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Shibata T, Matsumoto S, Muramoto T, Matsukawa M. Comparison of the treatment status of patients with acute heart failure before and during the COVID-19 pandemic - Observational cohort study using Japanese administrative data. J Cardiol 2024; 84:47-54. [PMID: 38311113 DOI: 10.1016/j.jjcc.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 01/09/2024] [Accepted: 01/30/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND There is a concern that the coronavirus disease 2019 (COVID-19) pandemic has led to underutilization of non-invasive positive pressure ventilation (NPPV) in patients with acute heart failure (HF). We investigated the alterations in clinical management of acute HF during the COVID-19 pandemic. METHODS AND RESULTS This study was an observational study of patients treated in emergency care with acute HF, using a Japanese Administrative database for a period before and during the COVID-19 pandemic. Of the 9081 overall eligible patients, the ratio of patients receiving NPPV and tracheal intubation during to before the COVID-19 pandemic were 0.88 [95 % confidence interval (CI): 0.80, 0.96] and 1.38 (95 % CI: 1.11, 1.71), respectively. Propensity score matching in patients treated in COVID-19 receiving facilities and emergency declaration response areas showed that ratio of NPPV and tracheal intubation during to before the COVID-19 pandemic were 0.88 (95 % CI: 0.76, 1.03), and 1.65 (95 % CI: 1.19, 2.28), respectively. CONCLUSIONS The implementation rate of NPPV decreased significantly in eligible patients, with a decreasing trend observed in patient populations in COVID-19 receiving facilities and emergency declaration response areas. Tracheal intubation increased in all populations.
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Affiliation(s)
- Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan.
| | - Shingo Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Tomoki Muramoto
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan
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Merrick R, McKerr C, Song J, Donnelly K, Gerrard R, Morgan M, Williams C, Craine N. Transferring inpatients between wards drives large nosocomial COVID-19 outbreaks, Wales, 2020-22: a matched case-control study using routine and enhanced surveillance data. J Hosp Infect 2024; 145:1-10. [PMID: 38081454 DOI: 10.1016/j.jhin.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND The role of the hospital environment in the spread of COVID-19 is unclear. AIM To measure associations between ward characteristics and outbreak size to inform mitigations. METHODS Wards with large (case wards) and small (control wards) outbreaks in three acute hospitals were compared. Cases were healthcare-associated COVID-19 inpatients (positive polymerase chain reaction test ≥8 days post admission). Case wards were adult medical/surgical wards with ≥10 cases within rolling 14-day periods, between April 1st, 2020 and April 30th, 2022. Control wards were equivalents with 2-9 cases. Demographic and laboratory data were extracted from routine surveillance systems. Continuous data were aggregated fortnightly and analysed as binary variables according to median values. Each case ward was compared with two control wards matched on outbreak start date (±14 days) to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) using univariable and conditional multivariable logistic regression. FINDINGS From 170 outbreaks (median: 5 cases; interquartile range: 2-9), 35 case wards were identified. Community admissions were lower in case wards vs control wards (5 vs 10 median admissions; P<0.01, respectively), whereas transfers between wards within the same hospital were higher (58 vs 29 median transfers; P<0.01, respectively). Wards with more transfers in the preceding fortnight were significantly more likely to experience a large outbreak (≥35 vs <35 transfers; adjusted OR: 9.08; 95% CI: 2.5-33). CONCLUSION We recommend safely minimizing patient movements, such as by asking clinicians to record the rationale for transfer, to reduce the likelihood of disease transmission.
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Affiliation(s)
- R Merrick
- UK Field Epidemiology Training Programme (UKFETP), UK Health Security Agency, UK; Public Health Wales, UK
| | | | | | | | | | - M Morgan
- UK Field Epidemiology Training Programme (UKFETP), UK Health Security Agency, UK; Public Health Wales, UK
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Kim YJ, Hong MY, Kang HM, Yum SK, Youn YA, Lee DG, Kang JH. Using adenosine triphosphate bioluminescence level monitoring to identify bacterial reservoirs during two consecutive Enterococcus faecium and Staphylococcus capitis nosocomial infection outbreaks at a neonatal intensive care unit. Antimicrob Resist Infect Control 2023; 12:68. [PMID: 37443079 PMCID: PMC10339505 DOI: 10.1186/s13756-023-01273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION This study aimed to assess the role of adenosine triphosphate (ATP) bioluminescence level monitoring for identifying reservoirs of the outbreak pathogen during two consecutive outbreaks caused by Enterococcus faecium and Staphylococcus capitis at a neonatal intensive care unit (NICU). The secondary aim was to evaluate the long-term sustainability of the infection control measures employed one year after the final intervention measures. METHODS Two outbreaks occurred during a 53-day period in two disconnected subunits, A and B, that share the same attending physicians. ATP bioluminescence level monitoring, environmental cultures, and hand cultures from healthcare workers (HCW) in the NICU were performed. Pulsed-field gel electrophoresis (PFGE) typing was carried out to investigate the phylogenetic relatedness of the isolated strains. RESULTS Four cases of E. faecium sepsis (patients A-8, A-7, A-9, B-8) and three cases of S. capitis sepsis (patients A-16, A-2, B-8) were diagnosed in six preterm infants over a span of 53 days. ATP levels remained high on keyboard 1 of the main station (2076 relative light unit [RLU]/100 cm2) and the keyboard of bed A-9 (4886 RLU/100 cm2). By guidance with the ATP results, environmental cultures showed that E. faecium isolated from the patients and from the main station's keyboard 1 were genotypically indistinguishable. Two different S. capitis strains caused sepsis in three patients. A total 77.8% (n = 7/9) of S. capitis cultured from HCW's hands were genotypically indistinguishable to the strains isolated from A-2 and A-16. The remaining 22.2% (n = 2/9) were genotypically indistinguishable to patient B-8. Three interventions to decrease the risk of bacterial transmission were applied, with the final intervention including a switch of all keyboards and mice in NICU-A and B to disinfectable ones. Post-intervention prospective monitoring up to one year showed a decrease in blood culture positivity (P = 0.0019) and catheter-related blood stream infection rate (P = 0.016) before and after intervention. CONCLUSION ATP monitoring is an effective tool in identifying difficult to disinfect areas in NICUs. Non-medical devices may serve as reservoirs of pathogens causing nosocomial outbreaks, and HCWs' hands contribute to bacterial transmission in NICUs.
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Affiliation(s)
- Ye Ji Kim
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Infection Control Office, Seoul St. Mary's Hospital, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Yeong Hong
- Infection Control Office, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Hyun Mi Kang
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
- Infection Control Office, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Sook Kyung Yum
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Ah Youn
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Gun Lee
- Infection Control Office, Seoul St. Mary's Hospital, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Ruby JM, Illescas A, Zhong H, DelPizzo KR, Poeran J, Liu J, Cozowicz C, Memtsoudis SG. Pediatric anesthesia practices during the COVID‐19 pandemic: A retrospective cohort study. Health Sci Rep 2022; 6:e979. [PMCID: PMC9742494 DOI: 10.1002/hsr2.979] [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: 03/30/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Background and Aims The onset of the coronavirus 2019 (COVID‐19) pandemic brought together the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anaesthesia and Pain Therapy (ESRA) to release a joint statement on anesthesia use. Their statement included a recommendation to use regional anesthesia whenever possible to mitigate the risk associated with aerosolizing procedures. We sought to examine the utilization of anesthesia in pediatric patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID‐19. Methods Using the Premier Health Database, we retrospectively analyzed pediatric patients undergoing a surgical intervention for fractures or ligament repair before and during COVID‐19. We sought to determine if there were differences in anesthesia use among this cohort during the two time periods. Fracture groups included shoulder and clavicle, humerus and elbow, forearm and wrist, hand and finger, pelvis and hip, femur and knee, leg and ankles, and foot and toes. Ligament procedures included surgical intervention for the anterior cruciate ligament and ulnar collateral ligament repair. Results We identified a total of 5935 patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID‐19. After exclusion for unknown anesthesia use, 2,807 patients were included in our cohort with 81.5% (n = 2288) of patients undergoing a procedure under general anesthesia, 6.4% (n = 181) under regional anesthesia, and 12.0% (n = 338) under combined general‐regional anesthesia. There did not appear to be a significant difference in the type of anesthesia used before and during COVID‐19 (p = 0.052). Conclusions Our study did not identify a difference in anesthesia use before and during COVID‐19 among pediatric patients undergoing a surgical procedure. Further studies should estimate the change in anesthesia used during the time period when elective procedures were resumed.
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Affiliation(s)
- Jordan M. Ruby
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA,Department of AnesthesiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Alex Illescas
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA
| | - Haoyan Zhong
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA
| | - Kathryn R. DelPizzo
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA,Department of AnesthesiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Jashvant Poeran
- Department of Population Health Science & Policy/Orthopedics, Icahn School of Medicine at Mount SinaiInstitute for Healthcare Delivery ScienceNew YorkNew YorkUSA
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA,Department of AnesthesiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care MedicineParacelsus Medical UniversitySalzburgAustria
| | - Stavros G. Memtsoudis
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA,Department of AnesthesiologyWeill Cornell MedicineNew YorkNew YorkUSA,Department of Health Policy and ResearchWeill Cornell Medical CollegeNew YorkNew YorkUSA
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Khatib MN, Sinha A, Mishra G, Quazi SZ, Gaidhane S, Saxena D, Gaidhane AM, Bhardwaj P, Sawleshwarkar S, Zahiruddin QS. WASH to control COVID-19: A rapid review. Front Public Health 2022; 10:976423. [PMID: 36033810 PMCID: PMC9403322 DOI: 10.3389/fpubh.2022.976423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 01/25/2023] Open
Abstract
Background Preventive public health has been suggested as methods for reducing the transmission of COVID-19. Safety and efficacy of one such public health measure: WASH intervention for COVID-19 has not been systematically reviewed. We undertook a rapid review to assess the effect of WASH intervention in reducing the incidence of COVID-19. Methods We conducted searches in PubMed, MEDLINE, and EMBASE. We undertook screening of studies in two stages and extracted data and assessed the quality of evidence for the primary outcome using GRADE recommendations. Main results We included a total of 13 studies with three studies on COVID-19 and 10 on SARS. The study found that hand washing, sterilization of hands, gargling, cleaning/shower after attending patients of COVID-19, or SARS was protective. Evidence also found that frequent washes can prevent SARS transmission among HCWs. However; one study reported that due to enhanced infection-prevention measures, front-line HCWs are more prone to hand-skin damage. The certainty of the evidence for our primary outcome as per GRADE was very low. We did not find any studies that assessed the effect of WASH on hospitalizations, and mortality due to COVID-19. Also; we did not find any study that compared WASH interventions with any other public health measures. Conclusions Current evidence of WASH interventions for COVID-19 is limited as it is largely based on indirect evidence from SARS. Findings from the included studies consistently show that WASH is important in reducing the number of cases during a pandemic. Timely implementation of WASH along with other public health interventions can be vital to ensure the desired success. Further good-quality studies providing direct evidence of the efficacy of WASH on COVID-19 are needed.
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Affiliation(s)
- Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Anju Sinha
- Division of Reproductive, Maternal and Child Health, Indian Council of Medical Research Headquarters, New Delhi, India
| | - Gaurav Mishra
- Department of Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Syed Ziauddin Quazi
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Shilpa Gaidhane
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Deepak Saxena
- Department of Public Health, Indian Institute of Public Health Gandhinagar, Gandhinagar, India
| | - Abhay M. Gaidhane
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Pankaj Bhardwaj
- Department of Community Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Shailendra Sawleshwarkar
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Quazi Syed Zahiruddin
- Centre for Global Evidence Synthesis Initiative (GESI), School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
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Yan K, Lin J, Albaugh S, Yang M, Wang E, Cyberski T, Abasiyanik MF, Wroblewski KE, O'Connor M, Klock A, Tung A, Shahul S, Kurian D, Tay S, Pinto JM. Measuring SARS-CoV-2 aerosolization in rooms of hospitalized patients. Laryngoscope Investig Otolaryngol 2022; 7:1033-1041. [PMID: 35942422 PMCID: PMC9350181 DOI: 10.1002/lio2.802] [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] [Received: 11/23/2021] [Accepted: 04/12/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Airborne spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a significant risk for healthcare workers. Understanding transmission of SARS-CoV-2 in the hospital could help minimize nosocomial infection. The objective of this pilot study was to measure aerosolization of SARS-CoV-2 in the hospital rooms of COVID-19 patients. Methods Two air samplers (Inspirotec) were placed 1 and 4 m away from adults with SARS-CoV-2 infection hospitalized at an urban, academic tertiary care center from June to October 2020. Airborne SARS-CoV-2 concentration was measured by quantitative reverse transcription polymerase chain reaction and analyzed by clinical parameters and patient demographics. Results Thirteen patients with COVID-19 (eight females [61.5%], median age: 57 years old, range 25-82) presented with shortness of breath (100%), cough (38.5%) and fever (15.4%). Respiratory therapy during air sampling varied: mechanical ventilation via endotracheal tube (n = 3), high flow nasal cannula (n = 4), nasal cannula (n = 4), respiratory helmet (n = 1), and room air (n = 1). SARS-CoV-2 RNA was identified in rooms of three out of three intubated patients compared with one out of 10 of the non-intubated patients (p = .014). Airborne SARS-CoV-2 tended to decrease with distance (1 vs. 4 m) in rooms of intubated patients. Conclusions Hospital rooms of intubated patients had higher levels of aerosolized SARS-CoV-2, consistent with increased aerosolization of virus in patients with severe disease or treatment with positive pressure ventilation through an endotracheal tube. While preliminary, these data have safety implications for health care workers and design of protective measures in the hospital. Level of Evidence 2.
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Affiliation(s)
- Kenneth Yan
- Department of Head and Neck SurgeryUniversity of California Los AngelesCaliforniaLos AngelesUSA
| | - Jing Lin
- Pritzker School of Molecular EngineeringThe University of ChicagoChicagoIllinoisUSA
- Institute for Genomics and Systems BiologyThe University of ChicagoChicagoIllinoisUSA
| | - Shaley Albaugh
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Meredith Yang
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Esther Wang
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Thomas Cyberski
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Mustafa Fatih Abasiyanik
- Pritzker School of Molecular EngineeringThe University of ChicagoChicagoIllinoisUSA
- Institute for Genomics and Systems BiologyThe University of ChicagoChicagoIllinoisUSA
| | | | - Michael O'Connor
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Allan Klock
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Avery Tung
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Sajid Shahul
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Dinesh Kurian
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Savaş Tay
- Pritzker School of Molecular EngineeringThe University of ChicagoChicagoIllinoisUSA
- Institute for Genomics and Systems BiologyThe University of ChicagoChicagoIllinoisUSA
| | - Jayant M. Pinto
- Section of Otolaryngology‐Head and Neck Surgery, Department of SurgeryThe University of ChicagoChicagoIllinoisUSA
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Stein RA, Bianchini EC. Bacterial-Viral Interactions: A Factor That Facilitates Transmission Heterogeneities. FEMS MICROBES 2022. [DOI: 10.1093/femsmc/xtac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The transmission of infectious diseases is characterized by heterogeneities that are shaped by the host, the pathogen, and the environment. Extreme forms of these heterogeneities are called super-spreading events. Transmission heterogeneities are usually identified retrospectively, but their contribution to the dynamics of outbreaks makes the ability to predict them valuable for science, medicine, and public health. Previous studies identified several factors that facilitate super-spreading; one of them is the interaction between bacteria and viruses within a host. The heightened dispersal of bacteria colonizing the nasal cavity during an upper respiratory viral infection, and the increased shedding of HIV-1 from the urogenital tract during a sexually transmitted bacterial infection, are among the most extensively studied examples of transmission heterogeneities that result from bacterial-viral interactions. Interrogating these transmission heterogeneities, and elucidating the underlying cellular and molecular mechanisms, are part of much-needed efforts to guide public health interventions, in areas that range from predicting or controlling the population transmission of respiratory pathogens, to limiting the spread of sexually transmitted infections, and tailoring vaccination initiatives with live attenuated vaccines.
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Affiliation(s)
- Richard A Stein
- NYU Tandon School of Engineering Department of Chemical and Biomolecular Engineering 6 MetroTech Center Brooklyn , NY 11201 USA
| | - Emilia Claire Bianchini
- NYU Tandon School of Engineering Department of Chemical and Biomolecular Engineering 6 MetroTech Center Brooklyn , NY 11201 USA
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Sullivan ZP, Zazzeron L, Berra L, Hess DR, Bittner EA, Chang MG. Noninvasive respiratory support for COVID-19 patients: when, for whom, and how? J Intensive Care 2022; 10:3. [PMID: 35033204 PMCID: PMC8760575 DOI: 10.1186/s40560-021-00593-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/26/2021] [Indexed: 12/14/2022] Open
Abstract
The significant mortality rate and prolonged ventilator days associated with invasive mechanical ventilation (IMV) in patients with severe COVID-19 have incited a debate surrounding the use of noninvasive respiratory support (NIRS) (i.e., HFNC, CPAP, NIV) as a potential treatment strategy. Central to this debate is the role of NIRS in preventing intubation in patients with mild respiratory disease and the potential beneficial effects on both patient outcome and resource utilization. However, there remains valid concern that use of NIRS may prolong time to intubation and lung protective ventilation in patients with more advanced disease, thereby worsening respiratory mechanics via self-inflicted lung injury. In addition, the risk of aerosolization with the use of NIRS has the potential to increase healthcare worker (HCW) exposure to the virus. We review the existing literature with a focus on rationale, patient selection and outcomes associated with the use of NIRS in COVID-19 and prior pandemics, as well as in patients with acute respiratory failure due to different etiologies (i.e., COPD, cardiogenic pulmonary edema, etc.) to understand the potential role of NIRS in COVID-19 patients. Based on this analysis we suggest an algorithm for NIRS in COVID-19 patients which includes indications and contraindications for use, monitoring recommendations, systems-based practices to reduce HCW exposure, and predictors of NIRS failure. We also discuss future research priorities for addressing unanswered questions regarding NIRS use in COVID-19 with the goal of improving patient outcomes.
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Affiliation(s)
- Zachary P Sullivan
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Luca Zazzeron
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Dean R Hess
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Edward A Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Marvin G Chang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA.
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Factors Preventing Nosocomial Outbreak Following a Single case of COVID-19 Diagnosed During Hospitalization: A Retrospective Review. Disaster Med Public Health Prep 2022; 17:e107. [PMID: 35000646 PMCID: PMC8886090 DOI: 10.1017/dmp.2022.8] [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: 02/07/2023]
Abstract
OBJECTIVE Our hospital experienced a hospital shutdown and 2 week quarantine after a case of COVID-19 was diagnosed during hospitalization. We analyzed the reopening process following hospital closure and possible factors that prevented hospital spread. METHODS We retrospectively reviewed the confirmed patient's medical records and results of epidemiological survey available from the infection control team of our hospital. RESULTS A total of 117 hospital staff members were tested, 26 of whom were self-isolated. Of the 54 inpatients tested, 28 on the same floor, and 2 close contacts in the endoscopic room were quarantined in a single room. Finally, all quarantined hospital staff, inpatients and outpatients were tested for COVID-19 on the 14th day of close contact. The results were all negative, and the hospital work resumed completely. CONCLUSION Although closing and isolating the hospital appeared to have played a useful role in preventing the spread of COVID-19 inside the hospital and to the local community, it is still debated whether or not the duration of hospital closure or quarantine was appropriate. The lessons from the 2-week hospital closure suggest that wearing a mask, hand hygiene and the ward environment are important factors in preventing nosocomial outbreaks of COVID-19.
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Modes de transmission du SARS-CoV-2 : que sait-on actuellement ? M�DECINE ET MALADIES INFECTIEUSES FORMATION 2022. [PMCID: PMC8815781 DOI: 10.1016/j.mmifmc.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Des progrès remarquables ont été obtenus dans notre compréhension de la transmission du SARS-CoV-2 et la réduction de sa propagation. La prise en compte du risque majeur des formes asymptomatiques par le port universel du masque est une de ces avancées. Les données épidémiologiques (taux d'attaque et R0) ainsi que l'accumulation de données en contexte clinique suggèrent une similitude de transmission du SARS-CoV-2 avec celle des autres virus respiratoires comme la grippe ou le SARS-CoV-1, un mode de transmission principal direct de personne à personne, à courte distance par les gouttelettes. La transmission aéroportée est possible mais rare, et ne semble se produire que dans des circonstances opportunistes, notamment lors de procédures médicales sur la sphère respiratoire de patients infectés, ou dans des conditions d'excrétion virale élevée en zone confinée mal ventilée. L'hygiène des mains et le port du masque sont les deux armes essentielles de prévention dans le contexte de la COVID-19.
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Dhala A, Gotur D, Hsu SHL, Uppalapati A, Hernandez M, Alegria J, Masud F. A Year of Critical Care: The Changing Face of the ICU During COVID-19. Methodist Debakey Cardiovasc J 2021; 17:31-42. [PMID: 35855452 PMCID: PMC9244858 DOI: 10.14797/mdcvj.1041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
During the SARS-CoV-2 pandemic, admissions to hospital intensive care units (ICUs) surged, exerting unprecedented stress on ICU resources and operations. The novelty of the highly infectious coronavirus disease 2019 (COVID-19) required significant changes to the way critically ill patients were managed. Houston Methodist’s incident command center team navigated this health crisis by ramping up its bed capacity, streamlining treatment algorithms, and optimizing ICU staffing while ensuring adequate supplies of personal protective equipment (PPE), ventilators, and other ICU essentials. A tele–critical-care program and its infrastructure were deployed to meet the demands of the pandemic. Community hospitals played a vital role in creating a collaborative ecosystem for the treatment and referral of critically ill patients. Overall, the healthcare industry’s response to COVID-19 forced ICUs to become more efficient and dynamic, with improved patient safety and better resource utilization. This article provides an experiential account of Houston Methodist’s response to the pandemic and discusses the resulting impact on the function of ICUs.
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Affiliation(s)
- Atiya Dhala
- Houston Methodist Hospital, Houston, Texas, US
| | - Deepa Gotur
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Steven Huan-Ling Hsu
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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12
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Aymerich H, Bonome C, González-Rivas D. Non intubated video-assisted thoracoscopic lung resections (NI-VATS) in COVID times. Saudi J Anaesth 2021; 15:362-367. [PMID: 34764844 PMCID: PMC8579503 DOI: 10.4103/sja.sja_421_21] [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] [Received: 06/05/2021] [Accepted: 06/05/2021] [Indexed: 11/04/2022] Open
Abstract
The emergence of epidemic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in December 2019 in Wuhan, China causing Coronavirus Disease 2019 (COVID-19) and its rapid expansion around the world, leading to a global pandemic of dimensions not observed at least since the "Spanish influenza" pandemic in 1917-18, has had great consequences at all levels, including social, health and economic spheres. This pandemic situation forces us, as health care workers, to redefine our medical and surgical actions to adapt them to this new reality. It is important, when the rules of the game change, to rethink and to reevaluate if the balance between risk and benefit have moved to a different point of equilibrium, and if our indications of certain surgical interventions need to be redefined. In this article we try to answer the doubts that arise about the suitability of the NI-VATS technique and assess whether its use in these new pandemic circumstances might add advantages, especially in relation to minimize the risks of virus contagion between patients and all healthcare personnel during the surgical procedure, as well as the known advantages described in many articles the last ten years.
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Affiliation(s)
- H Aymerich
- Department of Anesthesia, Quironsalud Hospital, Coruña, Spain
| | - C Bonome
- Department of Anesthesia, San Rafael Hospital, Coruña, Spain
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13
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Sanaie S, Mahmoodpoor A, Hosseini MS. Individualized masks and respirators for COVID-19 patients and involved medical staff. ACTA ACUST UNITED AC 2021; 67:488-489. [PMID: 34495048 DOI: 10.1590/1806-9282.20210100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Sarvin Sanaie
- Tabriz University of Medical Sciences, Aging Research Institute, Neurosciences Research Center - Tabriz, Iran
| | - Ata Mahmoodpoor
- Tabriz University of Medical Sciences, Faculty of Medicine, Department of Anesthesiology - Tabriz, Iran
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14
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Sheikh M, Kuperberg S. An organ systems-based review of outcomes associated with sleep apnea in hospitalized patients. Medicine (Baltimore) 2021; 100:e26857. [PMID: 34449455 PMCID: PMC8389950 DOI: 10.1097/md.0000000000026857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 01/04/2023] Open
Abstract
The current global health crisis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has prompted the medical community to investigate the effects of underlying medical conditions, including sleep-disordered breathing, on inpatient care. Obstructive sleep apnea (OSA) is a common form of sleep-disordered breathing that may complicate numerous acquired conditions, particularly in inpatient and critical care settings. Viral pneumonia is a major contributor to intensive care unit (ICU) admissions and often presents more severely in patients with underlying pulmonary disease, especially those with obesity and OSA. This review summarizes the most recent data regarding complications of both OSA and obesity and highlights their impact on clinical outcomes in hospitalized patients. Additionally, it will highlight pertinent evidence for the complications of OSA in an organ-systems approach. Finally, this review will also discuss impatient treatment approaches for OSA, particularly in relation to the SARS-CoV-2 pandemic.
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Affiliation(s)
- Maaz Sheikh
- Stony Brook University Hospital, Department of Internal Medicine, Stony Brook, NY
| | - Stephen Kuperberg
- Stony Brook University Hospital, Department of Pulmonology and Critical Care, Department of Internal Medicine, Stony Brook, NY
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15
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Andal V, Lakshmipathy R, Jose D. Effect of sanitizer on obliteration of SARS -CoV2/COVID 19: A mini review. ACTA ACUST UNITED AC 2021; 55:264-266. [PMID: 34249617 PMCID: PMC8257430 DOI: 10.1016/j.matpr.2021.07.026] [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: 11/08/2022]
Abstract
Corona virus is a respiratory virus which causes infectious Covid-19 (Corona Virus −2019) disease and globally the virus continues to pose major risks of mortality. It is lucid that close links are the key aspect for transitory of communicable Corona virus. Rapid research is in progress to identify prolific drugs and vaccine for Covid-19 however, it is a time consuming process. Social distancing and Sanitizers are helpful in combating virus and safeguarding the human health. Hand sanitizers are prolific when hands washing with soaps are not possible. Sanitizers are effective antibacterial agents and classified into two types as alcohol based and alcohol free. Among which alcohol based sanitizers are prospective in persuading the public needs. Efficient use of alcohol-based sanitizers during this epidemic season could significantly reduce the propagation of corona virus. This review aims at explaining the interactions of virus with hand sanitizers.
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Affiliation(s)
- V Andal
- Department of Chemistry, KCG College of Technology, Chennai 600 097, India
| | - R Lakshmipathy
- Department of Chemistry, KCG College of Technology, Chennai 600 097, India
| | - Deepa Jose
- Dept of Electronics and Communication Engineering, KCG College of Technology, Chennai 600 097, India
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16
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Hui DS, Zumla A, Tang JW. Lethal zoonotic coronavirus infections of humans - comparative phylogenetics, epidemiology, transmission, and clinical features of coronavirus disease 2019, The Middle East respiratory syndrome and severe acute respiratory syndrome. Curr Opin Pulm Med 2021; 27:146-154. [PMID: 33660619 DOI: 10.1097/mcp.0000000000000774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW Severe acute respiratory syndrome-coronaviruses-2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), emerged as a new zoonotic pathogen of humans at the end of 2019 and rapidly developed into a global pandemic. Over 106 million COVID-19 cases including 2.3 million deaths have been reported to the WHO as of February 9, 2021. This review examines the epidemiology, transmission, clinical features, and phylogenetics of three lethal zoonotic coronavirus infections of humans: SARS-CoV-1, SARS-CoV-2, and The Middle East respiratory syndrome coronavirus (MERS-COV). RECENT FINDINGS Bats appear to be the common natural source of SARS-like CoV including SARS-CoV-1 but their role in SARS-CoV-2 and MERS-CoV remains unclear. Civet cats and dromedary camels are the intermediary animal sources for SARS-CoV-1 and MERS-CoV infection, respectively whereas that of SARS-CoV-2 remains unclear. SARS-CoV-2 viral loads peak early on days 2-4 of symptom onset and thus high transmission occurs in the community, and asymptomatic and presymptomatic transmission occurs commonly. Nosocomial outbreaks are hallmarks of SARS-CoV-1 and MERS-CoV infections whereas these are less common in COVID-19. Several COVID-19 vaccines are now available. SUMMARY Of the three lethal zoonotic coronavirus infections of humans, SARS-CoV-2 has caused a devastating global pandemic with over a million deaths. The emergence of genetic variants, such as D614G, N501Y (variants 1 and 2), has led to an increase in transmissibility and raises concern about the possibility of re-infection and impaired vaccine response. Continued global surveillance is essential for both SARS-CoV-2 and MERS-CoV, to monitor changing epidemiology due to viral variants.
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Affiliation(s)
- David S Hui
- Department of Medicine & Therapeutics & Stanley Ho Center for Emerging Infectious Diseases
- The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London
| | - Julian W Tang
- Respiratory Sciences, University of Leicester, Leicester, UK
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17
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Goldstein KM, Ghadimi K, Mystakelis H, Kong Y, Meng T, Cantrell S, Von Isenburg M, Gordon A, Ear B, Gierisch JM, Williams JW. Risk of Transmitting Coronavirus Disease 2019 During Nebulizer Treatment: A Systematic Review. J Aerosol Med Pulm Drug Deliv 2021; 34:155-170. [PMID: 33887156 DOI: 10.1089/jamp.2020.1659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Rationale: There is an urgent need to understand the risk of viral transmission during nebulizer treatment of patients with coronavirus disease 2019 (COVID-19). Objectives: To assess the risk of transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SARS, Middle East respiratory syndrome (MERS), and influenza with administration of drugs via nebulizer. Methods: We searched multiple electronic databases, including PubMed®, China National Knowledge Infrastructure, Wanfang, preprint databases, and clinicaltrials.gov through December 1, 2020. Any study design in any language describing the risk of viral transmission with nebulizer treatment was eligible. Data were abstracted by one investigator and verified by a second. Results: We identified 22 articles: 1 systematic review, 7 cohort/case-control studies, 7 case series, and 7 simulation-based studies. Eight individual studies involved patients with SARS, five involved MERS, and one involved SARS-CoV-2. The seven cohort/case-control studies (four high risk of bias [ROB], three unclear ROB) found mixed results (median odds ratio 3.91, range 0.08-20.67) based on very weak data among a small number of health care workers (HCWs) with variable use of personal protective equipment (PPE). Case series had multiple potential contributors to transmission. Simulation studies found evidence for droplet dispersion after saline nebulization and measureable influenza viral particles up to 1.7 m from the source after 10 minutes of nebulization with a patient simulator. Study heterogeneity prevented meta-analysis. Conclusions: Case series raise concern of transmission risk, and simulation studies demonstrate droplet dispersion with virus recovery, but specific evidence that exposure to nebulizer treatment increases transmission of coronaviruses similar to COVID-19 is inconclusive. Tradeoffs balancing HCW safety and patient appropriateness can potentially minimize risk, including choice of delivery method for inhaled medications (e.g., nebulizer vs. metered dose inhaler) and PPE (e.g., N95 vs. surgical mask).
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Affiliation(s)
- Karen M Goldstein
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kamrouz Ghadimi
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Critical Care Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Yuanyuan Kong
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Tongtong Meng
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Sarah Cantrell
- Duke University Medical Center Library & Archives, Durham, North Carolina, USA
| | - Megan Von Isenburg
- Duke University Medical Center Library & Archives, Durham, North Carolina, USA
| | - Adelaide Gordon
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Belinda Ear
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Jennifer M Gierisch
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - John W Williams
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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18
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Hamilton GS. Aerosol-generating procedures in the COVID era. Respirology 2021; 26:416-418. [PMID: 33660369 PMCID: PMC8014278 DOI: 10.1111/resp.14031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Garun S Hamilton
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Melbourne, VIC, Australia.,School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
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19
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Youssef FA, Patel M, Park H, Patel JV, Leo J, Tanios MA. Protected code blue: using in situ simulation to develop a protected code blue and modify staff training protocol-experience in a large community teaching hospital during the COVID-19 pandemic. BMJ Open Qual 2021; 10:bmjoq-2020-001097. [PMID: 33589506 PMCID: PMC7886667 DOI: 10.1136/bmjoq-2020-001097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 11/04/2022] Open
Abstract
The surge in clinical demand, shortage in personal protective equipment and high-exposure risk for healthcare workers during the COVID-19 pandemic has challenged hospital common practices and forced a reassessment of care delivery models. Code blue teams are highly specialised units that partake in life-saving situations that can jeopardise the safety of team members. There is a paucity of guidance in regards to proper infection control measures to protect the responders.This study describes a methodical approach to assessing vulnerabilities to transmission of SARS-CoV-2 within existing code blue practices, modalities to limit the number of code blue team responders and modifications to the protocol at a large community teaching hospital. The effort undertaken faced challenges due to the nature of the pandemic and the increased demand on healthcare workers. Quality improvement methods facilitated our protocol design and implementation. To this date, there has been no identified COVID-19 disease in any protected code blue (PCB) team members. We recommend that similar practices be considered and adopted widely and practised periodically.
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Affiliation(s)
- Fady A Youssef
- Department of Medicine, Division of Critical Care Medicine, MemorialCare - Long Beach Medical Center, Long Beach, California, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California Irvine, Irvine, California, USA
| | - Monique Patel
- Department of Medicine, University of California Irvine, Irvine, California, USA
| | - Hyunsoon Park
- Department of Medicine, Division of Critical Care Medicine, MemorialCare - Long Beach Medical Center, Long Beach, California, USA
| | - Jay V Patel
- Department of Medicine, Division of Critical Care Medicine, MemorialCare - Long Beach Medical Center, Long Beach, California, USA
| | - James Leo
- Department of Medicine, Division of Critical Care Medicine, MemorialCare - Long Beach Medical Center, Long Beach, California, USA
| | - Maged A Tanios
- Department of Medicine, Division of Critical Care Medicine, MemorialCare - Long Beach Medical Center, Long Beach, California, USA .,Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California Irvine, Irvine, California, USA
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20
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Arif S, Sadeeqa S, Saleem Z, Latif S, Sharif M. The burden of healthcare-associated infections among pediatrics: a repeated point prevalence survey from Pakistan. Hosp Pract (1995) 2021; 49:34-40. [PMID: 32990488 DOI: 10.1080/21548331.2020.1826783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are considered a major threat to public health resulting in significant morbidity, mortality, and additional costs. The present study aimed to assess the current patterns and risk factors of HAIs among hospitalized children. MATERIALS AND METHODS Three repeated point prevalence surveys were conducted in the pediatric inpatients of four hospitals by using the methodology developed by the European Center for Disease Prevention and Control. All patients present in the ward at 8:00 AM on the survey day and not discharged from the hospital on the same day were included. A standardized data collection form containing information on the presence of HAIs and the associated risk factors was completed for the patients. FINDINGS Out of 888 hospitalized patients, 116 (13.1%) had the symptoms of HAIs. Most common infections were bloodstream infections (BSIs) (32.8%), pneumonia (21.0%), ear, eyes, nose and throat infections (11.8%), and skin and soft tissue infections (SSTs) (19.0%). Factors significantly associated with infections were the length of hospital stay (p = 0.000), admission to the medicine ward (p = 0.034), and male gender (p = 0.010). BSIs were most common in children belonging to the age group of less than one month (78.9%), who were admitted to intensive care units (73.7%). SSTs including surgical site infections were more prevalent in surgery wards (78.3%). CONCLUSIONS A high rate of HAIs among pediatrics was found in Pakistan. Infection control and prevention strategies are needed with a major focus on interventions to prevent the spread of most prevalent HAIs.
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Affiliation(s)
- Sara Arif
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University , Lahore, Pakistan
| | - Saleha Sadeeqa
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University , Lahore, Pakistan
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Sumaira Latif
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University , Lahore, Pakistan
| | - Muhammad Sharif
- Department of Paediatric Surgery, King Edward Medical University , Lahore, Pakistan
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21
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Yen MY, Schwartz J, Shih CL. Seventeen years after first implementation of traffic control bundling. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 54:1-3. [PMID: 33518501 PMCID: PMC8058945 DOI: 10.1016/j.jmii.2020.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/24/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Muh-Yong Yen
- Division of Infectious Diseases, Taipei City Hospital, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan; Division of Infectious Diseases, Cheng-Hsin General Hospital, Taipei, Taiwan.
| | - Jonathan Schwartz
- Department of Political Science, State University of New York, New Paltz, NY, USA
| | - Chung-Liang Shih
- Department of Medical Affaires, Ministry of Health and Welfare, Taipei, Taiwan
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22
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El-Goly AMM. Lines of Treatment of COVID-19 Infection. COVID-19 INFECTIONS AND PREGNANCY 2021. [PMCID: PMC8298380 DOI: 10.1016/b978-0-323-90595-4.00002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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Agarwal M, Ranjan P, Baitha U, Mittal A. Hydroxychloroquine as a Chemoprophylactic Agent for COVID-19: A Clinico-Pharmacological Review. Front Pharmacol 2020; 11:593099. [PMID: 33390974 PMCID: PMC7773916 DOI: 10.3389/fphar.2020.593099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/04/2020] [Indexed: 12/11/2022] Open
Abstract
Hydroxychloroquine has gained much attention as one of the candidate drugs that can be repurposed as a prophylactic agent against SARS-CoV-2, the agent responsible for the COVID-19 pandemic. Due to high transmissibility and presence of asymptomatic carriers and presymptomatic transmission, there is need for a chemoprophylactic agent to protect the high-risk population. In this review, we dissect the currently available evidence on hydroxychloroquine prophylaxis from a clinical and pharmacological point of view. In vitro studies on Vero cells show that hydroxychloroquine effectively inhibits SARS-CoV-2 by affecting viral entry and viral transport via endolysosomes. However, this efficacy has failed to replicate in in vivo animal models as well as in most clinical observational studies and clinical trials assessing pre-exposure prophylaxis and postexposure prophylaxis in healthcare workers. An analysis of the pharmacology of HCQ in COVID-19 reveals certain possible reasons for this failure-a pharmacokinetic failure due to failure to achieve adequate drug concentration at the target site and attenuation of its inhibitory effect due to the presence of TMPRSS2 in airway epithelial cells. Currently, many clinical trials on HCQ prophylaxis in HCW are ongoing; these factors should be taken into account. Using higher doses of HCQ for prophylaxis is likely to be associated with increased safety concerns; thus, it may be worthwhile to focus on other possible interventions.
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Affiliation(s)
- Mudit Agarwal
- MBBS, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Mittal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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24
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Fiorelli S, Menna C, Piccioni F, Ibrahim M, Rendina EA, Rocco M, Massullo D. The Cutting Edge of Thoracic Anesthesia During the Coronavirus Disease 2019 (COVID-19) Outbreak. J Cardiothorac Vasc Anesth 2020; 34:3203-3210. [PMID: 32631666 PMCID: PMC7276138 DOI: 10.1053/j.jvca.2020.05.042] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 01/02/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has quickly spread globally, causing a real pandemic. In this critical scenario, lung cancer patients scheduled for surgical treatment need to continue to receive optimal care while protecting them from an eventual severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Adequate use of personal protective equipment (PPE) during aerosol-generating procedures (AGPs) and a COVID-19 specific intraoperative management are paramount in order to prevent cross infections. New suggestions or improvement of existing contagion control guidance are needed, even in case of non-symptomatic patients, possibly responsible for virus spread.
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Affiliation(s)
- Silvia Fiorelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Cecilia Menna
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Federico Piccioni
- Department of Critical Care and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mohsen Ibrahim
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Monica Rocco
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Domenico Massullo
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
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25
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Rubbi I, Pasquinelli G, Brighenti A, Fanelli M, Gualandi P, Nanni E, D'Antoni V, Fabbri C. Healthcare personnel exposure to COVID - 19: an observational study on quarantined positive workers. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020012. [PMID: 33263344 PMCID: PMC8023106 DOI: 10.23750/abm.v91i12-s.10814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY COVID-19 is characterized by super spread events occurring in communities, e.g., hospitals. To limit virus diffusion among healthcare workers the use of personal protective equipment and screening tests are highly advised; also, isolation of virus positive professionals while monitoring their health condition is recommended. This study aims to assess, in a cohort of COVID-19 positive quarantined healthcare workers, the perceived source of infection and exposure risk as well as the clinical evolution of the disease through a surveillance interview. METHODS A retrospective observational study accounting 896 observations on 93 healthcare professionals tested positive for COVID-19. Data were collected from the Nursing and Technical Directorate of Romagna, Ravenna, Local Health Company, Italy. RESULTS 99.5% of the positive workers accepted phone interviews with management staff. 2.6% of workers were positive with increasing records in the specialist medical area. Nurses and social health professionals were mostly affected. Patient exposure at a distance <1 m and a contact time > 2 hours was the first cause of positivity. In COVID-19 and territorial emergency departments, the first cause was the contact with colleagues. At the time of the infection, most of the staff wore a surgical mask. Cough, asthenia, fever, anosmia, dysgeusia, and rhinitis were common symptoms. Asymptomatic percentage was about 10%. The self-perceived physical condition was high (>7) and improved during the observation period. CONCLUSIONS The diffusion rate of COVID-19 among healthcare workers is relatively low, probably due to the use of personal protective equipment. The distancing, also among colleagues, is a fundamental measure to reduce the possibility of infection. Symptoms are mild and can be controlled by surveillance measures. Constant contact with the organization is an essential strategy for promoting recovering of workers and reducing the spread of the virus within the healthcare organization.
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Affiliation(s)
- Ivan Rubbi
- Corso di Laurea in Infermieristica Università di Bologna - Faenza.
| | - Gianandrea Pasquinelli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna,Italy.
| | | | | | | | | | | | - Cristina Fabbri
- Nursing and Technical Direction AUSL Romagna - Ravenna, Italy.
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26
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Stuart RL, Zhu W, Morand EF, Stripp A. Breaking the chain of transmission within a tertiary health service: An approach to contact tracing during the COVID-19 pandemic. Infect Dis Health 2020; 26:118-122. [PMID: 33281108 PMCID: PMC7670898 DOI: 10.1016/j.idh.2020.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/07/2020] [Accepted: 11/08/2020] [Indexed: 11/02/2022]
Abstract
BACKGROUND Tertiary referral health service. INTERVENTION(S) An approach to hospital based contact tracing is described along with tools employed to streamline the process and including the development of an outbreak management team (OMT) for each contact trace. RESULTS Forty-one OMTs occurred, involving 23 HCW and 18 patient index cases. The total furloughed HCWs arising from these contact traces was 383, with individual contact traces furloughing a mean (range) of 10 (0-80) HCWs. Importantly, 15 furloughed HCWs subsequently became COVID-19 positive during their 14-day isolation period, showing the importance of the contact tracing process and the ability to remove workers from the workplace before they become infectious. CONCLUSIONS A standardised, streamlined contact tracing procedure in healthcare settings ensures any impacts of COVID-19 positive cases are consistently managed. This response framework may be of use to other health services and help reduce the transmission of COVID-19 in the workplace.
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Affiliation(s)
- Rhonda L Stuart
- Monash Health, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - Wendy Zhu
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric F Morand
- Monash Health, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrew Stripp
- Monash Health, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Bahl A, Van Baalen MN, Ortiz L, Chen NW, Todd C, Milad M, Yang A, Tang J, Nygren M, Qu L. Early predictors of in-hospital mortality in patients with COVID-19 in a large American cohort. Intern Emerg Med 2020; 15:1485-1499. [PMID: 32970246 PMCID: PMC7512216 DOI: 10.1007/s11739-020-02509-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/12/2020] [Indexed: 02/07/2023]
Abstract
Coronavirus disease (COVID-19) has aggressively spread across the United States with numerous fatalities. Risk factors for mortality are poorly described. This was a multicentered cohort study identifying patient characteristics and diagnostic markers present on initial evaluation associated with mortality in hospitalized COVID-19 patients. Epidemiological, demographic, clinical, and laboratory characteristics of survivors and non-survivors were obtained from electronic medical records and a multivariable survival regression analysis was conducted to identify risk factors of in-hospital death. Of 1629 consecutive hospitalized adult patients with confirmed COVID-19 from March 1st thru March 31, 2020, 1461 patients were included in final analysis. 327 patients died during hospitalization and 1134 survived to discharge. Median age was 62 years (IQR 50.0, 74.0) with 56% of hospitalized patients under the age of 65. 47% were female and 63% identified as African American. Most patients (55%) had either no or one comorbidity. In multivariable analysis, older age, admission respiratory status including elevated respiratory rate and oxygen saturation ≤ 88%, and initial laboratory derangements of creatinine > 1.33 mg/dL, alanine aminotransferase > 40 U/L, procalcitonin > 0.5 ng/mL, and lactic acid ≥ 2 mmol/L increased risk of in-hospital death. This study is one of the largest analyses in an epicenter for the COVID-19 pandemic. Older age, low oxygen saturation and elevated respiratory rate on admission, and initial lab derangements including renal and hepatic dysfunction and elevated procalcitonin and lactic acid are risk factors for in-hospital death. These factors can help clinicians prognosticate and should be considered in management strategies.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, 3601 13 Mile Rd, Royal Oak, MI, 48073, USA.
| | | | - Laura Ortiz
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, 3601 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - Nai-Wei Chen
- Beaumont Health Research Institute, Royal Oak, MI, USA
| | - Courtney Todd
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Merit Milad
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Alex Yang
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Jonathan Tang
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Madalyn Nygren
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lihua Qu
- Beaumont Health Research Institute, Royal Oak, MI, USA
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Gaeckle NT, Lee J, Park Y, Kreykes G, Evans MD, Hogan CJ. Aerosol Generation from the Respiratory Tract with Various Modes of Oxygen Delivery. Am J Respir Crit Care Med 2020; 202:1115-1124. [PMID: 32822208 PMCID: PMC7560792 DOI: 10.1164/rccm.202006-2309oc] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022] Open
Abstract
Rationale: Aerosol generation with modes of oxygen therapy such as high-flow nasal cannula and noninvasive positive-pressure ventilation is a concern for healthcare workers during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The amount of aerosol generation from the respiratory tract with these various oxygen modalities is unknown.Objectives: To measure the size and number concentration of particles and droplets generated from the respiratory tract of humans exposed to various oxygen delivery modalities.Methods: Ten healthy participants with no active pulmonary disease were enrolled. Oxygen modalities tested included nonhumidified nasal cannula, face mask, heated and humidified high-flow nasal cannula, and noninvasive positive-pressure ventilation. Aerosol generation was measured with each oxygen mode while participants performed maneuvers of normal breathing, talking, deep breathing, and coughing. Testing was conducted in a negative-pressure room. Particles with a diameter between 0.37 and 20 μm were measured using an aerodynamic particle spectrometer.Measurements and Main Results: Median particle concentration ranged from 0.041 to 0.168 particles/cm3. Median diameter ranged from 1.01 to 1.53 μm. Cough significantly increased the number of particles measured. Measured aerosol concentration did not significantly increase with the use of either humidified high-flow nasal cannula or noninvasive positive-pressure ventilation. This was the case during normal breathing, talking, deep breathing, and coughing.Conclusions: Oxygen delivery modalities of humidified high-flow nasal cannula and noninvasive positive-pressure ventilation do not increase aerosol generation from the respiratory tract in healthy human participants with no active pulmonary disease measured in a negative-pressure room.
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Affiliation(s)
- Nathaniel T. Gaeckle
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine
| | | | | | - Gean Kreykes
- Department of Respiratory Care, M Health Fairview, Minneapolis, Minnesota
| | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota; and
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Montrief T, Ramzy M, Long B, Gottlieb M, Hercz D. COVID-19 respiratory support in the emergency department setting. Am J Emerg Med 2020; 38:2160-2168. [PMID: 33046288 PMCID: PMC7413866 DOI: 10.1016/j.ajem.2020.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/26/2020] [Accepted: 08/01/2020] [Indexed: 01/25/2023] Open
Abstract
Introduction Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19), may result in severe complications, multiorgan dysfunction, acute respiratory failure, and death. SARS-CoV-2 is highly contagious and places healthcare workers at significant risk, especially during aerosol-generating procedures, including airway management. Objective This narrative review outlines the underlying respiratory pathophysiology of patients with COVID-19 and discusses approaches to airway management in the emergency department (ED) based on current literature. Discussion Patients presenting with SARS-CoV-2 infection are at high risk for acute respiratory failure requiring airway management. Among hospitalized patients, 10–20% require intensive care unit admission, and 3–10% require intubation and mechanical ventilation. While providing respiratory support for these patients, proper infection control measures, including adherence to personal protective equipment policies, are necessary to prevent nosocomial transmission to healthcare workers. A structured approach to respiratory failure in these patients includes the use of exogenous oxygen via nasal cannula or non-rebreather, as well as titrated high-flow nasal cannula and non-invasive ventilation. This review offers several guiding principles and resources designed to be adapted in conjunction with local workplace policies for patients requiring respiratory support. Conclusions While the fundamental principles of acute respiratory failure management are similar between COVID-19 and non-COVID-19 patients, there are some notable differences, including a focus on provider safety. This review provides an approach to airway management and respiratory support in the patient with COVID-19.
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Affiliation(s)
- Tim Montrief
- Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, United States of America
| | - Mark Ramzy
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, United States of America
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, United States of America.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Dan Hercz
- Department of Emergency Medicine, Jackson Memorial Hospital, Miami, FL, United States of America
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Implementation of infection control measures to prevent healthcare-associated transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2). Infect Control Hosp Epidemiol 2020; 42:229-232. [PMID: 33040753 PMCID: PMC7591740 DOI: 10.1017/ice.2020.1262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Mottiar M, Hendin A, Fischer L, Roze des Ordons A, Hartwick M. End-of-life care in patients with a highly transmissible respiratory virus: implications for COVID-19. Can J Anaesth 2020; 67:1417-1423. [PMID: 32394338 PMCID: PMC7212843 DOI: 10.1007/s12630-020-01699-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 01/08/2023] Open
Abstract
Symptom management and end-of-life care are core skills for all physicians, although in ordinary times many anesthesiologists have fewer occasions to use these skills. The current coronavirus disease (COVID-19) pandemic has caused significant mortality over a short time and has necessitated an increase in provision of both critical care and palliative care. For anesthesiologists deployed to units caring for patients with COVID-19, this narrative review provides guidance on conducting goals of care discussions, withdrawing life-sustaining measures, and managing distressing symptoms.
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Affiliation(s)
- Miriam Mottiar
- Department of Anesthesiology & Pain Medicine, Division of Palliative Medicine, Department of Medicine, The Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Room 1401, Ottawa, ON, K1H 8L6, Canada.
| | - Ariel Hendin
- Department of Emergency Medicine, Division of Critical Care, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Fischer
- Department of Emergency Medicine, Division of Palliative Medicine, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Amanda Roze des Ordons
- Department of Anesthesiology, Perioperative and Pain Medicine, Department of Critical Care Medicine, Division of Palliative Medicine, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Michael Hartwick
- Division of Critical Care, Division of Palliative Medicine, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Agarwal A, Basmaji J, Muttalib F, Granton D, Chaudhuri D, Chetan D, Hu M, Fernando SM, Honarmand K, Bakaa L, Brar S, Rochwerg B, Adhikari NK, Lamontagne F, Murthy S, Hui DSC, Gomersall C, Mubareka S, Diaz JV, Burns KEA, Couban R, Ibrahim Q, Guyatt GH, Vandvik PO. High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission. Can J Anaesth 2020; 67:1217-1248. [PMID: 32542464 PMCID: PMC7294988 DOI: 10.1007/s12630-020-01740-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 01/03/2023] Open
Abstract
PURPOSE We conducted two World Health Organization-commissioned reviews to inform use of high-flow nasal cannula (HFNC) in patients with coronavirus disease (COVID-19). We synthesized the evidence regarding efficacy and safety (review 1), as well as risks of droplet dispersion, aerosol generation, and associated transmission (review 2) of viral products. SOURCE Literature searches were performed in Ovid MEDLINE, Embase, Web of Science, Chinese databases, and medRxiv. Review 1: we synthesized results from randomized-controlled trials (RCTs) comparing HFNC to conventional oxygen therapy (COT) in critically ill patients with acute hypoxemic respiratory failure. Review 2: we narratively summarized findings from studies evaluating droplet dispersion, aerosol generation, or infection transmission associated with HFNC. For both reviews, paired reviewers independently conducted screening, data extraction, and risk of bias assessment. We evaluated certainty of evidence using GRADE methodology. PRINCIPAL FINDINGS No eligible studies included COVID-19 patients. Review 1: 12 RCTs (n = 1,989 patients) provided low-certainty evidence that HFNC may reduce invasive ventilation (relative risk [RR], 0.85; 95% confidence interval [CI], 0.74 to 0.99) and escalation of oxygen therapy (RR, 0.71; 95% CI, 0.51 to 0.98) in patients with respiratory failure. Results provided no support for differences in mortality (moderate certainty), or in-hospital or intensive care length of stay (moderate and low certainty, respectively). Review 2: four studies evaluating droplet dispersion and three evaluating aerosol generation and dispersion provided very low certainty evidence. Two simulation studies and a crossover study showed mixed findings regarding the effect of HFNC on droplet dispersion. Although two simulation studies reported no associated increase in aerosol dispersion, one reported that higher flow rates were associated with increased regions of aerosol density. CONCLUSIONS High-flow nasal cannula may reduce the need for invasive ventilation and escalation of therapy compared with COT in COVID-19 patients with acute hypoxemic respiratory failure. This benefit must be balanced against the unknown risk of airborne transmission.
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Affiliation(s)
- Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Basmaji
- Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Fiona Muttalib
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - David Granton
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Devin Chetan
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Malini Hu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kimia Honarmand
- Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Department of Medicine, Western University, London, ON, Canada
| | - Layla Bakaa
- Honours Life Sciences Program, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Sonia Brar
- School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
| | - Bram Rochwerg
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Neill K Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Francois Lamontagne
- Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada
| | - Srinivas Murthy
- BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - David S C Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
- Stanley Ho, Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Charles Gomersall
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Samira Mubareka
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Janet V Diaz
- Pacific Medical Center, San Francisco, CA, USA
- World Health Organization, Geneva, Switzerland
| | - Karen E A Burns
- Unity Health Toronto - St. Michael's Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Rachel Couban
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Quazi Ibrahim
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Goldhaber-Fiebert SN, Greene JA, Garibaldi BT. Low-flow nasal cannula oxygen and potential nosocomial spread of COVID-19. Br J Anaesth 2020; 125:e309-e310. [PMID: 32425208 PMCID: PMC7231724 DOI: 10.1016/j.bja.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022] Open
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Xin H, Jiang F, Xue A, Liang J, Zhang J, Yang F, Han Y. Risk factors associated with occurrence of COVID-19 among household persons exposed to patients with confirmed COVID-19 in Qingdao Municipal, China. Transbound Emerg Dis 2020; 68:782-788. [PMID: 32688447 PMCID: PMC7404761 DOI: 10.1111/tbed.13743] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023]
Abstract
Tracing and isolation of close contacts is used to control outbreaks of coronavirus disease 2019 (COVID-19) in China. However, risk factors associated with the occurrence of COVID-19 among close contacts have not been well described. A total of 106 household contacts were included in this study, of whom 19 developed into COVID-19 cases, and the secondary attack rate was 17.9%. Multivariable analysis showed that increasing risk of occurrence of COVID-19 among household contacts was associated with female index patients (adjusted hazard ratio [aHR] = 3.84, 95% CI = 1.07-13.78), critical disease index patients (aHR = 7.58, 95% CI = 1.66-34.66), effective contact duration with index patients > 2 days (aHR = 4.21, 95% CI = 1.29-13.73), and effective contact duration > 11 days (aHR = 17.88, 95% CI = 3.26-98.01). The sex and disease severity of index patients with COVID-19 and longer effective contact duration with patients with confirmed COVID-19 could help epidemiologists to identify potential COVID-19 cases among household contacts at an early stage.
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Affiliation(s)
- Hualei Xin
- Qingdao Municipal Centre for Disease Control and Prevention, Qingdao City, China.,Qingdao Institute of Prevention Medicine, Qingdao City, China
| | - Fachun Jiang
- Qingdao Municipal Centre for Disease Control and Prevention, Qingdao City, China.,Qingdao Institute of Prevention Medicine, Qingdao City, China
| | - Aili Xue
- Qingdao Women and Children's Hospital, Qingdao City, China
| | - Jiwei Liang
- Qingdao Municipal Centre for Disease Control and Prevention, Qingdao City, China.,Qingdao Institute of Prevention Medicine, Qingdao City, China
| | - Jingfei Zhang
- Qingdao Municipal Centre for Disease Control and Prevention, Qingdao City, China.,Qingdao Institute of Prevention Medicine, Qingdao City, China
| | - Feng Yang
- Qingdao Municipal Centre for Disease Control and Prevention, Qingdao City, China.,Qingdao Institute of Prevention Medicine, Qingdao City, China
| | - Yalin Han
- Qingdao Municipal Centre for Disease Control and Prevention, Qingdao City, China.,Qingdao Institute of Prevention Medicine, Qingdao City, China
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Kim SW, Jo SJ, Lee H, Oh JH, Lim J, Lee SH, Choi JH, Lee J. Containment of a healthcare-associated COVID-19 outbreak in a university hospital in Seoul, Korea: A single-center experience. PLoS One 2020; 15:e0237692. [PMID: 32797094 PMCID: PMC7428087 DOI: 10.1371/journal.pone.0237692] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/31/2020] [Indexed: 01/08/2023] Open
Abstract
Background Our hospital experienced the first healthcare-associated COVID-19 outbreak in Seoul at the time the first COVID-19 cases were confirmed in Korea. The first confirmed COVID-19 patient was a hospital personnel who was in charge of transferring patients inside our hospital. To contain the virus spread, we shutdown our hospital, and tested all inpatients, medical staff members, and employees. Methods We retrospectively analyzed the results of SARS-CoV-2 RT-PCR testing according to the contact history, occupation, and presence of respiratory symptoms. Closed-circuit television (CCTV) was reviewed in the presence of an epidemiologist to identify individuals who came into contact with confirmed COVID-19 patients. Results A total of 3,091 respiratory samples from 2,924 individuals were obtained. Among 2,924 individuals, two inpatients, and one caregiver tested positive (positivity rate, 0.1%). Although all confirmed cases were linked to a general ward designated for pulmonology patients, no medical staff members, medical support personnel, or employees working at the same ward were infected. Contact with confirmed COVID-19 cases was frequent among inpatients and medical support personnel. The most common contact area was the general ward for pulmonology patients and medical support areas, including clinical and imaging examination rooms. Finally, the total number of hospital-associated infections was 14, consisting of four diagnosed at our hospital and ten diagnosed outside the hospital. Conclusions The robust control of the COVID-19 outbreak further minimized the transmission of SARS-CoV-2 in the hospital and local communities. However, there was also a debate over the appropriate period of hospital shutdown and testing of all hospital staff and patients. Future studies are required to refine and establish the in-hospital quarantine and de-isolation guidelines based on the epidemiological and clinical settings.
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Affiliation(s)
- Sei Won Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Jin Jo
- Department of Laboratory Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Heayon Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Hwan Oh
- Division of Gastroenterology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jihyang Lim
- Department of Laboratory Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jehoon Lee
- Department of Laboratory Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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Luo WY, Sun JW, Zhang WL, Li Q, Ni P, Zhao LB, Tian JH, Zhang YQ, Lu H. Management in the paediatric wards facing novel coronavirus infection: a rapid review of guidelines and consensuses. BMJ Open 2020; 10:e039897. [PMID: 32788192 PMCID: PMC7422658 DOI: 10.1136/bmjopen-2020-039897] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Relevant guidelines and consensuses for COVID-19 contain recommendations aimed at optimising the management in paediatric wards. The goal of this study was to determine the quality of those recommendations and provide suggestions to hospital managers for the adjustment of existing hospital prevention and control strategies, and also to offer recommendations for further research. DESIGN A rapid review of the guidelines and consensuses for the management in paediatric wards facing COVID-19. METHODS PubMed, EMBASE, the Cochrane Library, UpToDate, China National Knowledge Infrastructure, the Wanfang database and relevant websites such as medlive.cn, dxy.cn, the National Health and Health Commission and the China Center for Disease Control and Prevention were systematically searched through late May 2020. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool was then used to assess the quality of the selected articles and summarise the relevant evidence concerning management in paediatric wards. RESULTS A total of 35 articles were included, composed of 3 consensus guidelines, 25 expert consensuses and 7 expert opinions. Of the 35 papers, 24 were from China, 2 from the USA, 1 from Spain, 1 from Brazil, 1 from Saudi Arabia and 6 from multinational cooperative studies. Scores for the six domains of the AGREE II tool (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability and editorial independence) were 98.57%, 53.57%, 17.92%, 69.62%, 26.96% and 50.35%, respectively. Recommendations for nosocomial infection and control, human resource management as well as management of paediatric patients and their families were summarised. CONCLUSIONS Due to the outbreak of COVID-19, the quality of rapid guidelines and consensuses for the management in paediatric wards affected by COVID-19 is unsatisfactory. In the future, it will be necessary to develop more high-quality guidelines or consensuses for the management in paediatric wards to deal with nosocomial outbreaks in order to fully prepare for emergency medical and health problems.
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Affiliation(s)
- Wen-Yi Luo
- Department of Nursing, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ji-Wen Sun
- Department of Nursing, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Lan Zhang
- Pediatric Intensive Care Unit, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Li
- Department of General Surgical, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Ni
- Department of Nursing, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lie-Bin Zhao
- Dean's Office, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin-Hui Tian
- Evidence-Based Medicine Center, Lanzhou University School of Basic Medical Sciences, Lanzhou, Gansu, China
| | - Ya-Qing Zhang
- Editorial Department of Journal of Shanghai Jiao Tong University (Medical Science), Shanghai Jiao Tong University, Shanghai, China
| | - Hong Lu
- Department of Nursing, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Cournoyer A, Grand'Maison S, Lonergan AM, Lessard J, Chauny JM, Castonguay V, Marquis M, Frégeau A, Huard V, Garceau-Tremblay Z, Turcotte AS, Piette É, Paquet J, Cossette S, Féral-Pierssens AL, Leblanc RX, Martel V, Daoust R. Oxygen Therapy and Risk of Infection for Health Care Workers Caring for Patients With Viral Severe Acute Respiratory Infection: A Systematic Review and Meta-analysis. Ann Emerg Med 2020; 77:19-31. [PMID: 32788066 PMCID: PMC7415416 DOI: 10.1016/j.annemergmed.2020.06.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023]
Abstract
Study objective To synthesize the evidence regarding the infection risk associated with different modalities of oxygen therapy used in treating patients with severe acute respiratory infection. Health care workers face significant risk of infection when treating patients with a viral severe acute respiratory infection. To ensure health care worker safety and limit nosocomial transmission of such infection, it is crucial to synthesize the evidence regarding the infection risk associated with different modalities of oxygen therapy used in treating patients with severe acute respiratory infection. Methods MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to April 1, 2020, for studies describing the risk of infection associated with the modalities of oxygen therapy used for patients with severe acute respiratory infection. The study selection, data extraction, and quality assessment were performed by independent reviewers. The primary outcome measure was the infection of health care workers with a severe acute respiratory infection. Random-effect models were used to synthesize the extracted data. Results Of 22,123 citations, 50 studies were eligible for qualitative synthesis and 16 for meta-analysis. Globally, the quality of the included studies provided a very low certainty of evidence. Being exposed or performing an intubation (odds ratio 6.48; 95% confidence interval 2.90 to 14.44), bag-valve-mask ventilation (odds ratio 2.70; 95% confidence interval 1.31 to 5.36), and noninvasive ventilation (odds ratio 3.96; 95% confidence interval 2.12 to 7.40) were associated with an increased risk of infection. All modalities of oxygen therapy generate air dispersion. Conclusion Most modalities of oxygen therapy are associated with an increased risk of infection and none have been demonstrated as safe. The lowest flow of oxygen should be used to maintain an adequate oxygen saturation for patients with severe acute respiratory infection, and manipulation of oxygen delivery equipment should be minimized.
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Affiliation(s)
- Alexis Cournoyer
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Corporation d'Urgences-santé, Montreal, Quebec, Canada.
| | - Sophie Grand'Maison
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Ann-Marie Lonergan
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Justine Lessard
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Jean-Marc Chauny
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Véronique Castonguay
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Martin Marquis
- Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Amélie Frégeau
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Vérilibe Huard
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Zoé Garceau-Tremblay
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Ann-Sophie Turcotte
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Éric Piette
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Jean Paquet
- Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Sylvie Cossette
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada; Research Center, Institut de Cardiologie de Montréal, Montreal, Quebec, Canada
| | - Anne-Laure Féral-Pierssens
- Charles Lemoyne-Saguenay-Lac-Saint-Jean Research Center on Health Innovations, Université de Sherbrooke, Longueuil, Quebec, Canada; Department of Emergency Medicine, Hôpital Européen Georges Pompidou, Paris, France
| | - Renaud-Xavier Leblanc
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré de santé et de services sociaux de Laval, Hôpital Cité de la Santé, Laval, Quebec, Canada
| | - Valéry Martel
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Raoul Daoust
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Emergency Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
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Acute Care Surgeons' Response to the COVID-19 Pandemic: Observations and Strategies From the Epicenter of the American Crisis. Ann Surg 2020; 272:e66-e71. [PMID: 32675500 PMCID: PMC7268825 DOI: 10.1097/sla.0000000000004028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Rubulotta F, Soliman-Aboumarie H, Filbey K, Geldner G, Kuck K, Ganau M, Hemmerling TM. Technologies to Optimize the Care of Severe COVID-19 Patients for Health Care Providers Challenged by Limited Resources. Anesth Analg 2020. [PMID: 32433248 DOI: 10.1213/ane.0000000000004985.pmid:32433248;pmcid:pmc7258840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.
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Affiliation(s)
- Francesca Rubulotta
- From the Department of Anaesthesia and Intensive Care Medicine, Imperial College London, London, United Kingdom
| | - Hatem Soliman-Aboumarie
- Department of Anaesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Kevin Filbey
- Department of Anesthesia, Intensive Care Medicine, Chronic Pain and Emergency Medicine, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Goetz Geldner
- Department of Anesthesia, Intensive Care Medicine, Chronic Pain and Emergency Medicine, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Kai Kuck
- Department of Anesthesiology and Bioengineering, University of Utah, Salt Lake City, Utah
| | - Mario Ganau
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Vanni G, Pellicciaro M, Materazzo M, Dauri M, D'angelillo RM, Buonomo C, De Majo A, Pistolese C, Portarena I, Mauriello A, Servadei F, Giacobbi E, Chiaravalloti A, Buonomo OC. Awake breast cancer surgery: strategy in the beginning of COVID-19 emergency. Breast Cancer 2020; 28:137-144. [PMID: 32734327 PMCID: PMC7391474 DOI: 10.1007/s12282-020-01137-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/16/2020] [Indexed: 01/09/2023]
Abstract
Introduction COVID-19 is a declared worldwide pandemic. In our country, due to shortage of hospitals and beds in intensive care unit, oncological and breast cancer (BC) resources are temporarily shifted to COVID-19 patients. In addition, risk of cross-infections should be considered in these frail patients. To accomplish more surgical procedures and to reduce the length of hospital stay (LOS), fast track awake BC surgery should be implemented. The aim of the study is to estimate the effects of surgical shift in our facility during the early COVID-19 outbreak. Materials and methods From 30th January 2020 to 30th of March 2020, 86 consecutive patients were retrospectively enrolled and divided into pre-COVID-19-BC and COVID-19-BC. Clinical parameters and anamnestic data were collected and analyzed. Surgical procedures, relative complications and type of anaesthesia were reported. The effect on surgical time (ST), operative room time (ORT) and length of stay (LOS) were described and examined. Results No statistical difference was found in complications rate, clinical data and surgical procedures (p > 0.05). Awake breast conservative surgery (BCS) was the most frequent procedure in COVID-19-BC (p = 0.006). A statistically significant decrease in ORT and LOS was reported in COVID-19-BC (p = 0.040 and p = 0.0015 respectively), while comparable time resulted for ST (p = 0.976). Mean ORT and LOS reduction were 20.79 min and 0.57 hospital bed days. Conclusion In the “COVID-19 era”, fast track awake breast surgery provides a reduction of ORT, LOS and potentially surgical treatment for a wider number of oncological patients.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy.
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Mario Dauri
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy
| | - Rolando Maria D'angelillo
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Chiara Buonomo
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy
| | - Adriano De Majo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Chiara Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Alessandro Mauriello
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Erica Giacobbi
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Via Atinense 18, 86077, Pozzilli, IS, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
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Regional anesthesia in the time of COVID-19: a minireview. J Anesth 2020; 35:341-344. [PMID: 32712704 PMCID: PMC7382562 DOI: 10.1007/s00540-020-02834-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/18/2020] [Indexed: 01/08/2023]
Abstract
The treatment of surgical patients who are confirmed or suspected of coronavirus disease 2019 (COVID-19) is a challenge for all anesthesiologists. The safety of both patients and healthcare workers should be taken into consideration when performing anesthesia management for patients with COVID-19. General anesthesia requiring airway intervention may exacerbate COVID-19 pneumonia, and aerosol generation during airway intervention risks COVID-19 transmission to medical staff. However, regional anesthesia is not an aerosol-generating procedure. The neuraxial anesthesia may have little adverse influence on clinical outcomes in patients with COVID-19 after reviewing previous case reports. Regional anesthesia may have some advantages over general anesthesia for this group of patients, but unplanned conversion to general anesthesia during surgery is not preferred. Thus, careful consideration should be given to ensure that the surgery is performed entirely under regional anesthesia. The use of ultrasound guidance and the performance by an experienced physician may reduce the incidence of failed block and complications. The use of long-acting local anesthetic prolongs the anesthetic effect of regional anesthesia. Besides, a safe and sufficient dose of local anesthetic should be used.
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Technologies to Optimize the Care of Severe COVID-19 Patients for Health Care Providers Challenged by Limited Resources. Anesth Analg 2020; 131:351-364. [PMID: 32433248 PMCID: PMC7258840 DOI: 10.1213/ane.0000000000004985] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Supplemental Digital Content is available in the text. Health care systems are belligerently responding to the new Coronavirus Disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance.1 When a patient requires intubation and invasive ventilation, the outcome is poor,2–4 and the length of stay in the intensive care unit (ICU) is usually 2or 3 weeks.2 In this article, theauthors review several technological devices, which could support health care providers at the bedside to optimizethe care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilizedto better titrate neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography(TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.
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Duke T, English M, Carai S, Qazi S. Paediatric care in the time of COVID-19 in countries with under-resourced healthcare systems. Arch Dis Child 2020; 105:616-617. [PMID: 32424004 PMCID: PMC7613554 DOI: 10.1136/archdischild-2020-319333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Trevor Duke
- Intensive Care Unit and University of Melbourne Department of Paediatrics, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia .,Child Health Discipline, University of Papua New Guinea School of Medicine and Health Sciences, Port Moresby, Papua New Guinea
| | - Mike English
- Wellcome Trust Research Programme, KEMRI, Nairobi, Kenya,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Susanne Carai
- Paediatrics, University Witten Herdecke Faculty of Medicine, Witten, Nordrhein-Westfalen, Germany
| | - Shamim Qazi
- Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneve, Switzerland
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Hendin A, La Rivière CG, Williscroft DM, O'Connor E, Hughes J, Fischer LM. End-of-life care in the emergency department for the patient imminently dying of a highly transmissible acute respiratory infection (such as COVID-19). CAN J EMERG MED 2020; 22:414-417. [PMID: 32213224 PMCID: PMC7138612 DOI: 10.1017/cem.2020.352] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ariel Hendin
- University of Ottawa Department of Emergency Medicine, Ottawa, ON
- University of Manitoba Department of Emergency Medicine and Department of Family Medicine, Section of Palliative Care, Winnipeg, MB
| | | | - David M Williscroft
- University of British Columbia Department of Emergency Medicine and Division of Palliative Care, Vancouver, BC
| | - Erin O'Connor
- University of Toronto Department of Medicine, Divisions of Emergency Medicine and Palliative Medicine, Toronto, ON
| | - Jennifer Hughes
- University of Calgary Department of Emergency Medicine and Division of Palliative Medicine, Calgary, AB
| | - Lisa M Fischer
- University of Ottawa Department of Emergency Medicine, Ottawa, ON
- University of Ottawa Department of Medicine, Division of Palliative Care, Ottawa, ON
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Sharma D, Rasmussen M, Han R, Whalin MK, Davis M, Kofke WA, Venkatraghvan L, Raychev R, Fraser JF. Anesthetic Management of Endovascular Treatment of Acute Ischemic Stroke During COVID-19 Pandemic: Consensus Statement From Society for Neuroscience in Anesthesiology & Critical Care (SNACC): Endorsed by Society of Vascular & Interventional Neurology (SVIN), Society of NeuroInterventional Surgery (SNIS), Neurocritical Care Society (NCS), European Society of Minimally Invasive Neurological Therapy (ESMINT) and American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) Cerebrovascular Section. J Neurosurg Anesthesiol 2020; 32:193-201. [PMID: 32282614 PMCID: PMC7236841 DOI: 10.1097/ana.0000000000000688] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) has unique implications for the anesthetic management of endovascular therapy for acute ischemic stroke. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert recommendations using available evidence for the safe and effective anesthetic management of endovascular therapy for acute ischemic stroke during the COVID-19 pandemic. The goal of this consensus statement is to provide recommendations for anesthetic management considering the following (and they are): (1) optimal neurological outcomes for patients; (2) minimizing the risk for health care professionals, and (3) facilitating judicious use of resources while accounting for existing variability in care. It provides a framework for selecting the optimal anesthetic technique (general anesthesia or monitored anesthesia care) for a given patient and offers suggestions for best practices for anesthesia care during the pandemic. Institutions and health care providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.
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Affiliation(s)
- Deepak Sharma
- Departments of Anesthesiology & Pain Medicine
- Neurological Surgery, University of Washington, Seattle, WA
| | - Mads Rasmussen
- Department of Anesthesia, Aarhus University Hospital, Aarhus, Denmark
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Matthew K. Whalin
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - Melinda Davis
- Department of Anesthesiology, Pain and Perioperative Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - W. Andrew Kofke
- Departments of Anesthesiology and Critical Care
- Neurosurgery, University of Pennsylvania, Philadelphia, PA
| | | | - Radoslav Raychev
- Department of Neurology, University of California Los Angeles, Los Angeles, CA
| | - Justin F. Fraser
- Departments of Neurological Surgery
- Neurology
- Radiology
- Anatomy & Neurobiology, University of Kentucky, Lexington, KY
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Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; 395:1973-1987. [PMID: 32497510 PMCID: PMC7263814 DOI: 10.1016/s0140-6736(20)31142-9] [Citation(s) in RCA: 2252] [Impact Index Per Article: 563.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. METHODS We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. FINDINGS Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] -10·2%, 95% CI -11·5 to -7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD -14·3%, -15·9 to -10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12-16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD -10·6%, 95% CI -12·5 to -7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. INTERPRETATION The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. FUNDING World Health Organization.
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Affiliation(s)
- Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Stephanie Duda
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Karla Solo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sally Yaacoub
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Michael G DeGroote Cochrane Canada and GRADE Centres, Hamilton, ON, Canada.
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Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020. [PMID: 32497510 DOI: 10.1016/s0140-6736(20)31142-31149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. METHODS We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. FINDINGS Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] -10·2%, 95% CI -11·5 to -7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD -14·3%, -15·9 to -10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12-16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD -10·6%, 95% CI -12·5 to -7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. INTERPRETATION The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. FUNDING World Health Organization.
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Affiliation(s)
- Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Stephanie Duda
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Karla Solo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sally Yaacoub
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Michael G DeGroote Cochrane Canada and GRADE Centres, Hamilton, ON, Canada.
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Frieden TR, Lee CT. Identifying and Interrupting Superspreading Events-Implications for Control of Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis 2020; 26:1059-1066. [PMID: 32187007 PMCID: PMC7258476 DOI: 10.3201/eid2606.200495] [Citation(s) in RCA: 196] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
It appears inevitable that severe acute respiratory syndrome coronavirus 2 will continue to spread. Although we still have limited information on the epidemiology of this virus, there have been multiple reports of superspreading events (SSEs), which are associated with both explosive growth early in an outbreak and sustained transmission in later stages. Although SSEs appear to be difficult to predict and therefore difficult to prevent, core public health actions can prevent and reduce the number and impact of SSEs. To prevent and control of SSEs, speed is essential. Prevention and mitigation of SSEs depends, first and foremost, on quickly recognizing and understanding these events, particularly within healthcare settings. Better understanding transmission dynamics associated with SSEs, identifying and mitigating high-risk settings, strict adherence to healthcare infection prevention and control measures, and timely implementation of nonpharmaceutical interventions can help prevent and control severe acute respiratory syndrome coronavirus 2, as well as future infectious disease outbreaks.
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Harding H, Broom A, Broom J. Aerosol-generating procedures and infective risk to healthcare workers from SARS-CoV-2: the limits of the evidence. J Hosp Infect 2020; 105:717-725. [PMID: 32497651 PMCID: PMC7263217 DOI: 10.1016/j.jhin.2020.05.037] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/26/2020] [Indexed: 01/12/2023]
Abstract
The transmission behaviour of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is still being defined. It is likely that it is transmitted predominantly by droplets and direct contact and it is possible that there is at least opportunistic airborne transmission. In order to protect healthcare staff adequately it is necessary that we establish whether aerosol-generating procedures (AGPs) increase the risk of transmission of SARS-CoV-2. Where we do not have evidence relating to SARS-CoV-2, guidelines for safely conducting these procedures should consider the risk of transmitting related pathogens. Currently there is very little evidence detailing the transmission of SARS-CoV-2 associated with any specific procedures. Regarding AGPs and respiratory pathogens in general, there is still a large knowledge gap that will leave clinicians unsure of the risk to themselves when offering these procedures. This review aimed to summarize the evidence (and gaps in evidence) around AGPs and SARS-CoV-2.
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Affiliation(s)
- H Harding
- Sunshine Coast Hospital and Health Service, Queensland, Australia.
| | - A Broom
- School of Social and Political Sciences, The University of Sydney, New South Wales, Australia
| | - J Broom
- Sunshine Coast Health Institute, Queensland, Australia; University of Queensland, Brisbane, Australia
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Jing JLJ, Pei Yi T, Bose RJC, McCarthy JR, Tharmalingam N, Madheswaran T. Hand Sanitizers: A Review on Formulation Aspects, Adverse Effects, and Regulations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3326. [PMID: 32403261 PMCID: PMC7246736 DOI: 10.3390/ijerph17093326] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 12/14/2022]
Abstract
Hand hygiene is of utmost importance as it may be contaminated easily from direct contact with airborne microorganism droplets from coughs and sneezes. Particularly in situations like pandemic outbreak, it is crucial to interrupt the transmission chain of the virus by the practice of proper hand sanitization. It can be achieved with contact isolation and strict infection control tool like maintaining good hand hygiene in hospital settings and in public. The success of the hand sanitization solely depends on the use of effective hand disinfecting agents formulated in various types and forms such as antimicrobial soaps, water-based or alcohol-based hand sanitizer, with the latter being widely used in hospital settings. To date, most of the effective hand sanitizer products are alcohol-based formulations containing 62%-95% of alcohol as it can denature the proteins of microbes and the ability to inactivate viruses. This systematic review correlated with the data available in Pubmed, and it will investigate the range of available hand sanitizers and their effectiveness as well as the formulation aspects, adverse effects, and recommendations to enhance the formulation efficiency and safety. Further, this article highlights the efficacy of alcohol-based hand sanitizer against the coronavirus.
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Affiliation(s)
- Jane Lee Jia Jing
- School of Pharmacy, International Medical University, No. 126 Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (J.L.J.J.); (T.P.Y.)
| | - Thong Pei Yi
- School of Pharmacy, International Medical University, No. 126 Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (J.L.J.J.); (T.P.Y.)
| | - Rajendran J. C. Bose
- Masonic Medical Research Institute, 2150 Bleecker St, Utica, NY 13501, USA; (R.J.C.B.); (J.R.M.)
| | - Jason R. McCarthy
- Masonic Medical Research Institute, 2150 Bleecker St, Utica, NY 13501, USA; (R.J.C.B.); (J.R.M.)
| | - Nagendran Tharmalingam
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA;
| | - Thiagarajan Madheswaran
- Department of Pharmaceutical Technology, International Medical University, No. 126 Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia
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