High-flow cannula for frail patients with SARS-CoV-2 infection non-eligible for intensive care unit management

OBJECTIVES

High-flow nasal cannula (HFNC) was widely used during the COVID-19 pandemic in intensive care units (ICU), but there is no recommendation for elderly patients non-eligible for ICU management. We aimed to describe the outcomes of HFNC treatment in patients with COVID-19 who are not eligible for ICU management.

METHODS

Retrospective bicentric cohort study performed between September 1, 2020 and June 30, 2021 in two infectious diseases departments of Colmar Hospital and Antoine Beclere University Hospital, France.

RESULTS

Sixty-four patients were treated with HFNC: 33 in Colmar and 31 in Beclere hospital (median age: 85 years; IQ, 82-92). Of these, 16 patients survived (25%). Surviving patients had a lower Charlson comorbidity index score than deceased patients (five vs six; p = 0.02).

CONCLUSIONS

Despite a high death rate, with survivors being younger and having fewer comorbidities, HFNC is an easy tool to implement in non-ICU wards for the frailest patients.

Factors associated with hospital admission and adverse outcome for COVID-19: role of social factors and medical care

Background

Beyond sex, age, and various comorbidities, geographical origin and socioeconomic deprivation are associated with Coronavirus Disease (COVID-19) morbidity and mortality in the general population. We aimed to assess factors associated with severe forms of COVID-19 after a hospital emergency department visit, focusing on socioeconomic factors.

Methods

Patients with laboratory-confirmed COVID-19 attending the emergency department of Béclère Hospital (France) in March–April 2020 were included. Postal addresses were used to obtain two geographical deprivation indices at the neighborhood level. Factors associated with hospitalization and factors associated with adverse outcomes, i.e. mechanical ventilation or death, were studied using logistic and Cox analyses, respectively.

Results

Among 399 included patients, 321 were hospitalized. Neither geographical origin nor socioeconomic deprivation was associated with any of the outcomes. Being male, older, overweight or obese, diabetic, or having a neuropsychiatric disorder were independent risk factors for hospitalization. Among 296 patients hospitalized at Béclère Hospital, 91 experienced an adverse outcome. Older age, being overweight or obese, desaturation and extent of chest CT scan lesions > 25% at admission (aHR: 2.2 [95% CI: 1.3–3.5]) and higher peak CRP levels and acute kidney failure (aHR: 2.0 [1.2–3.3]) during follow-up were independently associated with adverse outcomes, whereas treatment with hydrocortisone reduced the risk of mechanical ventilation or death by half (aHR: 0.5 [0.3–0.8]).

Conclusion

No association between geographical origin or socioeconomic deprivation and the occurrence of a severe form of COVID-19 was observed in our population after arrival to the emergency department. Empirical corticosteroid use with hydrocortisone had a strong protective impact.

Forme sévère de COVID-19 pendant la première vague épidémique en France : rôle des facteurs sociaux et des traitements empiriques

Introduction

La COVID-19 est une maladie multiforme, allant d’un rhume banal au syndrome de détresse respiratoire aiguë. L’identification précoce des patients à risque de forme sévère est cruciale. Le sexe masculin, l’âge, l’obésité et diverses comorbidités sont maintenant clairement reconnus comme associés à une évolution défavorable. La vaste étude britannique OpenSafely suggère qu’au-delà de l’état de santé individuel, l’ethnicité et le désavantage social sont associés significativement avec la mortalité hospitalière au cours des infections par le SARS-CoV-2, mais très peu de données sont disponibles en France à ce sujet.

L’objectif principal de ce travail était d’étudier les facteurs, notamment socioéconomiques, associés à la survenue d’une forme grave. L’objectif secondaire était d’étudier le rôle des traitements empiriques utilisés par les praticiens.

Matériels et méthodes

Tous les patients adultes ayant eu un diagnostic par PCR d’infection à SARS-CoV-2 de mars à mai 2020 dans un hôpital français ont été inclus. Les femmes enceintes et les cas nosocomiaux ont été exclus. Les données des dossiers médicaux ont été recueillies de manière anonymisée via un e-CRF. L’adresse du patient a été utilisée pour obtenir l’IRIS du domicile et la correspondance avec deux indicateurs socioéconomiques validés : FDEP et French EDI. Les traitements empiriques utilisés par les praticiens ont été recueillis. Les facteurs associés à une forme grave, définie par la survenue du décès ou la nécessité d’une ventilation mécanique, ont été étudiés à l’aide de modèles de Cox.

Résultats

Parmi 399 patients inclus à partir des urgences, 78 patients sont retournés au domicile et 25 ont été transférés dans un autre hôpital. Parmi les 296 patients hospitalisés, 91 ont présenté une forme sévère (68 décès). L’origine ethnique, le FDEP et le FEDI n’étaient pas associés à la survenue d’une forme grave. Parmi les différentes comorbidités, un IMC > 25, un antécédent cardiovasculaire, au moins deux comorbidités étaient associés à la survenue d’une forme grave en analyse univariée. Les facteurs associés à la survenue d’une forme grave lors de l’analyse multivariée étaient : âge > 80 ans (HR : 2,2 [1,3–3,5]), surpoids (HR : 2,3 [1,4–3,7]), lésions sévères au TDM thoracique (HR : 3,3 [2,0–5,3]). La prescription d’une corticothérapie pendant au moins 48 h était un facteur protecteur (HR : 0,4 [0,2–0,6]).

Conclusion

Aucune association entre ethnicité ou désavantage social et survenue d’une forme sévère de COVID-19 n’a été retrouvée dans notre population. La prescription d’une corticothérapie était un facteur protecteur.

Global distribution of crustal magnetization discovered by the mars global surveyor MAG/ER experiment

Vector magnetic field observations of the martian crust were acquired by the Mars Global Surveyor (MGS) magnetic field experiment/electron reflectometer (MAG/ER) during the aerobraking and science phasing orbits, at altitudes between approximately 100 and 200 kilometers. Magnetic field sources of multiple scales, strength, and geometry were observed. There is a correlation between the location of the sources and the ancient cratered terrain of the martian highlands. The absence of crustal magnetism near large impact basins such as Hellas and Argyre implies cessation of internal dynamo action during the early Naochian epoch ( approximately 4 billion years ago). Sources with equivalent magnetic moments as large as 1.3 x 10(17) ampere-meter2 in the Terra Sirenum region contribute to the development of an asymmetrical, time-variable obstacle to solar wind flow around Mars.

Magnetic lineations in the ancient crust of mars

The Mars Global Surveyor spacecraft, in a highly elliptical polar orbit, obtained vector magnetic field measurements above the surface of Mars (altitudes >100 kilometers). Crustal magnetization, mainly confined to the most ancient, heavily cratered martian highlands, is frequently organized in east-west-trending linear features, the longest extending over 2000 kilometers. Crustal remanent magnetization exceeds that of terrestrial crust by more than an order of magnitude. Groups of quasi-parallel linear features of alternating magnetic polarity were found. They are reminiscent of similar magnetic features associated with sea floor spreading and crustal genesis on Earth but with a much larger spatial scale. They may be a relic of an era of plate tectonics on Mars.