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Rodríguez-Moguel N, Osuna-Padilla IA, Piekarska KB, Negrete-García MF, Hernández-Muñoz A, Contreras-Marín JA, Montaño-Mattar R, Casas-Aparicio G. Fluid Status Assessment in Critically Ill Patients with COVID-19: A Retrospective Cohort Study. J Clin Med 2024; 13:540. [PMID: 38256674 PMCID: PMC10816646 DOI: 10.3390/jcm13020540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
Fluid status (FS) is a diagnostic challenge in critically ill patients with COVID-19. Here, we compared parameters related to FS derived from cumulative fluid balance (CFB), bioelectrical impedance analysis (BIA) and venous congestion assessed by ultrasound (VExUS) to predict mortality. We retrospectively reviewed the medical records of individuals with severe pneumonia due to COVID-19 between July and November 2021 in a single center. Comorbidities, demographic, clinical and laboratory data as well as results from CFB, BIA and VExUS measurements were collected on admission and weekly afterwards for two consecutive evaluations. Seventy-nine patients were included, of which eighteen (14.2%) died. Abnormalities of FS were only identified by BIA. Extracellular water/total body water ratio (ECW/TBW) > 0.394 (overhydrated) by BIA was a good predictor of mortality (AUC = 0.78, 95% CI: 0.067-0.89). Mortality risk was higher in overhydrated patients (OR: 6.2, 95% CI: 1.2-32.6, p = 0.02) and in persistently overhydrated patients (OR: 9.57, 95% CI: 1.18-77.5, p = 0.03) even after adjustment to age, serum albumin and acute kidney injury (AKI) in stages 2-3. Time to death was shorter in overhydrated patients (HR: 2.82, 95% CI: 1.05-7.5, log-rank test p = 0.03). Abnormalities in FS associated with mortality were only identified by BIA in critically ill patients with COVID-19.
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Affiliation(s)
- Nadia Rodríguez-Moguel
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico;
| | - Ivan Armando Osuna-Padilla
- Departamento de Áreas Críticas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico;
| | - Karolina Bozena Piekarska
- Departamento de Enseñanza, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (K.B.P.); (M.-F.N.-G.); (J.A.C.-M.); (R.M.-M.)
| | - María-Fernanda Negrete-García
- Departamento de Enseñanza, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (K.B.P.); (M.-F.N.-G.); (J.A.C.-M.); (R.M.-M.)
| | - Andrea Hernández-Muñoz
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Cuernavaca 62209, Mexico;
| | - Julián Andrés Contreras-Marín
- Departamento de Enseñanza, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (K.B.P.); (M.-F.N.-G.); (J.A.C.-M.); (R.M.-M.)
| | - Roberto Montaño-Mattar
- Departamento de Enseñanza, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (K.B.P.); (M.-F.N.-G.); (J.A.C.-M.); (R.M.-M.)
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Cuernavaca 62209, Mexico;
- Departamento de Nefrología, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico
| | - Gustavo Casas-Aparicio
- Departamento de Nefrología, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico
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Hasanin A, Karam N, Mostafa M, Abdelnasser A, Hamimy W, Fouad AZ, Eladawy A, Lotfy A. THE ACCURACY OF INFERIOR VENA CAVA DISTENSIBILITY THROUGH THE TRANSHEPATIC APPROACH TO PREDICT FLUID RESPONSIVENESS IN PATIENTS WITH SEPTIC SHOCK AFTER EMERGENCY LAPAROTOMY. Shock 2023; 60:560-564. [PMID: 37625114 DOI: 10.1097/shk.0000000000002212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
ABSTRACT Background: We aimed to evaluate the ability of inferior vena cava (IVC) distensibility using the transhepatic approach to predict fluid responsiveness in mechanically ventilated patients with septic shock after emergency laparotomy. Methods: This prospective observational study included mechanically ventilated paralyzed adult who had septic shock after emergency laparotomy. The IVC dimensions were measured through the transhepatic and subxiphoid approaches. The fluid responsiveness was confirmed with >15% increase in cardiac output after 500 mL of fluid bolus. The outcomes were the ability of transhepatic (primary outcome) and subxiphoid approach to predict fluid responders using the area under the receiver operating characteristics curve analysis. The gray zone for the two approaches was calculated. Results: Data from 51 patients were analyzed, and the number of fluid responders was 30 of 52 (58%). The transhepatic approach was feasible in all patients, whereas the subxiphoid approach was only feasible in 42 patients. The area under the receiver operating characteristics curve (95% confidence interval) for the transhepatic IVC distensibility was 0.88 (0.76-0.95), and it was comparable with that of the subxiphoid approach (0.81 [0.66-0.92], P = 0.417). The gray zone for the transhepatic IVC distensibility was 17% to 35% including 24 of 51 patients (47%), whereas the gray zone for the subxiphoid IVC distensibility was 13% to 34% including 18 of 42 patients (43%). Conclusion: In conclusion, the transhepatic approach for evaluation of IVC distensibility showed good accuracy in predicting fluid responsiveness in patients with septic shock after emergency laparotomy. The transhepatic approach showed the same accuracy as the subxiphoid approach with the advantage of being feasible in larger number of patients.
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Affiliation(s)
- Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
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Paranjape VV, Henao-Guerrero N, Menciotti G, Saksena S. Performance of four cardiac output monitoring techniques vs. intermittent pulmonary artery thermodilution during a modified passive leg raise maneuver in isoflurane-anesthetized dogs. Front Vet Sci 2023; 10:1238549. [PMID: 37781276 PMCID: PMC10538972 DOI: 10.3389/fvets.2023.1238549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Objective This study investigated the performance among four cardiac output (CO) monitoring techniques in comparison with the reference method intermittent pulmonary artery thermodilution (iPATD) and their ability to diagnose fluid responsiveness (FR) during a modified passive leg raise (PLRM) maneuver in isoflurane-anesthetized dogs undergoing acute blood volume manipulations. The study also examined the simultaneous effect of performing the PLRM on dynamic variables such as stroke distance variation (SDV), peak velocity variation (PVV), and stroke volume variation (SVV). Study design Prospective, nonrandomized, crossover design. Study animals Six healthy male Beagle dogs. Methods The dogs were anesthetized with propofol and isoflurane and mechanically ventilated under neuromuscular blockade. After instrumentation, they underwent a series of sequential, nonrandomized steps: Step 1: baseline data collection; Step 2: removal of 33 mL kg-1 of circulating blood volume; Step 3: blood re-transfusion; and Step 4: infusion of 20 mL kg-1 colloid solution. Following a 10-min stabilization period after each step, CO measurements were recorded using esophageal Doppler (EDCO), transesophageal echocardiography (TEECO), arterial pressure waveform analysis (APWACO), and electrical cardiometry (ECCO). Additionally, SDV, PVV, and SVV were recorded. Intermittent pulmonary artery thermodilution (iPATDCO) measurements were also recorded before, during, and after the PLRM maneuver. A successful FR diagnosis made using a specific test indicated that CO increased by more than 15% during the PLRM maneuver. Statistical analysis was performed using one-way analysis of variance for repeated measures with post hoc Tukey test, linear regression, Lin's concordance correlation coefficient (ρc), and Bland-Altman analysis. Statistical significance was set at p < 0.05. Results All techniques detected a reduction in CO (p < 0.001) during hemorrhage and an increase in CO after blood re-transfusion and colloid infusion (p < 0.001) compared with baseline. During hemorrhage, CO increases with the PLRM maneuver were as follows: 33% for iPATD (p < 0.001), 19% for EC (p = 0.03), 7% for APWA (p = 0.97), 39% for TEE (p < 0.001), and 17% for ED (p = 0.02). Concurrently, decreases in SVV, SDV, and PVV values (p < 0.001) were also observed. The percentage error for TEE, ED, and EC was less than 30% but exceeded 55% for APWA. While TEECO and ECCO slightly underestimated iPATDCO values, EDCO and APWACO significantly overestimated iPATDCO values. TEE and EC exhibited good and acceptable agreement with iPATD. However, CO measurements using all four techniques and iPATD did not differ before, during, and after PLRM at baseline, blood re-transfusion, and colloid infusion. Conclusion and clinical relevance iPATD, EC, TEE, and ED effectively assessed FR in hypovolemic dogs during the PLRM maneuver, while the performance of APWA was unacceptable and not recommended. SVV, SDV, and PVV could be used to monitor CO changes during PLRM and acute blood volume manipulations, suggesting their potential clinical utility.
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Affiliation(s)
- Vaidehi V. Paranjape
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Natalia Henao-Guerrero
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Giulio Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Siddharth Saksena
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
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Asai T. Pandemic and infodemic: the role of academic journals and preprints. J Anesth 2022; 37:173-176. [PMID: 36459231 PMCID: PMC9716145 DOI: 10.1007/s00540-022-03149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
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Shaker A, Hasanin A, Nagy M, Mostafa M, Fouad AZ, Mohamed H, Abdallah AS, Elsayad M. The Use of Lactate-Capillary Refill Time Product as Novel Index for Tissue Perfusion in Patients with Abdominal Sepsis: A Prospective Observational Study. Int J Gen Med 2022; 15:7443-7448. [PMID: 36172088 PMCID: PMC9512536 DOI: 10.2147/ijgm.s380195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ahmed Shaker
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
- Correspondence: Ahmed Hasanin, Department of anesthesia and critical care medicine, Faculty of Medicine, 01 elsarayah Street, Elmanyal, Cairo, Egypt, Tel +201000365115, Fax +20224168736, Email
| | - Mostafa Nagy
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Z Fouad
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Hassan Mohamed
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | | | - Mohamed Elsayad
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
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Helmy MA, Milad LM, Hasanin A, Elbasha YS, ElSabbagh HA, Elmarzouky MS, Mostafa M, Abdelhakeem AK, Morsy MAEM. Ability of IMPROVE and IMPROVE-DD scores to predict outcomes in patients with severe COVID-19: a prospective observational study. Sci Rep 2022; 12:13323. [PMID: 35922436 PMCID: PMC9349222 DOI: 10.1038/s41598-022-17466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/26/2022] [Indexed: 12/03/2022] Open
Abstract
In this study we aimed to evaluate the ability of IMPROVE and IMPROVE-DD scores in predicting in-hospital mortality in patients with severe COVID-19. This prospective observational study included adult patients with severe COVID-19 within 12 h from admission. We recorded patients' demographic and laboratory data, Charlson comorbidity index (CCI), SpO2 at room air, acute physiology and chronic health evaluation II (APACHE II), IMPROVE score and IMPROVE-DD score. In-hospital mortality and incidence of clinical worsening (the need for invasive mechanical ventilation, vasopressors, renal replacement therapy) were recorded. Our outcomes included the ability of the IMPROVE and IMPROVE-DD to predict in-hospital mortality and clinical worsening using the area under receiver operating characteristic curve (AUC) analysis. Multivariate analysis was used to detect independent risk factors for the study outcomes. Eighty-nine patients were available for the final analysis. The IMPROVE and IMPROVE-DD score showed the highest ability for predicting in-hospital mortality (AUC [95% confidence intervals {CI}] 0.96 [0.90–0.99] and 0.96 [0.90–0.99], respectively) in comparison to other risk stratification tools (APACHE II, CCI, SpO2). The AUC (95% CI) for IMPROVE and IMPROVE-DD to predict clinical worsening were 0.80 (0.70–0.88) and 0.79 (0.69–0.87), respectively. Using multivariate analysis, IMPROVE-DD and SpO2 were the only predictors for in-hospital mortality and clinical worsening. In patients with severe COVID-19, high IMPROVE and IMOROVE-DD scores showed excellent ability to predict in-hospital mortality and clinical worsening. Independent risk factors for in-hospital mortality and clinical worsening were IMPROVE-DD and SpO2.
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Affiliation(s)
- Mina Adolf Helmy
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Lydia Magdy Milad
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yasmin S Elbasha
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hala A ElSabbagh
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr K Abdelhakeem
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Abd El-Monem Morsy
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Overhydration Assessed Using Bioelectrical Impedance Vector Analysis Adversely Affects 90-Day Clinical Outcome among SARS-CoV2 Patients: A New Approach. Nutrients 2022; 14:nu14132726. [PMID: 35807907 PMCID: PMC9268688 DOI: 10.3390/nu14132726] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background: COVID-19 has taken on pandemic proportions with growing interest in prognostic factors. Overhydration is a risk factor for mortality in several medical conditions with its role in COVID-19, assessed with bioelectrical impedance (BI), gaining research interest. COVID-19 affects hydration status. The aim was to determine the hydration predictive role on 90 d survival COVID-19 and to compare BI assessments with traditional measures of hydration. Methods: We studied 127 consecutive COVID-19 patients. Hydration status was estimated using a 50 kHz phase-sensitive BI and estimated, compared with clinical scores and laboratory markers to predict mortality. Results: Non-surviving COVID-19 patients had significantly higher hydration 85.2% (76.9−89.3) vs. 73.7% (73.2−82.1) and extracellular water/total body water (ECW/TBW) 0.67 (0.59−0.75) vs. 0.54 (0.48−0.61) (p = 0.001, respectively), compared to surviving. Patients in the highest hydration tertile had increased mortality (p = 0.012), Intensive Care Unit (ICU) admission (p = 0.027), COVID-19 SEIMC score (p = 0.003), and inflammation biomarkers [CRP/prealbumin (p = 0.011)]. Multivariate analysis revealed that hydration status was associated with increased mortality. HR was 2.967 (95%CI, 1.459−6.032, p < 0.001) for hydration and 2.528 (95%CI, 1.664−3.843, p < 0.001) for ECW/TBW, which were significantly greater than traditional measures: CRP/prealbumin 3.057(95%CI, 0.906−10.308, p = 0.072) or BUN/creatinine 1.861 (95%CI, 1.375−2.520, p < 0.001). Hydration > 76.15% or ECW/TBW > 0.58 were the cut-off values predicting COVID-19 mortality with 81.3% and 93.8% sensitivity and 64 and 67.6% specificity, respectively. Hydration status offers a sensitive and specific prognostic test at admission, compared to established poor prognosis parameters. Conclusions and Relevance: Overhydration, indicated as high hydration (>76.15%) and ECW/TBW (>0.58), were significant predictors of COVID-19 mortality. These findings suggest that hydration evaluation with 50 kHz phase-sensitive BI measurements should be routinely included in the clinical assessment of COVID-19 patients at hospital admission, to identify increased mortality risk patients and assist medical care.
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Suehiro K. Assessing fluid responsiveness during spontaneous breathing. J Anesth 2022; 36:579-582. [PMID: 35606608 DOI: 10.1007/s00540-022-03075-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Koichi Suehiro
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan.
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Adolf Helmy M, Magdy Milad L, Hasanin A, Mostafa M. The novel use of diaphragmatic excursion on hospital admission to predict the need for ventilatory support in patients with coronavirus disease 2019. Anaesth Crit Care Pain Med 2021; 40:100976. [PMID: 34748940 PMCID: PMC8570438 DOI: 10.1016/j.accpm.2021.100976] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 02/06/2023]
Abstract
Background We aimed to evaluate the ability of diaphragmatic excursion at hospital admission to predict outcomes in patients with coronavirus disease-2019 (COVID-19). Methods In this prospective observational study, we included adult patients with severe COVID-19 admitted to a tertiary hospital. Ultrasound examination of the diaphragm was performed within 12 h of admission. Other collected data included peripheral oxygen saturation (SpO2), respiratory rate, and computed tomography (CT) score. The outcomes included the ability of diaphragmatic excursion, respiratory rate, SpO2, and CT score at admission to predict the need for ventilatory support (need for non-invasive or invasive ventilation) and patient mortality using the area under the receiver operating characteristic curve (AUC) analysis. Univariate and multivariable analyses about the need for ventilatory support and mortality were performed. Results Diaphragmatic excursion showed an excellent ability to predict the need for ventilatory support, which was the highest among respiratory rate, SpO2, and CT score; the AUCs (95% confidence interval [CI]) was 0.96 (0.85–1.00) for the right diaphragmatic excursion and 0.94 (0.82–0.99) for the left diaphragmatic excursion. The right diaphragmatic excursion also had the highest AUC for predicting mortality in relation to respiratory rate, SpO2, and CT score. Multivariable analysis revealed that low diaphragmatic excursion was an independent predictor of mortality with an odds ratio (95% CI) of 0.55 (0.31–0.98). Conclusion Diaphragmatic excursion on hospital admission can accurately predict the need for ventilatory support and mortality in patients with severe COVID-19. Low diaphragmatic excursion was an independent risk factor for in-hospital mortality.
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Affiliation(s)
- Mina Adolf Helmy
- Department of Anaesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Lydia Magdy Milad
- Department of Anaesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anaesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
| | - Maha Mostafa
- Department of Anaesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
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Elshal MM, Hasanin AM, Mostafa M, Gamal RM. Plethysmographic Peripheral Perfusion Index: Could It Be a New Vital Sign? Front Med (Lausanne) 2021; 8:651909. [PMID: 34660615 PMCID: PMC8517109 DOI: 10.3389/fmed.2021.651909] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/06/2021] [Indexed: 01/05/2023] Open
Abstract
The plethysmographic peripheral perfusion index (PPI) is a very useful parameter with various emerging utilities in medical practice. The PPI represents the ratio between pulsatile and non-pulsatile portions in peripheral circulation and is mainly affected by two main determinants: cardiac output and balance between sympathetic and parasympathetic nervous systems. The PPI decreases in cases of sympathetic predominance and/or low cardiac output states; therefore, it is a useful predictor of patient outcomes in critical care units. The PPI could be a surrogate for cardiac output in tests for fluid responsiveness, as an objective measure of pain especially in un-cooperative patients, and as a predictor of successful weaning from mechanical ventilation. The PPI is simple to measure, easy to interpret, and has continuously displayed variables, making it a convenient parameter for detecting the adequacy of blood flow and sympathetic-parasympathetic balance.
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Affiliation(s)
- Mamdouh M Elshal
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed M Hasanin
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Reham M Gamal
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
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11
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Thermodynamic effect of RNA virus infection on the human cardiovascular system. J Therm Biol 2021; 100:103039. [PMID: 34503786 DOI: 10.1016/j.jtherbio.2021.103039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/03/2021] [Accepted: 06/25/2021] [Indexed: 11/23/2022]
Abstract
In this work, analysis of cardiovascular system under the influence of RNA virus infection has been performed from a thermodynamic perspective. An exergetic efficiency of the system has been defined for this purpose. Results show that except for asymptomatic case, the exergetic efficiency reduces as the viral load goes up. Dynamics of viral growth along with change in efficiency is examined under different parameters such as virus production rate, infectivity rate and cell death rate. Results show that the drop in the exergetic efficiency of cardiovascular system under viral infection can be up to about 20%. Under infection, the exergy requirement of the lungs increases significantly as the work rate required by lungs increase by up to 240%.
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Mukhtar A, Rady A, Hasanin A, Lotfy A, El Adawy A, Hussein A, El-Hefnawy I, Hassan M, Mostafa H. Admission SpO 2 and ROX index predict outcome in patients with COVID-19. Am J Emerg Med 2021; 50:106-110. [PMID: 34332217 PMCID: PMC8313790 DOI: 10.1016/j.ajem.2021.07.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 12/23/2022] Open
Abstract
Background This study aimed to evaluate the accuracy of pulse oximetry-derived oxygen saturation (SpO2) on room air, determined at hospital admission, as a predictor for the need for mechanical ventilatory support in patients with Coronavirus Disease-2019 (COVID-19). Methods In this retrospective observational study, demographic and clinical details of the patients were obtained during ICU admission. SpO2 and respiratory rate (RR) on room air were determined within the first 6 h of hospital admission. As all measurements were obtained on room air, we calculated the simplified respiratory rate‑oxygenation (ROX) index by dividing the SpO2 by the RR. Based on the use of any assistance of mechanical ventilator (invasive or noninvasive), patients were divided into mechanical ventilation (MV) group and oxygen therapy group. The accuracy of the SpO2, CT score, and ROX index to predict the need to MV were determined using the Area under receiver operating curve (AUC). Results We included 72 critically ill patients who tested COVID-19-positive. SpO2 on the room air could predict any MV requirement (AUC [95% confidence interval]: 0.9 [0.8–0.96], sensitivity: 70%, specificity 100%, cut-off value ≤78%, P < 0.001). Within the MV group, the use of noninvasive ventilation (NIV) was successful in 37 (74%) patients, whereas 13 patients (26%) required endotracheal intubation. The cut-off ROX value for predicting early NIV failure was ≤1.4, with a sensitivity of 85%, a specificity of 86%, and an AUC of 0.86 (95% confidence interval of 0.73–0.94, P < 0.0001). Conclusions A baseline SpO2 ≤78% is an excellent predictor of MV requirement with a positive predictive value of 100%. Moreover, the ROX index measured within the first 6 h of hospital admission is a good indicator of early NIV failure.
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Affiliation(s)
- Ahmed Mukhtar
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt
| | - Ashraf Rady
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt.
| | - Ahmed Lotfy
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt
| | - Akram El Adawy
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt
| | - Amr Hussein
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt
| | | | | | - Hanan Mostafa
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt
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13
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Yuan S, Jiang SC, Zhang ZW, Fu YF, Hu J, Li ZL. The Role of Alveolar Edema in COVID-19. Cells 2021; 10:cells10081897. [PMID: 34440665 PMCID: PMC8391241 DOI: 10.3390/cells10081897] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) has spread over the world for more than one year. COVID-19 often develops life-threatening hypoxemia. Endothelial injury caused by the viral infection leads to intravascular coagulation and ventilation-perfusion mismatch. However, besides above pathogenic mechanisms, the role of alveolar edema in the disease progression has not been discussed comprehensively. Since the exudation of pulmonary edema fluid was extremely serious in COVID-19 patients, we bring out a hypothesis that severity of alveolar edema may determine the size of poorly-ventilated area and the blood oxygen content. Treatments to pulmonary edema (conservative fluid management, exogenous surfactant replacements and ethanol–oxygen vapor therapy hypothetically) may be greatly helpful for reducing the occurrences of severe cases. Given that late mechanical ventilation may cause mucus (edema fluid) to be blown deep into the small airways, oxygen therapy should be given at the early stages. The optimal time and blood oxygen saturation (SpO2) threshold for oxygen therapy are also discussed.
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Affiliation(s)
- Shu Yuan
- College of Resources, Sichuan Agricultural University, Chengdu 611130, China; (Z.-W.Z.); (Y.-F.F.)
- Correspondence:
| | - Si-Cong Jiang
- Chengdu Kang Hong Pharmaceutical Group Comp. Ltd., Chengdu 610036, China;
| | - Zhong-Wei Zhang
- College of Resources, Sichuan Agricultural University, Chengdu 611130, China; (Z.-W.Z.); (Y.-F.F.)
| | - Yu-Fan Fu
- College of Resources, Sichuan Agricultural University, Chengdu 611130, China; (Z.-W.Z.); (Y.-F.F.)
| | - Jing Hu
- School of Medicine, Northwest University, Xi’an 710069, China;
| | - Zi-Lin Li
- Department of Cardiovascular Surgery, Xijing Hospital, Medical University of the Air Force, Xi’an 710032, China;
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14
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van Zyl JS, Alam A, Felius J, Youssef RM, Bhakta D, Jack C, Jamil AK, Hall SA, Klintmalm GB, Spak CW, Gottlieb RL. ALLY in fighting COVID-19: magnitude of albumin decline and lymphopenia (ALLY) predict progression to critical disease. J Investig Med 2021; 69:710-718. [PMID: 33431604 PMCID: PMC7802390 DOI: 10.1136/jim-2020-001525] [Citation(s) in RCA: 4] [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] [Accepted: 11/10/2020] [Indexed: 01/13/2023]
Abstract
The global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic leading to coronavirus disease 2019 (COVID-19) is straining hospitals. Judicious resource allocation is paramount but difficult due to the unpredictable disease course. Once hospitalized, discerning which patients may progress to critical disease would be valuable for resource planning. Medical records were reviewed for consecutive hospitalized patients with COVID-19 in a large healthcare system in Texas. The main outcome was progression to critical disease within 10 days from admission. Albumin trends from admission to 7 days were analyzed using mixed-effects models, and progression to critical disease was modeled by multivariable logistic regression of laboratory results. Risk models were evaluated in an independent group. Of 153 non-critical patients, 28 (18%) progressed to critical disease. The rate of decrease in mean baseline-corrected (Δ) albumin was -0.08 g/dL/day (95% CI -0.11 to -0.04; p<0.001) or four times faster, in those who progressed compared with those who did not progress. A model of Δ albumin combined with lymphocyte percentage predicting progression to critical disease was validated in 60 separate patients (sensitivity, 0.70; specificity, 0.74). ALLY (delta albumin and lymphocyte percentage) is a simple tool to identify patients with COVID-19 at higher risk of disease progression when: (1) a 0.9 g/dL or greater albumin drop from baseline within 5 days of admission or (2) baseline lymphocyte of ≤10% is observed. The ALLY tool identified >70% of hospitalized cases that progressed to critical COVID-19 disease. We recommend prospectively tracking albumin. This is a globally applicable tool for all healthcare systems.
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Affiliation(s)
- Johanna S van Zyl
- Baylor Scott & White Research Institute, Baylor Scott and White Health, Dallas, Texas, USA
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
- Baylor Annette C and Harold C Simmons Transplant Institute, Baylor Scott and White Health, Dallas, Texas, USA
- College of Medicine, Texas A&M Health Science Center, Texas A&M University, Dallas, Texas, USA
| | - Amit Alam
- Baylor Scott & White Research Institute, Baylor Scott and White Health, Dallas, Texas, USA
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
- Baylor Annette C and Harold C Simmons Transplant Institute, Baylor Scott and White Health, Dallas, Texas, USA
- College of Medicine, Texas A&M Health Science Center, Texas A&M University, Dallas, Texas, USA
| | - Joost Felius
- Baylor Scott & White Research Institute, Baylor Scott and White Health, Dallas, Texas, USA
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
- Baylor Annette C and Harold C Simmons Transplant Institute, Baylor Scott and White Health, Dallas, Texas, USA
- College of Medicine, Texas A&M Health Science Center, Texas A&M University, Dallas, Texas, USA
| | - Ronnie M Youssef
- College of Medicine, Texas A&M Health Science Center, Texas A&M University, Dallas, Texas, USA
| | - Dipesh Bhakta
- College of Medicine, Texas A&M Health Science Center, Texas A&M University, Dallas, Texas, USA
| | - Christina Jack
- College of Medicine, Texas A&M Health Science Center, Texas A&M University, Dallas, Texas, USA
| | - Aayla K Jamil
- Baylor Scott & White Research Institute, Baylor Scott and White Health, Dallas, Texas, USA
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
- Baylor Annette C and Harold C Simmons Transplant Institute, Baylor Scott and White Health, Dallas, Texas, USA
- College of Medicine, Texas A&M Health Science Center, Texas A&M University, Dallas, Texas, USA
| | - Shelley A Hall
- Baylor Scott & White Research Institute, Baylor Scott and White Health, Dallas, Texas, USA
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
- Baylor Annette C and Harold C Simmons Transplant Institute, Baylor Scott and White Health, Dallas, Texas, USA
- College of Medicine, Texas A&M Health Science Center, Texas A&M University, Dallas, Texas, USA
| | - Göran B Klintmalm
- Baylor Scott & White Research Institute, Baylor Scott and White Health, Dallas, Texas, USA
- Baylor Annette C and Harold C Simmons Transplant Institute, Baylor Scott and White Health, Dallas, Texas, USA
- College of Medicine, Texas A&M Health Science Center, Texas A&M University, Dallas, Texas, USA
| | - Cedric W Spak
- Baylor Scott & White Research Institute, Baylor Scott and White Health, Dallas, Texas, USA
- Baylor Annette C and Harold C Simmons Transplant Institute, Baylor Scott and White Health, Dallas, Texas, USA
- College of Medicine, Texas A&M Health Science Center, Texas A&M University, Dallas, Texas, USA
- Division of Infectious Disease, Baylor University Medical Center, Dallas, Texas, USA
- Texas Centers for Infectious Disease Associates, Dallas, Texas, USA
| | - Robert L Gottlieb
- Baylor Scott & White Research Institute, Baylor Scott and White Health, Dallas, Texas, USA
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
- Baylor Annette C and Harold C Simmons Transplant Institute, Baylor Scott and White Health, Dallas, Texas, USA
- College of Medicine, Texas A&M Health Science Center, Texas A&M University, Dallas, Texas, USA
- Division of Precision Medicine, Baylor University Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, TCU and UNTHSC School of Medicine, Fort Worth, Texas, USA
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15
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Hasanin A, Karam N, Mukhtar AM, Habib SF. The ability of pulse oximetry-derived peripheral perfusion index to detect fluid responsiveness in patients with septic shock. J Anesth 2021; 35:254-261. [PMID: 33616758 DOI: 10.1007/s00540-021-02908-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fluid challenge test is a widely used method for the detection of fluid responsiveness in acute circulatory failure. However, detection of the patient's response to the fluid challenge requires monitoring of cardiac output which is not feasible in many settings. We investigated whether the changes in the pulse oximetry-derived peripheral perfusion index (PPI), as a non-invasive surrogate of cardiac output, can detect fluid responsiveness using the fluid challenge test or not. METHODS We prospectively enrolled 58 patients with septic shock on norepinephrine infusion. Fluid challenge test, using 200 mL crystalloid solution, was performed in all study subjects. All patients received an additional 300 mL crystalloid infusion to confirm fluid responsiveness. Velocity time integral (VTI) (using transthoracic echocardiography), and PPI were measured at the baseline, after 200 mL fluid challenge, and after completion of 500 mL crystalloids. Fluid responsiveness was defined by 10% increase in the VTI after completion of the 500 mL. The predictive ability of ∆PPI [Calculated as (PPI after 200 mL - baseline PPI)/baseline PPI] to detect fluid responders was obtained using the receiver operating characteristic curve. RESULTS Forty-two patients (74%) were fluid responders; in whom, the mean arterial pressure, the central venous pressure, the VTI, and the PPI increased after fluid administration compared to the baseline values. ∆PPI showed moderate ability to detect fluid responders [area under receiver operating characteristic curve (95% confidence interval) 0.82 (0.70-0.91), sensitivity 76%, specificity 80%, positive predictive value 92%, negative predictive value 54%, cutoff value ≥ 5%]. There was a significant correlation between ∆PPI and ∆VTI induced by the fluid challenge. CONCLUSION ∆PPI showed moderate ability to detect fluid responsiveness in patients with septic shock on norepinephrine infusion. Increased PPI after 200 mL crystalloid challenge can detect fluid responsiveness with a positive predictive value of 92%; however, failure of the PPI to increase does not exclude fluid responsiveness. CLINICAL TRIAL IDENTIFIER NCT03805321. Date of registration: 15 January 2019. Clinical trial registration URL: https://clinicaltrials.gov/ct2/show/NCT03805321?term=ahmed+hasanin&rank=9 .
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Affiliation(s)
- Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
| | - Nadia Karam
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Mukhtar
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Sara F Habib
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
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16
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Enev R, Krastev P, Abedinov F. Prediction of fluid responsiveness: a review. BIOTECHNOL BIOTEC EQ 2021. [DOI: 10.1080/13102818.2021.1960190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Rostislav Enev
- Department of Anesthesiology and Intensive Care, University Hospital “Sveta Ekaterina”, Medical University of Sofia, Sofia, Bulgaria
| | - Plamen Krastev
- Department of Cardiology, University Hospital “Sveta Ekaterina”, Medical University of Sofia, Sofia, Bulgaria
| | - Filip Abedinov
- Department of Anesthesiology and Intensive Care, University Hospital “Sveta Ekaterina”, Medical University of Sofia, Sofia, Bulgaria
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17
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Abstract
Initial studies found increased severity of coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in patients with diabetes mellitus. Furthermore, COVID-19 might also predispose infected individuals to hyperglycaemia. Interacting with other risk factors, hyperglycaemia might modulate immune and inflammatory responses, thus predisposing patients to severe COVID-19 and possible lethal outcomes. Angiotensin-converting enzyme 2 (ACE2), which is part of the renin-angiotensin-aldosterone system (RAAS), is the main entry receptor for SARS-CoV-2; although dipeptidyl peptidase 4 (DPP4) might also act as a binding target. Preliminary data, however, do not suggest a notable effect of glucose-lowering DPP4 inhibitors on SARS-CoV-2 susceptibility. Owing to their pharmacological characteristics, sodium-glucose cotransporter 2 (SGLT2) inhibitors might cause adverse effects in patients with COVID-19 and so cannot be recommended. Currently, insulin should be the main approach to the control of acute glycaemia. Most available evidence does not distinguish between the major types of diabetes mellitus and is related to type 2 diabetes mellitus owing to its high prevalence. However, some limited evidence is now available on type 1 diabetes mellitus and COVID-19. Most of these conclusions are preliminary, and further investigation of the optimal management in patients with diabetes mellitus is warranted.
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Affiliation(s)
- Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
| | - Jae Hyun Bae
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Hyuk-Sang Kwon
- Department of Internal Medicine, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Michael A Nauck
- Diabetes Division, Katholisches Klinikum Bochum, St Josef-Hospital (Ruhr-Universität Bochum), Bochum, Germany.
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18
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Gandhi A, Sokhi J, Lockie C, Ward PA. Emergency Tracheal Intubation in Patients with COVID-19: Experience from a UK Centre. Anesthesiol Res Pract 2020; 2020:8816729. [PMID: 33376486 PMCID: PMC7729388 DOI: 10.1155/2020/8816729] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/06/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
This retrospective observational case series describes a single centre's preparations and experience of 53 emergency tracheal intubations in patients with COVID-19 respiratory failure. The findings of a contemporaneous online survey exploring technical and nontechnical aspects of airway management, completed by intubation team members, are also presented. Preparations included developing a COVID-19 intubation standard operating procedure and checklist, dedicated airway trolleys, a consultant-led mobile intubation team, and an airway education programme. Tracheal intubation was successful in all patients. Intubation first-pass success rate was 85%, first-line videolaryngoscopy use 79%, oxygen desaturation 49%, and hypotension 21%. Performance was consistent across all clinical areas. The main factor impeding first-pass success was larger diameter tracheal tubes. The majority of intubations was performed by consultant anaesthetists. Nonconsultant intubations demonstrated higher oxygen desaturation rates (75% vs. 45%, p=0.610) and lower first-pass success (0% vs. 92%, p < 0.001). Survey respondents (n = 29) reported increased anxiety at the start of the pandemic, with statistically significant reduction as the pandemic progressed (median: 4/5 very high vs. 2/5 low anxiety, p < 0.001). Reported procedural/environmental challenges included performing tasks in personal protective equipment (62%), remote-site working (48%), and modification of normal practices (41%)-specifically, the use of larger diameter tracheal tubes (21%). Hypoxaemia was identified by 90% of respondents as the most challenging patient-related factor during intubations. Our findings demonstrate that a consultant-led mobile intubation team can safely perform tracheal intubation in critically ill COVID-19 patients across all clinical areas, aided by thorough preparation and training, despite heightened anxiety levels.
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Affiliation(s)
- Ajay Gandhi
- Chelsea and Westminster Hospital, London, UK
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19
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Salem A, Elamir H, Alfoudri H, Shamsah M, Abdelraheem S, Abdo I, Galal M, Ali L. Improving management of hospitalised patients with COVID-19: algorithms and tools for implementation and measurement. BMJ Open Qual 2020; 9:e001130. [PMID: 33199287 PMCID: PMC7670554 DOI: 10.1136/bmjoq-2020-001130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/12/2020] [Accepted: 11/08/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic represents an unprecedented challenge to healthcare systems and nations across the world. Particularly challenging are the lack of agreed-upon management guidelines and variations in practice. Our hospital is a large, secondary-care government hospital in Kuwait, which has increased its capacity by approximately 28% to manage the care of patients with COVID-19. The surge in capacity has necessitated the redeployment of staff who are not well-trained to manage such conditions. There was a great need to develop a tool to help redeployed staff in decision-making for patients with COVID-19, a tool which could also be used for training. METHODS Based on the best available clinical knowledge and best practices, an eight member multidisciplinary group of clinical and quality experts undertook the development of a clinical algorithm-based toolkit to guide training and practice for the management of patients with COVID-19. The team followed Horabin and Lewis' seven-step approach in developing the algorithms and a five-step method in writing them. Moreover, we applied Rosenfeld et al's five points to each algorithm. RESULTS A set of seven clinical algorithms and one illustrative layout diagram were developed. The algorithms were augmented with documentation forms, data-collection online forms and spreadsheets and an indicators' reference sheet to guide implementation and performance measurement. The final version underwent several revisions and amendments prior to approval. CONCLUSIONS A large volume of published literature on the topic of COVID-19 pandemic was translated into a user-friendly, algorithm-based toolkit for the management of patients with COVID-19. This toolkit can be used for training and decision-making to improve the quality of care provided to patients with COVID-19.
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Affiliation(s)
- Ahmed Salem
- Anaesthesia and Intensive Care Department, Sabah Al Ahmad Urology Centre, Ministry of Health, Sabah, Kuwait
- Anaesthesia and Intensive Care Department, Faculty of Medicine, Banha University, Benha, Egypt
| | - Hossam Elamir
- Quality and Accreditation Directorate, Ministry of Health, Safat, Kuwait
| | - Huda Alfoudri
- Anaesthesia, Critical Care and Pain Management Department, Adan Hospital, Ministry of Health, Hadiya, Kuwait
| | - Mohammed Shamsah
- Anaesthesia, Critical Care and Pain Management Department, Adan Hospital, Ministry of Health, Hadiya, Kuwait
| | - Shams Abdelraheem
- Critical Care Department, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Ibtissam Abdo
- Quality and Accreditation Directorate, Ministry of Health, Safat, Kuwait
| | - Mohammad Galal
- Quality and Accreditation Directorate, Ministry of Health, Safat, Kuwait
| | - Lamiaa Ali
- Quality and Accreditation Directorate, Ministry of Health, Safat, Kuwait
- Public Health Department, Fayoum University Faculty of Medicine, Fayoum, Egypt
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20
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Suassuna JHR, de Lima EQ, Rocha E, Castro A, Burdmann EDA, do Carmo LPDF, Yu L, Ibrahim MY, Betônico GN, Cuvello AL, Ávila MON, Gonçalves ARR, Costa CBS, Bresolin NL, de Abreu AP, Lobo SMA, do Nascimento MM. Technical note and clinical instructions for Acute Kidney Injury (AKI) in patients with Covid-19: Brazilian Society of Nephrology and Brazilian Association of Intensive Care Medicine. J Bras Nefrol 2020; 42:22-31. [PMID: 32877495 PMCID: PMC7479984 DOI: 10.1590/2175-8239-jbn-2020-s107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
We produced this document to bring pertinent information to the practice of nephrology, as regards to the renal involvement with COVID-19, the management of acute kidney injury cases, and practical guidance on the provision of dialysis support.As information on COVID-19 evolves at a pace never before seen in medical science, these recommendations, although based on recent scientific evidence, refer to the present moment. The guidelines may be updated when published data and other relevant information become available.
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Affiliation(s)
| | | | - Eduardo Rocha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Alan Castro
- Complexo Hospitalar de Niterói, Niterói, RJ, Brasil
| | | | | | - Luis Yu
- Universidade de São Paulo, São Paulo, SP, Brasil
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