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Cornejo RA, Montoya J, Gajardo AIJ, Graf J, Alegría L, Baghetti R, Irarrázaval A, Santis C, Pavez N, Leighton S, Tomicic V, Morales D, Ruiz C, Navarrete P, Vargas P, Gálvez R, Espinosa V, Lazo M, Pérez-Araos RA, Garay O, Sepúlveda P, Martinez E, Bruhn A, Rossel N, Martin MJ, Medel JN, Oviedo V, Vera M, Torres V, Montes JM, Salazar Á, Muñoz C, Tala F, Migueles M, Ortiz C, Gómez F, Contreras L, Daviu I, Rodriguez Y, Ortiz C, Aquevedo A, Parada R, Vargas C, Gatica M, Guerrero D, Valenzuela A, Torrejón D. Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile. Ann Intensive Care 2022; 12:109. [PMCID: PMC9702866 DOI: 10.1186/s13613-022-01082-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Prone positioning is currently applied in time-limited daily sessions up to 24 h which determines that most patients require several sessions. Although longer prone sessions have been reported, there is scarce evidence about the feasibility and safety of such approach. We analyzed feasibility and safety of a continuous prolonged prone positioning strategy implemented nationwide, in a large cohort of COVID-19 patients in Chile.
Methods
Retrospective cohort study of mechanically ventilated COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted in 15 Intensive Care Units, which adhered to a national protocol of continuous prone sessions ≥ 48 h and until PaO2:FiO2 increased above 200 mm Hg. The number and extension of prone sessions were registered, along with relevant physiologic data and adverse events related to prone positioning. The cohort was stratified according to the first prone session duration: Group A, 2–3 days; Group B, 4–5 days; and Group C, > 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety.
Results
We included 417 patients who required a first prone session of 4 (3–5) days, of whom 318 (76.3%) received only one session. During the first prone session the main adverse event was grade 1–2 pressure sores in 97 (23.9%) patients; severe adverse events were infrequent with 17 non-scheduled extubations (4.2%). 90-day mortality was 36.2%. Ninety-eight patients (24%) were classified as group C; they exhibited a more severe ARDS at baseline, as reflected by lower PaO2:FiO2 ratio and higher ventilatory ratio, and had a higher rate of pressure sores (44%) and higher 90-day mortality (48%). However, after adjustment for severity and several relevant confounders, prone session duration was not associated with mortality or pressure sores.
Conclusions
Nationwide implementation of a continuous prolonged prone positioning strategy for COVID-19 ARDS patients was feasible. Minor pressure sores were frequent but within the ranges previously described, while severe adverse events were infrequent. The duration of prone session did not have an adverse effect on safety.
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Temsah MH, Alrabiaah A, Al-Eyadhy A, Al-Sohime F, Al Huzaimi A, Alamro N, Alhasan K, Upadhye V, Jamal A, Aljamaan F, Alhaboob A, Arabi YM, Lazarovici M, Somily AM, Boker AM. COVID-19 Critical Care Simulations: An International Cross-Sectional Survey. Front Public Health 2021; 9:700769. [PMID: 34631644 PMCID: PMC8500233 DOI: 10.3389/fpubh.2021.700769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To describe the utility and patterns of COVID-19 simulation scenarios across different international healthcare centers. Methods: This is a cross-sectional, international survey for multiple simulation centers team members, including team-leaders and healthcare workers (HCWs), based on each center's debriefing reports from 30 countries in all WHO regions. The main outcome measures were the COVID-19 simulations characteristics, facilitators, obstacles, and challenges encountered during the simulation sessions. Results: Invitation was sent to 343 simulation team leaders and multidisciplinary HCWs who responded; 121 completed the survey. The frequency of simulation sessions was monthly (27.1%), weekly (24.8%), twice weekly (19.8%), or daily (21.5%). Regarding the themes of the simulation sessions, they were COVID-19 patient arrival to ER (69.4%), COVID-19 patient intubation due to respiratory failure (66.1%), COVID-19 patient requiring CPR (53.7%), COVID-19 transport inside the hospital (53.7%), COVID-19 elective intubation in OR (37.2%), or Delivery of COVID-19 mother and neonatal care (19%). Among participants, 55.6% reported the team's full engagement in the simulation sessions. The average session length was 30-60 min. The debriefing process was conducted by the ICU facilitator in (51%) of the sessions followed by simulation staff in 41% of the sessions. A total of 80% reported significant improvement in clinical preparedness after simulation sessions, and 70% were satisfied with the COVID-19 sessions. Most perceived issues reported were related to infection control measures, followed by team dynamics, logistics, and patient transport issues. Conclusion: Simulation centers team leaders and HCWs reported positive feedback on COVID-19 simulation sessions with multidisciplinary personnel involvement. These drills are a valuable tool for rehearsing safe dynamics on the frontline of COVID-19. More research on COVID-19 simulation outcomes is warranted; to explore variable factors for each country and healthcare system.
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Affiliation(s)
- Mohamad-Hani Temsah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulkarim Alrabiaah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Infectious Disease Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ayman Al-Eyadhy
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fahad Al-Sohime
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Clinical Skills & Simulation Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Huzaimi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Pediatric Cardiology, Department of Cardiac Sciences, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
- Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Nurah Alamro
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Khalid Alhasan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Nephrology Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Vaibhavi Upadhye
- Clinical Lead in Simulation, Dr. Indumati Amodkar Simulation Center, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Amr Jamal
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
- Evidence-Based Health Care & Knowledge Translation Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Fadi Aljamaan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Critical Care Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ali Alhaboob
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yaseen M. Arabi
- National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Marc Lazarovici
- Ludwig-Maximilians-University, Munich University Hospital, Munich, Germany
| | - Ali M. Somily
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz M. Boker
- Anesthesia and Critical Care Department, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Clinical Skills and Simulation Centre, King Abdulaziz University, Jeddah, Saudi Arabia
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DeVita T, Brett-Major D, Katz R. How are healthcare provider systems preparing for health emergency situations? WORLD MEDICAL & HEALTH POLICY 2021; 14:102-120. [PMID: 34226853 PMCID: PMC8242524 DOI: 10.1002/wmh3.436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/19/2020] [Accepted: 01/14/2021] [Indexed: 11/12/2022]
Abstract
Natural disasters, disease outbreaks, famine, and human conflict have strained communities everywhere over the course of human existence. However, modern changes in climate, human mobility, and other factors have increased the global community's vulnerability to widespread emergencies. We are in the midst of a disruptive health event, with the COVID-19 pandemic testing our health provider systems globally. This study presents a qualitative analysis of published literature, obtained systematically, to examine approaches health providers are taking to prepare for and respond to mass casualty incidents around the globe. The research reveals emerging trends in the weaknesses of systems' disaster responses while highlighting proposed solutions, so that others may better prepare for future disasters. Additionally, the research examines gaps in the literature, to foster more targeted and actionable contributions to the literature.
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Affiliation(s)
- Timothy DeVita
- Department of Internal Medicine Yale University School of Medicine New Haven Connecticut USA
| | - David Brett-Major
- Department of Epidemiology, College of Public Health University of Nebraska Medical Center Omaha Nebraska USA
| | - Rebecca Katz
- Center for Global Health Science and Security Georgetown University School of Medicine Washington District of Columbia USA
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Cecconi M, Kesecioglu J, Azoulay E. Diversity and inclusivity: the way to multidisciplinary intensive care medicine in Europe. Intensive Care Med 2021; 47:598-601. [PMID: 33914111 PMCID: PMC8082476 DOI: 10.1007/s00134-021-06384-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy. .,IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy.
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elie Azoulay
- Médecine Intensive et Réanimation, PHP, Hôpital Saint-Louis, Paris University, Paris, France
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Richards GA, Baker T, Amin P. Ebola virus disease: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2017; 43:352-355. [PMID: 29128378 DOI: 10.1016/j.jcrc.2017.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
Abstract
Ebola virus is a filovirus that can cause fatal hemorrhagic fever (HF) and five distinct species exist that vary in terms of geographical distribution and virulence. Once the more virulent forms enter the human population, transmission occurs primarily through direct contact with infected body fluids and may result in significant outbreaks. The devastating has been the recent West African outbreak. Clinically, signs and symptoms are similar to those of the other VHFs [4]. The incubation period is 2-21days, followed by fever, headache, myalgia, diarrhoea, vomiting and dehydration; thereafter, there may be recovery or deterioration with collapse, neurological manifestations and bleeding, that can lead to a fatal outcome. Elevated hepatic transaminases is common and severe hepatitis is more common in fatal cases and frequently there is associated fluid depletion. Real time reverse transcription-PCR (RT-PCR) techniques on blood specimens are the gold standard for diagnosis [6]. Management is discussed and is essentially supportive with strict attention to infection control and prevention. None of the pharmacological interventions have shown conclusive benefit and future management of epidemics should centre around prevention and containment, specifically isolation, hygiene, and vaccination.
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Affiliation(s)
- Guy A Richards
- Division of Critical Care, Charlotte Maxeke Hospital, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Tim Baker
- Department of Anaesthesia & Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi; Global Health - Health Systems & Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Pravin Amin
- Head of Department of Critical Care Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, India.
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Devereaux AV, Tosh PK, Hick JL, Hanfling D, Geiling J, Reed MJ, Uyeki TM, Shah UA, Fagbuyi DB, Skippen P, Dichter JR, Kissoon N, Christian MD, Upperman JS. Engagement and education: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2015; 146:e118S-33S. [PMID: 25144161 PMCID: PMC4504247 DOI: 10.1378/chest.14-0740] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Engagement and education of ICU clinicians in disaster preparedness is fragmented by time constraints and institutional barriers and frequently occurs during a disaster. We reviewed the existing literature from 2007 to April 2013 and expert opinions about clinician engagement and education for critical care during a pandemic or disaster and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this article are important for all of those involved in a pandemic or large-scale disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS A systematic literature review was performed and suggestions formulated according to the American College of Chest Physicians (CHEST) Consensus Statement development methodology. We assessed articles, documents, reports, and gray literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS Twenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: (1) situational awareness, (2) clinician roles and responsibilities, (3) education, and (4) community engagement. Together, these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care. CONCLUSIONS The optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a pandemic or disaster will require a departure from the routine independent systems operating in hospitals. An effective response will require robust information systems; coordination among clinicians, hospitals, and governmental organizations; pre-event engagement of relevant stakeholders; and standardized core competencies for the education and training of critical care clinicians.
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Affiliation(s)
- Asha V. Devereaux
- Sharp Hospital, Coronado, CA
- 1224 10th Place #205, Coronado, CA 92118
| | | | - John L. Hick
- Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - Dan Hanfling
- Inova Health System, Falls Church, VA
- George Washington University, Washington, DC
| | - James Geiling
- VA Medical Center, White River Junction, VT
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Mary Jane Reed
- Geisinger Medical Center, Temple School of Medicine, Danville, PA
| | | | - Umair A. Shah
- Harris County Public Health and Environmental Services, Houston, TX
| | - Daniel B. Fagbuyi
- The George Washington University, Children's National Medical Center, Washington, DC
| | - Peter Skippen
- BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Niranjan Kissoon
- BC Children's Hospital and Sunny Hill Health Centre, University of British Columbia, Vancouver, BC, Canada
| | - Michael D. Christian
- Royal Canadian Medical Service, Canadian Armed Forces and Mount Sinai Hospital, Toronto, ON, Canada
| | - Jeffrey S. Upperman
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Year in review in Intensive Care Medicine 2010: II. Pneumonia and infections, cardiovascular and haemodynamics, organization, education, haematology, nutrition, ethics and miscellanea. Intensive Care Med 2011; 37:196-213. [PMID: 21225240 PMCID: PMC3029678 DOI: 10.1007/s00134-010-2123-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 12/27/2010] [Indexed: 12/14/2022]
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