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Bird DH, Beringer DC, Parris DP. The use of non-invasive ventilation by emergency doctors in Johannesburg Academic Hospitals, South Africa - assessing knowledge, attitudes and practices. Afr J Emerg Med 2023; 13:322-327. [PMID: 38021353 PMCID: PMC10665829 DOI: 10.1016/j.afjem.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Non-invasive ventilation (NIV) is an alternative ventilatory method to endotracheal intubation and invasive ventilation in patients presenting in acute respiratory failure. Appropriate and timely application of NIV has shown benefits over invasive ventilation. In recent years, there has been an increase in the use of NIV for varying pathologies in response to limited resources.Emergency department doctors' knowledge of NIV, as well as their attitude towards its use can have significant effects on the success of NIV. The aim of this study was to assess emergency doctors' use of NIV in the South African setting. Methods This was a multi-centre prospective cross-sectional study that was conducted across three academic emergency departments in Johannesburg, South Africa. Doctors of various grades were included in the study and their responses were analysed according to their level of experience and their job description. Results The mean knowledge score of the participants was shown to increase with an increase in job designation (p < 0.001). The doctors' attitude towards NIV was more positive in those with higher knowledge scores (p < 0.001). Participants with previous critical care experience versus those without was associated with a higher average knowledge score (77% vs. 69 %, p = 0.009) as was formal NIV training versus those without (77% vs. 69 %, p = 0.01). The COVID-19 pandemic increased confidence in the use of NIV in 61 % of participants. The majority (69 %) of participants did not use a checklist when administering NIV. Only 53 % used a guideline when initiating a patient on NIV and just 26 % used a locally produced protocol. Conclusion Increased clinical experience, critical care exposure and formal NIV training corresponded with higher knowledge scores. Formal NIV training programs, the implementation of a checklist and the development of locally produced protocols are recommended to improve knowledge, attitudes and NIV practice that is in-keeping with international standards.
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Affiliation(s)
- Dr Holly Bird
- Division of Emergency Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Dr Craig Beringer
- Division of Emergency Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Dr Pano Parris
- Division of Emergency Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Hill JE, Hebatalla A, Hamer O, Gomez KU, Harrison J, Bongers T. Non-invasive respiratory support in the management of COVID-19: a synthesis of systematic reviews. BRITISH JOURNAL OF CARDIAC NURSING 2023; 18:0060. [PMID: 38736533 PMCID: PMC7615950 DOI: 10.12968/bjca.2022.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Hospitalised patients with COVID-19 often require oxygen because of the increased risk of hypoxia, and one of the main treatment goals is to avoid mechanical ventilation where possible. Non-invasive respiratory support such as high-flow nasal oxygen, bi-level positive airway pressure and continuous positive airway pressure appear to be clinical alternatives. However, further research is needed to assess the effectiveness of non-invasive respiratory support and its varying modes as a treatment for COVID-19 within a diverse population. This commentary aims to critically appraise three reviews concerning the use of non-invasive respiratory support in patients with COVID-19 and expand upon the findings with regards to clinical practice.
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Affiliation(s)
| | | | | | | | | | - Thomas Bongers
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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Gopalakrishnan M, Khichar S, Saurabh S, Vijayvergia P, Thangaraju K, Tripathi S, Devarakonda HV, Kumar A, Kumar PS, Garg MK. Effectiveness of early awake self proning strategy in non-intubated patients with COVID-19 hypoxemia: an open-labelled randomized clinical trial from Jodhpur, India. Monaldi Arch Chest Dis 2022; 93. [PMID: 36524853 DOI: 10.4081/monaldi.2022.2431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Awake self-proning is being used widely as respiratory support in COVID-19 hypoxemia, in resource-limited settings. We aimed to investigate the effectiveness of early awake self-proning in preventing mortality and the need for intubation in adults with moderate COVID-19 hypoxemia. In this randomized clinical trial with inten-tion-to-treat analysis, we enrolled eligible adults with COVID-19 hypoxemia (SpO2 <94%), requiring supplemental oxygen via nasal prongs or facemask from a tertiary-care setting in Jodhpur, India between June 15 to December 24, 2020. Awake proning comprised of 4-hour cycles with prone position maintained 2 h per cycle. The control group did not maintain any specific position. All participants received standard care. The primary outcomes were 30-day mortal-ity and requirement for mechanical ventilation. Of 502 participants included, mean (SD) age was 59.7 (12.7) years with 124 women (24.6%); 257 were randomized to awake-proning, 245 to control group and all 502 were included for follow-up mortality analysis. Mortality at follow-up was 16.3% in the awake-prone and 15.1% in the control group [OR:1.10 (0.68-1.78), p=0.703). The requirement of mechanical ventilation was 10% in both groups (p=0.974). Survival time (in days) was not significantly different between the groups [Log-rank test, HR: 1.08 (95% CI, 0.70-1.68), p=0.726]. Likewise, time to intubation was comparable (Log-rank test, HR: 0.93 (95% CI, 0.56-1.70), p=0.974). Hence, awake self-proning did not improve survival or requirement of mechanical-ventilation in non-intubated patients with mild to moderate COVID-19 hypox-emia. Trial Registration: Clinical trial registry of India, ID: CTRI/2020/06/025804. The trial is accessible from WHO's International Clinical Trials Registry Platform (ICTRP) at https://trialsearch.who.int *************************************************************** *Appendix Authors list Deepak Kumar1, Gopal Krishna Bohra1, Nishant Kumar Chauhan2, Nikhil Kothari3, Vijaya Lakshmi Nag4 Sanjeev Misra5 1Department of Internal Medicine; 2Department of Pulmonary Medicine; 3Department of Anaesthesiology and Critical Care; 4Department of Microbiology; 5Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India.
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Affiliation(s)
- Maya Gopalakrishnan
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Satyendra Khichar
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Suman Saurabh
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - Parag Vijayvergia
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Karthikeyan Thangaraju
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Swapnil Tripathi
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | | | - Akhilesh Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Pranav S Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Mahendra Kumar Garg
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
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Sunkonkit K, Kungsuwan S, Seetaboot S, Reungrongrat S. Factors associated with failure of using high flow nasal cannula in children. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:732-739. [PMID: 36038361 PMCID: PMC9629993 DOI: 10.1111/crj.13533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION High flow nasal cannula (HFNC) has significantly success in treating acute respiratory distress while HFNC failure dramatically increases mortality and morbidity. OBJECTIVE To describe factors associated with failure of HFNC use in children. METHODS We performed a retrospective observational study using demographic and laboratory findings. We compared clinical and laboratory variables in both successful and failed HFNC groups. The correlations between factors and HFNC failure were constructed by binary logistic regression analysis. RESULTS Between August 2016 and May 2018, 250 children receiving HFNC (median age 16 months; range 1-228 months, male 50.8%) were enrolled. Pneumonia was the most common cause of respiratory distress, and the median length of stay (LOS) in hospital was 11 days. HFNC failure was found 16.4% while HFNC complication was 4.8% including epistaxis, pressure sore, and gastric distension. Based on multivariable logistic regression analysis, factors associated with HFNC failure were children with congenital heart disease comorbidity (p = 0.005), HFNC use with maximum FiO2 > 0.6 (p = 0.021), lobar infiltration on chest X-ray (p = 0.012), the reduction of heart rate, and respiratory rate <20% after 1 h of HFNC use (p = 0.001 and p = 0.001, respectively). CONCLUSION HFNC is feasible to use for children with respiratory distress; however, patients with congenital heart disease, using HFNC with FiO2 > 0.6, lobar infiltration on chest X-ray should be closely monitored. Heart rate and respiratory rate are important parameters in addition to clinical assessment for evaluating HFNC failure in children.
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Affiliation(s)
- Kanokkarn Sunkonkit
- Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Supakanya Kungsuwan
- Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Sukanlaya Seetaboot
- Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Sanit Reungrongrat
- Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
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Mehta C, Mehta Y. Noninvasive Respiratory Devices in COVID-19. Indian J Crit Care Med 2022; 26:770-772. [PMID: 36864875 PMCID: PMC9973168 DOI: 10.5005/jp-journals-10071-24268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Mehta C, Mehta Y. Noninvasive Respiratory Devices in COVID-19. Indian J Crit Care Med 2022;26(7):770-772.
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Affiliation(s)
- Chitra Mehta
- Institute of Critical Care and Anesthesiology, Medanta–The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta–The Medicity, Gurugram, Haryana, India,Yatin Mehta, Institute of Critical Care and Anesthesiology, Medanta–The Medicity, Gurugram, Haryana, India, Phone: +91 9971698149, e-mail:
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Boules ME, Laz NI, Elberry AA, Hussein RRS, Abdelrahim MEA. Effect of pressures and type of ventilation on aerosol delivery to chronic obstructive pulmonary disease patients. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2022; 11:57. [PMID: 35441078 PMCID: PMC9010937 DOI: 10.1186/s43088-022-00234-y] [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: 01/12/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Continuous Positive Airway Pressure (CPAP), BiPhasic Positive Airway Pressure (BiPAP), and high flow nasal cannula (HFNC) show some evidence to have efficacy in COVID-19 patients. Delivery during noninvasive mechanical ventilation (NIV) or HFNC gives faster and more enhanced clinical effects than when aerosols are given without assisted breath. The present work aimed to compare the effect of BiPhasic Positive Airway Pressure (BiPAP) mode at two different pressures; low BiPAP (Inspiratory Positive Airway Pressure (IPAP)/Expiratory Positive Airway Pressure (EPAP) of 10/5 cm water) and high BiPAP (IPAP/EPAP of 20/5 cm water), with HFNC system on pulmonary and systemic drug delivery of salbutamol. On the first day of the experiment, all patients received 2500 μg salbutamol using Aerogen Solo vibrating mesh nebulizer. Urine samples 30 min post-dose and cumulative urinary salbutamol during the next 24 h were collected on the next day. On the third day, the ex-vivo filter was inserted before the patient to collect the delivered dose to the patient of the 2500 μg salbutamol. Salbutamol was quantified using high-performance liquid chromatography (HPLC). Results Low-pressure BiPAP showed the highest amount delivered to the lung after 30 min followed by HFNC then high-pressure BiPAP. But the significant difference was only observed between low and high-pressure BiPAP modes (p = 0.012). Low-pressure BiPAP showed the highest delivered systemic delivery amount followed by HFNC then high-pressure BiPAP. Low-pressure BiPAP was significantly higher than HFNC (p = 0.017) and high-pressure BiPAP (p = 0.008). No significant difference was reported between HFNC and high-pressure BiPAP. The ex-vivo filter was the greatest in the case of low-pressure BiPAP followed by HFNC then high-pressure BiPAP. Low-pressure BiPAP was significantly higher than HFNC (p = 0.033) and high-pressure BiPAP (p = 0.008). Also, no significant difference was found between HFNC and high-pressure BiPAP. Conclusions Our results of pulmonary, systemic, and ex-vivo drug delivery were found to be consistent. The low BiPAP delivered the highest amount followed by the HFNC then the high BiPAP with the least amount. However, no significant difference was found between HFNC and high BiPAP.
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Singh RB, Mishra P, Singh AK, Srivastava DK, Gupta V, Malviya D, Rai S. Modified Bain's Circuit as an Alternate to Non-invasive Ventilation in COVID 19. Cureus 2022; 14:e22772. [PMID: 35371837 PMCID: PMC8971127 DOI: 10.7759/cureus.22772] [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] [Accepted: 03/01/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction COVID-19 is a pandemic that severely affects the lungs. Symptomatically affected individuals often become severely hypoxic, requiring non-invasive ventilation. The scarcity of resources in resource-compromised countries like India led to the adoption of novel strategies like using Bain’s circuit for assisting spontaneous ventilation. This study compares the outcome when a standard circuit is replaced with a shortened Bain’s circuit. Aims and objectives To compare shortened Bain’s circuit and bilevel positive airway pressure (BiPAP) in spontaneously ventilated COVID 19 patients with regards to effects on hemodynamic stability and efficacy of ventilation using blood gas analysis. Methodology Twenty-four COVID patients aged between 35-70 years, requiring non-invasive ventilation but not tolerating BiPAP or not improving on BiPAP were enrolled in the study. Baseline heart rate and arterial blood gases (ABG) were recorded. Patients were then ventilated using shortened Bain’s circuit. Heart rate and ABG were then recorded two hours after ventilation. Results Hemodynamic and blood gas parameters were comparable between the two groups at baseline and on BiPAP. Group A showed better hemodynamic and blood gas profiles compared to group B, but the difference was not statistically significant because of small sample size. Conclusion Shortened Bain’s circuit may be a viable alternative to non-invasive ventilation in spontaneously breathing hypoxic patients with efficacy comparable to a standard Bain’s circuit and reduced chances of carbon dioxide retention. Studies with a larger sample size are needed to further validate the conclusion.
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Bliznuks D, Kistkins S, Teličko J, Geža V, Zāģeris Ģ, Svaža A, Syundyukov E, Purenkovs M, Zeme D, Jēkabsone S, Žentiņa D, Pīrāgs V, Taivans I. The oxygenation module: the missing link in using sleep apnea devices to treat COVID-19 pneumonia at home. Biomed Eng Online 2022; 21:10. [PMID: 35120521 PMCID: PMC8814782 DOI: 10.1186/s12938-022-00982-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aims at solving the problem with the limitations of the homecare CPAP equipment such as sleep apnea devices in the treatment of COVID-19 pneumonia. By adding an advanced, rapid-to-produce oxygenation module to existing CPAP devices we allow distributing healthcare at all levels, reducing the load on intensive care units, promoting treatment in the early stages at homecare. A significant part of the COVID-19 pneumonia patients requires not only an oxygen supply but also additional air pressure. Existing home care devices are able to create precise positive airway pressure, but cannot precisely measure supplied oxygen concentration. Either uses uncertified and potentially unsafe mechanisms. RESULTS The developed system allows using certified and widely available CPAP (constant positive airway pressure) devices to perform the critical function of delivering pressure and oxygen to airways. CPAP device is connected to the designed add-on module that can provide predefined oxygen concentration in a precise and stable manner. Clinical test results include data from 12 COVID-19 positive patients. The device has been compared against certified NIV (non-invasive) equipment under 6-20 hPa pressure and 30-70% FiO2. Tests have proved that the developed system can achieve the same SaO2 (p = 0.93) and PaO2 (p = 0.80) levels as NIV with clinically insignificant differences. Test results show that the designed system can substitute NIV equipment for a significant part of COVID-19 patients while leaving existing NIV devices for unstable and critical patients. The system has been designed to be mass-produced while having medically certified critical components. CONCLUSION The clinical testing of the new device for oxygen supplementation of patients treated using simple CPAP devices looks promising and could be used for the treatment of COVID-19 pneumonia.
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Affiliation(s)
- Dmitrijs Bliznuks
- Institute of Smart Computer Technologies, Riga Technical University, 2-335 Daugavgrivas street, Riga, 1658, Latvia.
| | - Svjatoslavs Kistkins
- Department of Internal Medicine, Paul Stradins Clinical University Hospital, 13 Pilsonu street, Riga, 1002, Latvia
| | - Jevgēnijs Teličko
- University of Latvia Institute of Numerical Modelling, 3 Jelgavas street, Riga, 1004, Latvia
| | - Vadims Geža
- University of Latvia Institute of Numerical Modelling, 3 Jelgavas street, Riga, 1004, Latvia
| | - Ģirts Zāģeris
- University of Latvia Institute of Numerical Modelling, 3 Jelgavas street, Riga, 1004, Latvia
| | - Artis Svaža
- Paul Stradins Clinical University Hospital, Research Institute, 13 Pilsonu street, Riga, 1002, Latvia
| | - Emil Syundyukov
- Faculty of Computing, University of Latvia, 19 Raina bulvaris, Riga, 1586, Latvia
| | - Mārtiņš Purenkovs
- Department of Internal Medicine, Paul Stradins Clinical University Hospital, 13 Pilsonu street, Riga, 1002, Latvia
| | - Dana Zeme
- Department of Internal Medicine, Paul Stradins Clinical University Hospital, 13 Pilsonu street, Riga, 1002, Latvia
| | - Solveiga Jēkabsone
- Department of Internal Medicine, Paul Stradins Clinical University Hospital, 13 Pilsonu street, Riga, 1002, Latvia
| | - Dace Žentiņa
- Department of Internal Medicine, Paul Stradins Clinical University Hospital, 13 Pilsonu street, Riga, 1002, Latvia
| | - Valdis Pīrāgs
- Department of Internal Medicine, Paul Stradins Clinical University Hospital, 13 Pilsonu street, Riga, 1002, Latvia
| | - Immanuels Taivans
- Department of Internal Medicine, Paul Stradins Clinical University Hospital, 13 Pilsonu street, Riga, 1002, Latvia
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Schmid B, Griesel M, Fischer AL, Romero CS, Metzendorf MI, Weibel S, Fichtner F. Awake Prone Positioning, High-Flow Nasal Oxygen and Non-Invasive Ventilation as Non-Invasive Respiratory Strategies in COVID-19 Acute Respiratory Failure: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11020391. [PMID: 35054084 PMCID: PMC8782004 DOI: 10.3390/jcm11020391] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Acute respiratory failure is the most important organ dysfunction of COVID-19 patients. While non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) oxygen are frequently used, efficacy and safety remain uncertain. Benefits and harms of awake prone positioning (APP) in COVID-19 patients are unknown. Methods: We searched for randomized controlled trials (RCTs) comparing HFNC vs. NIV and APP vs. standard care. We meta-analyzed data for mortality, intubation rate, and safety. Results: Five RCTs (2182 patients) were identified. While it remains uncertain whether HFNC compared to NIV alters mortality (RR: 0.92, 95% CI 0.65–1.33), HFNC may increase rate of intubation or death (composite endpoint; RR 1.22, 1.03–1.45). We do not know if HFNC alters risk for harm. APP compared to standard care probably decreases intubation rate (RR 0.83, 0.71–0.96) but may have little or no effect on mortality (RR: 1.08, 0.51–2.31). Conclusions: Certainty of evidence is moderate to very low. There is no compelling evidence for either HFNC or NIV, but both carry substantial risk for harm. The use of APP probably has benefits although mortality appears unaffected.
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Affiliation(s)
- Benedikt Schmid
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080 Wuerzburg, Germany; (B.S.); (S.W.)
| | - Mirko Griesel
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Services, 04103 Leipzig, Germany; (M.G.); (A.-L.F.)
| | - Anna-Lena Fischer
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Services, 04103 Leipzig, Germany; (M.G.); (A.-L.F.)
| | - Carolina S. Romero
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, General University Hospital, 46014 Valencia, Spain;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, 40225 Duesseldorf, Germany;
| | - Stephanie Weibel
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080 Wuerzburg, Germany; (B.S.); (S.W.)
| | - Falk Fichtner
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Services, 04103 Leipzig, Germany; (M.G.); (A.-L.F.)
- Correspondence: ; Tel.: +49-341-97-10709
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Kumar S, Saini V. Portable BiPAP machines in Covid: A saviour in second pandemic wave. J Anaesthesiol Clin Pharmacol 2022; 38:S144-S145. [PMID: 36060173 PMCID: PMC9438845 DOI: 10.4103/joacp.joacp_373_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/08/2021] [Indexed: 11/12/2022] Open
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Raafat RH, Alboraie M, Elkhadry SW, Abdelnasier M, Hashish MA, Almansoury YA, Yousef N, Elshaarawy O, Madkour A. Non-invasive predictors of ICU admission and mortality in initially asymptomatic COVID-19 patients. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022; 16:54. [PMCID: PMC9612617 DOI: 10.1186/s43168-022-00156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) can present with pulmonary and non-pulmonary manifestations, or it may be asymptomatic. Asymptomatic patients have a major impact on transmission of the disease, and prediction of their outcome and prognosis is challenging. We aim to identify the predictors of intensive care unit (ICU) admission and mortality in hospitalized COVID-19 patients with initially asymptomatic presentation. Methods This was a prospective multicenter study using cohort data that included all admitted patients aged 21 years and above, with different clinical presentations other (than pulmonary manifestation) and were discovered to have COVID-19. Demographic data, clinical data and progression were reported. Univariate analysis and logistic regression analysis were performed to predict ICU admission and mortality during hospitalization. Results One hundred forty-nine consecutive patients, 92 (61.7% males) were included in our study, Median age (IQR) was 59.00 (43–69]. Only 1 patient (0.7%) had a contact with a confirmed case of COVID-19. 58 patients (39%) were admitted to ICU and 22 patients (14.8%) have died. High ferritin level (more than 422.5), low oxygen saturation (less than 93%), and in need of non-invasive ventilation (NIV) have 3.148, 8.159 and 26.456 times likelihood to be admitted to ICU, respectively. Patients with high CO-RADS, low oxygen saturation (less than 92.5%), and in need for mechanical ventilation (MV) have 82.8, 15.9, and 240.77 times likelihood to die, respectively. Conclusion Initially asymptomatic hospitalized patients with COVID-19 have a great impact on health system with high ICU admission and mortality rate. We identified the predictors that may help in early management and improving prognosis. Trial registration Trial was registered in Clinicaltrials.gov, registration number is NCT05298852, 26 March 2022, retrospectively registered.
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Affiliation(s)
- Riham Hazem Raafat
- grid.7269.a0000 0004 0621 1570Chest Department, Ain Shams University, Cairo, Egypt
| | - Mohamed Alboraie
- grid.411303.40000 0001 2155 6022Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Sally Waheed Elkhadry
- grid.411775.10000 0004 0621 4712Epidemiology and Preventive Medicine Department, National Liver Institute Menoufia University, Menoufia, Egypt
| | - Mostafa Abdelnasier
- grid.7269.a0000 0004 0621 1570Internal Medicine Department, Ain Shams University, Cairo, Egypt
| | - Mohamed Ahmed Hashish
- grid.7269.a0000 0004 0621 1570Internal Medicine Department, Ain Shams University, Cairo, Egypt
| | - Yahya Ahmed Almansoury
- grid.412707.70000 0004 0621 7833Internal Medicine Department, Gastroenterology and Hepatology Division, Qena University Hospital, South Valley University, Qena, Egypt
| | - Noha Yousef
- grid.7269.a0000 0004 0621 1570Chest Department, Ain Shams University, Cairo, Egypt
| | - Omar Elshaarawy
- grid.411775.10000 0004 0621 4712Hepatology, Gastroenterology and Liver Transplantation Department, National Liver Institute, Menoufia University, Menoufia, Egypt ,grid.415970.e0000 0004 0417 2395Department of Gastroenterology, Royal Liverpool University Hospital, NHS, Liverpool, UK
| | - Ahmad Madkour
- grid.412093.d0000 0000 9853 2750Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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Brown RB. Sodium Toxicity in the Nutritional Epidemiology and Nutritional Immunology of COVID-19. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:739. [PMID: 34440945 PMCID: PMC8399536 DOI: 10.3390/medicina57080739] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023]
Abstract
Dietary factors in the etiology of COVID-19 are understudied. High dietary sodium intake leading to sodium toxicity is associated with comorbid conditions of COVID-19 such as hypertension, kidney disease, stroke, pneumonia, obesity, diabetes, hepatic disease, cardiac arrhythmias, thrombosis, migraine, tinnitus, Bell's palsy, multiple sclerosis, systemic sclerosis, and polycystic ovary syndrome. This article synthesizes evidence from epidemiology, pathophysiology, immunology, and virology literature linking sodium toxicological mechanisms to COVID-19 and SARS-CoV-2 infection. Sodium toxicity is a modifiable disease determinant that impairs the mucociliary clearance of virion aggregates in nasal sinuses of the mucosal immune system, which may lead to SARS-CoV-2 infection and viral sepsis. In addition, sodium toxicity causes pulmonary edema associated with severe acute respiratory syndrome, as well as inflammatory immune responses and other symptoms of COVID-19 such as fever and nasal sinus congestion. Consequently, sodium toxicity potentially mediates the association of COVID-19 pathophysiology with SARS-CoV-2 infection. Sodium dietary intake also increases in the winter, when sodium losses through sweating are reduced, correlating with influenza-like illness outbreaks. Increased SARS-CoV-2 infections in lower socioeconomic classes and among people in government institutions are linked to the consumption of foods highly processed with sodium. Interventions to reduce COVID-19 morbidity and mortality through reduced-sodium diets should be explored further.
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Affiliation(s)
- Ronald B Brown
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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13
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Forrest IS, Jaladanki SK, Paranjpe I, Glicksberg BS, Nadkarni GN, Do R. Non-invasive ventilation versus mechanical ventilation in hypoxemic patients with COVID-19. Infection 2021; 49:989-997. [PMID: 34089483 PMCID: PMC8179090 DOI: 10.1007/s15010-021-01633-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/25/2021] [Indexed: 01/01/2023]
Abstract
Purpose Limited mechanical ventilators (MV) during the Coronavirus disease (COVID-19) pandemic have led to the use of non-invasive ventilation (NIV) in hypoxemic patients, which has not been studied well. We aimed to assess the association of NIV versus MV with mortality and morbidity during respiratory intervention among hypoxemic patients admitted with COVID-19. Methods We performed a retrospective multi-center cohort study across 5 hospitals during March–April 2020. Outcomes included mortality, severe COVID-19-related symptoms, time to discharge, and final oxygen saturation (SpO2) at the conclusion of the respiratory intervention. Multivariable regression of outcomes was conducted in all hypoxemic participants, 4 subgroups, and propensity-matched analysis. Results Of 2381 participants with laboratory-confirmed SARS-CoV-2, 688 were included in the study who were hypoxemic upon initiation of respiratory intervention. During the study period, 299 participants died (43%), 163 were admitted to the ICU (24%), and 121 experienced severe COVID-19-related symptoms (18%). Participants on MV had increased mortality than those on NIV (128/154 [83%] versus 171/534 [32%], OR = 30, 95% CI 16–60) with a mean survival of 6 versus 15 days, respectively. The MV group experienced more severe COVID-19-related symptoms [55/154 (36%) versus 66/534 (12%), OR = 4.3, 95% CI 2.7–6.8], longer time to discharge (mean 17 versus 7.1 days), and lower final SpO2 (92 versus 94%). Across all subgroups and propensity-matched analysis, MV was associated with a greater OR of death than NIV. Conclusions NIV was associated with lower respiratory intervention mortality and morbidity than MV. However, findings may be liable to unmeasured confounding and further study from randomized controlled trials is needed to definitively determine the role of NIV in hypoxemic patients with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01633-6.
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Affiliation(s)
- Iain S Forrest
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA
| | - Suraj K Jaladanki
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Mount Sinai Clinical Intelligence Center, New York, NY, USA
| | - Ishan Paranjpe
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Mount Sinai Clinical Intelligence Center, New York, NY, USA
| | - Benjamin S Glicksberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Mount Sinai Clinical Intelligence Center, New York, NY, USA
| | - Girish N Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.,The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Mount Sinai Clinical Intelligence Center, New York, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA. .,The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA. .,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 18 Room 80A, 1468 Madison Ave, New York, NY, 10029, USA.
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14
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Oxygenation Strategies in Critically Ill Patients With COVID-19. Dimens Crit Care Nurs 2021; 40:75-82. [PMID: 33961375 DOI: 10.1097/dcc.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 is the virus that causes coronavirus disease 2019 (COVID-19). COVID-19 is a disease characterized by a range of clinical syndromes including variable degrees of respiratory symptoms from mild respiratory illness and severe interstitial pneumonia to acute respiratory distress syndrome, septic shock, coagulopathies, and multiorgan dysfunction. This virus carries the potential to manifest in a wide range of pulmonary findings and hypoxemias, from mild respiratory symptoms to more severe syndromes, such as acute respiratory distress syndrome. The rapid accumulation of evidence and persistent gaps in knowledge related to the virus presents a host of challenges for clinicians. This creates a complex environment for clinical decision-making. OBJECTIVE To examine oxygenation strategies in critically ill patients with hypoxia who are hospitalized with COVID-19. DISCUSSION These proposed strategies may help to improve the respiratory status and oxygenation of those affected by COVID-19. However, additional high-quality research is needed to provide further evidence for improved respiratory management strategies. Areas of future research should focus on improving understanding of the inflammatory and clotting processes associated with the virus, particularly in the lungs. High-level evidence and randomized controlled trials should target the most effective strategies for improving oxygenation, time requiring mechanical ventilation, and survival for hospitalized patients with COVID-19 presenting with hypoxemia.
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15
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Carpagnano GE, Migliore G, Grasso S, Procacci V, Resta E, Panza F, Resta O. More skilled clinical management of COVID-19 patients modified mortality in an intermediate respiratory intensive care unit in Italy. Respir Res 2021; 22:16. [PMID: 33451327 PMCID: PMC7809547 DOI: 10.1186/s12931-021-01613-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background Some studies investigated epidemiological and clinical features of laboratory-confirmed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the virus causing coronavirus disease 2019 (COVID-19), but limited attention has been paid to the follow-up of hospitalized patients on the basis of clinical setting and the expertise of clinical management. Methods In the present single-centered, retrospective, observational study, we reported findings from 87 consecutive laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory syndrome hospitalized in an intermediate Respiratory Intensive Care Unit (RICU), subdividing the patients in two groups according to the admission date (before and after March 29, 2020). Results With improved skills in the clinical management of COVID-19, we observed a significant lower mortality in the T2 group compared with the T1 group and a significantly difference in terms of mortality among the patients transferred in Intensive Care Unit (ICU) from our intermediate RICU (100% in T1 group vs. 33.3% in T2 group). The average length of stay in intermediate RICU of ICU-transferred patients who survived in T1 and T2 was significantly longer than those who died (who died 3.3 ± 2.8 days vs. who survived 6.4 ± 3.3 days). T Conclusions The present findings suggested that an intermediate level of hospital care may have the potential to modify survival in COVID-19 patients, particularly in the present phase of a more skilled clinical management of the pandemic.
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Affiliation(s)
- Giovanna E Carpagnano
- Department of Basic Medical Science, Institute of Respiratory Disease, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | | | - Salvatore Grasso
- Department of Emergency and Organ Transplantation, Section of Anesthesia and Intensive Care, University of Bari "Aldo Moro", Bari, Italy
| | - Vito Procacci
- Emergency Department, Policlinico Hospital, Bari, Italy
| | - Emanuela Resta
- Translational Medicine and Health System Management, University of Foggia, Foggia, Italy
| | - Francesco Panza
- Population Health Unit, Healthy Aging Phenotypes Research Unit, "Salus in Apulia Study", National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Onofrio Resta
- Department of Basic Medical Science, Institute of Respiratory Disease, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.
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16
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Probiotics in the prophylaxis of COVID-19: something is better than nothing. 3 Biotech 2021; 11:1. [PMID: 33262924 PMCID: PMC7690945 DOI: 10.1007/s13205-020-02554-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/12/2020] [Indexed: 02/07/2023] Open
Abstract
The new viral pandemic of COVID-19 is caused by a novel coronavirus (SARS-CoV-2) that has brought the world at another unprecedented crisis in terms of health and economy. The lack of specific therapeutics necessitates other strategies to prevent the spread of infection caused by this previously unknown viral etiological agent. Recent pieces of evidence have shown an association between COVID-19 disease and intestinal dysbiosis. Probiotics comprise living microbes that upon oral administration benefit human health by reshaping the composition of gut microbiota. The close kinship of the gastrointestinal and respiratory tract suggests why the dysfunction of one may incite illness in others. The emerging studies suggest the capability of probiotics to regulate immune responses in the respiratory system. The efficacy of probiotics has been studied previously on several respiratory tract viral infections. Therefore, the purpose of this review is to comprehend existing information on the gut mediated-pulmonary immunity conferred by probiotic bacteria, in the course of respiratory virus infections and administration as a prophylactic measure in COVID-19 pandemic in managing intestinal dysbiosis as well.
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17
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Carpagnano GE, Buonamico E, Migliore G, Resta E, Di Lecce V, de Candia ML, Solfrizzi V, Panza F, Resta O. Bilevel and continuous positive airway pressure and factors linked to all-cause mortality in COVID-19 patients in an intermediate respiratory intensive care unit in Italy. Expert Rev Respir Med 2020; 15:853-857. [PMID: 33334197 PMCID: PMC7784777 DOI: 10.1080/17476348.2021.1866546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives: In the present single-centered, retrospective, observational study, we reported findings from 78 consecutive laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS) hospitalized in an intermediate Respiratory Intensive Care Unit, subdividing the patients into two groups according to their clinical outcome, dead patients and discharged patients.Methods: We further subdivided patients depending on the noninvasive respiratory support used during hospitalization.Results: In those patients who died, we found significant older age and higher multimorbidity and higher values of serum lactate dehydrogenase, C-reactive protein, and D-dimer. Among patients who were submitted to bilevel positive airway pressure (BPAP), those who died had a significant shorter number of days in overall length of stay and lower values of arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2 ratio) compared to those who survived. No difference in all-cause mortality was observed between the two different noninvasive respiratory support groups [48% for continuous positive airway pressure (CPAP) and 52% for BPAP].Conclusion: In COVID-19 patients with moderate-to-severe ARDS using BPAP in an intermediate level of hospital care had more factors associated to all-cause mortality (shorter length of stay and lower baseline PaO2/FiO2 ratio) compared to those who underwent CPAP.
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Affiliation(s)
- Giovanna E Carpagnano
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Enrico Buonamico
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni Migliore
- Azienda Universitaria Ospedaliera Consorziale, General Director Office, Policlinico Bari, Italy
| | - Emanuela Resta
- Translational Medicine and Health System Management, University of Foggia, Foggia, Italy
| | - Valentina Di Lecce
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Luisa de Candia
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Vincenzo Solfrizzi
- "Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Panza
- Population Health Unit, "Salus in Apulia Study", National Institute of Gastroenterology "Saverio De Bellis", Research Hospital, Bari, Italy
| | - Onofrio Resta
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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18
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Kumar S, Mehta S, Sarangdhar N, Ray A, Sinha S, Wig N. Management of COVID-19 from the pulmonologist's perspective: a narrative review. Expert Rev Respir Med 2020; 15:519-535. [PMID: 33211553 DOI: 10.1080/17476348.2021.1853529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: The COVID-19 pandemic has provided global challenges to health-care facilities in ensuring the delivery of care to patients. Tremendous international collaboration has enabled the swift formulation of evidence-based guidelines that aim to clarify day-to-day issues faced by physicians and other health-care providers on the frontlines.Areas covered: In order to provide answers to the common questions and dilemmas faced by physicians and policymakers, especially those handling pulmonary manifestations of COVID-19, the authors made a list of pertinent clinical topics that were reviewed between 21st of August, 2020 to 30th of August, 2020 by the authors using online databases that included PubMed, EBSCO, and the Cochrane Library. Literature was reviewed and included based on relevance to the topics selected. The review was aimed to serve as a quick reference for addressing practical issues faced during patient care in the ongoing pandemic with a brief account of the management of COVID-19 patients as per international guidelines.Expert opinion: As more evidence continues to generate regarding the optimal methods of managing COVID-19 cases while caring for non-COVID patients concurrently, physicians will need to constantly reeducate themselves to keep pace with a rapidly evolving landscape of therapeutic options.
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Affiliation(s)
- Sanchit Kumar
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shubham Mehta
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Vivas Fernández FJ, Sánchez Segovia J, Martel Bravo I, García Ramos C, Ruiz Castilla D, Gamero López J, Andújar Márquez JM. ResUHUrge: A Low Cost and Fully Functional Ventilator Indicated for Application in COVID-19 Patients. SENSORS 2020; 20:s20236774. [PMID: 33260852 PMCID: PMC7730294 DOI: 10.3390/s20236774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/23/2022]
Abstract
Although the cure for the SARS-CoV-2 virus (COVID-19) will come in the form of pharmaceutical solutions and/or a vaccine, one of the only ways to face it at present is to guarantee the best quality of health for patients, so that they can overcome the disease on their own. Therefore, and considering that COVID-19 generally causes damage to the respiratory system (in the form of lung infection), it is essential to ensure the best pulmonary ventilation for the patient. However, depending on the severity of the disease and the health condition of the patient, the situation can become critical when the patient has respiratory distress or becomes unable to breathe on his/her own. In that case, the ventilator becomes the lifeline of the patient. This device must keep patients stable until, on their own or with the help of medications, they manage to overcome the lung infection. However, with thousands or hundreds of thousands of infected patients, no country has enough ventilators. If this situation has become critical in the Global North, it has turned disastrous in developing countries, where ventilators are even more scarce. This article shows the race against time of a multidisciplinary research team at the University of Huelva, UHU, southwest of Spain, to develop an inexpensive, multifunctional, and easy-to-manufacture ventilator, which has been named ResUHUrge. The device meets all medical requirements and is developed with open-source hardware and software.
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Affiliation(s)
- Francisco José Vivas Fernández
- Control and Robotics Research Team (TEP192), University of Huelva, 21004 Huelva, Spain; (D.R.C.); (J.G.L.); (J.M.A.M.)
- Correspondence:
| | - José Sánchez Segovia
- Structure of Matter Research Team (FQM318), University of Huelva, 21004 Huelva, Spain; (J.S.S.); (I.M.B.); (C.G.R.)
| | - Ismael Martel Bravo
- Structure of Matter Research Team (FQM318), University of Huelva, 21004 Huelva, Spain; (J.S.S.); (I.M.B.); (C.G.R.)
| | - Carlos García Ramos
- Structure of Matter Research Team (FQM318), University of Huelva, 21004 Huelva, Spain; (J.S.S.); (I.M.B.); (C.G.R.)
| | - Daniel Ruiz Castilla
- Control and Robotics Research Team (TEP192), University of Huelva, 21004 Huelva, Spain; (D.R.C.); (J.G.L.); (J.M.A.M.)
| | - José Gamero López
- Control and Robotics Research Team (TEP192), University of Huelva, 21004 Huelva, Spain; (D.R.C.); (J.G.L.); (J.M.A.M.)
| | - José Manuel Andújar Márquez
- Control and Robotics Research Team (TEP192), University of Huelva, 21004 Huelva, Spain; (D.R.C.); (J.G.L.); (J.M.A.M.)
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20
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Honore PM, Barreto Gutierrez L, Kugener L, Redant S, Attou R, Gallerani A, De Bels D. Compared to NIPPV, HFNC is more dangerous regarding aerosol dispersion and contamination of healthcare personnel: we are not sure. Crit Care 2020; 24:482. [PMID: 32753062 PMCID: PMC7399586 DOI: 10.1186/s13054-020-03184-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Patrick M. Honore
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hospital, Place Van Gehuchtenplein, 4, 1020 Brussels, Belgium
| | - Leonel Barreto Gutierrez
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hospital, Place Van Gehuchtenplein, 4, 1020 Brussels, Belgium
| | - Luc Kugener
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hospital, Place Van Gehuchtenplein, 4, 1020 Brussels, Belgium
| | - Sebastien Redant
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hospital, Place Van Gehuchtenplein, 4, 1020 Brussels, Belgium
| | - Rachid Attou
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hospital, Place Van Gehuchtenplein, 4, 1020 Brussels, Belgium
| | - Andrea Gallerani
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hospital, Place Van Gehuchtenplein, 4, 1020 Brussels, Belgium
| | - David De Bels
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hospital, Place Van Gehuchtenplein, 4, 1020 Brussels, Belgium
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Chawla R, Nasa P. Ventilatory Management of COVID-19-related ARDS: Stick to Basics and Infection Control. Indian J Crit Care Med 2020; 24:609-610. [PMID: 33024358 PMCID: PMC7519619 DOI: 10.5005/jp-journals-10071-23513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
How to cite this article: Chawla R, Nasa P. Ventilatory Management of COVID-19-related ARDS: Stick to Basics and Infection Control. Indian J Crit Care Med 2020;24(8):609-610.
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Affiliation(s)
- Rajesh Chawla
- Department of Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai (UAE)
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