Visual loss following assisted mechanical ventilation due to SARS-CoV-2—a case series

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

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Clinical features and predictors of severity in COVID-19 patients with critical illness in Singapore

Scientific Reports ◽

10.1038/s41598-021-81377-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ser Hon Puah ◽

◽

Barnaby Edward Young ◽

Po Ying Chia ◽

Vui Kian Ho ◽

...

Keyword(s):

Mechanical Ventilation ◽

Clinical Features ◽

Operating Characteristic ◽

Characteristic Curve ◽

Case Series ◽

Plateau Pressure ◽

Apache Ii Score ◽

Multivariable Logistic Regression Model ◽

Reactive Protein ◽

Ventilatory Management

AbstractWe aim to describe a case series of critically and non-critically ill COVID-19 patients in Singapore. This was a multicentered prospective study with clinical and laboratory details. Details for fifty uncomplicated COVID-19 patients and ten who required mechanical ventilation were collected. We compared clinical features between the groups, assessed predictors of intubation, and described ventilatory management in ICU patients. Ventilated patients were significantly older, reported more dyspnea, had elevated C-reactive protein and lactate dehydrogenase. A multivariable logistic regression model identified respiratory rate (aOR 2.83, 95% CI 1.24–6.47) and neutrophil count (aOR 2.39, 95% CI 1.34–4.26) on admission as independent predictors of intubation with area under receiver operating characteristic curve of 0.928 (95% CI 0.828–0.979). Median APACHE II score was 19 (IQR 17–22) and PaO2/FiO2 ratio before intubation was 104 (IQR 89–129). Median peak FiO2 was 0.75 (IQR 0.6–1.0), positive end-expiratory pressure 12 (IQR 10–14) and plateau pressure 22 (IQR 18–26) in the first 24 h of ventilation. Median duration of ventilation was 6.5 days (IQR 5.5–13). There were no fatalities. Most COVID-19 patients in Singapore who required mechanical ventilation because of ARDS were extubated with no mortality.

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POINT-OF-CARE ECHOCARDIOGRAPHY IN PRONE PATIENTS ON MECHANICAL VENTILATION: A PROSPECTIVE CASE SERIES

CHEST Journal ◽

10.1016/j.chest.2021.07.1368 ◽

2021 ◽

Vol 160 (4) ◽

pp. A1496

Author(s):

Yaser Dawod ◽

Syed Nazeer Mahmood ◽

Benjamin Kenigsberg ◽

Anantha Mallia

Keyword(s):

Mechanical Ventilation ◽

Point Of Care ◽

Case Series ◽

Prospective Case Series

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Positive pressure inspiratory aid v assisted mechanical ventilation after esophageal surgery

Journal of Critical Care ◽

10.1016/0883-9441(87)90144-4 ◽

1987 ◽

Vol 2 (2) ◽

pp. 101-108 ◽

Cited By ~ 4

Author(s):

J.J. Fargier ◽

D. Robert ◽

F. Boyer ◽

J. Chagny ◽

C. Kopp ◽

...

Keyword(s):

Mechanical Ventilation ◽

Esophageal Surgery ◽

Positive Pressure ◽

Assisted Mechanical Ventilation

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NEAR FATAL AMITRAZ: A NOT SO UNCOMMON POISONING

10.36106/gjra/5601517 ◽

2021 ◽

pp. 42-43

Author(s):

Rohan J Desai ◽

Prasad Ugargol

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Clinical Features ◽

Case Series ◽

Agricultural Product ◽

Common Symptom ◽

Retrospective Case ◽

Case Series Study ◽

Cns Depression ◽

Series Study

Background: Amitraz is a pharmaceutical, veterinary, and agricultural product which is used worldwide to control ectoparasites in animals. Its widespread use has led to increased cases of poisoning in rural parts of India. Aim: To study the clinical features, complications, laboratory abnormalities and outcome of the patients with acute amitraz intoxication. Methodology: The study is a retrospective case series study conducted in HSK hospital between the period of Feb 2019 and May 2020. Results: A total of 11 patients were analysed and results revealed CNS depression and vomiting in 8 of those patients with 1 patient with respiratory failure requiring mechanical ventilation. Conclusion: Amitraz poisoning appears to be severe with CNS depression being the most common symptom. But most patients stabilise and recover quickly. Patients should be monitored for respiratory failure as it is a dreadful complication. Treatment is symptomatic as no antidote is available.

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Cerebral microhaemorrhage in COVID-19: a critical illness related phenomenon?

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000652 ◽

2020 ◽

Vol 5 (4) ◽

pp. 315-322 ◽

Cited By ~ 1

Author(s):

Luke Dixon ◽

Cillian McNamara ◽

Pritika Gaur ◽

Dermot Mallon ◽

Christopher Coughlan ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critical Illness ◽

Clinical Characteristics ◽

Case Series ◽

Severe Hypoxia ◽

Related Phenomenon ◽

Test Results ◽

Secondary Effects ◽

Preceding Period ◽

Baseline Characteristics

BackgroundCerebral microhaemorrhages are increasingly being recognised as a complication of COVID-19. This observational retrospective study aims to further investigate the potential pathophysiology through assessing the pattern of microhaemorrhage and clinical characteristics of patients with COVID-19 and microhaemorrhage. By comparing with similar patterns of microhaemorrhage in other non-COVID-19 disease, this study aims to propose possible common pathogenic mechanisms.MethodsA retrospective observational case series was performed identifying all patients with COVID-19 complicated by cerebral microhaemorrhage on MRI. The distribution and number of microhaemorrhages were recorded using the microbleed anatomical scale, and patients’ baseline characteristics and salient test results were also recorded.ResultsCerebral microhaemorrhages were noted to have a predilection for the corpus callosum, the juxtacortical white matter and brainstem. All patients had a preceding period of critical illness with respiratory failure and severe hypoxia necessitating intubation and mechanical ventilation.DiscussionThis study demonstrates a pattern of cerebral microhaemorrhage that is similar to the pattern reported in patients with non-COVID-19 related critical illness and other causes of severe hypoxia. This raises questions regarding whether microhaemorrhage occurs from endothelial dysfunction due the direct effect of SARS-CoV-2 infection or from the secondary effects of critical illness and hypoxia.

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Patient-ventilator asynchrony during assisted mechanical ventilation

Yearbook of Critical Care Medicine ◽

10.1016/s0734-3299(08)70465-9 ◽

2008 ◽

Vol 2008 ◽

pp. 33-34

Author(s):

I. Cinel

Keyword(s):

Mechanical Ventilation ◽

Assisted Mechanical Ventilation

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Adverse Outcomes in Pregnant Women Hospitalized With Respiratory Syncytial Virus Infection: A Case Series

Clinical Infectious Diseases ◽

10.1093/cid/ciaa668 ◽

2020 ◽

Author(s):

Anne M Hause ◽

Lakshmi Panagiotakopoulos ◽

Eric S Weintraub ◽

Lina S Sy ◽

Sungching C Glenn ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Syncytial Virus ◽

Respiratory Failure ◽

Virus Infection ◽

Respiratory Syncytial Virus Infection ◽

Case Series ◽

Adverse Outcomes ◽

Syncytial Virus

Abstract We identified 10 women hospitalized with respiratory syncytial virus infection during pregnancy. Diagnoses included pneumonia/atelectasis (5), respiratory failure (2), and sepsis (2). Six had obstetrical complications during hospitalization, including 1 induced preterm birth. One required intensive care unit admission and mechanical ventilation. Four infants had complications at birth.

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Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

Critical Care Research and Practice ◽

10.1155/2020/6688120 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Andrei Karpov ◽

Anish R. Mitra ◽

Sarah Crowe ◽

Gregory Haljan

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Failure ◽

Respiratory Rate ◽

Prolonged Mechanical Ventilation ◽

Case Series ◽

Prone Positioning ◽

Retrospective Case ◽

Number Of Patients

Objective and Rationale. Prone positioning of nonintubated patients has prevented intubation and mechanical ventilation in patients with respiratory failure from coronavirus disease 2019 (COVID-19). A number of patients in a recently published cohort have undergone postextubation prone positioning (PEPP) following liberation from prolonged mechanical ventilation in attempt to prevent reintubation. The objective of this study is to systematically search the literature for reports of PEPP as well as describe the feasibility and outcomes of PEPP in patients with COVID-19 respiratory failure. Design. This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions. The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

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Nosocomial Myiasis Caused by Lucilia sericata (Diptera: Calliphoridae) and Neonatal Myiasis by Sarcophaga spp. (Diptera: Sarcophagidae) in Mexico

Case Reports in Infectious Diseases ◽

10.1155/2018/5067569 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Hugo Martínez-Rojano ◽

Julio C. Noguez ◽

Herón Huerta

Keyword(s):

Health Care ◽

Mechanical Ventilation ◽

Developing Countries ◽

Rare Event ◽

Lucilia Sericata ◽

Health Care Personnel ◽

Medical Attention ◽

Loss Of Consciousness ◽

First Report ◽

Assisted Mechanical Ventilation

The presence of nosocomial myiasis reflects a lack of adequate medical attention, due to the physical facilities and/or the health care personnel. Patients requiring special attention are more susceptible, such as those with a loss of consciousness, assisted mechanical ventilation, tracheal tubes, or nasogastric probes. Nosocomial myiasis is a rare event that has a greater occurrence in the hospitals of poor and developing countries. The two cases herein described represent the first report of nosocomial myiasis in Mexico. The causal agents were found to be Lucilia sericata and Sarcophaga spp. The taxonomical identification of the larvae of the second and third instar was based on the morphology of the cephaloskeleton, anterior spiracles, and peritreme plaques.

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