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Val F, Freire RS, Barros CMSS, Valente J, Goulart CDL, Santos AGR, Fonseca FH, Saenz ST, Dias AS, Rodrigues MGA, Silva BM, Fernandes E, Cubas-Vega N, Sampaio V, Simão M, Baía-da-Silva D, Severin R, ArêArêAs GPT, Gonçalves RL, Mendes RG, Martinez-Espinosa FE. Prone positioning in awake patients without ventilatory support does not alter major clinical outcomes in severe COVID-19: results from a retrospective observational cohort study, systematic review and meta-analysis. Expert Rev Respir Med 2024. [PMID: 38712558 DOI: 10.1080/17476348.2024.2350587] [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: 11/25/2023] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES During the Coronavirus disease (COVID-19) pandemic, clinicians recommended awake-prone positioning (APP) to avoid the worst outcomes. The objectives of this study were to investigate if APP reduces intubation, death rates and hospital length of stay (HLOS) in acute COVID-19. METHODS We performed a retrospective cohort with non-mechanically ventilated patients hospitalized in a reference center in Manaus, Brazil, 2020. Participants were stratified into APP and awake-not-prone positioning (ANPP) groups. Also, we conducted a systematic review and performed a meta-analysis to understand if this intervention had different outcomes in resource-limited settings (PROSPERO CRD42023422452). RESULTS A total of 115 participants were allocated into the groups. There was no statistical difference between both groups regarding time to intubation (HR: 0.861; 95 CI: 0.474-1.1562; p = 0.622) and time to death (HR: 1.666; 95 CI: 0.939-2.951; p = 0.081). APP was not significantly associated with reduced HLOS. A total of 86 articles were included in the systematic review, of which 76 (88,3%) show similar findings after APP. Also, low/middle, and high-income countries were similar regarding such outcomes. CONCLUSION APP in COVID-19 does not present clinical improvement that affects mortality, intubation rate and HLOS. The lack of a prone position protocol, obtained through a controlled study is necessary. After 3 years, APP benefits are still inconclusive.
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Affiliation(s)
- Fernando Val
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, AM, Brazil
- Universidade Federal do Amazonas, Manaus, AM, Brazil
| | - Raíssa S Freire
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Camila M S S Barros
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Jefferson Valente
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | | | - Anna G R Santos
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, AM, Brazil
| | - Fernando H Fonseca
- Hospital and Pronto Socorro Delphina Rinaldi Abdel Aziz, Manaus, AM, Brazil
| | - Sabrina T Saenz
- Maternidade de Referência da Zona Leste Ana Braga, Manaus, AM, Brazil
| | - Andiana S Dias
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Maria G A Rodrigues
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Bernardo Maia Silva
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Eduardo Fernandes
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Nadia Cubas-Vega
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
- Postgrado Medicina de Rehabilitación, Universidad Nacional Autónoma de Honduras, Tegucigalpa, FM, Honduras
| | - Vanderson Sampaio
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Mariana Simão
- Programa de Pós-graduação em Pesquisa Clínica em Doenças Infecciosas, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Djane Baía-da-Silva
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, AM, Brazil
| | - Richard Severin
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | | | | | | | - Flor E Martinez-Espinosa
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
- Instituto Leônidas & Maria Deane, Manaus, Brazil
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Coxwell Matthewman M, Yanase F, Costa-Pinto R, Jones D, Karalapillai D, Modra L, Radford S, Ukor IF, Warrillow S, Bellomo R. Haemodynamic changes during prone versus supine position in patients with COVID-19 acute respiratory distress syndrome. Aust Crit Care 2024; 37:391-399. [PMID: 37160405 PMCID: PMC10063572 DOI: 10.1016/j.aucc.2023.03.006] [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: 06/13/2022] [Revised: 03/10/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Prone positioning improves oxygenation in patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19. However, its haemodynamic effects are poorly understood. OBJECTIVES The objective of this study was to investigate the acute haemodynamic changes associated with prone position in mechanically ventilated patients with COVID-19 ARDS. The primary objective was to describe changes in cardiac index with prone position. The secondary objectives were to describe changes in mean arterial pressure, FiO2, PaO2/FiO2 ratio, and oxygen delivery (DO2) with prone position. METHODS We performed this cohort-embedded study in an Australian intensive care unit, between September and November 2021. We included adult patients with severe COVID-19 ARDS, requiring mechanical ventilation and prone positioning for respiratory failure. We placed patients in the prone position for 16 h per session. Using pulse contour technology, we collected haemodynamic data every 5 min for 2 h in the supine position and for 2 h in the prone position consecutively. RESULTS We studied 18 patients. Cardiac index, stroke volume index, and mean arterial pressure increased significantly in the prone position compared to supine position. The mean cardiac index was higher in the prone group than in the supine group by 0.44 L/min/m2 (95% confidence interval, 0.24 to 0.63) (P < 0.001). FiO2 requirement decreased significantly in the prone position (P < 0.001), with a significant increase in PaO2/FiO2 ratio (P < 0.001). DO2 also increased significantly in the prone position, from a median DO2 of 597 mls O2/min (interquartile range, 504 to 931) in the supine position to 743 mls O2/min (interquartile range, 604 to 1075) in the prone position (P < 0.001). CONCLUSION Prone position increased the cardiac index, mean arterial pressure, and DO2 in invasively ventilated patients with COVID-19 ARDS. These changes may contribute to improved tissue oxygenation and improved outcomes observed in trials of prone positioning.
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Affiliation(s)
| | - Fumitaka Yanase
- Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
| | | | - Daryl Jones
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
| | | | - Lucy Modra
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
| | - Sam Radford
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
| | - Ida-Fong Ukor
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
| | | | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia; Department of Critical Care, Department of Medicine and Radiology, University of Melbourne, Melbourne, Australia; Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Australia
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Perez-Garzon M, Poveda-Henao C, Bastidas-Goyes A, Robayo-Amortegui H. Oxygen Debt as Predictor of Mortality and Multiple Organ Dysfunction Syndrome in Severe COVID-19 Patients: A Retrospective Study. J Intensive Care Med 2024; 39:358-367. [PMID: 37876236 DOI: 10.1177/08850666231208433] [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] [Indexed: 10/26/2023]
Abstract
Background: Oxygen debt (DEOx) represents the disparity between resting and shock oxygen consumption (VO2) and is associated with metabolic insufficiency, acidosis, severity, and mortality. This study aimed to assess the reliability of DEOx as an indirect quantitative measure for predicting multiple organ dysfunction syndrome (MODS) and 28-day mortality in patients admitted to the intensive care unit (ICU) with respiratory syndrome severe acute coronavirus type 2 (SARS-CoV-2) infection, in comparison to the Acute Physiology and Chronic Health Evaluation II (APACHE II), sepsis-related organ failure assessment (SOFA), and 4C scores. Methods: A retrospective cohort study was conducted, including ICU patients with SARS-CoV-2 infection between 2020 and 2021. Clinical data were extracted from the EPIMED Monitor Database®. APACHE II, SOFA, and 4C scores were calculated upon ICU admission, and their accuracy in predicting 28-day mortality and MODS was compared to DEOx. Multivariate logistic regression analysis was performed to analyze the outcome variables. Results: 708 patients were included, with a mortality rate of 44.4%. DEOx value was 11.16 ml O2/kg. The mean age was 58.7 years. Multivariate analysis showed that DEOx was independently associated with mortality, intubation, and renal injury. Each point increase in creatinine was associated with a higher risk of MODS. To determine the precision of the scores, area under the receiver operating characteristic curves (AUROC) analysis was performed with weak discrimination and similar behavior for the primary outcomes. The most accurate scale for mortality and MODS was 4C with an AUC of 0.683 and APACHE II with an AUC of 0.814, while that of the AUROC of DEOx was 0.612 and 0.646, respectively. Conclusions: DEOx showed similar predictive value to established scoring systems in critically ill patients with SARS-CoV-2 infection. The correlation of DEOx with these scores may facilitate early intervention in critically ill patients.
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Affiliation(s)
- Michel Perez-Garzon
- Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
- Critical Medicine and Intensive Care, Msc Mechanical Ventilation and Respiratory Support, Department of Investigation, Fundación Clínica Shaio. Bogota DC. Colombia
| | - Claudia Poveda-Henao
- Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
- Critical Medicine and Intensive Care, Msc Mechanical Ventilation and Respiratory Support, Department of Investigation, Fundación Clínica Shaio. Bogota DC. Colombia
- Clinical Cardiology, Intensive Care Department, Shaio Clinic Foundation. Bogota DC. Colombia
| | - Alirio Bastidas-Goyes
- Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
| | - Henry Robayo-Amortegui
- Critical Care Resident, Department of Medicine, Universidad de La Sabana. Chia Cundinamarca. Bogotá DC, Colombia
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Brugnolli A, Chini G, Scartezzini R, Ambrosi E. Qualitative study of COVID-19 patient experiences with non-invasive ventilation and pronation: strategies to enhance treatment adherence. BMJ Open 2023; 13:e077417. [PMID: 38070911 PMCID: PMC10729144 DOI: 10.1136/bmjopen-2023-077417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Non-invasive ventilation (NIV) treatment combined with pronation in patients with COVID-19 respiratory failure has been shown to be effective in improving respiratory function and better patient outcomes. These patients may experience discomfort or anxiety that may reduce adherence to treatment. OBJECTIVE The aim of this study was to explore and describe the subjective experiences of patients undergoing helmet NIV and pronation during hospitalisation for COVID-19 respiratory failure, with a focus on the elements of care and strategies adopted by patients that enabled good adaptation to treatments. METHOD A qualitative descriptive study, using face-to-face interviews, was carried out with a purposeful sample of 20 participants discharged from a pulmonary intensive care unit who underwent helmet continuous positive airway pressure and pronation during hospitalisation for COVID-19. RESULTS Content analysis of the transcripts revealed feelings and experiences related to illness and treatments, strategies for managing one's own negative thoughts, and practical strategies of one's own and healthcare workers to facilitate adaptation to pronation and helmet. Experience was reflected in five major topics related to specific time points and settings: feelings and experiences, helmet and pronation: heavy but beneficial, positive thinking strategies, patients' practical strategies, support of healthcare professionals (HCPs). CONCLUSIONS This study may be useful to HCPs to improve the quality and appropriateness of care they provide.
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Affiliation(s)
- Anna Brugnolli
- Campus of health sciences, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Gabriele Chini
- Risorse Umane - Polo universitario delle Professioni Sanitarie di Trento, Trento Provincial Authority for Health Services, Trento, Italy
| | - Riccardo Scartezzini
- Pneumology department, Trento Provincial Authority for Health Services, Trento, Italy
| | - Elisa Ambrosi
- Dipartimento di Diagnostica e Sanità Pubblica, Università degli Studi di Verona, Verona, Italy
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Jalilian N, Pakzad R, Shahbazi M, Edrisi SR, Haghani K, Jalilian M, Bakhtiyari S. Circulating FABP-4 Levels in Patients with Atherosclerosis or Coronary Artery Disease: A Comprehensive Systematic Review and Meta-Analysis. Cardiovasc Ther 2023; 2023:1092263. [PMID: 38024104 PMCID: PMC10673666 DOI: 10.1155/2023/1092263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/22/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
Background Cardiovascular diseases (CDs), notably coronary artery disease (CAD) due to atherosclerosis, impose substantial global health and economic burdens. Fatty acid-binding proteins (FABPs), including FABP-4, have been recently linked to CDs. This study conducted a systematic review and meta-analysis to examine FABP-4 levels in CAD and atherosclerosis patients, exploring their potential links to these conditions. Methods A systematic review and meta-analysis were done based on the PRISMA guideline. The international databases including Medline, Embase, Cochrane Library, Scopus, Web of Science, and UpToDate were searched to find all related studies on the effect of FABP-4 on patients with CAD or atherosclerosis which were published till June 2022 without language restriction. The Cochran's Q-test and I2 statistic were applied to assess heterogeneity, a random effect model was used to estimate the pooled standardized mean difference (SMD), a metaregression method was utilized to investigate the factors affecting heterogeneity between studies, and Egger's test was used to assess the publication bias. Results Of 1051 studies, 9 studies with a sample size of 2327 were included in the systematic review and meta-analysis. The level of circulating FABP-4 in the patient groups was significantly higher than in the control groups (SMD = 0.60 (95% CI: 0.30 to 0.91, I2: 91.47%)). The SMD in female and male patients were 0.26 (95% CI: 0.01 to 0.52, I2: 0%) and 0.22 (95% CI: 0.08 to 0.35, I2: 44.7%), respectively. There was considerable heterogeneity between the studies. The countries had a positive relationship with heterogeneity (coefficient = 0.29, p < 0.001); but BMI, lipid indices, gender, study design, and type of kit had no effect on the heterogeneity. No publication bias was observed (p: 0.137). Conclusion In summary, this meta-analysis revealed elevated circulating FABP-4 levels in CDs, suggesting its potential as a biomarker for these conditions. Further research is warranted to explore its clinical relevance.
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Affiliation(s)
- Narges Jalilian
- Department of Medical Biochemistry, Faculty of Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Reza Pakzad
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
- Health and Environment Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Mahdi Shahbazi
- Department of Medical Biochemistry, Faculty of Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Seyyed-Reza Edrisi
- Department of Medical Biochemistry, Faculty of Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Karimeh Haghani
- Department of Medical Biochemistry, Faculty of Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohsen Jalilian
- Department of Health Education and Promotion, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Salar Bakhtiyari
- Department of Medical Biochemistry, Faculty of Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
- Feinberg Cardiovascular and Renal Research Institute, Northwestern University, Chicago, IL, USA
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Ziyaei K, Abdi F, Mokhtari M, Daneshmehr MA, Ataie Z. Phycocyanin as a nature-inspired antidiabetic agent: A systematic review. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 119:154964. [PMID: 37544212 DOI: 10.1016/j.phymed.2023.154964] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Nutraceuticals have been important for more than two decades for their safety, efficacy, and outstanding effects. Diabetes is a major metabolic syndrome, which may be improved using nutritional pharmaceuticals. Some microalgae species, such as spirulina, stand out by providing biomass with exceptional nutritional properties. Spirulina has a wide range of pharmacological effects, mostly related to phycocyanin. Phycocyanin is a protein compound with antidiabetic properties, known as a nutraceutical. OBJECTIVE This review delves into phycocyanin applications in diabetes and its complications and ascertains the mechanisms involved. METHODS Scopus, PubMed, Cochrane Library, Web of Science, and ProQuest databases were systematically reviewed (up to April 30, 2023), in which only animal and cellular studies were found. RESULTS According to animal studies, the administration of phycocyanin affected biochemical parameters (primary outcome) related to diabetes. These results showed an increase in fasting insulin serum and a decrease in fasting blood glucose, glycosylated serum protein, and glycosylated hemoglobin. In cellular studies, though, phycocyanin prevented methylglyoxal and human islet amyloid polypeptide-induced dysfunction in β-cells and induced apoptosis through different molecular pathways (secondary outcome), including activation of Nrf2, PI3K/Akt, and suppression of JNK and p38. Also, phycocyanin exerted its antidiabetic effect by affecting the pathways regulating hepatic glucose metabolism. CONCLUSIONS Thus, based on the available information and literature, targeting these pathways by phycocyanin may unleash an array of benefits, including positive outcomes of the antidiabetic effects of phycocyanin as a nutraceutical. OTHER This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) at the National Institute of Health. The registration number is CRD42022307522.
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Affiliation(s)
- Kobra Ziyaei
- Department of Fisheries, Faculty of Natural Resources, University of Tehran, Karaj, Iran
| | - Fatemeh Abdi
- Non-communicable Diseases Research Centre, Alborz University of Medical Sciences, Karaj, Iran
| | - Majid Mokhtari
- Department of Bioinformatics, Kish International Campus, University of Tehran, Kish Island, Iran; Department of Bioinformatics, Personalized Precision Medicine Institute, Tehran, Iran
| | - Mohammad Ali Daneshmehr
- Department of Medicinal Chemistry, School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ataie
- Evidence-based Phytotherapy & Complementary Medicine Research Center, Alborz University of Medical Sciences, Karaj, Iran; Department of Pharmaceutics, Faculty of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran.
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García A, Galeiras R, Pertega-Díaz S. Awake Prone Decubitus Positioning in COVID-19 Patients: A Systematic Review and MetaAnalysis. J Crit Care Med (Targu Mures) 2023; 9:73-86. [PMID: 37593248 PMCID: PMC10429621 DOI: 10.2478/jccm-2023-0014] [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: 03/01/2023] [Accepted: 04/26/2023] [Indexed: 08/19/2023] Open
Abstract
To date, recommendations for the implementation of awake prone positioning in patients with hypoxia secondary to SARSCoV2 infection have been extrapolated from prior studies on respiratory distress. Thus, we carried out a systematic review and metaanalysis to evaluate the benefits of pronation on the oxygenation, need for endotracheal intubation (ETI), and mortality of this group of patients. We carried out a systematic search in the PubMed and Embase databases between June 2020 and November 2021. A randomeffects metaanalysis was performed to evaluate the impact of pronation on the ETI and mortality rates. A total of 213 articles were identified, 15 of which were finally included in this review. A significant decrease in the mortality rate was observed in the group of pronated patients (relative risk [RR] = 0.69; 95% confidence interval [CI]: 0.480.99; p = 0.044), but no significant effect was observed on the need for ETI (RR = 0.79; 95% CI: 0.631.00; p = 0.051). However, a subgroup analysis of randomized clinical trials (RCTs) did reveal a significant decrease in the need for this intervention (RR = 0.83; 95% CI: 0.710.97). Prone positioning was found to significantly reduce mortality, also diminishing the need for ETI, although this effect was statistically significant only in the subgroup analysis of RCTs. Patients' response to awake prone positioning could be greater when this procedure is implemented early and in combination with noninvasive mechanical ventilation (NIMV) or highflow nasal cannula (HFNC) therapy.
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Onji M, Kakizoe S, Nakai A, Shimizu K, Masui Y, Naito K, Mikumo H. Short-Term Outcomes of the First-Session Prone Position in Patients With Severe Coronavirus Disease 2019: A Retrospective Chart Review. Cureus 2023; 15:e35437. [PMID: 36994294 PMCID: PMC10041127 DOI: 10.7759/cureus.35437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 02/27/2023] Open
Abstract
Introduction Prone positioning during ventilation is recommended for patients with severe coronavirus disease 2019 (COVID-19). However, the efficacy of first-session prone positioning in improving short-term outcomes remains unclear. Therefore, we aimed to investigate the impact of the rate of change in partial pressure of oxygen/fraction of inspired oxygen (P/F) ratio before and after initial prone positioning on activities of daily living (ADL) and outcomes at discharge. Methods In this retrospective chart review, 22 patients with severe COVID-19 who required ventilator management between April and September 2021 were analyzed. Patients with an improvement in the P/F ratio (after initial prone positioning, compared to that before the session) by > 16mHg and < 16mmHg were defined as responders and non-responders, respectively. Results Compared with non-responders, responders had a significantly shorter ventilator duration, a higher Barthel Index at discharge, and a higher proportion of discharged patients. There was a significant between-group difference in chronic respiratory comorbidities, with one case (7.7%) among responders and six cases (66.7%) among non-responders. Conclusions This study is the first of its kind to investigate short-term outcomes in patients with COVID-19 requiring ventilator management after initial prone positioning. After initial prone positioning, responders had higher P/F ratios as well as improved ADLs and outcomes at discharge.
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Richrot TS, Lima J, Stello BB, Milanez DSJ, Burgel CF, Silva FM. Prone position, time to reach nutrition target, and energy/protein achievement rate on the seventh day of intensive care unit stay in patients with COVID-19: A cohort study. Nutr Clin Pract 2023; 38:609-616. [PMID: 36680507 DOI: 10.1002/ncp.10952] [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: 09/20/2022] [Revised: 11/29/2022] [Accepted: 12/17/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We aimed to evaluate the mean time to reach the energy (EAR) and protein (PAR) achievement rate among patients with coronavirus disease 2019 (COVID-19) who did or did not undergo prone position (PP) therapy in the first week of their stay in the intensive care unit (ICU), and the interaction of these nutrition therapy indicators on the association between PP and clinical outcomes. METHODS This cohort study used retrospective data collected from medical records of patients with COVID-19 admitted to the ICU (≥18 years). We collected nutrition data, clinical information, prescription of PP, and its frequency during the first week, and clinical outcomes. RESULTS PP therapy was administered to 75.2% of 153 patients (61.5 ± 14.8 years, 57.6% males) during the first week of their ICU stay. Patients who underwent PP reached nutrition therapy goals later (4 [3-6] vs 3 [2-4] days; P = 0.030) and had lower EAR (91.9 ± 25.7 vs 101.6 ± 84.0; P = 0.002) and PAR (88.0 ± 27.7 vs 98.1 ± 13.5; P = 0.009) in comparison to those who did not receive PP. Grouping patients who underwent PP according to the EAR (≥70% or <70%) did not show any differences in the incidence of ICU death, duration of mechanical ventilation, or ICU stay (P > 0.05). CONCLUSIONS In this exploratory study, PP was associated with a delayed time to reach the nutrition target and the lowest EAR and estimated protein requirement on the seventh day of ICU stay in patients with COVID-19. Permissive enteral nutrition prescription in patients who underwent PP was not associated with worse clinical outcomes.
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Affiliation(s)
- Thamy Schossler Richrot
- Residence Multiprofessional Program: Intensive Care, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Júlia Lima
- Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Bruna Barbosa Stello
- Department of Nutrition, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Danielle Silla Jobim Milanez
- Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Camila Ferri Burgel
- Nutrition and Dietetics Service, Hospital Complex Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Flávia Moraes Silva
- Residence Multiprofessional Program: Intensive Care, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Nutrition Department, Nutrition Science Graduate Program and Residence Multiprofessional Program: Intensive Care, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Yarahmadi S, Ebrahimzadeh F, Mohamadipour F, Cheraghian T, Eskini M. Effect of Prone Position on Clinical Outcomes of Non-Intubated Patients with Covid-19: A Randomized Clinical Trial. Collegian 2022; 30:449-456. [PMID: 36591534 PMCID: PMC9792421 DOI: 10.1016/j.colegn.2022.12.005] [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: 07/15/2021] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Background Prone positioning (PP) is a well-known respiratory support approach. Limited data are available for the use of PP in non-intubated patients with COVID-19. Aim This study aims to investigate the effect of PP on the clinical outcomes of patients with COVID-19 pneumonia. Methods In This clinical trial, the participants in the PP group (n=41) were asked to lie comfortably in a prone position for 90 minutes. In the supine position (SP) group (n=41), the participants were asked to lie comfortably in a supine position for 90 minutes. Clinical data such as oxygen saturation, respiratory rate, the severity of dyspnea, mean arterial pressure, and pulse rate were assessed at 0 (immediately before), 30, 60, 90 minutes after the start of the intervention and 30 min after resuming the supine position. The participants in the PP group were then asked to intermittently stay in a prone position for a total of eight hours per 24 hours of hospitalization. The participants in the control group were asked to remain in their usual positions during the hospital stay. Finally, the length of hospital stay, intubation rate, and survival assessed. Findings Prone positioning was associated with significant improvement in oxygen saturation (P = 0.001), respiratory rate (P=0.004), the severity of dyspnea (P=0.014), and mean arterial pressure (P=0.027). There was no significant difference between the two groups in terms of pulse rate (P=0.890), hospital stay (P=0.994), intubation rate (P=0.324), and survival (P=0.091). Discussion Our results demonstrated that prone positioning showed marked improvement in some short-term clinical outcomes in non-intubated patients with COVID-19. Conclusion Prone positioning can be considered an inexpensive, accessible, and simple measure in awake non-intubated patients with COVID-19.
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Affiliation(s)
- Sajad Yarahmadi
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran,Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran,Correspondence to: Environmental Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farzad Ebrahimzadeh
- Nutritional Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Mohamadipour
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Tayebeh Cheraghian
- Cardiovascular Research Center, Shahid Rahimi Hospital, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mahtab Eskini
- Social Determinants of Health Research Center, Shohadaye Ashayer Hospital, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
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11
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Dragoi L, Siuba MT, Fan E. Lessons learned in mechanical ventilation/oxygen support in COVID19. Clin Chest Med 2022; 44:321-333. [PMID: 37085222 PMCID: PMC9678831 DOI: 10.1016/j.ccm.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The clinical spectrum of severe acute respiratory syndrome coronavirus-2 infection ranges from asymptomatic infection or mild respiratory symptoms to pneumonia, with severe cases leading to acute respiratory distress syndrome with multiorgan involvement. The clinical management of patients with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) changed over the course of the pandemic, being adjusted as more evidence became available. This article will review how the ventilatory management of COVID-19 ARDS evolved and will conclude with current evidence-based recommendations.
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12
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Aeen FB, Pakzad R, Tayebi Z, Kashkooli RI, Abdi F. Clinical outcomes of off-pump coronary artery bypass graft in patients with diabetes and non-diabetics: A systematic review and meta-analysis. Diabetes Metab Syndr 2022; 16:102643. [PMID: 36279703 DOI: 10.1016/j.dsx.2022.102643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/18/2022] [Accepted: 10/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Diabetes mellitus is a prevalent risk factor for developing coronary artery disease which worsens the clinical outcomes of patients undergoing coronary artery bypass grafting (CABG). This study aimed to determine the clinical outcomes of patients with diabetes and non-diabetic patients who underwent off-pump CABG surgery. METHOD Medline, Scopus, Proquest, Embase, Web of Science, and Google scholar were searched until September 10, 2021. The effect sizes including unstandardized mean difference and odds ratio with 95% confidence interval were calculated using "Metan" package. The Cochran's Q-test and I2 statistic were used to assess heterogeneity, a random-effects model was applied to estimate the pooled effect sizes, and meta-regression was used to investigate the factors affecting heterogeneity between studies. RESULTS 10 studies with 6200 sample sizes were included in the study. In groups with diabetes, Summary odds ratio (SOR) and 95% confidence interval of infection was 2.18 more than non-diabetic groups. Also, odds renal complication was 1.74 more than non-diabetic groups, and the odds cardiovascular complication in groups with diabetes was 1.30 more than non-diabetics. There were no differences in mortality, neurologic, respiratory and surgical complications between groups with diabetes and non-diabetics. Based on meta-regression results, age (Coefficient: 0.942; p = 0.009) had a significant direct relationship and sample size (Coefficient: 0.001; p = 0.009) had an indirect significant relationship with heterogeneity of neurologic outcomes. There was no significant publication bias in our results. CONCLUSION Our study revealed that off-pump CABG led to some significant outcomes in patients with diabetes compared to non-diabetics. Renal and infection complications were higher in patients with diabetes but no significant differences were seen in most of other postoperative outcomes between the two groups.
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Affiliation(s)
- Fatemeh Behesht Aeen
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Zahra Tayebi
- Faculty of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| | - Razie Iloon Kashkooli
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Abdi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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13
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Rehman S, Shahiman MA, Khaleel MA, Holý O. Does the intubation timeline affect the in-hospital mortality of COVID-19 patients? A retrospective cohort study. Front Med (Lausanne) 2022; 9:1023229. [PMID: 36275820 PMCID: PMC9582598 DOI: 10.3389/fmed.2022.1023229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Effective strategies for managing coronavirus disease 19 (COVID-19) patients suffering from acute respiratory distress are constantly evolving. The timeline and threshold for transitioning from non-invasive ventilation to intermittent mandatory ventilation in critical cases who develop COVID-19-related respiratory distress are undetermined. The present research intends to investigate if emergency room intubations in COVID-19 patients affect mortality. Methods Between January 1, 2021 and June 30, 2021, we retrospectively reviewed chart analysis on all patients with confirmed positive COVID-19 screening and who underwent endotracheal intubation. Depending on when the intubation was performed; early in the emergency room or delayed outside the emergency room, patients were separated into two cohorts. In addition to comorbid clinical manifestations, the quick sequential organ failure assessment (qSOFA) score, and in-hospital mortality were all recorded as demographic and clinical information. Results Fifty-eight of the 224 corona-positive patients who underwent intubation had their intubations performed in the emergency room. Age, sex, alcohol use, and smoking status did not significantly differ between the two categories at the baseline. The mean qSOFA score was higher in the early intubation cohort (3.5; p < 0.000) along with more underlying comorbidities (3.0; p < 0.000). When compared to the late intubation cohort (45.78%), patients treated with early intubation had a significantly greater death rate (67.24%). Conclusion In summary, we discovered that patients who underwent intubation in the emergency units exhibited a high quick SOFA score as well as maximum co-morbid conditions than patients intubated somewhere else in the hospital. The findings of our investigation imply that intubating patients too early might be risky.
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Affiliation(s)
- Shazia Rehman
- Department of Biomedical Sciences, Pak-Austria Fachhochschule, Institute of Applied Sciences and Technology, Haripur, Pakistan
| | - Muhammad Ali Shahiman
- Department of Urology, and Renal Transplantation, Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Mundher A. Khaleel
- Department of Mathematics, College of Computer Science and Mathematics, Tikrit University, Tikrit, Iraq
| | - Ondřej Holý
- Science and Research Center, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czechia,*Correspondence: Ondřej Holý
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14
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Kang H, Gu X, Tong Z. Effect of Awake Prone Positioning in non-Intubated COVID-19 Patients with Acute Hypoxemic Respiratory Failure: A Systematic Review and Meta-Analysis. J Intensive Care Med 2022; 37:1493-1503. [PMID: 36017576 PMCID: PMC9412157 DOI: 10.1177/08850666221121593] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Awake prone positioning (APP) has been considered as a feasible treatment for patients with acute hypoxemic respiratory failure in non-intubated coronavirus disease 2019 (COVID-19). However, the efficacy and safety of APP remain uncertain. This meta-analysis aims to assess the effect of APP on intubation rate and mortality in COVID-19 patients with acute respiratory failure. Methods Relevant studies published from January 1, 2020, to June 17, 2022, were systematically searched. The primary outcomes were the intubation rate and mortality; the secondary outcome was the incidence of adverse events. Results Of 5746 identified publications, 22 were eligible for inclusion in the meta-analysis (N = 5146 patients). In comparison to the non-APP group, APP could decrease the intubation rates (OR 0.64; 95% CI 0.48-0.83; P = .001), particularly in the subgroup of the daily median duration of APP > 8 h and in the subgroup of receiving high flow nasal cannula (HFNC) or non-invasive ventilation (NIV). Patients treated with APP were associated with lower mortality rates (OR 0.61; 95% CI 0.45-0.81; P = .0008), but no mortality benefit was found in the APP group in the subgroup of randomized controlled trials (RCTs). No significant difference was found in the incidence of adverse events between the groups (OR 1.13; 95% CI 0.75-1.71; P = .56). Conclusion Our results demonstrated that APP could be an effective strategy to avoid intubation without detrimental effects in non-intubated patients with COVID-19, especially for patients requiring HFNC or NIV, and the daily APP duration with the target of minimally eight hours was suggested. In the subgroup of RCTs, the pooled results did not demonstrate any benefit of APP on mortality. Given the limited number of RCTs, further high-quality RCTs are needed to confirm the results. INPLASY registration number INPLASY2021110037.
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Affiliation(s)
- Hanyujie Kang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, 74639Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xueqing Gu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, 74639Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, 74639Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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15
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Complicated Laryngotracheal Stenosis Occurring Early after COVID-19 Intubation. SURGERIES 2022. [DOI: 10.3390/surgeries3030023] [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: Airway stenosis is a known complication of prolonged intubation in hospitalized patients. With the high rate of intubations in patients with COVID-19 pneumonia, laryngotracheal stenosis (LTS) is a complication of COVID-19 that drastically reduces quality of life for patients who may remain tracheostomy-dependent. Methods: Patient medical history, laryngoscopy, and CT imaging were obtained from medical records. Results: We report four cases of complicated LTS following intubation after COVID-19 pneumonia and explore the current literature in a narrative review. Four patients developed LTS following intubation from COVID-19 pneumonia. Three patients remain tracheostomy-dependent, and the fourth required a heroic operative schedule to avoid tracheostomy. Conclusion: Intubation for COVID-19 pneumonia can result in severe LTS, which may persist despite endoscopic intervention.
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16
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Smith LM, Glauser JM. Managing Severe Hypoxic Respiratory Failure in COVID-19. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022; 10:31-35. [PMID: 35572208 PMCID: PMC9091541 DOI: 10.1007/s40138-022-00245-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 12/11/2022]
Abstract
Purpose of Review Adult respiratory distress syndrome is a life-threatening complication from severe COVID-19 infection resulting in severe hypoxic respiratory failure. Strategies at improving oxygenation have evolved over the course of the pandemic. Recent Findings Although non-invasive respiratory support reduces the need for intubation, a significant number of patients with COVID-19 progress to invasive mechanical ventilation. Once intubated, a lung protective ventilation strategy should be employed that limits tidal volumes to 6 ml/kg of predicted body weight and employs sufficient positive end-expiratory pressure to maximize oxygen delivery while minimizing the fraction of inspired oxygen. Intermittent prone positioning is effective at improving survival, and there is a growing body of evidence that it can be safely performed in spontaneously breathing patients to reduce the need for invasive mechanical ventilation. Inhaled pulmonary vasodilators have not been shown to improve survival or cost-effectiveness in COVID-19 and should be used selectively. Summary Finally, the best outcomes are likely achieved at centers with experience at severe ARDS management and protocols for escalation of care.
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Affiliation(s)
- Lane M. Smith
- Division of Critical Care Medicine, Department of Anesthesiology, University of Michigan Health System, 4172 Cardiovascular Center, 1500 East Medical Center Dr., SPC 5861, Ann Arbor, MI 48109-5861 USA
| | - Jonathan M. Glauser
- Department of Emergency Medicine, MetroHealth System and Case Western Reserve University, Cleveland, OH 44109 USA
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17
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Tronstad O, Martí JD, Ntoumenopoulos G, Gosselink R. An Update on Cardiorespiratory Physiotherapy during Mechanical Ventilation. Semin Respir Crit Care Med 2022; 43:390-404. [PMID: 35453171 DOI: 10.1055/s-0042-1744307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Physiotherapists are integral members of the multidisciplinary team managing critically ill adult patients. However, the scope and role of physiotherapists vary widely internationally, with physiotherapists in some countries moving away from providing early and proactive respiratory care in the intensive care unit (ICU) and focusing more on early mobilization and rehabilitation. This article provides an update of cardiorespiratory physiotherapy for patients receiving mechanical ventilation in ICU. Common and some more novel assessment tools and treatment options are described, along with the mechanisms of action of the treatment options and the evidence and physiology underpinning them. The aim is not only to summarize the current state of cardiorespiratory physiotherapy but also to provide information that will also hopefully help support clinicians to deliver personalized and optimal patient care, based on the patient's unique needs and guided by accurate interpretation of assessment findings and the current evidence. Cardiorespiratory physiotherapy plays an essential role in optimizing secretion clearance, gas exchange, lung recruitment, and aiding with weaning from mechanical ventilation in ICU. The physiotherapists' skill set and scope is likely to be further optimized and utilized in the future as the evidence base continues to grow and they get more and more integrated into the ICU multidisciplinary team, leading to improved short- and long-term patient outcomes.
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia.,Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
| | - Joan-Daniel Martí
- Cardiac Surgery Critical Care Unit, Institut Clinic Cardiovascular, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Rik Gosselink
- Department Rehabilitation Sciences, University of Leuven, University Hospitals Leuven, Belgium
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18
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Harper DC, Poe TL, Stewart J, Powers S, Watts P, McLain R, Shirey MR. Academic-Practice Partnership Pivot During COVID-19 Pandemic Surge. Nurs Adm Q 2022; 46:103-112. [PMID: 35174797 DOI: 10.1097/naq.0000000000000520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Health care systems continue to experience the sequential aftermath of the COVID-19 pandemic, with major care access, quality, safety, financial sustainability, and workforce considerations. Yet, academic-clinical partnership opportunities exist for transformational change, even when efforts to respond to a pandemic seem insurmountable. A nursing partnership between an academic health center nursing school and university health system provided short- and long-term support for the nursing workforce shortage during a COVID-19 surge. An academic-clinical integration framework guided planning, clinical support activities, outcomes achieved, technology innovations, and shared lessons associated with these efforts. The COVID-19 surge response steps included a call to action, preparation for surge support by the academic and clinical partners, and a team approach for clinical service delivery by faculty, students, and staff. Through the 6-week COVID-19 surge response, more than 10 000 hours of hospital nurse staffing were provided by nursing school faculty and students; over 770 worked shifts that provided approximately 30% of the full surge hospital supplemental staffing and approximately 46 000 vaccine encounters. Well-established academic-clinical nursing partnerships allow for quick pivots in the rapidly changing COVID-19 environment that can enhance nursing clinical proficiency and competency, augment clinically immersive learning, and reinforce analytics to measure health outcomes, lower costs, improve access, quality, safety, and workforce conditions.
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Affiliation(s)
- Doreen C Harper
- University of Alabama at Birmingham School of Nursing (Drs Harper, Poe, Powers, Watts, McLain, and Shirey); and University of Alabama at Birmingham Hospital (Drs Poe and Stewart)
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19
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Beran A, Mhanna M, Srour O, Ayesh H, Sajdeya O, Ghazaleh S, Mhanna A, Ghazaleh D, Khokher W, Maqsood A, Assaly R. Effect of Prone Positioning on Clinical Outcomes of Non-Intubated Subjects With COVID-19. Respir Care 2022; 67:471-479. [PMID: 34753813 PMCID: PMC9994005 DOI: 10.4187/respcare.09362] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Awake prone positioning (APP) has been recently proposed as an adjunctive treatment for non-intubated coronavirus disease 2019 (COVID-19) patients requiring oxygen therapy to improve oxygenation and reduce the risk of intubation. However, the magnitude of the effect of APP on clinical outcomes in these patients remains uncertain. We performed a comparative systematic review and meta-analysis to evaluate the effectiveness of APP to improve the clinical outcomes in non-intubated subjects with COVID-19. METHODS The primary outcomes were the need for endotracheal intubation and mortality. The secondary outcome was hospital length of stay. Pooled risk ratio (RR) and mean difference with the corresponding 95% CI were obtained by the Mantel-Haenszel method within a random-effect model. RESULTS A total of 14 studies (5 randomized controlled trials [RCTs] and 9 observational studies) involving 3,324 subjects (1,495 received APP and 1,829 did not) were included. There was a significant reduction in the mortality rate in APP group compared to control (RR 0.68 [95% CI 0.51-0.90]; P = .008, I2 = 52%) with no significant effect on intubation (RR 0.85 [95% CI 0.66-1.08]; P = .17, I2 = 63%) or hospital length of stay (mean difference -3.09 d [95% CI-10.14-3.96]; P = .39, I2 = 97%). Subgroup analysis of RCTs showed significant reduction in intubation rate (RR 0.83 [95% CI 0.72-0.97]; P = .02, I2 = 0%). CONCLUSIONS APP has the potential to reduce the in-hospital mortality rate in COVID-19 subjects with hypoxemia without a significant effect on the need for intubation or length of hospital stay. However, there was a significant decrease in the need for intubation on subgroup analysis of RCTs. More large-scale trials with a standardized protocol for prone positioning are needed to better evaluate its effectiveness in this select population.
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Affiliation(s)
- Azizullah Beran
- Department of Internal Medicine, University of Toledo, Toledo, Ohio.
| | - Mohammed Mhanna
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Omar Srour
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Hazem Ayesh
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Omar Sajdeya
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Sami Ghazaleh
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | | | | | - Waleed Khokher
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Aadil Maqsood
- Department of Pulmonary and Critical Care Medicine, University of Toledo, Toledo, Ohio
| | - Ragheb Assaly
- Department of Pulmonary and Critical Care Medicine, University of Toledo, Toledo, Ohio
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20
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Soltani S, Zandi M, Faramarzi S, Shahbahrami R, Vali M, Rezayat SA, Pakzad R, Malekifar P, Pakzad I, Jahandoost N, Moludi J. Worldwide prevalence of fungal coinfections among COVID-19 patients: a comprehensive systematic review and meta-analysis. Osong Public Health Res Perspect 2022; 13:15-23. [PMID: 35255675 PMCID: PMC8907610 DOI: 10.24171/j.phrp.2021.0293] [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: 11/03/2021] [Accepted: 01/02/2022] [Indexed: 11/05/2022] Open
Abstract
Microbial coinfections can increase the morbidity and mortality rates of viral respiratory diseases. Therefore, this study aimed to determine the pooled prevalence of fungal coinfections in coronavirus disease 2019 (COVID-19) patients. Web of Science, Medline, Scopus, and Embase were searched without language restrictions to identify the related research on COVID-19 patients with fungal coinfections from December 1, 2019, to December 30, 2020. A random-effects model was used for analysis. The sample size included 2,246 patients from 8 studies. The pooled prevalence of fungal coinfections was 12.60%. The frequency of fungal subtype coinfections was 3.71% for Aspergillus, 2.39% for Candida, and 0.39% for other. The World Health Organization’s Regional Office for Europe and Regional Office for Southeast Asia had the highest (23.28%) and lowest (4.53%) estimated prevalence of fungal coinfection, respectively. Our findings showed a high prevalence of fungal coinfections in COVID-19 cases, which is a likely contributor to mortality in COVID-19 patients. Early identification of fungal pathogens in the laboratory for COVID-19 patients can lead to timely treatment and prevention of further damage by this hidden infection.
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21
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Team V, Jones A, Weller CD. Prevention of Hospital-Acquired Pressure Injury in COVID-19 Patients in the Prone Position. Intensive Crit Care Nurs 2022; 68:103142. [PMID: 34736831 PMCID: PMC8418919 DOI: 10.1016/j.iccn.2021.103142] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Corresponding author at: Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 5 Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004 Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Carolina D. Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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22
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Schultz MJ, Roca O, Shrestha GS. Global lessons learned from COVID-19 mass casualty incidents. Br J Anaesth 2021; 128:e97-e100. [PMID: 34865825 PMCID: PMC8590954 DOI: 10.1016/j.bja.2021.10.040] [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: 10/14/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022] Open
Abstract
With healthcare systems rapidly becoming overwhelmed and occupied by patients during a pandemic, effective and safe care for patients is easily compromised. During the course of the current pandemic, numerous treatment guidelines have been developed and published that have improved care for patients with COVID-19. Certain lessons have only been learned during the course of the outbreak, from which we can learn for future pandemics. This editorial aims to raise awareness about the importance of timely stockpiling of sufficient amounts of personal protection equipment and medications, adequate oxygen supplies, uninterrupted electricity, and fair locally adapted triage strategies.
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Affiliation(s)
- Marcus J Schultz
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Oriol Roca
- Servei de Medicina Intensiva, Hospital Vall d'Hebron, Barcelona, Spain; Ciber Enfermedades Respiratorias (CibeRes), Instituto de Salud Carlos III, Madrid, Spain
| | - Gentle S Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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