Re. Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): rationale and feasibility of a shared pragmatic protocol

Introduction: Coronavirus disease 2019 (COVID-19) is an emerging global health care threat that is caused by a novel coronavirus named 2019-nCoV (SARS-CoV-2). The first case of diagnosed COVID-19 patient was declared in Jordan in early March 2020. As of June 8, Jordan had confirmed 831 cases, with 9 deaths, with an overall mortality rate of 1.08%. As there is no published data about critically ill patients in Jordan, we aimed to describe the characteristics and outcomes of critically ill COVID-19 patients in a tertiary hospital in Jordan.

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Pragmatic Disease-Focused Checklist for Use During Rounding on Critically Ill Patients With COVID-19

American Journal of Critical Care ◽

10.4037/ajcc2021697 ◽

2021 ◽

pp. e1-e5

Author(s):

Somnath Bose ◽

Akiva Leibowitz

Keyword(s):

Critically Ill ◽

Family Communication ◽

Critically Ill Patients ◽

Inflammatory Markers ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical ◽

Ventilation Strategies ◽

Novel Coronavirus ◽

Existing Structure

The sudden surge in cases of novel coronavirus disease 2019 (COVID-19) has presented unprecedented challenges in the care of critically ill patients with the disease. A disease-focused checklist was developed to supplement and streamline the existing structure of rounds during a time of significant resource constraint. A total of 51 critical care consultants across multiple specialties at a tertiary academic medical center were surveyed regarding their preference for a structured checklist. Among the respondents, 82% were in favor of a disease-focused checklist. Mechanical ventilation parameters, rescue ventilation strategies, sedation regimens, inflammatory markers specific to COVID-19, and family communication were the elements most commonly identified as being important for inclusion in such a checklist.

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Clinical characteristics of non-critically ill patients with novel coronavirus infection (COVID-19) in a Fangcang Hospital

Clinical Microbiology and Infection ◽

10.1016/j.cmi.2020.03.032 ◽

2020 ◽

Vol 26 (8) ◽

pp. 1063-1068 ◽

Cited By ~ 56

Author(s):

X. Wang ◽

J. Fang ◽

Y. Zhu ◽

L. Chen ◽

F. Ding ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Clinical Characteristics ◽

Coronavirus Infection ◽

Novel Coronavirus

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The Pavlov University experience in medical assistance for patients with the novel coronavirus infection: first results and lessons

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2021-18-2-7-16 ◽

2021 ◽

Vol 18 (2) ◽

pp. 7-16

Author(s):

S. F. Bagnenko, ◽

Yu. S. Polushin ◽

I. V. Shlyk ◽

V. M. Teplov ◽

E. A. Karpova ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Medical Center ◽

Demographic Data ◽

Third Wave ◽

The Novel ◽

Medical Department ◽

Results Of Treatment ◽

Coronavirus Infection ◽

Novel Coronavirus

The constant mutation of the virus and the complicated epidemiological situation in other countries keep the probability of a third wave of the pandemic in the Russian Federation fairly high. It is important to summarize the gained experience as fast as possible to use it appropriately once it is needed.The objective: to analyze the specific parameters of care for critically ill patients with the novel coronavirus infection in Pavlov Multidisciplinary Medical Center.Subjects and methods. This is a result-based report on the work performed by the Infection Center, which was deployed twice in Pavlov Multidisciplinary Medical Center (from 28.04.2020 to 03.08.2020 and from 01.11.2020 to 15.03.2021). Totally, 3,830 patients with SARS-CoV-2 were managed (1,680 patients during the first deployment and 2,150 patients during the second one). In the preparatory period, the operation of the emergency department based on the inpatient emergency medical department (EMD) had been simulated to clarify its staff structure and the procedure for admission, examination, and treatment of patients. Here we compare the organizational approaches during the first and second waves of the pandemic and present the characteristics of the demographic data of the treated patients, the incidence of certain complications, and outcomes.Results. The overall lethality in the Center made 6.2%. Despite the experience gained in the first wave, the results of treatment during the second wave (autumn-winter) did not improve (5.7% died in the first wave and 6.7% in the second one). Lethality in ICU and EMD was 40.0% and 49.6%, in ICU only – 38.5% and 46.9% respectively. A moderate lethality increase in ICU was due to the concentration of critically ill and most critically ill patients. There were 51.4% of patients with comorbidities and 53.5% were above 65 years of age. Refinement and differentiation of tasks performed by departments, simulation of the operation of the Center before opening made it possible to increase the throughput of the medical unit avoiding rush during admission and deterioration the quality of treatment.Conclusion. Certain aspects of the organization of medical care affect the performance of a multidisciplinary medical institution transformed into an infectious diseases hospital. The experience gained under such circumstances can be useful in other emergencies with a large number of victims and patients.

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Early Tocilizumab Dosing is Associated with Improved Survival In Critically Ill Patients Infected With Sars-CoV-2

10.1101/2020.10.27.20211433 ◽

2020 ◽

Author(s):

Russell M. Petrak ◽

Nicholas W. Van Hise ◽

Nathan C. Skorodin ◽

Robert M. Fliegelman ◽

Vishnu Chundi ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Inflammatory Markers ◽

Standard Of Care ◽

Control Group ◽

Cytokine Storm ◽

Novel Coronavirus ◽

Multi Center Study ◽

Center Study

AbstractBackgroundSARS-CoV-2 is a novel coronavirus that has rapidly expanded to become a pandemic, resulting in millions of deaths worldwide. The cytokine storm is caused by the release of inflammatory agents and results in a physiologic disruption. Tocilizumab is an IL-6 receptor antagonist with the ability to suppress the cytokine storm in critically ill patients infected with SARS-CoV-2.MethodsThis was a multi-center study of patients infected with SARS-CoV-2, admitted between 3/13/20 and 4/16/20, requiring mechanical ventilation. Parameters that were evaluated included age, sex, race, usage of steroids, inflammatory markers, and comorbidities. Early dosing was defined as a tocilizumab dose administered prior to or within one (1) day of intubation. Late dosing was defined as a dose administered greater than one (1) day after intubation. A control group that was treated only with standard of care, and without tocilizumab, was utilized for comparison (untreated).FindingsWe studied 118 patients who required mechanical ventilation. Eighty-one (81) received tocilizumab, compared to 37 who were untreated. Early tocilizumab therapy was associated with a statistically significant decrease in mortality as compared to patients who were untreated (p=0.003). Dosing tocilizumab late was associated with an increased mortality compared to the untreated group (p=0.006).InterpretationEarly tocilizumab administration was associated with decreased mortality in critically ill SARS-Co-V-2 patients, but a potential detriment was suggested by dosing later in a patient’s course.FundingThis work did not receive outside funding or sponsorship.

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COVID-19 in Moscow: prognoses and scenarios

PHARMACOECONOMICS Modern pharmacoeconomics and pharmacoepidemiology ◽

10.17749/2070-4909.2020.13.1.43-51 ◽

2020 ◽

Vol 13 (1) ◽

pp. 43-51 ◽

Cited By ~ 2

Author(s):

M. V. Tamm

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Herd Immunity ◽

Control Measures ◽

Published Data ◽

The Novel ◽

Epidemic Control ◽

Slow Development ◽

Medium Level ◽

Novel Coronavirus

Aim: to present a mathematical model of the development of COVID-19 in Moscow along with the analysis of some scenarios of epidemic control and possible epidemic consequences.Materials and Methods. The modeling of the epidemics was based on the extended SEIR model proposed lately in the group of Prof. R. Neher and realized as a freely available software program. The authors based the choice of the parameters of modeling on published data on the epidemiological properties of the novel coronavirus SARS-CoV-2 and open access data on the registered cases of COVID-19 in Moscow for 8-27 March 2020.Results. Five potential scenarios of the development of COVID-19 epidemics are studied. The scenarios are differed by the levels of the control measures: Null Scenario corresponded to the lack of protective measures, Scenario A – mild measures of the epidemic control (closing of schools and universities, recommendations for senior citizens to stay inside), Scenario B – medium level of control (closing of all public places, recommendation for the citizens to stay inside), Scenarios C and D – complete lockdown (from the beginning of May 2020 within Scenario C and from the beginning of April 2020 within Scenario D). It was shown that within the Null Scenario, the lethality from the novel coronavirus in Moscow will exceed 100 thousand people, and the number of critically ill patients on the peak of the epidemics will exceed the capacities of the system of healthcare. Scenarios A and B did not provide for a radical decrease in the fatality rate, and the number of critically ill patients at the peak of epidemics will still exceed the capacities of the system of healthcare. Besides, within Scenario B, the epidemics will last for more than a year. Scenarios C and D will allow for the control of epidemics and a significant decrease in the rate of letha lity (by 30 and 400 times, respectively). At the same time, these two scenarios prevent the population from developing herd immunity, which would result in the population susceptibility to repeated epidemics outbreaks. Conclusion. The scenarios intended for the slow development of herd immunity in the conditions of epidemic control would not bring sufficient results: the lethality would remain unacceptably high, the capacities of the system of healthcare would be overloaded, and the time of limiting measures would be unacceptably long. Such measures as complete lockdown would stop the present epidemics. The earlier they are introduced, the more efficient will be the results. To prevent further repeated outbreaks of the epidemics, it is necessary to establish a system of available, quick, and efficient testing in combination with point isolation of the infected patients and their contacts.

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