351
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Patel V, Jimenez E, Cornwell L, Tran T, Paniagua D, Denktas AE, Chou A, Hankins SJ, Bozkurt B, Rosengart TK, Jneid H. Cardiac Surgery During the Coronavirus Disease 2019 Pandemic: Perioperative Considerations and Triage Recommendations. J Am Heart Assoc 2020; 9:e017042. [PMID: 32418460 PMCID: PMC7670528 DOI: 10.1161/jaha.120.017042] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The coronavirus disease 2019 pandemic, caused by severe acute respiratory syndrome coronavirus‐2, represents the third human affliction attributed to the highly pathogenic coronavirus in the current century. Because of its highly contagious nature and unprecedented global spread, its aggressive clinical presentation, and the lack of effective treatment, severe acute respiratory syndrome coronavirus‐2 infection is causing the loss of thousands of lives and imparting unparalleled strain on healthcare systems around the world. In the current report, we discuss perioperative considerations for patients undergoing cardiac surgery and provide clinicians with recommendations to effectively triage and plan these procedures during the coronavirus disease 2019 outbreak. This will help reduce the risk of exposure to patients and healthcare workers and allocate resources appropriately to those in greatest need. We include an algorithm for preoperative testing for coronavirus disease 2019, personal protective equipment recommendations, and a classification system to categorize and prioritize common cardiac surgery procedures.
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Affiliation(s)
- Vivek Patel
- Department of Cardiothoracic Surgery Baylor College of Medicine Houston TX
| | - Ernesto Jimenez
- Department of Cardiothoracic Surgery Baylor College of Medicine Houston TX
| | - Lorraine Cornwell
- Department of Cardiothoracic Surgery Baylor College of Medicine Houston TX
| | - Trung Tran
- Department of Cardiothoracic Surgery Baylor College of Medicine Houston TX
| | | | | | - Andrew Chou
- Infectious Disease Baylor College of Medicine Houston TX
| | | | | | - Todd K Rosengart
- Department of Cardiothoracic Surgery Baylor College of Medicine Houston TX
| | - Hani Jneid
- Cardiology Baylor College of Medicine Houston TX
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352
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Abstract
My colleague asked, “Do you remember that patient?” I froze because, like most emergency physicians, this phrase haunts me. It was the early days of the COVID-19 epidemic, and the story that followed was upsetting. A patient who looked comfortable when I admitted him was intubated hours later by the rapid response team who was called to the floor. All I could think was, “But he looked so comfortable when I admitted him; he was just on a couple of liters of oxygen. Why was he intubated?”
In the days after COVID-19 arrived in our region, there were many such stories of patients sent to the floor from the Emergency Department who were intubated shortly after admission. Many of those patients subsequently endured prolonged and complicated courses on the ventilator. While we would typically use noninvasive modalities such as high-flow nasal cannula (HFNC) or noninvasive ventilation (NIV) for acute respiratory failure, our quickness to intubate was driven by two factors: (1) early reports that noninvasive modalities posed a high risk of failure and subsequent intubation and (2) fear that HFNC and NIV would aerosolize SARS-CoV-2 and unnecessarily expose the heath care team.1 We would soon find out that our thinking was flawed on both accounts.
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353
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Prescribing COVID-19 treatments: what we should never forget. J Infect 2020; 81:e85. [PMID: 32405110 PMCID: PMC7219411 DOI: 10.1016/j.jinf.2020.05.018] [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: 04/28/2020] [Revised: 05/03/2020] [Accepted: 05/10/2020] [Indexed: 01/03/2023]
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354
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Affiliation(s)
- Giovanni Grasso
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Sunil Munakomi
- Department of Neurosurgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
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355
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Patwa A, Shah A, Garg R, Divatia JV, Kundra P, Doctor JR, Shetty SR, Ahmed SM, Das S, Myatra SN. All India difficult airway association (AIDAA) consensus guidelines for airway management in the operating room during the COVID-19 pandemic. Indian J Anaesth 2020; 64:S107-S115. [PMID: 32773848 PMCID: PMC7293372 DOI: 10.4103/ija.ija_498_20] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023] Open
Abstract
Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) which causes coronavirus disease (COVID-19) is a highly contagious virus. The closed environment of the operation room (OR) with aerosol generating airway management procedures increases the risk of transmission of infection among the anaesthesiologists and other OR personnel. Wearing complete, fluid impermeable personal protective equipment (PPE) for airway related procedures is recommended. Team preparation, clear methods of communication and appropriate donning and doffing of PPEs are essential to prevent spread of the infection. Optimal pre oxygenation, rapid sequence induction and video laryngoscope aided tracheal intubation (TI) are recommended. Supraglottic airways (SGA) and surgical cricothyroidotomy should be preferred for airway rescue. High flow nasal oxygen, face mask ventilation, nebulisation, small bore cannula cricothyroidotomy with jet ventilation should be avoided. Tracheal extubation should be conducted with the same levels of precaution as TI. The All India Difficult Airway Association (AIDAA) aims to provide consensus guidelines for safe airway management in the OR, while attempting to prevent transmission of infection to the OR personnel during the COVID-19 pandemic.
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Affiliation(s)
- Apeksh Patwa
- Chief Consultant Anesthesiologist, Kailash Cancer Hospital and Research Centre, Muni Ashram, Goraj, VINS, Vadodara, Gujarat, India
| | - Amit Shah
- Chief Consultant Anesthesiologist, Kailash Cancer Hospital and Research Centre, Muni Ashram, Goraj, VINS, Vadodara, Gujarat, India
| | - Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Jigeeshu Vasishtha Divatia
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Pankaj Kundra
- Department of Anaesthesiology, JIPMER, Puducherry, India
| | - Jeson Rajan Doctor
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sumalatha Radhakrishna Shetty
- Department of Anaesthesiology and Critical Care, K S Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Syed Moied Ahmed
- Department of Anaesthesiology and Critical Care, J N Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Sabyasachi Das
- Professor of Anaesthesiology, Medical College, Kolkata, West Bengal, India
| | - Sheila Nainan Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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356
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Dabrowska D, Lock GJ. Staying Ahead of the Curve: Modified Approach to Emergency Caesarean Section Under General Anaesthesia in COVID-19 Pandemic. Turk J Anaesthesiol Reanim 2020; 48:174-179. [PMID: 32551443 PMCID: PMC7279880 DOI: 10.5152/tjar.2020.280420] [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] [Received: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 11/22/2022] Open
Abstract
The recent outbreak of SARS-CoV-2 has prompted healthcare professionals to re-design and modify the standards of care and operating procedures relevant to dealing with suspected or confirmed cases of COVID-19. The aim of this review is to highlight the key recommendations related to obstetric anaesthesia from scientific bodies in the United Kingdom and United States and to summarize recently developed and implemented clinical pathways for care of obstetric patients – specifically those requiring urgent general anaesthesia for caesarean section within a large maternity unit in London. The need to perform an emergency operative delivery in a timely manner while ensuring clinicians are suitably equipped and protected represents a uniquely challenging scenario, given the higher risk of viral transmission with aerosol generating procedures. In these settings, emphasis needs to be put on meticulous preparation, safety checklists and specific equipment and staffing adjustments. We present a structured framework comprised of four critical steps aimed to facilitate the development of local strategies and protocols.
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Affiliation(s)
- Dominika Dabrowska
- Department of Anaesthetics and Intensive Care, West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Gareth John Lock
- Department of Obstetrics and Gynaecology, West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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357
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Adelaja I, Sayma M, Walton H, McLachlan G, de Boisanger J, Bartlett-Pestell S, Roche E, Gandhi V, Wilson GJ, Brookes Z, Yeen Fung C, Macfarlane H, Navaratnam A, James C, Scolding P, Sara H. A comprehensive hospital agile preparedness (CHAPs) tool for pandemic preparedness, based on the COVID-19 experience. Future Healthc J 2020; 7:165-168. [PMID: 32550286 DOI: 10.7861/fhj.2020-0030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
COVID-19 presents an unprecedented challenge to hospitals and the systems in which they operate. The primary exponential surge of COVID-19 cases is arguably the most devastating event a hospital will face. In some countries, these surges during the initial outbreak of the disease have resulted in hospitals suffering from significant resource strain, leading to excess patient mortality and negatively impacting staff wellbeing. As experience builds in managing these surges, it has become evident that agile, tailored planning tools are required. The comprehensive hospital agile preparedness (CHAPs) tool provides clinical planners with six key domains to consider that frequently create resource strain during COVID-19; it also allows local planners to identify issues unique to their hospital, system or region. Although this tool has been developed from COVID-19 experiences, it has potential to be modified for a variety of pandemic scenarios according to transmission modes, rates and critical care resource requirements.
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Affiliation(s)
| | | | - Henry Walton
- NHS England and NHS Improvement, London, UK, and A&E registrar, Barts Health NHS Trust, London, UK
| | | | | | | | - Emma Roche
- NHS England and NHS Improvement, London, UK
| | | | | | | | | | | | | | | | | | - Hurley Sara
- England, and deputy strategic incident commander COVID-19, NHS England and NHS Improvement, London, UK
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358
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Goldman RA, Swendseid B, Chan JYK, Lewandowski M, Adams J, Purcell M, Cognetti DM. Tracheostomy Management during the COVID-19 Pandemic. Otolaryngol Head Neck Surg 2020; 163:67-69. [PMID: 32340538 DOI: 10.1177/0194599820923632] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The ongoing coronavirus disease 2019 pandemic has led to unprecedented demands on the modern health care system, and the highly contagious nature of the virus has led to particular concerns of infection among health care workers and transmission within health care facilities. While strong data regarding the transmissibility of the infection are not yet widely available, preliminary information suggests risk of transmission among asymptomatic individuals, including those within health care facilities. We believe that the presence of a tracheostomy or laryngectomy stoma poses a unique risk of droplet and aerosol spread particularly among patients with unsuspected infection. At our institution, guidelines for the care of open airways were developed by a multidisciplinary open airway working group, and here we review those recommendations to provide practical guidance to other institutions.
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Affiliation(s)
- Richard A Goldman
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Brian Swendseid
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Jason Y K Chan
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Michelle Lewandowski
- Department of Nursing, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Jacqueline Adams
- Department of Nursing, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Monica Purcell
- Department of Pulmonary Care, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
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359
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Kotfis K, Williams Roberson S, Wilson JE, Dabrowski W, Pun BT, Ely EW. COVID-19: ICU delirium management during SARS-CoV-2 pandemic. Crit Care 2020; 24:176. [PMID: 32345343 PMCID: PMC7186945 DOI: 10.1186/s13054-020-02882-x] [Citation(s) in RCA: 298] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/08/2020] [Indexed: 12/20/2022] Open
Abstract
The novel coronavirus, SARS-CoV-2-causing Coronavirus Disease 19 (COVID-19), emerged as a public health threat in December 2019 and was declared a pandemic by the World Health Organization in March 2020. Delirium, a dangerous untoward prognostic development, serves as a barometer of systemic injury in critical illness. The early reports of 25% encephalopathy from China are likely a gross underestimation, which we know occurs whenever delirium is not monitored with a valid tool. Indeed, patients with COVID-19 are at accelerated risk for delirium due to at least seven factors including (1) direct central nervous system (CNS) invasion, (2) induction of CNS inflammatory mediators, (3) secondary effect of other organ system failure, (4) effect of sedative strategies, (5) prolonged mechanical ventilation time, (6) immobilization, and (7) other needed but unfortunate environmental factors including social isolation and quarantine without family. Given early insights into the pathobiology of the virus, as well as the emerging interventions utilized to treat the critically ill patients, delirium prevention and management will prove exceedingly challenging, especially in the intensive care unit (ICU). The main focus during the COVID-19 pandemic lies within organizational issues, i.e., lack of ventilators, shortage of personal protection equipment, resource allocation, prioritization of limited mechanical ventilation options, and end-of-life care. However, the standard of care for ICU patients, including delirium management, must remain the highest quality possible with an eye towards long-term survival and minimization of issues related to post-intensive care syndrome (PICS). This article discusses how ICU professionals (e.g., physicians, nurses, physiotherapists, pharmacologists) can use our knowledge and resources to limit the burden of delirium on patients by reducing modifiable risk factors despite the imposed heavy workload and difficult clinical challenges posed by the pandemic.
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Affiliation(s)
- Katarzyna Kotfis
- Department Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
| | - Shawniqua Williams Roberson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Bioengineering, Vanderbilt University, Nashville, TN, USA
| | - Jo Ellen Wilson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education and Clinical Center (GRECC), Tennessee Valley Veterans Affairs Healthcare System, Nashville, TN, USA
| | - Wojciech Dabrowski
- Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Brenda T Pun
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education and Clinical Center (GRECC), Tennessee Valley Veterans Affairs Healthcare System, Nashville, TN, USA
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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360
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Cook TM. Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic - a narrative review. Anaesthesia 2020; 75:920-927. [PMID: 32246849 DOI: 10.1111/anae.15071] [Citation(s) in RCA: 353] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2020] [Indexed: 02/06/2023]
Abstract
Personal protective equipment has become an important and emotive subject during the current coronavirus disease 2019 epidemic. Coronavirus disease 2019 is predominantly caused by contact or droplet transmission attributed to relatively large respiratory particles which are subject to gravitational forces and travel only approximately 1 metre from the patient. Airborne transmission may occur if patient respiratory activity or medical procedures generate respiratory aerosols. These aerosols contain particles that may travel much longer distances and remain airborne longer, but their infective potential is uncertain. Contact, droplet and airborne transmission are each relevant during airway manoeuvres in infected patients, particularly during tracheal intubation. Personal protective equipment is an important component, but only one part, of a system protecting staff and other patients from coronavirus disease 2019 cross-infection. Appropriate use significantly reduces risk of viral transmission. Personal protective equipment should logically be matched to the potential mode of viral transmission occurring during patient care - contact, droplet or airborne. Recommendations from international organisations are broadly consistent, but equipment use is not. Only airborne precautions include a fitted high-filtration mask, and this should be reserved for aerosol generating procedures. Uncertainty remains around certain details of personal protective equipment including use of hoods, mask type and the potential for re-use of equipment.
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Affiliation(s)
- T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital NHS Trust, Bath, UK
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361
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Tang LY, Wang J. Anesthesia and COVID-19: What We Should Know and What We Should Do. Semin Cardiothorac Vasc Anesth 2020; 24:127-137. [PMID: 32336243 DOI: 10.1177/1089253220921590] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), was first reported in Wuhan, Hubei, China, and has spread to more than 200 other countries around the world. COVID-19 is a highly contagious disease with continuous human-to-human transmission. The origin of the virus is unknown. Airway manipulations and intubations, which are common during anesthesia procedures may increasingly expose anesthesia providers and intensive care unit team members to SARS-CoV-2. Through a comprehensive review of existing studies on COVID-19, this article presents the epidemiological and clinical characteristics of COVID-19, reviews current medical management, and suggests ways to improve the safety of anesthetic procedures. Owing to the highly contagious nature of the virus and the lack of therapeutic drugs or vaccines, precautions should be taken to prevent medical staff from COVID-19.
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Affiliation(s)
- Linda Y Tang
- Duke University Trinity College, Durham, NC, USA
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362
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Sorbello M, Di Giacinto I, Corso RM, Cataldo R. Prevention is better than the cure, but the cure cannot be worse than the disease: fibreoptic tracheal intubation in COVID-19 patients. Br J Anaesth 2020; 125:e187-e188. [PMID: 32386832 PMCID: PMC7183937 DOI: 10.1016/j.bja.2020.04.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022] Open
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363
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Srivatana V, Aggarwal V, Finkelstein FO, Naljayan M, Crabtree JH, Perl J. Peritoneal Dialysis for Acute Kidney Injury Treatment in the United States: Brought to You by the COVID-19 Pandemic. ACTA ACUST UNITED AC 2020; 1:410-415. [DOI: 10.34067/kid.0002152020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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364
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Wong WY, Kong YC, See JJ, Kan RKC, Lim MPP, Chen Q, Lim B, Ong S. Anaesthetic management of patients with COVID-19: infection prevention and control measures in the operating theatre. Br J Anaesth 2020; 125:e239-e241. [PMID: 32362338 PMCID: PMC7174186 DOI: 10.1016/j.bja.2020.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022] Open
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365
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Mattioli F, Fermi M, Ghirelli M, Molteni G, Sgarbi N, Bertellini E, Girardis M, Presutti L, Marudi A. Tracheostomy in the COVID-19 pandemic. Eur Arch Otorhinolaryngol 2020; 277:2133-2135. [PMID: 32322959 PMCID: PMC7174541 DOI: 10.1007/s00405-020-05982-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/11/2020] [Indexed: 12/31/2022]
Abstract
Purpose The role of tracheostomy in COVID-19-related ARDS is unknown. Nowadays, there is no clear indication regarding the timing of tracheostomy in these patients. Methods We describe our synergic experience between ENT and ICU Departments at University Hospital of Modena underlining some controversial aspects that would be worth discussing tracheostomies in these patients. During the last 2 weeks, we performed 28 tracheostomies on patients with ARDS due to COVID-19 infection who were treated with IMV. Results No differences between percutaneous and surgical tracheostomy in terms of timing and no case of team virus infection. Conclusion In our experience, tracheostomy should be performed only in selected patients within 7- and 14-day orotracheal intubation.
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Affiliation(s)
- Francesco Mattioli
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy.
| | - Matteo Fermi
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Michael Ghirelli
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | | | - Nicola Sgarbi
- Department of Anesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Elisabetta Bertellini
- Department of Anesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Massimo Girardis
- Department of Anesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Livio Presutti
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Andrea Marudi
- Department of Anesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
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366
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Moshayedi P, Ryan TE, Mejia LLP, Nour M, Liebeskind DS. Triage of Acute Ischemic Stroke in Confirmed COVID-19: Large Vessel Occlusion Associated With Coronavirus Infection. Front Neurol 2020; 11:353. [PMID: 32373061 PMCID: PMC7186326 DOI: 10.3389/fneur.2020.00353] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/09/2020] [Indexed: 01/28/2023] Open
Abstract
The outbreak of COVID-19 has posed a significant challenge to global healthcare. Acute stroke care requires rapid bedside attendance, imaging, and intervention. However, for acute stroke patients who have a diagnosis of or are under investigation for COVID-19, the concern for nosocomial transmission moderates operational procedures for acute stroke care. We present our experience with an in-hospital stroke code called on a COVID-19-positive patient with a left middle cerebral artery syndrome and the challenges faced for timely examination, imaging, and decision to intervene. The outlook for the ongoing COVID-19 pandemic necessitates the development of protocols to sustain timely and effective acute stroke care while mitigating healthcare-associated transmission.
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Affiliation(s)
- Pouria Moshayedi
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Timothy E Ryan
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lucido Luciano Ponce Mejia
- Department of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - May Nour
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - David S Liebeskind
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
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367
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Mavioglu HL, Unal EU. Cardiovascular surgery in the COVID-19 pandemic. J Card Surg 2020; 35:1391. [PMID: 32306474 PMCID: PMC7264533 DOI: 10.1111/jocs.14559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 01/07/2023]
Affiliation(s)
| | - Ertekin U Unal
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
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368
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Kranke P, Weibel S, Sitter M, Meybohm P, Girard T. [Obstetric Anesthesia During the SARS-CoV-2 Pandemic - a Brief Overview of Published Recommendations for Action by National and International Specialist Societies and Committees]. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55:266-274. [PMID: 32274774 PMCID: PMC7295301 DOI: 10.1055/a-1144-5562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The most common human corona viruses cause common colds. But three of these viruses cause more serious, acute diseases; Middle East Respiratory Syndrome (MERS by MERS-CoV), Severe Acute Respiratory Syndrome (SARS) by SARS-CoV and COVID-19 by SARS-CoV-2. The current outbreak was classified by the WHO as a "global public health emergency". Despite all efforts to reduce the surgical lists and to cancel or postpone non-time-critical surgical interventions, some surgical and anesthetic interventions outside of intensive care medicine are still necessary and must be performed. This is particularly true for obstetric interventions and neuraxial labor analgesia. Workload in the delivery room is presumably not going to decrease and planned cesarean sections cannot be postponed. In the meantime, the clinical course and outcome of some COVID-19 patients with an existing pregnancy or peripartum courses have been reported. There are already numerous recommendations from national and international bodies regarding the care of such patients. Some of these recommendations will be summarized in this manuscript. The selection of aspects should by no means be seen as a form of prioritization. The general treatment principles in dealing with COVID-19 patients and the recommendations for action in intensive care therapy also apply to pregnant and postpartum patients. In this respect, there are naturally considerable redundancies and only a few aspects apply strictly or exclusively to the cohort of obstetric patients. In summary, at present it must be stated that the general care recommendations that also apply to non-COVID-19 patients are initially valid with regard to obstetric anesthesia. Nevertheless, the special requirements on the part of hygiene and infection protection result in special circumstances that should be taken into account when caring for pregnant patients from an anesthetic point of view. These relate to both medical aspects, but also to a particular extent logistics issues with regard to spatial separation, staffing and material resources.
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COVID-19: Respiratory support outside the intensive care unit. THE LANCET RESPIRATORY MEDICINE 2020; 8:538-539. [PMID: 32278367 PMCID: PMC7146718 DOI: 10.1016/s2213-2600(20)30176-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 12/18/2022]
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370
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Matava CT, Yu J, Denning S. Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: implications for COVID-19. Can J Anaesth 2020; 67:902-904. [PMID: 32246431 PMCID: PMC7124129 DOI: 10.1007/s12630-020-01649-w] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/01/2022] Open
Affiliation(s)
- Clyde T Matava
- Department of Anesthesia and Pain Medicine, Department of Anesthesia, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Julie Yu
- Department of Anesthesia and Pain Medicine, Department of Anesthesia, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Simon Denning
- Department of Anesthesia and Pain Medicine, Department of Anesthesia, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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371
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Borre-Naranjo D, Santacruz J, Gonzalez-Hernandez J, Anichiarico W, Rubio-Romero J. Infección por SARS-CoV-2 en la paciente obstétrica: una perspectiva desde el cuidado crítico. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2020. [PMCID: PMC7158844 DOI: 10.1016/j.acci.2020.04.002] [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
La nueva infección por coronavirus (COVID-19) se constituye en el principal problema de salud pública en el mundo. Entre el 5 y el 30% de los pacientes afectados por esta enfermedad requieren manejo en una unidad de cuidado intensivo. Se han generado diferentes publicaciones con recomendaciones para la población general. Sin embargo, en la población obstétrica la evidencia científica es reducida, aún más cuando se trata de infección por COVID-19 en escenarios de cuidado intensivo obstétrico. Por esta razón, se realizó una revisión narrativa no sistemática de la literatura utilizando como fuente de información MEDLINE, sociedades científicas y los repositorios de la Organización Mundial de la Salud y el Ministerio de Salud y Protección Social de Colombia, con el objetivo de describir algunas sugerencias para el manejo de una paciente embarazada con COVID-19 en una unidad de cuidado intensivo. Se resalta que la atención debe ser realizada por un equipo interdisciplinario, bajo monitorización materna y fetal cuando corresponda, vigilando los niveles de saturación de oxígeno y la hemodinamia materna para minimizar la hipoxemia fetal. Se describen recomendaciones sobre algunos tópicos relevantes en el escenario crítico, como la intubación oportuna, la utilización adecuada de los equipos de protección personal (EPP), el manejo de la falla circulatoria, las estrategias restrictivas de fluidos y/o vasopresores, entre otros.
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372
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Mallick R, Odejinmi F, Clark TJ. Covid 19 pandemic and gynaecological laparoscopic surgery: knowns and unknowns. Facts Views Vis Obgyn 2020; 12:3-7. [PMID: 32259155 PMCID: PMC7117791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The worldwide impact of COVID 19 continues to be felt as hospitals in all countries reduce elective and non-urgent cases to allow staffing and resources to be deployed elsewhere. Urgent gynaecological and cancer procedures are continuing, and it is imperative all theatre staff are protected and risks of SARS-CoV-2 viral transmission reduced when operating on asymptomatic, suspected or confirmed COVID 19 patients. In particular, there are concerns relating to the transmission of COVID 19 during gynaecological laparoscopic surgery, arising from the potential generation of SARS-CoV-2 contaminated aerosols from CO2 leakage and the creation of smoke from the use of energy devices. The aim of this paper is to review all the up to date evidence, including experiences from China and Italy, to guide the safe management of such patients when undergoing gynaecological procedures.
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Affiliation(s)
- R Mallick
- Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Lewes Road, Haywards Heath, RH16 4EX, UK
| | - F Odejinmi
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, Leytonstone, London, E11 1NR, UK
| | - T J Clark
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's Hospital,Birmingham, B15 2TG, UK
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373
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Rajan S, Subramanian A, Babu K, Kadapamannil D. Airway management of a COVID-19 suspected patient using “Aerosol Box”. BALI JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.4103/bjoa.bjoa_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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374
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Freitas AS, Zica GM, Albuquerque CLD. Pandemia de coronavírus (COVID-19): o que os fonoaudiólogos devem saber. Codas 2020; 32:e20200073. [DOI: 10.1590/2317-1782/20192020073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/02/2020] [Indexed: 01/21/2023] Open
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375
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Kaye K, Paprottka F, Escudero R, Casabona G, Montes J, Fakin R, Moke L, Stasch T, Richter D, Benito-Ruiz J. Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS-COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management. Aesthetic Plast Surg 2020; 44:1014-1042. [PMID: 32410196 PMCID: PMC7224128 DOI: 10.1007/s00266-020-01752-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The worldwide spread of a novel coronavirus disease (COVID-19) has led to a near total stop of non-urgent, elective surgeries across all specialties in most affected countries. In the field of aesthetic surgery, the self-imposed moratorium for all aesthetic surgery procedures recommended by most international scientific societies has been adopted by many surgeons worldwide and resulted in a huge socioeconomic impact for most private practices and clinics. An important question still unanswered in most countries is when and how should elective/aesthetic procedures be scheduled again and what kind of organizational changes are necessary to protect patients and healthcare workers when clinics and practices reopen. Defining manageable, evidence-based protocols for testing, surgical/procedural risk mitigation and clinical flow management/contamination management will be paramount for the safety of non-urgent surgical procedures. METHODS We conducted a MEDLINE/PubMed research for all available publications on COVID-19 and surgery and COVID-19 and anesthesia. Articles and referenced literature describing possible procedural impact factors leading to exacerbation of the clinical evolution of COVID-19-positive patients were identified to perform risk stratification for elective surgery. Based on these impact factors, considerations for patient selection, choice of procedural complexity, duration of procedure, type of anesthesia, etc., are discussed in this article and translated into algorithms for surgical/anesthesia risk management and clinical management. Current recommendations and published protocols on contamination control, avoidance of cross-contamination and procedural patient flow are reviewed. A COVID-19 testing guideline protocol for patients planning to undergo elective aesthetic surgery is presented and recommendations are made regarding adaptation of current patient information/informed consent forms and patient health questionnaires. CONCLUSION The COVID-19 crisis has led to unprecedented challenges in the acute management of the crisis, and the wave only recently seems to flatten out in some countries. The adaptation of surgical and procedural steps for a risk-minimizing management of potential COVID-19-positive patients seeking to undergo elective aesthetic procedures in the wake of that wave will present the next big challenge for the aesthetic surgery community. We propose a clinical algorithm to enhance patient safety in elective surgery in the context of COVID-19 and to minimize cross-contamination between healthcare workers and patients. New evidence-based guidelines regarding surgical risk stratification, testing, and clinical flow management/contamination management are proposed. We believe that only the continuous development and broad implementation of guidelines like the ones proposed in this paper will allow an early reintegration of all aesthetic procedures into the scope of surgical care currently performed and to prepare the elective surgical specialties better for a possible second wave of the pandemic. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- K. Kaye
- Ocean Clinic Marbella, Marbella, Spain
| | | | | | | | - J. Montes
- Torre Medica Auxilio Mutuo, San Juan, PR USA
| | - R. Fakin
- Ocean Clinic Zurich, Zurich, Switzerland
| | - L. Moke
- grid.410569.f0000 0004 0626 3338Department of Orthopedic Surgery, University Hospital Leuven, Louvain, Belgium
| | - T. Stasch
- Vitality Fountain Clinic Plastic and Aesthetic Surgery Centre, Nairobi, Kenya
| | - D. Richter
- Department for Plastic Surgery, Dreifaltigkeitskrankenhaus Wesseling, Wesseling, Germany
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376
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Maddani SS, Deepa HC, Rao S, Chaudhuri S. A Multicenter Cross-sectional Questionnaire-based Study to Know the Practices and Strategies of Ventilatory Management of COVID-19 Patients among the Treating Physicians. Indian J Crit Care Med 2020; 24:643-648. [PMID: 33024368 PMCID: PMC7519590 DOI: 10.5005/jp-journals-10071-23516] [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] [Indexed: 01/07/2023] Open
Abstract
Introduction COVID-19 has been declared a pandemic by the World Health Organization (WHO). Many of the COVID-19 patients develop acute respiratory distress syndrome (ARDS) and require ventilatory support based on their severity for which conventional strategies are being used along with few newer strategies. We conducted this multicenter survey to know the physician's current ventilation strategies adopted for the care of COVID-19 patients. Materials and methods The survey was conducted after taking the ethical committee clearance. The web-based multicenter, cross-sectional questionnaire study was sent to physicians, who were involved in the management of COVID-19 patients. The questionnaire was segregated into three parts: part one consisted of general information and consent form, part two was concerned regarding demographic characteristics, and part three was concerned about their practices and strategies for ventilation of COVID-19 patients. Results A total of 223 responders replied for the questionnaire; 190 participated in the study saying that they are involved in the management of COVID-19 patients. The answers to the questionnaires were expressed as a percentage of total responses. 86% of the respondents said they have a designated intensive care unit (ICU) and 89% of the responders said they have an intubation/extubation protocol for suspect/confirmed COVID-19 patients. The responses of junior residents (JRs), senior residents (SRs), assistant professors/junior consultants, and professors/consultants were analyzed separately, and a few significant differences were observed. 39% of JRs were aware of prone ventilation as the most effective rescue ventilation strategy compared to 69% of consultants/professors. Extracorporeal membranous oxygenation (ECMO) strategy was also more significant in consultants/professors (40%) vs JRs (12%). The responders were also diverged based on medical college and corporate hospitals, and their responses were noted. Most commonly, responders in the corporate hospitals had a facility to ventilate COVID-19 patients in a negative pressure isolation facility compared to a nonnegative pressure room isolation facility in medical colleges. Conclusion Most of the responders were practicing ventilation strategies in a standard manner. JRs need to undergo further training in a few aspects of the ventilatory management, and also, they need to update themselves with newer treatment modalities as they keep evolving. Medical colleges are providing at par facility compared to corporate hospitals except for few advance care facilities. Clinical significance This study highlights the current practice of ventilatory management of COVID-19 patients, which is satisfactory. The survey can be used to develop study tools, to educate resident doctors, to further improve quality of care of critical COVID-19 patients. How to cite this article Maddani SS, Deepa HC, Rao S, Chaudhuri S. A Multicenter Cross-sectional Questionnaire-based Study to know the Practices and Strategies of Ventilatory Management of COVID-19 Patients among the Treating Physicians. Indian J Crit Care Med 2020;24(8):643–648.
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Affiliation(s)
- Sagar S Maddani
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Shwethapriya Rao
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Souvik Chaudhuri
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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377
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Ramalho Neto JM, Viana RAPP, Franco AS, Prado PRD, Gonçalves FAF, Nóbrega MMLD. NURSING DIAGNOSIS/OUTCOMES AND INTERVENTIONS FOR CRITICALLY ILL PATIENTS AFFECTED BY COVID-19 AND SEPSIS. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2020-0160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
ABSTRACT Objective: to relate nursing diagnoses/outcomes and interventions for critically ill patients affected by COVID-19 and sepsis in the Intensive Care Unit, according to the International Classification for Nursing Practice (ICNP®). Method: a documentary study conducted in March and April 2020 from the ICNP® terminology subset for adult patients with sepsis. The documentary corpus was composed of the list of nursing diagnoses/outcomes and interventions based on Horta's Theory of Basic Human Needs; on the 7-Axis Model of the International Classification for Nursing Practice, version 2017; on the Pathophysiological model of sepsis; as well as relying on the authors' expertise in direct care for suspected or confirmed critically ill patients affected by COVID-19. Outcomes: a total of 58 nursing diagnoses/outcomes were identified that belong to the psychobiological needs of oxygenation (13-22.4%), vascular regulation (12-20.7%), neurological regulation (10-17.2%), hydration (08-13.8%), elimination (08-13.8%), immunological regulation (04-6.9%) and thermal regulation (03-5.2%), evidencing a total of 172 nursing interventions with a mean of 03 for each nursing diagnosis/outcome. Conclusion: data analysis provided greater knowledge about the disease and the nursing process in the ICU setting, serving as a guide for the professional practice for critically ill patients hospitalized with COVID-19 and sepsis.
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378
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Abstract
PURPOSE OF REVIEW As a global pandemic, COVID-19 has profoundly disrupted the lives of individuals, families, communities, and nations. This report summarizes the expected impact of COVID-19 on behavioral health, as well as strategies to address mental health needs during the COVID-19 pandemic and its aftermath. The state of Michigan in the USA is used to illustrate the complexity of the mental health issues and the critical gaps in the behavioral health infrastructure as they pertain to COVID-19. Scoping review was conducted to identify potential mental health needs and issues during the COVID-19 pandemic and its aftermath. RECENT FINDINGS The ramifications of COVID-19 on mental health are extensive, with the potential to negatively impact diverse populations including healthcare providers, children and adolescents, older adults, the LGBTQ community, and individuals with pre-existing mental illness. Suicide rates, alone, are expected to rise for Michiganders due to the economic downturn, isolation and quarantine, increased substance use, insomnia, and increased access to guns associated with the COVID-19 pandemic. This report promotes awareness of a behavioral health crisis due to COVID-19. Increasing access to behavioral health care should minimize COVID-19's negative influence on mental health in Michigan. We propose a three-prong approach to access: awareness, affordability, and technology. Addressing workforce development and fixing gaps in critical behavioral health infrastructure will also be essential. These actions need to be implemented immediately to prepare for the expected "surge" of behavioral health needs in the ensuing months.
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379
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Juneja D, Savio RD, Srinivasan S, Pandit RA, Ramasubban S, Reddy PK, Singh MK, Gopal PB, Chaudhry D, Govil D, Dixit SB, Samavedam S. Basic Critical Care for Management of COVID-19 Patients: Position Paper of the Indian Society of Critical Care Medicine, Part II. Indian J Crit Care Med 2020; 24:S254-S262. [PMID: 33354049 PMCID: PMC7724927 DOI: 10.5005/jp-journals-10071-23593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In a resource-limited country like India, rationing of scarce critical care resources might be required to ensure appropriate delivery of care to the critically ill patients suffering from COVID-19 infection. Most of these patients require critical care support because of respiratory failure or presence of multiorgan dysfunction syndrome. As there is no pharmacological therapy available, respiratory support in the form of supplemental oxygen, noninvasive ventilation, and invasive mechanical ventilation remains mainstay of care in intensive care units. As there is still dearth of direct evidence, most of the data are extrapolated from the experience gained from the management of general critical care patients. How to cite this article: Juneja D, Savio RD, Srinivasan S, Pandit RA, Ramasubban S, Reddy PK, et al. Basic Critical Care for Management of COVID-19 Patients: Position Paper of the Indian Society of Critical Care Medicine, Part II. Indian J Crit Care Med 2020;24(Suppl 5):S254–S262.
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Affiliation(s)
- Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Raymond D Savio
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Rahul A Pandit
- Department of Intensive Care, Fortis Hospital, Mulund, Mumbai, Maharashtra, India
| | - Suresh Ramasubban
- Department of Critical Care, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Pavan K Reddy
- Department of Critical Care, CARE-Banjara, Hyderabad, Telangana, India
| | - Manoj K Singh
- Department of Critical Care, Apollo Hospitals International Limited, Ahmedabad, Gujarat, India
| | - Palepu Bn Gopal
- Department of Critical Care, Continental Hospital, Hyderabad, Telangana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta: The Medicity, Gurugram, Haryana, India
| | - Subhal B Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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380
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Hote M, Gupta S. Cardiothoracic surgery practice at a tertiary center during the COVID-19 pandemic. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.4103/jpcs.jpcs_35_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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381
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A COVID-19 Airway Management Innovation with Pragmatic Efficacy Evaluation: The Patient Particle Containment Chamber. Ann Biomed Eng 2020; 48:2371-2376. [PMID: 32856180 PMCID: PMC7453071 DOI: 10.1007/s10439-020-02599-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 01/25/2023]
Abstract
The unique resource constraints, urgency, and virulence of the coronavirus disease 2019 pandemic has sparked immense innovation in the development of barrier devices to protect healthcare providers from infectious airborne particles generated by patients during airway management interventions. Of the existing devices, all have shortcomings which render them ineffective and impractical in out-of-hospital environments. Therefore, we propose a new design for such a device, along with a pragmatic evaluation of its efficacy. Must-have criteria for the device included: reduction of aerosol transmission by at least 90% as measured by pragmatic testing; construction from readily available, inexpensive materials; easy to clean; and compatibility with common EMS stretchers. The Patient Particle Containment Chamber (PPCC) consists of a standard shower liner draped over a modified octagonal PVC pipe frame and secured with binder clips. 3D printed sleeve portals were used to secure plastic sleeves to the shower liner wall. A weighted tube sealed the exterior base of the chamber with the contours of the patient's body and stretcher. Upon testing, the PPCC contained 99% of spray-paint particles sprayed over a 90s period. Overall, the PPCC provides a compact, affordable option that can be used in both the in-hospital and out-of-hospital environments.
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382
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Kanagalingam J, Amtha R. Povidone-iodine in dental and oral health: a narrative review. J Int Oral Health 2020. [DOI: 10.4103/jioh.jioh_89_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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383
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Mavioğlu HL, Ünal EU, Aşkın G, Küçüker ŞA, Özatik MA. Perioperative planning for cardiovascular operations in the COVID-19 pandemic. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2019; 28:236-243. [PMID: 32551151 PMCID: PMC7298362 DOI: 10.5606/tgkdc.dergisi.2020.09294] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 12/21/2022]
Abstract
Coronavirus disease-2019 (COVID-19) is a serious health concern which alert all healthcare professionals worldwide. There are two main issues caused by this pandemic regarding for the healthcare system. First, it is a necessity to postpone many elective procedures/surgeries to reduce the burden of the healthcare system which may be confronted with strain by the increased speed of transmission. Therefore, we aimed to develop an algorithm called as Level of Priority to identify the priority and deferrability of cardiovascular diseases requiring surgery. Second, it is essential to perform surgery and intensive care unit follow-up in a setting where the infection prevention measures are followed for primary patients requiring emergency cardiovascular surgery. In this article, we present necessary precautions to be exercised to provide the patient safety and the highest level of protection for the surgical team.
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Affiliation(s)
| | - Ertekin Utku Ünal
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Göktan Aşkın
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Şeref Alp Küçüker
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Ali Özatik
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
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