scholarly journals Benefits of wireless technology in mechanically-ventilation to navigate through the COVID- 19 crisis

2020 ◽  
Vol 1 (2) ◽  
pp. 52-54
Author(s):  
Robert Cabbat ◽  
Helen Chen
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Protective Equipment ◽  
Mechanical Ventilator ◽  
Wireless Technology ◽  
Laptop Computer ◽  
Contact Precautions ◽  
Telecommunication Technology ◽  
Wireless Telecommunication ◽  
And Control

With COVID-19 cases rising quickly at alarming rates across the U.S. and globally, the pandemic crisis has exposed the importance and accelerated the need for wireless telecommunication technology in the intensive care unit. Many of these critically ill COVID-19 patients in the ICU require mechanical ventilation. Moreover, due to their underlying diagnosis, these patients are required to be in isolated rooms and under contact precautions. Often times, immediate and emergency access to the mechanical ventilator are delayed or stalled by the hurdle to properly gown up with personal protective equipment before entering the room. Wireless telecommunication to access and control ventilator settings promptly from outside the isolation room, for example from a laptop computer, would overcome this barrier and time obstacle. Additionally, will save the already limited equipment and save money. Thus, the development of such technology is quite urgent as more and more critically ill COVID-19 patients are ending up on mechanical ventilation. Keywords: Remote control, Wireless, COVID-19

scholarly journals A STUDY OF VENTILATOR-ASSOCIATED PNEUMONIA: INCIDENCE, OUTCOME, RISK FACTORS AND MEASURES TO BE TAKEN FOR PREVENTION

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Dr. Raghvendra Singh ◽  
Dr. Ramesh Kumar
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
P Value ◽  
Mechanical Ventilator ◽  
Tertiary Care Centre ◽  
High Incidence ◽  
Time Of Admission

Background: Pneumonia is the second most common nosocomial infection among critically ill patients, affecting 27% of all critically ill patients. Methods: The study was conducted in an intensive care unit (ICU) of a tertiary care centre. A total of 100 patients who were kept on mechanical ventilator were randomly selected. Cases included were patients of both sexes who were kept on mechanical ventilator for more than 48 h, having the age of >15 years. Patients who died or developed pneumonia within 48 h or those who were admitted with pneumonia at the time of admission and patients of ARDS (Acute Respiratory Distress Syndrome) were excluded from the study. Results: The mean duration of mechanical ventilation was found to be 12.3±3.1 days for the non-VAP group and 19.1 ±4.2 days for the VAP group that those requiring prolonged ventilator support (>15 days) had a significantly higher incidence of VAP (P-value, 0.001). Supine position and stuporous, comatose patients were found to be risk factors, having a high incidence of VAP, and proved to be statistically significant. Conclusion: Incidence is directly proportional to duration of mechanical ventilation and re-intubation is a strong risk factor for development of VAP. Therefore, duration of ventilation has to be reduced to get rid of morbidity and mortality associated with mechanical ventilation, which can be achieved by administering a proper weaning protocol and titrating sedation regimens as per the need of the patients. Keywords: Incidence, Infection, ICU

scholarly journals Study of role of oral probiotics in patients on ventilator in paediatric Intensive Care Unit at tertiary care center

2020 ◽  
Vol 7 (5) ◽  
pp. 988
Author(s):  
Prashant Chawan ◽  
Aswathy Rajan
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Critically Ill ◽  
Tertiary Care ◽  
Control Group ◽  
Case Group ◽  
Age Group ◽  
Duration Of Hospital Stay ◽  
Significant Difference ◽  
And Control

Background: The normal intestinal microbiota of critically ill patients is altered and replaced by pathogens. Any significant insult to the gut or alteration to its microbiota plays a role in promoting systemic inflammation and infection in the critically ill population. Probiotics may affect other body sites in addition to the GI tract , and they can have applications in a variety of populations, including healthy individuals, children, elderly, immunocompromised and genetically predisposed individuals. These studies the effect of probiotics in pediatric population on mechanical ventilation in a tertiary care hospital.Methods: Present study was conducted in a PICU of a tertiary care teaching hospital in children aged 12 years or less admitted to PICU and who were likely to need mechanical ventilation for more than 48 h were recruited.Results: In present study 25 patients were recruited in each group i.e. case (probiotics) group and control group. Most common age group among case group was 6-8 years (44 %), while 9-12 years (36 %) was most common age group in control group. Mean age was comparable in both groups (7.6±3.5 years in case group and 7.9±4.1 years in control group). In both groups septic shock and pneumonia were most common diagnosis followed by admission due to miscellaneous cause. In both groups mechanical ventilation was used due to respiratory failure and shock. Outcome was compared in both groups. Authors noted a statistically significant difference in duration of ICU stay, duration of hospital stay and duration of mechanical ventilation, between case 7 control group (p<0.05). In terms of overall mortality, authors did not noted any significant difference among groups.Conclusions: Authors noted a statistically significant difference in duration of ICU stay, duration of hospital stay and duration of mechanical ventilation, between case and control group (p<0.05).   

scholarly journals 802. Corynebacterium striatum Outbreak Among Ventilated COVID-19 Patients in an Acute Care Hospital – California, 2021

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S495-S496
Author(s):  
Janice J Kim ◽  
Nancy E Turner ◽  
Emily Holman ◽  
Linda Lefrak ◽  
Fady A Youssef ◽  
...  
Keyword(s):  
Critically Ill ◽  
Acute Care Hospital ◽  
Chronically Ill ◽  
Infection Prevention And Control ◽  
Care Hospital ◽  
Prevalence Survey ◽  
Environmental Cleaning ◽  
Contact Precautions ◽  
Corynebacterium Striatum ◽  
And Control

Abstract Background Corynebacterium striatum (CS), a common human commensal colonizing the skin and nasopharynx, has been associated with nosocomial infections in immunocompromised and chronically ill patients. During the winter 2020-2021 COVID-19 surge, a 420-bed California hospital reported a marked increase in CS respiratory cultures among ventilated COVID-19 patients. We conducted a public health investigation to assess and mitigate nosocomial transmission and contributing infection prevention and control (IPC) practices. Methods A case was defined as a patient with CS in respiratory cultures from January 1, 2020 - February 28, 2021. We reviewed clinical characteristics on a subset of cases in 2021 and IPC practices in affected hospital locations. CS respiratory isolates collected on different dates and locations were assessed for relatedness by whole genome sequencing (WGS) on MiSeq. Results Eighty-three cases were identified, including 75 among COVID-19 patients (Figure 1). Among 62 patients identified in 2021, all were ventilated; 58 also had COVID-19, including 4 cases identified on point prevalence survey (PPS). The median time from admission to CS culture was 19 days (range, 0-60). Patients were critically ill; often it was unclear whether CS cultures represented colonization or infection. During the COVID-19 surge, two hospital wings (7W and 7S) were converted to negative-pressure COVID-19 units. Staff donned and doffed personal protective equipment in anterooms outside the units; extended use of gowns was practiced, and lapses in glove changes and hand hygiene (HH) between patients likely occurred. In response to the CS outbreak, patients were placed in Contact precautions and cohorted. Staff were re-educated on IPC for COVID-19 patients. Gowns were changed between CS patients. Subsequent PPS were negative. Two CS clusters were identified by WGS: cluster 1 (5 cases) in unit 7W, and cluster 2 (2 cases) in unit 7S (Figure 2). Figure 1. Corynebacterium striatum Respiratory Cultures January 2020-February 2021 Figure 2. Phylogenetic Tree Corynebacterium striatum Isolates Conclusion A surge in patients, extended use of gowns and lapses in core IPC practices including HH and environmental cleaning and disinfection during the winter 2020-2021 COVID-19 surge likely contributed to this CS outbreak. WGS provides supportive evidence for nosocomial CS transmission among critically ill COVID-19 patients. Disclosures All Authors: No reported disclosures

COVID-19: The Importance of Adequate Personal Protective Equipment in Healthcare Medical Staff

2020 ◽  
Author(s):  
Anne Weissenstein
Keyword(s):  
Health Care ◽  
Personal Protective Equipment ◽  
Health Care Services ◽  
Infection Prevention And Control ◽  
Protective Equipment ◽  
Emotional Resilience ◽  
Healthcare Facilities ◽  
Care Services ◽  
Healthcare Settings ◽  
And Control

We present an update on infection prevention and control for COVID-19 in healthcare settings. This update focuses on measures to be applied in settings with increasing community transmission, growing demand for concern about COVID-19 patients, and subsequent staffing issues in the event of shortages of personal protective equipment for healthcare facilities worldwide. The comfort and emotional resilience of health care workers are key components in maintaining essential health care services during the COVID-19 virus (coronavirus) outbreak.

scholarly journals Infection control practices and challenges in Pakistan during the COVID-19 pandemic: a multicentre cross-sectional study

2021 ◽  
pp. 175717742110127
Author(s):  
Salma Abbas ◽  
Faisal Sultan
Keyword(s):  
Personal Protective Equipment ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Hospital Staff ◽  
Cross Sectional Study ◽  
Infection Prevention And Control ◽  
Protective Equipment ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
And Control

Background: Patient and staff safety at healthcare facilities during outbreaks hinges on a prompt infection prevention and control response. Physicians leading these programmes have encountered numerous obstacles during the pandemic. Aim/objective: The aim of this study was to evaluate infection prevention and control practices and explore the challenges in Pakistan during the coronavirus disease 2019 pandemic. Methods: We conducted a cross-sectional study and administered a survey to physicians leading infection prevention and control programmes at 18 hospitals in Pakistan. Results: All participants implemented universal masking, limited the intake of patients and designated separate triage areas, wards and intensive care units for coronavirus disease 2019 patients at their hospitals. Eleven (61%) physicians reported personal protective equipment shortages. Staff at three (17%) hospitals worked without the appropriate personal protective equipment due to limited supplies. All participants felt overworked and 17 (94%) reported stress. Physicians identified the lack of negative pressure rooms, fear and anxiety among hospital staff, rapidly evolving guidelines, personal protective equipment shortages and opposition from hospital staff regarding the choice of recommended personal protective equipment as major challenges during the pandemic. Discussion: The results of this study highlight the challenges faced by physicians leading infection prevention and control programmes in Pakistan. It is essential to support infection prevention and control personnel and bridge the identified gaps to ensure patient and staff safety at healthcare facilities.

scholarly journals Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eleni Papoutsi ◽  
Vassilis G. Giannakoulis ◽  
Eleni Xourgia ◽  
Christina Routsi ◽  
Anastasia Kotanidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
All Cause Mortality ◽  
Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

scholarly journals Effectiveness of anaesthesia ventilator use for mechanical ventilation in critically ill patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
Aurélie GOUEL-CHERON ◽  
Yoann ELMALEH ◽  
Camille COUFFIGNAL ◽  
Elie KANTOR ◽  
Simon MESLIN ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yongfang Zhou ◽  
Steven R. Holets ◽  
Man Li ◽  
Gustavo A. Cortes-Puentes ◽  
Todd J. Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
History Of ◽  
Training Background ◽  
The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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