The utility and futility of non-invasive ventilation in non-designated areas: Can critical care outreach nurses influence practice?

2011 ◽  
Vol 27 (4) ◽  
pp. 211-217 ◽  
Author(s):  
Karen Sumner ◽  
Ghasem Yadegafar
Keyword(s):  
Critical Care ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Critical Care Outreach

scholarly journals Mid-Regional pro-Adrenomedullin (MR-proADM), C-Reactive Protein (CRP) and Other Biomarkers in the Early Identification of Disease Progression in COVID-19 Patients in the Acute NHS Setting

2021 ◽  
Author(s):  
Nathan Moore ◽  
Rebecca Williams ◽  
Matilde Mori ◽  
Beatrice Bertolusso ◽  
Gabrielle Vernet ◽  
...  
Keyword(s):  
Critical Care ◽  
Disease Progression ◽  
Early Identification ◽  
Adult Patients ◽  
Invasive Ventilation ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Increased Risk

BackgroundThere is a lack of biomarkers validated for assessing clinical deterioration in COVID-19 patients upon presentation to secondary or tertiary care. This evaluation looked at the potential clinical application of a range of biomarkers, including C-Reactive Protein (CRP) and Procalcitonin (PCT) and Mid-Regional pro-adrenomedullin (MR-proADM), and White Cell Count to support prediction of clinical outcomes.MethodsAdult patients presenting to Hampshire Hospitals NHS Foundation Trust between April and June 2020 confirmed to have COVID-19 via RT-qPCR were included. Biomarkers were measured in blood samples taken within 24 hours of admission and logistic regression and area under the receiver operating characteristic (AUROC) curves were used to predict disease progression. The endpoints assessed were 30-day all-cause mortality, intubation and ventilation, admission to critical care and non-invasive ventilation (NIV) use.FindingsA total of 135 adult patients were identified. Elevated levels of MR-proADM were shown to have the greatest ability to predict 30-day mortality adjusting for age, cardiovascular disease, renal disease and neurological disease. A significant association was also noted between raised MR-proADM and CRP concentrations and the requirement for critical care admission and non-invasive ventilation, when controlling for covariates.InterpretationThe measurement of biomarkers, particularly MR-proADM and CRP in patients with confirmed COVID-19 infection upon admission to secondary care shows significant potential to support clinicians in the early identification of those at increased risk of disease progression and need for higher level care, subsequently enabling prompt escalation in clinical interventions and treatment.FundingNo funding was required for this article

scholarly journals The impact of high dose oral cotrimoxazole in patients with COVID-19 with hypoxic respiratory failure requiring non-invasive ventilation: A Case Control Study

2021 ◽  
Author(s):  
Saurabh Singh ◽  
Thomas John ◽  
Prashant Kumar ◽  
Syed Rehan Quadery
Keyword(s):  
Critical Care ◽  
Respiratory Failure ◽  
Standard Therapy ◽  
High Dose ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Dose Oral ◽  
Hypoxic Respiratory Failure ◽  
The Impact

ABSTRACTBackgroundCOVID-19 can be fatal in a significant proportion of people who develop critical illness, resulting in hypoxic respiratory failure secondary to Acute Respiratory Distress Syndrome (ARDS) which is thought to be mediated by a cytokine storm syndrome. Steroids have been shown to be of some benefit, but the mainstay of treatment remains supportive.MethodsThe data was collected retrospectively from consecutive, newly diagnosed patients presenting to the critical care facility of I Q City Medical College Hospital, Durgapur, India between June and November 2020 with critical COVID-19 on non-invasive ventilation treated with high dose oral cotrimoxazole (CTX) in addition to standard therapy (ST) and compared with patients with critical COVID-19 receiving standard therapy alone.Results201 patients were identified. Of which 151 patients received CTX in addition to ST (mean age ± SD 59 ± 13 years, 81% male and mean BMI ± SD 28 ± 2) and 50 patients received ST alone (mean age ± SD 63 ± 12, 64% male and mean BMI ± SD 27 ± 2). We observed that the patients with critical COVID-19 receiving CTX in addition to ST had significantly better outcomes including reduced in-patient mortality (13% versus 40%, p <0.001), length of hospital and critical care unit stay (mean, 11 versus 15 days (p <0.001) and 6 versus 11 days (p <0.001) respectively), and the need for mechanical ventilation (16% versus 42%, p <0.001) with improved CRP at day 7 (mean, 38mg/L versus 62mg/L, p = 0.001).ConclusionThese results may be due to the antibiotic and anti-cytokine effects of CTX. Clinical trials are currently underway to test our observations.

Sign in / Sign up

Export Citation Format

Share Document