scholarly journals Features of clinical manifestations of new coronavirus infection in patients at hospitalization during the COVID-19 epidemic depending on the severity

2021 ◽  
Vol 17 (8) ◽  
pp. 73-80
Author(s):  
V.I. Trykhlib ◽  
N.R. Tsiurak ◽  
K.P. Beliaeva ◽  
T.I. Lysenko ◽  
A.O. Yeroshenko ◽  
...  
Keyword(s):  
Respiratory Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Manifestations ◽  
Normal Range ◽  
Average Temperature ◽  
General Weakness ◽  
Number Of Patients ◽  
Significant Difference ◽  
Coronavirus Infection

The article presents a review of the literature sources and results of a personal study. It was found that in our group, there were more persons aged 18–30 years among those who were in inpatient treatment, and among those who were treated in the ICU, the patients were aged 60 years or over. On average, patients who were treated in the ICU were admitted on the 6th day of illness. Most patients complained of dry or unproductive cough, moderate general weakness. Relatively more often moderate general weakness was registered in patients with a moderate course, and moderate and pronounced was typical for patients with a severe course (p < 0.05). Dyspnea was predominantly found in severely ill patients (in one-third of patients during exercise, in 17.7 % patients at rest). In patients with a non-serious course, a small number of patients had dyspnea on exertion (4.3 to 12.1 %). On admission, the average temperature was within normal or subfebrile, which predominated in patients with a moderate course (p < 0.05). With a mild course, half of the patients had a temperature within the normal range. Febrile fever was more often registered in the moderate and severe course. Pyretic body temperature was most typical for a severe course (p < 0.05). It is noteworthy that even in those patients who were treated in the intensive care unit, at admission a quarter of the patients had a normal temperature, and 41.2 % — subfebrile. On ave-rage, the duration of fever before admission in critically ill patients was 5 days, and in those who died — 2 days. Dry cough was significantly more common in severe patients (p < 0.05). In the mild course, only one-fifth of patients complained of dry or unproductive cough. In the moderate course, the dry or unproductive cough was symptomatic for one-third of patients. There was no significant difference in the frequency of complaints of sore throat (p > 0.05). On average, a respiratory rate on admission in critically ill patients did not differ between those who survived and those who died, while those who died more often presented with a respiratory rate of 30/min or more, tachycardia, and more reduced saturation values.

scholarly journals Peculiarities of clinical manifestations of the new COVID-19 coronavirus infection in patients hospitalized during the epidemic depending on their age

2021 ◽  
Vol 17 (7) ◽  
pp. 32-36
Author(s):  
V.I. Trykhlib ◽  
N.R. Tsiurak ◽  
K.P. Beliaeva ◽  
T.I. Lysenko ◽  
A.O. Yeroshenko ◽  
...  
Keyword(s):  
Chest Pain ◽  
Age Groups ◽  
Young Patients ◽  
Clinical Manifestations ◽  
Productive Cough ◽  
Thoracic Pain ◽  
Average Temperature ◽  
General Weakness ◽  
Significant Difference ◽  
Coronavirus Infection

This article presents a review of the literature and data from a personal study concerning the clinical manifestations of new coronavirus infection in patients hospitalized during the COVID-19 epidemic depending on their age. It was found that most patients complained about dry or low-productive cough, moderate general weakness. The patients aged 18–30 years old more frequently experienced no cough. The patients aged 31–40 years old significantly more frequently complained about dry cough (p < 0.05). Low-productive cough was less frequent but typical in all age groups and more frequent in patients aged 51–60 years. Moist cough was more frequent in patients over 60 years. Chest pain was registered in patients over 60 years (p < 0.05). The frequency of dyspnea was found to increase with age. More often dyspnea was registered in patients older than 60 years old. No dyspnea was noted in young patients aged 18–30 years. Half of the patients aged 18–30 years had no fever. At hospitalization, the average temperature was within normal or subfebrile, which predominated in patients aged 41–50 years (p < 0.05). The frequency of febrile fever increased in patients with age. There was no significant difference in the frequency of pyretic temperature among all age groups. The patients aged over 30 years complained more about moderate weakness, and patients aged over 40 years complained more about severe weakness. Younger patients more often complained about a sore throat, while older patients had practically no symptoms (p > 0.05). Thoracic pain was significantly more frequently registered in patients older than 60 years old. Young patients aged 18–30 years and 31–40 years had no chest pain.

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 Effect of Central Venous Catheter Care Bundle Implementation on Outcomes of Critically Ill Patients

2020 ◽  
Vol 2 (1) ◽  
pp. 12
Author(s):  
Gehan A. F. Atia
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Venous Catheter ◽  
Care Bundle ◽  
Central Venous ◽  
Significant Difference ◽  
Post Test ◽  
Catheter Care

Context: Central venous access device (CVAD) bundles for insertion and maintenance demonstrate a reduction in the frequency of complications and bloodstream infection when implemented with compliance monitoring, with the reported success of CVAD bundles. Aim: This study aimed to examine the effect of central venous catheter care bundle implementation on outcomes of critically ill patients. Methods: Quasi-experimental research (pre/post-test design) used to achieve the aim of this study. The study conducted at general and surgical intensive care units affiliated to Menoufia University and teaching hospital. Two study samples recruited in this study. All nurses working at the ICUs, as mentioned above, were recruited in this study. They were 6o critical care nurses. A convenient sample of all available critically ill patients at the time of the study was subjected to treatment via a central venous catheter. Four study tools used to collect the data of this study. These are a structured interview questionnaire, CVC nurses’ knowledge assessment questionnaire, nurses’ compliance assessment checklists, and patient complications assessment records. Results: The study result showed a highly statistically significant difference between pre and post-test knowledge scores of studied nurses regarding assisting line insertion, removal, maintenance, care, and infection control practices. Besides, a highly statistically significant difference between pre and post-test scores of nurses’ compliance to central venous catheter care practices of assisting in CVC insertion, blood sample withdrawal, medication and fluid administration, CVP measurements, CVC removal, and the management of central venous line complications. The study also revealed a highly statistically significant difference between the study and control group patients regarding the central venous catheter complications. However, signs of infection were the most frequent complications in both groups. Conclusion. The study concluded that a statistically significant difference between pre and post nurses’ knowledge and compliance with the CVC care bundle. The patients’ outcomes were also improved significantly after the implementation of the CVC care bundle compared to the controls. The study recommended the adoption of the current care bundle that should be disseminated and updated following the international organizations’ recommendation for implementing evidence-based practices for successful central line-associated bloodstream infection (CLABSI) prevention.

scholarly journals Observations on the Application of Nursing Risk Management in the Care of Critically Ill Patients in the Respiratory Unit

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Yannan Sun
Keyword(s):  
Risk Management ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Treatment Satisfaction ◽  
Clinical Symptoms ◽  
Statistical Significance ◽  
Management Model ◽  
Control Group ◽  
Observation Group ◽  
Significant Difference

 Objective: Investigate the effectiveness of nursing risk management in the care of critically ill patients in the respiratory unit. Methods: Among the critically ill respiratory patients admitted to our hospital between May 2019 and April 2020, 78 patients were randomly selected and divided into an observation group and a control group, each consisting of 39 patients. In the observation group, a nursing risk management model was implemented, i.e., patients' clinical symptoms were observed at any time to monitor their treatment satisfaction and the effectiveness of their care and routine care was implemented for the control group. Results: The heart rate, respiratory rate, and pH of patients in the observation group were more stable than those in the control group, and their respiratory status was better, with differences in data. There was also significant statistical significance (P<0.05). The incidence of patient-provider disputes, unplanned extubation, and unplanned events were lower in the observation group compared to the control group, and their data difference was statistically significant (P<0.05). The treatment satisfaction as well as the total effective rate of patients in the observation group was also much higher than that of the control group, and there was also a statistically significant difference in the data (P<0.05). Conclusion: The nursing risk management model has a significant therapeutic effect in the care of critically ill respiratory patients. Therefore, it is worth popularizing to use in the clinical nursing of respiratory critical patients.

scholarly journals Effect of Permissive Underfeeding with Intensive Insulin Therapy on MCP-1, sICAM-1, and TF in Critically Ill Patients

Nutrients ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 987
Author(s):  
Ahmad Aljada ◽  
Ghada Fahad AlGwaiz ◽  
Demah AlAyadhi ◽  
Emad Masuadi ◽  
Mahmoud Zahra ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Critically Ill ◽  
Intensive Insulin Therapy ◽  
Inflammatory Mediators ◽  
Critically Ill Patients ◽  
Caloric Intake ◽  
Intercellular Adhesion Molecule ◽  
P Value ◽  
Permissive Underfeeding ◽  
Significant Difference

Purpose: This study examined the effect of permissive underfeeding compared to target feeding and intensive insulin therapy (IIT) compared to conventional insulin therapy (CIT) on the inflammatory mediators monocyte chemoattractant protein 1 (MCP-1), soluble intercellular adhesion molecule 1 (sICAM-1), and tissue factor (TF) in critically ill patients. Methodology: This was a substudy of a 2 × 2 factorial design randomized controlled trial in which intensive care unit (ICU) patients were randomized into permissive underfeeding compared to target feeding groups and into IIT compared to CIT groups (ISRCTN96294863). In this substudy, we included 91 patients with almost equal numbers across randomization groups. Blood samples were collected at baseline and at days 3, 5, and 7 of an ICU stay. Linear mixed models were used to assess the differences in MCP-1, sICAM-1, and TF across randomization groups over time. Results: Baseline characteristics were balanced across randomization groups. Daily caloric intake was significantly higher in the target feeding than in the permissive underfeeding groups (P-value < 0.01), and the daily insulin dose was significantly higher in the IIT than in the CIT groups (P-value < 0.01). MCP-1, sICAM-1, and TF did not show any significant difference between the randomization groups, while there was a time effect for MCP-1. Baseline sequential organ failure assessment (SOFA) score and platelets had a significant effect on sICAM-1 (P-value < 0.01). For TF, there was a significant association with age (P-value < 0.01). Conclusions: Although it has been previously demonstrated that insulin inhibits MCP-1, sICAM-1 in critically ill patients, and TF in non-critically ill patients, our study demonstrated that IIT in critically ill patients did not affect these inflammatory mediators. Similarly, caloric intake had a negligible effect on the inflammatory mediators studied.

scholarly journals Saline versus 5% dextrose in water as a drug diluent for critically ill patients: a retrospective cohort study

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Yukari Aoyagi ◽  
Takuo Yoshida ◽  
Shigehiko Uchino ◽  
Masanori Takinami ◽  
Shoichi Uezono
Keyword(s):  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Control ◽  
Blood Glucose Control ◽  
Kidney Injury ◽  
Saline Group ◽  
Significant Difference ◽  
The Impact ◽  
Electrolyte Abnormalities

Abstract Background The choice of intravenous infusion products for critically ill patients has been studied extensively because it can affect prognosis. However, there has been little research on drug diluents in this context. The purpose of this study is to evaluate the impact of diluent choice (saline or 5% dextrose in water [D5W]) on electrolyte abnormalities, blood glucose control, incidence of acute kidney injury (AKI), and mortality. Methods This before-after, two-group comparative, retrospective study enrolled adult patients who stayed for more than 48 h in a general intensive care unit from July 2015 to December 2018. We changed the default diluent for intermittent drug sets in our electronic ordering system from D5W to saline at the end of 2016. Results We included 844 patients: 365 in the D5W period and 479 in the saline period. Drug diluents accounted for 21.4% of the total infusion volume. The incidences of hypernatremia and hyperchloremia were significantly greater in the saline group compared to the D5W group (hypernatremia 27.3% vs. 14.6%, p < 0.001; hyperchloremia 36.9 % vs. 20.4%, p < 0.001). Multivariate analyses confirmed the similar effects (hypernatremia adjusted odds ratio (OR), 2.43; 95% confidence interval (CI), 1.54–3.82; hyperchloremia adjusted OR, 2.09; 95% CI, 1.31–3.34). There was no significant difference in the incidences of hyperglycemia, AKI, and mortality between the two groups. Conclusions Changing the diluent default from D5W to saline had no effect on blood glucose control and increased the incidences of hypernatremia and hyperchloremia.

scholarly journals Identifying the effects of an upgraded ‘fever clinic’ on COVID-19 control and the workload of emergency department: retrospective study in a tertiary hospital in China

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039177
Author(s):  
Jiangshan Wang ◽  
Liang Zong ◽  
Jinghong Zhang ◽  
Han Sun ◽  
Joseph Harold Walline ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Disease Transmission ◽  
Healthcare Providers ◽  
Tertiary Hospital ◽  
College Hospital ◽  
Upper Respiratory Infection ◽  
Number Of Patients ◽  
Screening And Prevention

ObjectiveCOVID-19 started spreading widely in China in January 2020. Outpatient fever clinics (FCs), instituted during the SARS epidemic in 2003, were upgraded to serve for COVID-19 screening and prevention of disease transmission in large tertiary hospitals in China. FCs were hoped to relieve some of the healthcare burden from emergency departments (EDs). We aimed to evaluate the effect of upgrading the FC system on rates of nosocomial COVID-19 infection and ED patient attendance at Peking Union Medical College Hospital (PUMCH).DesignA retrospective cohort study.ParticipantsA total of 6365 patients were screened in the FC.MethodsThe FC of PUMCH was upgraded on 20 January 2020. We performed a retrospective study of patients presenting to the FC between 12 December 2019 and 29 February 2020. The date when COVID-19 was declared an outbreak in Beijing was 20 January 2020. Two groups of data were collected and subsequently compared with each other: the first group of data was collected within 40 days before 20 January 2020; the second group of data was collected within 40 days after 20 January 2020. All necessary data, including patient baseline information, diagnosis, follow-up conditions and the transfer records between the FC and ED, were collected and analysed.Results6365 patients were screened in the FC, among whom 2912 patients were screened before 21 January 2020, while 3453 were screened afterward. Screening results showed that upper respiratory infection was the major disease associated with fever. After the outbreak of COVID-19, the number of patients who were transferred from the FC to the ED decreased significantly (39.21% vs 15.75%, p<0.001), and patients generally spent more time in the FC (55 vs 203 min, p<0.001), compared with before the outbreak. For critically ill patients waiting for their screening results, the total length of stay in the FC was 22 min before the outbreak, compared with 442 min after the outbreak (p<0.001). The number of in-hospital deaths of critically ill patients in the FC was 9 out of 29 patients before the outbreak and 21 out of 38 after the outbreak (p<0.05). Nineteen cases of COVID-19 were confirmed in the FC during the period of this study. However, no other patients nor any healthcare providers were cross-infected.ConclusionThe workload of the FC increased significantly after the COVID-19 outbreak. New protocols regarding the use of FC likely helped prevent the spread of COVID-19 within the hospital. The upgraded FC also reduced the burden on the ED.

scholarly journals Physical methods for the treatment of fever in critically ill patients: a randomized controlled trial

2016 ◽  
Vol 50 (5) ◽  
pp. 823-830 ◽  
Author(s):  
Patrícia de Oliveira Salgado ◽  
Ludmila Christiane Rosa da Silva ◽  
Priscila Marinho Aleixo Silva ◽  
Tânia Couto Machado Chianca
Keyword(s):  
Body Temperature ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Intervention Group ◽  
Tympanic Temperature ◽  
Control Group ◽  
Physical Methods ◽  
Group I ◽  
Significant Difference ◽  
Ice Pack

Abstract OBJECTIVE To evaluate the effects of physical methods of reducing body temperature (ice pack and warm compression) in critically ill patients with fever. METHOD A randomized clinical trial involving 102 adult patients with tympanic temperature ≥ 38.3°C of an infectious focus, and randomized into three groups: Intervention I - ice pack associated with antipyretic; Intervention II - warm compress associated with antipyretic; and Control - antipyretic. Tympanic temperature was measured at 15 minute intervals for 3 hours. The effect of the interventions was evaluated through the Mann-Whitney test and Survival Analysis. "Effect size" calculation was carried out. RESULTS Patients in the intervention groups I and II presented greater reduction in body temperature. The group of patients receiving intervention I presented tympanic temperature below 38.3°C at 45 minutes of monitoring, while the value for control group was lower than 38.3°C starting at 60 minutes, and those who received intervention II had values lower than 38.3°C at 75 minutes of monitoring. CONCLUSION No statistically significant difference was found between the interventions, but with the intervention group I patients showed greater reduction in tympanic temperature compared to the other groups. Brazilian Registry of Clinical Trials: RBR-2k3kbq

scholarly journals The Role of Mean Platelet Volume as a Predictor of Mortality in Critically Ill Patients: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Pattraporn Tajarernmuang ◽  
Arintaya Phrommintikul ◽  
Atikun Limsukon ◽  
Chaicharn Pothirat ◽  
Kaweesak Chittawatanarat
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Mean Platelet Volume ◽  
Meta Analysis ◽  
Small Sample ◽  
Mean Difference ◽  
Platelet Volume ◽  
Significant Difference ◽  
The Mean

Background. An increase in the mean platelet volume (MPV) has been proposed as a novel prognostic indicator in critically ill patients.Objective. We conducted a systematic review and meta-analysis to determine whether there is an association between MPV and mortality in critically ill patients.Methods. We did electronic search in Medline, Scopus, and Embase up to November 2015.Results. Eleven observational studies, involving 3724 patients, were included. The values of initial MPV in nonsurvivors and survivors were not different, with the mean difference with 95% confident interval (95% CI) being 0.17 (95% CI: −0.04, 0.38;p=0.112). However, after small sample studies were excluded in sensitivity analysis, the pooling mean difference of MPV was 0.32 (95% CI: 0.04, 0.60;p=0.03). In addition, the MPV was observed to be significantly higher in nonsurvivor groups after the third day of admission. On the subgroup analysis, although patient types (sepsis or mixed ICU) and study type (prospective or retrospective study) did not show any significant difference between groups, the difference of MPV was significantly difference on the unit which had mortality up to 30%.Conclusions. Initial values of MPV might not be used as a prognostic marker of mortality in critically ill patients. Subsequent values of MPV after the 3rd day and the lower mortality rate unit might be useful. However, the heterogeneity between studies is high.

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