High Mortality Among Patients With Severe COVID-19 and Do-not-intubate Orders Despite Use of Remdesivir and Dexamethasone

Abstract Background Moderate to severe respiratory distress among patients with coronavirus disease 2019 (COVID-19) is associated with a high mortality. Dexamethasone and remdesivir were introduced in the second wave of COVID-19 in Denmark. Methods This is a retrospective study of patients with COVID-19 and a supplemental oxygen requirement of ≥15 Liters per minute (L/min). The patients were divided in two groups corresponding to the first- and second wave of COVID-19 and analysed regarding need of ventilator support and mortality dependent on orders to Do Intubate (DI) or Do Not Intubate (DNI), respectively. Results The study included 178 patients. The mortality was 24% for patients with DI orders (n=115) and 81% for patients with DNI orders (n=63) increasing to 98% (n=46) for patients with DNI orders and very high flow oxygen requirements (≥30 L/min). Use of constant continuous positive airway pressure (cCPAP) increased from 71% in the first wave to 91% in the second wave (p<0.001) whereas the use of mechanical ventilation (MV) decreased from 54% to 28% (p=0.005). Conclusion The mortality was high for patients with DNI orders and respiratory distress with very high levels in supplemental oxygen in both the first and second wave of COVID-19 despite treatment with dexamethasone and remdesivir and improved prognosis for patients with DI orders. Hence careful evaluation on transition to palliative care must be considered for these patients. Study Registration The study was retrospectively registered and approved by the Danish Patient Safety Authority (record no. 31-1521-309) and the Regional Data Protection Center (record no. WZ20017637-2020-37).

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The Provo Multicenter Early High-frequency Oscillatory Ventilation Trial: Improved Pulmonary and Clinical Outcome in Respiratory Distress Syndrome

PEDIATRICS ◽

10.1542/peds.98.6.1044 ◽

1996 ◽

Vol 98 (6) ◽

pp. 1044-1057 ◽

Cited By ~ 6

Author(s):

Dale R. Gerstmann ◽

Stephen D. Minton ◽

Ronald A. Stoddard ◽

Keith S. Meredith ◽

Frank Monaco ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

High Frequency ◽

Neonatal Intensive Care ◽

Distress Syndrome ◽

Study Groups ◽

Supplemental Oxygen ◽

High Frequency Oscillatory Ventilation ◽

Ventilator Support ◽

High Frequency Oscillatory

Objective. To compare the hospital course and clinical outcome of preterm infants with respiratory distress syndrome treated with surfactant and managed with high-frequency oscillatory ventilation (HFOV) or conventional mechanical ventilation (CV) as their primary mode of ventilator support. Design. A prospective randomized clinical trial. Setting. Three community-based level III neonatal intensive care units. Subjects. A total of 125 neonates who were 35 weeks or less estimated gestation requiring intubation and assisted ventilation for respiratory distress syndrome with arterial to alveolar oxygen ratio less than .50. Interventions. Patients were randomized to continue CV (61 patients) or be changed to HFOV (64 patients) after exogenous surfactant administration (100 mg/kg). HFOV was used in a strategy to promote lung recruitment and maintain lung volume. Protocol respiratory care guidelines were followed; otherwise routine care was provided by each neonatal intensive care unit. Measurements and Main Results. No differences were noted in demographic features between the two study groups. The study population birth weight was 1.51 ± .47 kg (mean ± SD), gestational age was 30.9 ± 2.5 weeks, and study entry age was 2 to 3 hours. Patients randomized to HFOV demonstrated the following significant findings compared with CV-treated patients: vasopressor support was less intensive; surfactant redosing was not as frequent; oxygenation improved more rapidly and remained higher during the first 7 days; fewer infants required prolonged supplemental oxygen or ventilator support; treatment failure was reduced; more patients survived without chronic lung disease at 30 days; need for continuous supplemental oxygen at discharge was less; frequency of necrotizing enterocolitis illness was lower; there were fewer abnormal hearing tests; and hospital costs were decreased. No differences were seen between the two study groups in the frequency or severity of patent ductus arteriosus, air leak, retinopathy of prematurity, or intraventricular hemorrhage. Length of hospital stay and survival to discharge were similar for HFOV- and CV-treated infants. Conclusions. When used early with a lung recruitment strategy, HFOV after surfactant replacement resulted in clinical outcomes consistent with a reduction in both acute and chronic lung injury. Benefit was evident for preterm infants both less than or equal to 1 kg and more than 1 kg. In addition, early HFOV treatment may have had a more global effect on patient health throughout the hospitalization, resulting in reduced morbidity and decreased health care cost.

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Children, comorbidities and COVID-19 - What tilts the balance?

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i3.32738 ◽

2021 ◽

Vol 12 (3) ◽

pp. 10-13

Author(s):

Umesh Shukla ◽

Nita Radhakrishnan ◽

Bhanu Kiran Bhakhri ◽

Ravi Shankar ◽

Sohini Ghosh ◽

...

Keyword(s):

Respiratory Distress ◽

Care Center ◽

Tertiary Care ◽

Thalassemia Major ◽

Clinical Severity ◽

National Capital Region ◽

Severe Respiratory Distress ◽

Multiple Rib Fractures ◽

High Flow Oxygen ◽

National Capital

Background: Data on the outcome of children with SARS-COV-2 infection (COVID-19) is still evolving as the pandemic unfolds. Aims and Objective: The present study aims at describing the clinical severity, course and outcome of COVID-19 in children who had underlying illnesses or co-infections. Materials and Methods: Retrospective, single center, observational study, conducted in a pediatric tertiary care center at Noida (National Capital Region, India). Results: We analyzed the data of 15 children with co-morbidities associated with COVID-19. Cancer (n=4, 26.6%), co-infections (n=5, 33.3%), Thalassemia major (n=2, 13.3%) and one child each with celiac disease, cholelithiasis, Duchenne muscular dystrophy and multiple rib fractures were diagnosed with COVID-19. None were asymptomatic. 9 children (60%) had mild symptoms and 4 had moderate symptoms (26.6%) with respiratory distress. 2 children had severe respiratory distress requiring high flow oxygen. Convalescent plasma, IVIG, Oseltamivir, Azithromycin, Hydroxychloroquine were given as treatment in varying combinations. All children recovered from COVID-19. Conclusion: Active malignancy, hypogammaglobinemia, underlying lung disease were associated with moderate to severe symptoms in this series of patients. Convalescent plasma helped in both children with severe hypoxia.

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Whole-Genome Sequences of Chlamydia psittaci Strain HJ, Isolated from Meat Pigeons with Severe Respiratory Distress and High Mortality

Genome Announcements ◽

10.1128/genomea.00035-15 ◽

2015 ◽

Vol 3 (2) ◽

Cited By ~ 4

Author(s):

Qiang Zhang ◽

Zongxue Wu ◽

Ruixue Sun ◽

Jun Chu ◽

Er Han ◽

...

Keyword(s):

Respiratory Distress ◽

High Mortality ◽

Chlamydia Psittaci ◽

Whole Genome ◽

Genome Sequences ◽

Severe Respiratory Distress

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Association of severe respiratory distress syndrome and thyroid agenesis in a term neonate

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/s-2006-943309 ◽

2006 ◽

Vol 210 (S 5) ◽

Author(s):

S Vanhaesebrouck ◽

K Allegaert ◽

F de Zegher ◽

C Vanhole

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Term Neonate ◽

Severe Respiratory Distress ◽

Severe Respiratory Distress Syndrome

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688 Pediatric Obstructive Sleep Apnea (OSA) and COVID-19-Related Adverse Clinical Outcomes

SLEEP ◽

10.1093/sleep/zsab072.686 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A269-A269

Author(s):

Vaishal Shah ◽

Nancy Foldvary-Schaefer ◽

Lu Wang ◽

Lara Jehi ◽

Cynthia Pena Obrea ◽

...

Keyword(s):

High Risk ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Pediatric Patients ◽

Control Design ◽

Supplemental Oxygen ◽

Case Control ◽

World Health ◽

Invasive Ventilation ◽

High Flow Oxygen

Abstract Introduction The relationship of OSA and human coronavirus (COVID-19) in the pediatric population is unknown. We postulate that OSA is associated with SARS-CoV-2 positivity and with adverse COVID-19 outcomes in children. Methods A retrospective review of 120 consecutive patients (<18 years) with prior polysomnogram (PSG) and COVID-19 testing from the Cleveland Clinic COVID-19 registry was conducted. Using a case control design of SARS-CoV-2 positive and negative pediatric patients, we examined COVID-19 and pre-existing OSA (dichotomized AHI≥1) using logistic (OR,95%CI) regression and as continuous measures: AHI, oxygen(SpO2) nadir, %time SpO2<90%) using linear regression(beta+/-SE). In those positive for SARS-CoV-2(cases only), we assessed the association of OSA and World Health Organization(WHO) COVID-19 clinical outcome composite score (hospitalization, requiring supplemental oxygen, non-invasive ventilation/high-flow oxygen, invasive ventilation/ECMO or death) using Wilcoxon rank sum test for ordinal data. Results Cases (n=36) were 11.8±4.4 years, 61% male, 27.8% black and 88.9% with OSA, while 85.7% of controls (n=84) had OSA. OSA was not associated with increased SARS-CoV-2 positivity: OR=1.33(0.40, 4.45,p=0.64). No significant difference between cases and controls for mean AHI 3.7(1.5,6.0) vs 3.5(1.5,7.1),p=0.91,SpO2 nadir 88.6±5.4 vs 89.1±4.4,p=0.58,%time SpO2<90% 0.05[0.00,1.00) vs 0.10 (0.00,1.00, p=0.65) respectively was noted. WHO-7 COVID-19 clinical outcome did not meet statistical significance in relation to OSA due to the low event frequency (p=0.49). Of note, those with OSA vs without OSA had a higher WHO-7 outcome score of 2 vs 0 and prevalence of hospitalization: 12.5 vs 0% respectively. Of hospitalized patients, the following was observed: 23% had moderate/severe OSA vs 4.3% mild OSA, 50% required supplemental oxygen and 25% required intubation/invasive ventilation. No deaths or readmissions were reported. High risk conditions included: 75% obesity, 50% asthma, 25% sickle cell disease and 25% hypoplastic left heart. Conclusion In this first report of which we are aware focused on COVID-19 in pediatric OSA, we use a case control design leveraging COVID-19 and sleep laboratory registries. Albeit not statistically significant, pediatric patients with OSA had a higher percentage of worse clinical outcomes. Larger network studies are needed to clarify whether poorer COVID-19 outcomes may be attributable to OSA or modulated via high risk health conditions. Support (if any):

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A homozygous variant in ABCA3 is associated with severe respiratory distress and early neonatal death

Congenital Anomalies ◽

10.1111/cga.12437 ◽

2021 ◽

Author(s):

Montaha Al‐Iede ◽

Mariam Khanfar ◽

Luma Srour ◽

Raja Rabah ◽

Mousa Al‐Abbadi ◽

...

Keyword(s):

Respiratory Distress ◽

Neonatal Death ◽

Early Neonatal Death ◽

Severe Respiratory Distress ◽

Homozygous Variant

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Intraoral teratoma in a newborn presenting as severe respiratory distress

BMJ Case Reports ◽

10.1136/bcr-2013-008735 ◽

2013 ◽

Vol 2013 (mar25 1) ◽

pp. bcr2013008735-bcr2013008735 ◽

Cited By ~ 1

Author(s):

V. K. Kundal ◽

M. Gajdhar ◽

C. Sharma ◽

R. Kundal

Keyword(s):

Respiratory Distress ◽

Severe Respiratory Distress

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Radiologic Observations in Severe Neonatal Respiratory Distress Syndrome Treated with the Isolated Phospholipid Fraction of Natural Surfactant

Acta Radiologica ◽

10.1177/028418518702800404 ◽

1987 ◽

Vol 28 (4) ◽

pp. 389-394 ◽

Cited By ~ 16

Author(s):

W. Mortensson ◽

G. Noack ◽

T. Curstedt ◽

P. Herin ◽

B. Robertson

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Randomized Clinical Trials ◽

Distress Syndrome ◽

Phospholipid Fraction ◽

Neonatal Respiratory Distress Syndrome ◽

Dramatic Improvement ◽

Long Term Effects ◽

Severe Respiratory Distress ◽

Neonatal Respiratory Distress

Ten newborn babies with severe respiratory distress syndrome, all dependent on artificial ventilation, were treated via the airways with the isolated phospholipid fraction of bovine or porcine surfactant. After treatment with surfactant at a median age of 10.5h, there was in all patients a striking improvement of lung aeration in chest films, with a decrease in parenchymal fluid retention and in distension of bronchioli. These radiologic findings were associated with a dramatic improvement of oxygenation and a significant reduction of the right-to-left shunt. In spite of the rapid therapeutic response, four patients died from cerebral hemorrhage. One of the surviving patients developed bronchopulmonary dysplasia. Our findings document efficacy of this new surfactant preparation in the neonatal respiratory distress syndrome, but the long-term effects need to be further tested in randomized clinical trials.

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