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Non-invasive ventilation with the use of non-vented full face mask and single limb respiratory circuit with leak port. Note the leak port (black arrow) and antiviral filter (empty arrow) between the mask and the leak port
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In 2019, a pandemic began due to infection with a novel coronavirus, SARS-CoV-2. In many cases, this coronavirus leads to the development of the COVID-19 disease. Lung damage in the course of this disease often leads to acute hypoxic respiratory failure and may eventually lead to acute respiratory distress syndrome (ARDS). Respiratory failure as a...
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Traced back to December 2019, an unexpected outbreak of a highly contagious new coronavirus pneumonia (COVID-19) has rapidly swept around China and the globe. There have now been an estimated 2 580 000 infections and more than 170 000 fatal cases around the world. The World Health Organization (WHO) estimated that approximately 14% of infections de...
Citations
... Five percent of these patients require treatment in the intensive care unit (ICU) (Chan et al. 2019;Wu and McGoogan 2020). The lung injury caused by SARS-CoV-2 pneumonia can lead to acute respiratory distress syndrome (ARDS), a life-threatening complication with a high mortality rate (Czajkowska-Malinowska et al. 2020). In a global literature survey, Tzotzos et al. found that around one-third of hospitalized patients with COVID-19 developed ARDS with nearly three-quarters of those admitted to the ICU already presenting with this condition. ...
Patients treated with ECMO are at great risk of nosocomial infections, and around 10% of isolates are gram-positive pathogens. Linezolid (LZD) is effective in the treatment of these infections but appropriate dosing is challenging. The aim was to evaluate the occurrence of thrombocytopenia during ECMO when treated with LZD. An LZD trough concentration of 8 mg/L was set as the cutoff value for thrombocytopenia occurrence among critically ill patients who received parenteral LZD therapy at a dose of 600 mg every 8 h during ECMO. Eleven patients were included in this prospective observational study. Median LZD trough concentrations were 7.85 (interquartile range (IQR), 1.95-11) mg/L. Thrombocytopenia was found in 81.8% of patients. Based on the median LZD trough concentrations cutoff value, patients were divided into two groups, 1.95 (IQR, 0.91–3.6) and 10.3 (IQR, 9.7–11.7) mg/L, respectively. Median platelet values differed significantly between groups on admission, ECMO day 0, ECMO day 1, and LZD sampling day [194 and 152.5, (p < 0.05)], [113 and 214, (p < 0.05)], [76 and 147.5, (p < 0.01)], and [26 and 96.5, (p < 0.01)], respectively. Duration of LZD therapy was similar between the groups. Significant platelet reduction was observed in both groups, emphasizing the need for closer monitoring to prevent LZD-associated thrombocytopenia.
... During the pandemic, hospitals reported that the incidence of in-hospital acquired events such as cardiac arrest increased markedly [6][7][8], and the rate of survival of these patients was much lower compared to pre-pandemic [7,8]. In addition, cardiac arrest [9,10] cerebral infarction [11,12] respiratory failure [13] and sepsis were also reported to be higher in COVID-19 patients, and their risk of mortality increases as well [7,9,10,[14][15][16][17][18][19]. ...
... Moreover, one of the most concerning complications in COVID-19 patients is acute hypoxaemic respiratory failure [13]. COVID-19 patients can exhibit lung damage with low oxygenation index, often leading to acute hypoxic respiratory failure, with small percentages of patients have higher risk of in-hospital mortality [14,15]. In addition, sepsis also occurred in hospitalized patients with severe cases of COVID-19 [18,27]. ...
Introduction
The objective of the study was to assess the effects of high-reliability system by implementing a command centre (CC) on clinical outcomes in a community hospital before and during COVID-19 pandemic from the year 2016 to 2021.
Methods
A descriptive, retrospective study was conducted at an acute care community hospital. The administrative data included monthly average admissions, intensive care unit (ICU) admissions, average length of stay, total ICU length of stay, and in-hospital mortality. In-hospital acquired events were recorded and defined as one of the following: cardiac arrest, cerebral infarction, respiratory arrest, or sepsis after hospital admissions. A subgroup statistical analysis of patients with in-hospital acquired events was performed. In addition, a subgroup statistical analysis was performed for the department of medicine.
Results
The rates of in-hospital acquired events and in-hospital mortality among all admitted patients did not change significantly throughout the years 2016 to 2021. In the subgroup of patients with in-hospital acquired events, the in-hospital mortality rate also did not change during the years of the study, despite the increase in the ICU admissions during the COVID-19 pandemic.Although the in-hospital mortality rate did not increase for all admitted patients, the in-hospital mortality rate increased in the department of medicine.
Conclusion
Implementation of CC and centralized management systems has the potential to improve quality of care by supporting early identification and real-time management of patients at risk of harm and clinical deterioration, including COVID-19 patients.
... The utility of CPAP in the treatment of respiratory failure is highly reported during the SARS-CoV-1 pandemic. 35 The main benefit of this model in the treatment of acute hypoxemic respiratory failure (AHRF) is that there is no need for tracheal intubation, sedation, and mechanical ventilation. 36 Furthermore, the advantage of a helmet interface that is put on the patient's head, in comparison to other used interfaces, is that it allows for effective isolation of infected patients and enables a significant reduction of the risk of contamination and transmission of infection. ...
... The ELMO 1.0 is a non-invasive ventilation device that prevents air leakage and droplet dispersion and also provides CPAP. Regarding advantages reported in the literature, 35,38 CPAP therapy includes high availability, low cost, no need for high medical competence, no patient-device asynchrony, and low risk of treatment. ...
Purpose
The paper describes the design concept and findings from technological and initial clinical trials conducted to develop a helmet for non-invasive oxygen therapy using positive pressure, known as hCPAP (Helmet Continuous Positive Airway Pressure).
Methods
The study utilized PET-G filament, a recommended material for medical applications, along with the FFF 3D printing technique. Additional technological investigations were performed for the production of fitting components. The authors proposed a parameter identification method for 3D printing, which reduced the time and cost of the study while ensuring high mechanical strength and quality of the manufactured elements.
Results
The proposed 3D printing technique facilitated the rapid development of an ad hoc hCPAP device, which was utilized in preclinical testing and treatment of Covid-19 patients, and yielded positive results. Based on the promising outcomes of the preliminary tests, further development of the hCPAP device’s current version was pursued.
Conclusion
The proposed approach offered a crucial benefit by significantly reducing the time and costs involved in developing customized solutions to aid in the fight against the Covid-19 pandemic.
... Berdasarkan pada laporan penelitian Malinowska, et al, pada tahun 2020, dalam beberapa kasus penyakit COVID-19 pasien mengalami kerusakan paru-paru yang kemudian mengarah pada gagal napas hipoksia akut dan akhirnya dapat menyebabkan sindrom gangguan pernapasan akut (ARDS). Kondisi ini berkembang cepat dan mampu menyebabkan kematian pada sebagian pasien yang terinfeksi 17 . Sehingga pasien dengan gangguan ARDS memerlukan bantuan ventilator untuk mengontrol volume aliran udara, tekanan udara, dan laju pernapasan 18 . ...
Background: The health referral system regulates the delegation of duties and responsibilities of health services in reverse. SISRUTE (Integrated Referral Information System) as a reference for managing national referrals in Indonesia. During the pandemic, most hospitals were overwhelmed with patients; therefore, hospitals were encouraged to optimize the use of SISRUTE. Objective:This study aims to identify the implementation of SIS-RUTE in the Infectious Emergency Room of RSUP Dr Sardjito.Method:This research used quantitative descriptive research witha retrospective approach. The sample of this study was secondarydata in the SISRUTE application from June-August 2021. This study used a total sampling technique. The instrument used worksheets,and data analysis was performed using a univariate method to findout reasons for referrals rejected, reasons for referrals received, and SISRUTE response time.Result:Referral patients with Social Security Agency for Health(BPJS) were (42%). Most referrals came from Type C Hospital(41.29%) during the afternoon shift (36.8%). The highest reason forrefusing referrals was limited room (68.03%). The most needed wasthe Intensive Care Unit (ICU) (52.68%). The highest SISRUTE re-sponse time was in the range of 1-5 minutes (59.73%).Conclusion:The implementation of SISRUTE in the IGD InfectionRSUP Dr. Sardjito Yogyakarta is generally good, with a fast responsetime. Referrals are mostly accepted due to the availability of inpatientrooms. The reasons for referrals rejected are due to the limited ICUspace.
... Acute hypoxemic respiratory failure is a major clinical feature of COVID-19 during inflammation of the lungs. COVID-19-related respiratory failure has features of injury to the alveolar epithelium cells, while the endothelium cells may be less damaged [3]. ...
... A proportional failure of the hypoxic pulmonary vasoconstriction mechanism or constriction of intrapulmonary arteries in alveolar hypoxia in COVID-19 condition usually causes a never-ceasing increase in the pulmonary flow of blood to nonaerated alveoli of the lung [3]. This cascade of events leads to the loss of control over lung perfusion. ...
Respiratory failure, characterized as the unsuccessful maintenance of adequate gas exchange, is associated with abnormalities of arterial blood gas tensions. The coronavirus disease-2019 (COVID-19) is majorly a respiratory disease capable of causing infection caused by the newly discovered coronavirus (SARS-CoV-2) with a consequential effect on respiratory failure. Simply put, respiratory failure is the major clinical demonstration of COVID-19 and the frontline cause of the associated mortality. Respiratory failure instigated by COVID-19 has some clinical features in affected patients. Disorders of the respiratory neuromuscular, airway, pulmonary vesicles, and lung parenchyma all manifest in COVID-19. These features are heterogeneous and categorized into progressive respiratory distress and unique “silent hypoxemia” as two phenotypes. Knowing the exact phenotype in patients with COVID-19 has been of important clinical significance in seeking the right treatment strategies for treating respiratory failure. The chapter will, therefore, provide more insights into the pathophysiology, clinical attributes, pathogenesis, and treatment approach of respiratory failure in COVID-19 conditions, as well as evaluate any similarities and differences that may exist.
... The mortality rate of ARDS continues to remain high at 43% [6]. The frequency of ARDS in critically ill patients has only continued to increase due to the coronavirus, SARS-CoV-2, pandemic that began in 2019 [7]. ...
Treatments for acute respiratory distress syndrome are still unavailable, and the prevalence of the disease has only increased due to the COVID-19 pandemic. Mechanical ventilation regimens are still utilized to support declining lung function but also contribute to lung damage and increase the risk for bacterial infection. The anti-inflammatory and pro-regenerative abilities of mesenchymal stromal cells (MSCs) have shown to be a promising therapy for ARDS. We propose to utilize the regenerative effects of MSCs and the extracellular matrix (ECM) in a nanoparticle. Our mouse MSC (MMSC) ECM nanoparticles were characterized using size, zeta potential, and mass spectrometry to evaluate their potential as pro-regenerative and antimicrobial treatments. The nanoparticles had an average size of 273.4 nm (±25.6) and possessed a negative zeta potential, allowing them to surpass defenses and reach the distal regions of the lung. It was found that the MMSC ECM nanoparticles are biocompatible with mouse lung epithelial cells and MMSCs, increasing the wound healing rate of human lung fibroblasts while also inhibiting the growth of Pseudomonas aeruginosa, a common lung pathogen. Our MMSC ECM nanoparticles display characteristics of healing injured lungs while preventing bacterial infection, which can increase recovery time.
... Depending on the severity of hypoxemia, different techniques can be used to improve oxygenation. In some patients, conventional (passive) oxygen therapy alone is sufficient; however, in patients with worsening respiratory failure, high flow nasal oxygen therapy or even invasive ventilation must be used [22]. What is most important, oxygen therapy is often accompanied by delivering various medications through inhalation (antibiotics, corticosteroids), mostly using nebulizers. ...
A dispersion of oxygen nanobubbles (O2-NBs) is an extraordinary gas–liquid colloidal system where spherical gas elements can be considered oxygen transport agents. Its conversion into inhalation aerosol by atomization with the use of nebulizers, while maintaining the properties of the dispersion, gives new opportunities for its applications and may be attractive as a new concept in treating lung diseases. The screening of O2-NBs interactions with lung fluids is particularly needed in view of an O2-NBs application as a promising aerosol drug carrier with the additional function of oxygen supplementation. The aim of the presented studies was to investigate the influence of O2-NBs dispersion combined with the selected inhalation drugs on the surface properties of two types of pulmonary surfactant models (lipid and lipid–protein model). The characteristics of the air–liquid interface were carried out under breathing-like conditions using two selected tensiometer systems: Langmuir–Wilhelmy trough and the oscillating droplet tensiometer. The results indicate that the presence of NBs has a minor effect on the dynamic characteristics of the air–liquid interface, which is the desired effect in the context of a potential use in inhalation therapies.
... In the review article by Akoumianaki et al., the proposed scheme of therapy escalation was NIV/HFNO introduction if SpO 2 was lower or equal to 90% on the conventional oxygen therapy with 6-12 L/min flow, with an emphasis on earlier HFNO than NIV introduction, mostly due to its better tolerability [23]. According to Ref. [25], as mentioned above, in September 2021, the ERS published guidelines on the use of HFNO in ARF, including COVID-19 [26]. The authors recommend the use of HFNO over NIV in patients with progressive or moderate to severe ARF, owing mostly due to the evidence suggesting lower rate of intubation, and potentially lower risk of death in patients ventilated with HFNO. ...
... However, the use of HFNO is rather unchangeable, as it allows modification of three respiratory parameters (air temperature, oxygen quotient, and flow), while the use of NIV might differ in terms of ventilation mode (spontaneous continuous positive airway pressure-CPAP or controlled biphasic positive airway pressure-BIPAP), the pressures and volumes set for specific patients, the percentage of oxygen in the inspiratory air, as well as the duration of NIV treatment throughout the day. Furthermore, to compensate for hypoxemia, higher FiO 2 is required when comparing HFNO to NIV; however, high oxygen concentration might bring a similarly devastating effect on alveoli as COVID-19 [25,27]. Moreover, higher positive airway pressure in NIV (usually 8-14 cmH 2 O) when compared with HFNO (estimated at 5 cmH 2 O) may result in more effective alveolar recruitment. ...
... Moreover, higher positive airway pressure in NIV (usually 8-14 cmH 2 O) when compared with HFNO (estimated at 5 cmH 2 O) may result in more effective alveolar recruitment. In all treated patients, awake proning was used whenever tolerated by patients [25,26]. ...
Mallampati score has been identified and accepted worldwide as an independent predictor of difficult intubation and obstructive sleep apnea. We aimed to determine whether Mallampati score assessed on the first patient medical assessment allowed us to stratify the risk of worsening of conditions in patients hospitalized due to COVID-19. A total of 493 consecutive patients admitted between 13 November 2021 and 2 January 2022 to the temporary hospital in Pyrzowice were included in the analysis. The clinical data, chest CT scan, and major, clinically relevant laboratory parameters were assessed by patient-treating physicians, whereas the Mallampati score was assessed on admission by investigators blinded to further treatment. The primary endpoints were necessity of active oxygen therapy (AOT) during hospitalization and 60-day all-cause mortality. Of 493 patients included in the analysis, 69 (14.0%) were in Mallampati I, 57 (11.6%) were in Mallampati II, 78 (15.8%) were in Mallampati III, and 288 (58.9%) were in Mallampati IV. There were no differences in the baseline characteristics between the groups, except the prevalence of chronic kidney disease (p = 0.046). Patients with Mallampati IV were at the highest risk of AOT during the hospitalization (33.0%) and the highest risk of death due to any cause at 60 days (35.0%), which significantly differed from other scores (p = 0.005 and p = 0.03, respectively). Mallampati IV was identified as an independent predictor of need for AOT (OR 3.089, 95% confidence interval 1.65–5.77, p < 0.001) but not of all-cause mortality at 60 days. In conclusion, Mallampati IV was identified as an independent predictor of AOT during hospitalization. Mallampati score can serve as a prehospital tool allowing to identify patients at higher need for AOT.
... The method of passive oxygen therapy was selected depending on the level of saturation. Individual methods of oxygen therapy were applied in accordance with the guidelines presented by Czajkowska-Malinowska et al. [7]. ...
... Table 1 shows the distribution of use of particular methods of oxygen supplementation in consecutive patients admitted to the department. The methods of oxygen supplementation have been ranked by the increasing possibility of achieving a higher concentration of oxygen in the breathing mixture, respectively: a nasal cannula, a simple face mask, a face mask with a reservoir bag, HF-NOT, CPAP/BPAP [7] Patients were assigned to the groups shown in Table 1 when they required the highest fraction of inspired oxygen (FiO 2 ). ...
Introduction:
The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection resulted in significant worldwide morbidity and mortality. The aim of our study was to evaluate the results of laboratory tests performed on patients on admission to the hospital between groups of patients requiring and not requiring oxygen supplementation, and to find predictive laboratory indicators for the use of high-flow nasal oxygen therapy (HFNOT)/continuous positive airway pressure (CPAP)/bilevel positive airway pressure (BPAP).
Materials and methods:
We retrospectively analysed the data of consecutive patients hospitalised in the Pulmonology Department of the Temporary COVID Hospital in Poznan from February to May 2021. On admission to the department, the patients had a panel of laboratory blood tests.
Results:
The study group consisted of 207 patients with a mean age of 59.2 ± 15.0 years of whom 179 (72%) were male. During hospitalisation, oxygen supplementation was required by 87% of patients. Patients requiring oxygen supplementation and/or the use of HFNOT/CPAP/BPAP had lower lymphocyte counts and higher levels of urea, C-reactive protein, D-dimer, troponin, glucose, lactate dehydrogenase (LDH) as well as higher white blood cell and neutrophil counts, The parameter that obtained the highest area under curve value in the receiver operator curve analysis for the necessary use of HFNOT/CPAP/BPAP or CPAP/BPAP was LDH activity.
Conclusions:
Among the basic parameters assessed on admission to the temporary hospital, LDH activity turned out to be the most useful for assessing the need for CPAP/BPAP active oxygen therapy. Other parameters that may be helpful for predicting the need for HFNOT/CPAP/BPAP are serum levels of urea, D-dimer and troponin.
... The method of passive oxygen therapy was selected depending on the level of saturation. Individual methods of oxygen therapy were applied in accordance with the guidelines presented by Czajkowska-Malinowska et al. [7]. ...
... Table 1 shows the distribution of use of particular methods of oxygen supplementation in consecutive patients admitted to the department. The methods of oxygen supplementation have been ranked by the increasing possibility of achieving a higher concentration of oxygen in the breathing mixture, respectively: a nasal cannula, a simple face mask, a face mask with a reservoir bag, HF-NOT, CPAP/BPAP [7] Patients were assigned to the groups shown in Table 1 when they required the highest fraction of inspired oxygen (FiO 2 ). ...
Introduction:
The role of comorbidities in determining health-related quality of life (HRQL) in obstructive sleep apnea (OSA) pa-tients has not been thoroughly investigated. Commonly used comorbidity tools, such as Charlson Comorbidity Index (CCI), have been designed with mortality as the outcome variable. A new tool, the Functional Comorbidity Index (FCI), has been especially developed to assess the effect of comorbidities on the "physical functioning" subscale of the Medical Outcomes Short Form-36 Health Survey (SF-36).
Aims:
1) To determine the role of FCI in the prediction of the effect of comorbidities on HRQL in OSA. 2) To determine whether FCI and CCI are equally robust in predicting the effect of comorbidities on HRQL in OSA.
Material and methods:
Two hundred and fifty-five OSA patients were enrolled. Patients completed the SF-36 and the Medical Outcomes Study Sleep Scale (MOS-SS) forms, while their comorbidity status was assessed by FCI and CCI. The SF-36 physical (PCS-36) and mental component summary (MCS-36) scores were also calculated.
Results:
PCS-36 was predicted by FCI (p < 0.001), male gender (p = 0.001), BMI (p = 0.002) and the "awakening with "breathlessness/headache" MOS-SS subscale (p = 0.011) (R2 = 0.348). Among these predictors, FCI exerted the most important quantitative effect. MCS-36 was predicted only by the "sleep disturbance" (p = 0.005) and the "awakening with breathlessness/headache" MOS-SS subscales (p < 0.001) (R2 = 0.221).
Conclusions:
In patients with OSA, FCI is an independent predictor of the physical aspect of their HRQL. FCI is more robust than CCI in assessing the effect of comorbidities on HRQL in OSA.
