scholarly journals Helmet CPAP to treat hypoxic pneumonia outside the ICU: an observational study during the COVID-19 outbreak

2021 ◽  
Author(s):  
Andrea Coppadoro ◽  
Annalisa Benini ◽  
Robert Fruscio ◽  
Luisa Verga ◽  
Paolo Mazzola ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Observational Study ◽  
Oxygen Therapy ◽  
Rescue Therapy ◽  
Health Care Systems ◽  
Reactive Protein ◽  
Cpap Treatment ◽  
Full Treatment ◽  
Care Systems ◽  
Cpap Failure

Abstract Background: Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment. Helmet is as effective interface to provide Continuous Positive Airway Pressure (CPAP) non-invasively. We report data about the usefulness of helmet CPAP during pandemic, either as an effective treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI).Methods: In this observational study we collected data regarding patients failing standard oxygen therapy (i.e. non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients’ data were recorded before, at initiation of CPAP treatment and once a day, thereafter. CPAP failure was defined as a composite outcome of intubation or death.Results: A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full-treatment and 28% of the DNI patients (P<0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P<0.001); respiratory rate decreased from 28 [22-32] to 24 [20-29] breaths per minute, P<0.001). C-Reactive Protein, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities were independently associated with CPAP failure. Helmet CPAP was maintained for 6 [3-9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wards.Conclusions: Helmet CPAP treatment is feasible for several days outside the ICU, despite persistent impairment in gas exchange. It was used, without escalating to intubation, in the majority of full treatment patients after standard oxygen therapy failed. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival.Trial Registration: NCT04424992

scholarly journals Helmet CPAP to treat hypoxic pneumonia outside the ICU: an observational study during the COVID-19 outbreak

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Andrea Coppadoro ◽  
Annalisa Benini ◽  
Robert Fruscio ◽  
Luisa Verga ◽  
Paolo Mazzola ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Observational Study ◽  
Oxygen Therapy ◽  
Rescue Therapy ◽  
Health Care Systems ◽  
Reactive Protein ◽  
Cpap Treatment ◽  
Full Treatment ◽  
Care Systems ◽  
Cpap Failure

Abstract Background Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment. Helmet is an effective interface to provide continuous positive airway pressure (CPAP) noninvasively. We report data about the usefulness of helmet CPAP during pandemic, either as treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI). Methods In this observational study we collected data regarding patients failing standard oxygen therapy (i.e., non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients’ data were recorded before, at initiation of CPAP treatment and once a day, thereafter. CPAP failure was defined as a composite outcome of intubation or death. Results A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full treatment and 28% of the DNI patients (P < 0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P < 0.001); respiratory rate decreased from 28 [22–32] to 24 [20–29] breaths per minute, P < 0.001). C-reactive protein, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities were independently associated with CPAP failure. Helmet CPAP was maintained for 6 [3–9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wards. Conclusions Helmet CPAP treatment is feasible for several days outside the ICU, despite persistent impairment in gas exchange. It was used, without escalating to intubation, in the majority of full treatment patients after standard oxygen therapy failed. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival. Trial Registration: NCT04424992

scholarly journals Helmet CPAP to Treat Hypoxic Pneumonia Outside the ICU: An Observational Study During the COVID-19 Outbreak

2020 ◽  
Author(s):  
Andrea Coppadoro ◽  
Annalisa Benini ◽  
Robert Fruscio ◽  
Luisa Verga ◽  
Paolo Mazzola ◽  
...  
Keyword(s):  
Observational Study ◽  
Oxygen Therapy ◽  
Positive Airway Pressure ◽  
Rescue Therapy ◽  
Healthcare Systems ◽  
Composite Outcome ◽  
Cpap Treatment ◽  
Full Treatment ◽  
Report Data ◽  
Cpap Failure

Abstract Background: Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may threaten healthcare systems hold, due to the surge patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe hypoxia. Helmet is as effective interface to provide Continuous Positive Airway Pressure (CPAP) non-invasively. We report data about the usefulness of helmet CPAP during pandemic, either as an effective treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI).Methods: In this observational study we collected data regarding patients failing standard oxygen therapy (i.e. non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients’ data were recorded before, at initiation of CPAP treatment and once a day, since. CPAP failure was defined as a composite outcome of intubation or death.Results: A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full-treatment and 29% of the DNI patients (P<0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P<0.001); respiratory rate decreased from 28 [22-32] to 24 [20-29] breaths per minute, P<0.001). CPAP failure was independently associated with CRP, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities. Helmet CPAP was maintained for 6 [3-9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wardsConclusions: Helmet CPAP treatment is feasible for several days outside the ICU, despite persisting hypoxia. It is effective, avoiding intubation in the majority of full treatment patients when standard oxygen therapy fails. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival.Trial Registration: NCT04424992

HSR19-105: The Role of Chemotherapy in Elderly Colorectal Cancer Survivors: An Observational Study

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-105
Author(s):  
Pamala A. Pawloski ◽  
Gabriela Vazquez-Benitez ◽  
Jeanette Y. Ziegenfuss ◽  
Terese A. DeFor ◽  
Elisabeth M. Seburg
Keyword(s):  
Colorectal Cancer ◽  
Observational Study ◽  
Cancer Survivors ◽  
Health Care Systems ◽  
Cancer Registries ◽  
Factors Associated ◽  
Colon Cancers ◽  
Chart Abstraction ◽  
Care Systems ◽  
Chemotherapy Initiation

Background: Older patients diagnosed with colorectal cancer are not routinely included in clinical trials and are frequently treated with less aggressive chemotherapy. To identify factors associated with treatment initiation in older adults, we conducted an observational study of patients diagnosed with stage I–IV colon or rectal cancer at 65 years and older between 2010 and 2014 across 6 integrated health care systems. Methods: Data were obtained from cancer registries based on chart abstraction and medical records. Time from diagnosis to surgery, chemotherapy, and radiation was measured in weeks and censored when disenrollment, death, or the end of the study period occurred. We assessed patient factors associated with time to chemotherapy initiation using survival analysis methods. Results: Among 8,088 patients diagnosed after the age of 65 with colon cancer, the mean age at diagnosis was 76 years (SD 7.7), 4,150 (51%) were female, and 34% were stage 3 or greater. More than half, 55% (n=4,434) of colon cancers were right-sided (RCC), 23% (n=1833) were left-sided (LCC), and 19% (n=1,559) were rectal cancers. Two-thirds (n=5,201) had moderately differentiated disease. Most (57%) received surgery within 4 weeks and 89% within 6 months of diagnosis (median, 3.4 weeks). At 6 months following diagnosis, 33% of patients had received chemotherapy, and only 4% received radiation. Factors associated with the receipt of chemotherapy were assessed in a multivariable survival model that included age, gender, stage, and site. Patients of older age were less likely to receive chemotherapy (HR, 0.49; 95%CI, 0.45–.53 for 75–79 vs 65–69 years), and more likely for advanced stage, and rectal site. No difference was observed between men and women. Refusal of chemotherapy was reported for only 6% of patients and was associated with age, stage, and site. Six month mortality was 13.3%. Conclusions: Factors associated with the receipt of treatment among older cancer survivors are similar to those in the general population.

scholarly journals Predict Score: A New Biological and Clinical Tool to Help Predict Risk of Intensive Care Transfer for COVID-19 Patients

Biomedicines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 566
Author(s):  
Mickael Gette ◽  
Sara Fernandes ◽  
Marion Marlinge ◽  
Marine Duranjou ◽  
Wijayanto Adi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Health Care Systems ◽  
University Hospital ◽  
World Health ◽  
Biological Parameters ◽  
Clinical Tool ◽  
Neutrophil Lymphocyte Ratio ◽  
Reactive Protein ◽  
Baseline Group ◽  
Care Systems

Background: The COVID-19 crisis has strained world health care systems. This study aimed to develop an innovative prediction score using clinical and biological parameters (PREDICT score) to anticipate the need of intensive care of COVID-19 patients already hospitalized in standard medical units. Methods: PREDICT score was based on a training cohort and a validation cohort retrospectively recruited in 2020 in the Marseille University Hospital. Multivariate analyses were performed, including clinical, and biological parameters, comparing a baseline group composed of COVID-19 patients exclusively treated in standard medical units to COVID-19 patients that needed intensive care during their hospitalization. Results: Independent variables included in the PREDICT score were: age, Body Mass Index, Respiratory Rate, oxygen saturation, C-reactive protein, neutrophil–lymphocyte ratio and lactate dehydrogenase. The PREDICT score was able to correctly identify more than 83% of patients that needed intensive care after at least 1 day of standard medical hospitalization. Conclusions: The PREDICT score is a powerful tool for anticipating the intensive care need for COVID-19 patients already hospitalized in a standard medical unit. It shows limitations for patients who immediately need intensive care, but it draws attention to patients who have an important risk of needing intensive care after at least one day of hospitalization.

Plasma Total Ascorbic Acid and Serum 25-Hydroxy-Vitamin-D Status in Patients with Venous Leg Ulcers: A Case–Control Study

2021 ◽  
pp. 153473462110619
Author(s):  
Charlton Agius ◽  
Daniel Micallef ◽  
Ian Brincat ◽  
Gerald Buhagiar ◽  
Mark Gruppetta ◽  
...  
Keyword(s):  
Health Care Systems ◽  
Nutritional Therapy ◽  
Control Group ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Reactive Protein ◽  
Significant Difference ◽  
Significant Burden ◽  
Care Systems ◽  
25 Hydroxy Vitamin D

Venous leg ulcers (VLUs) pose a significant burden on patients, health care systems, and national economies. Nutritional health is an important determinant of wound healing. Vitamin C and D levels and additional biochemical markers, C-reactive protein, and albumin in a group of patients with VLUs, were compared with a control group without VLUs. No significant difference in either nutrient marker was found with the presence, size, or duration of VLUs. Obesity was significantly more common in the VLU group, as noted in other studies. Additional controlled studies should be performed with measures of VLU size and duration to assess long-term outcomes with nutritional therapy.

160: Cost-Effectiveness of Medical Management Strategies of Nephrolithiasis in Different Health Care Systems

2004 ◽  
Vol 171 (4S) ◽  
pp. 42-43 ◽  
Author(s):  
Yair Latan ◽  
David M. Wilhelm ◽  
David A. Duchene ◽  
Margaret S. Pearle
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Medical Management ◽  
Health Care Systems ◽  
Management Strategies ◽  
Care Systems

J 5 — A Data Processing System for Medical Information

1967 ◽  
Vol 06 (01) ◽  
pp. 1-6
Author(s):  
P. Hall ◽  
Ch. Mellner ◽  
T. Danielsson
Keyword(s):  
Medical Records ◽  
Medical Information ◽  
Health Care Systems ◽  
Processing System ◽  
Linear Pattern ◽  
Flexible Form ◽  
Care Systems ◽  
Pattern Recognition Analysis ◽  
Numeric Information

A system for medical information has been developed. The system is a general and flexible one which without reprogramming or new programs can accept any alphabetic and/or numeric information. Coded concepts and natural language can be read, stored, decoded and written out. Medical records or parts of records (diagnosis, operations, therapy, laboratory tests, symptoms etc.) can be retrieved and selected. The system can process simple statistics but even make linear pattern recognition analysis.The system described has been used for in-patients, outpatients and individuals in health examinations.The use of computers in hospitals, health examinations or health care systems is a problem of storing information in a general and flexible form. This problem has been solved, and now it is possible to add new routines like booking and follow-up-systems.

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