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Adrish M, Doppalapudi S, Lvovsky D. Driving pressure decoded: Precision strategies in adult respiratory distress syndrome management. World J Crit Care Med 2024; 13:92441. [PMID: 38855266 PMCID: PMC11155505 DOI: 10.5492/wjccm.v13.i2.92441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/17/2024] [Accepted: 04/24/2024] [Indexed: 06/03/2024] Open
Abstract
Mechanical ventilation (MV) is an important strategy for improving the survival of patients with respiratory failure. However, MV is associated with aggravation of lung injury, with ventilator-induced lung injury (VILI) becoming a major concern. Thus, ventilation protection strategies have been developed to minimize complications from MV, with the goal of relieving excessive breathing workload, improving gas exchange, and minimizing VILI. By opting for lower tidal volumes, clinicians seek to strike a balance between providing adequate ventilation to support gas exchange and preventing overdistension of the alveoli, which can contribute to lung injury. Additionally, other factors play a role in optimizing lung protection during MV, including adequate positive end-expiratory pressure levels, to maintain alveolar recruitment and prevent atelectasis as well as careful consideration of plateau pressures to avoid excessive stress on the lung parenchyma.
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Affiliation(s)
- Muhammad Adrish
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Sai Doppalapudi
- Department of Medicine, BronxCare Health System/Icahn School of Medicine at Mount Sinai, Bronx, NY 10467, United States
| | - Dmitry Lvovsky
- Department of Medicine, BronxCare Health System/Icahn School of Medicine at Mount Sinai, Bronx, NY 10467, United States
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Frisch C, Woyke S, Mair N, Haller T, Ronzani M, Marcher K, Schantl D, Rugg C, Schlager A. The impact of cannabinoids on methemoglobin formation and hemoglobin oxygen affinity: An ex-vivo study. Toxicology 2024; 505:153832. [PMID: 38759720 DOI: 10.1016/j.tox.2024.153832] [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: 04/04/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/19/2024]
Abstract
The affinity of hemoglobin (Hb) to oxygen (O2) influences processes of oxygen delivery and extraction at the tissue level. Despite cannabinoids being utilized or ingested in various ways, their possible impact on Hb-O2 affinity has barely been studied. This is an experimental ex-vivo trial. Venous blood samples were drawn from 5 male and 6 female healthy volunteers and subsequently exposed to different cannabinoid types: (delta-9-tetrahydrocannabinol [Δ9-THC], delta-8-tetrahydrocannabinol [Δ8-THC], cannabidiol [CBD]) at different concentrations. Oxygen dissociation curves (ODC) were measured and blood gas analyses were performed for methemoglobin (MetHb) determination. The results revealed no MetHb formation. Besides two statistically significant changes (+1.4 mmHg and -0.9 mmHg) in the female cohort, following Δ9-THC and Δ8-THC exposure, no further P50 changes could be observed. The study demonstrated an in-vitro effect of selected cannabinoids and dosages on P50 values in female participants, with variations not observed at other dosages, leaving the underlying mechanisms open for debate. MetHb formation, as potential mechanism, was not detected in this study. The precise reasons why changes only occurred at specific dosages remain unclear, indicating a need for further in-vivo research to understand the interaction between cannabinoids and Hb-O2 affinity completely.
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Affiliation(s)
- Christoph Frisch
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Austria
| | - Simon Woyke
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Austria.
| | - Norbert Mair
- Department of Physiology and Medical Physics, Institute of Physiology, Medical University of Innsbruck, Austria
| | - Thomas Haller
- Department of Physiology and Medical Physics, Institute of Physiology, Medical University of Innsbruck, Austria
| | - Marco Ronzani
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Austria
| | - Katharina Marcher
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Austria
| | | | - Christopher Rugg
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Austria
| | - Andreas Schlager
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Austria
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Peng P, Manini AF. Diagnostic utility of capnography in emergency department triage for screening acidemia: a pilot study. Int J Emerg Med 2024; 17:57. [PMID: 38649817 PMCID: PMC11036727 DOI: 10.1186/s12245-024-00631-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Capnography is a quantitative and reliable method of determining the ventilatory status of patients. We describe the test characteristics of capnography obtained during Emergency Department triage for screening acidemia. RESULTS We performed an observational, pilot study of adult patients presenting to Emergency Department (ED) triage. The primary outcome was acidemia, as determined by the basic metabolic panel and/or blood gas during the ED visit. Secondary outcomes include comparison of estimated and measured respiratory rates (RR), relationships between end-tidal CO2 (EtCO2) and venous partial pressure of CO2, admission disposition, in-hospital mortality during admission, and capnogram waveform analysis. A total of 100 adult ED encounters were included in the study and acidemia ([Formula: see text] or [Formula: see text]) was identified in 28 patients. The measured respiratory rate (20.3 ± 6.4 breaths/min) was significantly different from the estimated rate (18.4 ± 1.6 breaths/min), and its area under the receiver operating curve (c-statistic) to predict acidemia was only 0.60 (95% CI 0.51-0.75, p = 0.03). A low end-tidal CO2 (EtCO2 < 32 mmHg) had positive (LR+) and negative (LR-) likelihood ratios of 4.68 (95% CI 2.59-8.45) and 0.34 (95% CI 0.19-0.61) for acidemia, respectively-corresponding to sensitivity 71.4% (95% CI 51.3-86.8) and specificity 84.7% (95% CI 74.3-92.1). The c-statistic for EtCO2 was 0.849 (95% CI 0.76-0.94, p = 0.00). Waveform analysis further revealed characteristically abnormal capnograms that were associated with underlying pathophysiology. CONCLUSIONS Capnography is a quantitative method of screening acidemia in patients and can be implemented feasibly in Emergency Department triage as an adjunct to vital signs. While it was shown to have only modest ability to predict acidemia, triage capnography has wide generalizability to screen other life-threatening disease processes such as sepsis or can serve as an early indicator of clinical deterioration.
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Affiliation(s)
- Paul Peng
- Department of Emergency Medicine, The State University of New Jersey, 08901, Rutgers, New Brunswick, NJ, United States of America.
| | - Alex F Manini
- Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 10029, New York, NY, United States of America
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Ting YL, Lim JZM, Yeo PM, Sim WY. Methaemoglobinaemia: a potential confounder in COVID-19 respiratory failure. Singapore Med J 2024; 65:S24-S25. [PMID: 34749490 PMCID: PMC11073664 DOI: 10.11622/smedj.2021192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Yang Lin Ting
- Department of General Medicine, Tan Tock Seng Hospital, Singapore
| | | | - Pei Ming Yeo
- Department of General Medicine, Tan Tock Seng Hospital, Singapore
| | - Wen Yuan Sim
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
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Fisher JM, Subbian V, Essay P, Pungitore S, Bedrick EJ, Mosier JM. Acute Respiratory Failure From Early Pandemic COVID-19: Noninvasive Respiratory Support vs Mechanical Ventilation. CHEST CRITICAL CARE 2024; 2:100030. [PMID: 38645483 PMCID: PMC11027508 DOI: 10.1016/j.chstcc.2023.100030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
BACKGROUND The optimal strategy for initial respiratory support in patients with respiratory failure associated with COVID-19 is unclear, and the initial strategy may affect outcomes. RESEARCH QUESTION Which initial respiratory support strategy is associated with improved outcomes in patients with COVID-19 with acute respiratory failure? STUDY DESIGN AND METHODS All patients with COVID-19 requiring respiratory support and admitted to a large health care network were eligible for inclusion. We compared patients treated initially with noninvasive respiratory support (NIRS; noninvasive positive pressure ventilation by facemask or high-flow nasal oxygen) with patients treated initially with invasive mechanical ventilation (IMV). The primary outcome was time to in-hospital death analyzed using an inverse probability of treatment weighted Cox model adjusted for potential confounders. Secondary outcomes included unweighted and weighted assessments of mortality, lengths of stay (ICU and hospital), and time to intubation. RESULTS Nearly one-half of the 2,354 patients (47%) who met inclusion criteria received IMV first, and 53% received initial NIRS. Overall, in-hospital mortality was 38% (37% for IMV and 39% for NIRS). Initial NIRS was associated with an increased hazard of death compared with initial IMV (hazard ratio, 1.42; 95% CI, 1.03-1.94), but also an increased hazard of leaving the hospital sooner that waned with time (noninvasive support by time interaction: hazard ratio, 0.97; 95% CI, 0.95-0.98). INTERPRETATION Patients with COVID-19 with acute hypoxemic respiratory failure initially treated with NIRS showed an increased hazard of in-hospital death.
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Affiliation(s)
- Julia M Fisher
- Statistics Consulting Laboratory, The University of Arizona College of Medicine, Tucson, AZ; College of Engineering, the BI05 Institute, The University of Arizona College of Medicine, Tucson, AZ
| | - Vignesh Subbian
- Department of Systems and Industrial Engineering, The University of Arizona College of Medicine, Tucson, AZ; Department of Biomedical Engineering, The University of Arizona College of Medicine, Tucson, AZ; College of Engineering, the BI05 Institute, The University of Arizona College of Medicine, Tucson, AZ
| | - Patrick Essay
- Department of Systems and Industrial Engineering, The University of Arizona College of Medicine, Tucson, AZ
| | - Sarah Pungitore
- Program in Applied Mathematics, The University of Arizona College of Medicine, Tucson, AZ
| | - Edward J Bedrick
- Statistics Consulting Laboratory, The University of Arizona College of Medicine, Tucson, AZ; College of Engineering, the BI05 Institute, The University of Arizona College of Medicine, Tucson, AZ
| | - Jarrod M Mosier
- The University of Arizona, the Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ; Division of Pulmonary, Allergy, Critical Care, and Sleep, The University of Arizona College of Medicine, Tucson, AZ; Department of Medicine, The University of Arizona College of Medicine, Tucson, AZ
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Díaz I, Hoffman KL, Hejazi NS. Causal survival analysis under competing risks using longitudinal modified treatment policies. LIFETIME DATA ANALYSIS 2024; 30:213-236. [PMID: 37620504 DOI: 10.1007/s10985-023-09606-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/17/2023] [Indexed: 08/26/2023]
Abstract
Longitudinal modified treatment policies (LMTP) have been recently developed as a novel method to define and estimate causal parameters that depend on the natural value of treatment. LMTPs represent an important advancement in causal inference for longitudinal studies as they allow the non-parametric definition and estimation of the joint effect of multiple categorical, ordinal, or continuous treatments measured at several time points. We extend the LMTP methodology to problems in which the outcome is a time-to-event variable subject to a competing event that precludes observation of the event of interest. We present identification results and non-parametric locally efficient estimators that use flexible data-adaptive regression techniques to alleviate model misspecification bias, while retaining important asymptotic properties such as [Formula: see text]-consistency. We present an application to the estimation of the effect of the time-to-intubation on acute kidney injury amongst COVID-19 hospitalized patients, where death by other causes is taken to be the competing event.
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Affiliation(s)
- Iván Díaz
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY, 10016, USA.
| | - Katherine L Hoffman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Nima S Hejazi
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
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Pavlov I, Li J, Kharat A, Luo J, Ibarra-Estrada M, Perez Y, McNicolas B, Poole D, Roca O, Vines D, Tavernier E, Allen T, Shyamsundar M, Ehrmann S, Simpson SQ, Guérin C, Laffey JG. Awake prone positioning in acute hypoxaemic respiratory failure: An international expert guidance. J Crit Care 2023; 78:154401. [PMID: 37639921 DOI: 10.1016/j.jcrc.2023.154401] [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: 04/17/2023] [Revised: 07/12/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Awake prone positioning (APP) of non-intubated patients with acute hypoxaemic respiratory failure (AHRF) has been inconsistently adopted into routine care of patients with COVID-19, likely due to apparent conflicting evidence from recent trials. This short guideline aims to provide evidence-based recommendations for the use of APP in various clinical scenarios. METHODS An international multidisciplinary panel, assembled for their expertise and representativeness, and supported by a methodologist, performed a systematic literature search, summarized the available evidence derived from randomized clinical trials, and developed recommendations using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. RESULTS The panel strongly recommends that APP rather than standard supine care be used in patients with COVID-19 receiving advanced respiratory support (high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation). Due to lack of evidence from randomized controlled trials, the panel provides no recommendation on the use of APP in patients with COVID-19 supported with conventional oxygen therapy, nor in patients with AHRF due to causes other than COVID-19. CONCLUSION APP should be routinely implemented in patients with COVID-19 receiving advanced respiratory support.
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Affiliation(s)
- Ivan Pavlov
- Department of Emergency Medicine, Hôpital de Verdun, Montréal, Québec, Canada
| | - Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
| | - Aileen Kharat
- Department of Respiratory Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Jian Luo
- Respiratory Medicine Unit and Oxford NIHR Biomedical Research Centre, NDM Experimental Medicine, University of Oxford, Oxford, UK
| | - Miguel Ibarra-Estrada
- Unidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Yonatan Perez
- Médecine Intensive Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Bairbre McNicolas
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals and School of Medicine, University of Galway, Galway, Ireland
| | - Daniele Poole
- Operative Unit of Anesthesia and Intensive Care, S. Martino Hospital, Belluno, Italy
| | - Oriol Roca
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Parc del Taulí 1, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Vines
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
| | - Elsa Tavernier
- Methods in Patient-Centered Outcomes and Health Research, INSERM UMR 1246, Nantes, France; Clinical Investigation Centre, INSERM 1415 CHRU Tours, Tours, France
| | - Thérèse Allen
- Retired Nurse, and Patient Representative, Galway, Ireland
| | - Murali Shyamsundar
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, Clinical Investigation Center, INSERM 1415, INSERM, Centre d'Etude des Pathologies Respiratoires, Université de Tours - All in Tours, U1100, France
| | | | - Claude Guérin
- Université de Lyon, Lyon, France; Institut Mondor de Recherches Biomédicales, INSERM 955 CNRS, 7200, Créteil, France
| | - John G Laffey
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals and School of Medicine, University of Galway, Galway, Ireland.
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Prada SI, Garcia-Garcia MP, Ospina-Tascón GA, Rosselli D. Cost Analysis of High-Flow Oxygen Therapy Compared with Conventional Oxygen Therapy in Severe COVID-19 in Colombia: Data from a Randomized Clinical Trial. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:733-738. [PMID: 37822790 PMCID: PMC10564115 DOI: 10.2147/ceor.s412087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/30/2023] [Indexed: 10/13/2023] Open
Abstract
Background A randomized clinical trial (HiFlo-COVID-19 Trial) showed that among patients with severe COVID-19, treatment with high-flow oxygen therapy (HFOT) significantly reduced the need for invasive mechanical ventilation support and time for clinical recovery compared with conventional oxygen therapy (COT). However, the cost of this strategy is unknown. Objective We examined total cost of HFOT treatment compared with COT in real-world setting. Methods We conducted a post-trial-based cost analysis from the perspective of a managed competition healthcare system, using actual records of billed costs. Cost categories include general ward, intensive care unit, procedures, imaging, laboratories, medications, supplies, and others. Results A total of 188 participants (mean age 60, 33% female) were included. Average costs (and standard deviation) in the HFOT group were USD $7992 (7394) and in the COT group USD $ 10,190 (9402). Differences, however, did not reach statistical significance (P=0.093). However, resource use was always less costly for the HNFO group, with an overall percentage decrease of 27%. Two categories make up 72% of all savings: medications (41%) and intensive care unit (31%). Conclusion For patients in ICU with severe COVID-19 the cost of treatment with HFOT as compared to COT is likely to be cost-saving due to less use of medications and length of stay in ICU.
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Affiliation(s)
- Sergio I Prada
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
- Universidad Icesi, Centro PROESA, Cali, Colombia
| | | | - Gustavo A Ospina-Tascón
- Department of Intensive Care, Fundación Valle del Lili, Cali, Colombia
- Translational Medicine Laboratory in Critical Care (TransLab-CCM), Universidad Icesi, Cali, Colombia
| | - Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Bogota, Colombia
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Wanis KN, Madenci AL, Hao S, Moukheiber M, Moukheiber L, Moukheiber D, Moukheiber S, Young JG, Celi LA. Emulating Target Trials Comparing Early and Delayed Intubation Strategies. Chest 2023; 164:885-891. [PMID: 37150505 PMCID: PMC10567927 DOI: 10.1016/j.chest.2023.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/15/2023] [Accepted: 04/30/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Whether intubation should be initiated early in the clinical course of critically ill patients remains a matter of debate. Results from prior observational studies are difficult to interpret because of avoidable flaws including immortal time bias, inappropriate eligibility criteria, and unrealistic treatment strategies. RESEARCH QUESTION Do treatment strategies that intubate patients early in the critical care admission improve 30-day survival compared with strategies that delay intubation? STUDY DESIGN AND METHODS We estimated the effect of strategies that require early intubation of critically ill patients compared with those that delay intubation. With data extracted from the Medical Information Mart for Intensive Care-IV database, we emulated three target trials, varying the flexibility of the treatment strategies and the baseline eligibility criteria. RESULTS Under unrealistically strict treatment strategies with broad eligibility criteria, the 30-day mortality risk was 7.1 percentage points higher for intubating early compared with delaying intubation (95% CI, 6.2-7.9). Risk differences were 0.4 (95% CI, -0.1 to 0.9) and -0.9 (95% CI, -2.5 to 0.7) percentage points in subsequent target trial emulations that included more realistic treatment strategies and eligibility criteria. INTERPRETATION When realistic treatment strategies and eligibility criteria are used, strategies that delay intubation result in similar 30-day mortality risks compared with those that intubate early. Delaying intubation ultimately avoids intubation in most patients.
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Affiliation(s)
- Kerollos Nashat Wanis
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Division of General Surgery, Department of Surgery, Western University, London, ON, Canada.
| | - Arin L Madenci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Sicheng Hao
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA
| | - Mira Moukheiber
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA
| | - Lama Moukheiber
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Dana Moukheiber
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Sulaiman Moukheiber
- Department of Computer Science, Worcester Polytechnic Institute, Worcester, MA
| | - Jessica G Young
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Leo Anthony Celi
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA
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Cassano G, Nattino G, Belotti M, Cortellaro F, Cosentini R, Ghilardi GI, Paganuzzi M, Paglia S, Rossi C, Solbiati M, Bertolini G, Brambilla AM. Prognostic value of respiratory parameters for COVID-19 patients in the emergency department: results from the EC-COVID study. Intern Emerg Med 2023; 18:2075-2082. [PMID: 37338715 DOI: 10.1007/s11739-023-03324-6] [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: 12/20/2022] [Accepted: 05/23/2023] [Indexed: 06/21/2023]
Abstract
While several studies have evaluated the prognostic weight of respiratory parameters in patients with COVID-19, few have focused on patients' clinical conditions at the first emergency department (ED) assessment. We analyzed a large cohort of ED patients recruited within the EC-COVID study over the year 2020, and assessed the association between key bedside respiratory parameters measured in room air (pO2, pCO2, pH, and respiratory rate [RR]) and hospital mortality, after adjusting for key confounding factors. Analyses were based on a multivariable logistic Generalized Additive Model (GAM). After excluding patients who did not perform a blood gas analysis (BGA) test in room air or with incomplete BGA results, a total of 2458 patients were considered in the analyses. Most patients were hospitalized on ED discharge (72.0%); hospital mortality was 14.3%. Strong, negative associations with hospital mortality emerged for pO2, pCO2 and pH (p-values: < 0.001, < 0.001 and 0.014), while a significant, positive association was observed for RR (p-value < 0.001). Associations were quantified with nonlinear functions, learned from the data. No cross-parameter interaction was significant (all p-values were larger than 0.10), suggesting a progressive, independent effect on the outcome as the value of each parameter departed from normality. Our results collide with the hypothesized existence of patterns of breathing parameters with specific prognostic weight in the early stages of the disease.
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Affiliation(s)
- Giulio Cassano
- Emergency Medicine Unit, Luigi Sacco Hospital, ASST FBF Sacco, Milan, Italy
| | - Giovanni Nattino
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica (BG), Italy
| | - Mauro Belotti
- Emergency Medicine Unit, Luigi Sacco Hospital, ASST FBF Sacco, Milan, Italy
| | | | | | - Giulia Irene Ghilardi
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica (BG), Italy
| | - Marco Paganuzzi
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica (BG), Italy
| | | | - Carlotta Rossi
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica (BG), Italy.
| | - Monica Solbiati
- Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan (MI), Italy
- Università Degli Studi Di Milano, Milan (MI), Italy
| | - Guido Bertolini
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica (BG), Italy
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Peterson ME, Docter S, Ruiz-Betancourt DR, Alawa J, Arimino S, Weiser TG. Pulse oximetry training landscape for healthcare workers in low- and middle-income countries: A scoping review. J Glob Health 2023; 13:04074. [PMID: 37736848 PMCID: PMC10514743 DOI: 10.7189/jogh.13.04074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
Background Pulse oximetry has been used in medical care for decades. Its use quickly became standard of care in high resource settings, with delayed widespread availability and use in lower resource settings. Pulse oximetry training initiatives have been ongoing for years, but a map of the literature describing such initiatives among health care workers in low- and middle-income countries (LMICs) has not previously been conducted. Additionally, the coronavirus disease 2019 (COVID-19) pandemic further highlighted the inequitable distribution of pulse oximetry use and training. We aimed to characterise the landscape of pulse oximetry training for health care workers in LMICs prior to the COVID-19 pandemic as described in the literature. Methods We systematically searched six databases to identify studies reporting pulse oximetry training among health care workers, broadly defined, in LMICs prior to the COVID-19 pandemic. Two reviewers independently assessed titles and abstracts and relevant full texts for eligibility. Data were charted by one author and reviewed for accuracy by a second. We synthesised the results using a narrative synthesis. Results A total of 7423 studies were identified and 182 screened in full. A total of 55 training initiatives in 42 countries met inclusion criteria, as described in 66 studies since some included studies reported on different aspects of the same training initiative. Five overarching reasons for conducting pulse oximetry training were identified: 1) anaesthesia and perioperative care, 2) respiratory support programme expansion, 3) perinatal assessment and monitoring, 4) assessment and monitoring of children and 5) assessment and monitoring of adults. Educational programmes varied in their purpose with respect to the types of patients being targeted, the health care workers being instructed, and the depth of pulse oximetry specific training. Conclusions Pulse oximetry training initiatives have been ongoing for decades for a variety of purposes, utilising a multitude of approaches to equip health care workers with tools to improve patient care. It is important that these initiatives continue as pulse oximetry availability and knowledge gaps remain. Neither pulse oximetry provision nor training alone is enough to bolster patient care, but sustainable solutions for both must be considered to meet the needs of both health care workers and patients.
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Affiliation(s)
| | - Shgufta Docter
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Jude Alawa
- Stanford University School of Medicine, Stanford, California, USA
| | - Sedera Arimino
- CHRR (Regional Hospital Centre of Reference) Vakinankaratra, Madagascar
| | - Thomas G Weiser
- Department of Surgery, Stanford University, Stanford, California, USA
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12
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Piluso M, Ferrari C, Pagani S, Usai P, Raschi S, Parachini L, Oggionni E, Melacini C, D’Arcangelo F, Cattaneo R, Bonacina C, Bernareggi M, Bencini S, Nadalin M, Borelli M, Bellini R, Salandini MC, Scarpazza P. COVID-19 Acute Respiratory Distress Syndrome: Treatment with Helmet CPAP in Respiratory Intermediate Care Unit by Pulmonologists in the Three Italian Pandemic Waves. Adv Respir Med 2023; 91:383-396. [PMID: 37736976 PMCID: PMC10514851 DOI: 10.3390/arm91050030] [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: 08/08/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Abstract
COVID-19 Acute Respiratory Distress Syndrome (CARDS) is the most serious complication of COVID-19. The SARS-CoV-2 outbreaks rapidly saturated intensive care unit (ICU), forcing the application of non-invasive respiratory support (NIRS) in respiratory intermediate care unit (RICU). The primary aim of this study is to compare the patients' clinical characteristics and outcomes (Helmet-Continuous Positive Airway Pressure (H-CPAP) success/failure and survival/death). The secondary aim is to evaluate and detect the main predictors of H-CPAP success and survival/death. A total of 515 patients were enrolled in our observational prospective study based on CARDS developed in RICU during the three Italian pandemic waves. All selected patients were treated with H-CPAP. The worst ratio of arterial partial pressure of oxygen (PaO2) and fraction of inspired oxygen (FiO2) PaO2/FiO2 during H-CPAP stratified the subjects into mild, moderate and severe CARDS. H-CPAP success has increased during the three waves (62%, 69% and 77%, respectively) and the mortality rate has decreased (28%, 21% and 13%). H-CPAP success/failure and survival/death were related to the PaO2/FiO2 (worst score) ratio in H-CPAP and to steroids' administration. D-dimer at admission, FiO2 and positive end expiratory pressure (PEEP) were also associated with H-CPAP success. Our study suggests good outcomes with H-CPAP in CARDS in RICU. A widespread use of steroids could play a role.
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Affiliation(s)
- Martina Piluso
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Clarissa Ferrari
- Research and Clinical Trials Office, Poliambulanza Foundation Hospital, 25124 Brescia, Italy;
| | - Silvia Pagani
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Pierfranco Usai
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Stefania Raschi
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Luca Parachini
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Elisa Oggionni
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Chiara Melacini
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Francesca D’Arcangelo
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Roberta Cattaneo
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Cristiano Bonacina
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Monica Bernareggi
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Serena Bencini
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Marta Nadalin
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.N.); (M.B.)
- Cardiothoracic Vascular Department, Respiratory Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Mara Borelli
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.N.); (M.B.)
- Cardiothoracic Vascular Department, Respiratory Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Roberto Bellini
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Maria Chiara Salandini
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
| | - Paolo Scarpazza
- Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy; (M.P.); (P.U.); (S.R.); (L.P.); (E.O.); (C.M.); (F.D.); (R.C.); (C.B.); (M.B.); (S.B.); (R.B.); (M.C.S.); (P.S.)
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13
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Nadeem R, Nadeem N, Albwidani RM, Falih FH, Husain HR, Krrak AZ, Mathews MP, Hussein KSH, Abdulkarim F, Dar F. The optimal time for endotracheal intubation in subjects with coronavirus disease 2019 pneumonia: A retrospective observational study. Int J Crit Illn Inj Sci 2023; 13:85-91. [PMID: 38023571 PMCID: PMC10664033 DOI: 10.4103/ijciis.ijciis_79_22] [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: 11/26/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background The optimal timing of intubation has been debated among healthcare professionals, current studies do not show any differences between early and late intubation. most studies failed to show any significant difference in clinical outcomes between early or late intubation. Methods The study was conducted as a retrospective review of subjects with confirmed coronavirus disease 2019 admitted to the Dubai Hospital intensive care unit (ICU). Study variables included time to intubation, duration of supplemental oxygen requirement >15 L/min, and cumulative duration of tachypnea and tachycardia while on the aforementioned oxygen requirement on this oxygen usage level. Each time duration was assessed for correlation with clinical variables including mortality and length of stay in ICU and hospital. Results Subjects who require endotracheal intubation within 4 h after the start of oxygen >15 L/min have lower survival (P = 0.03). Subjects who have tachypnea on the aforementioned oxygen requirement for 6-19.5 h (P = 0.01) before they require intubation have better survival. No duration of tachycardia has any significant effect on survival. Only the duration of invasive mechanical ventilation (MV) correlated with the hospital length of stay. Conclusions Subjects who require endotracheal intubation within 4 h after the start of oxygen >15 L/min have lower survival. The optimal time for intubation is after tachypnea of 6 h but before 19.5 h. No duration of tachycardia has any significant effect on survival. Only the duration of invasive MV correlated with the hospital length of stay.
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Affiliation(s)
- Rashid Nadeem
- Department of Intensive Care, Dubai Hospital, Dubai, UAE
| | - Nadia Nadeem
- Department of Medicine, Dubai Hospital, Dubai, UAE
| | | | | | | | | | | | | | | | - Farooq Dar
- Department of Thoracic Surgery, Dubai Healthcare Authority, Dubai, UAE
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14
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Lassan S, Tesar T, Tisonova J, Lassanova M. Pharmacological approaches to pulmonary fibrosis following COVID-19. Front Pharmacol 2023; 14:1143158. [PMID: 37397477 PMCID: PMC10308083 DOI: 10.3389/fphar.2023.1143158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Background: In the past few years, COVID-19 became the leading cause of morbidity and mortality worldwide. Although the World Health Organization has declared an end to COVID-19 as a public health emergency, it can be expected, that the emerging new cases at the top of previous ones will result in an increasing number of patients with post-COVID-19 sequelae. Despite the fact that the majority of patients recover, severe acute lung tissue injury can in susceptible individuals progress to interstitial pulmonary involvement. Our goal is to provide an overview of various aspects associated with the Post-COVID-19 pulmonary fibrosis with a focus on its potential pharmacological treatment options. Areas covered: We discuss epidemiology, underlying pathobiological mechanisms, and possible risk and predictive factors that were found to be associated with the development of fibrotic lung tissue remodelling. Several pharmacotherapeutic approaches are currently being applied and include anti-fibrotic drugs, prolonged use or pulses of systemic corticosteroids and non-steroidal anti-inflammatory and immunosuppressive drugs. In addition, several repurposed or novel compounds are being investigated. Fortunately, clinical trials focused on pharmacological treatment regimens for post-COVID-19 pulmonary fibrosis have been either designed, completed or are already in progress. However, the results are contrasting so far. High quality randomised clinical trials are urgently needed with respect to the heterogeneity of disease behaviour, patient characteristics and treatable traits. Conclusion: The Post-COVID-19 pulmonary fibrosis contributes to the burden of chronic respiratory consequences among survivors. Currently available pharmacotherapeutic approaches mostly comprise repurposed drugs with a proven efficacy and safety profile, namely, corticosteroids, immunosuppressants and antifibrotics. The role of nintedanib and pirfenidone is promising in this area. However, we still need to verify conditions under which the potential to prevent, slow or stop progression of lung damage will be fulfilled.
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Affiliation(s)
- Stefan Lassan
- Department of Pneumology, Phthisiology and Functional Diagnostics, Slovak Medical University and Bratislava University Hospital, Bratislava, Slovakia
| | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia
| | - Jana Tisonova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Monika Lassanova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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15
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Vetrugno L, Deana C, Castaldo N, Fantin A, Belletti A, Sozio E, De Martino M, Isola M, Palumbo D, Longhini F, Cammarota G, Spadaro S, Maggiore SM, Bassi F, Tascini C, Patruno V. Barotrauma during Noninvasive Respiratory Support in COVID-19 Pneumonia Outside ICU: The Ancillary COVIMIX-2 Study. J Clin Med 2023; 12:jcm12113675. [PMID: 37297869 DOI: 10.3390/jcm12113675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Noninvasive respiratory support (NIRS) has been extensively used during the COVID-19 surge for patients with acute respiratory failure. However, little data are available about barotrauma during NIRS in patients treated outside the intensive care unit (ICU) setting. METHODS COVIMIX-2 was an ancillary analysis of the previous COVIMIX study, a large multicenter observational work investigating the frequencies of barotrauma (i.e., pneumothorax and pneumomediastinum) in adult patients with COVID-19 interstitial pneumonia. Only patients treated with NIRS outside the ICU were considered. Baseline characteristics, clinical and radiological disease severity, type of ventilatory support used, blood tests and mortality were recorded. RESULTS In all, 179 patients were included, 60 of them with barotrauma. They were older and had lower BMI than controls (p < 0.001 and p = 0.045, respectively). Cases had higher respiratory rates and lower PaO2/FiO2 (p = 0.009 and p < 0.001). The frequency of barotrauma was 0.3% [0.1-1.3%], with older age being a risk factor for barotrauma (OR 1.06, p = 0.015). Alveolar-arterial gradient (A-a) DO2 was protective against barotrauma (OR 0.92 [0.87-0.99], p = 0.026). Barotrauma required active treatment, with drainage, in only a minority of cases. The type of NIRS was not explicitly related to the development of barotrauma. Still, an escalation of respiratory support from conventional oxygen therapy, high flow nasal cannula to noninvasive respiratory mask was predictive for in-hospital death (OR 15.51, p = 0.001). CONCLUSIONS COVIMIX-2 showed a low frequency for barotrauma, around 0.3%. The type of NIRS used seems not to increase this risk. Patients with barotrauma were older, with more severe systemic disease, and showed increased mortality.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Venezia Giulia, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Nadia Castaldo
- Pulmonology Unit, Department of Cardio-Thoracic Surgery, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
| | - Alberto Fantin
- Pulmonology Unit, Department of Cardio-Thoracic Surgery, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Emanuela Sozio
- Infectious Disease Unit, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
| | - Maria De Martino
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Miriam Isola
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater, Domini, Magna Graecia University, 88100 Catanzaro, Italy
| | - Gianmaria Cammarota
- Anesthesiology and Intensive Care, Department of Translational medicine, Faculty of Medicine and Surgery, University of Ferrara, 44121 Ferrara, Italy
| | - Savino Spadaro
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy
- Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, 66100 Chieti, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Venezia Giulia, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Carlo Tascini
- Infectious Disease Unit, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Unit, Department of Cardio-Thoracic Surgery, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
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16
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Li Y, Li C, Chang W, Liu L. High-flow nasal cannula reduces intubation rate in patients with COVID-19 with acute respiratory failure: a meta-analysis and systematic review. BMJ Open 2023; 13:e067879. [PMID: 36997243 PMCID: PMC10069279 DOI: 10.1136/bmjopen-2022-067879] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the effect of high-flow nasal cannula therapy (HFNC) versus conventional oxygen therapy (COT) on intubation rate, 28-day intensive care unit (ICU) mortality, 28-day ventilator-free days (VFDs) and ICU length of stay (ICU LOS) in adult patients with acute respiratory failure (ARF) associated with COVID-19. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Web of Science, Cochrane Library and Embase up to June 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Only randomised controlled trials or cohort studies comparing HFNC with COT in patients with COVID-19 were included up to June 2022. Studies conducted on children or pregnant women, and those not published in English were excluded. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened the titles, abstracts and full texts. Relevant information was extracted and curated in the tables. The Cochrane Collaboration tool and Newcastle-Ottawa Scale were used to assess the quality of randomised controlled trials or cohort studies. Meta-analysis was conducted using RevMan V.5.4 computer software using a random effects model with a 95% CI. Heterogeneity was assessed using Cochran's Q test (χ2) and Higgins I2 statistics, with subgroup analyses to account for sources of heterogeneity. RESULTS Nine studies involving 3370 (1480 received HFNC) were included. HFNC reduced the intubation rate compared with COT (OR 0.44, 95% CI 0.28 to 0.71, p=0.0007), decreased 28-day ICU mortality (OR 0.54, 95% CI 0.30 to 0.97, p=0.04) and improved 28-day VFDs (mean difference (MD) 2.58, 95% CI 1.70 to 3.45, p<0.00001). However, HFNC had no effect on ICU LOS versus COT (MD 0.52, 95% CI -1.01 to 2.06, p=0.50). CONCLUSIONS Our study indicates that HFNC may reduce intubation rate and 28-day ICU mortality, and improve 28-day VFDs in patients with ARF due to COVID-19 compared with COT. Large-scale randomised controlled trials are necessary to validate our findings. PROSPERO REGISTRATION NUMBER CRD42022345713.
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Affiliation(s)
- Yang Li
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Cong Li
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Wei Chang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Ling Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
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17
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Bertolini F, Witteveen AB, Young S, Cuijpers P, Ayuso-Mateos JL, Barbui C, Cabello M, Cadorin C, Downes N, Franzoi D, Gasior ME, Gray B, John A, Melchior M, van Ommeren M, Palantza C, Purgato M, Van der Waerden J, Wang S, Sijbrandij M. Risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 mortality in people with pre-existing mental disorders: an umbrella review. BMC Psychiatry 2023; 23:181. [PMID: 36941591 PMCID: PMC10026202 DOI: 10.1186/s12888-023-04641-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has posed a serious health risk, especially in vulnerable populations. Even before the pandemic, people with mental disorders had worse physical health outcomes compared to the general population. This umbrella review investigated whether having a pre-pandemic mental disorder was associated with worse physical health outcomes due to the COVID-19 pandemic. METHODS Following a pre-registered protocol available on the Open Science Framework platform, we searched Ovid MEDLINE All, Embase (Ovid), PsycINFO (Ovid), CINAHL, and Web of Science up to the 6th of October 2021 for systematic reviews on the impact of COVID-19 on people with pre-existing mental disorders. The following outcomes were considered: risk of contracting the SARS-CoV-2 infection, risk of severe illness, COVID-19 related mortality risk, risk of long-term physical symptoms after COVID-19. For meta-analyses, we considered adjusted odds ratio (OR) as effect size measure. Screening, data extraction and quality assessment with the AMSTAR 2 tool have been done in parallel and duplicate. RESULTS We included five meta-analyses and four narrative reviews. The meta-analyses reported that people with any mental disorder had an increased risk of SARS-CoV-2 infection (OR: 1.71, 95% CI 1.09-2.69), severe illness course (OR from 1.32 to 1.77, 95%CI between 1.19-1.46 and 1.29-2.42, respectively) and COVID-19 related mortality (OR from 1.38 to 1.52, 95%CI between 1.15-1.65 and 1.20-1.93, respectively) as compared to the general population. People with anxiety disorders had an increased risk of SAR-CoV-2 infection, but not increased mortality. People with mood and schizophrenia spectrum disorders had an increased COVID-19 related mortality but without evidence of increased risk of severe COVID-19 illness. Narrative reviews were consistent with findings from the meta-analyses. DISCUSSION AND CONCLUSIONS As compared to the general population, there is strong evidence showing that people with pre-existing mental disorders suffered from worse physical health outcomes due to the COVID-19 pandemic and may therefore be considered a risk group similar to people with underlying physical conditions. Factors likely involved include living accommodations with barriers to social distancing, cardiovascular comorbidities, psychotropic medications and difficulties in accessing high-intensity medical care.
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Affiliation(s)
- Federico Bertolini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Anke B Witteveen
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Susanne Young
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - María Cabello
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Camilla Cadorin
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Naomi Downes
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Social Epidemiology Research Team (ERES), Paris, F75012, France
| | - Daniele Franzoi
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Michael Elizabeth Gasior
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Brandon Gray
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Ann John
- Population Psychiatry, Suicide and Informatics, Medical School, Swansea University, Swansea, UK
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Social Epidemiology Research Team (ERES), Paris, F75012, France
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Christina Palantza
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Judith Van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Social Epidemiology Research Team (ERES), Paris, F75012, France
| | - Siyuan Wang
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
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18
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de Oliveira JPA, Costa ACT, Lopes AJ, de Sá Ferreira A, Reis LFDF. Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution. CRITICAL CARE SCIENCE 2023; 35:19-30. [PMID: 37712726 PMCID: PMC10275312 DOI: 10.5935/2965-2774.20230203-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/01/2022] [Indexed: 09/16/2023]
Abstract
OBJECTIVES To evaluate the factors associated with mortality in mechanically ventilated patients with acute respiratory distress syndrome due to COVID-19. METHODS This was a retrospective, multicenter cohort study that included 425 mechanically ventilated adult patients with COVID-19 admitted to 4 intensive care units. Clinical data comprising the SOFA score, laboratory data and mechanical characteristics of the respiratory system were collected in a standardized way immediately after the start of invasive mechanical ventilation. The risk factors for death were analyzed using Cox regression to estimate the risk ratios and their respective 95%CIs. RESULTS Body mass index (RR 1.17; 95%CI 1.11 - 1.20; p < 0.001), SOFA score (RR 1.39; 95%CI 1.31 - 1.49; p < 0.001) and driving pressure (RR 1.24; 95%CI 1.21 - 1.29; p < 0.001) were considered independent factors associated with mortality in mechanically ventilated patients with acute respiratory distress syndrome due to COVID-19. Respiratory system compliance (RR 0.92; 95%CI 0.90 - 0.93; p < 0.001) was associated with lower mortality. The comparative analysis of the survival curves indicated that patients with respiratory system compliance (< 30mL/cmH2O), a higher SOFA score (> 5 points) and higher driving pressure (> 14cmH2O) were more significantly associated with the outcome of death at 28 days and 60 days. CONCLUSION Patients with a body mass index > 32kg/m2, respiratory system compliance < 30mL/cmH2O, driving pressure > 14cmH2O and SOFA score > 5.8 immediately after the initiation of invasive ventilatory support had worse outcomes, and independent risk factors were associated with higher mortality in this population.
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Affiliation(s)
| | | | - Agnaldo José Lopes
- Postgraduate Program in Rehabilitation Sciences, Centro
Universitário Augusto Motta - Rio de Janeiro (RJ), Brazil
| | - Arthur de Sá Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro
Universitário Augusto Motta - Rio de Janeiro (RJ), Brazil
| | - Luis Felipe da Fonseca Reis
- Postgraduate Program in Rehabilitation Sciences, Centro
Universitário Augusto Motta - Rio de Janeiro (RJ), Brazil
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19
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Blot PL, DE Roquetaillade C, Deniau B, Gaugain S, Kindermans M, Julian N, LE Dorze M, Mebazaa A, Chousterman BG, Barthélémy R. Efficacy of almitrine as a rescue therapy for refractory hypoxemia in COVID and non-COVID acute respiratory distress syndrome. A retrospective monocenter study. Minerva Anestesiol 2023; 89:157-165. [PMID: 36287391 DOI: 10.23736/s0375-9393.22.16736-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Almitrine, a drug enhancing hypoxic pulmonary vasoconstriction, has been proposed as a rescue therapy for refractory hypoxemia in COVID related acute respiratory distress syndrome (C-ARDS). We aimed at investigating the response to almitrine depending on the cause of ARDS (COVID vs. non-COVID). METHODS Monocenter retrospective study from 2014 to 2021. All patients diagnosed with moderate to severe ARDS and treated with almitrine as rescue therapy for refractory hypoxemia were studied. Factor independently associated with oxygenation response to almitrine infusion were determined. RESULTS Sixty patients with ARDS and treated with almitrine were analyzed, 36 (60%) due to SARS-CoV-2 infection and 24 (40%) due to other causes. Baseline PaO2/FiO2 was 78 [61-101] mmHg, 76% had at least one prone positioning before the start of almitrine infusion. Median PaO2/FiO2 increased by +38 [7-142] mmHg (+61% [10-151]) after almitrine infusion. PaO2/FiO2 increased by +134 [12-186] mmHg in non-COVID ARDS (NC-ARDS) and by +19 [8-87] mmHg in C-ARDS. The increase in PaO2/FiO2 was lower in C-ARDS than in NC-ARDS (P=0.013). In multivariable analysis, C-ARDS, non-invasive ventilation and concomitant use of norepinephrine were independently associated with a decreased oxygenation response to almitrine infusion. CONCLUSIONS Our study reports a highly variable response to almitrine infusion in ARDS patients with refractory hypoxemia. Independent factors associated with a reduced oxygenation response to almitrine infusion were: COVID ARDS, concomitant use of norepinephrine, and non-invasive ventilatory strategy.
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Affiliation(s)
- Pierre-Louis Blot
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Charles DE Roquetaillade
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Benjamin Deniau
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Samuel Gaugain
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France
| | - Manuel Kindermans
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Nathan Julian
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Matthieu LE Dorze
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Romain Barthélémy
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France - .,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
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20
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Tobin MJ. Defining Acute Respiratory Distress Syndrome (Again): A Plea for Honesty. Am J Respir Crit Care Med 2023; 207:625. [PMID: 36384022 PMCID: PMC10870914 DOI: 10.1164/rccm.202210-1987le] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Martin J. Tobin
- Hines Veterans Affairs HospitalHines, Illinois
- Loyola University of Chicago Stritch School of MedicineHines, Illinois
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21
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Xiang M, Wu X, Jing H, Novakovic VA, Shi J. The intersection of obesity and (long) COVID-19: Hypoxia, thrombotic inflammation, and vascular endothelial injury. Front Cardiovasc Med 2023; 10:1062491. [PMID: 36824451 PMCID: PMC9941162 DOI: 10.3389/fcvm.2023.1062491] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
The role of hypoxia, vascular endothelial injury, and thrombotic inflammation in worsening COVID-19 symptoms has been generally recognized. Damaged vascular endothelium plays a crucial role in forming in situ thrombosis, pulmonary dysfunction, and hypoxemia. Thrombotic inflammation can further aggravate local vascular endothelial injury and affect ventilation and blood flow ratio. According to the results of many studies, obesity is an independent risk factor for a variety of severe respiratory diseases and contributes to high mechanical ventilation rate, high mortality, and slow recovery in COVID-19 patients. This review will explore the mechanisms by which obesity may aggravate the acute phase of COVID-19 and delay long COVID recovery by affecting hypoxia, vascular endothelial injury, and thrombotic inflammation. A systematic search of PubMed database was conducted for papers published since January 2020, using the medical subject headings of "COVID-19" and "long COVID" combined with the following keywords: "obesity," "thrombosis," "endothelial injury," "inflammation," "hypoxia," "treatment," and "anticoagulation." In patients with obesity, the accumulation of central fat restricts the expansion of alveoli, exacerbating the pulmonary dysfunction caused by SARS-CoV-2 invasion, inflammatory damage, and lung edema. Abnormal fat secretion and immune impairment further aggravate the original tissue damage and inflammation diffusion. Obesity weakens baseline vascular endothelium function leading to an early injury and pre-thrombotic state after infection. Enhanced procoagulant activity and microthrombi promote early obstruction of the vascular. Obesity also prolongs the duration of symptoms and increases the risk of sequelae after hospital discharge. Persistent viral presence, long-term inflammation, microclots, and hypoxia may contribute to the development of persistent symptoms, suggesting that patients with obesity are uniquely susceptible to long COVID. Early interventions, including supplemental oxygen, comprehensive antithrombotic therapy, and anti-inflammatory drugs, show effectiveness in many studies in the prevention of serious hypoxia, thromboembolic events, and systemic inflammation, and are therefore recommended to reduce intensive care unit admission, mortality, and sequelae.
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Affiliation(s)
- Mengqi Xiang
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Xiaoming Wu
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Haijiao Jing
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Valerie A. Novakovic
- Department of Research, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, United States
| | - Jialan Shi
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China,Department of Research, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, United States,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, United States,*Correspondence: Jialan Shi, ,
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22
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Rama-Maceiras P, Sanduende Y, Taboada M, Casero M, Leal S, Pita-Romero R, Fernández R, López E, López JA, Pita E, Tubío A, Rodríguez A, Varela M, Campaña D, Delgado C, Lombardía M, Villar E, Blanco P, Martínez A, Sarmiento A, Díaz P, Ojea M, Rodríguez Á, Mouriz L, Cid M, Ramos L, Seoane-Pillado T. Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:70-78. [PMID: 35907774 PMCID: PMC9903149 DOI: 10.1016/j.eimce.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/20/2021] [Accepted: 06/27/2021] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To compare the clinical characteristics, treatments, and evolution of critical patients with COVID-19 pneumonia treated in Intensive Care Units (ICU) after one year of pandemic. METHODOLOGY Multicenter, prospective study, which included critical COVID-19 patients in 9 ICUs in northwestern Spain. The clinical characteristics, treatments, and evolution of patients admitted to the ICU during the months of March-April 2020 (period 1) were compared with patients admitted in January-February 2021 (period 2). RESULTS 337 patients were included (98 in period 1 and 239 in period 2). In period 2, fewer patients required invasive mechanical ventilation (IMV) (65% vs 84%, p < 0.001), using high-flow nasal cannulas (CNAF) more frequently (70% vs 7%, p < 0.001), ventilation non-invasive mechanical (NIMV) (40% vs 14%, p < 0.001), corticosteroids (100% vs 96%, p = 0.007) and prone position in both awake (42% vs 28%, p = 0.012), and intubated patients (67% vs 54%, p = 0.034). The days of IMV, ICU stay and hospital stay were lower in period 2. Mortality was similar in the two periods studied (16% vs 17%). CONCLUSIONS After 1 year of pandemic, we observed that in patients admitted to the ICU, CNAF, NIMV, use of the prone position, and corticosteroids have been used more frequently, reducing the number of patients in IMV, and the length of stay in the ICU and hospital stay. Mortality was similar in the two study periods.
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Affiliation(s)
- Pablo Rama-Maceiras
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Yolanda Sanduende
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra (CHUP), Pontevedra, Spain
| | - Manuel Taboada
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, Spain.
| | - María Casero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - Sonsoles Leal
- Servicio de Anestesiología y Reanimación, Hospital POVISA, Vigo, Pontevedra, Spain
| | - Rafael Pita-Romero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, Spain
| | - Ricardo Fernández
- Servicio de Anestesiología y Reanimación, Hospital Universitario Lucus Augusti (HULA), Lugo, Spain
| | - Eva López
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, Spain
| | - José Antonio López
- Servicio de Anestesiología y Reanimación, Hospital da Mariña, Burela, Lugo, Spain
| | - Elvira Pita
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Ana Tubío
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Arancha Rodríguez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - Marina Varela
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra (CHUP), Pontevedra, Spain
| | - Daniel Campaña
- Servicio de Anestesiología y Reanimación, Hospital POVISA, Vigo, Pontevedra, Spain
| | - Carla Delgado
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, Spain
| | - Mónica Lombardía
- Servicio de Anestesiología y Reanimación, Hospital Universitario Lucus Augusti (HULA), Lugo, Spain
| | - Eva Villar
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, Spain
| | - Pilar Blanco
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Adrián Martínez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Ana Sarmiento
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - Pilar Díaz
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra (CHUP), Pontevedra, Spain
| | - María Ojea
- Servicio de Anestesiología y Reanimación, Hospital POVISA, Vigo, Pontevedra, Spain
| | - Ángel Rodríguez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, Spain
| | - Lorena Mouriz
- Servicio de Anestesiología y Reanimación, Hospital Universitario Lucus Augusti (HULA), Lugo, Spain
| | - Milagros Cid
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, Spain
| | - Lorena Ramos
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Teresa Seoane-Pillado
- The Preventive Medicine and Public Health Sciences, University of A Coruña, A Coruña, Spain
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23
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Rama-Maceiras P, Sanduende Y, Taboada M, Casero M, Leal S, Pita-Romero R, Fernández R, López E, López JA, Pita E, Tubío A, Rodríguez A, Varela M, Campaña D, Delgado C, Lombardía M, Villar E, Blanco P, Martínez A, Sarmiento A, Díaz P, Ojea M, Rodríguez Á, Mouriz L, Cid M, Ramos L, Seoane-Pillado T. [Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study]. Enferm Infecc Microbiol Clin 2023; 41:70-78. [PMID: 34305229 PMCID: PMC8286862 DOI: 10.1016/j.eimc.2021.06.016] [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: 04/27/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023]
Abstract
Objective To compare the clinical characteristics, treatments, and evolution of critical patients with COVID-19 pneumonia treated in intensive care units (ICU) after one year of pandemic. Methodology Multicenter, prospective study, which included critical COVID-19 patients in 9 ICUs in northwestern Spain. The clinical characteristics, treatments, and evolution of patients admitted to the ICU during the months of March-April 2020 (period 1) were compared with patients admitted in January-February 2021 (period 2). Results 337 patients were included (98 in period 1 and 239 in period 2). In period 2, fewer patients required invasive mechanical ventilation (IMV) (65% vs. 84%, P < .001), using high-flow nasal cannulas (CNAF) more frequently (70% vs. 7%, P < .001), ventilation non-invasive mechanical (NIMV) (40% vs. 14%, P < .001), corticosteroids (100% vs. 96%, P = .007) and prone position in both awake (42% vs. 28%, P = .012), and intubated patients (67% vs. 54%, P = .034). The days of IMV, ICU stay and hospital stay were lower in period 2. Mortality was similar in the two periods studied (16% vs. 17%). Conclusions After one year of pandemic, we observed that in patients admitted to the ICU, CNAF, NIMV, use of the prone position, and corticosteroids have been used more frequently, reducing the number of patients in IMV, and the length of stay in the ICU and hospital stay. Mortality was similar in the two study periods.
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Affiliation(s)
- Pablo Rama-Maceiras
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Yolanda Sanduende
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra (CHUP), Pontevedra, España
| | - Manuel Taboada
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, España
| | - María Casero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, España
| | - Sonsoles Leal
- Servicio de Anestesiología y Reanimación, Hospital POVISA, Vigo, Pontevedra, España
| | - Rafael Pita-Romero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España
| | - Ricardo Fernández
- Servicio de Anestesiología y Reanimación, Hospital Universitario Lucus Augusti (HULA), Lugo, España
| | - Eva López
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, España
| | - José Antonio López
- Servicio de Anestesiología y Reanimación, Hospital da Mariña, Burela, Lugo, España
| | - Elvira Pita
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Ana Tubío
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, España
| | - Arancha Rodríguez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, España
| | - Marina Varela
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra (CHUP), Pontevedra, España
| | - Daniel Campaña
- Servicio de Anestesiología y Reanimación, Hospital POVISA, Vigo, Pontevedra, España
| | - Carla Delgado
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España
| | - Mónica Lombardía
- Servicio de Anestesiología y Reanimación, Hospital Universitario Lucus Augusti (HULA), Lugo, España
| | - Eva Villar
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, España
| | - Pilar Blanco
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Adrián Martínez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, España
| | - Ana Sarmiento
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, España
| | - Pilar Díaz
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra (CHUP), Pontevedra, España
| | - María Ojea
- Servicio de Anestesiología y Reanimación, Hospital POVISA, Vigo, Pontevedra, España
| | - Ángel Rodríguez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España
| | - Lorena Mouriz
- Servicio de Anestesiología y Reanimación, Hospital Universitario Lucus Augusti (HULA), Lugo, España
| | - Milagros Cid
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, España
| | - Lorena Ramos
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Teresa Seoane-Pillado
- The Preventive Medicine and Public Health Sciences, University of A Coruña, A Coruña, España
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24
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Fisher JM, Subbian V, Essay P, Pungitore S, Bedrick EJ, Mosier JM. Outcomes in Patients with Acute Hypoxemic Respiratory Failure Secondary to COVID-19 Treated with Noninvasive Respiratory Support versus Invasive Mechanical Ventilation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.12.19.22283704. [PMID: 36597544 PMCID: PMC9810223 DOI: 10.1101/2022.12.19.22283704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose The goal of this study was to compare noninvasive respiratory support to invasive mechanical ventilation as the initial respiratory support in COVID-19 patients with acute hypoxemic respiratory failure. Methods All patients admitted to a large healthcare network with acute hypoxemic respiratory failure associated with COVID-19 and requiring respiratory support were eligible for inclusion. We compared patients treated initially with noninvasive respiratory support (noninvasive positive pressure ventilation by facemask or high flow nasal oxygen) with patients treated initially with invasive mechanical ventilation. The primary outcome was time-to-in-hospital death analyzed using an inverse probability of treatment weighted Cox model adjusted for potential confounders. Secondary outcomes included unweighted and weighted assessments of mortality, lengths-of-stay (intensive care unit and hospital) and time-to-intubation. Results Over the study period, 2354 patients met inclusion criteria. Nearly half (47%) received invasive mechanical ventilation first and 53% received initial noninvasive respiratory support. There was an overall 38% in-hospital mortality (37% for invasive mechanical ventilation and 39% for noninvasive respiratory support). Initial noninvasive respiratory support was associated with an increased hazard of death compared to initial invasive mechanical ventilation (HR: 1.61, p < 0.0001, 95% CI: 1.33 - 1.94). However, patients on initial noninvasive respiratory support also experienced an increased hazard of leaving the hospital sooner, but the hazard ratio waned with time (HR: 0.97, p < 0.0001, 95% CI: 0.96 - 0.98). Conclusion These data show that the COVID-19 patients with acute hypoxemic respiratory failure initially treated with noninvasive respiratory support had an increased hazard of in-hospital death.
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Affiliation(s)
- Julia M Fisher
- Statistics Consulting Laboratory, The University of Arizona, Tucson, AZ
- BIO5 Institute, The University of Arizona, Tucson, AZ
| | - Vignesh Subbian
- Department of Systems and Industrial Engineering, College of Engineering, The University of Arizona, Tucson, AZ
- Department of Biomedical Engineering, College of Engineering, The University of Arizona, Tucson, AZ
- BIO5 Institute, The University of Arizona, Tucson, AZ
| | - Patrick Essay
- Department of Systems and Industrial Engineering, College of Engineering, The University of Arizona, Tucson, AZ
| | - Sarah Pungitore
- Program in Applied Mathematics, The University of Arizona, Tucson, AZ
| | - Edward J Bedrick
- Statistics Consulting Laboratory, The University of Arizona, Tucson, AZ
- BIO5 Institute, The University of Arizona, Tucson, AZ
| | - Jarrod M Mosier
- Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, The University of Arizona College of Medicine, Tucson, AZ
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25
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Pini S, Radovanovic D, Saad M, Gatti M, Danzo F, Mondoni M, Aliberti S, Centanni S, Blasi F, Chiumello DA, Santus P. Acute Improvements of Oxygenation with Cpap and Clinical Outcomes in Severe COVID-19 Pneumonia: A Multicenter, Retrospective Study. J Clin Med 2022; 11:jcm11237186. [PMID: 36498759 PMCID: PMC9735603 DOI: 10.3390/jcm11237186] [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: 11/04/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
It is not known if the degrees of improvement in oxygenation obtained by CPAP can predict clinical outcomes in patients with COVID-19 pneumonia. This was a retrospective study conducted on patients with severe COVID-19 pneumonia treated with CPAP in three University hospitals in Milan, Italy, from March 2020 to March 2021. Arterial gas analysis was obtained before and 1 h after starting CPAP. CPAP failure included either death in the respiratory units while on CPAP or the need for intubation. Two hundred and eleven patients (mean age 64 years, 74% males) were included. Baseline median PaO2, PaO2/FiO2 ratio (P/F), and the alveolar-arterial (A-a) O2 gradient were 68 (57−83) mmHg, 129 (91−179) mmHg and 310 (177−559) mmHg, respectively. Forty-two (19.9%) patients died in the respiratory units and 51 (24.2%) were intubated. After starting CPAP, PaO2/FiO2 increased by 57 (12−113; p < 0.001) mmHg, and (A-a) O2 was reduced by 68 (−25−250; p < 0.001) mmHg. A substantial overlap of PaO2, P/F, and A-a gradient at baseline and during CPAP was observed in CPAP failures and successes; CPAP-associated improvements in oxygenation in both groups were similar. In conclusion, CPAP-associated improvements in oxygenation do not predict clinical outcomes in patients with severe COVID-19 pneumonia.
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Affiliation(s)
- Stefano Pini
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Ospedale Luigi Sacco, Polo Universitario, 20157 Milano, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Ospedale Luigi Sacco, Polo Universitario, 20157 Milano, Italy
| | - Marina Saad
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Ospedale Luigi Sacco, Polo Universitario, 20157 Milano, Italy
| | - Marina Gatti
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Ospedale Luigi Sacco, Polo Universitario, 20157 Milano, Italy
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi Di Milano, 20157 Milano, Italy
| | - Fiammetta Danzo
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Ospedale Luigi Sacco, Polo Universitario, 20157 Milano, Italy
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi Di Milano, 20157 Milano, Italy
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy
- Dipartimento di Scienze Della Salute, Università Degli Studi Di Milano, 20146 Milano, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy
- Respiratory Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy
- Dipartimento di Scienze Della Salute, Università Degli Studi Di Milano, 20146 Milano, Italy
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, 20122 Milano, Italy
| | - Davide Alberto Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, 20142 Milano, Italy
- Coordinated Research Center on Respiratory Failure, Università Degli Studi Di Milano, 20142 Milano, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Ospedale Luigi Sacco, Polo Universitario, 20157 Milano, Italy
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi Di Milano, 20157 Milano, Italy
- Correspondence: ; Tel.: +39-02-39-042-372; Fax: +39-02-39-042-473
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Reddy MP, Subramaniam A, Chua C, Ling RR, Anstey C, Ramanathan K, Slutsky AS, Shekar K. Respiratory system mechanics, gas exchange, and outcomes in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome: a systematic review and meta-analysis. THE LANCET. RESPIRATORY MEDICINE 2022; 10:1178-1188. [PMID: 36335956 PMCID: PMC9708089 DOI: 10.1016/s2213-2600(22)00393-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/28/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
The association of respiratory mechanics, particularly respiratory system static compliance (CRS), with severity of hypoxaemia in patients with COVID-19-related acute respiratory distress syndrome (ARDS) has been widely debated, with some studies reporting distinct ARDS phenotypes based on CRS. Ascertaining whether such phenotypes exist is important, because they might indicate the need for ventilation strategies that differ from those used in patients with ARDS due to other causes. In a systematic review and meta-analysis of studies published between Dec 1, 2019, and March 14, 2022, we evaluated respiratory system mechanics, ventilator parameters, gas exchange parameters, and clinical outcomes in patients with COVID-19-related ARDS. Among 11 356 patients in 37 studies, mean reported CRS, measured close to the time of endotracheal intubation, was 35·8 mL/cm H2O (95% CI 33·9-37·8; I2=96·9%, τ2=32·6). Pooled mean CRS was normally distributed. Increasing ARDS severity (assessed by PaO2/FiO2 ratio as mild, moderate, or severe) was associated with decreasing CRS. We found no evidence for distinct CRS-based clinical phenotypes in patients with COVID-19-related ARDS, and we therefore conclude that no change in conventional lung-protective ventilation strategies is warranted. Future studies should explore the personalisation of mechanical ventilation strategies according to factors including respiratory system mechanics and haemodynamic status in patients with ARDS.
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Affiliation(s)
- Mallikarjuna Ponnapa Reddy
- Department of Intensive Care Medicine, Calvary Hospital, Canberra, ACT, Australia,Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia,Correspondence to: Dr Mallikarjuna Ponnapa Reddy, Department of Intensive Care Medicine, Calvary Hospital, Canberra ACT 2617, Australia
| | - Ashwin Subramaniam
- Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia,Peninsula Clinical School, Monash University, Clayton, VIC, Australia
| | - Clara Chua
- Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christopher Anstey
- Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine University of Queensland, Brisbane, QLD, Australia,School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Kollengode Ramanathan
- Department of Surgery, National University of Singapore, Singapore,Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore
| | - Arthur S Slutsky
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada,Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Kiran Shekar
- Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine University of Queensland, Brisbane, QLD, Australia,Department of Intensive Care Medicine, Bond University, Gold Coast, QLD, Australia,Adult Intensive Care Services and Critical Care Research Group, the Prince Charles Hospital, Brisbane, QLD, Australia,Department of Intensive Care Medicine, Queensland University of Technology, Brisbane, QLD, Australia
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27
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Pulse oximeter provision and training of non-physician anesthetists in Zambia: a qualitative study exploring perioperative care after training. BMC Health Serv Res 2022; 22:1395. [PMID: 36419106 PMCID: PMC9682720 DOI: 10.1186/s12913-022-08698-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pulse oximetry monitoring is included in the WHO Safe Surgery Checklist and recognized as an essential perioperative safety monitoring device. However, many low resource countries do not have adequate numbers of pulse oximeters available or healthcare workers trained in their use. Lifebox, a nonprofit organization focused on improving anesthetic and surgical safety, has procured and distributed pulse oximeters and relevant educational training in over 100 countries. We aimed to understand qualitatively how pulse oximetry provision and training affected a group of Zambian non-physician anesthetists' perioperative care and what, if any, capacity gaps remain. METHODS We identified and approached non-physician anesthetists (NPAPs) in Zambia who attended a 2019 Lifebox pulse oximetry training course to participate in a semi-structured interview. Interviews were audio recorded and transcribed. Codes were iteratively derived; the codebook was tested for inter-rater reliability (pooled kappa > 0.70). Team-based thematic analysis identified emergent themes on pulse oximetry training and perioperative patient care. RESULTS Ten of the 35 attendees were interviewed. Two themes emerged concerning pulse oximetry provision and training in discussion with non-physician anesthetists about their experience after training: (1) Impact on Non-Physician Anesthetists and the Healthcare Team and (2) Impact on Perioperative Patient Monitoring. These broad themes were further explored through subthemes. Increased knowledge brought confidence in monitoring and facilitated quick interventions. NPAPs reported improved preoperative assessments and reaffirmed the necessity of having pulse oximetry intraoperatively. However, lack of device availability led to case delays or cancellations. A portable device travelling with the patient to the recovery ward was noted as a major improvement in postoperative care. Pulse oximeters also improved communication between nurses and NPAPs, giving NPAPs confidence in the recovery process. However, this was not always possible, as lack of pulse oximeters and ward staff unfamiliarity with oximetry was commonly reported. NPAPs expressed that wider pulse oximetry availability and training would be beneficial. CONCLUSION Among a cohort of non-physician anesthetists in Zambia, the provision of pulse oximeters and training was perceived to improve patient care throughout the perioperative timeline. However, capacity and resource gaps remain in their practice settings, especially during transfers of care. NPAPs identified a number of areas where patient care and safety could be improved, including expanding access to pulse oximetry training and provision to ward and nursing staff to ensure the entire healthcare team is aware of the benefits and importance of its use.
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Lee HJ, Kim J, Choi M, Choi WI, Joh J, Park J, Kim J. Early intubation and clinical outcomes in patients with severe COVID-19: a systematic review and meta-analysis. Eur J Med Res 2022; 27:226. [PMID: 36329482 PMCID: PMC9631590 DOI: 10.1186/s40001-022-00841-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Evidence regarding the timing of the application of mechanical ventilation among patients with severe coronavirus disease (COVID-19) is insufficient. This systematic review and meta-analysis aimed to evaluate the effectiveness of early intubation compared to late intubation in patients with severe and critical COVID-19. METHODS For this study, we searched the MEDLINE, EMBASE, and Cochrane databases as well as one Korean domestic database on July 15, 2021. We updated the search monthly from September 10, 2021 to February 10, 2022. Studies that compared early intubation with late intubation in patients with severe COVID-19 were eligible for inclusion. Relative risk (RR) and mean difference (MD) were calculated as measures of effect using the random-effects model for the pooled estimates of in-hospital mortality, intensive care unit (ICU) length of stay (LOS), duration of mechanical ventilation (MV), hospital LOS, ICU-free days, and ventilator-free days. Subgroup analysis was performed based on the definition of early intubation and the index time. To assess the risk of bias in the included studies, we used the Risk of Bias Assessment tool for Non-randomized studies 2.0. RESULTS Of the 1523 records identified, 12 cohort studies, involving 2843 patients with severe COVID-19 were eligible. There were no differences in in-hospital mortality (8 studies, n = 795; RR 0.91, 95% CI 0.75-1.10, P = 0.32, I2 = 33%), LOS in the ICU (9 studies, n = 978; MD -1.77 days, 95% CI -4.61 to 1.07 days, P = 0.22, I2 = 78%), MV duration (9 studies, n = 1,066; MD -0.03 day, 95% CI -1.79 to 1.72 days, P = 0.97, I2 = 49%), ICU-free days (1 study, n = 32; 0 day vs. 0 day; P = 0.39), and ventilator-free days (4 studies, n = 344; MD 0.94 day, 95% CI -4.56 to 6.43 days, P = 0.74, I2 = 54%) between the early and late intubation groups. However, the early intubation group had significant advantage in terms of hospital LOS (6 studies, n = 738; MD -4.32 days, 95% CI -7.20 to -1.44 days, P = 0.003, I2 = 45%). CONCLUSION This study showed no significant difference in both primary and secondary outcomes between the early intubation and late intubation groups. Trial registration This study was registered in the Prospective Register of Systematic Reviews on 16 February, 2022 (registration number CRD42022311122).
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Affiliation(s)
- Hyeon-Jeong Lee
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Joohae Kim
- grid.415619.e0000 0004 1773 6903Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Miyoung Choi
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Won-Il Choi
- grid.49606.3d0000 0001 1364 9317Department of Internal Medicine, Myongji Hospital, Hanyang University, Gyeonggi-do, Republic of Korea
| | - Joonsung Joh
- grid.415619.e0000 0004 1773 6903Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Jungeun Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Junghyun Kim
- grid.415619.e0000 0004 1773 6903Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea ,grid.488450.50000 0004 1790 2596Present Address: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
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29
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Bruinooge AJG, Mao R, Gottschalk TH, Srinathan SK, Buduhan G, Tan L, Halayko AJ, Kidane B. Identifying biomarkers of ventilator induced lung injury during one-lung ventilation surgery: a scoping review. J Thorac Dis 2022; 14:4506-4520. [PMID: 36524064 PMCID: PMC9745541 DOI: 10.21037/jtd-20-2301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/14/2022] [Indexed: 10/08/2023]
Abstract
BACKGROUND Ventilator-induced lung injury (VILI) can occur as a result of mechanical ventilation to two lungs. Thoracic surgery often requires one-lung ventilation (OLV). The potential for VILI is likely higher in OLV. The impact of OLV on development of post-operative pulmonary complications is not well understood. We aimed to perform a scoping review to determine reliable biomarkers of VILI after OLV. METHODS A scoping review was performed using Cochrane Collaboration methodology. We searched Medline, EMBASE and SCOPUS. Gray literature was searched. Studies of adult human or animal models without pre-existing lung damage exposed to OLV, with biomarker responses analyzed were included. RESULTS After screening 5,613 eligible papers, 89 papers were chosen for full text review, with 29 meeting inclusion. Approximately half (52%, n=15) of studies were conducted in humans in an intra-operative setting. Bronchoalveolar lavage (BAL) & serum analyses with enzyme-linked immunosorbent assay (ELISA)-based assays were most commonly used. The majority of analytes were investigated by a single study. Of the analytes that were investigated by two or more studies (n=31), only 16 were concordant in their findings. Across all sample types and studies 84% (n=66) of the 79 inflammatory markers and 75% (n=6) of the 8 anti-inflammatory markers tested were found to increase. Half (48%) of all studies showed an increase in TNF-α or IL-6. CONCLUSIONS A scoping review of the state of the evidence demonstrated that candidate biomarkers with the most evidence and greatest reliability are general markers of inflammation, such as IL-6 and TNF-α assessed using ELISA assays. Studies were limited in the number of biomarkers measured concurrently, sample size, and studies using human participants. In conclusion these identified markers can potentially serve as outcome measures for studies on OLV.
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Affiliation(s)
- Allan J. G. Bruinooge
- Section of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada
- University of Manitoba, Winnipeg, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | | | | | - Sadeesh K. Srinathan
- Section of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada
- University of Manitoba, Winnipeg, Canada
| | - Gordon Buduhan
- Section of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada
- University of Manitoba, Winnipeg, Canada
| | - Lawrence Tan
- Section of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada
- University of Manitoba, Winnipeg, Canada
| | - Andrew J. Halayko
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada
- University of Manitoba, Winnipeg, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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30
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González-Castro A, Fajardo Campoverde A, Roncalli A. High-flow nasal cannulas in COVID-19 pneumonia. Med Clin (Barc) 2022; 159:e53. [PMID: 34654553 PMCID: PMC8324403 DOI: 10.1016/j.medcli.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Alejandro González-Castro
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España,Autor para correspondencia
| | | | - Angello Roncalli
- Unidad de Fisioterapia Respiratoria, Hospital General del Estado de Alagoas, Maceió, Brasil
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31
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González-Castro A, Fajardo Campoverde A, Roncalli A. High-flow nasal cannulas in COVID-19 pneumonia. MEDICINA CLINICA (ENGLISH ED.) 2022; 159:e53. [PMID: 36212521 PMCID: PMC9527218 DOI: 10.1016/j.medcle.2021.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alejandro González-Castro
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander. Spain,Corresponding author
| | | | - Angello Roncalli
- Unidad de Fisioterapia Respiratoria, General Hospital of the State of Alagoas, Maceió, Brazil
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32
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Quinn KL, Abdel‐Qadir H, Barrett K, Bartsch E, Beaman A, Biering‐Sørensen T, Colacci M, Cressman A, Detsky A, Gosset A, Lassen MH, Kandel C, Khaykin Y, Lapointe‐Shaw L, Lovblom E, MacFadden DR, Perkins B, Rothman KJ, Skaarup KG, Stall N, Tang T, Yarnell C, Zipursky J, Warkentin MT, Fralick M. Variation in the risk of death due to COVID-19: An international multicenter cohort study of hospitalized adults. J Hosp Med 2022; 17:793-802. [PMID: 36040111 PMCID: PMC9539016 DOI: 10.1002/jhm.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/28/2022] [Accepted: 07/06/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is wide variation in mortality among patients hospitalized with COVID-19. Whether this is related to patient or hospital factors is unknown. OBJECTIVE To compare the risk of mortality for patients hospitalized with COVID-19 and to determine whether the majority of that variation was explained by differences in patient characteristics across sites. DESIGN, SETTING, AND PARTICIPANTS An international multicenter cohort study of hospitalized adults with laboratory-confirmed COVID-19 enrolled from 10 hospitals in Ontario, Canada and 8 hospitals in Copenhagen, Denmark between January 1, 2020 and November 11, 2020. MAIN OUTCOMES AND MEASURES Inpatient mortality. We used a multivariable multilevel regression model to compare the in-hospital mortality risk across hospitals and quantify the variation attributable to patient-level factors. RESULTS There were 1364 adults hospitalized with COVID-19 in Ontario (n = 1149) and in Denmark (n = 215). In Ontario, the absolute risk of in-hospital mortality ranged from 12.0% to 39.8% across hospitals. Ninety-eight percent of the variation in mortality in Ontario was explained by differences in the characteristics of the patients. In Denmark, the absolute risk of inpatients ranged from 13.8% to 20.6%. One hundred percent of the variation in mortality in Denmark was explained by differences in the characteristics of the inpatients. CONCLUSION There was wide variation in inpatient COVID-19 mortality across hospitals, which was largely explained by patient-level factors, such as age and severity of presenting illness. However, hospital-level factors that could have affected care, including resource availability and capacity, were not taken into account. These findings highlight potential limitations in comparing crude mortality rates across hospitals for the purposes of reporting on the quality of care.
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Affiliation(s)
- Kieran L. Quinn
- Department of Medicine, Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
- Division of Internal Medicine, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Interdepartmental Division of Palliative Care, Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Husam Abdel‐Qadir
- Department of Medicine, Division of CardiologyWomen's College HospitalTorontoOntarioCanada
- Department of MedicineUniversity Health NetworkTorontoOntarioCanada
| | - Kali Barrett
- Department of MedicineUniversity Health NetworkTorontoOntarioCanada
- Department of Medicine, Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoOntarioCanada
| | - Emily Bartsch
- Department of Medicine, Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Andrea Beaman
- Department of PharmacyTrillium Health PartnersMississaugaOntarioCanada
| | | | - Michael Colacci
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Alex Cressman
- Division of Internal Medicine, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Allan Detsky
- Department of Medicine, Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Alexi Gosset
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Mats H. Lassen
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Chris Kandel
- Department of MedicineMichael Garron HospitalTorontoOntarioCanada
| | - Yaariv Khaykin
- Department of MedicineSouthlake Regional Health CentreNewmarketOntarioCanada
| | | | - Erik Lovblom
- Department of Medicine, Lunenfeld‐Tanenbaum Research InstituteMount Sinai HospitalTorontoOntarioCanada
| | - Derek R. MacFadden
- Department of MedicineThe Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Bruce Perkins
- Department of MedicineUniversity Health NetworkTorontoOntarioCanada
| | - Kenneth J Rothman
- Department of Epidemiology, School of Public HealthBoston UniversityMassachusettsBostonUSA
| | | | - Nathan Stall
- Department of Medicine, Division of General Internal Medicine and GeriatricsSinai Health and the University Health NetworkTorontoOntarioCanada
| | - Terence Tang
- Department of Medicine, Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoOntarioCanada
| | - Chris Yarnell
- Department of Medicine, Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoOntarioCanada
| | - Jonathan Zipursky
- Department of MedicineSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Matthew T. Warkentin
- Department of Medicine, Lunenfeld‐Tanenbaum Research InstituteMount Sinai HospitalTorontoOntarioCanada
| | - Mike Fralick
- Department of Medicine, Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
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33
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de Hesselle ML, Borgmann S, Rieg S, Vehreshild JJ, Spinner CD, Koll CEM, Hower M, Stecher M, Ebert D, Hanses F, Schumann J. Invasiveness of Ventilation Therapy Is Associated to Prevalence of Secondary Bacterial and Fungal Infections in Critically Ill COVID-19 Patients. J Clin Med 2022; 11:jcm11175239. [PMID: 36079168 PMCID: PMC9457079 DOI: 10.3390/jcm11175239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 12/17/2022] Open
Abstract
Superinfections are a fundamental critical care problem, and their significance in severe COVID-19 cases needs to be determined. This study analyzed data from the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort focusing on intensive care patients. A retrospective analysis of patient data from 840 cases of COVID-19 with critical courses demonstrated that co-infections were frequently present and were primarily of nosocomial origin. Furthermore, our analysis showed that invasive therapy procedures accompanied an increased risk for healthcare-associated infections. Non-ventilated ICU patients were rarely affected by secondary infections. The risk of infection, however, increased even when non-invasive ventilation was used. A further, significant increase in infection rates was seen with the use of invasive ventilation and even more so with extracorporeal membrane oxygenation (ECMO) therapy. The marked differences among ICU techniques used for the treatment of COVID-19-induced respiratory failure in terms of secondary infection risk profile should be taken into account for the optimal management of critically ill COVID-19 patients, as well as for adequate antimicrobial therapy.
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Affiliation(s)
- Marie Louise de Hesselle
- University Clinic and Outpatient Clinic for Anesthesiology and Operative Intensive Care, University Medicine Halle (Saale), 06112 Halle (Saale), Germany
| | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, 85049 Ingolstadt, Germany
| | - Siegbert Rieg
- Department of Medicine II, University of Freiburg, 79106 Freiburg, Germany
| | - Jörg Janne Vehreshild
- Department II of Internal Medicine, Hematology and Oncology, Goethe University Frankfurt, 60323 Frankfurt, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Christoph D. Spinner
- Department of Internal Medicine II, University Hospital Rechts Der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- German Center for Infection Research (DZIF), 38106 Brunswick, Germany
| | - Carolin E. M. Koll
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Martin Hower
- Department of Pneumology, Infectious Diseases, Internal Medicine and Intensive Care, Klinikum Dortmund GmbH, 44137 Dortmund, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Daniel Ebert
- University Clinic and Outpatient Clinic for Anesthesiology and Operative Intensive Care, University Medicine Halle (Saale), 06112 Halle (Saale), Germany
| | - Frank Hanses
- Emergency Department and Department for Infection Control and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Julia Schumann
- University Clinic and Outpatient Clinic for Anesthesiology and Operative Intensive Care, University Medicine Halle (Saale), 06112 Halle (Saale), Germany
- Correspondence:
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Saigal S, Joshi A, Panda R, Goyal A, Kodamanchili S, Anand A, Brahmam D, Jha S, Pakhare A, Karna ST, Khurana A, Singh P, Niwariya Y, Khadanga S, Sharma JP, Joshi R. Changing Critical Care Patterns and Associated Outcomes in Mechanically Ventilated Severe COVID-19 Patients in Different Time Periods: An Explanatory Study from Central India. Indian J Crit Care Med 2022; 26:1022-1030. [PMID: 36213712 PMCID: PMC9492749 DOI: 10.5005/jp-journals-10071-24279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background The outcomes in critical illness depend on disease severity, practice protocols, workload, and access to care. This study investigates the factors affecting outcomes in mechanically ventilated coronavirus disease-2019 acute respiratory distress syndrome (COVID-19 ARDS) patients admitted in a tertiary teaching hospital intensive care unit (ICU) in Central India with reference to different time periods in pandemic. This is one of the largest series of mechanically ventilated COVID-19 ARDS patients, globally. Methods This retrospective cohort study classified the entire data into four time periods (Period 1: April 2020 to June 2020; Period 2: July 2020 to September 2020; Period 3: October 2020 to December 2020; and Period 4: January 2021 to April 2021). We performed a multivariable-adjusted analysis to evaluate predictors of mortality, adjusted for baseline-severity, sequential organ failure assessment (SOFA score) and time period. We applied mixed-effect binomial logistic regression to model fixed-effect variables with incremental complexity. Results Among the 56 survivors (19.4%) out of 288 mechanically ventilated patients, there was an up-gradient of survival proportion (0, 18.2, 17.4, and 28.6%) in four time periods. Symptom–intubation interval (OR 1.16; 95% CI 1.03–1.31) and driving pressures (DPs) (OR 1.17; 95% CI 1.07–1.28) were significant predictors of mortality in the model having minimal AIC and BIC values. Patients aged above 60 years also had a larger effect, but statistically insignificant effect favoring mortality (OR 1.99; 95% CI 0.92–4.27). The most complex but less parsimonious model (with higher AIC/BIC) indicated the protective odds of high steroid on mortality (OR 0.59; 95% CI 0.59–0.82). Conclusion The outcomes in mechanically ventilated COVID-19 ARDS patients are heterogeneous across time windows and may be affected by the complex interaction of baseline risk and critical care parameters. How to cite this article Saigal S, Joshi A, Panda R, Goyal A, Kodamanchili S, Anand A, et al. Changing Critical Care Patterns and Associated Outcomes in Mechanically Ventilated Severe COVID-19 Patients in Different Time Periods: An Explanatory Study from Central India. Indian J Crit Care Med 2022;26(9):1022–1030.
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Affiliation(s)
- Saurabh Saigal
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
- Saurabh Saigal, Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India, Phone: +91 9425301181, e-mail:
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rajesh Panda
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Abhishek Goyal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Saiteja Kodamanchili
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Abhijeet Anand
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Dodda Brahmam
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Surya Jha
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Abhijit Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sunaina Tejpal Karna
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Alkesh Khurana
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Pooja Singh
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Yogesh Niwariya
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sagar Khadanga
- Department of Medicine, AIIMS Bhopal Saket Nagar, Bhopal, Madhya Pradesh, India
| | - Jai Prakash Sharma
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rajnish Joshi
- Department of Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Krishnan JK, Rajan M, Baer BR, Hoffman KL, Alshak MN, Aronson KI, Goyal P, Ezeomah C, Hill SS, Martinez FJ, Turetz ML, Wells MT, Safford MM, Schenck EJ. Assessing mortality differences across acute respiratory failure management strategies in Covid-19. J Crit Care 2022; 70:154045. [PMID: 35490502 PMCID: PMC9049881 DOI: 10.1016/j.jcrc.2022.154045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/14/2022] [Accepted: 04/06/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE Prolonged observation could avoid invasive mechanical ventilation (IMV) and related risks in patients with Covid-19 acute respiratory failure (ARF) compared to initiating early IMV. We aimed to determine the association between ARF management strategy and in-hospital mortality. MATERIALS AND METHODS Patients in the Weill Cornell Covid-19 registry who developed ARF between March 5 - March 25, 2020 were exposed to an early IMV strategy; between March 26 - April 1, 2020 to an intermediate strategy; and after April 2 to prolonged observation. Cox proportional hazards regression was used to model in-hospital mortality and test an interaction between ARF management strategy and modified sequential organ failure assessment (mSOFA). RESULTS Among 632 patients with ARF, 24% of patients in the early IMV strategy died versus 28% in prolonged observation. At lower mSOFA, prolonged observation was associated with lower mortality compared to early IMV (at mSOFA = 0, HR 0.16 [95% CI 0.04-0.57]). Mortality risk increased in the prolonged observation strategy group with each point increase in mSOFA score (HR 1.29 [95% CI 1.10-1.51], p = 0.002). CONCLUSION In Covid-19 ARF, prolonged observation was associated with a mortality benefit at lower mSOFA scores, and increased mortality at higher mSOFA scores compared to early IMV.
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Affiliation(s)
- Jamuna K Krishnan
- Divison of Pulmonary and Critical Care Medicine, Weill Cornell Department of Medicine, NY, NY, United States of America.
| | - Mangala Rajan
- Division of General Internal Medicine, Weill Cornell Department of Medicine, NY, NY, United States of America
| | - Benjamin R Baer
- Department of Statistics and Data Science, Cornell University, Ithaca, New York, United States of America
| | - Katherine L Hoffman
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, NY, NY, United States of America
| | - Mark N Alshak
- Division of General Internal Medicine, Weill Cornell Department of Medicine, NY, NY, United States of America
| | - Kerri I Aronson
- Divison of Pulmonary and Critical Care Medicine, Weill Cornell Department of Medicine, NY, NY, United States of America
| | - Parag Goyal
- Division of General Internal Medicine, Weill Cornell Department of Medicine, NY, NY, United States of America; Division of Cardiology, Weill Cornell Department of Medicine, NY, NY, United States of America
| | - Chiomah Ezeomah
- Division of General Internal Medicine, Weill Cornell Department of Medicine, NY, NY, United States of America
| | - Shanna S Hill
- Department of Anesthesiology, Weill Cornell Medicine, NY, NY, United States of America
| | - Fernando J Martinez
- Divison of Pulmonary and Critical Care Medicine, Weill Cornell Department of Medicine, NY, NY, United States of America
| | - Meredith L Turetz
- Divison of Pulmonary and Critical Care Medicine, Weill Cornell Department of Medicine, NY, NY, United States of America
| | - Martin T Wells
- Department of Statistics and Data Science, Cornell University, Ithaca, New York, United States of America; Department of Population Health Sciences, Weill Cornell Medicine, NY, NY, United States of America
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Department of Medicine, NY, NY, United States of America
| | - Edward J Schenck
- Divison of Pulmonary and Critical Care Medicine, Weill Cornell Department of Medicine, NY, NY, United States of America
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Serbanescu-Kele Apor de Zalán CMC, Banwarie RP, Banwari KD, Panka BA. The unfriendly side of "happy hypoxaemia": Sudden cardiac death. Pulmonology 2022; 28:484-486. [PMID: 35864055 PMCID: PMC9623138 DOI: 10.1016/j.pulmoe.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- C M C Serbanescu-Kele Apor de Zalán
- Department of Internal Medicine and Intensive Care, s Lands Hospitaal, Paramaribo, Suriname; Department of Intensive Care, VieCuri Medical Center, Venlo, 5900 BX Venlo, the Netherlands.
| | - R P Banwarie
- Department of Internal Medicine and Intensive Care, s Lands Hospitaal, Paramaribo, Suriname; Department of Intensive Care, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - K D Banwari
- Department of Internal Medicine and Intensive Care, s Lands Hospitaal, Paramaribo, Suriname
| | - B A Panka
- Department of Internal Medicine and Intensive Care, s Lands Hospitaal, Paramaribo, Suriname; Department of Intensive Care, Academic Hospital Paramaribo, Paramaribo, Suriname
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Threshold of increase in oxygen demand to predict mechanical ventilation use in novel coronavirus disease 2019: A retrospective cohort study incorporating restricted cubic spline regression. PLoS One 2022; 17:e0269876. [PMID: 35834478 PMCID: PMC9282654 DOI: 10.1371/journal.pone.0269876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/29/2022] [Indexed: 12/15/2022] Open
Abstract
Background
Rapid deterioration of oxygenation occurs in novel coronavirus disease 2019 (COVID-19), and prediction of mechanical ventilation (MV) is needed for allocation of patients to intensive care unit. Since intubation is usually decided based on varying clinical conditions, such as required oxygen changes, we aimed to elucidate thresholds of increase in oxygen demand to predict MV use within 12 h.
Methods
A single-center retrospective cohort study using data between January 2020 and January 2021was conducted. Data were retrieved from the hospital data warehouse. Adult patients diagnosed with COVID-19 with a positive polymerase chain reaction (PCR) who needed oxygen during admission were included. Hourly increments in oxygen demand were calculated using two consecutive oxygen values. Covariates were selected from measurements at the closest time points of oxygen data. Prediction of MV use within 12 h by required oxygen changes was evaluated with the area under the receiver operating curves (AUCs). A threshold for increased MV use risk was obtained from restricted cubic spline curves.
Results
Among 66 eligible patients, 1835 oxygen data were analyzed. The AUC was 0.756 for predicting MV by oxygen demand changes, 0.888 by both amounts and changes in oxygen, and 0.933 by the model adjusted with respiratory rate, PCR quantification cycle (Ct), and days from PCR. The threshold of increments of required oxygen was identified as 0.44 L/min/h and the probability of MV use linearly increased afterward. In subgroup analyses, the threshold was lower (0.25 L/min/h) when tachypnea or frequent respiratory distress existed, whereas it was higher (1.00 L/min/h) when viral load is low (Ct ≥20 or days from PCR >7 days).
Conclusions
Hourly changes in oxygen demand predicted MV use within 12 h, with a threshold of 0.44 L/min/h. This threshold was lower with an unstable respiratory condition and higher with a low viral load.
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Zheng M, Jahanandish H, Li H. Dynamic Classification of Imageless Bioelectrical Impedance Tomography Features with Attention-Driven Spatial Transformer Neural Network. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:2495-2501. [PMID: 36086650 DOI: 10.1109/embc48229.2022.9870921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Point-of-Care monitoring devices have proven to be pivotal in the timely screening and intervention of critical care patients. The urgent demands for their deployment in the COVID-19 pandemic era has translated into the escalation of rapid, reliable, and low-cost monitoring systems research and development. Electrical Impedance Tomography (EIT) is a highly promising modality in providing deep tissue imaging that aids in patient bedside diagnosis and treatment. Motivated to bring forth an accurate and intelligent EIT screening system, we bypassed the complexity and challenges typically associated with its image reconstruction and feature identification processes by solely focusing on the raw data output to extract the embedded knowledge. We developed a novel machine learning architecture based on an attention-driven spatial transformer neural network to specifically accommodate for the patterns and dependencies within EIT raw data. Through elaborate precision-mapped phantom experiments, we validated the reproduction and recognition of features with systemically controlled changes. We demonstrated over 95% accuracy via state-of-the-art machine learning models, and an enhanced performance using our adapted transformer pipeline with shorter training time and greater computational efficiency. Our approach of using imageless EIT driven by a novel attention-focused feature learning algorithm is highly promising in revolutionizing conventional EIT operations and augmenting its practical usage in medicine and beyond.
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Mentzelopoulos SD, Adamos G. Key Advances in Intensive Care and the Coronavirus Disease-19 Research and Practice Boost. J Clin Med 2022; 11:jcm11123370. [PMID: 35743440 PMCID: PMC9224744 DOI: 10.3390/jcm11123370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 12/15/2022] Open
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Prevention and Treatment of Life-Threatening COVID-19 May Be Possible with Oxygen Treatment. Life (Basel) 2022; 12:life12050754. [PMID: 35629421 PMCID: PMC9142938 DOI: 10.3390/life12050754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/22/2022] [Accepted: 05/12/2022] [Indexed: 01/08/2023] Open
Abstract
Most SARS CoV-2 infections probably occur unnoticed or cause only cause a mild common cold that does not require medical intervention. A significant proportion of more severe cases is characterized by early neurological symptoms such as headache, fatigue, and impaired consciousness, including respiratory distress. These symptoms suggest hypoxia, specifically affecting the brain. The condition is best explained by primary replication of the virus in the nasal respiratory and/or the olfactory epithelia, followed by an invasion of the virus into the central nervous system, including the respiratory centers, either along a transneural route, through disruption of the blood-brain barrier, or both. In patients, presenting with early dyspnea, the primary goal of therapy should be the reversal of brain hypoxia as efficiently as possible. The first approach should be intermittent treatment with 100% oxygen using a tight oronasal mask or a hood. If this does not help within a few hours, an enclosure is needed to increase the ambient pressure. This management approach is well established in the hypoxia-related diseases in diving and aerospace medicine and preserves the patient’s spontaneous breathing. Preliminary research evidence indicates that even a small elevation of the ambient pressure might be lifesaving. Other neurological symptoms, presenting particularly in long COVID-19, suggest imbalance of the autonomous nervous system, i.e., dysautonomia. These patients could benefit from vagal nerve stimulation.
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Young AA, Rosas LE, Cooper ES, Yaxley PE, Davis IC. Impact of cytidine diphosphocholine on oxygenation in client-owned dogs with aspiration pneumonia. J Vet Intern Med 2022; 36:1089-1099. [PMID: 35484990 PMCID: PMC9151482 DOI: 10.1111/jvim.16434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND New drugs for veterinary patients with acute respiratory distress syndrome (ARDS) are urgently needed. Early or late postinfection treatment of influenza-infected mice with the liponucleotide cytidine diphosphocholine (CDP-choline) resulted in decreased hypoxemia, pulmonary edema, lung dysfunction, and inflammation without altering viral replication. These findings suggested CDP-choline could have benefit as adjunctive treatment for ARDS in veterinary patients (VetARDS). OBJECTIVES Determine if parenterally administered CDP-choline can attenuate mild VetARDS in dogs with aspiration pneumonia. ANIMALS Dogs admitted to a veterinary intensive care unit (ICU) for aspiration pneumonia. METHODS Subjects were enrolled in a randomized, double-blinded, placebo-controlled trial of treatment with vehicle (0.1 mL/kg sterile 0.9% saline, IV; n = 8) or CDP-choline (5 mg/kg in 0.1 mL/kg 0.9% saline, IV; n = 9) q12h over the first 48 hours after ICU admission. RESULTS No significant differences in signalment or clinical findings were found between placebo- and CDP-choline-treated dogs on admission. All dogs exhibited tachycardia, tachypnea, hypertension, hypoxemia, hypocapnia, lymphopenia, and neutrophilia. CDP-choline administration resulted in rapid, progressive, and clinically relevant increases in oxygenation as determined by pulse oximetry and ratios of arterial oxygen partial pressure (Pa O2 mmHg) to fractional inspired oxygen (% Fi O2 ) and decreases in alveolar-arterial (A-a) gradients that did not occur in placebo (saline)-treated animals. Treatment with CDP-choline was also associated with less platelet consumption over the first 48 hours, but had no detectable detrimental effects. CONCLUSIONS AND CLINICAL IMPORTANCE Ctyidine diphosphcholine acts rapidly to promote gas exchange in dogs with naturally occurring aspiration pneumonia and is a potential adjunctive treatment in VetARDS patients.
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Affiliation(s)
- Anda A. Young
- Division of Small Animal Emergency and Critical Care Medicine, Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhioUSA
| | - Lucia E. Rosas
- Department of Veterinary BiosciencesThe Ohio State UniversityColumbusOhioUSA
| | - Edward S. Cooper
- Division of Small Animal Emergency and Critical Care Medicine, Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhioUSA
| | - Page E. Yaxley
- Division of Small Animal Emergency and Critical Care Medicine, Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhioUSA
| | - Ian C. Davis
- Department of Veterinary BiosciencesThe Ohio State UniversityColumbusOhioUSA
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Singh A, Soni KD, Singh Y, Aggarwal R, Venkateswaran V, Ashar MS, Trikha A. Alveolar Arterial Gradient and Respiratory Index in Predicting the Outcome of COVID-19 Patients; a Retrospective Cross-Sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e28. [PMID: 35573712 PMCID: PMC9078060 DOI: 10.22037/aaem.v10i1.1543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction Alveolar arterial (A-a) oxygen gradient and respiratory index can be of immense help for the critical care physician in clinical decision making. This study aimed to evaluate the potential application of A-a oxygen gradient and respiratory index in predicting the survival of COVID-19 patients in intensive care unit (ICU). Method This is a retrospective cross-sectional study involving 215 adult patients with COVID-19 disease, admitted to the ICU between 1st April 2020 and 30 June 2021. Details regarding demographic variables, comorbidities, laboratory and arterial blood gas (ABG) findings were recorded. Alveolar-arterial gradient and respiratory index were calculated and tested as predictors of survival. Result The mean age of the patients was 51.92 years (65.6 % male). Hypertension was the most common comorbidity and oxygen via non-rebreathing mask was the most common modality used at the time of ICU admission. Mortality was 28.37% and average length of stay was 12.84 days. Patients who died were older (p=0.02), mostly male (p=0.017), had at least one comorbidity (p<0.001), and higher heart rate and respiratory rate (<0.001 and p=0.03, respectively), lower pH on arterial blood gas (ABG) (p=0.002), higher FiO2 requirement (p<0.001), and increased A-a oxygen gradient on admission compared to survivors. According to receiver operating characteristic (ROC) curve analysis, A-a oxygen gradient and respiratory index were not sensitive or specific in predicting mortality in the studied patient subset. Conclusion A-a oxygen gradient and respiratory index calculated at time of admission to ICU in patients with COVID-19 were poor predictors of survival.
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Affiliation(s)
- Abhishek Singh
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.,Corresponding author: Kapil Dev Soni; Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
| | - Yudhyavir Singh
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Venkateswaran
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mohd Suhail Ashar
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Maraziti G, Becattini C. Early Variation of Respiratory Indexes to Predict Death or ICU Admission in Severe Acute Respiratory Syndrome Coronavirus-2-Related Respiratory Failure. Respiration 2022; 101:632-637. [PMID: 35290981 PMCID: PMC9059089 DOI: 10.1159/000522275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background In severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-related respiratory failure, the prognostic value of clinically based or blood-gas-based respiratory indexes is unclear. Objectives We aimed to assess the prognostic value of Respiratory Index (RI, oxygen saturation [SpO2]/respiratory rate [RR]), RR-oxygenation index (ROX, SpO2/fraction of inspired oxygen [FiO2]/RR), partial pressure of oxygen (PaO2)/FiO2 ratio (P/F), or standard PaO2/FiO2 ratio (STP/F) at admission and of their variation during hospitalization in SARS-CoV-2-related respiratory failure. Methods In 100 consecutive patients hospitalized due to SARS-CoV-2-related respiratory failure, we assessed the association of RI, ROX, P/F and STP/F, and death; secondary outcome was the composite of 7-day death or intensive care unit (ICU) admission. Results ROX <3.85 at admission (hazard ratio [HR] 2.95, 95% confidence interval [CI] 1.29–6.77) and decreasing RI or P/F during hospitalization (RI: HR 1.05, 95% CI: 1.00–1.09; P/F: HR 1.01, 95% CI: 1.00–1.02) were predictors of in-hospital death. RI ≤3.8, ROX <3.85, and P/F <100 at admission were predictors for death or ICU admission (RI: HR 3.77, 95% CI: 1.30–10.98; ROX: HR 4.56, 95% CI: 1.90–10.96; P/F: HR 7.37, 95% CI: 1.59–34.2). The decrease of RI (HR 1.14, 95% CI: 1.03–1.25), ROX (HR 1.45, 95% CI: 1.11–1.88), P/F (HR 1.08, 95% CI: 1.01–1.15), or STP/F (HR 1.05, 95% CI: 1.01–1.08) during hospitalization was associated with 7-day death or ICU admission. Conclusions In patients with SARS-CoV-2-related respiratory failure, easy-to-calculate clinically based respiratory indexes at admission and their variation during hospital stay can be used to assess and monitor the risk for death or ICU admission.
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Affiliation(s)
- Giorgio Maraziti
- Internal and Cardiovascular Medicine - Stroke Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Cecilia Becattini
- Internal and Cardiovascular Medicine - Stroke Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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Donina ZA. Causes of Hypoxemia in COVID-19. J EVOL BIOCHEM PHYS+ 2022; 58:73-80. [PMID: 35283538 PMCID: PMC8897613 DOI: 10.1134/s0022093022010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022]
Abstract
The global pandemic of a new coronavirus disease (COVID-19)
has posed challenges to public health specialists around the world
associated with diagnosis, intensive study of epidemiological and
clinical features of the coronavirus infection, development of preventive
approaches, therapeutic strategies and rehabilitation measures.
However, despite the successes achieved in the study of COVID-19
pathogenesis, many aspects that aggravate the severity of the disease
and cause high mortality of patients remain unclear. The main clinical
manifestation of the new variant of SARS-CoV-2 virus infection is
pneumonia with massive parenchymal lesions of lung tissue, diffuse alveolar
damage, thrombotic manifestations, disruption of ventilation-perfusion
relationships, etc. However, symptoms in patients hospitalized with
COVID pneumonia show a broad diversity: the majority has minimal
manifestations, others develop severe respiratory failure complicated
by acute respiratory distress syndrome (ARDS) with rapidly progressing
hypoxemia that leads to high mortality. Numerous clinical data publications
report that some COVID pneumonia patients without subjective signs
of severe respiratory failure (dyspnea, “air hunger”) have an extremely
low saturation level. As a result, there arises a paradoxical condition
(called “silent hypoxia” or even “happy hypoxia”) contradicting
the very basics of physiology, as it essentially represents a severe life-incompatible
hypoxemia which lacks respiratory discomfort. All this raises numerous
questions among professionals and has already ignited a discussion
in scientific publications concerned with the pathogenesis of COVID-19.
Respiratory failure is a complex clinical problem, many aspects
of which remain controversial. However, according to the majority
of authors, one of the first objective indicators of the clinical
sign of respiratory failure are hypoxemia-associated changes in external
respiration. This review addresses some possible causes of hypoxemia
in COVID-19.
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Affiliation(s)
- Zh. A. Donina
- Pavlov Institute of Physiology,
Russian Academy of Sciences, St. Petersburg, Russia
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Kutsogiannis DJ, Alharthy A, Balhamar A, Faqihi F, Papanikolaou J, Alqahtani SA, Memish ZA, Brindley PG, Brochard L, Karakitsos D. Mortality and Pulmonary Embolism in Acute Respiratory Distress Syndrome From COVID-19 vs. Non-COVID-19. Front Med (Lausanne) 2022; 9:800241. [PMID: 35308552 PMCID: PMC8931188 DOI: 10.3389/fmed.2022.800241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/31/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose There may be a difference in respiratory mechanics, inflammatory markers, and pulmonary emboli in COVID-19 associated ARDS vs. ARDS from other etiologies. Our purpose was to determine differences in respiratory mechanics, inflammatory markers, and incidence of pulmonary embolism in patients with and without COVID-19 associated ARDS admitted in the same period and treated with a similar ventilation strategy. Methods A cohort study of COVID-19 associated ARDS and non COVID-19 patients in a Saudi Arabian center between June 1 and 15, 2020. We measured respiratory mechanics (ventilatory ratio (VR), recruitability index (RI), markers of inflammation, and computed tomography pulmonary angiograms. Results Forty-two patients with COVID-19 and 43 non-COVID patients with ARDS comprised the cohort. The incidence of “recruitable” patients using the recruitment/inflation ratio was slightly lower in COVID-19 patients (62 vs. 86%; p = 0.01). Fifteen COVID-19 ARDS patients (35.7%) developed a pulmonary embolism as compared to 4 (9.3%) in other ARDS patients (p = 0.003). In COVID-19 patients, a D-Dimer ≥ 5.0 mcg/ml had a 73% (95% CI 45–92%) sensitivity and 89% (95% CI 71–98%) specificity for predicting pulmonary embolism. Crude 60-day mortality was higher in COVID-19 patients (35 vs. 15%; p = 0.039) but three multivariate analysis showed that independent predictors of 60-day mortality included the ventilatory ratio (OR 3.67, 95% CI 1.61–8.35), PaO2/FIO2 ratio (OR 0.93; 95% CI 0.87–0.99), IL-6 (OR 1.02, 95% CI 1.00–1.03), and D-dimer (OR 7.26, 95% CI 1.11–47.30) but not COVID-19 infection. Conclusion COVID-19 patients were slightly less recruitable and had a higher incidence of pulmonary embolism than those with ARDS from other etiologies. A high D-dimer was predictive of pulmonary embolism in COVID-19 patients. COVID-19 infection was not an independent predictor of 60-day mortality in the presence of ARDS.
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Affiliation(s)
- Demetrios J. Kutsogiannis
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, Canada
- *Correspondence: Demetrios J. Kutsogiannis
| | | | - Abdullah Balhamar
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Fahad Faqihi
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - John Papanikolaou
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Saleh A. Alqahtani
- Department of Medicine, The Johns Hopkins University Hospital, Baltimore, MD, United States
| | - Ziad A. Memish
- Research and Innovation Center, King Saud Medical City, Riyadh, Saudi Arabia
| | - Peter G. Brindley
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, Canada
| | - Laurent Brochard
- Department of Critical Care, Keenan Research Center and Li Ka Shing Institute, St. Michael's Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Dimitrios Karakitsos
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Department of Internal Medicine, University of South Carolina, School of Medicine, Columbia, SC, United States
- Critical Care Department, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Yaroshetskiy AI, Avdeev SN, Politov ME, Nogtev PV, Beresneva VG, Sorokin YD, Konanykhin VD, Krasnoshchekova AP, Merzhoeva ZM, Tsareva NA, Trushenko NV, Mandel IA, Yavorovskiy AG. Potential for the lung recruitment and the risk of lung overdistension during 21 days of mechanical ventilation in patients with COVID-19 after noninvasive ventilation failure: the COVID-VENT observational trial. BMC Anesthesiol 2022; 22:59. [PMID: 35246024 PMCID: PMC8894841 DOI: 10.1186/s12871-022-01600-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Data on the lung respiratory mechanics and gas exchange in the time course of COVID-19-associated respiratory failure is limited. This study aimed to explore respiratory mechanics and gas exchange, the lung recruitability and risk of overdistension during the time course of mechanical ventilation. Methods This was a prospective observational study in critically ill mechanically ventilated patients (n = 116) with COVID-19 admitted into Intensive Care Units of Sechenov University. The primary endpoints were: «optimum» positive end-expiratory pressure (PEEP) level balanced between the lowest driving pressure and the highest SpO2 and number of patients with recruitable lung on Days 1 and 7 of mechanical ventilation. We measured driving pressure at different levels of PEEP (14, 12, 10 and 8 cmH2O) with preset tidal volume, and with the increase of tidal volume by 100 ml and 200 ml at preset PEEP level, and calculated static respiratory system compliance (CRS), PaO2/FiO2, alveolar dead space and ventilatory ratio on Days 1, 3, 5, 7, 10, 14 and 21. Results The «optimum» PEEP levels on Day 1 were 11.0 (10.0–12.8) cmH2O and 10.0 (9.0–12.0) cmH2O on Day 7. Positive response to recruitment was observed on Day 1 in 27.6% and on Day 7 in 9.2% of patients. PEEP increase from 10 to 14 cmH2O and VT increase by 100 and 200 ml led to a significant decrease in CRS from Day 1 to Day 14 (p < 0.05). Ventilatory ratio was 2.2 (1.7–2,7) in non-survivors and in 1.9 (1.6–2.6) survivors on Day 1 and decreased on Day 7 in survivors only (p < 0.01). PaO2/FiO2 was 105.5 (76.2–141.7) mmHg in non-survivors on Day 1 and 136.6 (106.7–160.8) in survivors (p = 0.002). In survivors, PaO2/FiO2 rose on Day 3 (p = 0.008) and then between Days 7 and 10 (p = 0.046). Conclusion Lung recruitability was low in COVID-19 and decreased during the course of the disease, but lung overdistension occurred at «intermediate» PEEP and VT levels. In survivors gas exchange improvements after Day 7 mismatched CRS. Trial registration ClinicalTrials.gov, NCT04445961. Registered 24 June 2020—Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01600-0.
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Affiliation(s)
- Andrey I Yaroshetskiy
- Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya str., 119991, Moscow, Russia. .,Pirogov Russian National Research Medical University, 1, Ostrovitianova str, 117997, Moscow, Russia.
| | - Sergey N Avdeev
- Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya str., 119991, Moscow, Russia
| | - Mikhail E Politov
- Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya str., 119991, Moscow, Russia
| | - Pavel V Nogtev
- Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya str., 119991, Moscow, Russia
| | - Victoria G Beresneva
- Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya str., 119991, Moscow, Russia
| | - Yury D Sorokin
- Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya str., 119991, Moscow, Russia
| | - Vasily D Konanykhin
- Pirogov Russian National Research Medical University, 1, Ostrovitianova str, 117997, Moscow, Russia
| | - Anna P Krasnoshchekova
- Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya str., 119991, Moscow, Russia
| | - Zamira M Merzhoeva
- Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya str., 119991, Moscow, Russia
| | - Natalia A Tsareva
- Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya str., 119991, Moscow, Russia
| | - Natalia V Trushenko
- Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya str., 119991, Moscow, Russia
| | - Irina A Mandel
- Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya str., 119991, Moscow, Russia
| | - Andrey G Yavorovskiy
- Sechenov First Moscow State Medical University (Sechenov University), 8/2, Trubetskaya str., 119991, Moscow, Russia
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Gonzales Carazas MM, Gavidia CM, Davila Fernandez R, Vargas Zuñiga JA, Crespo Paiva A, Bocanegra W, Calderon J, Sanchez E, Perales R, Zeña B, Calcina Isique JF, Reategui J, Castañeda B, Casado FL. Biological evaluation of a mechanical ventilator that operates by controlling an automated manual resuscitator. A descriptive study in swine. PLoS One 2022; 17:e0264774. [PMID: 35239740 PMCID: PMC8893637 DOI: 10.1371/journal.pone.0264774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
The Covid-19 outbreak challenged health systems around the world to design and implement cost-effective devices produced locally to meet the increased demand of mechanical ventilators worldwide. This study evaluates the physiological responses of healthy swine maintained under volume- or pressure-controlled mechanical ventilation by a mechanical ventilator implemented to bring life-support by automating a resuscitation bag and closely controlling ventilatory parameters. Physiological parameters were monitored in eight sedated animals (t0) prior to inducing deep anaesthesia, and during the next six hours of mechanical ventilation (t1-7). Hemodynamic conditions were monitored periodically using a portable gas analyser machine (i.e. BEecf, carbonate, SaO2, lactate, pH, PaO2, PaCO2) and a capnometer (i.e. ETCO2). Electrocardiogram, echocardiography and lung ultrasonography were performed to detect in vivo alterations in these vital organs and pathological findings from necropsy were reported. The mechanical ventilator properly controlled physiological levels of blood biochemistry such as oxygenation parameters (PaO2, PaCO2, SaO2, ETCO2), acid-base equilibrium (pH, carbonate, BEecf), and perfusion of tissues (lactate levels). In addition, histopathological analysis showed no evidence of acute tissue damage in lung, heart, liver, kidney, or brain. All animals were able to breathe spontaneously after undergoing mechanical ventilation. These preclinical data, supports the biological safety of the medical device to move forward to further evaluation in clinical studies.
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Affiliation(s)
| | - Cesar Miguel Gavidia
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | | | | | - William Bocanegra
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Joan Calderon
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Evelyn Sanchez
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Rosa Perales
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Brandon Zeña
- Instituto Veterinario de Oftalmologia (IVO), Lima, Peru
| | | | | | - Benjamin Castañeda
- Institute of Omics and Applied Biotechnology, Pontificia Universidad Catolica del Peru, Lima, Peru
- Department of Engineering, Pontificia Universidad Catolica del Peru, Lima, Peru
| | - Fanny L. Casado
- Institute of Omics and Applied Biotechnology, Pontificia Universidad Catolica del Peru, Lima, Peru
- Department of Engineering, Pontificia Universidad Catolica del Peru, Lima, Peru
- * E-mail:
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Tobin MJ, Jubran A. Unreliable pulse oximetry in dark-skin patients: a plea for algorithm disclosure. Ann Intensive Care 2022; 12:18. [PMID: 35190888 PMCID: PMC8860622 DOI: 10.1186/s13613-022-00993-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL, 60141, USA.
| | - Amal Jubran
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL, 60141, USA
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Viruez-Soto A, Arias S, Casas-Mamani R, Rada-Barrera G, Merino-Luna A, Molano-Franco D, Tinoco-Solorzano A, Marques DA, Zubieta-DeUrioste N, Zubieta-Calleja G, Arias-Reyes C, Soliz J. Oxygen therapy limiting peripheral oxygen saturation to 89-93% is associated with a better survival prognosis for critically ill COVID-19 patients at high altitudes. Respir Physiol Neurobiol 2022; 299:103868. [PMID: 35150939 PMCID: PMC8828373 DOI: 10.1016/j.resp.2022.103868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/06/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Abstract
Patients admitted to the Intensive Care Unit (ICU) with acute hypoxemic respiratory failure automatically receive oxygen therapy to improve inspiratory oxygen fraction (FiO2). Supplemental oxygen is the most prescribed drug for critically ill patients regardless of altitude of residence. In high altitude dwellers (i.e. in La Paz [≈3,400 m] and El Alto [≈4,150 m] in Bolivia), a peripheral oxygen saturation (SatpO2) of 89-95% and an arterial partial pressure of oxygen (PaO2) of 50-67 mmHg (lower as altitude rises), are considered normal values for arterial blood. Consequently, it has been suggested that limiting oxygen therapy to maintain SatpO2 around normoxia may help avoid episodes of hypoxemia, hyperoxemia, intermittent hypoxemia, and ultimately, mortality. In this study, we evaluated the impact of oxygen therapy on the mortality of critically ill COVID-19 patients who permanently live at high altitudes. A multicenter cross-sectional descriptive observational study was performed on 100 patients admitted to the ICU at the "Clinica Los Andes" (in La Paz city) and "Agramont" and "Del Norte" Hospitals (in El Alto city). Our results show that: 1) as expected, fatal cases were detected only in patients who required intubation and connection to invasive mechanical ventilation as a last resort to overcome their life-threatening desaturation; 2) among intubated patients, prolonged periods in normoxia are associated with survival, prolonged periods in hypoxemia are associated with death, and time spent in hyperoxemia shows no association with survival or mortality; 3) the oxygenation limits required to effectively support the intubated patients' survival in the ICU are between 89% and 93%; 4) among intubated patients with similar periods of normoxemic oxygenation, those with better SOFA scores survive; and 5) a lower frequency of observable reoxygenation events is not associated with survival. In conclusion, our findings indicate that high-altitude patients entering an ICU at altitudes of 3,400 - 4,150 m should undergo oxygen therapy to maintain oxygenation levels between 89 and 93 %.
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Affiliation(s)
- Antonio Viruez-Soto
- Clínica Los Andes del Grupo Embriovid, La Paz, Bolivia; Hospital Agramont, El Alto, Bolivia; Hospital del Norte, El Alto, Bolivia; High Altitude Intensive Care Medicine International Group, GIMIA, Bolivia
| | | | | | | | | | | | | | - Danuzia A Marques
- Centre de Recherche de l'Institute Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | | | | | - Christian Arias-Reyes
- Centre de Recherche de l'Institute Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Jorge Soliz
- High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), La Paz, Bolivia; Centre de Recherche de l'Institute Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada.
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50
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Development and Validation of the Acute PNeumonia Early Assessment Score for Safely Discharging Low-Risk SARS-CoV-2-Infected Patients from the Emergency Department. J Clin Med 2022; 11:jcm11030881. [PMID: 35160331 PMCID: PMC8837152 DOI: 10.3390/jcm11030881] [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: 12/18/2021] [Revised: 01/29/2022] [Accepted: 02/05/2022] [Indexed: 12/10/2022] Open
Abstract
A continuous demand for assistance and an overcrowded emergency department (ED) require early and safe discharge of low-risk severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients. We developed (n = 128) and validated (n = 330) the acute PNeumonia early assessment (aPNea) score in a tertiary hospital and preliminarily tested the score on an external secondary hospital (n = 97). The score's performance was compared to that of the National Early Warning Score 2 (NEWS2). The composite outcome of either death or oral intubation within 30 days from admission occurred in 101 and 28 patients in the two hospitals, respectively. The area under the receiver operating characteristic (AUROC) curve of the aPNea model was 0.86 (95% confidence interval (CI), 0.78-0.93) and 0.79 (95% CI, 0.73-0.89) for the development and validation cohorts, respectively. The aPNea score discriminated low-risk patients better than NEWS2 at a 10% outcome probability, corresponding to five cut-off points and one cut-off point, respectively. aPNea's cut-off reduced the number of unnecessary hospitalizations without missing outcomes by 27% (95% CI, 9-41) in the validation cohort. NEWS2 was not significant. In the external cohort, aPNea's cut-off had 93% sensitivity (95% CI, 83-102) and a 94% negative predictive value (95% CI, 87-102). In conclusion, the aPNea score appears to be appropriate for discharging low-risk SARS-CoV-2-infected patients from the ED.
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