|
1
|
Li R, Liu W, Liu D, Jin X, Wang S. The involvement of the dysfunctional insulin receptor signaling system in long COVID patients with diabetes and chronic pain and its implications for the clinical management using taVNS. FRONTIERS IN PAIN RESEARCH 2024; 5:1486851. [PMID: 39654800 PMCID: PMC11625755 DOI: 10.3389/fpain.2024.1486851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 11/08/2024] [Indexed: 12/12/2024] Open
Abstract
In clinical terms, chronic pain is the most prevalent sequela resulting from COVID-19, which is induced by the novel coronavirus (SARS-CoV-2), while type 2 diabetes mellitus (T2D) is the most common comorbidity. This triangular relationship can be attributed to the dysfunction of the insulin receptor signaling system (IRSS) in both central and peripheral systems. Patients with T2D are essentially more susceptible to SARS-CoV-2 infection due to the widespread expression of angiotensin converting enzyme 2 (ACE2) in their pancreatic beta cells, which serves as the cellular port for the SARS-CoV-2 to infect and enter the cell. This infection can exacerbate chronic pain and insulin resistance for various reasons. Peripherally, once infected, the virus can cause damage to peripheral nerves and pancreatic β-cells, further exacerbating pain and glucose metabolism conditions. Additionally, in the central nervous system, dysfunctional IRSS is closely linked to chronic pain. Over the past few years of the COVID-19 pandemic, an increasing body of evidence suggests that insulin and other medications currently used in clinical practice for hyperglycemia control may not be safe for treating these patients. Therefore, we need a proper approach for the treatment of chronic pain in long COVID patients, especially patients with T2D. This review presents evidence that transcutaneous auricular vagal nerve stimulation (taVNS) may provide a viable treatment option for chronic pain and metabolic dysfunction by improving the function of IRSS in both the central nervous system and peripheral tissues.
Collapse
Affiliation(s)
- Riwang Li
- Department of Anatomy, Medical School, Foshan University, Foshan, China
| | - Wenguo Liu
- Department of Anatomy, Medical School, Foshan University, Foshan, China
| | - Dahai Liu
- Department of Anatomy, Medical School, Foshan University, Foshan, China
| | - Xu Jin
- Department of Anesthesiology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Shuxing Wang
- Department of Anatomy, Medical School, Foshan University, Foshan, China
| |
Collapse
|
|
2
|
Vicentini C, Ugliono E, Elhadidy HSMA, Paladini G, Cornio AR, Cussotto F, Morino M, Zotti CM. Surgical reorganization during the COVID-19 pandemic and impact on case-mix and surgical site infections: A multicenter cohort study in Italy. Health Policy 2024; 146:105113. [PMID: 38896918 DOI: 10.1016/j.healthpol.2024.105113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 02/27/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) pandemic led to major disruptions in surgical activity, particularly in the first year (2020). The objective of this study was to assess the impact of surgical reorganization on surgical outcomes in Northern Italy in 2020 and 2021. METHODS A retrospective cohort study was conducted among 30 hospitals participating in the surveillance system for surgical site infections (SSIs). Abdominal surgery procedures performed between 2018 and 2021 were considered. Predicted SSI rates for 2020 and 2021 were estimated based on 2018-2019 data and compared with observed rates. Independent predictors for SSI were investigated using logistic regression, including procedure year. RESULTS 7605 procedures were included. Significant differences in case-mix were found comparing the three time periods. Observed SSI rates among all patients in 2020 were significantly lower than expected based on 2018-2019 SSI rates (p 0.0465). Patients undergoing procedures other than cancer surgery in 2020 had significantly lower odds for SSI (odds ratio, OR 0.52, 95 % confidence interval, CI 0.3-0.89, p 0.018) and patients undergoing surgery in 2021 had significantly higher odds for SSI (OR 1.49, 95 % CI 1.07-2.09, p 0.019) compared to 2018-2019. CONCLUSIONS Enhanced infection prevention and control (IPC) measures could explain the reduced SSI risk during the first pandemic year. IPC practices should continue to be reinforced beyond the pandemic context.
Collapse
Affiliation(s)
- Costanza Vicentini
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.
| | - Elettra Ugliono
- Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti 14, 10126 Turin, Italy
| | | | - Giovanni Paladini
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Alessandro Roberto Cornio
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Federico Cussotto
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti 14, 10126 Turin, Italy
| | - Carla Maria Zotti
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| |
Collapse
|
|
3
|
Kasielska-Trojan A, Jabłkowski M, Białkowska-Warzecha J, Kwaśniewska O, Antoszewski B. Understanding Covid-19: Digit ratios and duration of oxygen therapy in hospitalized Covid-19 patients. Early Hum Dev 2024; 189:105940. [PMID: 38199045 DOI: 10.1016/j.earlhumdev.2024.105940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Covid-19 severity shows a sex difference (males>females) and progressive hypoxia among the most seriously affected. Digit ratios are sexually dimorphic and may be negatively-related to prenatal (2nd-to-4th digits' ratio; 2D:4D) and pubertal (3rd-to-5th digits' ratio; 3D:5D) testosterone. Oxygen therapy is important in Covid-19 treatment and low 2D:4D is linked to efficient oxygen metabolism. We consider relationships between digit ratios and duration of oxygen treatment in hospitalized Covid-19 patients. METHODS Digit lengths were measured from photographs of the patient's hands. Age, Sex, BMI, vaccination status and number of days of O2 treatment, were recorded. RESULTS There were 100 (58 women) patients. Sex differences (males CONCLUSION We have found that high (feminized) 2D:4D of males and females is positively related to duration of oxygen therapy. This adds to the evidence for links between severity of Covid-19 and national and individual level variation in foetal androgen (as measured by 2D:4D). We discuss our finding in the light of the "low-androgen-driven COVID-19 pandemic theory".
Collapse
Affiliation(s)
- Anna Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Lodz, Poland.
| | - Maciej Jabłkowski
- Department of Infectious and Liver Diseases, Medical University of Lodz, Lodz, Poland
| | | | | | - Bogusław Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
|
4
|
Tejiokem MC, Abessolo HA, Nkodo JM, Ouethy M, Mayaka GB, Touha Y, Dikoume UA, Tchatchueng‐Mbougua JB, Noumbissi DC, Ndjeukam WT, Mbarga HOO, Ngoupo PAT, Moussi C, Garoua BH, Njouom R, Richard V. High seroprevalence of severe acute respiratory syndrome coronavirus 2 among healthcare workers in Yaoundé, Cameroon after the first wave of Covid-19 pandemic and associated factors. Influenza Other Respir Viruses 2024; 18:e13239. [PMID: 38342486 PMCID: PMC10859237 DOI: 10.1111/irv.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Healthcare workers (HWs) are at a high risk of exposure to emerging health threats. Following the first wave of the coronavirus disease 2019 pandemic in Cameroon, we explored the presence and persistence of naturally acquired antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the factors associated with seropositivity in HWs. METHODS Staff at two referral hospitals in Yaoundé or two Health District Hospitals in Obala and Mbalmayo were included in a 6-month prospective cohort analysis or cross-sectional survey, respectively. Seroprevalence and associated factors were determined, and Kaplan-Meier curves and Cox proportional hazards models were used to assess antibody persistence or positive seroconversion over time. RESULTS From August 2020 to March 2021, 426 HWs (median age: 31 years, interquartile range: 27-37 years; 66.4% female) were enrolled. The overall seroprevalence of anti-SARS-CoV-2 antibodies was 54.0% (95% confidence interval [CI]: 49.1-58.8) and was significantly different between study sites (p = 0.04). Of the 216 HWs included in the 6-month cohort, 109 (50.5%) HWs were seropositive at inclusion; the probability of persistent antibodies or of becoming seropositive was 93.8% (95% CI: 84.2-100) and 78.9% (95% CI: 61.7-88.4), respectively. Seroconversion was associated with study site and occupation but not with infection prevention and control (IPC) practices. CONCLUSIONS We observed high seroprevalence of SARS-CoV-2 antibody and seroconversion among HWs associated with occupational risk. This suggests low compliance to the COVID-19 control measures. Continued training and implementation of IPC measures and accelerated preparedness are needed to better tackle future threats.
Collapse
Affiliation(s)
| | - Hermine Abessolo Abessolo
- Centre Spécialisé de Prise en Charge des Patients Covid‐19annexe 2 Hôpital Central de YaoundéYaoundéCameroon
| | | | | | | | | | | | | | | | | | | | | | - Charlotte Moussi
- Délégation Régionale de la Santé Publique du CentreYaoundéCameroon
| | - Bonaventure Hollong Garoua
- Centre Spécialisé de Prise en Charge des Patients Covid‐19annexe 2 Hôpital Central de YaoundéYaoundéCameroon
| | - Richard Njouom
- Service de virologieCentre Pasteur du CamerounYaoundéCameroon
| | - Vincent Richard
- Direction Internationale, Institut Pasteur, Réseau International des Instituts PasteurParisFrance
| |
Collapse
|
|
5
|
Carter BG, Harcourt E, Harris A, Zampetti M, Duke T, Tingay D. Making respiratory care safe for neonatal and paediatric intensive care unit staff: mitigation strategies and use of filters. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2024; 60:13-27. [PMID: 38384335 PMCID: PMC10881236 DOI: 10.29390/001c.91262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024]
Abstract
Background Many medical devices in pediatric and newborn intensive care units can potentially expose healthcare workers (HCWs) and others to transmission of respiratory and other viruses and bacteria. Such fomites include ventilators, nebulizers, and monitoring equipment. Approach We report the general, novel approach we have taken to identify and mitigate these risks and to protect HCWs, visitors and patients from exposure while maintaining the optimal performance of such respiratory equipment. Findings The approach combined a high level of personal protective equipment (PPE), strict hand hygiene, air filtration and air conditioning and other relevant viral risk mitigation guidelines. This report describes the experiences from the SARS-CoV-2 pandemic to provide a reference framework that can be applied generally. The steps we took consisted of auditing our equipment and processes to identify risk through sources of potentially contaminated gas that may contain aerosolized virus, seeking advice and liaising with suppliers/manufacturers, devising mitigation strategies using indirect and direct approaches (largely filtering), performing tests on equipment to verify proper function and the absence of negative impacts and the development and implementation of relevant procedures and practices. We had a multidisciplinary team to guide the process. We monitored daily for hospital-acquired infections among staff caring for SARS-CoV-2 patients. Conclusion Our approach was successful as we have continued to offer optimal intensive care to our patients, and we did not find any healthcare worker who was infected through the course of caring for patients at the bedside. The lessons learnt will be of benefit to future local outbreaks or pandemics.
Collapse
Affiliation(s)
- Bradley G Carter
- Neonatal and Paediatric Intensive Care UnitsThe Royal Children’s Hospital Melbourne
| | - Edward Harcourt
- Neonatal and Paediatric Intensive Care UnitsThe Royal Children’s Hospital Melbourne
| | | | - Michael Zampetti
- Neonatal and Paediatric Intensive Care UnitsThe Royal Children’s Hospital Melbourne
| | - Trevor Duke
- Paediatric Intensive Care UnitThe Royal Children’s Hospital
- Department of PediatricsThe University of Melbourne
| | - David Tingay
- Department of PediatricsUniversity of Melbourne
- Neonatal ResearchMurdoch Children’s Research Institute
- Department of NeonatologyThe Royal Children’s Hospital
| |
Collapse
|
|
6
|
Goh QY, Lie SA, Tan Z, Tan PYB, Ng SY, Abdullah HR. Time to intubation with McGrath ™ videolaryngoscope versus direct laryngoscope in powered air-purifying respirator: a randomised controlled trial. Singapore Med J 2024; 65:2-8. [PMID: 34688229 PMCID: PMC10863731 DOI: 10.11622/smedj.2021165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION During the coronavirus disease 2019 (COVID-19) pandemic, multiple guidelines have recommended videolaryngoscope (VL) for tracheal intubation. However, there is no evidence that VL reduces time to tracheal intubation, and this is important for COVID-19 patients with respiratory failure. METHODS To simulate intubation of COVID-19 patients, we randomly assigned 28 elective surgical patients to be intubated with either McGrath™ MAC VL or direct laryngoscope (DL) by specialist anaesthetists who donned 3M™ Jupiter™ powered air-purifying respirators (PAPR) and N95 masks. The primary outcome was time to intubation. RESULTS The median time to intubation was 61 s (interquartile range [IQR] 37-63 s) and 41.5 s (IQR 37-56 s) in the VL and DL groups, respectively ( P = 0.35). The closest mean distance between the anaesthetist and patient during intubation was 21.6 ± 4.8 cm and 17.6 ± 5.3 cm in the VL and DL groups, respectively ( P = 0.045). There were no significant differences in the median intubation difficulty scale scores, proportion of successful intubations at the first laryngoscopic attempt and proportion of intubations requiring adjuncts. All the patients underwent successful intubation with no adverse event. CONCLUSION There was no significant difference in the time to intubation of elective surgical patients with either McGrath™ VL or DL by specialist anaesthetists who donned PAPR and N95 masks. The distance between the anaesthetist and patient was significantly greater with VL. When resources are limited or disrupted during a pandemic, DL could be a viable alternative to VL for specialist anaesthetists.
Collapse
Affiliation(s)
- Qing Yuan Goh
- Division of Anaesthesiology and Perioperative Medicine, Department of Surgical Intensive Care, Singapore General Hospital, Singapore
| | - Sui An Lie
- Division of Anaesthesiology and Perioperative Medicine, Department of Surgical Intensive Care, Singapore General Hospital, Singapore
| | - Zihui Tan
- Division of Anaesthesiology and Perioperative Medicine, Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Pei Yi Brenda Tan
- Division of Anaesthesiology and Perioperative Medicine, Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Shin Yi Ng
- Division of Anaesthesiology and Perioperative Medicine, Department of Surgical Intensive Care, Singapore General Hospital, Singapore
| | - Hairil Rizal Abdullah
- Division of Anaesthesiology and Perioperative Medicine, Department of Anaesthesiology, Singapore General Hospital, Singapore
| |
Collapse
|
|
7
|
Mehmood N, Nesiama JAO, Yen K, Dhar A, Lowe GS. Assessing the New Norm: A Simulation Study to Assess Pediatric Emergency Physician Success in Critical Procedures With an Air Purifying Respirator. Pediatr Emerg Care 2023; 39:e86-e89. [PMID: 37205872 DOI: 10.1097/pec.0000000000002976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Physicians caring for patients with COVID-19 are at high risk for contracting the disease, thus, significant emphasis has been placed on personal protective equipment (PPE). The study aims to assess the impact of advanced PPE across 4 common procedures: endotracheal intubation, bag-valve mask ventilation, intraosseous (IO) insertion, and lumbar puncture (LP) performed by pediatric emergency physicians. METHOD Physicians performed the procedures in a simulated environment. Lumbar puncture and IO were performed with standard precautions versus an air purifying respirator (APR). A direct comparison was drawn for endotracheal intubation and bag-valve mask ventilation between 2 commonly used APRs. Success rate and number of attempts toward successful completion was recorded for all 4 procedures. Physicians filled out a postprocedure survey to assess their ease of use of the APR. RESULTS Twenty participants performed IO and LP using an APR and standard precautions. There was no statistical difference in the success rate, number of attempts, average time, or maintenance of sterility (LP only) for both procedures. Twenty total participants divided across 2 types of APR groups performed intubation and BMV. Success rate and number of attempts had no statistical difference for both procedures. Physician feedback surveys to assess the ease of use of APR compared with standard precautions had no statistically significant difference for all 4 procedures. CONCLUSIONS Wearing increased levels of PPE did not impact procedural success, length of time, sterility, number of attempts, or the physicians' ease in our study. Physicians should be encouraged to wear all appropriate PPE.
Collapse
Affiliation(s)
- Noormah Mehmood
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Jo-Ann O Nesiama
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Kenneth Yen
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Archana Dhar
- Division of Pediatric Critical Care, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Geoffrey S Lowe
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| |
Collapse
|
|
8
|
Kıran Ş, Bostan S. A New Experience in the Turkish Health System in Response to COVID-19. Disaster Med Public Health Prep 2023; 17:e483. [PMID: 37694296 DOI: 10.1017/dmp.2023.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
OBJECTIVE A substantial amount of work addressing strategies on how to respond to the coronavirus disease (COVID-19) crisis already exists. However, there is simply not enough evidence to support a systematic and all-encompassing approach. This study aims to systematically review and present the roadmap of Turkiye's response to COVID-19. METHODS This study is based on a thematic content analysis of official policy documents to present the roadmap in Turkiye's fight against COVID-19. The analysis included 46 press releases accessed from the Ministry of Health's website. The coding structure was created by the researchers based on the literature. Documents were analyzed by dividing them into 3 periods: the panic period, the controlled normalization period, and the normalization period. Each document was sub-coded under the main themes of "concerns" and "strategies" and interpreted by comparing them with each other. RESULTS The study results show that different categories and coding structures were formed between periods. Some categories that emerged under the theme of concerns were "vaccine concerns" and "social concerns." Similarly, some categories that appeared under the theme of strategies were "vaccine strategies," "monitoring and surveillance strategies," and "intervention strategies." CONCLUSION The results provide policy-makers with an appropriate conceptual framework to deal with the pandemic crisis that may be encountered in the future.
Collapse
Affiliation(s)
- Şafak Kıran
- Department of Health Management, Karadeniz Technical University, Trabzon, Türkiye
| | - Sedat Bostan
- Department of Health Management, Karadeniz Technical University, Trabzon, Türkiye
| |
Collapse
|
|
9
|
Cattin L, Ferrari F, Mongodi S, Pariani E, Bettini G, Daverio F, Donadello K, Polati E, Mojoli F, Danzi V, De Rosa S. Airways management in SARS-COV-2 acute respiratory failure: A prospective observational multi-center study. Med Intensiva 2023; 47:131-139. [PMID: 36155747 PMCID: PMC9359672 DOI: 10.1016/j.medine.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest. SETTING Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021. PATIENTS Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management. INTERVENTIONS Endotracheal Intubation Adverse Events. MAIN VARIABLES OF INTERESTS The primary endpoint was to determine the occurrence of at least 1 of the following events within 30 minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%; hemodynamic instability defined as a SBP 65 mmHg recoded at least once or SBP < 90 mmHg for 30 minutes, a new requirement or increase of vasopressors, fluid bolus >15 mL/kg to maintain the target blood pressure; cardiac arrest. RESULTS Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest. CONCLUSION In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent. CLINICAL TRIAL REGISTRATION www. CLINICALTRIALS gov identifier: NCT04909476.
Collapse
Affiliation(s)
- L Cattin
- Department of Anesthesia and Intensive Care Unit, St. Bortolo Hospital, Vicenza, Italy; Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy
| | - F Ferrari
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Mongodi
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Pariani
- Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
| | - G Bettini
- Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
| | - F Daverio
- Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
| | - K Donadello
- Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy
| | - E Polati
- Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy
| | - F Mojoli
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
| | - V Danzi
- Department of Anesthesia and Intensive Care Unit, St. Bortolo Hospital, Vicenza, Italy
| | - S De Rosa
- Department of Anesthesia and Intensive Care Unit, St. Bortolo Hospital, Vicenza, Italy.
| |
Collapse
|
|
10
|
Airways management in SARS-COV-2 acute respiratory failure: A prospective observational multi-center study. Med Intensiva 2023; 47:131-139. [PMID: 36855737 PMCID: PMC9950782 DOI: 10.1016/j.medin.2022.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/06/2022] [Indexed: 02/26/2023]
Abstract
Objective Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest. Setting Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021. Patients Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management. Interventions Endotracheal Intubation Adverse Events. Main variables of interests The primary endpoint was to determine the occurrence of at least 1 of the following events within 30 minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%; hemodynamic instability defined as a SBP 65 mmHg recoded at least once or SBP < 90 mmHg for 30 minutes, a new requirement or increase of vasopressors, fluid bolus >15 mL/kg to maintain the target blood pressure; cardiac arrest. Results Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest. Conclusion In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent. Clinical Trial registration www.clinicaltrials.gov identifier: NCT04909476.
Collapse
Key Words
- ARDS, acute respiratory distress syndrome
- Airway management
- CI, confidence interval
- COVID-19, Coronavirus disease 2019
- CPAP, continuous positive airways pressure
- Critical care
- DBP, diastolic blood pressure
- ECG, electrocardiography
- ETT, Emergency Endotracheal intubation
- EtCO2, end-tidal carbon dioxide
- HFNO, High flow nasal oxygen
- HR, heart rate
- ICU, intensive care unit
- NIV, noninvasive ventilation
- OR, odds ratio
- PCR, polymerase chain reaction
- PaO2/FiO2, arterial partial oxygen pressure / fraction of inspired oxygen
- RR, respiratory rate
- Respiratory failure
- SARS-CoV infection
- SARS-Cov2, severe acute respiratory syndrome coronavirus 2
- SBP, systolic blood pressure
- SpO2, Peripheral oxygen saturation
- Tracheal intubation
Collapse
|
|
11
|
Adi O, Fong CP, Keong YY, Apoo FN, Roslan NL. Helmet CPAP in the emergency department: A narrative review. Am J Emerg Med 2023; 67:112-119. [PMID: 36870251 DOI: 10.1016/j.ajem.2023.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND The choice of correct interface for the right patient is crucial for the success of non-invasive ventilation (NIV) therapy. Helmet CPAP is a type of interface used to deliver NIV. Helmet CPAP improves oxygenation by keeping the airway open throughout the breathing cycle with positive end-expiratory pressure (PEEP). OBJECTIVE This narrative review describes the technical aspects and clinical indications of helmet continuous positive airway pressure (CPAP). In addition, we explore the advantages and challenges faced using this device at the Emergency Department (ED). DISCUSSION Helmet CPAP is tolerable than other NIV interfaces, provides a good seal and has good airway stability. During Covid-19 pandemic, there are evidences it reduced the risk of aerosolization. The potential clinical benefit of helmet CPAP is demonstrated in acute cardiogenic pulmonary oedema (ACPO), Covid-19 pneumonia, immunocompromised patient, acute chest trauma and palliative patient. Compare to conventional oxygen therapy, helmet CPAP had been shown to reduce intubation rate and decrease mortality. CONCLUSION Helmet CPAP is one of the potential NIV interface in patients with acute respiratory failure presenting to the emergency department. It is better tolerated for prolonged usage, reduced intubation rate, improved respiratory parameters, and offers protection against aerosolization in infectious diseases.
Collapse
Affiliation(s)
- Osman Adi
- Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
| | - Chan Pei Fong
- Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Yip Yat Keong
- Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Farah Nuradhwa Apoo
- Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Nurul Liana Roslan
- Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Kuala Lumpur, Malaysia
| |
Collapse
|
|
12
|
Caggiano M, Acerra A, Martina S, Galdi M, D’Ambrosio F. Infection Control in Dental Practice during the COVID-19 Pandemic: What Is Changed? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3903. [PMID: 36900914 PMCID: PMC10001281 DOI: 10.3390/ijerph20053903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has profoundly changed our lives. Since the SARS-CoV-2 was discovered, many studies have been done on the transmission mode, its replication within humans, and its survival even in the outside environment and on inanimate surfaces. Undoubtedly, health care workers have faced the greatest risks because of their close contact with potentially infected patients. Of these, dental health care professionals are certainly among the most vulnerable categories, precisely because infection occurs with the airborne virus. The treatment of patients within the dental office has changed profoundly, respecting all preventive measures towards the patient and the practitioners themselves. The aim of this paper is to understand whether the protocols changed for the prevention of SARS-CoV-2 infection among dentists remained even after the most acute phase of the pandemic. In particular, this study analyzed habits, protocols, preventive measures, and any costs incurred in the COVID-19 era for the prevention of SARS-CoV-2 infection among dental workers and patients.
Collapse
|
|
13
|
D'Oria M, Veraldi GF, Mastrorilli D, Mezzetto L, Calvagna C, Taglialavoro J, Bassini S, Griselli F, Grosso L, Carere A, D'Andrea A, Lepidi S. Association Between the Lockdown for SARS-CoV-2 (COVID-19) and Reduced Surgical Site Infections after Vascular Exposure in the Groin at Two Italian Academic Hospitals. Ann Vasc Surg 2023; 89:60-67. [PMID: 36404473 PMCID: PMC9613778 DOI: 10.1016/j.avsg.2022.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The aim of this study was to evaluate whether the scrupulous hygiene rules and the restriction of contacts during the lockdown owing to the COVID-19 pandemic affected the rate and severity of surgical site infections (SSI) after vascular exposure in the groin at two Italian University Hospitals. METHODS Starting from March 2020, strict hygiene measures for protection of health care workers (HCW) and patients from COVID-19 infection were implemented, and partly lifted in July 2020. The main exposure for analysis purposes was the period in which patients were operated. Accordingly, study subjects were divided into two groups for subsequent comparisons (preCOVID-19 era: March-June 2018-2019 versus COVID-19 era: March-June 2020). The primary endpoint was the occurrence of superficial and/or deep SSI within 30 days after surgery. The Centers for Disease Control and Prevention definitions were used to classify superficial and deep SSI. RESULTS A total of 194 consecutive patients who underwent vascular exposure in the groin were retrospectively analyzed. Of those, 60 underwent surgery from April 1, 2018 to June 30 of the same year; 83 from April 1, 2019 to June 30 of the same year; and 51 from April 1, 2020 to June 30 of the same year. The mean age of the study cohort was 75 years and 140 (72%) were males. Patients who were operated in the COVID-19 era were less likely to develop SSI (10% vs. 28%; P = 0.008), including both deep SSI (4% vs. 13%; P = 0.04) and superficial SSI (6% vs. 15%; P = 0.05). After multivariate adjustments, being operated in the COVID-19 era was found to be a negative predictor for development of an SSI (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.09-0.76; P < 0.001) or deep SSI (OR = 0.21; 95% CI = 0.03-0.98; P < 0.001). Operative time was also found as independent predictor for the development of deep SSI (OR = 1.21; 95%CI = 1.21-1.52; P = 0.02). Using binary logistic regression, there were no independent predictors of superficial SSI that could be identified. CONCLUSIONS Vascular exposure in the groin carries a non-negligible risk of SSI. In this study, we provided important insights that are simple and easily viable precautions (such as the universal use of surgical masks both for patients and health care professionals during wound care, the widespread diffusion of hand sanitizers, and the reduction of the number of visitors in the surgical wards) could be promising and safe tools for SSI risk reduction.
Collapse
Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy,Correspondence to: Mario D'Oria, MD, Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, 34149, Trieste, Italy
| | - Gian Franco Veraldi
- Department of Vascular Surgery, University Hospital and Trust of Verona, Italy
| | - Davide Mastrorilli
- Department of Vascular Surgery, University Hospital and Trust of Verona, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital and Trust of Verona, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Jacopo Taglialavoro
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Silvia Bassini
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Filippo Griselli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Lorenzo Grosso
- Department of Vascular Surgery, University Hospital and Trust of Verona, Italy
| | - Andrea Carere
- Faculty of Medicine, University of Trieste Medical School, Italy
| | - Alessia D'Andrea
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| |
Collapse
|
|
14
|
Trivedi S, Hylton D, Mueller M, Juan I, Mun C, Tzeng E, Guan P, Filipovic M, Mandoorah S, Brezenski A, O'Brien EO, Malhotra A, Schmidt U. A Comparison of Intubation and Airway Complications Between COVID-19 and Non-COVID-19 Critically Ill Subjects. Cureus 2023; 15:e35145. [PMID: 36950006 PMCID: PMC10027016 DOI: 10.7759/cureus.35145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/20/2023] Open
Abstract
Introduction The number of subjects infected with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout the western hemisphere increased exponentially in the later months of 2020. With this increase in infection, the number of subjects requiring advanced ventilatory support increased concomitantly. We decided to compare the survival rates between coronavirus disease 2019 (COVID-19) subjects versus non-COVID-19 subjects undergoing intubation in the intensive care unit (ICU). We hypothesized that COVID-19 subjects would have lower rates of survival post-intubation. Methods We screened all subjects admitted to the adult critical care unit between January 2020 and June 2020 to determine if they met the inclusion criteria. These subjects were required to be spontaneously ventilating upon admission and eventually required intubation. Subjects were selected from our electronic health record (EHR) system EPIC© (Epic Systems, Verona, WI) through a retrospective ICU admission analysis. We identified and included 267 non-COVID-19 subjects and 56 COVID-19 subjects. Our primary outcome of interest was intubation-related mortality. We defined intubation mortality as unexpected death (within 48 hours of intubation). Our secondary outcomes were the length of stay in the ICU, length of time requiring ventilator support, and proportion of subjects requiring tracheostomy placement. Results Compared to non-coronavirus disease (COVID) subjects, COVID subjects were more likely to be intubated for acute respiratory distress. COVID subjects had longer stays in the ICU and longer ventilator duration than non-COVID subjects. COVID-positive subjects had a decreased hazard ratio for mortality (HR = 0.42, 95% CI: 0.20-0.87, P < 0.05) and increased chances of survival compared to non-COVID subjects. Conclusions We showed the rates of intubation survival were no different between the COVID and non-COVID groups. We attribute this finding to intubation preparation, a multidisciplinary team approach, and having the most experienced provider lead the intubation process.
Collapse
Affiliation(s)
- Suraj Trivedi
- Anesthesia and Critical Care, University of California San Diego School of Medicine, San Diego, USA
| | - Diana Hylton
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Matthew Mueller
- Critical Care Medicine, University of California San Diego, Washington, DC, USA
| | - Ilona Juan
- Anesthesiology, Kaiser San Diego, San Diego, USA
| | - Christie Mun
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Eric Tzeng
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Patricia Guan
- Anesthesiology, University of California San Diego, San Diego, USA
| | - Maya Filipovic
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Sohaib Mandoorah
- Critical Care Medicine, University of California San Diego, San Diego, USA
| | - Alyssa Brezenski
- Anesthesiology, University of California San Diego, San Diego, USA
| | - E Orestes O'Brien
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, USA
| | - Ulrich Schmidt
- Anesthesiology, University of California San Diego, San Diego, USA
| |
Collapse
|
|
15
|
Gorman L, Dickson AN, Monaghan M, Vaughan F, Murphy B, Dowling DP, McCaul C, Jones JFX. Novel co-axial, disposable, low-cost 3D printed videolaryngoscopes for patients with COVID-19: a manikin study. EUROPEAN JOURNAL OF ANAESTHESIOLOGY AND INTENSIVE CARE 2023; 2:e0015. [PMID: 39916760 PMCID: PMC11783612 DOI: 10.1097/ea9.0000000000000015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/09/2025]
Abstract
BACKGROUND COVID-19 continues to present challenges to both patient management and the protection of the airway management team involved, in particular in resource-constrained low-income countries. Among the most concerning complications in affected patients is rapid hypoxemic respiratory failure requiring tracheal intubation and mechanical ventilation. Videolaryngoscopy without peri-intubation oxygenation is the recommended approach in COVID-19 patients. However, the absence of peri-intubation oxygenation during intubation attempts can lead to hypoxia, and result in life-threatening complications in already critically ill patients. OBJECTIVE To develop low-cost disposable 3D printed videolaryngoscope designs with integrated channels for oxygen, suction, WIFI-enabled camera and tracheal tube channels, as well as a flexible transparent barrier anchor to offer optional additional protection to the user and airway management team. DESIGN A manikin study. SETTING AND PARTICIPANTS Three experienced consultant anaesthetists in the Mater Misericordiae University Hospital, Dublin, Ireland. MAIN OUTCOME MEASURES To generate novel co-axial videolaryngoscopes that meet International Standards, ISO7376 : 2020 standards for anaesthetic and respiratory equipment (laryngoscopes for tracheal intubation), and to demonstrate successful tracheal intubation of a manikin trainer in a range of configurations ('easy' to 'difficult') in accordance with the Cormack-Lehane grading of laryngeal view. RESULTS Final design prototypes met the minimum criteria for strength and rigidity according to ISO7376 : 2020, including blade tip displacement under load (65 N and 150 N). Preliminary validation has demonstrated successful tracheal intubation of a manikin trainer in all configurations including 'difficult' (Cormack-Lehane Grade 3 view). CONCLUSIONS This low-cost, rapid in-house manufacture could offer a mitigation of supply chain disruptions that can arise during global pandemics. Furthermore, it could offer a low-cost solution in low-income countries where there is an infection risk caused by re-using most current videolaryngoscopes requiring sterilisation before re-use, as well as limitations in the availability of personal protective equipment.
Collapse
Affiliation(s)
- Laura Gorman
- From the School of Medicine, University College Dublin (LG), I-Form Advanced Manufacturing Research Centre, University College Dublin (AND), Our Lady of Lourdes Hospital, Drogheda, Ireland (MM), I-Form Advanced Manufacturing Research Centre, University College Dublin (FV), The Adelaide and Meath Hospital Dublin, Incorporating the National Children's Hospital (AMNCH) & Rotunda Hospital (BM), I-Form Advanced Manufacturing Research Centre, University College Dublin (DPD), Rotunda Hospital Dublin & Mater Misericordiae University Hospital Dublin (CM), and School of Medicine, University College Dublin, Dublin, Ireland (JFXJ)
| | - Andrew N Dickson
- From the School of Medicine, University College Dublin (LG), I-Form Advanced Manufacturing Research Centre, University College Dublin (AND), Our Lady of Lourdes Hospital, Drogheda, Ireland (MM), I-Form Advanced Manufacturing Research Centre, University College Dublin (FV), The Adelaide and Meath Hospital Dublin, Incorporating the National Children's Hospital (AMNCH) & Rotunda Hospital (BM), I-Form Advanced Manufacturing Research Centre, University College Dublin (DPD), Rotunda Hospital Dublin & Mater Misericordiae University Hospital Dublin (CM), and School of Medicine, University College Dublin, Dublin, Ireland (JFXJ)
| | - Myles Monaghan
- From the School of Medicine, University College Dublin (LG), I-Form Advanced Manufacturing Research Centre, University College Dublin (AND), Our Lady of Lourdes Hospital, Drogheda, Ireland (MM), I-Form Advanced Manufacturing Research Centre, University College Dublin (FV), The Adelaide and Meath Hospital Dublin, Incorporating the National Children's Hospital (AMNCH) & Rotunda Hospital (BM), I-Form Advanced Manufacturing Research Centre, University College Dublin (DPD), Rotunda Hospital Dublin & Mater Misericordiae University Hospital Dublin (CM), and School of Medicine, University College Dublin, Dublin, Ireland (JFXJ)
| | - Frank Vaughan
- From the School of Medicine, University College Dublin (LG), I-Form Advanced Manufacturing Research Centre, University College Dublin (AND), Our Lady of Lourdes Hospital, Drogheda, Ireland (MM), I-Form Advanced Manufacturing Research Centre, University College Dublin (FV), The Adelaide and Meath Hospital Dublin, Incorporating the National Children's Hospital (AMNCH) & Rotunda Hospital (BM), I-Form Advanced Manufacturing Research Centre, University College Dublin (DPD), Rotunda Hospital Dublin & Mater Misericordiae University Hospital Dublin (CM), and School of Medicine, University College Dublin, Dublin, Ireland (JFXJ)
| | - Brian Murphy
- From the School of Medicine, University College Dublin (LG), I-Form Advanced Manufacturing Research Centre, University College Dublin (AND), Our Lady of Lourdes Hospital, Drogheda, Ireland (MM), I-Form Advanced Manufacturing Research Centre, University College Dublin (FV), The Adelaide and Meath Hospital Dublin, Incorporating the National Children's Hospital (AMNCH) & Rotunda Hospital (BM), I-Form Advanced Manufacturing Research Centre, University College Dublin (DPD), Rotunda Hospital Dublin & Mater Misericordiae University Hospital Dublin (CM), and School of Medicine, University College Dublin, Dublin, Ireland (JFXJ)
| | - Denis P Dowling
- From the School of Medicine, University College Dublin (LG), I-Form Advanced Manufacturing Research Centre, University College Dublin (AND), Our Lady of Lourdes Hospital, Drogheda, Ireland (MM), I-Form Advanced Manufacturing Research Centre, University College Dublin (FV), The Adelaide and Meath Hospital Dublin, Incorporating the National Children's Hospital (AMNCH) & Rotunda Hospital (BM), I-Form Advanced Manufacturing Research Centre, University College Dublin (DPD), Rotunda Hospital Dublin & Mater Misericordiae University Hospital Dublin (CM), and School of Medicine, University College Dublin, Dublin, Ireland (JFXJ)
| | - Conan McCaul
- From the School of Medicine, University College Dublin (LG), I-Form Advanced Manufacturing Research Centre, University College Dublin (AND), Our Lady of Lourdes Hospital, Drogheda, Ireland (MM), I-Form Advanced Manufacturing Research Centre, University College Dublin (FV), The Adelaide and Meath Hospital Dublin, Incorporating the National Children's Hospital (AMNCH) & Rotunda Hospital (BM), I-Form Advanced Manufacturing Research Centre, University College Dublin (DPD), Rotunda Hospital Dublin & Mater Misericordiae University Hospital Dublin (CM), and School of Medicine, University College Dublin, Dublin, Ireland (JFXJ)
| | - James F X Jones
- From the School of Medicine, University College Dublin (LG), I-Form Advanced Manufacturing Research Centre, University College Dublin (AND), Our Lady of Lourdes Hospital, Drogheda, Ireland (MM), I-Form Advanced Manufacturing Research Centre, University College Dublin (FV), The Adelaide and Meath Hospital Dublin, Incorporating the National Children's Hospital (AMNCH) & Rotunda Hospital (BM), I-Form Advanced Manufacturing Research Centre, University College Dublin (DPD), Rotunda Hospital Dublin & Mater Misericordiae University Hospital Dublin (CM), and School of Medicine, University College Dublin, Dublin, Ireland (JFXJ)
| |
Collapse
|
|
16
|
Jeong YJ, Shin S. The relationship between secondary traumatic stress and burnout in critical care nurses: The mediating effect of resilience. Intensive Crit Care Nurs 2023; 74:103327. [PMID: 36208974 DOI: 10.1016/j.iccn.2022.103327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To examine the mediating factor on the association of secondary traumatic stress and burnout among critical care nurses. DESIGN A correlational study. METHODS Data were collected from a convenience sampling of 147 nurses from two general hospitals who had six or more months of experience working in an intensive care unit. The collected data were analyzed through t-test, ANOVA, Scheffé test, Mann-Whitney test, Kruskal-Wallis test, Bonferroni correction, and Pearson's correlation coefficient using SPSS 25.0. The mediating effect of resilience was analyzed through the three-stage mediation effect test procedure using hierarchical regression analysis and the Sobel test. RESULTS Secondary traumatic stress had a statistically significant positive correlation with burnout (r = 0.45, p <.001), and a statistically significant negative correlation between burnout and resilience (r = -0.54, p <.001) was observed. Secondary traumatic stress was found to have a statistically significant effect on resilience, which was the mediating variable (β = -0.17, p =.042). Additionally, secondary traumatic stress had a statistically significant effect on burnout (β = 0.45, p <.001). The significance of the mediating effect of resilience on the relationship between secondary traumatic stress and burnout was investigated using the Sobel test, and the mediating effect of resilience was found to be statistically significant (Z = 1.98, p =.048). CONCLUSION Resilience was found to have a partial mediating effect in the relationship between critical care nurses' secondary traumatic stress and burnout. The study thus provides basic data on the importance of resilience in preventing burnout from secondary traumatic stress.
Collapse
Affiliation(s)
- Yun Jeong Jeong
- The Graduate School of Converging Clinical and Public Health, Ewha Womans University, Ewha Womans University, Mokdong Hospital, Republic of Korea.
| | - Sujin Shin
- College of Nursing, Ewha Womans University, Republic of Korea.
| |
Collapse
|
|
17
|
Lemos P, Guedes A, P Martins A, Branco C, Lobo C, Mourão J, S Pinto J, Serrano N, Abrunhosa R, Cadilha S, Almeida V. How Anaesthesiology Helped to Fight the First Wave of the COVID-19 Pandemic in Portugal. ACTA MEDICA PORT 2023; 36:42-48. [PMID: 35906853 DOI: 10.20344/amp.18453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The dissemination of the COVID-19 pandemic in Europe, namely in Portugal, demanded an organizational and clinical reaction from the Portuguese National Health Service. With the unpredictable impact of COVID-19 infected patients redefining hospital logistics, reducing non-priority elective care and extending the hospital capacity for critical care patients made mobilizing a significant part of human resources a priority. We conducted a national survey to monitor the contribution and the role of anaesthesiologists belonging to the 53 Portuguese National Health Service hospitals in the first wave fight against the pandemic. MATERIAL AND METHODS This prospective cross-sectional observational study used a weekly survey sent to the Directors of the Anaesthesiology Departments of all Portuguese National Health Service hospitals, between the period of 13th April and 21st June 2020. Directors were asked about human resources, hospital logistics, anaesthetic activity and residency programs in their departments as well as contingency plans facing the impact of the pandemic growth in the PNHS. RESULTS Contingency strategy for all Portuguese National Health Service hospitals planned for a total of 1524 level III critical care beds during the initial phases of the pandemic, an increase of 151% from the existing 607 level III critical care beds in Portugal in January 2020. This re-configuration effort of the Portuguese National Health Service was only possible due to the partial or total suspension of non-urgent elective activity that reached over 90% of these institutions in the first pandemic months (March and April) and the deployment of anaesthesiologists from their normal activities to the treatment of critical care patients. During the peak of the first pandemic wave, 209 anaesthesiology specialists and 170 trainees (22.9% of the total anaesthesiologist's staff in the Portuguese National Health Service) were deployed in critical care. There was an almost complete interruption of the residency program rotation in 70.4% of hospitals with anaesthesiology residents, between March and April 2020. CONCLUSION During the first pandemic wave there was an effective and fast reorganisation of the Portuguese National Health Service in order to increase level III critical care beds, which might have contributed to the low mortality rates in Portugal. We believe that this could have also been a result of the contribution given by all public anaesthesiology departments.
Collapse
Affiliation(s)
- Paulo Lemos
- Board of the Portuguese College of Anaesthesiology. Portuguese Medical Association. Lisbon. Portugal
| | - Alexandra Guedes
- Board of the Portuguese College of Anaesthesiology. Portuguese Medical Association. Lisbon. Portugal
| | - António P Martins
- Board of the Portuguese College of Anaesthesiology. Portuguese Medical Association. Lisbon. Portugal
| | - Carmo Branco
- Board of the Portuguese College of Anaesthesiology. Portuguese Medical Association. Lisbon. Portugal
| | - Clara Lobo
- Board of the Portuguese College of Anaesthesiology. Portuguese Medical Association. Lisbon. Portugal
| | - Joana Mourão
- Board of the Portuguese College of Anaesthesiology. Portuguese Medical Association. Lisbon. Portugal
| | - José S Pinto
- Board of the Portuguese College of Anaesthesiology. Portuguese Medical Association. Lisbon. Portugal
| | - Nuno Serrano
- Board of the Portuguese College of Anaesthesiology. Portuguese Medical Association. Lisbon. Portugal
| | - Rosário Abrunhosa
- Board of the Portuguese College of Anaesthesiology. Portuguese Medical Association. Lisbon. Portugal
| | - Susana Cadilha
- Board of the Portuguese College of Anaesthesiology. Portuguese Medical Association. Lisbon. Portugal
| | - Valentina Almeida
- Board of the Portuguese College of Anaesthesiology. Portuguese Medical Association. Lisbon. Portugal
| |
Collapse
|
|
18
|
Phelan HE, Stobbs SL, Sorbello M, Ward PA, McNarry AF. A prospective cohort evaluation of the McGrath™ MAC videolaryngoscope in a series of 979 cases. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.1016/j.tacc.2022.101209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
|
19
|
Taher A, Glazer P, Culligan C, Crump S, Guirguis S, Jones J, Dharamsi A, Chartier LB. Improving safety and communication for healthcare providers caring for SARS-COV-2 patients. Int J Emerg Med 2022; 15:62. [PMCID: PMC9652974 DOI: 10.1186/s12245-022-00464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/23/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Decreasing healthcare provider (HCP) exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus in emergency departments (EDs) is crucial. Approaches include limiting the HCP presence and ensuring sealed isolation rooms, which can result in communication difficulties. This quality improvement (QI) initiative aimed to decrease by 50% duration of isolation room door opening and increasing HCP-perceived communication clarity by one point on a five-point Likert scale.
Methods
This was a prospective, multi-stage project with three Plan-Do-Study-Act (PDSA) cycles between May and July 2020: (1) an educational intervention, (2) the introduction of a novel transceiver communication device, and (3) utilizing a clinical champion. Statistical Process Control XbarR charts were used to assess for special cause variation, and two-tailed Mann-Whitney U tests were used for statistical significance between Likert survey means. Qualitative responses underwent thematic analysis.
Results
Observation of 174 patient encounters was completed over 33 days, with 95 meeting the inclusion criteria. Door opening decreased from baseline (n=40; mean 72.97%) to PDSA 3 (n=21; mean 1.58%; p<0.0001). HCP-perceived communication clarity improved from baseline (n=36; mean 3.36) to PDSA-3 (n=49; mean 4.21; p<0.001). Survey themes included positive effects on communication and workflow, with some challenges on the integration of the new device into the clinical workflow. HCP-perceived errors, workarounds, and workflow pauses showed significant improvements.
Conclusion
This QI initiative with a novel transceiver showed significant decreases in isolation room door opening and increases in communication clarity. Future work will expand to operating rooms and intensive care units.
Collapse
|
|
20
|
Zhang S, Lin J, Diao X, Shi W, Huang L. Airway Management in Adult Intensive Care Units: A Survey of Two Regions in China. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4653494. [PMID: 36452062 PMCID: PMC9705077 DOI: 10.1155/2022/4653494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/14/2022] [Accepted: 11/03/2022] [Indexed: 02/22/2025]
Abstract
The critical medicine residency training in China started in 2020, but no investigation on the practice of tracheal intubation in ICUs in China has been conducted. A survey was sent to the adult ICUs in public hospitals in Shenzhen (SZ) city and Xinjiang (XJ) province using a WeChat miniprogram to be completed by intensive care physicians. It included questions on training on intubation, intubation procedures, and changes in the use of personal protective equipment due to COVID-19. We analyzed 301 valid questionnaires which were from 72 hospitals. A total of 37% of respondents had completed training in RSI (SZ, 40% vs. XJ, 30%; p = 0.066), and 50% had participated in a course on the emergency front of the neck airway (SZ, 47% vs. XJ, 54%; p = 0.256). Video laryngoscopy was preferred by 75% of respondents. Manual ventilation (56%) and noninvasive positive pressure ventilation (34%) were the first-line options for preoxygenation. For patients with a high risk of aspiration, nasogastric decompression (47%) and cricoid pressure (37%) were administered. Propofol (82%) and midazolam (70%) were the most commonly used induction agents. Only 19% of respondents routinely used neuromuscular blocking agents. For patients with difficult airways, a flexible endoscope was the most commonly used device by 76% of respondents. Most participants (77%) believed that the COVID-19 pandemic had significantly increased their awareness of the need for personal protective equipment during tracheal intubation. Our survey demonstrated that the ICU doctors in these areas lack adequate training in airway management.
Collapse
Affiliation(s)
- Sheng Zhang
- Department of Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jintuan Lin
- Department of Critical Care Medicine, Shenzhen Sixth People's Hospital, Shenzhen, Guangdong, China
| | - Xiaoyan Diao
- Obstetrics Department, Maternal and Child Health Hospital of Xinjiang Uygur Autonomous Region, Urumchi, Xinjiang, China
| | - Wenjian Shi
- Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumchi, Xinjiang, China
| | - Lei Huang
- Department of Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| |
Collapse
|
|
21
|
Edelman DA, Duggan LV, Lockhart SL, Marshall SD, Turner MC, Brewster DJ. Prevalence and commonality of non-technical skills and human factors in airway management guidelines: a narrative review of the last 5 years. Anaesthesia 2022; 77:1129-1136. [PMID: 36089858 PMCID: PMC9544663 DOI: 10.1111/anae.15813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 11/04/2022]
Abstract
The primary aim of this review was to identify, analyse and codify the prominence and nature of human factors and ergonomics within difficult airway management algorithms. A directed search across OVID Medline and PubMed databases was performed. All articles were screened for relevance to the research aims and according to predetermined exclusion criteria. We identified 26 published airway management algorithms. A coding framework was iteratively developed identifying human factors and ergonomic specific words and phrases based on the Systems Engineering Initiative for Patient Safety model. This framework was applied to the papers to delineate qualitative and quantitative results. Our results show that human factors are well represented within recent airway management guidelines. Human factors associated with work systems and processes featured more prominently than user and patient outcome measurement and adaption. Human factors are an evolving area in airway management and our results highlight that further considerations are necessary in further guideline development.
Collapse
Affiliation(s)
- D A Edelman
- Department of Medicine, Alfred Hospital, Melbourne, Australia
| | - L V Duggan
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - S L Lockhart
- Department of Anaesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, Canada
| | - S D Marshall
- Department of Anaesthesia and Peri-Operative Medicine, Monash University, Melbourne, Australia.,Department of Anaesthesia, Peninsula Health, Melbourne, VIC, Australia
| | - M C Turner
- Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, Australia
| | - D J Brewster
- Central Clinical School, Monash University, Melbourne, Australia.,Intensive Care Research Department, Cabrini Hospital, Melbourne, Australia
| |
Collapse
|
|
22
|
Martins MS, Lourenção DCDA, Pimentel RRDS, de Oliveira JM, Manganoti LTDCN, Modesto RC, Silva MSDS, Dos Santos MJ. Recommendations for the safety of hospitalised patients in the context of the COVID-19 pandemic: a scoping review. BMJ Open 2022; 12:e060182. [PMID: 36123068 PMCID: PMC9485646 DOI: 10.1136/bmjopen-2021-060182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/03/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To map the recommendations for hospitalised patient safety in the context of the COVID-19 pandemic. DESIGN Scoping review using the method recommended by the Joanna Briggs Institute. DATA SOURCES Databases: Medline, SCOPUS, EMBASE, ScienceDirect, LILACS, CINAHL and IBECS; grey literature platform: Google Scholar; and 11 official websites of leading healthcare institutions were searched on 27 April 2021 and updated on 11 April 2022. ELIGIBILITY CRITERIA We included documents that present recommendations for the safety of hospitalised patients in the context of the COVID-19 pandemic, published in any language, from 2020 onwards. DATA EXTRACTION AND SYNTHESIS Data extraction was performed in pairs with consensus rounds. A descriptive analysis was carried out to present the main characteristics of the articles. Qualitative data from the extraction of recommendations were analysed through content analysis. RESULTS One hundred and twenty-five documents were included. Most papers were identified as expert consensus (n=56, 44.8%). Forty-six recommendations were identified for the safety of hospitalised patients: 17 relating to the reorganisation of health services related to the flow of patients, the management of human and material resources and the reorganisation of the hospital environment; 11 on the approach to the airways and the prevention of the spread of aerosols; 11 related to sanitary and hygiene issues; 4 about proper use of personal protective equipment and 3 for effective communication. CONCLUSIONS The recommendations mapped in this scoping review present the best practices produced so far and serve as a basis for planning and implementing good practices to ensure safe hospital care, during and after COVID-19. The engagement of everyone involved in the care of hospitalised patients is essential to consolidate the mapped recommendations and provide dignified, safe and quality care.
Collapse
Affiliation(s)
| | | | | | - Janine Melo de Oliveira
- Escola de Enfermagem, Universidade Federal de Alagoas, Maceio, Brazil
- Curso de Enfermagem, Universidade Estadual de Ciências da Saúde de Alagoas, Maceio, Brazil
| | | | | | | | - Marcelo José Dos Santos
- Career Guidance Department, Universidade de São Paulo Escola de Enfermagem, Sao Paulo, Brazil
| |
Collapse
|
|
23
|
Maggio ID, Romola M, Lacava E, Maressa R, Bruno F. Dealing with COVID-19 stressful events, stress and anxiety: the mediating role of emotion regulation strategies in Italian women. HEALTH PSYCHOLOGY REPORT 2022; 11:70-80. [PMID: 38084343 PMCID: PMC10679912 DOI: 10.5114/hpr/152331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/28/2022] [Accepted: 07/24/2022] [Indexed: 02/11/2024] Open
Abstract
BACKGROUND This study aims to better understand the causal relationship between COVID-19 stressful events, perceived stress, emotion regulation strategies and anxiety symptoms in Italian women. Specifically, we assumed that: (i) different COVID-19 stressful events can directly or indirectly influence the manifestation of anxiety symptoms; (ii) perceived stress and emotion regulation strategies can mediate the relationship between COVID-19 stressful events and anxiety symptoms. PARTICIPANTS AND PROCEDURE An online survey was distributed during the Italian mandatory lockdown - between 18th and 28th April 2020 - across the national territory. The final sample was composed of 1132 women living in different Italian regions (North 63.30%, Centre 14.20%, South 18.50%, Islands 4.00%) with a mean age of 40.19 years, ranging from 19 to 83 years (SD = 12.87). Participants filled out the Perceived Stress Scale (PSS-10), Spielberger State-Trait Anxiety Inventory (STAI) X1/R, Emotion Regulation Questionnaire (ERQ-10), five dichotomous questions assessing the COVID-19 stressful events and a demographic form. Pearson correlation analyses were performed to examine whether associations between factors conformed to the prerequisites for path analysis. Path analysis was conducted to test the model. RESULTS "Having contracted the flu during the COVID-19 pandemic" and "having a family member infected by COVID-19" have a direct effect on the level of perceived stress and an indirect effect on the manifestation of anxiety symptoms. Finally, we found that emotion regulation strategies mediate the relationship between perceived stress and state anxiety symptoms. CONCLUSIONS Our results allow one to select the stressful events to which, in the pandemic era, it is necessary to pay particular attention in a clinical setting and suggest the implementation of psychological interventions that make emotion regulation an essential direct target of treatment in chronic stress-related pathology such as anxiety disorders.
Collapse
Affiliation(s)
- Ilaria Di Maggio
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
| | - Michela Romola
- Academy of Cognitive Behavioral Sciences of Calabria (ASCoC), Lamezia Terme, Italy
| | - Elisabetta Lacava
- Academy of Cognitive Behavioral Sciences of Calabria (ASCoC), Lamezia Terme, Italy
| | - Raffaella Maressa
- Academy of Cognitive Behavioral Sciences of Calabria (ASCoC), Lamezia Terme, Italy
| | - Francesco Bruno
- Academy of Cognitive Behavioral Sciences of Calabria (ASCoC), Lamezia Terme, Italy
- Regional Neurogenetic Centre (CRN), Department of Primary Care, ASP Catanzaro, Lamezia Terme, Italy
| |
Collapse
|
|
24
|
de Hesselle ML, Borgmann S, Rieg S, Vehreshild JJ, Spinner CD, Koll CEM, Hower M, Stecher M, Ebert D, Hanses F, Schumann J. Invasiveness of Ventilation Therapy Is Associated to Prevalence of Secondary Bacterial and Fungal Infections in Critically Ill COVID-19 Patients. J Clin Med 2022; 11:jcm11175239. [PMID: 36079168 PMCID: PMC9457079 DOI: 10.3390/jcm11175239] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 12/17/2022] Open
Abstract
Superinfections are a fundamental critical care problem, and their significance in severe COVID-19 cases needs to be determined. This study analyzed data from the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort focusing on intensive care patients. A retrospective analysis of patient data from 840 cases of COVID-19 with critical courses demonstrated that co-infections were frequently present and were primarily of nosocomial origin. Furthermore, our analysis showed that invasive therapy procedures accompanied an increased risk for healthcare-associated infections. Non-ventilated ICU patients were rarely affected by secondary infections. The risk of infection, however, increased even when non-invasive ventilation was used. A further, significant increase in infection rates was seen with the use of invasive ventilation and even more so with extracorporeal membrane oxygenation (ECMO) therapy. The marked differences among ICU techniques used for the treatment of COVID-19-induced respiratory failure in terms of secondary infection risk profile should be taken into account for the optimal management of critically ill COVID-19 patients, as well as for adequate antimicrobial therapy.
Collapse
Affiliation(s)
- Marie Louise de Hesselle
- University Clinic and Outpatient Clinic for Anesthesiology and Operative Intensive Care, University Medicine Halle (Saale), 06112 Halle (Saale), Germany
| | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, 85049 Ingolstadt, Germany
| | - Siegbert Rieg
- Department of Medicine II, University of Freiburg, 79106 Freiburg, Germany
| | - Jörg Janne Vehreshild
- Department II of Internal Medicine, Hematology and Oncology, Goethe University Frankfurt, 60323 Frankfurt, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Christoph D. Spinner
- Department of Internal Medicine II, University Hospital Rechts Der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- German Center for Infection Research (DZIF), 38106 Brunswick, Germany
| | - Carolin E. M. Koll
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Martin Hower
- Department of Pneumology, Infectious Diseases, Internal Medicine and Intensive Care, Klinikum Dortmund GmbH, 44137 Dortmund, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Daniel Ebert
- University Clinic and Outpatient Clinic for Anesthesiology and Operative Intensive Care, University Medicine Halle (Saale), 06112 Halle (Saale), Germany
| | - Frank Hanses
- Emergency Department and Department for Infection Control and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Julia Schumann
- University Clinic and Outpatient Clinic for Anesthesiology and Operative Intensive Care, University Medicine Halle (Saale), 06112 Halle (Saale), Germany
- Correspondence:
| | | |
Collapse
|
|
25
|
Cortese G, Sorbello M, Di Giacinto I, Cedrone M, Urdaneta F, Brazzi L. Human Factors and Airway Management in COVID-19 Patients: The Perfect Storm? J Clin Med 2022; 11:4271. [PMID: 35893372 PMCID: PMC9330625 DOI: 10.3390/jcm11154271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 01/27/2023] Open
Abstract
The SARS-CoV-2 pandemic heavily impacted healthcare workers, increasing their physical and psychological workload. Specifically, COVID-19 patients' airway management is definitely a challenging task regarding both severe and acute respiratory failure and the risk of contagion while performing aerosol-generating procedures. The category of anesthesiologists and intensivists, the main actors of airway management, showed a poor psychological well-being and a high stress and burnout risk. Identifying and better defining the specific main SARS-CoV-2-related stressors can help them deal with and effectively plan a strategy to manage these patients in a more confident and safer way. In this review, we therefore try to analyze the relevance of human factors and non-technical skills when approaching COVID-19 patients. Lessons from the past, such as National Audit Project 4 recommendations, have taught us that safe airway management should be based on preoperative assessment, the planning of an adequate strategy, the optimization of setting and resources and the rigorous evaluation of the scenario. Despite, or thanks to, the critical issues and difficulties, the "take home lesson" that we can translate from SARS-CoV-2 to every airway management is that there can be no more room for improvisation and that creating teamwork must become a priority.
Collapse
Affiliation(s)
- Gerardo Cortese
- Department of Anaesthesia, Intensive Care and Emergency, AOU Città della Salute e della Scienza, Corso Dogliotti 14, 10126 Turin, Italy; (G.C.); (L.B.)
| | | | - Ida Di Giacinto
- Anesthesia and Intensive Care, Mazzoni Hospital, 63100 Ascoli Piceno, Italy;
| | - Martina Cedrone
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Felipe Urdaneta
- Department of Anesthesiology, North Florida/South Georgia Veteran Health Systems, University of Florida, Gainesville, FL 32608, USA;
| | - Luca Brazzi
- Department of Anaesthesia, Intensive Care and Emergency, AOU Città della Salute e della Scienza, Corso Dogliotti 14, 10126 Turin, Italy; (G.C.); (L.B.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| |
Collapse
|
|
26
|
Duarte-Medrano G, Sorbello M, Susunaga-Hope RR, Fuentes-Castro PI, Avila-OrtIz BC, Velasco-Godinez AP, Contreras-Garcia WY, Pineda-Castillo MA, Urdaneta F, Téllez-Ávila FI. Aerosol boxes for airway management in coronavirus disease patients: a clinical retrospective study in Mexico. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022; 2:32. [PMID: 37386573 PMCID: PMC10246106 DOI: 10.1186/s44158-022-00061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/07/2022] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Significant concerns raise for the healthcare workers involved in airway management of patients diagnosed with coronavirus 2019 disease (COVID-19). Due to shortages of personal protective equipment (PPE), barrier enclosure systems such as aerosol box (AB) have been proposed worldwide. The aim of this study was to evaluate our experience using AB as protective equipment in patients with COVID-19 in a third-level center in Mexico. METHODS A retrospective study of COVID-19 patients requiring airway management using an AB in the Hospital Central Sur de Alta Especialidad de Pemex in Mexico City from March 1 to June 1, 2020. Antropometric data, pre-intubation vital signs, and laboratory tests were recorded; the primary endpoints were intubation success rate and complications associated with AB and patients' mortality. As a secondary endpoint, AB subjective evaluation was explored by administering a survey after airway management procedures. RESULTS Thirty-nine patients for a total of 40 intubations were documented. Thirty-one (77.5%) were men, with a mean age of 61.65 years; successful intubation occurred in 39 (97.55%) of the procedures, and AB was used in 36 (90%) of intubations, with success in 28 (70.0%); A Cormack-Lehane grade 3 view was recorded in 18 patients (46.2%), and during the procedure, the AB had to be removed in 8 (22.2%) cases, with migration documented in 91.6% of cases. The 30-day mortality was 48.71%, with 23.0% of patients discharged. 83.3% of surveyed anesthesiologists reported significant limitations in manipulating airway devices with AB used. CONCLUSION Our data indicate that in clinical practice, the use of AB may hinder airway management and decrease the intubation success rate and may also result in patients' injury. Further studies are necessary to validate the use of AB in clinical practice, and they should not replace certified PPE.
Collapse
Affiliation(s)
- Gilberto Duarte-Medrano
- Anesthesiology Department of the South-Central Hospital of High Specialty Pemex, Mexico City, Mexico
| | - Massimiliano Sorbello
- Anaesthesia, and Intensive Care, Policlinico San Marco University Hospital, Viale C. A. Ciampi, 95100, Catania, Italy.
| | | | | | - Beatriz C Avila-OrtIz
- Anesthesiology Department of the South-Central Hospital of High Specialty Pemex, Mexico City, Mexico
| | | | - Wendy Y Contreras-Garcia
- Anesthesiology Department of the South-Central Hospital of High Specialty Pemex, Mexico City, Mexico
| | | | - Felipe Urdaneta
- Clinical Professor Anesthesiology, Department of Anesthesiology, University of Florida/NFSGVHS, Florida, USA
| | - Félix Ignacio Téllez-Ávila
- Gastrointestinal Endoscopy Department of the National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| |
Collapse
|
|
27
|
Ban DK, Bodily T, Karkisaval AG, Dong Y, Natani S, Ramanathan A, Ramil A, Srivastava S, Bandaru P, Glinsky G, Lal R. Rapid self-test of unprocessed viruses of SARS-CoV-2 and its variants in saliva by portable wireless graphene biosensor. Proc Natl Acad Sci U S A 2022; 119:e2206521119. [PMID: 35763566 PMCID: PMC9282385 DOI: 10.1073/pnas.2206521119] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/26/2022] [Indexed: 12/20/2022] Open
Abstract
We have developed a DNA aptamer-conjugated graphene field-effect transistor (GFET) biosensor platform to detect receptor-binding domain (RBD), nucleocapsid (N), and spike (S) proteins, as well as viral particles of original Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus and its variants in saliva samples. The GFET biosensor is a label-free, rapid (≤20 min), ultrasensitive handheld wireless readout device. The limit of detection (LoD) and the limit of quantitation (LoQ) of the sensor are 1.28 and 3.89 plaque-forming units (PFU)/mL for S protein and 1.45 and 4.39 PFU/mL for N protein, respectively. Cognate spike proteins of major variants of concern (N501Y, D614G, Y453F, Omicron-B1.1.529) showed sensor response ≥40 mV from the control (aptamer alone) for fM to nM concentration range. The sensor response was significantly lower for viral particles and cognate proteins of Middle East Respiratory Syndrome (MERS) compared to SARS-CoV-2, indicating the specificity of the diagnostic platform for SARS-CoV-2 vs. MERS viral proteins. During the early phase of the pandemic, the GFET sensor response agreed with RT-PCR data for oral human samples, as determined by the negative percent agreement (NPA) and positive percent agreement (PPA). During the recent Delta/Omicron wave, the GFET sensor also reliably distinguished positive and negative clinical saliva samples. Although the sensitivity is lower during the later pandemic phase, the GFET-defined positivity rate is in statistically close alignment with the epidemiological population-scale data. Thus, the aptamer-based GFET biosensor has a high level of precision in clinically and epidemiologically significant SARS-CoV-2 variant detection. This universal pathogen-sensing platform is amenable for a broad range of public health applications and real-time environmental monitoring.
Collapse
Affiliation(s)
- Deependra Kumar Ban
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, CA 92093
| | - Tyler Bodily
- Department of Bioengineering, University of California, San Diego, CA 92093
| | - Abhijith G. Karkisaval
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, CA 92093
| | - Yongliang Dong
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, CA 92093
| | - Shreyam Natani
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, CA 92093
| | - Anirudh Ramanathan
- Department of Bioengineering, University of California, San Diego, CA 92093
| | - Armando Ramil
- Department of Bioengineering, University of California, San Diego, CA 92093
| | | | - Prab Bandaru
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, CA 92093
- Materials Science, University of California, San Diego, CA 92093
| | - Gennadi Glinsky
- Institute of Engineering in Medicine, University of California, San Diego, CA 92093
| | - Ratnesh Lal
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, CA 92093
- Department of Bioengineering, University of California, San Diego, CA 92093
- Materials Science, University of California, San Diego, CA 92093
| |
Collapse
|
|
28
|
Desenlaces clínicos en pacientes con diagnóstico de neumonía relacionada con SARS-CoV-2 manejados con cánula de alto flujo, una experiencia clínica. (Estudio CANALF). ACTA COLOMBIANA DE CUIDADO INTENSIVO 2022. [PMCID: PMC9050654 DOI: 10.1016/j.acci.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
|
29
|
Sami R, Soltaninejad F, Shayganfar A, Mirfendereski S, Mansourian M, Khademi N, Dehghan M, Khorrami Z, Jalali S, Mokhtari Z. Severity of Disease and COVID-19 Complications During Hospital Stay: A Prospective Cohort Study. ARCHIVES OF IRANIAN MEDICINE 2022; 25:383-393. [PMID: 35943018 PMCID: PMC11904273 DOI: 10.34172/aim.2022.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 10/04/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND COVID-19, with its high transmission and mortality rates and unknown outcomes, has become a major concern in the world. Among people with COVID-19, severe cases can quickly progress to serious complications, and even death. So, the present study aimed to examine the relationship between the severity of the disease and the outcome in patients afflicted by COVID-19 during hospitalization. METHODS A total of 653 patients with COVID-19 aged 18 years or older were included from Khorshid hospital in Isfahan, Iran and followed for a mean of 22.72 days (median 23.50; range 1-47). Severe COVID-19 was defined by respiration rate≥30 times/min, oxygen saturation level≤88% in the resting position, and pulse rate≥130/min. The primary outcome was mortality. The secondary outcomes included need for mechanical ventilation and intensive care unit (ICU) admission. RESULTS During 4233 person-days of follow-up, 49 (7.5%) deaths, 27 (4.1%) invasive ventilation and 89 (13.6%) ICU admissions in hospital were reported. After adjustment for potential confounders, severity of the disease was positively associated with risk of mortality, invasive ventilation and ICU admissions (hazard ratio [HR]: 5.99; 95% CI: 2.85, 12.59; P<0.001, HR: 7.09; 95% CI: 3.24, 15.52; P<0.001 and HR: 4.88; 95% CI: 2.98, 7.98; P<0.001, respectively). In addition, greater age (HR=1.04; 95% CI=1.02-1.07; P=0.002), chronic kidney disease (HR=3.05; 95% CI=1.35, 6.90; P=0.008), blood urea nitrogen (BUN) (HR=1.04; 95% CI=1.03-1.05; P<0.001) and creatinine (HR=1.44; 95% CI=1.26-1.65; P<0.001) were probably significant risk factors for mortality in severe COVID-19 patients. CONCLUSION More intensive therapy and special monitoring should be implemented for patients with older age, hypertension and kidney disease who are infected with COVID-19 to prevent rapid worsening.
Collapse
Affiliation(s)
- Ramin Sami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forogh Soltaninejad
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azin Shayganfar
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sam Mirfendereski
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Biostatistics, Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nilufar Khademi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrnegar Dehghan
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Khorrami
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Jalali
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zeinab Mokhtari
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
|
30
|
Fericean RM, Citu C, Manolescu D, Rosca O, Bratosin F, Tudorache E, Oancea C. Characterization and Outcomes of SARS-CoV-2 Infection in Overweight and Obese Patients: A Dynamic Comparison of COVID-19 Pandemic Waves. J Clin Med 2022; 11:2916. [PMID: 35629042 PMCID: PMC9143838 DOI: 10.3390/jcm11102916] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 02/01/2023] Open
Abstract
There are few data on the dynamics of SARS-CoV-2 viral manifestations in obese and overweight persons during each of the five waves that occurred in Romania during the last two years. As such, the purpose of this research was to characterize the variance in case severity, symptomatology, ICU hospitalizations, and mortality among overweight and obese individuals infected with the SARS-CoV-2 virus. We included 250 overweight and obese patients admitted to hospital with COVID-19, where 50 patients were selected from each of the five pandemic waves that existed in Romania until March 2022. A total of 113 patients with normal body mass index were included in the study. They were matched with overweight and obese patients by age, gender, and cardiovascular comorbidities to avoid the effect of confounding factors. Between the five waves of the COVID-19 pandemic in Romania, the present investigation found substantial changes in overweight and obese patient features. Obesity increases the risk of hospitalization, severe complications, and mortality from COVID-19. However, this unique demographic is disproportionately affected by obesity-related comorbidities, which contribute to these adverse outcomes. We advocate for the development of new guiding principles for the formulation of healthcare strategies aimed at high-prevalence special populations such as overweight and obese individuals, while also promoting pandemic containment and avoiding the recurrence of pandemic waves with the same guidelines that proved detrimental in terms of economic and human life loss.
Collapse
Affiliation(s)
- Roxana Manuela Fericean
- Department XIII, Discipline of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Doctoral School, ‘’Victor Babes’’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cosmin Citu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Diana Manolescu
- Department of Radiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Ovidiu Rosca
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.R.); (F.B.)
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.R.); (F.B.)
| | - Emanuela Tudorache
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.T.); (C.O.)
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.T.); (C.O.)
| |
Collapse
|
|
31
|
Gupta B, Jain G, Pathak S, Mishra P, Kumar H, Rao S. Airway management training program for nurses via online course in COVID-19 preparedness. World J Methodol 2022; 12:113-121. [PMID: 35721240 PMCID: PMC9157635 DOI: 10.5662/wjm.v12.i3.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/27/2022] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nursing officers are an integral component of any medical team. They participate in taking care of basic airway management and assist in advanced airway management, specifically amidst the current coronavirus disease 2019 (COVID-19) pandemic. AIM To assess the efficacy of a standardized web-based training module for nurses in preparedness to fight against COVID-19. METHODS The training was held in three sessions of 1 h each, consisting of live audio-visual lectures, case scenarios, and skill demonstrations. The sequence of airway equipment, drug preparation, airway examination, and plans of airway management was demonstrated through mannequin-based video-clips. RESULTS Pre- and post-test scores as well as objective structured clinical examination scores were analyzed using Student's t-test and the Likert scale was used for feedback assessment. It was found that the mean score out of the total score of 20 was 8.47 ± 4.2 in the pre-test, while in the post-test it was 17.4 ± 1.8 (P value < 0.001). The participants also felt self-reliant in executing the roles of airway assistant (63.3%) and drug assistant (74.3%). Fear of self-infection with COVID-19 was also high, as 66% of participants feared working with the patient's airway. CONCLUSION Amidst this COVID-19 emergency, when the health care systems are being persistently challenged, training of nursing staff in the safe conduct of airway management can ensure delivery of life-saving treatment.
Collapse
Affiliation(s)
- Bhavna Gupta
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Gaurav Jain
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Sharmishtha Pathak
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Priyanka Mishra
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Hemanth Kumar
- Department of Advanced Centre of Continuous Professional Development, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Shalinee Rao
- Department of Advanced Centre of Continuous Professional Development, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| |
Collapse
|
|
32
|
Hussain Khan Z, Maki Aldulaimi A, Varpaei HA, Mohammadi M. Various Aspects of Non-Invasive Ventilation in COVID-19 Patients: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:194-209. [PMID: 35634520 PMCID: PMC9126903 DOI: 10.30476/ijms.2021.91753.2291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 01/08/2023]
Abstract
Non-invasive ventilation (NIV) is primarily used to treat acute respiratory failure. However, it has broad applications to manage a range of other diseases successfully. The main advantage of NIV lies in its capability to provide the same physiological effects as invasive ventilation while avoiding the placement of an artificial airway and its associated life-threatening complications. The war on the COVID-19 pandemic is far from over. The present narrative review aimed at identifying various aspects of NIV usage, in COVID-19 and other patients, such as the onset time, mode, setting, positioning, sedation, and types of interface. A search for articles published from May 2020 to April 2021 was conducted using MEDLINE, PMC central, Scopus, Web of Science, Cochrane Library, and Embase databases. Of the initially identified 5,450 articles, 73 studies and 24 guidelines on the use of NIV were included. The search was limited to studies involving human cases and English language articles. Despite several reported benefits of NIV, the evidence on the use of NIV in COVID-19 patients does not yet fully support its routine use.
Collapse
Affiliation(s)
- Zahid Hussain Khan
- Department of Anesthesiology and Critical Care, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmed Maki Aldulaimi
- Al-furat Al-awsat Hospital, Al-furat Al-awsat Technical University, Health and Medical Technical College, Department of Anesthesia and Critical Care, Kufa, Iraq
| | - Hesam Aldin Varpaei
- Department of Nursing and Midwifery, School of Nursing, Islamic Azad University Tehran Medical Sciences, Tehran, Iran
| | - Mostafa Mohammadi
- Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran. Iran
| |
Collapse
|
|
33
|
Grudzinski AL, Sun B, Zhang M, Crnic A, Djokhdem AH, Hanna M, Montroy J, Duggan LV, Hamilton GM, Fergusson DA, Boet S, McIsaac DI, Lalu MM. Airway recommendations for perioperative patients during the COVID-19 pandemic: a scoping review. Can J Anaesth 2022; 69:644-657. [PMID: 35112304 PMCID: PMC8809630 DOI: 10.1007/s12630-022-02199-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/13/2021] [Accepted: 11/23/2021] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Numerous guideline recommendations for airway and perioperative management during the COVID-19 pandemic have been published. We identified, synthesized, and compared guidelines intended for anesthesiologists. SOURCE Member society websites of the World Federation of Societies of Anesthesiologists and the European Society of Anesthesiologists were searched. Recommendations that focused on perioperative airway management of patients with proven or potential COVID-19 were included. Accelerated screening was used; data were extracted by one reviewer and verified by a second. Data were organized into themes based on perioperative phase of care. PRINCIPAL FINDINGS Thirty unique sets of recommendations were identified. None reported methods for systematically searching or selecting evidence to be included. Four were updated following initial publication. For induction and airway management, most recommended minimizing personnel and having the most experienced anesthesiologist perform tracheal intubation. Significant congruence was observed among recommendations that discussed personal protective equipment. Of those that discussed tracheal intubation methods, most (96%) recommended videolaryngoscopy, while discordance existed regarding use of flexible bronchoscopy. Intraoperatively, 23% suggested specific anesthesia techniques and most (63%) recommended a specific operating room for patients with COVID-19. Postoperatively, a minority discussed extubation procedures (33%), or care in the recovery room (40%). Non-technical considerations were discussed in 27% and psychological support for healthcare providers in 10%. CONCLUSION Recommendations for perioperative airway management of patients with COVID-19 overlap to a large extent but also show significant differences. Given the paucity of data early in the pandemic, it is not surprising that identified publications largely reflected expert opinion rather than empirical evidence. We suggest future efforts should promote coordinated responses and provide suggestions for studying and establishing best practices in perioperative patients. STUDY REGISTRATION Open Science Framework ( https://osf.io/a2k4u/ ); date created, 26 March 2020.
Collapse
Affiliation(s)
- Alexa Lynn Grudzinski
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
| | - Billy Sun
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
| | - MengQi Zhang
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Blueprint Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Agnes Crnic
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
| | | | - Mary Hanna
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
| | - Joshua Montroy
- Blueprint Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Laura V Duggan
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
| | - Gavin M Hamilton
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
| | - Dean A Fergusson
- Blueprint Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, Francophone Affairs, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Faculty of Education, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- AIMS Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Manoj M Lalu
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada.
- Blueprint Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
| |
Collapse
|
|
34
|
Landoni G, Belloni O, Russo G, Bonaccorso A, Carà G, Jabaudon M. Inhaled Sedation for Invasively Ventilated COVID-19 Patients: A Systematic Review. J Clin Med 2022; 11:jcm11092500. [PMID: 35566625 PMCID: PMC9105857 DOI: 10.3390/jcm11092500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Volatile anesthetics were used as sedative agents in COVID-19 (Coronavirus Disease 2019) invasively ventilated patients for their potentially beneficial pharmacological effects and due to the temporary shortages of intravenous agents during the pandemic crisis. Methods: Online databases (PubMed, EMBASE, The Cochrane Central Register of Controlled Trial) and the “clinicaltrials.gov” website were searched for studies reporting the use of isoflurane, sevoflurane or desflurane. Results: We identified three manuscripts describing the beneficial effects of isoflurane on 41 COVID-19 patients with acute respiratory distress syndrome (ARDS) in Germany (n = 2) and in the USA (n = 1), in terms of reduction in the use of opioids and other sedatives. We also found a case report of two patients with transient nephrogenic diabetes insipidus, which started after 6 and 8 days of sevoflurane sedation. We identified two randomized controlled trials (RCTs; 92 patients overall), two observational studies (238 patients) on the use of volatile anesthetics in COVID-19 patients that were completed but not yet published, and one RCT interrupted for a low recruitment ratio (19 patients) and thus not published. We also identified five ongoing RCTs on the use of inhaled sedation in ARDS, which are also likely to be recruiting COVID-19 patients and which have currently enrolled a total of >1643 patients. Conclusion: Isoflurane was the most frequently used volatile agent in COVID-19 patients and allowed a reduction in the use of other sedative and analgesic drugs. Randomized evidence is building up and will be useful to confirm or challenge these findings.
Collapse
Affiliation(s)
- Giovanni Landoni
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (O.B.); (G.R.); (A.B.); (G.C.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Correspondence:
| | - Olivia Belloni
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (O.B.); (G.R.); (A.B.); (G.C.)
| | - Giada Russo
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (O.B.); (G.R.); (A.B.); (G.C.)
| | - Alessandra Bonaccorso
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (O.B.); (G.R.); (A.B.); (G.C.)
| | - Gianmarco Carà
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (O.B.); (G.R.); (A.B.); (G.C.)
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France;
- GReD, Université Clermont Auvergne, CNRS, INSERM, F-63000 Clermont-Ferrand, France
| |
Collapse
|
|
35
|
Saglietto A, D'Ascenzo F, Cavarretta E, Frati G, Anselmino M, Versaci F, Biondi-Zoccai G, DE Ferrari GM. Excess all-cause mortality during COVID-19 outbreak: potential role of untreated cardiovascular disease. Minerva Cardiol Angiol 2022; 70:160-166. [PMID: 32996311 DOI: 10.23736/s2724-5683.20.05349-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has rapidly spread globally. Due to different testing strategies, under-detection of positive subjects and COVID-19-related-deaths remains common. Aim of this analysis was to assess the real impact of COVID-19 through the analysis of 2020 Italian all-cause mortality data compared to historical series. METHODS We performed a retrospective analysis of 2020 and 2015-2019 all-cause mortality data released by the Italian National Institute for Statistics (ISTAT) for the time period January 1st-March 21st. This preliminary sample included 1084 Italian municipalities showing at least 10 deaths during the above-mentioned timeframe and an increase in mortality of more than 20% as compared to the previous five years (2015-2019), with a resulting coverage of 21% of Italian population. The difference between 2020 observed and expected deaths (mean of weekly deaths in 2015-2019) was computed, together with mortality rate ratio (MRR) for each of the four weeks following detection of the first autochthonous COVID-19 case in Italy (February 23rd, 2020 - March 21st, 2020), as well as for this entire timeframe. Subgroup analysis by age groups was also performed. RESULTS Overall MRR was 1.79 [1.75-1.84], with an observed excess mortality of 8750 individuals in the investigated sample, which in itself outweighs Italian Civil Protection report of only 4,825 COVID-19-related deaths across Italy, as of March 21. Subgroup analysis did not show any difference in mortality rate in '0-14 years' age group, while MRRs were significantly increased in older age groups, in particular in patients >75 years (MRR 1.84 [1.79-1.89]). In addition, week-by-week analysis showed a progressive increase in MRR during this period, peaking in the last week (March 15th, 2020 - March 21st, 2020) with an estimated value of 2.65 [2.53-2.78]. CONCLUSIONS The analysis of all-cause mortality data in Italy indicates that reported COVID-19-related deaths are an underestimate of the actual death toll. All-cause death should be seen as the epidemiological indicator of choice to assess the real mortality impact exerted by SARS-CoV-2, given that it also best reflects the toll on frail patient subsets (e.g. the elderly or those with cardiovascular disease).
Collapse
Affiliation(s)
- Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy -
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
- IRCCS NEUROMED, Pozzilli, Isernia, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Versaci
- Unit of Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Gaetano M DE Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| |
Collapse
|
|
36
|
Li Y, Fu Y, Zhang Y, Yu S, Luo J, Li Y, Wang C, Zhu J, Li H. An overview of COVID-19 aerosol box for preventing droplet and aerosol contaminations in healthcare providers performing airway intubation. Drug Dev Ind Pharm 2022; 47:1693-1699. [PMID: 35285771 DOI: 10.1080/03639045.2022.2053984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The COVID-19 is caused by the SARS-CoV-2, which is extremely infectious. Numerous virologist suggestions and guidelines advised using P2/N95 masks, gloves, goggles, face-shields, and frocks or gowns as routine specific protective tools during airway management to protect healthcare personnel from infection (PPE). However, numerous imitation research has indicated that conventional PPE cannot adequately protect healthcare personnel. Since then, numerous firms and healthcare professionals have created their personal reformed devices "aerosol containment devices" (ACD). Their usage has expanded throughout the world without being properly evaluated for usefulness, efficacy, or safety. The practice of "ACD" has been shown to make tracheal intubation (TI) more problematic in several simulated tests. Furthermore, the device should limit the transmission of droplets from a patient; however, it might put healthcare personnel at danger of being exposed to greater levels of viral aerosols. Consequently, the existing state of information suggests that "ACD" deprived of a vacuum mechanism can simply protect healthcare personnel against viral transmission to a limited extent. We search various databases for the literatures with keywords "COVID-19", "aerosol box", "aerosol contaminations" and "droplet contaminations. The current review focused on the aerosol box from various perspectives, including their mechanism, optimum time of use, the spread of aerosol control, current gaps and future perspective for bridging those gaps.
Collapse
Affiliation(s)
- Yan Li
- The outpatient department, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Yujun Fu
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Yunwei Zhang
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Shuai Yu
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Jinhong Luo
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Yuanyuan Li
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Caihong Wang
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Jingjing Zhu
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Huiling Li
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China.,Hainan Clinical Medical school of Southern Medical University, Sanya, Hainan, China
| |
Collapse
|
|
37
|
Coviello A, Vargas M, Marra A, Golino L, Saccone G, Iacovazzo C, Frigo MG, Tognù A, Ianniello M, Buonanno P, Servillo G. Protocols of Anesthesia Management in Parturients with SARS-CoV-2 Infection. Healthcare (Basel) 2022; 10:healthcare10030520. [PMID: 35326998 PMCID: PMC8950444 DOI: 10.3390/healthcare10030520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/03/2022] [Accepted: 03/10/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Our hospital became a referral center for COVID-19-positive obstetric patients from 1 May 2020. The aim of our study is to illustrate our management protocols for COVID-19-positive obstetric patients, to maintain safety standards for patients and healthcare workers. Methods: Women who underwent vaginal or operative delivery and induced or spontaneous abortion with a SARS-CoV-2-positive nasopharyngeal swab using real-time PCR (RT-PCR) were included in the study. Severity and onset of new symptoms were carefully monitored in the postoperative period. All the healthcare workers received a nasopharyngeal swab for SARS-CoV-2 using RT-PCR serially every five days. Results: We included 152 parturients with COVID-19 infection. None of the included women had general anesthesia, an increase of severe symptoms or onset of new symptoms. The RT-PCR test was “negative” for the healthcare workers. Conclusions: In our study, neuraxial anesthesia for parturients’ management with SARS-CoV-2 infection has been proven to be safe for patients and healthcare workers. Neuraxial anesthesia decreases aerosolization during preoxygenation, face-mask ventilation, endotracheal intubation, oral or tracheal suctioning and extubation. This anesthesia management protocol can be generalizable.
Collapse
Affiliation(s)
- Antonio Coviello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (M.V.); (A.M.); (G.S.); (C.I.); (M.I.); (P.B.); (G.S.)
- Correspondence: ; Tel.: +39-3497013533
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (M.V.); (A.M.); (G.S.); (C.I.); (M.I.); (P.B.); (G.S.)
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (M.V.); (A.M.); (G.S.); (C.I.); (M.I.); (P.B.); (G.S.)
| | - Ludovica Golino
- Department of Anesthesiology and Intensive Care, San Giovanni di Dio Hospital, 80027 Naples, Italy;
| | - Gabriele Saccone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (M.V.); (A.M.); (G.S.); (C.I.); (M.I.); (P.B.); (G.S.)
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (M.V.); (A.M.); (G.S.); (C.I.); (M.I.); (P.B.); (G.S.)
| | - Maria Grazia Frigo
- Department of Anesthesia and Resuscitation in Obstetrics, San Giovanni Calibita Fatebenefratelli Hospital, 39, 00186 Rome, Italy;
| | - Andrea Tognù
- Department of Anesthesiology and Intensive Care Medicine, Istituto Ortopedico Rizzoli IRCCS, 40136 Bologna, Italy;
| | - Marilena Ianniello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (M.V.); (A.M.); (G.S.); (C.I.); (M.I.); (P.B.); (G.S.)
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (M.V.); (A.M.); (G.S.); (C.I.); (M.I.); (P.B.); (G.S.)
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80100 Naples, Italy; (M.V.); (A.M.); (G.S.); (C.I.); (M.I.); (P.B.); (G.S.)
| |
Collapse
|
|
38
|
Aghamirza Moghim Aliabadi H, Eivazzadeh‐Keihan R, Beig Parikhani A, Fattahi Mehraban S, Maleki A, Fereshteh S, Bazaz M, Zolriasatein A, Bozorgnia B, Rahmati S, Saberi F, Yousefi Najafabadi Z, Damough S, Mohseni S, Salehzadeh H, Khakyzadeh V, Madanchi H, Kardar GA, Zarrintaj P, Saeb MR, Mozafari M. COVID-19: A systematic review and update on prevention, diagnosis, and treatment. MedComm (Beijing) 2022; 3:e115. [PMID: 35281790 PMCID: PMC8906461 DOI: 10.1002/mco2.115] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 01/09/2023] Open
Abstract
Since the rapid onset of the COVID-19 or SARS-CoV-2 pandemic in the world in 2019, extensive studies have been conducted to unveil the behavior and emission pattern of the virus in order to determine the best ways to diagnosis of virus and thereof formulate effective drugs or vaccines to combat the disease. The emergence of novel diagnostic and therapeutic techniques considering the multiplicity of reports from one side and contradictions in assessments from the other side necessitates instantaneous updates on the progress of clinical investigations. There is also growing public anxiety from time to time mutation of COVID-19, as reflected in considerable mortality and transmission, respectively, from delta and Omicron variants. We comprehensively review and summarize different aspects of prevention, diagnosis, and treatment of COVID-19. First, biological characteristics of COVID-19 were explained from diagnosis standpoint. Thereafter, the preclinical animal models of COVID-19 were discussed to frame the symptoms and clinical effects of COVID-19 from patient to patient with treatment strategies and in-silico/computational biology. Finally, the opportunities and challenges of nanoscience/nanotechnology in identification, diagnosis, and treatment of COVID-19 were discussed. This review covers almost all SARS-CoV-2-related topics extensively to deepen the understanding of the latest achievements (last updated on January 11, 2022).
Collapse
Affiliation(s)
- Hooman Aghamirza Moghim Aliabadi
- Protein Chemistry LaboratoryDepartment of Medical BiotechnologyBiotechnology Research CenterPasteur Institute of IranTehranIran
- Advance Chemical Studies LaboratoryFaculty of ChemistryK. N. Toosi UniversityTehranIran
| | | | - Arezoo Beig Parikhani
- Department of Medical BiotechnologyBiotechnology Research CenterPasteur InstituteTehranIran
| | | | - Ali Maleki
- Department of ChemistryIran University of Science and TechnologyTehranIran
| | | | - Masoume Bazaz
- Department of Medical BiotechnologyBiotechnology Research CenterPasteur InstituteTehranIran
| | | | | | - Saman Rahmati
- Department of Medical BiotechnologyBiotechnology Research CenterPasteur InstituteTehranIran
| | - Fatemeh Saberi
- Department of Medical BiotechnologySchool of Advanced Technologies in MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Zeinab Yousefi Najafabadi
- Department of Medical BiotechnologySchool of Advanced Technologies in MedicineTehran University of Medical SciencesTehranIran
- ImmunologyAsthma & Allergy Research InstituteTehran University of Medical SciencesTehranIran
| | - Shadi Damough
- Department of Medical BiotechnologyBiotechnology Research CenterPasteur InstituteTehranIran
| | - Sara Mohseni
- Non‐metallic Materials Research GroupNiroo Research InstituteTehranIran
| | | | - Vahid Khakyzadeh
- Department of ChemistryK. N. Toosi University of TechnologyTehranIran
| | - Hamid Madanchi
- School of MedicineSemnan University of Medical SciencesSemnanIran
- Drug Design and Bioinformatics UnitDepartment of Medical BiotechnologyBiotechnology Research CenterPasteur Institute of IranTehranIran
| | - Gholam Ali Kardar
- Department of Medical BiotechnologySchool of Advanced Technologies in MedicineTehran University of Medical SciencesTehranIran
- ImmunologyAsthma & Allergy Research InstituteTehran University of Medical SciencesTehranIran
| | - Payam Zarrintaj
- School of Chemical EngineeringOklahoma State UniversityStillwaterOklahomaUSA
| | - Mohammad Reza Saeb
- Department of Polymer TechnologyFaculty of ChemistryGdańsk University of TechnologyGdańskPoland
| | - Masoud Mozafari
- Department of Tissue Engineering & Regenerative MedicineIran University of Medical SciencesTehranIran
| |
Collapse
|
|
39
|
Nasa P, Azoulay E, Chakrabarti A, Divatia JV, Jain R, Rodrigues C, Rosenthal VD, Alhazzani W, Arabi YM, Bakker J, Bassetti M, De Waele J, Dimopoulos G, Du B, Einav S, Evans L, Finfer S, Guérin C, Hammond NE, Jaber S, Kleinpell RM, Koh Y, Kollef M, Levy MM, Machado FR, Mancebo J, Martin-Loeches I, Mer M, Niederman MS, Pelosi P, Perner A, Peter JV, Phua J, Piquilloud L, Pletz MW, Rhodes A, Schultz MJ, Singer M, Timsit JF, Venkatesh B, Vincent JL, Welte T, Myatra SN. Infection control in the intensive care unit: expert consensus statements for SARS-CoV-2 using a Delphi method. THE LANCET. INFECTIOUS DISEASES 2022; 22:e74-e87. [PMID: 34774188 PMCID: PMC8580499 DOI: 10.1016/s1473-3099(21)00626-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 02/07/2023]
Abstract
During the current COVID-19 pandemic, health-care workers and uninfected patients in intensive care units (ICUs) are at risk of being infected with SARS-CoV-2 as a result of transmission from infected patients and health-care workers. In the absence of high-quality evidence on the transmission of SARS-CoV-2, clinical practice of infection control and prevention in ICUs varies widely. Using a Delphi process, international experts in intensive care, infectious diseases, and infection control developed consensus statements on infection control for SARS-CoV-2 in an ICU. Consensus was achieved for 31 (94%) of 33 statements, from which 25 clinical practice statements were issued. These statements include guidance on ICU design and engineering, health-care worker safety, visiting policy, personal protective equipment, patients and procedures, disinfection, and sterilisation. Consensus was not reached on optimal return to work criteria for health-care workers who were infected with SARS-CoV-2 or the acceptable disinfection strategy for heat-sensitive instruments used for airway management of patients with SARS-CoV-2 infection. Well designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.
Collapse
Affiliation(s)
- Prashant Nasa
- NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Elie Azoulay
- Saint-Louis Teaching Hospital, APHP, University of Paris, Paris, France
| | | | | | - Ravi Jain
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Camilla Rodrigues
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Yaseen M Arabi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jan Bakker
- New York University Grossman School of Medicine, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Erasmus University Medical Center, Rotterdam, Netherlands; Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - George Dimopoulos
- Attikon University Hospital, Athens, Greece; National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Bin Du
- State Key Laboratory of Rare, Complex and Critical Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Sharon Einav
- Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | | | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Imperial College London, London, UK
| | - Claude Guérin
- University de Lyon, Lyon, France; Institut Mondor de Recherches Biomédicales, Créteil, France
| | - Naomi E Hammond
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Newton, Adelaide, SA, Australia
| | - Samir Jaber
- Hôpital Saint-Éloi, Montpellier University Hospital, Montpellier, France
| | - Ruth M Kleinpell
- Vanderbilt University School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Younsuck Koh
- College of Medicine, University of Ulsan College of Medicine, University of Ulsan, Seoul, South Korea
| | - Marin Kollef
- Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Mitchell M Levy
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Flavia R Machado
- Hospital Sao Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | | | - Paolo Pelosi
- IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy; University of Genoa, Genoa, Italy
| | - Anders Perner
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jason Phua
- Alexandra Hospital, National University Health System, Singapore; National University Hospital, National University Health System, Singapore
| | - Lise Piquilloud
- University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Andrew Rhodes
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marcus J Schultz
- Amsterdam University Medical Centers, Locatie AMC, Amsterdam, Netherlands; Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | | | - Tobias Welte
- German Center of Lung Research, Hannover, Germany
| | - Sheila N Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| |
Collapse
|
|
40
|
Olsby JH, Dihle A, Hofsø K, Steindal SA. Intensive care nurses' experiences using volatile anaesthetics in the intensive care unit: An exploratory study. Intensive Crit Care Nurs 2022; 70:103220. [PMID: 35216899 DOI: 10.1016/j.iccn.2022.103220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 01/16/2022] [Accepted: 02/09/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore the experiences intensive care nurses have with volatile anaesthetics in the intensive care unit. RESEARCH METHODOLOGY AND DESIGN A qualitative exploratory and descriptive design was used. Data were collected in 2019 from individual interviews with nine intensive care nurses, who were recruited using purposive sampling. Data were analysed using systematic text condensation. SETTING The study was undertaken in two general intensive care units from different university hospitals in Norway where volatile anaesthetics were utilised. FINDINGS Three categories emerged from the data analysis: experiencing the benefits of volatile anaesthetics; coping with unfamiliarity in handling volatile anaesthetics; and meeting challenges related to volatile anaesthetics in practice. CONCLUSION The intensive care nurses had positive experiences related to administering volatile anaesthetics in the intensive care unit and responded positively to the prospect of using it more often. Because volatile anaesthetics were rarely used in their units, the participants felt uncertain regarding its use due to unfamiliarity. Collegial support and guidelines were perceived as pivotal in helping them cope with this uncertainty. The participants also experienced several challenges in using volatile anaesthetics in the intensive care unit, with ambient pollution being regarded as the main challenge.
Collapse
Affiliation(s)
- Jim Harald Olsby
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456 Oslo, Norway; Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål sykehus, Postboks 4956 Nydalen, 0424 Oslo, Norway.
| | - Alfhild Dihle
- Faculty of Health Science, OsloMet - Oslo Metropolitan University, Oslo, Norway.
| | - Kristin Hofsø
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456 Oslo, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456 Oslo, Norway; Faculty of Health Studies, VID Specialized University, Oslo, Norway.
| |
Collapse
|
|
41
|
Aloweni F, Bouchoucha SL, Hutchinson A, Ang SY, Toh HX, Bte Suhari NA, Bte Sunari RN, Lim SH. Health care workers' experience of personal protective equipment use and associated adverse effects during the COVID-19 pandemic response in Singapore. J Adv Nurs 2022; 78:2383-2396. [PMID: 35170075 PMCID: PMC9111733 DOI: 10.1111/jan.15164] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/28/2021] [Accepted: 11/27/2021] [Indexed: 12/15/2022]
Abstract
Aim One of the greatest challenges in responding to the COVID‐19 pandemic is preventing staff exposure and infection by ensuring consistent and effective use of personal protective equipment (PPE). This study explored health care workers' experience of prolonged PPE use in clinical practice settings and their concerns regarding PPE supply, effectiveness and training needs. Design A descriptive cross‐sectional design was adopted in this study. Methods Health care workers (N = 592) from an acute care hospital completed an online survey from July to September 2020 assessing: (i) usage frequencies, side effects and interference with patient care; and (ii) perceptions of access to PPE, likelihood of exposure to infection and adequacy of PPE training. Results PPE‐related side effects were reported by 319 (53.8%) participants, the majority being nurses (88.4%) and those working in high‐risk areas such as the emergency department (39.5%), respiratory wards (acute 22.3% and non‐acute 23.8%) and COVID‐19 isolation ward (13.8%). The average time wearing PPE per shift was 6.8 h (SD 0.39). The most commonly reported symptoms were from donning N95 masks and included: pressure injuries (45.5%), mask‐induced acne (40.4%) and burning/pain (24.5%). Some 31.3% expressed that PPE‐related side effects had negatively affected their work. The odds of having PPE‐associated side effects was higher in women (OR 2.10, 95% CI [1.29–03.42], p = .003) and those working in high‐risk wards (OR 3.12, 95% CI [2.17–4.60], p < .001]. Most (90.1%) agreed that PPE supplies were readily available, sufficient for all (86.1%) and there was sufficient training in correct PPE use (93.6%). Only 13.7% of participants reported being ‘highly confident’ of overall PPE protection. Conclusions Prevention and management of PPE‐related adverse effects is vital to: preserve the integrity of PPE, improve adherence and minimize viral transmission. Impact The high incidence of PPE‐associated pressure injuries and perception that PPE use can interfere with clinical care should inform future development of PPE products, and strategies to better equip health care workers to prevent and manage PPE‐related side effects.
Collapse
Affiliation(s)
- Fazila Aloweni
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Stéphane L Bouchoucha
- Associate Head of School (International), Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University Geelong, School of Nursing and Midwifery, Victoria, Australia
| | - Ana Hutchinson
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Epworth Health/Deakin University Partnership, School of Nursing and Midwifery Geelong, Victoria, Australia
| | - Shin Yuh Ang
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Hui Xian Toh
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | | | | | - Siew Hoon Lim
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
|
42
|
Rispoli M, Piccioni F, Di Giacinto I, Cortese G, Falcetta S, Massullo D, Fiorelli S, Zdravkovic I, Coccia C, Rosboch G, Corcione A, Sorbello M. Airway management for one lung ventilation during COVID-19 pandemic: a survey within Italian anesthesiologists. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022; 2:3. [PMID: 37386672 PMCID: PMC8765104 DOI: 10.1186/s44158-021-00029-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/07/2021] [Indexed: 07/01/2023]
Abstract
BACKGROUND Airway management for thoracic surgery represents a high risk setting for SARS-CoV-2 infection diffusion due to complex and invasive airway instrumentation and techniques. RESULTS An 18-item questionnaire was submitted to the 56 members of the Thoracic subcommittee of the SIAARTI Cardio-Thoraco-Vascular Research Group to provide a snapshot of current situation and national variability of devices and procedures for airway management during the COVID-19 pandemic. The response rate was 64%. Eighty-three percent of anesthetists declared that they modified their airway management strategies. The Hospital Management considered necessary to provide a complete level 3 personal protective equipment for thoracic anesthetists only in 47% of cases. Double-lumen tube and bronchial blocker were preferred by 53% and 22% of responders to achieve one-lung ventilation respectively. Over 90% of responders considered the videolaryngoscope with separate screen and rapid sequence induction/intubation useful to minimize the infection risk. Thirty-nine percent of participants considered mandatory the bronchoscopic check of airway devices. Vivasight-DL was considered comfortable by more than 50% of responders while protective box and plastic drape were judged as uncomfortable by most of anesthetists. CONCLUSIONS The survey reveals many changes in the clinical practice due to SARS-CoV-2 outbreak. A certain diffusion of new devices such as the VivaSight-DL and barrier enclosure systems emerged too. Finally, we found that most of Italian hospitals did not recognize thoracic anesthesia as a high-risk specialty for risk of virus diffusion.
Collapse
Affiliation(s)
- Marco Rispoli
- Anesthesia and Intensive Care Unit, Vincenzo Monaldi Medical Hospital, Naples, Italy
| | - Federico Piccioni
- Anesthesia and Intensive Care Unit, Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ida Di Giacinto
- Anesthesia and Intensive Care, Anestesia e Terapia Intensiva Polivalente, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi-Alma Mater Studiorum, Bologna, Italy
| | - Gerardo Cortese
- Anesthesia and Intensive Care, Dipartimento di Anestesia, Rianimazione ed Emergenze AOU Citta della salute e della scienza, Torino, Italy
| | - Stefano Falcetta
- Anesthesia and Intensive Care, Clinica di Anestesia e Rianimazione Ospedali Riunit, Ancona, Italy
| | - Domenico Massullo
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Silvia Fiorelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
| | - Ivana Zdravkovic
- Anesthesia and Intensive Care, Casa di cura Gibiino, Catania, Italy
| | - Cecilia Coccia
- Anesthesia and Intensive Care, UOC Anestesia, Terapia Intensiva, IRCCS IFO "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giulio Rosboch
- Anesthesia and Intensive Care, Dipartimento di Anestesia, Rianimazione ed Emergenze AOU Citta della salute e della scienza, Torino, Italy
| | - Antonio Corcione
- Anesthesia and Intensive Care Unit, Vincenzo Monaldi Medical Hospital, Naples, Italy
| | - Massimiliano Sorbello
- Anesthesia and Intensive Care, Policlinico San Marco University Hospital, Catania, Italy
| |
Collapse
|
|
43
|
Meschiari M, Cozzi-Lepri A, Tonelli R, Bacca E, Menozzi M, Franceschini E, Cuomo G, Bedini A, Volpi S, Milic J, Brugioni L, Romagnoli E, Pietrangelo A, Corradini E, Coloretti I, Biagioni E, Busani S, Girardis M, Cossarizza A, Clini E, Guaraldi G, Mussini C. First and second waves among hospitalised patients with COVID-19 with severe pneumonia: a comparison of 28-day mortality over the 1-year pandemic in a tertiary university hospital in Italy. BMJ Open 2022; 12:e054069. [PMID: 34980623 PMCID: PMC8724593 DOI: 10.1136/bmjopen-2021-054069] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The first COVID-19-19 epidemic wave was over the period of February-May 2020. Since 1 October 2020, Italy, as many other European countries, faced a second wave. The aim of this analysis was to compare the 28-day mortality between the two waves among COVID-19 hospitalised patients. DESIGN Observational cohort study. Standard survival analysis was performed to compare all-cause mortality within 28 days after hospital admission in the two waves. Kaplan-Meier curves as well as Cox regression model analysis were used. The effect of wave on risk of death was shown by means of HRs with 95% CIs. A sensitivity analysis around the impact of the circulating variant as a potential unmeasured confounder was performed. SETTING University Hospital of Modena, Italy. Patients admitted to the hospital for severe COVID-19 pneumonia during the first (22 February-31 May 2020) and second (1 October-31 December 2020) waves were included. RESULTS During the two study periods, a total of 1472 patients with severe COVID-19 pneumonia were admitted to our hospital, 449 during the first wave and 1023 during the second. Median age was 70 years (IQR 56-80), 37% women, 49% with PaO2/FiO2 <250 mm Hg, 82% with ≥1 comorbidity, median duration of symptoms was 6 days. 28-day mortality rate was 20.0% (95% CI 16.3 to 23.7) during the first wave vs 14.2% (95% CI 12.0 to 16.3) in the second (log-rank test p value=0.03). After including key predictors of death in the multivariable Cox regression model, the data still strongly suggested a lower 28-day mortality rate in the second wave (aHR=0.64, 95% CI 0.45 to 0.90, p value=0.01). CONCLUSIONS In our hospitalised patients with COVID-19 with severe pneumonia, the 28-day mortality appeared to be reduced by 36% during the second as compared with the first wave. Further studies are needed to identify factors that may have contributed to this improved survival.
Collapse
Affiliation(s)
- Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | | | - Roberto Tonelli
- Respiratory Diseases Unit, University of Modena and Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Bacca
- Department of Infectious Diseases, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Gianluca Cuomo
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Andrea Bedini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Sara Volpi
- Department of Infectious Diseases, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Department of Infectious Diseases, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucio Brugioni
- Internal Medicine Department, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Elisa Romagnoli
- Internal Medicine Department, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Antonello Pietrangelo
- Department of Medical and Surgical Sciences for Children and Adults, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Elena Corradini
- Department of Medical and Surgical Sciences for Children and Adults, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Irene Coloretti
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
| | - Emanuela Biagioni
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
| | - Stefano Busani
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
| | - Massimo Girardis
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
- Anesthesia and Intensive Care, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
- Department of Infectious Diseases, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
- Department of Infectious Diseases, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
|
44
|
Prehospital care of cardiac arrest in COVID-19 patients. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh220306059a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
During the COVID-19 pandemic, there was an urgent need to revise the existing cardiopulmonary resuscitation (CPR) guidelines published in 2015. The coronavirus pandemic increased the rate of cardiac arrests, and the need for CPR. International resuscitation associations proposed updated resuscitation guidelines during the COVID-19 pandemic. Although there is a clear consensus in most recommendations, there are also disparities. Their implementation in everyday clinical practice would alleviate the fear of health workers at the prehospital level and reduce the indecision to apply CPR in such patients as well.
Collapse
|
|
45
|
Guzzetti L, Bacuzzi A, Ghislanzoni L, Marcato A. Technical aspects of one-lung ventilation (OLV) in a patient affected by viral pneumonia Sars-Cov-2 related. Saudi J Anaesth 2022; 16:504-505. [PMID: 36337403 PMCID: PMC9630669 DOI: 10.4103/sja.sja_113_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
|
|
46
|
P. Abhilash K, David S, St Joseph E, Peter J. Acute management of COVID-19 in the emergency department: An evidence-based review. J Family Med Prim Care 2022; 11:424-433. [PMID: 35360783 PMCID: PMC8963605 DOI: 10.4103/jfmpc.jfmpc_1309_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease (COVID-19) has been relentlessly battering the world wave after wave in different countries at different rates and times. Emergency departments (EDs) around the globe have had to constantly adapt to this ever-changing influx of information and recommendations by various national and international health agencies. This review compiles the available evidence on the guidelines for triaging, evaluation, and management of critically ill patients with COVID-19 presenting to the ED and in need of emergency resuscitation. The quintessential components of resuscitation focus on airway, breathing, and circulation with good supportive care as the cornerstone of acute management of critically ill COVID-19 patients. Irrational investigations and therapeutics must be avoided during these times of medical uncertainty and antibiotic stewardship should be diligently followed.
Collapse
|
|
47
|
Banjac N, Ramić I, Đokić S, Pejić T, Korać I, Stojisavljević Đ, Todorović N. COVID-19 in the Emergency Department of the Primary Healthcare Centre Banja Luka. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-36279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background / Aim: COVID-19 is acute virus disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It was proclaimed as pandemic starting from March 2020 and is still ongoing. COVID-19 pandemic forced all segments of the society, particularly the health sector, to function in changed and aggravating circumstances and because of the transmission and new strains of the virus it resulted in the change of the number of infected people with peaks and oscillations. Aim of this study was to make analysis of the data related to COVID-19 positive/suspect patients examined in the Primary Healthcare Centre Banja Luka in the period 15 March 2020 - 15 March 2021, which refers to the incidence of the infected persons, sex and age representation, laboratory diagnostics and clinical parameters, applied therapy, as well as the number of patients sent for the hospital treatment. Methods: Data for the analysis were obtained by the retrospective analysis of the statistical data from the electronic medical record of the examined COVID-19 positive/suspect patients in the Outpatient Clinic for Acute Respiratory Infections (ARI) and in the field. Pearson's ch2 test of contingency was used for the comparison of differences of the observed characteristics of the examined groups. Results: Personnel of the Emergency Department (ED) of the Primary Healthcare Centre Banja Luka, in the period 15 March 2020 - 15 March 2021, examined the total of 3,937 COVID-19 positive patients and patients suspect of COVID-19. Out of that number, 3,601 patients were examined in the ED - ARI and 336 patients were examined in the field. The biggest number of patients was registered in November 2020 (768). Male sex prevailed (55.50 %) and patients of 20-50 years of age were most represented. There were 3.10 % of those highly febrile patients and 2.5 % of those with low SpO2 of under 90 %. 14.90 % of patients had higher values of troponin T and 45.50 % of them had higher values of D-dimer. In the field, 69.60 % of patients had pathological changes on lungs and 33.30 % had pathological ECG report. The number of patients sent from the ARI for further diagnostic procedure or hospitalisation to the Clinic for Infectious Diseases of the University Clinical Centre of Banja Luka was 1,191 and 258 patients were sent from the field. Conclusion: For the purpose of preventing the spread of epidemics, the ED reorganised the existing space by introducing temporary clinics - containers for the patients with acute respiratory infections and febrile status, COVID-19 suspects. Clinical parameters changed depending on the new virus strains, as well as on age distribution and infection complications.
Collapse
|
|
48
|
Manjit G, Girijanandan M, Sunitha Z, Lintu G, Linby C, Sruthy V. Study on airway assessment practices for elective procedures during pre-anesthetic evaluation in COVID-19 pandemic- A national online survey (SAFE PAC Survey). J Anaesthesiol Clin Pharmacol 2022; 38:S79-S88. [PMID: 36060175 PMCID: PMC9438836 DOI: 10.4103/joacp.joacp_138_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background and Aims: A pilot study among anesthesiologists, revealed a wide variation among individual practices including skipping pre-anesthetic airway assessment during COVID-19 pandemic because of the fear of getting infected. Risk of infection during pre-anesthetic airway assessment has not been studied. The primary objective of the survey was to evaluate the practices of airway examination by anesthesiologists during this pandemic period. Secondary objectives were to study the effects of institutional factors and other individual practices on risk modification and the incidence of COVID-19 infection among anesthesiologists. Material and Methods: A survey was conducted using a pre-validated questionnaire comprising of 35 questions. The questionnaire was circulated among 4676 members of the Indian Society of Anaesthesiologists (ISA) through Google Forms by email. Results: Of the 4676 members contacted via email, 470 were returned undelivered. From the remaining 4206 questionnaire recipients, 456 completed responses were obtained giving a response rate of 10.8%. Percentage, mean and standard deviation were calculated using EZR software. The conduct of pre-anesthetic airway assessment has decreased by 31.7% during the pandemic, leading to 5.2% of participants encountering unanticipated difficult airway. Among the respondents, eight percent were infected. Conclusion: Avoidance of preoperative airway assessment by anesthesiologists during the COVID-19 pandemic has led to rising unanticipated difficult airway undermining the patient safety. Adherence to recommended practices ensures safety from risk of COVID-19 infection.
Collapse
|
|
49
|
Ismail M, Joudeh A, Al-Dahshan A, Nur MA, Hamed El Aguizy F, Selim N. Primary healthcare physicians' satisfaction towards work safety and personal protective equipment during the COVID-19 pandemic in Qatar: A cross-sectional study. Infect Dis Health 2021; 27:111-118. [PMID: 35033488 PMCID: PMC8687747 DOI: 10.1016/j.idh.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 11/15/2022]
Abstract
Background During COVID-19 pandemic, healthcare workers are experiencing unprecedented pressure from stressors including enormous workload, virus exposure, and inadequate PPE. This study aimed to assess primary healthcare physicians’ satisfaction towards work safety and personal protective equipment and their predictors during early stages of COVID-19 pandemic in Qatar. Methods A cross-sectional web-based survey was conducted in 27 primary healthcare centers in Qatar from 1st June to 30 July 2020. Descriptive and analytical statistics were used when appropriate. A multivariable linear regression analysis was done to identify predictors of satisfaction among participants. Results A total of 262 participants completed the questionnaire with a response rate of 58.2%. 51.9% were males and 68.3% were family physicians. Only 14.9% and 17.2% of respondents were satisfied or highly satisfied about the overall safety of work and the clinical guidelines on the use of PPE in the context of COVID-19 respectively. Participants who were general practitioners were significantly more likely to be satisfied with maintaining work safety and local PPE guidelines compared to family physicians by 2.93 scores (95% CI 1.43, 4,43 p -value <0.001), and 2.82 scores (95% CI 1.19, 4,44 p -value 0.001) respectively. Also, physicians who had more than ten years of experience in practice were significantly more likely to be satisfied with the PPE use guidelines compared to those who had fewer years of experience by 1.93 scores (95% CI 0.45, 3.41 p -value 0.011). Conclusion Overall satisfaction of participants with the safety of work and PPE clinical practice guidelines was low.
Collapse
Affiliation(s)
- Mansoura Ismail
- Primary Health Care Corporation, Doha, 26555, Qatar; Family Medicine Department, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Anwar Joudeh
- General Medicine Department, Hamad Medical Corporation, Doha, 3050, Qatar; Internal Medicine Department, Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Ayman Al-Dahshan
- Department of Medical Education, Community Medicine Residency Program, Hamad Medical Corporation, Doha, 3050, Qatar
| | | | - Fayrouz Hamed El Aguizy
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, 12613, Egypt
| | - Nagah Selim
- Primary Health Care Corporation, Doha, 26555, Qatar; Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, 12613, Egypt
| |
Collapse
|
|
50
|
Di Giacinto I, Guarnera M, Esposito C, Falcetta S, Cortese G, Pascarella G, Sorbello M, Cataldo R. Emergencies in obese patients: a narrative review. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8590435 DOI: 10.1186/s44158-021-00019-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Obesity is associated to an increased risk of morbidity and mortality due to respiratory, cardiovascular, metabolic, and neoplastic diseases. The aim of this narrative review is to assess the physio-pathological characteristics of obese patients and how they influence the clinical approach during different emergency settings, including cardiopulmonary resuscitation. A literature search for published manuscripts regarding emergency and obesity across MEDLINE, EMBASE, and Cochrane Central was performed including records till January 1, 2021. Increasing incidence of obesity causes growth in emergency maneuvers dealing with airway management, vascular accesses, and drug treatment due to both pharmacokinetic and pharmacodynamic alterations. Furthermore, instrumental diagnostics and in/out-hospital transport may represent further pitfalls. Therefore, people with severe obesity may be seriously disadvantaged in emergency health care settings, and this condition is enhanced during the COVID-19 pandemic, when obesity was stated as one of the most frequent comorbidity. Emergency in critical obese patients turns out to be an intellectual, procedural, and technical challenge. Organization and anticipation based on the understanding of the physiopathology related to obesity are very important for the physician to be mentally and physically ready to face the associated issues.
Collapse
|