scholarly journals Physiological Effect of Prone Positioning in Mechanically Ventilated SARS- CoV-2 Infected Patients with Severe ARDS: Preliminary Analysis of an Observational Study

Author(s):  
Avishek Roy ◽  
Srikant Behera ◽  
Aparna Pande ◽  
Anirban Bhattacharjee ◽  
Amrita Bhattacharyya ◽  
...  

Prone position ventilation has been shown to decrease mortality and improve oxygenation in ARDS patients. With best of our knowledge, no study reported physiological effect of prone position in SARS- CoV-2 infected ARDS patients. In this prospective observational study, data of n=20 consecutive laboratory confirmed SARS- CoV-2 patients with severe ARDS as per Berlin definition was included. Data of 20 patients analyzed with a median (Interquartile range, IQR) age of 56 (45.5- 67) y and median (IQR) P/F ratio of 56 (54- 66) with a median (IQR) PEEP of 12 (12- 14) before initiation of prone position. Seventy-five percentage (95% CI 53.1- 88.8) patients were prone responders at 16h prone session and 50 (95% CI 29.9- 70.1) % patients were sustained responders. There was a significant decrease in plateau airway pressure (p<0.0001), peak airway pressure (p<0.0001) and driving pressure(p<0.0001) and increase in static compliance (p=0.001), P/F ratio (p<0.0001), PaO2 (p=0.0002)and SpO2 (p=0.0004) at 4h and 16h since initiation of prone session and also after return of supine position. Prone position in SARS- CoV-2 infected severe ARDS patients is associated with improvement in lung compliance and oxygenation in two- third of the patients and persisted in half of the patients.

2020 ◽  
Author(s):  
Barbara Baranowska ◽  
Anna Kajdy ◽  
Iwona Kiersnowska ◽  
Dorota Sys ◽  
Urszula Tataj-Puzyna ◽  
...  

Abstract BackgroundThere is not enough data regarding practices and protocols that healthcare personnel follow and the amount of oxytocin that women receive during labour. Empirical evidence indicates that compliance with the guidelines improves the quality of healthcare and reduces adverse effects. The aim of the study was to evaluate oxytocin supply practices of oxytocin for labour induction and augmentation in Polish maternity units.MethodsThe article presents a prospective observational study. Data collection took place in two selected maternity units between January 15 and July 31, 2019 (n=545). Inclusion criteria were women in term pregnancies, undergoing oxytocin induction or augmentation of labour. Exclusion criteria were women who were in preterm labour, aged less than 18 years, and women whose baby was known to have a malformation. ResultsThe average total amount of oxytocin administrated to women before birth was 7,329µg following labour induction and 3.952µg following labour augmentation. The actual administration of oxytocin deviated both from the unit and national guidelines in 93,6% of all observed labours. We found no statistically significant correlation between the amount of oxytocin administered and mode of delivery, immediate postpartum blood loss or Apgar scores. There was no observed effect of total oxytocin on short-term perinatal outcomes. Hospitals with similar protocols did not differ significantly in terms of total oxytocin amount, induction to stimulation ratio—the only observed difference was the mode of delivery. ConclusionsThere is a need for a thorough analysis to find out the reasons for the observed discrepancies between protocols and practice.


2014 ◽  
Vol 59 (10) ◽  
pp. 1583-1589 ◽  
Author(s):  
A. J. Spooner ◽  
A. Corley ◽  
N. A. Sharpe ◽  
A. G. Barnett ◽  
L. R. Caruana ◽  
...  

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rajeev Gupta ◽  
Karthi Nallasamy ◽  
Vijai Williams ◽  
Akshay Kumar Saxena ◽  
Muralidharan Jayashree

Abstract Background Chest radiograph (CXR) prescribing pattern and practice vary widely among pediatric intensive care units (PICU). ‘On demand’ approach is increasingly recommended as against daily ‘routine’ CXRs; however, the real-world practice is largely unknown. Methods This was a prospective observational study performed in children younger than 12 years admitted to PICU of a tertiary care teaching hospital in India. Data were collected on all consecutive CXRs performed between December 2016 and April 2017. The primary outcome was to assess the factors that were associated with higher chest radiograph prescriptions in PICU. Secondary outcomes were to study the indications, association with mechanical ventilation, image quality and avoidable radiation exposure. Results Of 303 children admitted during the study period, 159 underwent a total of 524 CXRs in PICU. Median (IQR) age of the study cohort was 2 (0.6–5) years. More than two thirds [n = 115, 72.3%] were mechanically ventilated. Most CXRs (n = 449, 85.7%) were performed on mechanically ventilated patients, amounting to a median (IQR) of 3 (2–5) radiographs per ventilated patient. With increasing duration of ventilation, the number of CXRs proportionately increased in the first two weeks of mechanical ventilation. In non-ventilated children, about two thirds (68%) underwent only one CXR. Majority of the prescriptions were on demand (n = 461, 88%). Most common indications were peri-procedure prescriptions (37%) followed by evaluation for respiratory disease status (24%). About 40% CXRs resulted in interventions; adjustment in ventilator settings (13.5%) was the most frequent intervention. In 26% (n = 138) of radiographs, image quality required improvement. One or more additional body part exposure other than chest and upper abdomen were noted 336 (64%) images. Children with > 3 CXR had higher PRISM III score, more often mechanically ventilated, had higher number of indwelling devices [mean (SD) 2.6 (1.2) vs. 1.7 (1.0)] and stayed longer in PICU [median (IQR) 11(7.5–18.5) vs. 6 (3–9)]. Conclusion On demand prescription was the prevalent practice in our PICU. Most non-ventilated children underwent only one CXR while duration of PICU stay and the number of devices determined the number of CXRs in mechanically ventilated children. Quality improvement strategies should concentrate on the process of acquisition of images and limiting the radiation exposure to unwanted body parts.


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