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O'Toole C, McGrath JA, Joyce M, O'Sullivan A, Thomas C, Murphy S, MacLoughlin R, Byrne MA. Effect of Nebuliser and Patient Interface Type on Fugitive Medical Aerosol Emissions in Adult and Paediatric Patients. Eur J Pharm Sci 2023; 187:106474. [PMID: 37225006 DOI: 10.1016/j.ejps.2023.106474] [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: 01/19/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Open circuit aerosol therapy is associated with the potential for fugitive emissions of medical aerosol. Various nebulisers and interfaces are used in respiratory treatments, including the recent consideration of filtered interfaces. This study aims to quantify fugitive medical aerosols from various nebuliser types, in conjunction with different filtered and non-filtered interfaces. METHODS For both simulated adult and paediatric breathing, four nebuliser types were assessed including; a small volume jet nebuliser (SVN), a breath enhanced jet nebuliser (BEN), a breath actuated jet nebuliser (BAN) and a vibrating mesh nebuliser (VMN). A combination of different interfaces were used including filtered and unfiltered mouthpieces, as well as open, valved and filtered facemasks. Aerosol mass concentrations were measured using an Aerodynamic Particle Sizer at 0.8 m and 2.0 m. Additionally, inhaled dose was assessed. RESULTS Highest mass concentrations recorded were 214 (177, 262) µg m-3 at 0.8 m over 45-minute run. The highest and lowest fugitive emissions were observed for the adult SVN facemask combination, and the adult BAN filtered mouthpiece combination respectively. Fugitive emissions decreased when using breath-actuated (BA) mode compared to continuous (CN) mode on the BAN for the adult and paediatric mouthpiece combination. Lower fugitive emissions were observed when a filtered facemask or mouthpiece was used, compared to unfiltered scenarios. For the simulated adult, highest and lowest inhaled dose were 45.1 (42.6, 45.6)% and 11.0 (10.1,11.9)% for the VMN and SVN respectively. For the simulated paediatric, highest and lowest inhaled dose were 44.0 (42.4, 44.8)% and 6.1 (5.9, 7.0)% for the VMN and BAN CN respectively. Potential inhalation exposure of albuterol was calculated to be up to 0.11 µg and 0.12 µg for a bystander and healthcare worker respectively. CONCLUSION This work demonstrates the need for filtered interfaces in clinical and homecare settings to minimise fugitive emissions and to reduce the risk of secondary exposure to care givers.
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Affiliation(s)
- Ciarraí O'Toole
- Physics, School of Natural Sciences, Ryan Institute's Centre for Climate and Air Pollution Studies, College of Science & Engineering, University of Galway, H91 CF50, Galway, Ireland.
| | - James A McGrath
- Physics, School of Natural Sciences, Ryan Institute's Centre for Climate and Air Pollution Studies, College of Science & Engineering, University of Galway, H91 CF50, Galway, Ireland; Department of Experimental Physics, Maynooth University, Maynooth, Co. Kildare, Ireland.
| | - Mary Joyce
- R&D Science & Emerging Technologies, Aerogen Ltd., IDA Business Park, Dangan, Galway, Ireland.
| | - Andrew O'Sullivan
- R&D Science & Emerging Technologies, Aerogen Ltd., IDA Business Park, Dangan, Galway, Ireland.
| | - Ciara Thomas
- R&D Science & Emerging Technologies, Aerogen Ltd., IDA Business Park, Dangan, Galway, Ireland.
| | - Sarah Murphy
- R&D Science & Emerging Technologies, Aerogen Ltd., IDA Business Park, Dangan, Galway, Ireland.
| | - Ronan MacLoughlin
- R&D Science & Emerging Technologies, Aerogen Ltd., IDA Business Park, Dangan, Galway, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland; School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland.
| | - Miriam A Byrne
- Physics, School of Natural Sciences, Ryan Institute's Centre for Climate and Air Pollution Studies, College of Science & Engineering, University of Galway, H91 CF50, Galway, Ireland.
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Varela-Durán M, Martínez-Pillado M. Oportunidades clínicas y organizativas en el manejo de pacientes críticos en la pandemia COVID-19. REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACIÓN 2022; 69:377-378. [PMID: 34785825 PMCID: PMC8586879 DOI: 10.1016/j.redar.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- M Varela-Durán
- Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Pontevedra] (CHOP), Sergas, Pontevedra, España
- Grupo de Investigación (5), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO
| | - M Martínez-Pillado
- Unidad de Calidad, Área Sanitaria de Pontevedra e O Salnés, Unidad de Calidade, Complexo Hospitalario Universitario de Pontevedra] (CHOP), Sergas, Pontevedra, España
- Grupo de Investigación (E Health en Areas Integradas]), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO
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Principio de proporcionalidad terapéutica en la decisión de intubación orotraqueal y ventilación mecánica invasiva en paciente COVID-19 grave. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2022. [PMCID: PMC7843031 DOI: 10.1016/j.acci.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
En medicina cuando se aplica el principio de proporcionalidad terapéutica se valoran los medios empleados y el fin previsible en cada paciente. Y se distingue entre tratamientos proporcionados o desproporcionados, valorando el beneficio y utilidad. Entre ellos su aplicación en el paciente COVID-19 grave que requiere intubación orotraqueal y ventilación mecánica invasiva. En ocasiones nos puede generar el dilema ético de proceder a realizar dicho procedimiento y no encontrar beneficio alguno, sino al contrario generar sufrimiento, dolor y prolongación de su posible agonía. Teniendo el deber ético en estos casos de no abandonar sino acompañar a través de los cuidados paliativos, siempre informando al familiar sobre la decisión que se tome. El analizar este principio de proporcionalidad terapéutica y su aplicación en las unidades de cuidado intensivo requiere de una conciencia moral por parte del grupo que tiene la responsabilidad de la toma de la decisiòn y dirimir el dilema ético que se presente. Recordando que a los pacientes que requieran intubación orotraqueal se les deben ofrecer todas las medidas requeridas en ventilación mecánica invasiva y no invasiva para mejoría de la hipoxemia. Se presenta un análisis y reflexión sobre el principio de proporcionalidad terapéutica y su fundamentación ética al igual que una revisión sistemática de la literatura médica relacionada con pacientes con COVID-19 en insuficiencia respiratoria aguda. Y se establecen unas consideraciones científicas y éticas a tener en cuenta en el paciente COVID-19. El principio de proporcionalidad terapéutica ante la decisión de intubación orotraqueal debe fundamentarse en un juicio de proporcionalidad, que garantice que se han hecho y utilizado todos los medios previsibles para evitar la intubación orotraqueal y como único fin útil para beneficiar al paciente será la ventilación mecánica invasiva.
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4
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Clinical and organizational opportunities in the management of critical patients in pandemic COVID-19. REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACIÓN (ENGLISH EDITION) 2022; 69:377-378. [PMID: 35753932 PMCID: PMC9225934 DOI: 10.1016/j.redare.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022]
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5
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Ezzeddine Angulo A, Elía Martínez JM, Iñigo Huarte V, Máñez Añón I, Tenías Burillo JM, Peydro de Moya F. [Severe SARS-CoV-2 infection: Clinical assessment and biomechanical functional evaluation one month after hospital discharge]. Rehabilitacion (Madr) 2022; 56:142-149. [PMID: 34561107 PMCID: PMC8339570 DOI: 10.1016/j.rh.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/08/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe by an observational cross-sectional study the clinical and functional situation, at one month after hospital discharge, of patients admitted with COVID-19 in the hospital ICU between March and December 2020. MATERIAL AND METHODS 59 patients were studied using different clinical scales and biomechanical analysis tests (hand dynamometry, fall risk assessment, gait and balance analysis). RESULTS At one month after discharge, patients reported persistent symptoms: dyspnea (47.5%), arthromyalgia (45%) and cough (22%). In the EQ-5D-5L questionnaire up to 73% of patients reported levels of anxiety or depression. 74.6% and 69.5% presented alterations in the strength of the right and left hand, respectively. The risk of falls in 38% of patients was moderate to very high. The somatosensory index remained within normal parameters, while the vestibular and, to a lesser extent, the visual indexes were altered. In gait, 81.4% of patients showed no abnormalities outside the normal range, with a normal average walking speed. CONCLUSIONS In the short term after severe COVID-19, patients have persistent symptomatology, anxiety/depression, impaired balance with increased risk of falls and loss of grip strength in both hands.
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Affiliation(s)
- A Ezzeddine Angulo
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España; Facultad de Medicina, Universidad Católica de Valencia San Vicente Mártir, Valencia, España.
| | - J M Elía Martínez
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - V Iñigo Huarte
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - I Máñez Añón
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Oliveira MR, Back GD, de Mello Konzen V, Garcia-Araújo AS, da Luz Goulart C, Nunes Silva R, Mara Wibelinger L, Dixit S, Arena R, Borghi-Silva A. Noninvasive ventilation in patients with COVID-19 from the perspective of the risk of contamination: a narrative review. Expert Rev Respir Med 2021; 16:67-77. [PMID: 34826266 DOI: 10.1080/17476348.2021.2011223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION noninvasive ventilation (NIV) can be a useful resource to treat acute respiratory failure (ARF), which occurs in patients with COVID-19. However, it is important to consider that there are still no clinical studies that have verified the safety of its use in increase of contamination. AREAS COVERED Given the potential benefits and simultaneous concerns over the use of NIV in patients with COVID-19, further inquiry is necessary to reach a clinical consensus and provide recommendations for safe use, avoiding contamination. In this context, this narrative review, which included articles published in the Embase, SciELO, PEDro, PubMed and Cochrane up to August 2021, is focused to evaluate available studies related to interfaces, types of circuits, recommended filters, cares for the environment and protective factors for NIV use in patients with COVID-19. EXPERT OPINION The studies analyzed recommend that the use of NIV can be safe: 1) with equipment that allows the use of the helmet as a safer interface; 2) with double circuit and antimicrobial filter in the expiratory branch; 3) in an environment that allows negative pressure, reducing the dispersion of aerosol particles in the environment; 4) the health team must use the recommended PPE to avoid contamination.
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Affiliation(s)
- Murilo Rezende Oliveira
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Sao Carlos, Brazil
| | - Guilherme Dionir Back
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Sao Carlos, Brazil
| | | | - Adriana Sanches Garcia-Araújo
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Sao Carlos, Brazil
| | - Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Sao Carlos, Brazil
| | - Rebeca Nunes Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Sao Carlos, Brazil
| | - Lia Mara Wibelinger
- Physiotherapy Department, University of Passo Fundo, UPF, Passo Fundo, Brazil
| | - Snehil Dixit
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago; Healthy Living for Pandemic Event Protection (Hl - PIVOT) Network, Chicago, IL, USA.,Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago; Healthy Living for Pandemic Event Protection (Hl - PIVOT) Network, Chicago, IL, USA.,Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Sao Carlos, Brazil.,Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago; Healthy Living for Pandemic Event Protection (Hl - PIVOT) Network, Chicago, IL, USA
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7
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Estella Á. Intensive Care Medicine: Quiet leadership versus protagonist in times of SARS-CoV-2 pandemic crisis. Med Intensiva 2021; 45:566-567. [PMID: 34732315 PMCID: PMC8557809 DOI: 10.1016/j.medine.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Á Estella
- Servicio de Medicina Intensiva, Hospital Universitario de Jerez, Cádiz, Spain; Departamento de Medicina, Universidad de Cádiz, Cádiz, Spain.
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8
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Shen K, Hong J, El Beleidy A, Furman E, Liu H, Yin Y, Cano-Salas MDC, AlJassim FM, Al-Shammari N, Lochindarat S, Dieu Thuy NT. International expert opinion on the use of nebulization for pediatric asthma therapy during the COVID-19 pandemic. J Thorac Dis 2021; 13:3934-3947. [PMID: 34422324 PMCID: PMC8339766 DOI: 10.21037/jtd-21-841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Kunling Shen
- China National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jianguo Hong
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ahmed El Beleidy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Evgeny Furman
- Department of Pediatrics, E. A. Vagner Perm State Medical University, Perm, Russia
| | - Hanmin Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yong Yin
- Department of Respiratory, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Fatma Mohammed AlJassim
- Pediatric Pulmonology Section, Dubai Health Authority, Latifa Women and Children Hospital, Dubai, UAE
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9
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Matute-Villacís M, Moisés J, Embid C, Armas J, Fernández I, Medina M, Ferrer M, Sibila O, Badia JR. Role of respiratory intermediate care units during the SARS-CoV-2 pandemic. BMC Pulm Med 2021; 21:228. [PMID: 34256747 PMCID: PMC8275902 DOI: 10.1186/s12890-021-01593-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/09/2021] [Indexed: 01/28/2023] Open
Abstract
RATIONALE The SARS-CoV2 pandemic increased exponentially the need for both Intensive (ICU) and Intermediate Care Units (RICU). The latter are of particular importance because they can play a dual role in critical and post-critical care of COVID-19 patients. Here, we describe the setup of 2 new RICUs in our institution to face the SARS-CoV-2 pandemic and discuss the clinical characteristics and outcomes of the patients attended. METHODS Retrospective analysis of the characteristics and outcomes of COVID-19 patients admitted to 2 new RICUs built specifically in our institution to face the first wave of the SARS-CoV-2 pandemic, from April 1 until May 30, 2020. RESULTS During this period, 106 COVID-19 patients were admitted to these 2 RICUs, 65 of them (61%) transferred from an ICU (step-down) and 41 (39%) from the ward or emergency room (step-up). Most of them (72%) were male and mean age was 66 ± 12 years. 31% of them required support with oxygen therapy via high-flow nasal cannula (HFNC) and 14% non-invasive ventilation (NIV). 42 of the 65 patients stepping down (65%) had a previous tracheostomy performed and most of them (74%) were successfully decannulated during their stay in the RICU. Length of stay was 7 [4-11] days. 90-day mortality was 19% being significantly higher in stepping up patients than in those transferred from the ICU (25 vs. 10% respectively; p < 0.001). CONCLUSIONS RICUs are a valuable hospital resource to respond to the challenges of the SARS-CoV-2 pandemic both to treat deteriorating and recovering COVID-19 patients.
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Affiliation(s)
- Mónica Matute-Villacís
- Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic Respiratori, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Jorge Moisés
- Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic Respiratori, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Cristina Embid
- Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic Respiratori, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Judith Armas
- Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic Respiratori, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Isabel Fernández
- Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic Respiratori, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Montserrat Medina
- Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic Respiratori, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Miquel Ferrer
- Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic Respiratori, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Oriol Sibila
- Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic Respiratori, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Joan Ramón Badia
- Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic Respiratori, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain.
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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10
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Sudre CH, Lee KA, Lochlainn MN, Varsavsky T, Murray B, Graham MS, Menni C, Modat M, Bowyer RCE, Nguyen LH, Drew DA, Joshi AD, Ma W, Guo CG, Lo CH, Ganesh S, Buwe A, Pujol JC, du Cadet JL, Visconti A, Freidin MB, El-Sayed Moustafa JS, Falchi M, Davies R, Gomez MF, Fall T, Cardoso MJ, Wolf J, Franks PW, Chan AT, Spector TD, Steves CJ, Ourselin S. Symptom clusters in COVID-19: A potential clinical prediction tool from the COVID Symptom Study app. SCIENCE ADVANCES 2021; 7:7/12/eabd4177. [PMID: 33741586 PMCID: PMC7978420 DOI: 10.1126/sciadv.abd4177] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/29/2021] [Indexed: 05/02/2023]
Abstract
As no one symptom can predict disease severity or the need for dedicated medical support in coronavirus disease 2019 (COVID-19), we asked whether documenting symptom time series over the first few days informs outcome. Unsupervised time series clustering over symptom presentation was performed on data collected from a training dataset of completed cases enlisted early from the COVID Symptom Study Smartphone application, yielding six distinct symptom presentations. Clustering was validated on an independent replication dataset between 1 and 28 May 2020. Using the first 5 days of symptom logging, the ROC-AUC (receiver operating characteristic - area under the curve) of need for respiratory support was 78.8%, substantially outperforming personal characteristics alone (ROC-AUC 69.5%). Such an approach could be used to monitor at-risk patients and predict medical resource requirements days before they are required.
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Affiliation(s)
- Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, Westminster Bridge Road, London SE17EH, UK.
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London WC1E 7BH, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London UK
| | - Karla A Lee
- Department of Twin Research and Genetic Epidemiology King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Mary Ni Lochlainn
- Department of Twin Research and Genetic Epidemiology King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Thomas Varsavsky
- School of Biomedical Engineering & Imaging Sciences, King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Mark S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Ruth C E Bowyer
- Department of Twin Research and Genetic Epidemiology King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Long H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, MA, USA
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, MA, USA
| | - Amit D Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, MA, USA
| | - Wenjie Ma
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, MA, USA
| | - Chuan-Guo Guo
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, MA, USA
| | - Chun-Han Lo
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, MA, USA
| | | | - Abubakar Buwe
- Zoe Global Limited, 164 Westminster Bridge Road, London SE1 7RW, UK
| | | | | | - Alessia Visconti
- Department of Twin Research and Genetic Epidemiology King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Maxim B Freidin
- Department of Twin Research and Genetic Epidemiology King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Julia S El-Sayed Moustafa
- Department of Twin Research and Genetic Epidemiology King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Mario Falchi
- Department of Twin Research and Genetic Epidemiology King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Richard Davies
- Zoe Global Limited, 164 Westminster Bridge Road, London SE1 7RW, UK
| | - Maria F Gomez
- Department of Clinical Sciences, Lund University Diabetes Centre, Malmö, Sweden
| | - Tove Fall
- Department of Clinical Sciences, Lund University Diabetes Centre, Malmö, Sweden
| | - M Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Jonathan Wolf
- Zoe Global Limited, 164 Westminster Bridge Road, London SE1 7RW, UK
| | - Paul W Franks
- Department of Twin Research and Genetic Epidemiology King's College London, Westminster Bridge Road, London SE17EH, UK
- Department of Clinical Sciences, Lund University Diabetes Centre, Malmö, Sweden
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, MA, USA
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology King's College London, Westminster Bridge Road, London SE17EH, UK
| | - Sébastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, Westminster Bridge Road, London SE17EH, UK.
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11
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García-Salido A, Antón J, Martínez-Pajares JD, Giralt Garcia G, Gómez Cortés B, Tagarro A, Belda Hofheinz S, Calvo Penadés I, de Carlos Vicente JC, Grasa Lozano CD, Hernández Bou S, Pino Ramírez RM, Núñez Cuadros E, Pérez-Lescure Picarzo J, Saavedra Lozano J, Salas-Mera D, Villalobos Pinto E. [Spanish consensus document on diagnosis, stabilisation and treatment of pediatric multisystem inflammatory syndrome related to SARS-CoV-2 (SIM-PedS)]. An Pediatr (Barc) 2021; 94:116.e1-116.e11. [PMID: 33132066 PMCID: PMC7604157 DOI: 10.1016/j.anpedi.2020.09.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 12/24/2022] Open
Abstract
A new paediatric multisystem inflammatory syndrome, linked to SARS-CoV-2, has been described. The clinical picture is variable and is associated with an active or recent infection due to SARS-CoV-2. A review of the existing literature by a multidisciplinary group of paediatric specialists is presented in this document. Later, they make recommendations on the stabilisation, diagnosis, and treatment of this syndrome.
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Affiliation(s)
- Alberto García-Salido
- Sociedad Española de Cuidados Intensivos Pediátricos (SECIP); Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, , Madrid, España.
| | - Jordi Antón
- Sociedad Española de Reumatología pediátrica (SERPE); Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, España
| | - José David Martínez-Pajares
- Sociedad Española de Pediatría Hospitalaria (SEPHO); Unidad de Pediatría, Hospital de Antequera, Área Sanitaria Norte de Málaga, Málaga, España
| | - Gemma Giralt Garcia
- Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (SECPCC); Hospital Universitario Hospital Vall d'Hebron, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Borja Gómez Cortés
- Sociedad Española de Urgencias de Pediatría (SEUP); Servicio de Urgencias de Pediatría. Hospital Universitario Cruces, Barakaldo
| | - Alfredo Tagarro
- Sociedad Española de Infectología Pediátrica (SEIP); Servicio de Pediatría, Hospital Universitario Infanta Sofía, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, España
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12
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Carrillo Hernandez-Rubio J, Sanchez-Carpintero Abad M, Yordi Leon A, Doblare Higuera G, Garcia Rodriguez L, Garcia Torrejon C, Mayor Cacho A, Jimenez Rodriguez A, Garcia-Salmones Martin M. Outcomes of an intermediate respiratory care unit in the COVID-19 pandemic. PLoS One 2020; 15:e0243968. [PMID: 33326484 PMCID: PMC7743985 DOI: 10.1371/journal.pone.0243968] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/01/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND 15% of COVID-19 patients develop severe pneumonia. Non-invasive mechanical ventilation and high-flow nasal cannula can reduce the rate of endotracheal intubation in adult respiratory distress syndrome, although failure rate is high. OBJECTIVE To describe the rate of endotracheal intubation, the effectiveness of treatment, complications and mortality in patients with severe respiratory failure due to COVID-19. METHODS Prospective cohort study in a first-level hospital in Madrid. Patients with a positive polymerase chain reaction for SARS-CoV-2 and admitted to the Intermediate Respiratory Care Unit with tachypnea, use of accessory musculature or SpO2 <92% despite FiO2> 0.5 were included. Intubation rate, medical complications, and 28-day mortality were recorded. Statistical analysis through association studies, logistic and Cox regression models and survival analysis was performed. RESULTS Seventy patients were included. 37.1% required endotracheal intubation, 58.6% suffered medical complications and 24.3% died. Prone positioning was independently associated with lower need for endotracheal intubation (OR 0.05; 95% CI 0.005 to 0.54, p = 0.001). The adjusted HR for death at 28 days in the group of patients requiring endotracheal intubation was 5.4 (95% CI 1.51 to 19.5; p = 0.009). CONCLUSIONS The rate of endotracheal intubation in patients with severe respiratory failure from COVID-19 was 37.1%. Complications and mortality were lower in patients in whom endotracheal intubation could be avoided. Prone positioning could reduce the need for endotracheal intubation.
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Affiliation(s)
| | | | - Andrea Yordi Leon
- Department of Pulmonology and Respiratory Medicine, Infanta Elena University Hospital, Madrid, Spain
| | - Guillermo Doblare Higuera
- Department of Pulmonology and Respiratory Medicine, Infanta Elena University Hospital, Madrid, Spain
| | - Leticia Garcia Rodriguez
- Department of Pulmonology and Respiratory Medicine, Infanta Elena University Hospital, Madrid, Spain
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13
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Bibiano-Guillen C, Arias-Arcos B, Collado-Escudero C, Mir-Montero M, Corella-Montoya F, Torres-Macho J, Buendía-Garcia MJ, Larrainzar-Garijo R. Adapted Diving Mask (ADM) device as respiratory support with oxygen output during COVID-19 pandemic. Am J Emerg Med 2020; 39:42-47. [PMID: 33172745 PMCID: PMC7591320 DOI: 10.1016/j.ajem.2020.10.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/10/2020] [Accepted: 10/24/2020] [Indexed: 01/09/2023] Open
Affiliation(s)
- C Bibiano-Guillen
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense Madrid, Spain; Emergency Department.
| | - B Arias-Arcos
- Hospital Universitario Infanta Leonor, Madrid, Spain; Pulmonology Department
| | - C Collado-Escudero
- Hospital Universitario Infanta Leonor, Madrid, Spain; Orthopadics and Trauma Department
| | - M Mir-Montero
- Hospital Universitario Infanta Leonor, Madrid, Spain; Emergency Department
| | - F Corella-Montoya
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense Madrid, Spain; Orthopadics and Trauma Department
| | - J Torres-Macho
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense Madrid, Spain; Internal Medicine Department
| | - M J Buendía-Garcia
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense Madrid, Spain; Pulmonology Department
| | - R Larrainzar-Garijo
- Hospital Universitario Infanta Leonor, Madrid, Spain; Universidad Complutense Madrid, Spain; Orthopadics and Trauma Department
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14
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Ferrando C, Mellado-Artigas R, Gea A, Arruti E, Aldecoa C, Adalia R, Ramasco F, Monedero P, Maseda E, Tamayo G, Hernández-Sanz ML, Mercadal J, Martín-Grande A, Kacmarek RM, Villar J, Suárez-Sipmann F. Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:597. [PMID: 33023669 PMCID: PMC7537953 DOI: 10.1186/s13054-020-03314-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022]
Abstract
Background Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone. Methods Prospective, multicenter, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory Sequential Organ Failure Assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate, and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP. Results A total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO + awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95% CI 0.53–1.43), p = 0.60]. Patients treated with HFNO + awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0–2.5) vs 2 IQR 1.0–3.0] days (p = 0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95% CI 0.40–2.72), p = 0.92]. Conclusion In patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality.
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Affiliation(s)
- Carlos Ferrando
- Department of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Villarroel 170, 08036, Barcelona, Spain. .,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Ricard Mellado-Artigas
- Department of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Villarroel 170, 08036, Barcelona, Spain
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | | | - César Aldecoa
- Department of Anesthesiology and Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Ramón Adalia
- Department of Anesthesiology and Critical Care, Hospital del Mar, Barcelona, Spain
| | - Fernando Ramasco
- Department of Anesthesiology and Critical Care, Hospital Universitario La Princesa, Madrid, Spain
| | - Pablo Monedero
- Department of Anesthesiology and Intensive Care, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Emilio Maseda
- Department of Anesthesiology and Critical Care, Hospital Universitario La Paz, Madrid, Spain
| | - Gonzalo Tamayo
- Department of Anesthesiology and Critical Care, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - María L Hernández-Sanz
- Department of Anesthesiology and Critical Care, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - Jordi Mercadal
- Department of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Villarroel 170, 08036, Barcelona, Spain
| | - Ascensión Martín-Grande
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Robert M Kacmarek
- Department of Respiratory Care, Massachusetts General Hospital, Boston, MA, USA
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Fernando Suárez-Sipmann
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Intensive Care Unit, Hospital Universitario La Princesa, Madrid, Spain
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15
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Chowdhury P, Pathak P. Neuroprotective immunity by essential nutrient "Choline" for the prevention of SARS CoV2 infections: An in silico study by molecular dynamics approach. Chem Phys Lett 2020; 761:138057. [PMID: 33041350 PMCID: PMC7532804 DOI: 10.1016/j.cplett.2020.138057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 12/23/2022]
Abstract
Prenatal Choline level protects the fetus's developing brain from effects of CoV2. Choline from many food supplements can protect the fetus from Coronavirus. Choline is used for treatment of many neurodegenerative diseases like Alzheimer. Natural Choline may regulate 3CLpro protein’s viral replication.
Prenatal COVID infection is one of the worst affected and least attended aspects of the COVID-19 disease. Like other coronaviruses, CoV2 infection is anticipated to affect fetal development by maternal inflammatory response on the fetus and placenta. Studies showed that higher prenatal choline level in mother’s body can safeguard the developing brain of the fetus from the adverse effects of CoV2 infection. Choline is commonly used as food supplement. By virtual screening, molecular docking and molecular dynamics techniques, we have established a strong inhibitory possibility of choline for SARS 3CLpro protease which may provide a lead for prenatal COVID-19 treatment.
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Affiliation(s)
- Papia Chowdhury
- Department of Physics and Materials Science and Engineering, Jaypee Institute of Information Technology, Noida 201309, Uttar Pradesh, India
| | - Pustak Pathak
- Vishwa Bharati Public School, Arun Vihar, Noida, Sector 28, 201301, Uttar Pradesh, India
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16
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Martínez-Téllez E, Orús Dotú C, Trujillo-Reyes JC, Guarino M, Cladellas Gutiérrez E, Planas Cánovas G, Ramón Cervelló J, Carvi Mallo A, Venegas Pizarro MDP, León Vintró X, Belda-Sanchis J. Tracheotomy in patients COVID-19: A necessary high risk procedure. Two center experience. Arch Bronconeumol 2020; 56:673-674. [PMID: 32586706 PMCID: PMC7261441 DOI: 10.1016/j.arbres.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Elisabeth Martínez-Téllez
- Servicio de Cirugía Torácica. Hospital de la Santa Creu i Sant Pau, Barcelona, España; Servicio de Cirugía Torácica. Hospital HM Delfos, Barcelona, España; Departamento de Cirugía, Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), España.
| | - César Orús Dotú
- Servicio de Otorrinolaringología. Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departamento de Cirugía, Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), España
| | - Juan Carlos Trujillo-Reyes
- Servicio de Cirugía Torácica. Hospital de la Santa Creu i Sant Pau, Barcelona, España; Servicio de Cirugía Torácica. Hospital HM Delfos, Barcelona, España; Departamento de Cirugía, Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), España
| | - Mauro Guarino
- Servicio de Cirugía Torácica. Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | | | - Alex Carvi Mallo
- Servicio de Anestesiología, Reanimación y Clínica del Dolor. Hospital HM Delfos, Barcelona, España
| | | | - Xavier León Vintró
- Servicio de Otorrinolaringología. Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departamento de Cirugía, Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), España
| | - Josep Belda-Sanchis
- Servicio de Cirugía Torácica. Hospital de la Santa Creu i Sant Pau, Barcelona, España; Servicio de Cirugía Torácica. Hospital HM Delfos, Barcelona, España; Departamento de Cirugía, Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), España
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17
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Ramírez Prieto MT, Moreno-Zabaleta R, García Romero de Tejada JA. [COVID-19 Neumonia. What Does Ventilatory Support Offer? Review of a Cohort of Patients Treated in a Second Level Hospital]. OPEN RESPIRATORY ARCHIVES 2020; 2:297-298. [PMID: 38620359 PMCID: PMC7485492 DOI: 10.1016/j.opresp.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Raúl Moreno-Zabaleta
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
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18
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Martínez-Téllez E, Orús Dotú C, Trujillo-Reyes JC, Guarino M, Cladellas Gutiérrez E, Planas Cánovas G, Ramon Cervelló J, Carvi Mallo A, Venegas Pizarro MDP, León Vintró X, Belda-Sanchis J. Tracheotomy in patients COVID-19: A necessary high risk procedure. Two center experience. Arch Bronconeumol 2020. [PMID: 34024988 PMCID: PMC7489983 DOI: 10.1016/j.arbr.2020.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Elisabeth Martínez-Téllez
- Servicio de Cirugía Torácica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Servicio de Cirugía Torácica, Hospital HM Delfos, Barcelona, Spain.,Departamento de Cirugía, Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), Spain
| | - César Orús Dotú
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Departamento de Cirugía, Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), Spain
| | - Juan Carlos Trujillo-Reyes
- Servicio de Cirugía Torácica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Servicio de Cirugía Torácica, Hospital HM Delfos, Barcelona, Spain.,Departamento de Cirugía, Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), Spain
| | - Mauro Guarino
- Servicio de Cirugía Torácica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Alex Carvi Mallo
- Servicio de Anestesiología, Reanimación y Clínica del Dolor, Hospital HM Delfos, Barcelona, Spain
| | | | - Xavier León Vintró
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Departamento de Cirugía, Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), Spain
| | - Josep Belda-Sanchis
- Servicio de Cirugía Torácica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Servicio de Cirugía Torácica, Hospital HM Delfos, Barcelona, Spain.,Departamento de Cirugía, Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), Spain
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19
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Estella Á. Intensive Care Medicine: Quiet leadership versus protagonist in times of SARS-CoV-2 pandemic crisis. Med Intensiva 2020; 45:S0210-5691(20)30262-X. [PMID: 32962810 PMCID: PMC7462450 DOI: 10.1016/j.medin.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Á Estella
- Servicio de Medicina Intensiva, Hospital Universitario de Jerez, Cádiz, España; Departamento de Medicina, Universidad de Cádiz, Cádiz, España.
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20
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Ing RJ, Bills C, Merritt G, Ragusa R, Bremner RM, Bellia F. Role of Helmet-Delivered Noninvasive Pressure Support Ventilation in COVID-19 Patients. J Cardiothorac Vasc Anesth 2020; 34:2575-2579. [PMID: 32540245 PMCID: PMC7205670 DOI: 10.1053/j.jvca.2020.04.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/29/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Richard J Ing
- Department of Anesthesiology Children's Hospital Colorado Anschutz Medical Campus Aurora, CO; University of Colorado School of Medicine Children's Hospital Colorado Anschutz Medical Campus Aurora, CO
| | - Corey Bills
- University of Colorado School of Medicine Children's Hospital Colorado Anschutz Medical Campus Aurora, CO; Department of Emergency Medicine Children's Hospital Colorado Anschutz Medical Campus Aurora, CO
| | - Glenn Merritt
- Rocky Mountain Children's Hospital Denver, University of Colorado, CO; USAP Colorado Anesthesia, University of Colorado, CO
| | | | - Ross M Bremner
- Norton Thoracic Institute St Joseph's Hospital and Medical Center Phoenix, AZ
| | - Francesco Bellia
- Pediatric Hematology and Oncology Unit University Hospital G. Rodolico Catania, Italy
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