scholarly journals Changes in Oxygenation and Clinical Outcomes with Awake Prone Positioning in Patients with Suspected COVID-19 In Low-Resource Settings: A Retrospective Cohort Study

2021 ◽  
Vol 36 (11) ◽  
pp. 1347-1353
Author(s):  
Carmelo Dueñas-Castell ◽  
Diana Borre-Naranjo ◽  
Dairo Rodelo ◽  
Leydis Lora ◽  
Amilkar Almanza ◽  
...  
Keyword(s):  
Cohort Study ◽  
Respiratory Failure ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Prone Positioning ◽  
Low Resource Settings ◽  
Low Resource ◽  
Resource Setting ◽  
Tertiary Center ◽  
Rank Difference

Introduction This study aimed to describe the use of awake prone positioning (APP) and conventional oxygen therapy (COT) in patients with suspected coronavirus disease (COVID-19) and respiratory failure in a limited-resource setting. Methods This was a retrospective cohort study of hospitalized patients aged ≥18 years old who were placed in an awake prone position due to hypoxemic respiratory failure and suspected COVID-19. The patients were selected from a tertiary center in Cartagena, Colombia, between March 1, 2020, and August 31, 2020. Demographic, clinical, and laboratory variables were collated, and all the variables were compared between the groups. Results The median age of the participants was 63 (IQR, 48.8-73) years (survivors: 59 [IQR, 43.568] years vs. non-survivors: 70 [IQR, 63-78] years, P ≤ .001). Of the 1470 patients admitted for respiratory symptoms, 732 (49.8%) were hospitalized for more than 24 h, and 212 patients developed respiratory failure and required COT and APP (overall hospital mortality, 34% [73/212]). The mean rank difference in PaO2/FiO2 before and after APP was higher in the survivors than in the non-survivors (201.1-252.6, mean rank difference = 51.5, P = .001 vs. 134.1-172.4, mean rank difference = 38.28, P = .24, respectively). Conclusion While using COT in conjunction with APP can improve respiratory failure in patients with suspected COVID-19 in low-resource settings, persistent hypoxemia after APP can identify patients with higher mortality risk. More evidence is needed to establish the role of this strategy.

scholarly journals Awake Prone Positioning in COVID‐19 Hypoxemic Respiratory Failure: Exploratory Findings in a Single‐center Retrospective Cohort Study

2020 ◽  
Vol 27 (12) ◽  
pp. 1249-1259
Author(s):  
Eduardo M. H. Padrão ◽  
Fernando S. Valente ◽  
Bruno A. M. P. Besen ◽  
Hassan Rahhal ◽  
Paula S. Mesquita ◽  
...  
Keyword(s):  
Cohort Study ◽  
Respiratory Failure ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Prone Positioning ◽  
Single Center ◽  
Hypoxemic Respiratory Failure

scholarly journals Short term outcomes of newborn infants with Hypoxic Ischaemic Encephalopathy treated with therapeutic hypothermia in a low resource setting: A retrospective cohort study

2020 ◽  
Author(s):  
JENNIFER KRICITOBER DAMOI ◽  
Robert Sebunya ◽  
Victoria Nakibuuka Kirabira
Keyword(s):  
Cohort Study ◽  
Therapeutic Hypothermia ◽  
Median Time ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Newborn Infants ◽  
Short Term ◽  
Factors Associated ◽  
Low Resource ◽  
Resource Setting

Abstract Background Hypoxic Ischemic Encephalopathy (HIE) remains a significant cause of death and neuro-developmental deficits among children, especially in resource limited settings. Therapeutic hypothermia which is the mainstay of treatment for moderate to severe hypoxic ischaemic encephalopathy in developed countries, is not widely practiced in low resource settings and the available data is limited. We aimed to determine the short term outcomes and factors associated with survival among newborn infants with moderate to severe hypoxic ischaemic encephalopathy treated with therapeutic hypothermia at St. Francis Hospital, Nsambya. Methods Retrospective cohort study of 81 newborn infants with moderate to severe HIE who were 36 weeks and above that were cooled from June 2016 to February 2019, at St. Francis Hospital, Nsambya, Kampala, Uganda. Data on maternal and infant characteristics, clinical outcomes were extracted from the HIE registry and HIE follow up forms. Descriptive analysis was done to get the patient characteristics. Survival analysis was done to compare outcome among the groups of infants with significant factors at bivariate analysis. Multiple cox proportional hazards regression analysis was done to determine the factors independently associated with survival. Results The proportion of newborn infants who survived was 68/81(84%), (95%: CI: 0.74, 0.91).The factors associated with survival were a Thompson score of 7 to10 at initiation of cooling(HR: 0.07, 95% CI: 0.01, 0.94) and at 24 hours of cooling(HR:0.03, 95%CI: 0.004, 0.21), being born within the hospital providing therapeutic hypothermia (HR: 0.26, 95% CI: 0.07, 0.94) and not needing mechanical ventilator (HR: 0.03, 95% CI: 0.01, 0.14) or inotropic support.(HR: 0.13, 95%CI: 0.04, 0.38). The median time to attainment of full cup feeds was 6 days, with the majority 43/68(63%) attaining full feeds from 5 to 8 days. The median time to discharge was 7 days, and the median time to death was 3 days. The median Thompson score at discharge was 1 and at death was 16 Conclusion The survival rate of cooled infants in our setting at 84% is comparably high. The majority of infants have normal neurology at discharge.

scholarly journals The Prediction and Prognosis of Fungal Infection in Lung Transplant Recipients—A Retrospective Cohort Study in South Korea

2021 ◽  
Vol 7 (8) ◽  
pp. 639
Author(s):  
Yae-Jee Baek ◽  
Yun-Suk Cho ◽  
Moo-Hyun Kim ◽  
Jong-Hoon Hyun ◽  
Yu-Jin Sohn ◽  
...  
Keyword(s):  
Cohort Study ◽  
South Korea ◽  
Fungal Infection ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Lung Transplant ◽  
Fungal Infections ◽  
Transplant Recipients ◽  
Tertiary Center ◽  
Lung Transplant Recipients

(1) Background: Lung transplant recipients (LTRs) are at substantial risk of invasive fungal disease (IFD), although no consensus has been reached on the use of antifungal agents (AFAs) after lung transplantation (LTx). This study aimed to assess the risk factors and prognosis of fungal infection after LTx in a single tertiary center in South Korea. (2) Methods: The study population included all patients who underwent LTx between January 2012 and July 2019 at a tertiary hospital. It was a retrospective cohort study. Culture, bronchoscopy, and laboratory findings were reviewed during episodes of infection. (3) Results: Fungus-positive respiratory samples were predominant in the first 90 days and the overall cumulative incidence of Candida spp. was approximately three times higher than that of Aspergillus spp. In the setting of itraconazole administration for 6 months post-LTx, C. glabrata accounted for 36.5% of all Candida-positive respiratory samples. Underlying connective tissue disease-associated interstitial lung disease, use of AFAs before LTx, a longer length of hospital stay after LTx, and old age were associated with developing a fungal infection after LTx. IFD and fungal infection treatment failure significantly increased overall mortality. Host factors, antifungal drug resistance, and misdiagnosis of non-Aspergillus molds could attribute to the breakthrough fungal infections. (4) Conclusions: Careful bronchoscopy, prompt fungus culture, and appropriate use of antifungal therapies are recommended during the first year after LTx.

Predictive Factors for Successful Vaginal Delivery after a Trial of External Cephalic Version: A Retrospective Cohort Study of 946 Women

2021 ◽  
Author(s):  
Asaf Bilgory ◽  
Olena Minich ◽  
Maria Shvaikovsky ◽  
Genady Gurevich ◽  
Joseph B. Lessing ◽  
...  
Keyword(s):  
Cohort Study ◽  
Vaginal Delivery ◽  
Predictive Factors ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Goodness Of Fit ◽  
External Cephalic Version ◽  
Nulliparous Women ◽  
Tertiary Center ◽  
Vertex Presentation

Objective Our aim was to find the factors which predict a vertex presentation of vaginal delivery (VD) in women who are admitted for a trial of external cephalic version (ECV). Study Design This is a retrospective cohort study of women who underwent a trial of ECV and delivered between November 2011 and December 2018 in a single tertiary center. The main outcome measure was successful VD of a fetus in the vertex presentation. Women who achieved VD in the vertex presentation or underwent cesarean delivery were compared on the basis of variety of predictive factors. Adverse neonatal and maternal outcomes were reported. Logistic regression was used for the multivariate analysis. Results A total of 946 women were included; 717 (75.8%) women had a successful ECV and 663 (70.1%) women had a VD in the vertex presentation. Parous women had 79.3% VD rate (570/719) and nulliparous women had 41.0% VD rate (93/227). Women with an amniotic fluid index (AFI) of 50 to 79, 80 to 200, and >200 mm had 34.8, 71.0, and 83.1% VD rate, respectively. Parous versus nulliparous women had an adjusted odds ratio (aOR) of 5.42 (95% confidence interval [CI] 3.90–7.52, p < 0.001), women with AFI 50 to 79 mm compared with AFI 80 to 200 mm had an aOR of 0.21 (95% CI 0.12–0.37, p < 0.001), and women with an AFI >200 mm compared with AFI 80 to 200 mm had an aOR of 1.74 (95% CI 1.03–2.92, p = 0.037) to achieve VD. The final prediction model for the chances of a VD based on data on admission for ECV was reported. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model (p = 0.836). Conclusion Being parous and having an AFI >200 mm are positive independent predictive factors for achieving VD of a vertex presenting fetus after ECV. Whereas AFI 50 to 79 mm is a negative independent predictive factor. Key Points

scholarly journals A retrospective cohort study of idiopathic diaphragmatic palsy: a diagnostic triad, natural history and prognosis

2021 ◽  
pp. 00953-2020
Author(s):  
Syeda Nafisa ◽  
Ben Messer ◽  
Beatrice Downie ◽  
Patience Ehilawa ◽  
William Kinnear ◽  
...  
Keyword(s):  
Cohort Study ◽  
Respiratory Failure ◽  
Natural History ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Neuromuscular Disorders ◽  
Inspiratory Muscle ◽  
Diaphragmatic Palsy ◽  
Infection And Inflammation ◽  
Diaphragmatic Weakness

The diaphragm is the main inspiratory muscle, and diaphragmatic weakness can lead to respiratory failure. Diaphragmatic weakness or paralysis commonly presents in association with more generalised neuromuscular disorders. However, it can be caused by other pathologies, such as trauma, compression, infection and inflammation [1]. Isolated diaphragmatic palsy (DP) is well-described [2], but often missed in adults [3], especially in bilateral diaphragmatic palsy (BDP) where both domes of the diaphragm are elevated.

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