scholarly journals Rapid review of multisystem inflammatory syndrome in paediatrics: What we know one year later

2021 ◽  
Vol 47 (11) ◽  
pp. 466-472
Author(s):  
Megan Striha ◽  
Rojiemiahd Edjoc ◽  
Natalie Bresee ◽  
Nicole Atchessi ◽  
Lisa Waddell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Kawasaki Disease ◽  
Significant Proportion ◽  
Health Agency ◽  
Rapid Review ◽  
The Public ◽  
One Year ◽  
Inflammatory Syndrome

Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) is an emerging condition that was first identified in paediatrics at the onset of the COVID-19 pandemic. The condition is also known as pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS or PIMS), and multiple definitions have been established for this condition that share overlapping features with Kawasaki Disease and toxic shock syndrome. Methods: A review was conducted to identify literature describing the epidemiology of MIS-C, published up until March 9, 2021. A database established at the Public Health Agency of Canada with COVID-19 literature was searched for articles referencing MIS-C, PIMS or Kawasaki Disease in relation to COVID-19. Results: A total of 195 out of 988 articles were included in the review. The median age of MIS-C patients was between seven and 10 years of age, although children of all ages (and adults) can be affected. Multisystem inflammatory syndrome in children disproportionately affected males (58% patients), and Black and Hispanic children seem to be at an elevated risk for developing MIS-C. Roughly 62% of MIS-C patients required admission to an intensive care unit, with one in five patients requiring mechanical ventilation. Between 0% and 2% of MIS-C patients died, depending on the population and available interventions. Conclusion: Multisystem inflammatory syndrome in children can affect children of all ages. A significant proportion of patients required intensive care unit and mechanical ventilation and 0%–2% of cases resulted in fatalities. More evidence is needed on the role of race, ethnicity and comorbidities in the development of MIS-C.

scholarly journals Multisystem inflammatory syndrome in children in Canada

2021 ◽  
Vol 47 (11) ◽  
pp. 461-465
Author(s):  
Meghan Laverty ◽  
Marina Salvadori ◽  
Susan G Squires ◽  
May Ahmed ◽  
Lisa Eisenbeis ◽  
...  
Keyword(s):  
Public Health ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Abdominal Pain ◽  
Time Trend ◽  
Health Agency ◽  
The Public ◽  
Health Authorities ◽  
Almost All ◽  
Inflammatory Syndrome

This article provides a summary of the epidemiology of multisystem inflammatory syndrome in children (MIS-C) cases reported nationally in Canada by provincial and territorial health authorities. Multisystem inflammatory syndrome in children is a post-viral inflammatory syndrome that temporally follows coronavirus disease 2019 (COVID-19). Symptoms may include fever, abdominal pain, vomiting, diarrhea, skin rash and other signs of inflammation. In Canada, MIS-C is rare, with 269 cases reported to the Public Health Agency of Canada between March 11, 2020 and October 2, 2021. One hundred forty-two (53%) of these cases were lab-confirmed COVID-19 cases or epidemiologically-linked with COVID-19 cases. Cases have been reported in infants as young as one week to youth as old as 18 years, with a median age of six years. Cases were more likely to occur in males than females (58% vs 42%, respectively; p=0.006). Almost all MIS-C cases (99%) required hospitalization and 36% required intensive care unit admission. No deaths have been reported to date. The time trend of MIS-C aligns with the incidence rate time trend of COVID-19 reported in children, with a two to six-week lag.

scholarly journals Risk factors for severity of COVID-19: a rapid review to inform vaccine prioritisation in Canada

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044684
Author(s):  
Aireen Wingert ◽  
Jennifer Pillay ◽  
Michelle Gates ◽  
Samantha Guitard ◽  
Sholeh Rahman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Intensive Care ◽  
Low Income ◽  
Severe Disease ◽  
Male Gender ◽  
Rapid Review ◽  
Class Iii

ObjectivesRapid review to determine the magnitude of association between potential risk factors and severity of COVID-19, to inform vaccine prioritisation in Canada.SettingOvid MEDLINE(R) ALL, Epistemonikos COVID-19 in L·OVE Platform, McMaster COVID-19 Evidence Alerts and websites were searched to 15 June 2020. Eligible studies were conducted in high-income countries and used multivariate analyses.ParticipantsAfter piloting, screening, data extraction and quality appraisal were performed by a single experienced reviewer. Of 3740 unique records identified, 34 were included that reported on median 596 (range 44–418 794) participants, aged 42–84 years. 19/34 (56%) were good quality.OutcomesHospitalisation, intensive care unit admission, length of stay in hospital or intensive care unit, mechanical ventilation, severe disease, mortality.ResultsAuthors synthesised findings narratively and appraised the certainty of the evidence for each risk factor–outcome association. There was low or moderate certainty evidence for a large (≥2-fold) magnitude of association between hospitalisation in people with COVID-19, and: obesity class III, heart failure, diabetes, chronic kidney disease, dementia, age >45 years, male gender, black race/ethnicity (vs non-Hispanic white), homelessness and low income. Age >60 and >70 years may be associated with large increases in mechanical ventilation and severe disease, respectively. For mortality, a large magnitude of association may exist with liver disease, Bangladeshi ethnicity (vs British white), age >45 years, age >80 years (vs 65–69 years) and male gender among 20–64 years (but not older). Associations with hospitalisation and mortality may be very large (≥5-fold) for those aged ≥60 years.ConclusionsIncreasing age (especially >60 years) may be the most important risk factor for severe outcomes. High-quality primary research accounting for multiple confounders is needed to better understand the magnitude of associations for severity of COVID-19 with several other factors.PROSPERO registration numberCRD42020198001.

scholarly journals Mononeuritis multiplex: an unexpectedly frequent feature of severe COVID-19

2020 ◽  
Author(s):  
Edward Needham ◽  
Virginia Newcombe ◽  
Andrew Michell ◽  
Rachel Thornton ◽  
Andrew Grainger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Prolonged Mechanical Ventilation ◽  
Significant Proportion ◽  
Neurological Deficits ◽  
Mononeuritis Multiplex ◽  
Critical Illness Neuromyopathy

AbstractThe prolonged mechanical ventilation that is often required by patients with severe COVID-19 is expected to result in significant intensive care unit-acquired weakness (ICUAW) in many of the survivors. However, in our post-COVID-19 follow-up clinic we have found that, as well as the anticipated global weakness related to loss of muscle mass, a significant proportion of these patients also have disabling focal neurological deficits relating to multiple axonal mononeuropathies. Amongst the 69 patients with severe COVID-19 that have been discharged from the intensive care units in our hospital, we have seen 11 individuals (16%) with such a mononeuritis multiplex. In many instances, the multi-focal nature of the weakness in these patients was initially unrecognised as symptoms were wrongly assumed to relate simply to “critical illness neuromyopathy”. While mononeuropathy is well recognised as an occasional complication of intensive care, our experience suggests that such deficits are surprisingly frequent and often disabling in patients recovering from severe COVID-19.

scholarly journals Profile of Neurosurgical Patients in a Tertiary Level Intensive Care Unit in Nepal

2018 ◽  
Vol 16 (3) ◽  
pp. 336-339
Author(s):  
Subhash Prasad Acharya ◽  
Binita Bhattarai ◽  
Adheesh Bhattarai ◽  
Saurabh Pradhan ◽  
Mohan Raj Sharma
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Unit Mortality ◽  
Surgical Intensive Care Unit ◽  
Tertiary Level ◽  
Surgical Intensive Care ◽  
Mortality And Morbidity ◽  
Neurosurgical Patients ◽  
One Year

Background: Neurosurgery has developed as a separate specialty and neurosurgical patients are some of the most common admitted in the intensive care unit. The objective of the study was to study the profile of neurosurgical patients admitted in level III mixed, medical-surgical intensive care unit in a tertiary level teaching hospital in Nepal with the view to identify the causes of intensive care unit admission, types of neurosurgery performed, outcome of the patients, in terms of intensive care unit stay, mechanical ventilation days and mortality.Methods: A retrospective study was designed and all neurosurgical patients admitted to the intensive care unit of our center between 13 April 2017 and 13April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were enrolled in this study.Results: A total of 813 patients were admitted in ICU over a period of one year (2074 B.S.) of which 199 (24.48 %) were neurosurgical cases. Among these 170 (85.42%) cases were post-surgical, with 29 (14.58%) being pre-operative patients. One hundred forty nine patients (74.9%) were on mechanical ventilation. One hundred and thirty two (66.3%) patients improved and were transferred to a step down ward. Forty-three (22.5%) died in the intensive care unit, 14 (7.03%) left the hospital against medical advice and 9 (4.5%) patients expired after withdrawal of life support.Conclusions: Despite improved care over the recent years the mortality and morbidity of neurosurgical patients is high.Keywords: Intensive care unit; mortality; neurosurgery; outcome.

scholarly journals Physical Therapist Management of COVID-19 in the Intensive Care Unit: The West China Hospital Experience

2020 ◽  
Author(s):  
Lei Li ◽  
Pengming Yu ◽  
Mengxuan Yang ◽  
Wei Xie ◽  
Liyi Huang ◽  
...  
Keyword(s):  
Public Health ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Maximal Inspiratory Pressure ◽  
Mobility Index ◽  
The Public ◽  
Clinical Center

Abstract Objective Coronavirus disease 2019 (COVID-19) has dominated the attention of health care systems globally since January 2020. Various health disciplines including physical therapists are still exploring the best way to manage this new disease. The role and involvement of physical therapists in the management of COVID-19 are not yet well defined and are limited in many hospitals. This article reports a physical therapy service specially commissioned by the Health Commission of Sichuan Province to manage COVID-19 during patients’ stay in the intensive care unit (ICU) at the Public Health Clinical Center of Chengdu in China. Methods Patients diagnosed with COVID-19 were classified into 4 categories under a directive from the National Health Commission of the People’s Republic of China. Patients in the “severe” and “critical” categories were admitted to the ICU irrespective whether mechanical ventilation was required. Between January 31, 2020, and March 8, 2020, a cohort of 16 patients was admitted to the ICU at the Public Health Clinical Center of Chengdu. The median (minimum to maximum) hospital and ICU stays for these patients were 27 (11–46) and 15 (6–38) days, respectively. Medical management included antiviral, immunoregulation and supportive treatment of associated comorbidities. Physical therapist interventions included body positioning, airway clearance techniques, oscillatory positive end-expiratory pressure, inspiratory muscle training, and mobility exercises. All patients had at least 1 comorbidity. Three of the 16 patients required mechanical ventilation and were excluded for outcome measures that required understanding of verbal instructions. In the remaining 13 patients, respiratory outcomes—including the Borg Dyspnea Scale, peak expiratory flow rate, Pao2/Fio2 ratio, maximal inspiratory pressure, strength outcomes, Medical Research Council Sum Score, and functional outcomes (including the Physical Function in Intensive Care Test score, De Morton Mobility Index, and Modified Barthel Index)—were measured on the first day the patient received the physical therapist intervention and at discharge. Results At discharge from the ICU, while most outcome measures were near normal for the majority of the patients, 61% and 31% of these patients had peak expiratory flow rate and maximal inspiratory pressure below 80% of the predicted value and 46% had De Morton Mobility Index values below the normative value. Conclusion The respiratory and physical functions of some patients remained poor at ICU discharge, suggesting that long-term rehabilitation may be required for these patients. Impact Our experience in the management of patients with COVID-19 has revealed that physical therapist intervention is safe and appears to be associated with an improvement in respiratory and physical function in patients with COVID-19 in the ICU.

scholarly journals Profile of Neurosurgical Patients in a Tertiary Level Intensive Care Unit in Nepal

2018 ◽  
Vol 16 (3) ◽  
pp. 336-339
Author(s):  
Subhash Prasad Acharya ◽  
Binita Bhattarai ◽  
Adheesh Bhattarai ◽  
Saurabh Pradhan ◽  
Mohan Raj Sharma
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Advice ◽  
Surgical Intensive Care Unit ◽  
Tertiary Level ◽  
Surgical Intensive Care ◽  
Mortality And Morbidity ◽  
Neurosurgical Patients ◽  
One Year

Background: Neurosurgery has developed as a separate specialty and neurosurgical patients are some of the most common admitted in the intensive care unit. The objective of the study was to study the profile of neurosurgical patients admitted in level III mixed, medical-surgical intensive care unit in a tertiary level teaching hospital in Nepal with the view to identify the causes of intensive care unit admission, types of neurosurgery performed, outcome of the patients, in terms of intensive care unit stay, mechanical ventilation days and mortality.Methods: A retrospective study was designed and all neurosurgical patients admitted to the intensive care unit of our center between 13 April 2017 and 13April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were enrolled in this study.Results: A total of 813 patients were admitted in ICU over a period of one year (2074 B.S.) of which 199 (24.48 %) were neurosurgical cases. Among these 170 (85.42%) cases were post-surgical, with 29 (14.58%) being preoperative patients. One hundred forty nine patients (74.9%) were on mechanical ventilation. One hundred and thirty two (66.3%) patients improved and were transferred to a step down ward. Forty-three (22.5%) died in the intensive care unit, 14 (7.03%) left the hospital against medical advice and 9 (4.5%) patients expired after withdrawal of life support.Conclusions: Despite improved care over the recent years the mortality and morbidity of neurosurgical patients is high.

Communication Ability, Method, and Content Among Nonspeaking Nonsurviving Patients Treated With Mechanical Ventilation in the Intensive Care Unit

2004 ◽  
Vol 13 (3) ◽  
pp. 210-218 ◽  
Author(s):  
Mary Beth Happ ◽  
Patricia Tuite ◽  
Kathy Dobbin ◽  
Dana DiVirgilio-Thomas ◽  
Julius Kitutu
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Center ◽  
Significant Proportion ◽  
Message Content ◽  
Physical Restraints ◽  
Primary Methods ◽  
Communication Ability ◽  
Pain Symptoms

• Objective To describe the communication ability, methods, and content among nonspeaking nonsurviving patients treated with mechanical ventilation in an intensive care unit. • Methods Fifty patients who received mechanical ventilation and died during hospitalization were randomly selected from all adult patients (N = 396) treated in 8 ICUs in a tertiary medical center during a 12-month period. Clinicians’ notes, use of physical restraints, and medication records were reviewed retrospectively. Data on communication method, use of sedation/analgesia (within 4 hours of communication event), and use of physical restraints were recorded on an investigator-developed communication event record for the first 10 communication episodes documented in each patient’s record (n = 275). Message content and method were recorded for every documented communication episode (n = 694), resulting in a total of 812 content and 771 method data codes. • Results Most charts (72%) had documentation of communication by patients at some time during mechanical ventilation. Most documented communication exchanges were between patients and nurses. Primary methods of communication were head nods, mouthing words, gesture, and writing. Physical restraints were used in half of the patients. However, most of the documented communication episodes (127/202, 62.9%) occurred when physical restraints were not in use. Communication content was primarily related to pain, symptoms, feelings, and physical needs. Patients also initiated communication about their homes, families, and conditions. • Conclusions A clinically significant proportion of nonsurviving patients treated with mechanical ventilation in the intensive care unit communicate to nurses, other clinicians, and family members primarily through gesture, head nods, and mouthing words.

scholarly journals Mononeuritis multiplex: an unexpectedly common feature of severe COVID-19

2020 ◽  
Author(s):  
Edward Needham ◽  
Virginia Newcombe ◽  
Andrew Michell ◽  
Rachel Thornton ◽  
Andrew Grainger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Muscle Mass ◽  
Prolonged Mechanical Ventilation ◽  
Significant Proportion ◽  
Neurological Deficits ◽  
Mononeuritis Multiplex

The prolonged mechanical ventilation required by patients with severe COVID-19 is expected to result in significant Intensive Care Unit - Acquired Weakness (ICUAW) in many of the survivors. However, in our post-COVID-19 follow up clinic we have found that, as well as the anticipated global weakness related to loss of muscle mass, a significant proportion of these patients also have disabling focal neurological deficits relating to an axonal mononeuritis multiplex. Amongst the 69 patients with severe COVID-19 that have been discharged from the intensive care units in our hospital, we have seen 11 individuals (16%) with such neuropathies. In many instances, the multi-focal nature of the weakness in these patients was initially unrecognised as symptoms were wrongly assumed to simply relate to "critical illness neuropathy". While mononeuropathy is well recognised as an occasional complication of intensive care, our experience suggests that such deficits are common and frequently disabling in patients recovering from COVID-19.

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