scholarly journals Trends in oxygen therapy in patients with moderate to severe COVID-19 admitted to the ICU

2021 ◽  
Vol 8 (4) ◽  
pp. 10-14
Author(s):  
Raghunath S S ◽  
Bheema Devanand ◽  
Mohammed Nizamuddeen B ◽  
Bala Bhaskar S ◽  
Pradnya Kothari ◽  
...  
Keyword(s):  
Oxygen Therapy ◽  
Prospective Observational Study ◽  
Severe Disease ◽  
Comfort Level ◽  
Chi Square ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Chi Square Test ◽  
Polymerase Chain ◽  
Ethical Clearance

The most concerning complication of severe acute respiratory syndrome corona virus 2 (SARSCoV-2) pneumonia is acute hypoxemic failure. Though various antivirals, steroids, immunomodulators have been tried, oxygen therapy remains the mainstay of treatment. After obtaining institutional ethical clearance, a prospective observational study was conducted on 102 COVID-19 positive patients aged 20 years and above, admitted in the ICU with moderate to severe disease. COVID-19 infection was confirmed by polymerase chain reaction or rapid antigen test. Data of two demographically comparable groups i.e., patients on HFNO and NIV was analysed outcome was defined as discharge from ICU, shift to other non-invasive modes of oxygen therapy, endotracheal intubation or death, and comfort level for each mode. The data was analysed using SPSS-16.0, Chi-square test and “t” value test were applied.Comparison ofthe mean number of invasive ventilator free days of HFNO and NIV was insignificant(p>0.05). Among the patients on HFNO (high flow nasal oxygen) 49.09% were stepped down to NRB (non-rebreathing mask) whereas 7.27% went for intubation which is significant compared to NIV mask (non-invasive ventilation), where 13.64% were stepped down to HFNO and 34.09% were intubated (p=0.000).Oxygen therapy with HFNO is associated with better outcome and less mortality when compared with NIV.

scholarly journals Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045659
Author(s):  
René Robert ◽  
Denis Frasca ◽  
Julie Badin ◽  
C Girault ◽  
Christophe Guitton ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Invasive Ventilation ◽  
Clinical Practices ◽  
Icu Patients ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Registration Number

IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03673631

Department of Internal Medicine. University Hospital of Patras. Patras.

2022 ◽  
Vol 35 (13) ◽  
Author(s):  
Themistoklis Paraskevas ◽  
Eleousa Oikonomou ◽  
Maria Lagadinou ◽  
Vasileios Karamouzos ◽  
Nikolaos Zareifopoulos ◽  
...  
Keyword(s):  
Oxygen Therapy ◽  
Case Series ◽  
High Flow ◽  
University Hospital ◽  
Current Evidence ◽  
Cochrane Library ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen

Introduction: Oxygen therapy remains the cornerstone for managing patients with severe SARS-CoV-2 infection and several modalities of non-invasive ventilation are used worldwide. High-flow oxygen via nasal canula is one therapeutic option which may in certain cases prevent the need of mechanical ventilation. The aim of this review is to summarize the current evidence on the use of high-flow nasal oxygen in patients with severe SARS-CoV-2 infection.Material and Methods: We conducted a systematic literature search of the databases PubMed and Cochrane Library until April 2021 using the following search terms: “high flow oxygen and COVID-19” and “high flow nasal and COVID-19’’.Results: Twenty-three articles were included in this review, in four of which prone positioning was used as an adjunctive measure. Most of the articles were cohort studies or case series. High-flow nasal oxygen therapy was associated with a reduced need for invasive ventilation compared to conventional oxygen therapy and led to an improvement in secondary clinical outcomes such as length of stay. The efficacy of high-flow nasal oxygen therapy was comparable to that of other non-invasive ventilation options, but its tolerability is likely higher. Failure of this modality was associated with increased mortality.Conclusion: High flow nasal oxygen is an established option for respiratory support in COVID-19 patients. Further investigation is required to quantify its efficacy and utility in preventing the requirement of invasive ventilation.

scholarly journals Kondisi Kebersihan Lingkungan Berhubungan dengan Risiko Penularan Kasus Leptospirosis di Area Pasar Tradisional

2020 ◽  
pp. 199-208
Author(s):  
Dyah Widiastuti ◽  
Dwi Priyanto
Keyword(s):  
Cross Sectional Study ◽  
Market Area ◽  
Chi Square ◽  
Pathogenic Leptospira ◽  
Cross Sectional ◽  
Chi Square Test ◽  
History Of ◽  
Polymerase Chain ◽  
Gathering Place ◽  
The Relationship

Leptospirosis is associated with occupations which exposed workers to contaminated environments. The risk of leptospirosis exposure in the market as a gathering place for many people needs to be assessed, to obtain the basis for decision making to anticipate leptospirosis transmission. This study aimed to determine the relationship between market environmental conditions including market sanitation conditions, the level of rat density and the presence of leptospira-positive rats  toward the history of leptospirosis exposure among market workers (traders and janitors). A cross sectional study conducted in 35 markets in Banjarnegara and 175 market workers randomly selected. Blood samples analysed using ELISA against 40 Kda pathogenic Leptospira protein. Rat trapping  conducted in each market for two days with 100 traps. The caught mice examined with Polymerase Chain Reaction (PCR) to detect the presence of Leptospira bacteria in their kidneys. Leptospirosis exposure was spread in 17 markets in Banjarnegara. The PCR examination showed that the pathogenic Leptospira infected rats were spread in four markets in Banjarnegara. Chi square test showed that the hygene condition in market area was significantly associated with the leptospirosis exposure. Markets workers (traders and janitors) were at risk for leptospirosis proved by high seroprevalence of leptospirosis in this study.

scholarly journals Efficacy and Safety of Artemether-Lumefantrine for Treatment of Uncomplicated P. Falciparum malaria in Ethiopia: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Abdulhakim Abamecha ◽  
Daniel Yilma ◽  
Wondimagegn Adissu ◽  
Delenasaw Yewhalaw ◽  
Alemseged Abdissa
Keyword(s):  
Systematic Review ◽  
Falciparum Malaria ◽  
Meta Analysis ◽  
Treatment Success ◽  
Uncomplicated Falciparum Malaria ◽  
Chi Square ◽  
Inverse Variance ◽  
Chi Square Test ◽  
Polymerase Chain ◽  
Variance Index

Abstract Background: Anti-malarial drug resistance, in particular resistance to Plasmodium falciparum, challenges the treatment and control of malaria. In Ethiopia, the first-line treatment of uncomplicated falciparum malaria has been changed from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (AL) in 2004. To maximize efficacy of anti-malarial drugs and ensure adequate treatment outcomes; monitoring drug efficacy regularly is vital to establish rational malaria treatment guidelines. This systematic review and meta-analysis is performed to obtain an overall stronger evidence to guide management of uncomplicated falciparum malaria from the existing literature in Ethiopia after policy changes in 2004.Methods: A systematic literature search was performed using the preferred reporting items for systematic review and meta-analysis (PRISMA) from published therapeutic efficacy studies conducted in Ethiopia from 2004 to 2020. The search was performed from Pubmed, Google Scholar and Clinical trial registry databases to identify literature. Two reviewers independently assessed study eligibility and extracted data. While computing the efficacy of AL, polymerase chain reaction (PCR)-corrected cure rate (adequate clinical and parasitological response, ACPR) at 28th day was considered as the primary endpoint. Meta-analysis was computed using OpenMeta-Analysis software to calculate the pooled ACPR. Statistical heterogeneity was evaluated with the Cochran chi-square test (X2) test and inverse variance index (I2). Publication bias was analyzed using funnel plots and Egger’s test statistics. The review protocol is registered in PROSPERO, number CRD42020201859.Results: Out of studies screened, fifteen studies fulfilled the inclusion criteria, and were included in final analysis with a total number of 1523 participants. Treatment success of AL for uncomplicated falciparum malaria in all combined studies was 98.4% [(95% CI 97.6–99.1), P< 0.001]. Polymerase chain reaction (PCR)-corrected AL treatment success rate of 98.7% [(95% CI 97.7-99.6), P<0.001)]. The efficacy of AL with PCR-corrected cure rates ranging from 95.0 to 99.4% in per-protocol analysis, and 88.8 to 97.4% in intention-to-treat analysis. Based on the analysis, Cochrane chi-square test (X2) test and inverse variance index (I2) indicated that the included studies with heterogeneity (X2=20.48, (df=14), P=0.116 and I2=31.65%). The highest parasite positivity rate at day-3 was 5.7%. Adverse events ranged from mild to serious but were not directly attributed to the drug.Conclusion: The present review has shown that AL is efficacious and safe for treatment of uncomplicated malaria in Ethiopia. However, few therapeutic efficacy studies were conducted in Ethiopia after treatment guideline was revised in 2004. AL has been used more than a decade in the study population without other alternative artemisinin-based combination therapy in Ethiopia and considering that the potential evolution of drug resistance is of a great concern, regular and continuous monitoring of its efficacy is warranted.

scholarly journals The impact of non-invasive respiratory support techniques on the lethal outcome frequency in adult with severe respiratory failure caused by the new coronavirus infection

2021 ◽  
Vol 18 (1) ◽  
pp. 47-56
Author(s):  
К. A. Tsygankov ◽  
I. N. Grachev ◽  
Vladimir I. Shatalov ◽  
А. V. Schegolev ◽  
D. A. Аveryanov ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Severe Respiratory Failure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen ◽  
Coronavirus Infection ◽  
Group 2

The objective: to evaluate the effect of high-flow oxygen and non-invasive ventilation on the mortality rate in adults with severe respiratory failure caused by the new coronavirus infection in the intensive care unit (ICU).Subjects and methods. A one-center retrospective study was conducted. Electronic medical files of patients treated in the ICU from April 1 to May 25, 2020, were analyzed. Totally, 101 medical files were selected, further, they were divided into two groups. Group 1 (n = 49) included patients who received oxygen insufflation, and should it fail, they received traditional artificial ventilation. No non-invasive respiratory therapy was used in this group. Group 2 (n = 52) included patients who received high-flow oxygen therapy and non-invasive ventilation. The mortality rate in the groups made a primary endpoint for assessing the impact of high-flow oxygen therapy and non-invasive ventilation. The following parameters were also analyzed: drug therapy, the number of patients in whom non-invasive techniques were used taking into account the frequency of cases when these techniques failed, and the number of patients in whom artificial ventilation was initiated.Results. In Group 2, non-invasive methods of respiratory therapy were used in 31 (60%) cases. High-flow oxygen therapy was used in 19 (36%) of them; in 13 cases this method allowed weaning them from the high flow. Non-invasive ventilation was used in 18 cases, in 12 patients it was used due to progressing severe respiratory failure during humidified oxygen insufflation, in 6 patients – after the failed high-flow oxygen therapy. In Group 1, 25 (51%) patients were intubated and transferred to artificial ventilation, in Group 2, 10 (19.2%) underwent the same. The lethal outcome was registered in 23 (47%) cases in Group 1, and in 10 (19.2%) in Group 2 (p = 0.004). Analysis of drug therapy in the groups revealed the difference in the prescription of pathogenetic therapy. Logistic regression demonstrated the effectiveness of the combination of tocilizumab + a glucocorticoid in reducing the frequency of lethal cases (p = 0.001).Conclusion. The use of non-invasive respiratory support in adults with severe respiratory failure caused by the new coronavirus infection combined with therapy by tocilizumab + a glucocorticoid can reduce the incidence of lethal cases.

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