-PCR for the diagnosis of COVID-19-positive patients. GRADE criteria and the QUADAS 2 tool were used to assess the level of evidence. RESULTS A total of 20 articles were identified that addressed the question of sensitivity of CT for diagnosis of symptomatic and asymptomatic COVID-19-positive patients. Overall sensitivity of CT scan ranged from 57%-100% for symptomatic and 46%-100% for asymptomatic COVID-19 patients, while that of RT-PCR ranged from 39%-89%. CT chest was a better diagnostic modality and capable of detecting active infection earlier in the time course of infection than RT-PCR in symptomatic patients. In asymptomatic patients, disease prevalence seems to play a role in the positive predictive value. Minimal evidence exists regarding the sensitivity of CT in patients who are asymptomatic. CONCLUSIONS In surgical patients, CT chest should be considered as an important adjunct for detection of COVID-19 infection in patients who are symptomatic with negative RT-PCR prior to any operation. For surgical patients who are asymptomatic, there is insufficient evidence to recommend routine preoperative CT chest for COVID-19 screening.
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Affiliation(s)
- J. M. Shao
- Gastrointestinal and Minimally Invasive SurgeryDepartment of SurgeryCarolinas Medical CenterCharlotteNorth CarolinaUSA
| | - S. A. Ayuso
- Gastrointestinal and Minimally Invasive SurgeryDepartment of SurgeryCarolinas Medical CenterCharlotteNorth CarolinaUSA
| | - E. B. Deerenberg
- Gastrointestinal and Minimally Invasive SurgeryDepartment of SurgeryCarolinas Medical CenterCharlotteNorth CarolinaUSA
| | - S. A. Elhage
- Gastrointestinal and Minimally Invasive SurgeryDepartment of SurgeryCarolinas Medical CenterCharlotteNorth CarolinaUSA
| | - V. A. Augenstein
- Gastrointestinal and Minimally Invasive SurgeryDepartment of SurgeryCarolinas Medical CenterCharlotteNorth CarolinaUSA
| | - B. T. Heniford
- Gastrointestinal and Minimally Invasive SurgeryDepartment of SurgeryCarolinas Medical CenterCharlotteNorth CarolinaUSA
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260
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Augoustides JG. Perioperative Echocardiography During the Coronavirus Crisis: Considerations in Pediatrics and Congenital Heart Disease. J Cardiothorac Vasc Anesth 2020; 34:2303-2306. [PMID: 32387016 PMCID: PMC7165086 DOI: 10.1053/j.jvca.2020.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 12/22/2022]
Affiliation(s)
- John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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261
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COVID - 19 case study in emergency medicine preparedness and response: from personal protective equipment to delivery of care. Dis Mon 2020; 66:101060. [PMID: 32800348 PMCID: PMC7383175 DOI: 10.1016/j.disamonth.2020.101060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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262
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Mechanical Ventilation - A Friend in Need? J Crit Care Med (Targu Mures) 2020; 6:143-145. [PMID: 32864458 PMCID: PMC7430355 DOI: 10.2478/jccm-2020-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022] Open
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Del Castillo Pardo de Vera JL, Cebrián Carretero JL, Gutiérrez Melón C, Civantos Martín B. Hybrid tracheotomy. A valid alternative for obese critical patients COVID-19. ACTA ACUST UNITED AC 2020; 67:483-484. [PMID: 32854939 PMCID: PMC7832010 DOI: 10.1016/j.redar.2020.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - J L Cebrián Carretero
- Servicio de Cirugía Oral y Maxilofacial, Hospital Universitario La Paz, Madrid, España
| | - C Gutiérrez Melón
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España
| | - B Civantos Martín
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España
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264
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Kaseda ET, Levine AJ. Post-traumatic stress disorder: A differential diagnostic consideration for COVID-19 survivors. Clin Neuropsychol 2020; 34:1498-1514. [PMID: 32847484 DOI: 10.1080/13854046.2020.1811894] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: SARS-CoV-2 infection and its oft-associated illness COVID-19 may lead to neuropsychological deficits, either through direct mechanisms (i.e., neurovirulance) or indirect mechanisms, most notably complications caused by the virus (e.g., stroke) or medical procedures (e.g., intubation). The history of past human coronavirus outbreaks resulting in similar health emergencies suggests there will be a substantial prevalence of post-traumatic stress disorder (PTSD) among COVID-19 survivors. To prepare neuropsychologists for the difficult task of differentiating PTSD-related from neuropathology-related deficits in the oncoming wave of COVID-19 survivors, we integrate research across a spectrum of related areas.Methods: Several areas of literature were reviewed: psychiatric, neurologic, and neuropathological outcomes of SARS and MERS patients; neurological outcomes in COVID-19 survivors; PTSD associated with procedures common to COVID-19 patients; and differentiating neuropsychological deficits due to PTSD from those due to acquired brain injuries in other patient groups.Conclusions: Heightened risk of PTSD occurred in MERS and SARS survivors. While data concerning COVID-19 is lacking, PTSD is known to occur in patient groups who undergo similar hospital courses, including ICU survivors, patients who are intubated and mechanically ventilated, and those that experience delirium. Research with patients who develop PTSD in the context of mild traumatic brain injury further suggests that PTSD may account for some or all of a patient's subjective cognitive complaints and neuropsychological test performance. Recommendations are provided for assessing PTSD in the context of COVID-19.
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Affiliation(s)
- Erin T Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Andrew J Levine
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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265
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Asghar MS, Haider Kazmi SJ, Khan NA, Akram M, Jawed R, Rafaey W, Hassan M, Rasheed U, Khan M, Khan AR. Role of Biochemical Markers in Invasive Ventilation of Coronavirus Disease 2019 Patients: Multinomial Regression and Survival Analysis. Cureus 2020; 12:e10054. [PMID: 32999777 PMCID: PMC7520407 DOI: 10.7759/cureus.10054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and objectives Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic. The disease mainly affects the respiratory system of the patient, in particular, the lungs, which leads to patients presenting with acute respiratory distress syndrome and acute respiratory failure, with 5-15% of patients requiring observation in the intensive care unit (ICU) with respiratory support in the form of ventilation. This study was aimed at identifying the role of biochemical markers in the risk stratification of invasive and non-invasive ventilation of hospitalized COVID-19 patients. Materials and methods The study was conducted as a prospective, observational study of all admitted COVID-19 patients. A comparative analysis was performed of the survivors who were on invasive versus (vs) non-invasive ventilation and the non-survivors similarly. After computing the descriptive statistics, a multinomial logistic regression model was applied to obtain an unadjusted odds ratio (OR) at 95% confidence interval (CI), with Hosmer-Lemeshow (HL) goodness-of-fit test used to predict the fitness of the data. Kaplan-Meier survival curves were obtained for each of the laboratory investigations predicting survival along with the intensive care stay and invasive ventilation. A log-rank test was carried out to compare the survival distributions. Results A total of 373 included patients in the study had a mean age of 52.78 ± 15.76 years with females younger than males, and indifference amongst invasive vs non-invasively ventilated (p=0.821). Females were slightly more prone to invasive ventilation (p=0.097). Overall, 39% of the subjects did not need respiratory support, while 13% were on a ventilator, 16% on bilevel positive airway pressure/continuous positive airway pressure (BiPAP/CPAP), and 31% on supplemental oxygen therapy. Among the laboratory markers, mean hemoglobin was evidently lower in the invasive group, leukocytosis and thrombocytopenia were present in both invasively ventilated and non-surviving patients, while neutrophilia and lymphocytopenia were statistically indifferent among the mode of ventilation. Elevated urea, creatinine, and sodium were also significantly deranged laboratory markers amongst the invasively ventilated group. C-reactive protein (CRP) and lactate dehydrogenase (LDH) were elevated significantly in the invasive group, while serum ferritin was more frequently raised in the non-invasively ventilated group. Procalcitonin (PCT) was significantly associated with invasive ventilation as opposed to the non-invasive group. D-dimer was equally raised in both the groups at admission but significantly elevated in the invasive group at discharge. A multinomial regression model signified D-dimer (OR: 16.301), hypernatremia (OR: 12.738), creatinine (OR: 12.589), urea (OR: 12.576), and LDH (OR: 12.245) most significantly associated with death, while those for invasive ventilation were D-dimer (OR: 8.744), hypernatremia (OR: 4.532), PCT (OR: 3.829), neutrophilia (OR: 3.804), leukocytosis (OR: 3.330), and serum urea (OR: 3.312). Kaplan-Meier curves conclude total leucocyte count (TLC), neutrophils, lymphocytes, urea, creatinine, sodium, CRP, LDH, PCT, and D-dimer all significantly contributing to an early death. Conclusion The most significant marker for mortality was D-dimer, followed by serum sodium, urea/creatinine, LDH, ICU stay, and invasive ventilation.
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Affiliation(s)
| | | | - Noman A Khan
- General Surgery, Liaquat National Hospital, Karachi, PAK
| | - Mohammed Akram
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Rumael Jawed
- General Surgery, Liaquat National Hospital, Karachi, PAK
| | - Wania Rafaey
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Maira Hassan
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Uzma Rasheed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Mehak Khan
- Immunology, United Medical and Dental College, Karachi, PAK
| | - Ali R Khan
- Infectious Diseases, United Medical and Dental College, Karachi, PAK
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266
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Derraik JGB, Anderson WA, Connelly EA, Anderson YC. Rapid Review of SARS-CoV-1 and SARS-CoV-2 Viability, Susceptibility to Treatment, and the Disinfection and Reuse of PPE, Particularly Filtering Facepiece Respirators. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6117. [PMID: 32842655 PMCID: PMC7504573 DOI: 10.3390/ijerph17176117] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/12/2020] [Accepted: 08/18/2020] [Indexed: 01/22/2023]
Abstract
In the COVID-19 pandemic caused by SARS-CoV-2, hospitals are often stretched beyond capacity. There are widespread reports of dwindling supplies of personal protective equipment (PPE), particularly N95-type filtering facepiece respirators (FFRs), which are paramount to protect frontline medical/nursing staff, and to minimize further spread of the virus. We carried out a rapid review to summarize the existing literature on the viability of SARS-CoV-2, the efficacy of key potential disinfection procedures against the virus (specifically ultraviolet light and heat), and the impact of these procedures on FFR performance, material integrity, and/or fit. In light of the recent discovery of SARS-CoV-2 and limited associated research, our review also focused on the closely related SARS-CoV-1. We propose a possible whole-of-PPE disinfection solution for potential reuse that could be rapidly instituted in many health care settings, without significant investments in equipment.
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Affiliation(s)
- José G. B. Derraik
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland 1023, New Zealand;
- Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, Taranaki 4310, New Zealand
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
| | - William A. Anderson
- Department of Chemical Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Elizabeth A. Connelly
- Dermatology, Department of Medicine, Taranaki District Health Board, New Plymouth 4310, New Zealand;
| | - Yvonne C. Anderson
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland 1023, New Zealand;
- Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, Taranaki 4310, New Zealand
- Department of Paediatrics, Taranaki District Health Board, New Plymouth 4310, New Zealand
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267
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Baird BJ, Sung CK. Coronavirus Disease-19: Challenges Associated with the Treatment of Head and Neck Oncology and Laryngology Patients in the Coronavirus Disease-19 Era. Otolaryngol Clin North Am 2020; 53:1159-1170. [PMID: 33039099 PMCID: PMC7442893 DOI: 10.1016/j.otc.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This review explores the changes to practice associated with COVID-19 for providers treating patients with head and neck cancer and laryngeal pathology. The aim of the review is to highlight some of the challenges and considerations associated with treating this patient population during the pandemic. Additionally, it seeks to discuss some of the areas of concern related to ramping up clinical volume.
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Affiliation(s)
- Brandon J Baird
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, 5841 South Maryland Avenue, MC 1035, Chicago, IL 60637, USA.
| | - C Kwang Sung
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94304, USA
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268
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Lal T, Sircar M. COVID-19 patients: when and whom to ventilate? Acute Crit Care 2020; 35:218-219. [PMID: 32811136 PMCID: PMC7483014 DOI: 10.4266/acc.2020.00451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/17/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
- Tusharindra Lal
- Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Mrinal Sircar
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, India
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269
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Margus C, Sondheim SE, Peck NM, Storch B, Ngai KM, Ho HE, She T. Discharge in Pandemic: Suspected Covid-19 patients returning to the Emergency Department within 72 hours for admission. Am J Emerg Med 2020; 45:185-191. [PMID: 33046303 PMCID: PMC7434326 DOI: 10.1016/j.ajem.2020.08.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (Covid-19) has led to unprecedented healthcare demand. This study seeks to characterize Emergency Department (ED) discharges suspected of Covid-19 that are admitted within 72 h. METHODS We abstracted all adult discharges with suspected Covid-19 from five New York City EDs between March 2nd and April 15th. Those admitted within 72 h were then compared against those who were not using descriptive and regression analysis of background and clinical characteristics. RESULTS Discharged ED patients returning within 72 h were more often admitted if suspected of Covid-19 (32.9% vs 12.1%, p < .0001). Of 7433 suspected Covid-19 discharges, the 139 (1.9%) admitted within 72 h were older (55.4 vs. 45.6 years, OR 1.03) and more often male (1.32) or with a history of obstructive lung disease (2.77) or diabetes (1.58) than those who were not admitted (p < .05). Additional associations included non-English preference, cancer, heart failure, hypertension, renal disease, ambulance arrival, higher triage acuity, longer ED stay or time from symptom onset, fever, tachycardia, dyspnea, gastrointestinal symptoms, x-ray abnormalities, and decreased platelets and lymphocytes (p < .05 for all). On 72-h return, 91 (65.5%) subjects required oxygen, and 7 (5.0%) required mechanical ventilation in the ED. Twenty-two (15.8%) of the study group have since died. CONCLUSION Several factors emerge as associated with 72-h ED return admission in subjects suspected of Covid-19. These should be considered when assessing discharge risk in clinical practice.
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Affiliation(s)
- Colton Margus
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Samuel E Sondheim
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Nathan M Peck
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Bess Storch
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Ka Ming Ngai
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Hsi-En Ho
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Trent She
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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270
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Kunz Y, Horninger W, Pinggera GM. Are urologists in trouble with SARS-CoV-2? Reflections and recommendations for specific interventions. BJU Int 2020; 126:670-678. [PMID: 32562351 PMCID: PMC7323234 DOI: 10.1111/bju.15141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/24/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023]
Abstract
Objective To assess the risk of viral infection during urological surgeries due to the possible hazards in tissue, blood, urine and aerosolised particles generated during surgery, and thus to understand the risks and make recommendations for clinical practice. Patients and Methods We reviewed the available literature on urological and other surgical procedures in patients with virus infections, such as human papillomavirus, human immunodeficiency virus and hepatitis B, and current publications on coronavirus disease 2019 (COVID‐19). Results Several possible pathways for viral transmission appear in the literature. Recently, groups have detected severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) in the urine and faeces, even after negative pharyngeal swabs. In addition, viral RNA can be detected in the blood and several tissues. During surgery, viral particles are released, aerosol‐borne and present a certain risk of transmission and infection. However, there is currently no evidence on the exact risk of infection from the agents mentioned above. It remains unclear whether or not viral particles in the urine, blood or faeces are infectious. Conclusions Whether SARS‐CoV‐2 can be transmitted by aerosols remains controversial. Irrespective of this, standard surgical masks offer inadequate protection from SARS‐CoV‐2. Full personal protective equipment, including at least filtering facepiece‐2 masks and safety goggles should be used. Aerosolised particles might remain for a long time in the operating theatre and contaminate other surfaces, e.g. floors or computer input devices. Therefore, scrupulous hygiene and disinfection of surfaces must be carried out. To prevent aerosolisation during laparoscopic interventions, the pneumoperitoneum should be evacuated with suction devices. The use of virus‐proof high‐efficiency particulate air filters is recommended. Local separation of anaesthesia/intubation and the operating theatre can reduce the danger of viral transmission. Lumbar anaesthesia should be considered especially in endourology. Based on current knowledge, COVID‐19 is not a contraindication for acute urological surgery. However, if possible, as European guideline committees recommend, non‐emergency urological interventions should be postponed until negative SARS‐CoV‐2 tests become available.
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Affiliation(s)
- Yannic Kunz
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Germar-M Pinggera
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
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271
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An uncomplicated and safe technique for preventing endotracheal tube cuff damage during tracheostomy using pressure-controlled ventilation: the PCV method. Can J Anaesth 2020; 67:1879-1880. [PMID: 32779003 PMCID: PMC7417109 DOI: 10.1007/s12630-020-01783-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022] Open
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272
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Tsan SEH, Kamalanathan A, Lee CK, Zakaria SA, Wang CY. A survey on burnout and depression risk among anaesthetists during COVID-19: the tip of an iceberg? Anaesthesia 2020; 76 Suppl 3:8-10. [PMID: 32776524 PMCID: PMC7436440 DOI: 10.1111/anae.15231] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- S E H Tsan
- University of Malaysia Sarawak, Sarawak, Malaysia
| | | | - C K Lee
- Sungai Buloh Hospital, Ministry of Health, Malaysia
| | - S A Zakaria
- Sungai Buloh Hospital, Ministry of Health, Malaysia
| | - C Y Wang
- University of Malaya, Kuala Lumpur, Malaysia
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273
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Licina A, Silvers A, Stuart RL. Use of powered air-purifying respirator (PAPR) by healthcare workers for preventing highly infectious viral diseases-a systematic review of evidence. Syst Rev 2020; 9:173. [PMID: 32771035 PMCID: PMC7414632 DOI: 10.1186/s13643-020-01431-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/23/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) are at particular risk during pandemics and epidemics of highly virulent diseases with significant morbidity and case fatality rate. These diseases include severe acute respiratory syndrome coronaviruses, SARS-CoV-1 and SARS-CoV-2, Middle Eastern Respiratory Syndrome (MERS), and Ebola. With the current (SARS-CoV-2) global pandemic, it is critical to delineate appropriate contextual respiratory protection for HCWs. The aim of this systematic review was to evaluate the effect of powered air-purifying respirators (PAPRs) as part of respiratory protection versus another device (egN95/FFP2) on HCW infection rates and contamination. METHODS Our primary outcomes included HCW infection rates with SARS-CoV-2, SARS-CoV-1, Ebola, or MERS when utilizing PAPR. We included randomized controlled trials, non-randomized controlled trials, and observational studies. We searched the following databases: MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers independently screened all citations, full-text articles, and abstracted data. Due to clinical and methodological heterogeneity, we did not conduct a meta-analysis. Where applicable, we constructed evidence profile (EP) tables for each individual outcome. Confidence in cumulative evidence for each outcome was classified according to the GRADE system. RESULTS We identified 689 studies during literature searches. We included 10 full-text studies. A narrative synthesis was provided. Two on-field studies reported no difference in the rates of healthcare workers performing airway procedures during the care of critical patients with SARS-CoV-2. A single simulation trial reported a lower level of cross-contamination of participants using PAPR compared to alternative respiratory protection. There is moderate quality evidence that PAPR use is associated with greater heat tolerance but lower scores for mobility and communication ability. We identified a trend towards greater self-reported wearer comfort with PAPR technology in low-quality observational simulation studies. CONCLUSION Field observational studies do not indicate a difference in healthcare worker infection utilizing PAPR devices versus other compliant respiratory equipment. Greater heat tolerance accompanied by lower scores of mobility and audibility in PAPR was identified. Further pragmatic studies are needed in order to delineate actual effectiveness and provider satisfaction with PAPR technology. SYSTEMATIC REVIEW REGISTRATION The protocol for this review was prospectively registered with the International Register of Systematic Reviews identification number CRD42020184724 .
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Affiliation(s)
| | - Andrew Silvers
- Monash Medical Centre, Clayton, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria Australia
| | - Rhonda L. Stuart
- Infection Prevention & Epidemiology, Monash Health, Clayton, Victoria Australia
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274
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Rajajee V, Williamson CA. Use of a Novel Negative-Pressure Tent During Bedside Tracheostomy in COVID-19 Patients. Neurocrit Care 2020; 33:597-603. [PMID: 32770341 PMCID: PMC7413643 DOI: 10.1007/s12028-020-01068-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/25/2020] [Indexed: 01/25/2023]
Abstract
Background Many COVID-19 patients with neurological manifestations and respiratory failure remain dependent on mechanical ventilation and require tracheostomy, which is an aerosol generating procedure (AGP). The risk of SARS-CoV-2 transmission to healthcare staff during AGPs is well documented, and negative-pressure rooms are often unavailable. Innovative techniques to decrease risk to healthcare providers during AGPs are necessary. Our objective was to demonstrate the feasibility of percutaneous dilatational tracheostomy (PDT) performed using a novel prefabricated low-cost negative-pressure tent (AerosolVE). Methods Retrospective review of consecutive PDT procedures performed by neurointensivists on intubated adult patients with COVID-19 using the AerosolVE tent during the pandemic under an innovative clinical care protocol. The AerosolVE negative-pressure tent consists of a clear plastic canopy with slits for hand access attached to a U-shaped base with air vents. Air within the tent is drawn through a high-efficiency particulate air filter and released outside. Preliminary testing during simulated AGPs demonstrated negligible escape of particulate matter beyond the tent. The main outcome measure was successful completion of PDT and bronchoscopy within the AerosolVE tent, without complications. Results The patients were a 53-year-old man with multifocal ischemic stroke and acute respiratory distress syndrome (ARDS), 53-year-old woman with cerebellar hemorrhage and ARDS, and a 69-year-old man with ARDS. Pre-procedure FiO2 requirement was 40–50% and positive end-expiratory pressure (PEEP) 8–12 cm H2O. The tent was successfully positioned around the patient and PDT completed with real-time ultrasound guidance in all 3 patients. Bronchoscopy was performed to confirm tube position and perform pulmonary toilet. No complications occurred. Conclusions It is feasible to perform PDT on intubated COVID-19 patients using the AerosolVE negative-pressure tent. This is a promising low-cost device to decrease risk to healthcare providers during AGPs.
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Affiliation(s)
- Venkatakrishna Rajajee
- Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Health Care Center, SPC 5338, Ann Arbor, MI 48109 USA
- Department of Neurology, University of Michigan, Ann Arbor, MI USA
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI USA
| | - Craig A. Williamson
- Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Health Care Center, SPC 5338, Ann Arbor, MI 48109 USA
- Department of Neurology, University of Michigan, Ann Arbor, MI USA
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI USA
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275
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Liu Z, Wu Z, Zhao H, Zuo M. Personal protective equipment during tracheal intubation in patients with COVID-19 in China: a cross-sectional survey. Br J Anaesth 2020; 125:e420-e422. [PMID: 32863017 PMCID: PMC7413108 DOI: 10.1016/j.bja.2020.07.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Zhen Liu
- Department of Anaesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Zhouyang Wu
- Department of Anaesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyu Zhao
- Department of Anaesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Mingzhang Zuo
- Department of Anaesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China.
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276
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Peng M, Ren D, Liu YF, Meng X, Wu M, Chen RL, Yu BJ, Tao LC, Chen L, Lai ZQ. Two mechanically ventilated cases of COVID-19 successfully managed with a sequential ventilation weaning protocol: Two case reports. World J Clin Cases 2020; 8:3305-3313. [PMID: 32874986 PMCID: PMC7441264 DOI: 10.12998/wjcc.v8.i15.3305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/15/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with critical coronavirus disease 2019 (COVID-19), characterized by respiratory failure requiring mechanical ventilation (MV), are at high risk of mortality. An effective and practical MV weaning protocol is needed for these fragile cases.
CASE SUMMARY Here, we present two critical COVID-19 patients who presented with fever, cough and fatigue. COVID-19 diagnosis was confirmed based on blood cell counts, chest computed tomography (CT) imaging, and nuclei acid test results. To address the patients’ respiratory failure, they first received noninvasive ventilation (NIV). When their condition did not improve after 2 h of NIV, each patient was advanced to MV [tidal volume (Vt), 6 mL/kg ideal body weight (IBW); 8-10 cmH2O of positive end-expiratory pressure; respiratory rate, 20 breaths/min; and 40%-80% FiO2] with prone positioning for 12 h/day for the first 5 d of MV. Extensive infection control measures were conducted to minimize morbidity, and pharmacotherapy consisting of an antiviral, immune-enhancer, and thrombosis prophylactic was administered in both cases. Upon resolution of lung changes evidenced by CT, the patients were sequentially weaned using a weaning screening test, spontaneous breathing test, and airbag leak test. After withdrawal of MV, the patients were transitioned through NIV and high-flow nasal cannula oxygen support. Both patients recovered well.
CONCLUSION A MV protocol attentive to intubation/extubation timing, prone positioning early in MV, infection control, and sequential withdrawal of respiratory support, may be an effective regimen for patients with critical COVID-19.
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Affiliation(s)
- Mian Peng
- Department of Intensive Care Unit, The Third Affiliated Hospital of Shenzhen University, Shenzhen 518001, Guangdong Province, China
| | - Di Ren
- Department of Intensive Care Unit, The Second People’s Hospital of Shenzhen, Shenzhen 518035, Guangdong Province, China
| | - Yong-Feng Liu
- Department of Intensive Care Unit, Shenzhen Longgang Central Hospital, Shenzhen 518116, Guangdong Province, China
| | - Xi Meng
- Department of Intensive Care Unit, The Third People’s Hospital of Shenzhen, Shenzhen 518112, Guangdong Province, China
| | - Ming Wu
- Department of Intensive Care Unit, The Second People’s Hospital of Shenzhen, Shenzhen 518035, Guangdong Province, China
| | - Rong-Lin Chen
- Department of Intensive Care Unit, Shenzhen Longgang Central Hospital, Shenzhen 518116, Guangdong Province, China
| | - Bao-Jun Yu
- Department of Intensive Care Unit, Shenzhen Baoan District People’s Hospital, Shenzhen 518101, Guangdong Province, China
| | - Long-Cheng Tao
- Department of Intensive Care Unit, The Third Affiliated Hospital of Shenzhen University, Shenzhen 518001, Guangdong Province, China
| | - Li Chen
- Department of Intensive Care Unit, The Third Affiliated Hospital of Shenzhen University, Shenzhen 518001, Guangdong Province, China
| | - Zeng-Qiao Lai
- Department of Intensive Care Unit, The Third Affiliated Hospital of Shenzhen University, Shenzhen 518001, Guangdong Province, China
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Dastan F, Saffaei A, Haseli S, Marjani M, Moniri A, Abtahian Z, Abedini A, Kiani A, Seifi S, Jammati H, Hashemian SMR, Pourabdollah Toutkaboni M, Eslaminejad A, Heshmatnia J, Sadeghi M, Nadji SA, Dastan A, Baghaei P, Varahram M, Yousefian S, Salamzadeh J, Tabarsi P. Promising effects of tocilizumab in COVID-19: A non-controlled, prospective clinical trial. Int Immunopharmacol 2020; 88:106869. [PMID: 32889241 PMCID: PMC7402206 DOI: 10.1016/j.intimp.2020.106869] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/31/2020] [Accepted: 07/31/2020] [Indexed: 01/08/2023]
Abstract
The pathophysiology of SARS-CoV-2 infection may be attributed to cytokine release syndrome. In this syndrome, interleukin 6 is released after the activation of the inflammatory cascade. The mortality rate in the current study was 16%. Tocilizumab may be a promising agent to decrease the mortality rate in severe or critical SARS-CoV-2 infection.
Background The clinical presentation of SARS-CoV-2 infection ranges from mild symptoms to severe complications, including acute respiratory distress syndrome. In this syndrome, inflammatory cytokines are released after activation of the inflammatory cascade, with the predominant role of interleukin (IL)-6. The aim of this study was to evaluate the effects of tocilizumab, as an IL-6 antagonist, in patients with severe or critical SARS-CoV-2 infection. Methods In this prospective clinical trial, 76 patients with severe or critical SARS-CoV-2 infection were evaluated for eligibility, and ultimately, 42 patients were included. Tocilizumab was administered at a dose of 400 mg as a single dose via intravenous infusion. Primary outcomes included changes in oxygenation support, need for invasive mechanical ventilation, and death. Secondary outcomes included radiological changes in the lungs, IL-6 plasma levels, C-reactive protein levels, and adverse drug reactions. The data were analyzed using SPSS software. Results Of the 42 included patients, 20 (48%) patients presented the severe infection stage and 22 (52%) were in the critical stage. The median age of patients was 56 years, and the median IL-6 level was 28.55 pg/mL. After tocilizumab administration, only 6 patients (14%) required invasive ventilation. Additionally, 35 patients (83.33%) showed clinical improvement. By day 28, a total of 7 patients died (6 patients in the critical stage and 1 patient in the severe stage). Neurological adverse effects were observed in 3 patients. Conclusions Based on the current results, tocilizumab may be a promising agent for patients with severe or critical SARS-CoV-2 infection, if promptly initiated during the severe stage.
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Affiliation(s)
- Farzaneh Dastan
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Saffaei
- Student Research Committee, Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Haseli
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Moniri
- Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Abtahian
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sharareh Seifi
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Jammati
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mihan Pourabdollah Toutkaboni
- Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Eslaminejad
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jalal Heshmatnia
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Nadji
- Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Dastan
- Ernest and Julio Gallo Management Program, School of Engineering, University of California, Merced, CA, United States
| | - Parvaneh Baghaei
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Varahram
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Yousefian
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamshid Salamzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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278
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Zaga CJ, Pandian V, Brodsky MB, Wallace S, Cameron TS, Chao C, Orloff LA, Atkins NE, McGrath BA, Lazarus CL, Vogel AP, Brenner MJ. Speech-Language Pathology Guidance for Tracheostomy During the COVID-19 Pandemic: An International Multidisciplinary Perspective. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1320-1334. [PMID: 32525695 DOI: 10.1044/2020_ajslp-20-00089] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Purpose As the COVID-19 pandemic has unfolded, there has been growing recognition of risks to frontline health care workers. When caring for patients with tracheostomy, speech-language pathologists have significant exposure to mucosal surfaces, secretions, and aerosols that may harbor the SARS-CoV-2 virus. This tutorial provides guidance on practices for safely performing patient evaluation and procedures, thereby reducing risk of infection. Method Data were collated through review of literature, guidelines, and consensus statements relating to COVID-19 and similar high-consequent infections, with a focus on mitigating risk of transmission to health care workers. Particular emphasis was placed on speech-language pathologists, nurses, and other allied health professionals. A multinational interdisciplinary team then analyzed findings, arriving at recommendations through consensus via electronic communications and video conference. Results Reports of transmission of infection to health care workers in the current COVID-19 pandemic and previous outbreaks substantiate the need for safe practices. Many procedures routinely performed by speech-language pathologists have a significant risk of infection due to aerosol generation. COVID-19 testing can inform level of protective equipment, and meticulous hygiene can stem spread of nosocomial infection. Modifications to standard clinical practice in tracheostomy are often required. Personal protective equipment, including either powered air-purifying respirator or N95 mask, gloves, goggles, and gown, are needed when performing aerosol-generating procedures in patients with known or suspected COVID-19 infection. Conclusions Speech-language pathologists are often called on to assist in the care of patients with tracheostomy and known or suspected COVID-19 infection. Appropriate care of these patients is predicated on maintaining the health and safety of the health care team. Careful adherence to best practices can significantly reduce risk of infectious transmission.
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Affiliation(s)
- Charissa J Zaga
- Department of Speech Pathology, Austin Health, Melbourne, Victoria, Australia
- Centre for Neuroscience of Speech, University of Melbourne, Victoria, Australia
- Tracheostomy Review and Management Service, Austin Health, Melbourne, Victoria, Australia
| | - Vinciya Pandian
- Department of Nursing Faculty, Johns Hopkins University, Baltimore, MD
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD
| | - Martin B Brodsky
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Sarah Wallace
- Department of Speech Voice and Swallowing, Manchester University NHS Foundation Trust, United Kingdom
| | - Tanis S Cameron
- Tracheostomy Review and Management Service, Austin Health, Melbourne, Victoria, Australia
| | - Caroline Chao
- Tracheostomy Review and Management Service, Austin Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
| | - Lisa Ann Orloff
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, CA
| | - Naomi E Atkins
- Department of Respiratory Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Brendan A McGrath
- Anaesthetics & Intensive Care Medicine, Manchester University NHS Foundation Trust, United Kingdom
| | - Cathy L Lazarus
- Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adam P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Victoria, Australia
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tübingen, Germany
- Redenlab, Melbourne, Victoria, Australia
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor
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279
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Windisch W, Weber-Carstens S, Kluge S, Rossaint R, Welte T, Karagiannidis C. Invasive and Non-Invasive Ventilation in Patients With COVID-19. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:528-533. [PMID: 32900426 PMCID: PMC7658682 DOI: 10.3238/arztebl.2020.0528] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/02/2020] [Accepted: 06/25/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The reported high mortality of COVID-19 patients in intensive care has given rise to a debate over whether patients with this disease are being intubated too soon and might instead benefit from more non-invasive ventilation. METHODS This review is based on articles published up to 12 June 2020 that were retrieved by a selective literature search on the topic of invasive and non-invasive ventilation for respiratory failure in COVID-19. Guideline recommendations and study data on patients with respiratory failure in settings other than COVID-19 are also considered, as are the current figures of the intensive care registry of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin). RESULTS The high mortality figures among patients receiving invasive ventilation that have been reported in studies from abroad cannot be uncritically applied to the current situation in Germany. Study data on ventilation specifically in COVID-19 patients would be needed to do justice to the special pathophysiology of this disease, but such data are lacking. Being intubated too early is evidently associated with risks for the patient, but being intubated too late is as well. A particularly im - portant consideration is the potential harm associated with prolonged spontaneous breathing, with or without non-invasive assistance, as any increase in respiratory work can seriously worsen respiratory failure. On the other hand, it is clearly unacceptable to intubate patients too early merely out of concern that the medical staff might become infected with COVID-19 if they were ventilated non-invasively. CONCLUSION Nasal high flow, non-invasive ventilation, and invasive ventilation with intubation should be carried out in a stepwise treatment strategy, under appropriate intensive-care monitoring and with the observance of all relevant anti-infectious precautions. Germany is better prepared that other countries to provide COVID-19 patients with appropriate respiratory care, in view of the high per capita density of intensive-care beds and the availability of a nationwide, interdisciplinary intensive care registry for the guidance and coordination of intensive care in patients who need it.
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Affiliation(s)
- Wolfram Windisch
- Department of Respiratory Medicine, Kliniken der Stadt Köln gGmbH, University of Witten/Herdecke
| | - Steffen Weber-Carstens
- Surgical Intensive Care, Department of Anesthesiology, Charité University Medical Center, Berlin
| | - Stefan Kluge
- Department of Intensive Care, University Medical Center Hamburg-Eppendorf
| | - Rolf Rossaint
- Department of Anesthesiology, University Medical Center Aachen, RWTH Aachen University
| | - Tobias Welte
- Director of Patient Care at MHH, The German Center for Lung Research, University Medical School Hanover (MHH), Hanover
| | - Christian Karagiannidis
- Department of Respiratory Medicine, Kliniken der Stadt Köln gGmbH, University of Witten/Herdecke
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280
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Chien LC, Beÿ CK, Koenig KL. A Positive-Pressure Environment Disposable Shield (PEDS) for COVID-19 Health Care Worker Protection. Prehosp Disaster Med 2020; 35:434-437. [PMID: 32398188 PMCID: PMC7298103 DOI: 10.1017/s1049023x20000643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has strained health care system resources and reduced the availability of life-sustaining and medical-grade personal protective equipment (PPE) though the combination of increased demand and disrupted manufacturing supply chains. As a result of these shortages, many health care providers have temporarily used largely untested, improvised PPE (iPPE). Lack of quality control for makeshift PPE and frequent repurposing of used items to conserve supplies increase both the risk of provider infection and nosocomial spread to uninfected patients. One strategy to reduce risk of infection and preserve existing equipment is the implementation of secondary barrier devices placed directly over patients or providers. The authors describe an inexpensive, disposable, positive-pressure head isolation unit that can be rapidly constructed from materials readily available in nearly all health care settings for under five US dollars. The unit was successfully deployed in Taiwan during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, and again during the COVID-19 pandemic. The iPPE worn directly by the health care workers (HCWs) can be donned prior to patient contact in the presence of an air source. This strategy may be more protective than a covering placed over the patient in an aerosol-generating environment, which requires the HCW to be in close contact with the patient prior to securing the protective device.
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Affiliation(s)
- Li-Chien Chien
- Disaster Division, Emergency Department, Taipei City Hospital; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei City, Taiwan
| | | | - Kristi L. Koenig
- County of San Diego, Health & Human Services Agency, Emergency Medical Services, San Diego, CaliforniaUSA
- University of California Irvine, Department of Emergency Medicine, Orange, CaliforniaUSA
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281
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Sajayan A, Arora N, Williamson A, Nair A. COVID intubation team (CIT)- an experience at a tertiary UK centre. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2020; 33:27-29. [PMID: 38620254 PMCID: PMC7286253 DOI: 10.1016/j.tacc.2020.05.004] [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: 05/18/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Achuthan Sajayan
- University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom
- Consultant Anaesthetist, United Kingdom
| | - Nitin Arora
- University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom
- Consultant in Anaesthesia and Intensive Care, United Kingdom
| | - Alastair Williamson
- University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom
- Consultant Anaesthetist, United Kingdom
| | - Ashok Nair
- University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2TH, United Kingdom
- Consultant Anaesthetist, United Kingdom
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282
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Zeidan A, Bamadhaj M, Al-Faraidy M, Ali M. Videolaryngoscopy Intubation in Patients with COVID-19: How to Minimize Risk of Aerosolization? Anesthesiology 2020; 133:481-483. [PMID: 32427641 PMCID: PMC7255395 DOI: 10.1097/aln.0000000000003389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ahed Zeidan
- King Fahad Specialist Hospital, Dammam, Saudi Arabia. (A.Z.).
| | - Munir Bamadhaj
- King Fahad Specialist Hospital, Dammam, Saudi Arabia. (A.Z.).
| | - Mona Al-Faraidy
- King Fahad Specialist Hospital, Dammam, Saudi Arabia. (A.Z.).
| | - Mohiidin Ali
- King Fahad Specialist Hospital, Dammam, Saudi Arabia. (A.Z.).
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283
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Ballesteros Sanz MÁ, Hernández-Tejedor A, Estella Á, Jiménez Rivera JJ, González de Molina Ortiz FJ, Sandiumenge Camps A, Vidal Cortés P, de Haro C, Aguilar Alonso E, Bordejé Laguna L, García Sáez I, Bodí M, García Sánchez M, Párraga Ramírez MJ, Alcaraz Peñarrocha RM, Amézaga Menéndez R, Burgueño Laguía P. [Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)]. Med Intensiva 2020; 44:371-388. [PMID: 32360034 PMCID: PMC7142677 DOI: 10.1016/j.medin.2020.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]
Abstract
On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.
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Affiliation(s)
- M Á Ballesteros Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | | | - Á Estella
- Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
| | - J J Jiménez Rivera
- Servicio de Medicina Intensiva, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España
| | | | - A Sandiumenge Camps
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - P Vidal Cortés
- Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - C de Haro
- Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Medicina Intensiva, CIBERES Enfermedades Respiratorias, Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - E Aguilar Alonso
- Servicio de Medicina Intensiva, Hospital Infanta Margarita, Cabra, Córdoba, España
| | - L Bordejé Laguna
- Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - I García Sáez
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, España
| | - M Bodí
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
| | - M García Sánchez
- Servicio de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M J Párraga Ramírez
- Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | | | - R Amézaga Menéndez
- Servicio de Medicina Intensiva, Hospital Universitari Son Espases, Palma, Islas Baleares, España
| | - P Burgueño Laguía
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
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284
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Rubulotta F, Soliman-Aboumarie H, Filbey K, Geldner G, Kuck K, Ganau M, Hemmerling TM. Technologies to Optimize the Care of Severe COVID-19 Patients for Health Care Providers Challenged by Limited Resources. Anesth Analg 2020. [PMID: 32433248 DOI: 10.1213/ane.0000000000004985.pmid:32433248;pmcid:pmc7258840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.
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Affiliation(s)
- Francesca Rubulotta
- From the Department of Anaesthesia and Intensive Care Medicine, Imperial College London, London, United Kingdom
| | - Hatem Soliman-Aboumarie
- Department of Anaesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Kevin Filbey
- Department of Anesthesia, Intensive Care Medicine, Chronic Pain and Emergency Medicine, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Goetz Geldner
- Department of Anesthesia, Intensive Care Medicine, Chronic Pain and Emergency Medicine, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Kai Kuck
- Department of Anesthesiology and Bioengineering, University of Utah, Salt Lake City, Utah
| | - Mario Ganau
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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285
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Ballesteros Sanz M, Hernández-Tejedor A, Estella Á, Jiménez Rivera J, González de Molina Ortiz F, Sandiumenge Camps A, Vidal Cortés P, de Haro C, Aguilar Alonso E, Bordejé Laguna L, García Sáez I, Bodí M, García Sánchez M, Párraga Ramírez M, Alcaraz Peñarrocha R, Amézaga Menéndez R, Burgueño Laguía P. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19). MEDICINA INTENSIVA (ENGLISH EDITION) 2020. [PMCID: PMC7340388 DOI: 10.1016/j.medine.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.
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286
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Anand P, Slama MCC, Kaku M, Ong C, Cervantes‐Arslanian AM, Zhou L, David WS, Guidon AC. COVID-19 in patients with myasthenia gravis. Muscle Nerve 2020; 62:254-258. [PMID: 32392389 PMCID: PMC7272991 DOI: 10.1002/mus.26918] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic, but little is known about its potential impact on patients with myasthenia gravis (MG). METHODS We studied the clinical course of COVID-19 in five hospitalized patients with autoimmune MG (four with acetylcholine receptor antibodies, one with muscle-specific tyrosine kinase antibodies) between April 1, 2020-April 30-2020. RESULTS Two patients required intubation for hypoxemic respiratory failure, whereas one required significant supplemental oxygen. One patient with previously stable MG had myasthenic exacerbation. One patient treated with tocilizumab for COVID-19 was successfully extubated. Two patients were treated for MG with intravenous immunoglobulin without thromboembolic complications. DISCUSSION Our findings suggest that the clinical course and outcomes in patients with MG and COVID-19 are highly variable. Further large studies are needed to define best practices and determinants of outcomes in this unique population.
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Affiliation(s)
- Pria Anand
- Department of NeurologyBoston University Medical CenterBostonMassachusetts
| | - Michaël C. C. Slama
- Department of NeurologyMassachusetts General HospitalBostonMassachusetts
- Department of NeurologyBrigham and Women's HospitalBostonMassachusetts
| | - Michelle Kaku
- Department of NeurologyBoston University Medical CenterBostonMassachusetts
| | - Charlene Ong
- Department of NeurologyBoston University Medical CenterBostonMassachusetts
| | | | - Lan Zhou
- Department of NeurologyBoston University Medical CenterBostonMassachusetts
| | - William S. David
- Department of NeurologyMassachusetts General HospitalBostonMassachusetts
| | - Amanda C. Guidon
- Department of NeurologyMassachusetts General HospitalBostonMassachusetts
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287
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Zhang L, Xiong L, Meng L. Intubation and Ventilation amid COVID-19: Reply. Anesthesiology 2020; 133:465-466. [PMID: 32371758 PMCID: PMC7223572 DOI: 10.1097/aln.0000000000003375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Lina Zhang
- Shanghai Fourth People’s Hospital, Tongji University School of Medicine, Shanghai, China (L.X.).
| | - Lize Xiong
- Shanghai Fourth People’s Hospital, Tongji University School of Medicine, Shanghai, China (L.X.).
| | - Lingzhong Meng
- Shanghai Fourth People’s Hospital, Tongji University School of Medicine, Shanghai, China (L.X.).
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288
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Risk stratification in patients undergoing nonoperating room anesthesia. Curr Opin Anaesthesiol 2020; 33:571-576. [DOI: 10.1097/aco.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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289
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Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P, Cairo M, Mori S, Messinesi G, Contro E, Bonfanti P, Benini A, Valsecchi MG, Antolini L, Foti G. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. THE LANCET. RESPIRATORY MEDICINE 2020; 8:765-774. [PMID: 32569585 PMCID: PMC7304954 DOI: 10.1016/s2213-2600(20)30268-x] [Citation(s) in RCA: 318] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic is challenging advanced health systems, which are dealing with an overwhelming number of patients in need of intensive care for respiratory failure, often requiring intubation. Prone positioning in intubated patients is known to reduce mortality in moderate-to-severe acute respiratory distress syndrome. We aimed to investigate feasibility and effect on gas exchange of prone positioning in awake, non-intubated patients with COVID-19-related pneumonia. METHODS In this prospective, feasibility, cohort study, patients aged 18-75 years with a confirmed diagnosis of COVID-19-related pneumonia receiving supplemental oxygen or non-invasive continuous positive airway pressure were recruited from San Gerardo Hospital, Monza, Italy. We collected baseline data on demographics, anthropometrics, arterial blood gas, and ventilation parameters. After baseline data collection, patients were helped into the prone position, which was maintained for a minimum duration of 3 h. Clinical data were re-collected 10 min after prone positioning and 1 h after returning to the supine position. The main study outcome was the variation in oxygenation (partial pressure of oxygen [PaO2]/fractional concentration of oxygen in inspired air [FiO2]) between baseline and resupination, as an index of pulmonary recruitment. This study is registered on ClinicalTrials.gov, NCT04365959, and is now complete. FINDINGS Between March 20 and April 9, 2020, we enrolled 56 patients, of whom 44 (79%) were male; the mean age was 57·4 years (SD 7·4) and the mean BMI was 27·5 kg/m2 (3·7). Prone positioning was feasible (ie, maintained for at least 3 h) in 47 patients (83·9% [95% CI 71·7 to 92·4]). Oxygenation substantially improved from supine to prone positioning (PaO2/FiO2 ratio 180·5 mm Hg [SD 76·6] in supine position vs 285·5 mm Hg [112·9] in prone position; p<0·0001). After resupination, improved oxygenation was maintained in 23 patients (50·0% [95% CI 34·9-65·1]; ie, responders); however, this improvement was on average not significant compared with before prone positioning (PaO2/FiO2 ratio 192·9 mm Hg [100·9] 1 h after resupination; p=0·29). Patients who maintained increased oxygenation had increased levels of inflammatory markers (C-reactive protein: 12·7 mg/L [SD 6·9] in responders vs 8·4 mg/L [6·2] in non-responders; and platelets: 241·1 × 103/μL [101·9] vs 319·8 × 103/μL [120·6]) and shorter time between admission to hospital and prone positioning (2·7 days [SD 2·1] in responders vs 4·6 days [3·7] in non-responders) than did those for whom improved oxygenation was not maintained. 13 (28%) of 46 patients were eventually intubated, seven (30%) of 23 responders and six (26%) of 23 non-responders (p=0·74). Five patients died during follow-up due to underlying disease, unrelated to study procedure. INTERPRETATION Prone positioning was feasible and effective in rapidly ameliorating blood oxygenation in awake patients with COVID-19-related pneumonia requiring oxygen supplementation. The effect was maintained after resupination in half of the patients. Further studies are warranted to ascertain the potential benefit of this technique in improving final respiratory and global outcomes. FUNDING University of Milan-Bicocca.
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Affiliation(s)
- Anna Coppo
- Department of Emergency Medicine, San Gerardo Hospital, Monza, Italy
| | - Giacomo Bellani
- Department of Emergency Medicine, San Gerardo Hospital, Monza, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
| | - Dario Winterton
- Department of Emergency Medicine, San Gerardo Hospital, Monza, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Michela Di Pierro
- Department of Emergency Medicine, San Gerardo Hospital, Monza, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Alessandro Soria
- Clinic of Infectious Diseases, San Gerardo Hospital, Monza, Italy
| | - Paola Faverio
- Respiratory Unit, San Gerardo Hospital, Monza, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Matteo Cairo
- Department of Emergency Medicine, San Gerardo Hospital, Monza, Italy
| | - Silvia Mori
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | | | - Ernesto Contro
- Department of Emergency Medicine, San Gerardo Hospital, Monza, Italy
| | - Paolo Bonfanti
- Clinic of Infectious Diseases, San Gerardo Hospital, Monza, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Annalisa Benini
- Department of Emergency Medicine, San Gerardo Hospital, Monza, Italy
| | | | - Laura Antolini
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Giuseppe Foti
- Department of Emergency Medicine, San Gerardo Hospital, Monza, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
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290
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Cothran TP, Kellman S, Singh S, Beck JS, Powell KJ, Bolton CJ, Tam JW. A brewing storm: The neuropsychological sequelae of hyperinflammation due to COVID-19. Brain Behav Immun 2020; 88:957-958. [PMID: 32590055 PMCID: PMC7309913 DOI: 10.1016/j.bbi.2020.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Thomas P. Cothran
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Boulevard, Suite 400, Chicago, IL, 60612, USA,Corresponding author
| | - Suzanne Kellman
- Elmhurst Anesthesiologists, PC, Elmhurst Memorial Hospital, 155 E. Brush Hill Road, Elmhurst, IL, 60126, USA
| | - Shifali Singh
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Boulevard, Suite 400, Chicago, IL, 60612, USA
| | - Jonathan S. Beck
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Boulevard, Suite 400, Chicago, IL, 60612, USA
| | - Karina J. Powell
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Boulevard, Suite 400, Chicago, IL, 60612, USA
| | - Corey J. Bolton
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Boulevard, Suite 400, Chicago, IL, 60612, USA
| | - Joyce W. Tam
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Boulevard, Suite 400, Chicago, IL, 60612, USA
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291
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Abstract
As the COVID-19 pandemic has unfolded, there has been growing recognition of risks to the anesthesia and surgical teams that require careful consideration to ensure optimal patient care. Airway management and other head and neck procedures risk exposure to mucosal surfaces, secretions, droplets, and aerosols that may harbor the SARS-CoV-2 virus. This review provides guidance on optimal practice approaches for performing patient evaluation and management of head and neck procedures with the shared goal of providing safe and effective patient care while minimizing the risk of viral transmission.
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292
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Singh GP, Hrishi AP, Rath GP. Emergency neurological procedures during COVID-19 pandemic: Practical issues. J Anaesthesiol Clin Pharmacol 2020; 36:S104-S109. [PMID: 33100657 PMCID: PMC7574009 DOI: 10.4103/joacp.joacp_243_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/20/2020] [Accepted: 06/07/2020] [Indexed: 12/02/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) has emerged as a global pandemic. A significant number of these patients would present to hospitals with neurological manifestations and neurosurgical emergencies requiring urgent treatment. The anesthesiologists should be prepared to manage these cases in an efficient and timely manner in the operating room, intensive care units, and interventional neuroradiology suites. The clinical course of the disease is in an evolving stage. As we acquire more knowledge about COVID-19, new recommendations and guidelines are being formulated and regularly updated. This article discusses the anesthetic management of urgent neurosurgical and neurointerventional procedures. In addition, a brief overview of intrahospital transport of neurologically injured patients has been addressed.
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Affiliation(s)
- Gyaninder Pal Singh
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ajay Prasad Hrishi
- Division of Neuroanaesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - Girija Prasad Rath
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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293
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Drum E, McClung Pasqualino H, Subramanyam R. Anesthesia and potential aerosol generation during magnetic resonance imaging in children with COVID-19. Paediatr Anaesth 2020; 30:944-946. [PMID: 32564492 PMCID: PMC7323391 DOI: 10.1111/pan.13951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Elizabeth Drum
- Department of Anesthesiology and Critical Care MedicinePerelman School of MedicineChildren's Hospital of PhiladelphiaUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Heather McClung Pasqualino
- Department of Anesthesiology and Critical Care MedicinePerelman School of MedicineChildren's Hospital of PhiladelphiaUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Rajeev Subramanyam
- Department of Anesthesiology and Critical Care MedicinePerelman School of MedicineChildren's Hospital of PhiladelphiaUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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294
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Rubulotta F, Soliman-Aboumarie H, Filbey K, Geldner G, Kuck K, Ganau M, Hemmerling TM. Technologies to Optimize the Care of Severe COVID-19 Patients for Health Care Providers Challenged by Limited Resources. Anesth Analg 2020; 131:351-364. [PMID: 32433248 PMCID: PMC7258840 DOI: 10.1213/ane.0000000000004985] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 12/13/2022]
Abstract
Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.
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Affiliation(s)
- Francesca Rubulotta
- From the Department of Anaesthesia and Intensive Care Medicine, Imperial College London, London, United Kingdom
| | - Hatem Soliman-Aboumarie
- Department of Anaesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Kevin Filbey
- Department of Anesthesia, Intensive Care Medicine, Chronic Pain and Emergency Medicine, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Goetz Geldner
- Department of Anesthesia, Intensive Care Medicine, Chronic Pain and Emergency Medicine, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Kai Kuck
- Department of Anesthesiology and Bioengineering, University of Utah
| | - Mario Ganau
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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295
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Leonardi A, Scipione R, Alfieri G, Petrillo R, Dolciami M, Ciccarelli F, Perotti S, Cartocci G, Scala A, Imperiale C, Iafrate F, Francone M, Catalano C, Ricci P. Role of computed tomography in predicting critical disease in patients with covid-19 pneumonia: A retrospective study using a semiautomatic quantitative method. Eur J Radiol 2020; 130:109202. [PMID: 32745895 PMCID: PMC7388797 DOI: 10.1016/j.ejrad.2020.109202] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
Background So far, only a few studies evaluated the correlation between CT features and clinical outcome in patients with COVID-19 pneumonia. Purpose To evaluate CT ability in differentiating critically ill patients requiring invasive ventilation from patients with less severe disease. Methods We retrospectively collected data from patients admitted to our institution for COVID-19 pneumonia between March 5th-24th. Patients were considered critically ill or non-critically ill, depending on the need for mechanical ventilation. CT images from both groups were analyzed for the assessment of qualitative features and disease extension, using a quantitative semiautomatic method. We evaluated the differences between the two groups for clinical, laboratory and CT data. Analyses were conducted on a per-protocol basis. Results 189 patients were analyzed. PaO2/FIO2 ratio and oxygen saturation (SaO2) were decreased in critically ill patients. At CT, mixed pattern (ground glass opacities (GGO) and consolidation) and GGO alone were more frequent respectively in critically ill and in non-critically ill patients (p < 0.05). Lung volume involvement was significantly higher in critically ill patients (38.5 % vs. 5.8 %, p < 0.05). A cut-off of 23.0 % of lung involvement showed 96 % sensitivity and 96 % specificity in distinguishing critically ill patients from patients with less severe disease. The fraction of involved lung was related to lactate dehydrogenase (LDH) levels, PaO2/FIO2 ratio and SaO2 (p < 0.05). Conclusion Lung disease extension, assessed using quantitative CT, has a significant relationship with clinical severity and may predict the need for invasive ventilation in patients with COVID-19.
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Affiliation(s)
- Andrea Leonardi
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Roberto Scipione
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Giulia Alfieri
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Roberta Petrillo
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Fabio Ciccarelli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Stefano Perotti
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Gaia Cartocci
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Annarita Scala
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Carmela Imperiale
- Department of Emergency and Acceptance, Anesthesiology and Intensive Care Unit, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Franco Iafrate
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Paolo Ricci
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy.
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296
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Dhont S, Derom E, Van Braeckel E, Depuydt P, Lambrecht BN. The pathophysiology of 'happy' hypoxemia in COVID-19. Respir Res 2020; 21:198. [PMID: 32723327 PMCID: PMC7385717 DOI: 10.1186/s12931-020-01462-5] [Citation(s) in RCA: 284] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic is a global crisis, challenging healthcare systems worldwide. Many patients present with a remarkable disconnect in rest between profound hypoxemia yet without proportional signs of respiratory distress (i.e. happy hypoxemia) and rapid deterioration can occur. This particular clinical presentation in COVID-19 patients contrasts with the experience of physicians usually treating critically ill patients in respiratory failure and ensuring timely referral to the intensive care unit can, therefore, be challenging. A thorough understanding of the pathophysiological determinants of respiratory drive and hypoxemia may promote a more complete comprehension of a patient's clinical presentation and management. Preserved oxygen saturation despite low partial pressure of oxygen in arterial blood samples occur, due to leftward shift of the oxyhemoglobin dissociation curve induced by hypoxemia-driven hyperventilation as well as possible direct viral interactions with hemoglobin. Ventilation-perfusion mismatch, ranging from shunts to alveolar dead space ventilation, is the central hallmark and offers various therapeutic targets.
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Affiliation(s)
- Sebastiaan Dhont
- Department of Internal Medicine and Paediatrics, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Eric Derom
- Department of Internal Medicine and Paediatrics, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Eva Van Braeckel
- Department of Internal Medicine and Paediatrics, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Pieter Depuydt
- Department of Internal Medicine and Paediatrics, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Bart N Lambrecht
- Department of Internal Medicine and Paediatrics, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- VIB-UGent Center for Inflammation Research, Ghent, Belgium
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297
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Novel technique using surgical scrub sponges to protect the nose and face during prone ventilation for coronavirus disease 2019. The Journal of Laryngology & Otology 2020; 134:735-738. [PMID: 32718361 PMCID: PMC7419742 DOI: 10.1017/s0022215120001590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Coronavirus disease 2019 is an international pandemic. One of the cardinal features is acute respiratory distress syndrome, and proning has been identified as beneficial for a subset of patients. However, proning is associated with pressure-related side effects, including injury to the nose and face. Method This paper describes a pressure-relieving technique using surgical scrub sponges. This technique was derived based on previous methods used in patients following rhinectomy. Conclusion The increased use of prone ventilation has resulted in a number of referrals to the ENT team with concerns regarding nasal pressure damage. The described technique, which is straightforward and uses readily available materials, has proven effective in relieving pressure in a small number of patients.
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298
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Setlur R, Jaiswal A, Jahan N. Preventing exposure to COVID-19 in the operation theatre and intensive care unit. J Anaesthesiol Clin Pharmacol 2020; 36:S127-S133. [PMID: 33100662 PMCID: PMC7574012 DOI: 10.4103/joacp.joacp_213_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has gripped the world since January 2020 and has changed our lives in unprecedented ways. It has changed the way we work in the Operation Theatres and Intensive Care Units mainly because of the high risk of disease transmission to the healthcare workers. In order to reduce the risk of disease transmission, an understanding of the means of transmission of the virus is essential to develop a rational strategy that allows patients to receive treatment without placing either the patient or healthcare workers at risk. It should be cautioned that this is a rapidly changing field and there is a paucity of randomised controlled trials related to various aspects of the disease. It is therefore advisable to revise any recommendations in this article, as and when new evidence emerges.
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Affiliation(s)
- Rangraj Setlur
- Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Alok Jaiswal
- Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Nikahat Jahan
- Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
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299
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Zheng P, Zhou R, Yin L, Yin X, Mao Y, Wang H, Ye L, Zhu T. Emergency Response Measures for Anesthesia Nursing During the COVID-19 Pandemic: West China Hospital Experiences. Front Med (Lausanne) 2020; 7:460. [PMID: 32793621 PMCID: PMC7387662 DOI: 10.3389/fmed.2020.00460] [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: 04/16/2020] [Accepted: 07/09/2020] [Indexed: 02/05/2023] Open
Abstract
During the COVID-19 pandemic, ensuring the gradual recovery of anesthesia nursing unit and avoiding cross-infection between surgical patients and staff are difficult problems for hospital managers. We outlined the emergency response measures and the transition to normal operation of the anesthesia nursing unit in West China Hospital, which is a large teaching hospital. This mainly included hospital and operating room channel management, three-level screening management of patients and medical staff, classification management of patients undergoing anesthesia and recovery, training management of medical personnel, strict environmental management, and online teaching management.
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Affiliation(s)
- Ping Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Ruihao Zhou
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Yin
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaorong Yin
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Yongqiao Mao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Heng Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Ling Ye
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
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300
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Meng L, McDonagh DL. Impact of Coronavirus and Covid-19 on Present and Future Anesthesiology Practices. Front Med (Lausanne) 2020; 7:452. [PMID: 32793617 PMCID: PMC7385134 DOI: 10.3389/fmed.2020.00452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/08/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Lingzhong Meng
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, United States
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, United States
- *Correspondence: Lingzhong Meng
| | - David L. McDonagh
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, United States
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, United States
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