scholarly journals Practical challenges of managing COVID-19 positive patients in the adult intensive care unit of a tertiary care teaching hospital of Ireland

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
Shankar Lal ◽  
Ehtesham Khan ◽  
Muhammad Anwar Malik

On March 11th, 2020, the WHO (World Health Organization) announced the coronavirus disease (a respiratory tract infection) as a pandemic. It originally outbroke in Wuhan (China) and spread all around the world. It is caused by the beta coronavirus1 (Zoonotic Virus) a member of the severe acute metastasis syndrome-related coronavirus species (SARS-CoV-2) 2, 3. COVID-19 ranges in severity from asymptomatic or moderate to severe; a considerable percentage of patients develop a more severe disorder 1, depending on their co-morbidities. 

Author(s):  
SeyedAhmad SeyedAlinaghi ◽  
Maryam Ghadimi ◽  
Mehrnaz Asadi Gharabaghi ◽  
Fereshteh Ghiasvand

: Since December 2019, there has been an increasing number of patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) around the world. As of March 2020, the World Health Organization declared a global pandemic. To our best knowledge, this is the first report of a patient with SARS-CoV-2 infection presenting with constrictive pericarditis, possibly from the COVID infection. She was presented after a week of fever, persistent dry cough, and diarrhea. She received a single dose of hydroxychloroquine 400 mg, Oseltamivir 75 mg every 12 hours, lopinavir/ritonavir (Kaletra) 400/100 mg every 12 hours, and levofloxacin 750 mg daily. After 24 hours, she was immediately transferred to the Intensive Care Unit (ICU) because of dyspnea and progressive respiratory failure with a drop of the O2 saturation to 70%. After a week of progress, her respiratory condition deteriorated again. She was re-admitted to the ICU and she expired. She died due to isolated constrictive pericarditis, most probably caused by SARS-CoV-2.


2020 ◽  
Vol 66 (7) ◽  
pp. 894-897
Author(s):  
Werther Brunow de Carvalho ◽  
Maria Augusta Bento Cicaroni Gibelli ◽  
Vera Lucia Jornada Krebs ◽  
Carla Regina Tragante ◽  
Maria Beatriz Moliterno Perondi

SUMMARY On 11th March 2020, the World Health Organization (WHO) declared the COVID-19 a pandemic. The Obstetrics and Neonatology disciplines needed to be revised to suit the institutional need to expand intensive care beds to care for confirmed or suspected patients with COVID-19 in the state of São Paulo, following the recommendations of the Institutional Crisis Committee. Three different actions were needed: the structuring of teams and advanced medical post to attend COVID-19-free patients and those with suspect or confirmed COVID-19; elaborating the protocols from the delivery room throughout hospitalization. Some special considerations about breastfeeding and rooming-in were needed. The third action was the drafting of a protocol to admit infants from other hospitals with confirmed COVID-19 as the unit never admitted outpatients before.


The outbreak of emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) in China has been brought to global attention and declared a pandemic by the World Health Organization (WHO) on March 11, 2020. In a recent study of Nanshan Chen et al., on patients of Wuhan Jinyintan Hospital, Wuhan, China, from the 99 patients with SARSCoV-2 infection, 51% had chronic diseases and they had symptoms of fever (83%), cough (82%) shortness of breath (31%), muscle ache (11%), fatigue (9%), headache (8%), sore throat (5%), rhinorrhea (4%), chest pain (2%), diarrhea (2%), and nausea and vomiting (1%) [1, 2]. The majority of patients can recover, however, about 25% of patients will progress into severe complications including acute respiratory distress syndrome (ARDS), which may worsen rapidly into respiratory failure, need an intensive care unit (ICU) and even cause multiple organ failure [3]. Depending on the pathophysiological mechanisms supposed to be involved in the development of the various clinical forms of the disease, various types of treatment have been tested with varying degrees of success. We have developed a nanotherapy to block the entry of the virus into the host cell, to reduce its potential for replication and to regulate the immune response against the microbial aggressor [4].


Author(s):  
Ahmet Tolga Erol ◽  
Sinan Aşar ◽  
Mehmet Süleyman Sabaz ◽  
Beyza Ören Bilgin ◽  
Zafer Çukurova

Objective: In late 2019, the Coronavirus disease 2019 (COVID-19) has been pandemic worldwide, starting in Wuhan, China. In this study, we aimed to evaluate the factors associated with 28-day outcomes in patients admitted to the intensive care unit with the diagnosis of COVID-19. Methods: This study has a retrospective cohort design. COVID-19 patients identified according to World Health Organization guidelines are included. Patient data were recorded to a centralized system utilizing ImdSoft-Meta vision/QlinICU Clinical Decision Support Software. Individual datasets about required parameters were obtained from Structured Query Language (SQL) queries. The main laboratory parameters were examined. SOFA, APACHE II, and Charlson Comorbidity Score (CCS) were calculated. In evaluating laboratory parameters and disease risk scores, which are thought to affect 28-day mortality, logistic analysis were performed using the Backward LR model. Results: The study was carried out with 101 patients, 40 (39.6%) of whom were women, and 61 (60.4%) of men, who met the inclusion criteria. The ages of the patients ranged from 21 to 88, and the mean age was 58.45 ± 15.41 years. The mean intensive care hospitalization period was 12.5 ± 10.2 days. The all-cause in-hospital mortality rate was 61.4%. Leukocyte count, CK, NT-proBNP, PCT, CRP, ferritin, neutrophil count and percentage, D-Dimer, LDH, AST values were found to be significantly higher in non-survivors. The lymphocyte count and percentage, and platelet count values were found to be significantly low in non-survivors. The lymphocyte percentage, LDH, and CCS were significant in the 28-day mortality in multivariate analysis (p values are 0.01, 0.003, 0.008, respectively). Conclusions: High lymphocyte values have been found to significantly reduce the risk of death in patients diagnosed with COVID-19. Lymphocyte percentage, LDH, and CCS were evaluated as the most successful parameters in predicting 28-day mortality in the intensive care unit.


2020 ◽  
Vol 15 (03) ◽  
pp. 155-160
Author(s):  
André Ricardo Araujo da Silva ◽  
Cristina Vieira de Souza Oliveira ◽  
Cristiane Henriques Teixeira ◽  
Izabel Alves Leal

Abstract Objective The recommended percentage of antibiotic use in pediatric intensive care units (PICUs) using the World Health Organization (WHO) Access, Watch, and Reserve (AWaRE) classification is not known. Methods We have conducted an interrupted time series analysis in two PICUs in Rio de Janeiro, Brazil, over a period of 18 months. The type of antibiotics used was evaluated using the WHO AWaRE classification, and the amount of antibiotic was measured using days of therapy/1,000 patient-days (DOT/1000PD) after implementation of an antimicrobial stewardship program (ASP). The first and last semesters were compared using medians and the Mann–Whitney's test. The trends of antibiotic consumption were performed using time series analysis in three consecutive 6-month periods. Results A total of 2,205 patients were admitted, accounting for 12,490 patient-days. In PICU 1, overall antibiotic consumption (in DOT/1000PD) was 1,322 in the first 6 months of analysis and 1,264.5 in the last 6 months (p = 0.81). In PICU 2, the consumption for the same period was 1,638.5 and 1,344.5, respectively (p = 0.031). In PICU 1, the antibiotics classified in the AWaRE groups were used 33.2, 57.9, and 8.4% of the time, respectively. The remaining 0.5% of antibiotics used were not classified in any of these groups. In PICU 2, the AWaRE groups corresponded to 30.2, 60.5, and 9.3% of all antibiotics used, respectively. There was no use of unclassified antibiotics in this unit. The use of all three groups of WHO AWaRE antibiotics was similar in the first and the last semesters, with the exception of Reserve group in PICU 2 (183.5 × 92, p = 0.031). Conclusion A significant reduction of overall antibiotic use and also in the Reserve group was achieved in one of the PICU units studied. The antibiotics classified in the Watch group were the most used in both units, representing ∼60% of all the antibiotics consumed.


2020 ◽  
Vol 49 (3) ◽  
pp. 259-264 ◽  
Author(s):  
Bjorn Meijers ◽  
Piergiorgio Messa ◽  
Claudio Ronco

The World Health Organization has recognized the pandemic nature of the coronavirus disease 19 (COVID-19) outbreak. A large proportion of positive patients require hospitalization, while 5–6% of them may need more aggressive therapies in intensive care. Most governments have recommended social separation and severe measures of prevention of further spreading of the epidemic. Because hemodialysis (HD) patients need to access hospital and dialysis center facilities 3 times a week, this category of patients requires special attention. In this editorial, we tried to summarize the experience of our centers that hopefully may contribute to help other centers and colleagues that are facing the coming wave of the epidemic. Special algorithms for COVID-19 spreading in the dialysis population, recommendations for isolation and preventive measures in positive HD patients, and finally directions to manage logistics and personnel are reported. These recommendations should be considered neither universal nor absolute. Instead, they require local adjustments based on geographic location, cultural and social environments, and level of available resources.


2016 ◽  
Vol 130 (S2) ◽  
pp. S23-S27 ◽  
Author(s):  
P Charters ◽  
I Ahmad ◽  
A Patel ◽  
S Russell

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The anaesthetic considerations for head and neck cancer surgery are especially challenging given the high burden of concurrent comorbidity in this patient group and the need to share the airway with the surgical team. This paper provides recommendations on the anaesthetic considerations during surgery for head and neck cancer.Recommendations• All theatre staff should participate in the World Health Organization checklist process. (R)• Post-operative airway management should be guided by local protocols. (R)• Patients admitted to post-operative care units with tracheal tubes in place should be monitored with continuous capnography. Removal for tracheal tubes is the responsibility of the anaesthetist. (R)• Anaesthetists should formally hand over care to an appropriately trained practitioner in the post-operative or intensive care unit. (G)• Intensive care unit staff looking after post-operative tracheostomies must be clear about which patients are not suitable for bag-mask ventilation and/or oral intubation in the event of emergencies. (R)


2021 ◽  
Vol 24 (2) ◽  
pp. 63-70
Author(s):  
Mara-Andrada Plesu ◽  
◽  
Gabriel Cristian Bejan ◽  
Ioana Veronica Grajdeanu ◽  
Anca Angela Simionescu ◽  
...  

The coronavirus disease 2019 (COVID-19) is a contagious respiratory tract infection caused by the betacoronavirus SARS-CoV-2. The World Health Organization declared the COVID-19 outbreak a pandemic on March 11, 2020. Since the COVID-19 pandemic started, more than 166 million patients have been tested positive worldwide with more than 3.4 million related death recorded. COVID-19 has a wide range of signs and symptoms. Hematological changes such as lymphopenia, thrombocytopenia, and coagulation disturbances are not unusual in patients with COVID-19. However, the mechanisms causing these changes are partially comprehended. Immune thrombocytopenia was identified to be among the hematologic autoimmune diseases seen in patients infected with SARS-CoV-2. This review summarizes the evidence on COVID-19-associated immune thrombocytopenia and the underlying mechanisms involved in its development.


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