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Morata L, Vollman K, Rechter J, Cox J. Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices. Crit Care Nurse 2024; 44:e1-e9. [PMID: 38295861 DOI: 10.4037/ccn2023201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
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Guillen-Grima F, Guillen-Aguinaga S, Guillen-Aguinaga L, Alas-Brun R, Onambele L, Ortega W, Montejo R, Aguinaga-Ontoso E, Barach P, Aguinaga-Ontoso I. Evaluating the Efficacy of ChatGPT in Navigating the Spanish Medical Residency Entrance Examination (MIR): Promising Horizons for AI in Clinical Medicine. Clin Pract 2023; 13:1460-1487. [PMID: 37987431 PMCID: PMC10660543 DOI: 10.3390/clinpract13060130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023] Open
Abstract
The rapid progress in artificial intelligence, machine learning, and natural language processing has led to increasingly sophisticated large language models (LLMs) for use in healthcare. This study assesses the performance of two LLMs, the GPT-3.5 and GPT-4 models, in passing the MIR medical examination for access to medical specialist training in Spain. Our objectives included gauging the model's overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. MATERIAL AND METHODS We studied the 2022 Spanish MIR examination results after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM GPT-4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length, sequence, and performance. We also analyzed the 23 questions with images, using GPT-4's new image analysis capability. RESULTS GPT-4 outperformed GPT-3.5, scoring 86.81% in Spanish (p < 0.001). English translations had a slightly enhanced performance. GPT-4 scored 26.1% of the questions with images in English. The results were worse when the questions were in Spanish, 13.0%, although the differences were not statistically significant (p = 0.250). Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, and the Pharmacology, Critical Care, and Infectious Diseases specialties showed lower performance. The error analysis revealed that while a 13.2% error rate existed, the gravest categories, such as "error requiring intervention to sustain life" and "error resulting in death", had a 0% rate. CONCLUSIONS GPT-4 performs robustly on the Spanish MIR examination, with varying capabilities to discriminate knowledge across specialties. While the model's high success rate is commendable, understanding the error severity is critical, especially when considering AI's potential role in real-world medical practice and its implications for patient safety.
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Affiliation(s)
- Francisco Guillen-Grima
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Healthcare Research Institute of Navarra (IdiSNA), 31008 Pamplona, Spain
- Department of Preventive Medicine, Clinica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain
| | - Sara Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | - Laura Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Department of Nursing, Kystad Helse-og Velferdssenter, 7026 Trondheim, Norway
| | - Rosa Alas-Brun
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | - Luc Onambele
- School of Health Sciences, Catholic University of Central Africa, Yaoundé 1100, Cameroon;
| | - Wilfrido Ortega
- Department of Surgery, Medical and Social Sciences, University of Alcala de Henares, 28871 Alcalá de Henares, Spain;
| | - Rocio Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 413 46 Gothenburg, Sweden;
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden
| | | | - Paul Barach
- Jefferson College of Population Health, Philadelphia, PA 19107, USA;
- School of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, 1020 Vienna, Austria
- Department of Surgery, Imperial College, London SW7 2AZ, UK
| | - Ines Aguinaga-Ontoso
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Healthcare Research Institute of Navarra (IdiSNA), 31008 Pamplona, Spain
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Morata L, Vollman K, Rechter J, Cox J. Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices. Crit Care Nurse 2023; 43:59-66. [PMID: 36720277 DOI: 10.4037/ccn2023174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Chilkoti GT, Mohta M, Ahmad Z, Saxena AK. Awake Prone-Positioning in Patients on Non-Invasive Ventilation for Management of SARS-CoV-2 Pneumonia: A Systematic Review. Adv Respir Med 2022; 90:362-375. [PMID: 36004966 PMCID: PMC9717405 DOI: 10.3390/arm90040046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/07/2022] [Accepted: 07/29/2022] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Patients with corona virus disease-19 (COVID-19)-induced acute hypoxemic respiratory failure (AHRF) are often on non-invasive ventilation (NIV) and use of awake prone positioning (PP) may pose concern in terms of feasibility, efficacy and side effects. This systematic review was undertaken to evaluate the feasibility and efficacy of awake PP along with NIV in them. MATERIALS AND METHODS A systematic literature search was conducted from the inception of COVID-19 until 15 August 2021. Various factors including feasibility, interface used, outcome, efficacy, side effects and limitations in both intensive care unit (ICU) and Non-ICU setups were noted. RESULTS A total of 12 original articles and six case series including 359 patients were involved. Out of it, 40% (n = 122) of patients were in ICU and 60% (n = 237) in Non-ICU areas. Four clinical studies and four case series including 114 patients had evaluated PP along with helmet continuous positive airway pressure (CPAP). All had found PP with helmet CPAP to be feasible and efficacious; however, only one study documented the sustained improvement in oxygenation i.e., 12 h after PP. CONCLUSIONS The present systematic review observed moderate to serious risk of bias amongst the included studies along with heterogeneity in terms of varied respiratory support amongst patients. However, the use of awake PP in patients on NIV has been found to be feasible and efficacious with no adverse events.
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Affiliation(s)
- Geetanjali Tolia Chilkoti
- Department of Anesthesiology and Critical Care, Guru Teg Bahadur Hospital, University College of Medical Sciences, Shahdara, Delhi 110095, India
| | - Medha Mohta
- Department of Anesthesiology and Critical Care, Guru Teg Bahadur Hospital, University College of Medical Sciences, Shahdara, Delhi 110095, India
| | - Zainab Ahmad
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences Bhopal, Saket Nagar, Bhopal 462020, India
| | - Ashok Kumar Saxena
- Department of Anesthesiology and Critical Care, Guru Teg Bahadur Hospital, University College of Medical Sciences, Shahdara, Delhi 110095, India
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Montgomery AP, Patrician PA, Hall A, Miltner RS, Enogela EM, Polancich S. Modeling Patient Risk for Hospital-Acquired Pressure Injuries During COVID-19: A Retrospective Study. J Nurs Care Qual 2022; 37:162-167. [PMID: 34611108 PMCID: PMC8860131 DOI: 10.1097/ncq.0000000000000602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND COVID-19 negatively impacts many organ systems including the skin. One of the most significant skin-associated adverse events related to hospitalization are pressure injuries. PURPOSE The aim of this study was to determine 8 risk factors that would place hospitalized patients at a higher risk for hospital-acquired pressure injuries (HAPIs) during the COVID-19 pandemic. METHODS A retrospective, descriptive analysis was conducted in an urban academic health science center located in the southeastern United States. RESULTS There were 247 of 23 093 patients who had pressure injuries and 1053 patients who had a positive COVID-19 diagnosis. Based on the generalized estimating equation model, diagnosis of COVID-19, age, male gender, risk of mortality, severity of illness, and length of stay are statistically significant factors associated with the development of HAPIs. CONCLUSIONS Further study should explore pathology of COVID-19 skin changes and what interventions are effective against HAPIs in the COVID-19 population taking into consideration current treatments.
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Affiliation(s)
- Aoyjai P. Montgomery
- School of Nursing (Drs Montgomery, Patrician, Miltner, and Polancich), Department of Health Services Administration (Dr Hall), and School of Public Health (Ms Enogela), University of Alabama at Birmingham; and University of Alabama at Birmingham Hospital (Dr Polancich)
| | - Patricia A. Patrician
- School of Nursing (Drs Montgomery, Patrician, Miltner, and Polancich), Department of Health Services Administration (Dr Hall), and School of Public Health (Ms Enogela), University of Alabama at Birmingham; and University of Alabama at Birmingham Hospital (Dr Polancich)
| | - Allyson Hall
- School of Nursing (Drs Montgomery, Patrician, Miltner, and Polancich), Department of Health Services Administration (Dr Hall), and School of Public Health (Ms Enogela), University of Alabama at Birmingham; and University of Alabama at Birmingham Hospital (Dr Polancich)
| | - Rebecca S. Miltner
- School of Nursing (Drs Montgomery, Patrician, Miltner, and Polancich), Department of Health Services Administration (Dr Hall), and School of Public Health (Ms Enogela), University of Alabama at Birmingham; and University of Alabama at Birmingham Hospital (Dr Polancich)
| | - Ene M. Enogela
- School of Nursing (Drs Montgomery, Patrician, Miltner, and Polancich), Department of Health Services Administration (Dr Hall), and School of Public Health (Ms Enogela), University of Alabama at Birmingham; and University of Alabama at Birmingham Hospital (Dr Polancich)
| | - Shea Polancich
- School of Nursing (Drs Montgomery, Patrician, Miltner, and Polancich), Department of Health Services Administration (Dr Hall), and School of Public Health (Ms Enogela), University of Alabama at Birmingham; and University of Alabama at Birmingham Hospital (Dr Polancich)
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Díaz-Bohada L, Segura-Salguero JC, Garzón-Beltrán NF, Salazar-Balcázar D, Otálora-Estéban M. Considerations of invasive mechanical ventilation in prone position. A narrative review. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The evidence regarding logistic considerations and safety events associated with prone position ventilation (PPV) is summarized and a flow diagrama for safe provision of mechanical ventilation in the setting of the COVID-19 pandemic is proposed. A review of the literature was conducted in the Medline via Pubmed, Embase, and Lilacs databases, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Randomized Controlled Trials, Cochrane Database of Abstracts of Reviews of Effects, ProQuest Nursing and Allied Health Database, and Google scholar. Overall, 31 articles were selected for the analysis. The incidence of PPV-related safety events varies between 1% and 11.9% and the most frequent complications are pressure ulcers and airway complications. Early initiation of enteral nutrition is recommended, and transfers are possible in patients on PPV. There is controversy regarding contraindications and recommendations for PPV. Recommendations for its safe provision are based on expert opinions and the establishment of protocols for healthcare staff training. Clinical studies are required to determine which are the recommendations that should be considered for safe and reproducible PPV use during this pandemic.
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Joseph B, Mackinson LG, Sokol-Hessner L, Law AC, DeSanto-Madeya S. CE: A Prone Positioning Protocol for Awake, Nonintubated Patients with COVID-19. Am J Nurs 2021; 121:36-44. [PMID: 34510111 PMCID: PMC11044981 DOI: 10.1097/01.naj.0000794108.07908.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT Prone positioning of critically ill patients with acute respiratory distress syndrome is an accepted therapy done to improve oxygenation and promote weaning from mechanical ventilation. But there is limited information regarding its use outside of the ICU. At one Boston hospital, the influx of patients with suspected or confirmed COVID-19 strained its resources, requiring sweeping systems changes and inspiring innovations in clinical care. This article describes how an interdisciplinary team of clinicians developed a prone positioning protocol for use with awake, nonintubated, oxygen-dependent patients with suspected or confirmed COVID-19 on medical-surgical units, with the hope of hastening their recovery and avoiding deterioration and ICU transfer. A protocol implementation plan and staff educational materials were disseminated via the hospital incident command system and supported through daily leadership huddles. Patient eligibility criteria, including indications and contraindications, and a clear nursing procedure for the implementation of prone positioning with a given patient, were key elements. Nurses' feedback of their experiences with the protocol was elicited through an e-mailed survey. Nearly all respondents reported improvements in patients' oxygen saturation levels, while few respondents reported barriers to protocol implementation. The prone positioning protocol was found to be both feasible for and well tolerated by awake, nonintubated patients on medical-surgical units, and can serve as an example for other hospitals during this pandemic.
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Affiliation(s)
- Bridgid Joseph
- Bridgid Joseph is program director of the Emergency Cardiovascular Care Center at Beth Israel Deaconess Medical Center in Boston, where Lynn G. Mackinson is a nurse specialist in the Department of Cardiovascular Medicine, Lauge Sokol-Hessner is an attending physician in the Department of Hospital Medicine and the medical director of patient safety, and Anica C. Law is an attending physician in the Department of Pulmonary, Critical Care, and Sleep Medicine. Susan DeSanto-Madeya is the Miriam Weyker Endowed Chair for Palliative Care and an associate professor at the University of Rhode Island College of Nursing, Providence. Contact author: Bridgid Joseph, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Chilkoti GT, Mohta M, Saxena AK, Ahmad Z, Sharma CS. Awake Prone Positioning in the Management of COVID-19 Pneumonia: A Systematic Review. Indian J Crit Care Med 2021; 25:896-905. [PMID: 34733031 PMCID: PMC8559737 DOI: 10.5005/jp-journals-10071-23932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: The aim was to investigate the efficacy of prone positioning (PP) in the management of coronavirus disease-2019 (COVID-19) pneumonia in various setups, with various modes of oxygen therapy and its optimal duration. Materials and methods: A systematic literature search was conducted from inception until May 15, 2021. Patients with a validated diagnosis of COVID-19 and receiving PP were included. Various factors, including intensive care unit (ICU) or non-ICU setup, mode of oxygen therapy, outcome, duration of proning, and limitations, were noted. Results: We retrieved 36 articles with a total of 1,385 patients for qualitative analysis. Out of 36 articles, there were 17 original articles, 09 case series, and 10 case reports. Out of 1,385 participants, 78.9% (n = 1,093) and 21.0% (n = 292) of patients were managed in ICU and non-ICU setup, respectively. Awake PP with high flow nasal cannula (HFNC) was found to be a promising technique; however, the result was inconclusive with helmet continuous positive airway pressure (CPAP). No study has evaluated the optimal duration of awake PP and the associated long-term outcomes. Conclusion: We encourage the use of early awake self-proning in the management of COVID19 disease. However, the evidence in terms of its use in non-ICU setup, the optimal duration of PP, and various oxygenation devices are insufficient, thereby mandating further well-designed multicentric studies to evaluate its efficacy as an adjunct in the management of COVID-19 pneumonia in context to the aforementioned factor. How to cite this article: Chilkoti GT, Mohta M, Saxena AK, Ahmad Z, Sharma CS. Awake Prone Positioning in the Management of COVID-19 Pneumonia: A Systematic Review. Indian J Crit Care Med 2021;25(8):896-905.
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Affiliation(s)
- Geetanjali T Chilkoti
- Department of Anaesthesiology, University College of Medical Sciences, New Delhi, India
| | - Medha Mohta
- Department of Anaesthesiology, University College of Medical Sciences, New Delhi, India
| | - Ashok K Saxena
- Department of Anaesthesiology, University College of Medical Sciences, New Delhi, India
| | - Zainab Ahmad
- Department of Anaesthesiology, University College of Medical Sciences, New Delhi, India
| | - Chhavi S Sharma
- Department of Anaesthesiology, University College of Medical Sciences, New Delhi, India
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Liu C, Chen Y, Chen Y, Chen B, Xie G, Chen Y. Effects of prone positioning during extracorporeal membrane oxygenation for refractory respiratory failure: a systematic review. ACTA ACUST UNITED AC 2021; 3:2109-2115. [PMID: 34308257 PMCID: PMC8279882 DOI: 10.1007/s42399-021-01008-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 01/19/2023]
Abstract
As more and more studies have shown that venovenous extracorporeal membrane oxygenation (VV-ECMO) improves oxygenation and prognosis of critical patients, VV-ECMO has been frequently used in critical patients for severe acute respiratory distress syndrome (ARDS). Prone positioning (PP) is a postural therapy for ARDS, which permits for better ventilation/perfusion ratio (V/Q) matching, improvement of hypoxemia. Some articles revealed that performing PP during ECMO for refractory respiratory failure is feasible; however, the results obtained were controversial. Therefore, we performed a systematic review to further assess the effects of PP during ECMO for refractory respiratory failure. Six studies with 465 subjects were enrolled. Four articles examined changes of PaO2/FiO2 ratio after PP during VV-ECMO; PaO2/FiO2 ratio improved from 18.5 to 62 mmHg. Our analysis inferred that the PP-ECMO group did not have a significant advantage in survival at discharge (odds risk 1.42, 95% confidence interval 0.92–2.18; p = 0.11) compared with the ECMO group. We found that the PP-ECMO group had a significantly longer duration than the ECMO group (MD 5.37, 95% CI 4.19–6.54, I2 = 67%, P < .00001). ICU length of stay in the PP-ECMO group was significantly longer than the ECMO group (MD 7.29, 95% CI 4.06–10.52, I2 = 64%, P < .00001). No unplanned extubation of ECMO was recorded. In conclusion, our review found that performing PP during ECMO for refractory respiratory failure is safe and PP can improve the PaO2/FiO2 ratio, which is in line with the length of PP performed.
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Affiliation(s)
- Chaofan Liu
- Department of Intensive Care Unit, Binhaiwan Central Hospital of Dongguan, Guangdong Province, Dongguan City, China
| | - Yanzhu Chen
- Department of Intensive Care Unit, Binhaiwan Central Hospital of Dongguan, Guangdong Province, Dongguan City, China
| | - Yulan Chen
- Department of Intensive Care Unit, Binhaiwan Central Hospital of Dongguan, Guangdong Province, Dongguan City, China
| | - Bin Chen
- Department of Intensive Care Unit, Binhaiwan Central Hospital of Dongguan, Guangdong Province, Dongguan City, China
| | - Guojin Xie
- Department of Intensive Care Unit, Binhaiwan Central Hospital of Dongguan, Guangdong Province, Dongguan City, China
| | - Yi Chen
- Department of Intensive Care Unit, Binhaiwan Central Hospital of Dongguan, Guangdong Province, Dongguan City, China.,Dongguan City, China
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Polancich S, Hall AG, Miltner R, Poe T, Enogela EM, Montgomery AP, Patrician PA. Learning During Crisis: The Impact of COVID-19 on Hospital-Acquired Pressure Injury Incidence. J Healthc Qual 2021; 43:137-144. [PMID: 33955955 PMCID: PMC8210579 DOI: 10.1097/jhq.0000000000000301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT The impact of COVID-19, on the health and safety of patients, staff, and healthcare organizations, has yet to be fully uncovered. Patient adverse events, such as hospital-acquired pressure injuries (HAPIs), have been problematic for decades. The introduction of a pandemic to an environment that is potentially at-risk for adverse events may result in unintended patient safety and quality concerns. We use the learning health system framework to motivate our understanding of the impact of the COVID-19 pandemic on the incidence of HAPIs within our health system. Using a retrospective, observational design, we used descriptive statistics to evaluate trends in HAPI from March to July 2020. Hospital-acquired pressure injury numbers have fluctuated from a steady increase from March-May 2020, hitting a peak high of 90 cases in the month of May. However, the trend in the total all stage HAPIs began to decline in June 2020, with a low of 51 in July, the lowest number since March 2020. Patients evaluated in this study did not have a longitudinal increase in HAPIs from March-July 2020 during the COVID-19 pandemic, despite similarities in illness severity between the two time points. Our experience has demonstrated the ability of our organizational leaders to learn quickly during crisis.
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Liu X, Liu H, Lan Q, Zheng X, Duan J, Zeng F. Early prone positioning therapy for patients with mild COVID-19 disease. ACTA ACUST UNITED AC 2021; 156:386-389. [PMID: 33898754 PMCID: PMC8052860 DOI: 10.1016/j.medcle.2020.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022]
Abstract
Objective In December 2019, Wuhan, China, experienced an outbreak of coronavirus disease 2019 (COVID-19). Some patients admitted to our hospital were treated with early prone positioning (PP). Here, we analyzed its clinical significance. Methods This was a retrospective observational study. We defined the early PP group as mild COVID-19 patients who were placed into a prone position within 24 h of admission; others served as the control group. We recorded basic data and outcomes of early PP and compared the results to those of controls. Results After 1 day of treatment, oxygenation was greater in the early PP group than in the control group (P/F: 421.6 ± 39.74 vs. 382.1 ± 38.84 mmHg [1 mmHg = 0.133 kPa], p < 0.01). And early PP group spent less total time in prone position (11.1 ± 4.17 vs. 16.9 ± 5.20 days, p < 0.01), and required shorter hospitalization duration (12.2 ± 4.49 vs. 23.2 ± 4.83 days, p < 0.001). Conclusions Early PP treatment can improve hypoxia and shorten the prone position time and hospitalization duration in mild COVID-19 patients. It is a potential clinically applicable intervention.
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Affiliation(s)
- Xiaoyi Liu
- Department of Critical Care Medicine, The Central Hospital of Dazhou, Dazhou, Sichuan, PR China
| | - Hui Liu
- Ophthalmology, The Central Hospital of Dazhou, Dazhou, Sichuan, PR China
| | - Qing Lan
- Department of Critical Care Medicine, The Central Hospital of Dazhou, Dazhou, Sichuan, PR China
| | - Xiangde Zheng
- Department of Critical Care Medicine, The Central Hospital of Dazhou, Dazhou, Sichuan, PR China
| | - Jun Duan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Fanwei Zeng
- Orthopedics, The Central Hospital of Dazhou, Dazhou, Sichuan, PR China
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Francisco MA, Pierce NL, Ely E, Cerasale MT, Anderson D, Pavkovich D, Puello F, Tummala S, Tyker A, D'Souza FR. Implementing Prone Positioning for COVID-19 Patients Outside the Intensive Care Unit. J Nurs Care Qual 2021; 36:105-111. [PMID: 33259470 DOI: 10.1097/ncq.0000000000000537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Proning intubated intensive care unit patients for the management of acute respiratory distress syndrome is an accepted standard of practice. We examined the nursing climate in 4 units and its impact on implementing a novel self-proning protocol to treat COVID-19 patients outside the intensive care unit. LOCAL PROBLEM Nursing units previously designated for medical/surgical populations had to adjust quickly to provide evidence-based care for COVID-19 patients attempting self-proning. METHODS Nurses from 4 nursing units were surveyed about the implementation process on the self-proning protocol. Their perception of unit implementation was assessed via the Implementation Climate Scale. INTERVENTIONS A new self-proning nursing protocol was implemented outside the intensive care unit. RESULTS Consistent education on the protocol, belief in the effectiveness of the intervention, and a strong unit-based climate of evidence-based practice contributed to greater implementation of the protocol. CONCLUSIONS Implementation of a new nursing protocol is possible with strong unit-based support, even during a pandemic.
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Affiliation(s)
- Mary Ann Francisco
- Department of Nursing Research and Evidence Based Practice, University of Chicago Medical Center, Chicago, Illinois (Ms Francisco and Drs Pierce and Ely); and The University of Chicago Biological Sciences Division, Chicago, Illinois (Drs Pierce, Cerasale, Anderson, Pavkovich, Puello, Tummala, Tyker, and D'Souza)
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Peng M, Li R, Cao W, Li W, Wu M, Lyu Y, Meng X, Ji K. A critical COVID-19 patient managed with timely evaluation, early prone positioning ventilation, and a multi-pronged pharmacotherapy. EUR J INFLAMM 2021. [DOI: 10.1177/20587392211025935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
There is not yet a standard drug regimen for the treatment of coronavirus disease 2019 (COVID-19) patients. Here, we summarize our experience and successful treatment plan with a critical COVID-19 patient who required mechanical ventilation (MV). A 56-year-old man presented with a fever, cough, and dyspnea. He had not been to a medium/high risk epidemic area in the past year and had no family history of a disease cluster. COVID-19 was suspected based on clinical symptoms and radiologically detected ground-glass lung changes in the context of a normal white blood cell count (WBCC) and lymphocyte fraction (L%). A diagnosis of COVID-19 was confirmed by nucleic acid testing. Initially, he was started on noninvasive ventilation (NIV). Because his respiratory distress worsened over the following 2 h, he was transitioned to mechanical ventilation (MV), placed in prone positioning 12 h/day, and given a multi-pronged pharmacotherapy regimen that included an antiviral cocktail (lopinavir/ritonavir plus α-interferon), an immunity enhancer (thymosin α1), an anti-coagulant to prevent thrombosis (heparin). He was given an antibiotic to treat an opportunistic nosocomial infection. The patient has recovered well. The regimen applied in this case of timely evaluation, early prone positioning with MV, and a multi-pronged pharmacotherapy may be an effective strategy for patients with critical COVID-19, particularly with respect to preventing life-threatening worsening of the illness.
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Affiliation(s)
- Mian Peng
- Department of Critical Care Medicine, The Third Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Rongsong Li
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China
| | - Weiling Cao
- Department of Pharmacy, The Third Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Weiqing Li
- Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Ming Wu
- Department of Critical Care Medicine, The Second People’s Hospital of Shenzhen, Shenzhen, China
| | - Yansi Lyu
- Department of Dermatology, Shenzhen University General Hospital, Shenzhen, China
| | - Xi Meng
- Department of Critical Care Medicine, The Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Kunmei Ji
- Department of Biochemistry and Molecular Biology, Health Science Center, Shenzhen University, Shenzhen, China
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Liu X, Liu H, Lan Q, Zheng X, Duan J, Zeng F. Early prone positioning therapy for patients with mild COVID-19 disease. Med Clin (Barc) 2020; 156:386-389. [PMID: 33478810 PMCID: PMC7834567 DOI: 10.1016/j.medcli.2020.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022]
Abstract
Objective In December 2019, Wuhan, China, experienced an outbreak of coronavirus disease 2019 (COVID-19). Some patients admitted to our hospital were treated with early prone positioning (PP). Here, we analyzed its clinical significance. Methods This was a retrospective observational study. We defined the early PP group as mild COVID-19 patients who were placed into a prone position within 24 h of admission; others served as the control group. We recorded basic data and outcomes of early PP and compared the results to those of controls. Results After 1 day of treatment, oxygenation was greater in the early PP group than in the control group (P/F: 421.6 ± 39.74 vs. 382.1 ± 38.84 mmHg [1 mmHg = 0.133 kPa], p < 0.01). And early PP group spent less total time in prone position (11.1 ± 4.17 vs. 16.9 ± 5.20 days, p < 0.01), and required shorter hospitalization duration (12.2 ± 4.49 vs. 23.2 ± 4.83 days, p < 0.001). Conclusions Early PP treatment can improve hypoxia and shorten the prone position time and hospitalization duration in mild COVID-19 patients. It is a potential clinically applicable intervention.
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Affiliation(s)
- Xiaoyi Liu
- Department of Critical Care Medicine, The Central Hospital of Dazhou, Dazhou, Sichuan, PR China.
| | - Hui Liu
- Ophthalmology, The Central Hospital of Dazhou, Dazhou, Sichuan, PR China
| | - Qing Lan
- Department of Critical Care Medicine, The Central Hospital of Dazhou, Dazhou, Sichuan, PR China
| | - Xiangde Zheng
- Department of Critical Care Medicine, The Central Hospital of Dazhou, Dazhou, Sichuan, PR China
| | - Jun Duan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Fanwei Zeng
- Orthopedics, The Central Hospital of Dazhou, Dazhou, Sichuan, PR China.
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Acute Rehabilitation in the COVID-19 Pandemic: A Case Report of Physical Therapy Perspectives From the Front Line. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Peng M, Ren D, Liu YF, Meng X, Wu M, Chen RL, Yu BJ, Tao LC, Chen L, Lai ZQ. Two mechanically ventilated cases of COVID-19 successfully managed with a sequential ventilation weaning protocol: Two case reports. World J Clin Cases 2020; 8:3305-3313. [PMID: 32874986 PMCID: PMC7441264 DOI: 10.12998/wjcc.v8.i15.3305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/15/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with critical coronavirus disease 2019 (COVID-19), characterized by respiratory failure requiring mechanical ventilation (MV), are at high risk of mortality. An effective and practical MV weaning protocol is needed for these fragile cases.
CASE SUMMARY Here, we present two critical COVID-19 patients who presented with fever, cough and fatigue. COVID-19 diagnosis was confirmed based on blood cell counts, chest computed tomography (CT) imaging, and nuclei acid test results. To address the patients’ respiratory failure, they first received noninvasive ventilation (NIV). When their condition did not improve after 2 h of NIV, each patient was advanced to MV [tidal volume (Vt), 6 mL/kg ideal body weight (IBW); 8-10 cmH2O of positive end-expiratory pressure; respiratory rate, 20 breaths/min; and 40%-80% FiO2] with prone positioning for 12 h/day for the first 5 d of MV. Extensive infection control measures were conducted to minimize morbidity, and pharmacotherapy consisting of an antiviral, immune-enhancer, and thrombosis prophylactic was administered in both cases. Upon resolution of lung changes evidenced by CT, the patients were sequentially weaned using a weaning screening test, spontaneous breathing test, and airbag leak test. After withdrawal of MV, the patients were transitioned through NIV and high-flow nasal cannula oxygen support. Both patients recovered well.
CONCLUSION A MV protocol attentive to intubation/extubation timing, prone positioning early in MV, infection control, and sequential withdrawal of respiratory support, may be an effective regimen for patients with critical COVID-19.
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Affiliation(s)
- Mian Peng
- Department of Intensive Care Unit, The Third Affiliated Hospital of Shenzhen University, Shenzhen 518001, Guangdong Province, China
| | - Di Ren
- Department of Intensive Care Unit, The Second People’s Hospital of Shenzhen, Shenzhen 518035, Guangdong Province, China
| | - Yong-Feng Liu
- Department of Intensive Care Unit, Shenzhen Longgang Central Hospital, Shenzhen 518116, Guangdong Province, China
| | - Xi Meng
- Department of Intensive Care Unit, The Third People’s Hospital of Shenzhen, Shenzhen 518112, Guangdong Province, China
| | - Ming Wu
- Department of Intensive Care Unit, The Second People’s Hospital of Shenzhen, Shenzhen 518035, Guangdong Province, China
| | - Rong-Lin Chen
- Department of Intensive Care Unit, Shenzhen Longgang Central Hospital, Shenzhen 518116, Guangdong Province, China
| | - Bao-Jun Yu
- Department of Intensive Care Unit, Shenzhen Baoan District People’s Hospital, Shenzhen 518101, Guangdong Province, China
| | - Long-Cheng Tao
- Department of Intensive Care Unit, The Third Affiliated Hospital of Shenzhen University, Shenzhen 518001, Guangdong Province, China
| | - Li Chen
- Department of Intensive Care Unit, The Third Affiliated Hospital of Shenzhen University, Shenzhen 518001, Guangdong Province, China
| | - Zeng-Qiao Lai
- Department of Intensive Care Unit, The Third Affiliated Hospital of Shenzhen University, Shenzhen 518001, Guangdong Province, China
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Scientific and Clinical Abstracts From WOCNext 2020 Reimagined. J Wound Ostomy Continence Nurs 2020. [DOI: 10.1097/won.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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