scholarly journals Clinical and morphological comparison of respiratory failure in patients with COVID-19 who died under different options of respiratory support

2021 ◽  
pp. 4-12
Author(s):  
Vita Skoryk ◽  
Volodymyr Korsunov ◽  
Tetiana Bocharova ◽  
Pavel Nartov ◽  
Maslova Valentina
Keyword(s):  
Mechanical Ventilation ◽  
Interstitial Pneumonia ◽  
Invasive Mechanical Ventilation ◽  
Lung Damage ◽  
Wilcoxon Test ◽  
Respiratory Support ◽  
Irreversible Processes ◽  
Fibrosing Alveolitis ◽  
Group 2 ◽  
Group 1

The aim. Based on the study of the effect of invasive mechanical ventilation and NIV in the CPAP mode on the pathomorphosis of lung damage in patients with HRF caused by SARS-nCoV-2 and deaths in intensive care unit (ICU), determine the safest method of respiratory support. Materials and methods. The study included morphological material from 20 patients with HRF caused by SARS-nCoV-2 (COVID-19) who died in ICU. Group 1 included patients who received non-invasive lung ventilation in CPAP mode through a face mask (n=10), group 2 - patients who underwent invasive ventilation (n=10). The prepared sections, 5 μm thick, were stained according to the Van Gizon method. Photomicrographs were taken using Zeiss ZENliteimaging. Data are presented as M [25-75] and P±Sp. Statistical analysis of the results was performed using the program “Statistica 10”. Significance of differences in indicators was assessed using the nonparametric Wilcoxon test, the parametric Student's test. The results were considered reliable at values of p<0.05. Results The morphological structure of the lungs of patients of group 1 corresponded to the exudative phase of DAD with severe edematous-hemorrhagic syndrome, signs of interstitial pneumonia with desquamation of alveolocytes and the formation of hyaline membranes. In patients of group 2 in the lung tissue there was a picture of the proliferative phase of DAD with signs of interstitial pneumonia, and the development of focal fibrosing alveolitis. Thus, invasive mechanical ventilation, can accelerate the development of irreversible processes in the lungs in the form of fibrosing alveolitis and promote the formation of ventilator-associated pneumonia Conclusions. CPAP NIV is a promising method of respiratory support in patients with ARDS caused by SARS-nCoV-2 virus (COVID-19), which needs further study

scholarly journals Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Begüm Ergan ◽  
Recai Ergün ◽  
Taner Çalışkan ◽  
Kutlay Aydın ◽  
Murat Emre Tokur ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Thrombolytic Therapy ◽  
Invasive Mechanical Ventilation ◽  
Apache Ii Score ◽  
Risk Patients ◽  
Group 2 ◽  
Group 1

Introduction. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission.Patients and Methods. PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients.Results. Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68.3%;p<0.001) and need for invasive mechanical ventilation (6.7 vs 36.6%;p=0.043) were more frequent in group 1. The treatment of choice for group 1 was thrombolytic therapy in 29 (70.7%) and anticoagulation in 12 (29.3%) patients. ICU mortality for group 1 was 31.7% (n=13). In multivariate logistic regression analysis, APACHE II score >18 (OR 42.47 95% CI 1.50–1201.1), invasive mechanical ventilation (OR 30.10 95% CI 1.96–463.31), and thrombolytic therapy (OR 0.03 95% CI 0.01–0.98) were found as independent predictors of mortality.Conclusion. In high-risk PE, admission APACHE II score and need for invasive mechanical ventilation may predict death in ICU. Thrombolytic therapy seems to be beneficial in these patients.

scholarly journals Chronic Parenchymal Lung Changes after COVID-19 Infection

2021 ◽  
Author(s):  
Abdelfattah Touman ◽  
Mohammed Khayat ◽  
Adeeb Bulkhi ◽  
Mutaz Khairo ◽  
Wael Alyamani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Multivariate Analyses ◽  
Invasive Mechanical Ventilation ◽  
Nasopharyngeal Swab ◽  
Retrospective Case ◽  
Medical City ◽  
Group 2 ◽  
Parenchymal Lung ◽  
Group 1

Abstract Background: Persistent parenchymal lung changes are an important long-term sequela of COVID-19. There are limited data on the disease characteristics and trajectories. This study aims to evaluate persistent COVID-19-related parenchymal lung changes after 10 weeks of acute viral pneumonia and to identify its risk factors. Methods: This was a retrospective case-control observational study involving 38 COVID-19 confirmed cases using nasopharyngeal swab reverse-transcriptase-polymerase-chain-reaction (RT-PCR) at King Abdullah Medical City (KAMC) hospital, Makkah. Patients were recruited from the Post-COVID interstitial lung disease (ILD) clinic. Referral to this clinic was based on the pulmonology consultants’ assessment of hospitalized patients suspected of developing COVID-19-related ILD changes during hospitalization. Measurements and Main Results: Nineteen patients with persistent parenchymal lung changes after 10 weeks of the acute illness (group-1) were compared with 19 control patients referred for assessment of post-COVID-19 ILD and had accelerated clinical and/or radiological features (group-2). Group-1 was found to have more severe clinical and radiological disease, with higher peak value of inflammatory biomarkers. Two risk factors were identified, NLR >3.13 at admission increases the odds ratio (OR) of chronic parenchymal changes by 6.42 and 13.09 in the univariate and multivariate analyses, respectively. Invasive mechanical ventilation had a more profound effect with ORs of 5.92 and 44.5 in the univariate and multivariate analyses, respectively.Conclusion: Herein, persistent parenchymal lung changes were observed in several patients 10 weeks after acute COVID-19 infection. We found that only receiving invasive mechanical ventilation and NLR >3.13 at admission were strong risk factors for persistent parenchymal lung changes.

scholarly journals Inhaled nitric oxide use in COVID19-induced hypoxemic respiratory failure.

2021 ◽  
Author(s):  
Abhishek R. Giri ◽  
Siva Naga S. Yarrarapu ◽  
Nirmaljot Kaur ◽  
Alexander P. Hochwald ◽  
Julia Crook ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Patient Outcomes ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hypoxemic Respiratory Failure ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Introduction: Nitric Oxide (NO) is an endogenous vasodilator that is synthesized by the vascular endothelium. Due to its vasodilatory effect and short half-life, the use of NO as an exogenous inhaled medication (iNO) to target the pulmonary vasculature, in conditions with increased pulmonary vascular resistance, has been studied. The use of iNO in patients with ARDS secondary to COVID-19 has therapeutic importance in improving oxygenation. It also has potential anti-viral, anti-inflammatory, and anti-thrombotic properties. Herein, we want to share our experience of use of iNO in hypoxemic respiratory failure secondary to COVID 19 pneumonia. We hypothesized that iNO may be beneficial at preventing intubation, decreasing invasive mechanical ventilation duration, and consequently improve outcomes including hospital mortality. Methods: This is a descriptive hypothesis generating study of patients admitted for COVID-19 pneumonia who received iNO for hypoxemic respiratory failure, at a single tertiary care center. We collected information on patient demographics, co-morbidities, iNO treatment, need for intubation, arterial blood gas analysis, laboratory values, hospital length of stay, and mortality. Patients were divided into two groups based on the timing of iNO administration: group 1 - pre-intubation (i.e. iNO started at least 1 day prior to endotracheal intubation, if any) and group 2 - post-intubation (i.e. iNO started on the same day as or after endotracheal intubation and mechanical ventilation). Result: A total of 45 (group 1, n=26 [57.8%] vs group2, n=19 [42.2%]) COVID 19 patients who had iNO use. The mean time from hospital admission to iNO administration(days) in group 1 was 2.1 (1.8, SD) vs 4.2 (5.9, SD) in group 2. The mean hospital length of stay from the beginning of iNO treatment until discharge or death was 18.3 vs 26.2 days, with 8 deaths (30.8%) vs 9 deaths (47.4%) in group 1 vs group 2, respectively. Discussion: Our study is unable to demonstrate comparably outcomes benefit of iNO. Although there was a trend towards decreased need for invasive mechanical ventilation in group 1[Only 11 (42.3 %) patients were intubated out of 26 who received iNO early after hospital admission (2.3 days)], no statistical significance could be achieved because of small sample size. Our study demonstrated that iNO administration pre-intubation did not appear harmful and appears to be safe, complementary to HFNC, signalling the domain where systematic investigation is required to confirm or not the potential for iNO to improve patient outcomes in the management of COVID 19-induced hypoxemic respiratory failure. Conclusion: This study showcases the potential benefit of early pre-intubation use of iNO in COVID patients with hypoxemic respiratory failure. This study could conclusively form the basis for a prospective trial and could have a tremendous impact in improving patient outcomes.

scholarly journals Effect of Dexamethasone in Hospitalized Patients with COVID-19 – Preliminary Report

2020 ◽  
Author(s):  
Peter Horby ◽  
Wei Shen Lim ◽  
Jonathan Emberson ◽  
Marion Mafham ◽  
Jennifer Bell ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Usual Care ◽  
Invasive Mechanical Ventilation ◽  
Randomization Test ◽  
Lung Damage ◽  
Respiratory Support ◽  
Open Label ◽  
Immune Mediated ◽  
Adjusted Rate ◽  
To Receive

ABSTRACTBackgroundCoronavirus disease 2019 (COVID-19) is associated with diffuse lung damage. Corticosteroids may modulate immune-mediated lung injury and reducing progression to respiratory failure and death.MethodsThe Randomised Evaluation of COVID-19 therapy (RECOVERY) trial is a randomized, controlled, open-label, adaptive, platform trial comparing a range of possible treatments with usual care in patients hospitalized with COVID-19. We report the preliminary results for the comparison of dexamethasone 6 mg given once daily for up to ten days vs. usual care alone. The primary outcome was 28-day mortality.Results2104 patients randomly allocated to receive dexamethasone were compared with 4321 patients concurrently allocated to usual care. Overall, 454 (21.6%) patients allocated dexamethasone and 1065 (24.6%) patients allocated usual care died within 28 days (age-adjusted rate ratio [RR] 0.83; 95% confidence interval [CI] 0.74 to 0.92; P<0.001). The proportional and absolute mortality rate reductions varied significantly depending on level of respiratory support at randomization (test for trend p<0.001): Dexamethasone reduced deaths by one-third in patients receiving invasive mechanical ventilation (29.0% vs. 40.7%, RR 0.65 [95% CI 0.51 to 0.82]; p<0.001), by one-fifth in patients receiving oxygen without invasive mechanical ventilation (21.5% vs. 25.0%, RR 0.80 [95% CI 0.70 to 0.92]; p=0.002), but did not reduce mortality in patients not receiving respiratory support at randomization (17.0% vs. 13.2%, RR 1.22 [95% CI 0.93 to 1.61]; p=0.14).ConclusionsIn patients hospitalized with COVID-19, dexamethasone reduced 28-day mortality among those receiving invasive mechanical ventilation or oxygen at randomization, but not among patients not receiving respiratory support.Trial registrationsThe RECOVERY trial is registered with ISRCTN (50189673) and clinicaltrials.gov (NCT04381936).FundingMedical Research Council and National Institute for Health Research (Grant ref: MC_PC_19056).

scholarly journals Can the cytokine adsorber CytoSorb® help to mitigate cytokine storm and reduce mortality in critically ill patients? A propensity score matching analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christina Scharf ◽  
Ines Schroeder ◽  
Michael Paal ◽  
Martin Winkels ◽  
Michael Irlbeck ◽  
...  
Keyword(s):  
Propensity Score ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Wilcoxon Test ◽  
Relative Reduction ◽  
Cytokine Storm ◽  
Saps Ii ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Abstract Background A cytokine storm is life threatening for critically ill patients and is mainly caused by sepsis or severe trauma. In combination with supportive therapy, the cytokine adsorber Cytosorb® (CS) is increasingly used for the treatment of cytokine storm. However, it is questionable whether its use is actually beneficial in these patients. Methods Patients with an interleukin-6 (IL-6) > 10,000 pg/ml were retrospectively included between October 2014 and May 2020 and were divided into two groups (group 1: CS therapy; group 2: no CS therapy). Inclusion criteria were a regularly measured IL-6 and, for patients allocated to group 1, CS therapy for at least 90 min. A propensity score (PS) matching analysis with significant baseline differences as predictors (Simplified Acute Physiology Score (SAPS) II, extracorporeal membrane oxygenation, renal replacement therapy, IL-6, lactate and norepinephrine demand) was performed to compare both groups (adjustment tolerance: < 0.05; standardization tolerance: < 10%). U-test and Fisher’s-test were used for independent variables and the Wilcoxon test was used for dependent variables. Results In total, 143 patients were included in the initial evaluation (group 1: 38; group 2: 105). Nineteen comparable pairings could be formed (mean initial IL-6: 58,385 vs. 59,812 pg/ml; mean SAPS II: 77 vs. 75). There was a significant reduction in IL-6 in patients with (p < 0.001) and without CS treatment (p = 0.005). However, there was no significant difference (p = 0.708) in the median relative reduction in both groups (89% vs. 80%). Furthermore, there was no significant difference in the relative change in C-reactive protein, lactate, or norepinephrine demand in either group and the in-hospital mortality was similar between groups (73.7%). Conclusion Our study showed no difference in IL-6 reduction, hemodynamic stabilization, or mortality in patients with Cytosorb® treatment compared to a matched patient population.

scholarly journals Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1035
Author(s):  
Rachel K. Marlow ◽  
Sydney Brouillette ◽  
Vannessa Williams ◽  
Ariann Lenihan ◽  
Nichole Nemec ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Center ◽  
Invasive Mechanical Ventilation ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Respiratory Support ◽  
Non Invasive ◽  
Lengths Of Stay

The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.

scholarly journals Stimulasi Magnetik Lebih Meningkatkan Kemampuan Fungsional pada Pasien Nyeri Punggung Bawah Dibanding Stimulasi Elektris

2020 ◽  
Vol 5 (1) ◽  
pp. 21-27
Author(s):  
Aditya Johan Romadhon
Keyword(s):  
Electrical Stimulation ◽  
Low Back Pain ◽  
Back Pain ◽  
Functional Activity ◽  
Magnetic Stimulation ◽  
Wilcoxon Test ◽  
Low Back ◽  
Group 2 ◽  
Pain Patients ◽  
Group 1

AbstractIntroduction : A long with the development of physical agents modalities, there are many recent modalities that has many beneficial for physical therapy practice, generally physical agents modalities are suit for musculoskeletal cases, one of beneficial effect for musculoskeletal case is maintaining of muscle’s physiology, electrical stimulations are familiar modalities we find in physiotherapy practice, this modality is use to inhibit pain signal and produce muscle contraction. Recently a new physical agent modality such as magnetic stimulation also has smiliar effect such as electrical stimulations, however there are less evidence to compare magnetic and electrical stimulation for musculoskeletal problems. Objective : Purpose of this study to compare magnetic and electrical stimulation effect for reducing pain and improve functional activity in low back pain patients. Methods : 60 low back pain patients recruited as subjects, devided into two groups, Group 1 given magnetic stimulation and Group 2 given electrical stimulation, after four mounth intervention two days in every weeks, pain index and functional activity measured with Oswestry instrument. Result : After 4 mounth intervention we find reducing pain index and improvement of functional activity in two groups, Group 1 the Oswestry score is 0.2 ± 0.08, while Group 2 the Oswestry score is 0.3 ± 0.05, based on the result we analyzed with Wilcoxon test, we find significant different between two groups, the significant value is 0.001 (p<0.05). Conclussion : magnetic stimulation is more effective to reduce pain index and improve functional activity by using Oswestry instrument than electrical stimulation. Keyword : Magnetic, Electrical, Stimulation, C fiber, A delta fiber

scholarly journals The role of Continuous Positive Airway Pressure (CPAP) in Delaying or Avoiding Mechanical Ventilation in COVID-19 Respiratory Failure: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Allan Cameron ◽  
Sharif Fattah ◽  
Laura Knox ◽  
Pauline Grose
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Royal Infirmary ◽  
High Dependency ◽  
Number Of Patients

Abstract Background - During the winter of 2020-2021, the second wave of the COVID19 pandemic in the United Kingdom caused increased demand for intensive care unit (ICU) beds, and in particular, for invasive mechanical ventilation (IMV). To alleviate some of this pressure, some centres offered non-invasive continuous positive airway pressure (CPAP), delivered on specialised COVID high dependency units (cHDUs). However, this practice was based largely on anecdotal reports, and it is not clear from the literature how effective CPAP is at delaying or preventing IMV. Methods - This was a retrospective observational cohort study of consecutive patients admitted to a specialised cHDU at Glasgow Royal Infirmary between November 2020 and February 2021. Each patient had a continuous record of the level of respiratory support required, and was followed up to hospital discharge or death. We examined patient outcomes according to age, sex and maximum level of respiratory support, using logistic regression and time-to-event analysis. The number of patients who could not be oxygenated by standard oxygen facemask but could be oxygenated by CPAP was counted and compared to the number of patients admitted to ICU for IMV over the same period.Results - There were 152 admissions to cHDU over the study period. Of these, 125 received CPAP treatment. Of the patients who received support in cHDU, the overall mortality rate was 37.9% (95% CI 30.3% - 46.1%)). Odds of mortality were closely correlated with increasing age and oxygen requirement. Of the 152 patients, 44 patients (28.8%, 95% CI 22.0 – 36.9%) went on to require IMV in ICU. This represents 77.2% of the 57 COVID-19 admissions to ICU during the same period. However, there were also 41 patients who received levels of respiratory support on cHDU which would normally necessitate ICU admission but who never went to ICU, potentially reducing ICU admissions by 41.8% (95% CI 32.1 – 52.2%).Conclusion - Providing respiratory support in cHDU reduced the number of potential ICU admissions by 41.8%, as well as delaying IMV for over 75% of ICU admissions. This represents a significant sparing of ICU capacity at a time when IMV beds were in high demand.

scholarly journals Pharmacokinetics of a New Pharmaceutical Form of Vitamin D3 100,000 IU in Soft Capsule

Nutrients ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 703 ◽  
Author(s):  
Romuald Mentaverri ◽  
Jean-Claude Souberbielle ◽  
Gilles Brami ◽  
Christelle Daniel ◽  
Patrice Fardellone
Keyword(s):  
Single Dose ◽  
Vitamin D3 ◽  
Oral Solution ◽  
Wilcoxon Test ◽  
Late Winter ◽  
Reference Drug ◽  
Significant Difference ◽  
Group 2 ◽  
New Formulation ◽  
Group 1

Vitamin D deficiency is frequent in the general population and both subjects and health professionals could benefit from a broader range of vitamin D3 formulations. We conducted a single-dose, open-label, parallel-group, randomized bioequivalence study to compare a single dose of a newly developed vitamin D3 100,000 IU in a soft capsule (Group 1) with the reference drug vitamin D3 100,000 IU oral solution in ampoule (Group 2) in healthy volunteers over a four-month period. The primary endpoint was the area under the curve (AUC) of serum 25-hydroxyvitamin-D (25(OH)D) concentrations on Day 112. This study was conducted in France from February to June 2014 in 53 young adults with a mean age of 26.9 years. At baseline, low mean serum 25(OH)D levels were observed in both groups (10.6 ng/mL in Group 1 and 9.0 ng/mL in Group 2). On Day 112, the AUC of serum 25(OH)D concentration was 2499.4 ± 463.8 nmol/mL (7.8 ± 0.2 for LogAUC) for Group 1 and 2152.3 ± 479.8 nmol/mL (7.6 ± 0.2 for LogAUC) for Group 2. Bioequivalence of the two treatments was not demonstrated. Superiority of vitamin D3 100,000 IU soft capsule was observed with p = 0.029 for AUC and p = 0.03 for LogAUC using a non-parametric Wilcoxon test. The profile of the serum 25(OH)D concentration showed a significant difference in favor of Group 1 on Days 1, 3, 7, 14 and 90. Mean serum 25(OH)D concentrations in Group 1 were between 20 and 30 ng/mL during the four-month period and under 20 ng/mL throughout the study in Group 2, except on Day 112. Mean Cmax for Group 1 was significantly higher (p = 0.002). Fourteen days were needed to reach Tmax by more than half the subjects in Group 1 compared to 45 days in Group 2. Both treatments were well tolerated, with no severe or related adverse events reported. In conclusion, the pharmacokinetic profile of the new formulation of vitamin D3 100,000 IU soft capsule is superior to that of the oral solution in ampoule. The new formulation increased serum 25(OH)D levels to above 20 ng/mL and maintained levels from 20 ng/mL to 30 ng/mL for four months in late winter and spring.

Sign in / Sign up

Export Citation Format

Share Document