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Jha OK, Kumar S, Mehra S, Sircar M, Gupta R. Helmet NIV in Acute Hypoxemic Respiratory Failure due to COVID-19: Change in PaO 2/FiO 2 Ratio a Predictor of Success. Indian J Crit Care Med 2021; 25:1137-1146. [PMID: 34916746 PMCID: PMC8645804 DOI: 10.5005/jp-journals-10071-23992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
In acute respiratory failure due to severe coronavirus disease 2019 (COVID-19) pneumonia, mechanical ventilation remains challenging and may result in high mortality. The use of noninvasive ventilation (NIV) may delay required invasive ventilation, increase adverse outcomes, and have a potential aerosol risk to caregivers. Data of 30 patients were collected from patient files and analyzed. Twenty-one (70%) patients were weaned successfully after helmet-NIV support (NIV success group), and invasive mechanical ventilation was required in 9 (30%) patients (NIV failure group) of which 8 (26.7%) patients died. In NIV success vs failure patients, the mean baseline PaO2/FiO2 ratio (PFR) (147.2 ± 57.9 vs 156.8 ± 59.0 mm Hg; p = 0.683) and PFR before initiation of helmet (132.3 ± 46.9 vs 121.6 ± 32.7 mm Hg; p = 0.541) were comparable. The NIV success group demonstrated a progressive improvement in PFR in comparison with the failure group at 2 hours (158.8 ± 56.1 vs 118.7 ± 40.7 mm Hg; p = 0.063) and 24 hours (PFR-24) (204.4 ± 94.3 vs 121.3 ± 32.6; p = 0.016). As predictor variables, PFR-24 and change (delta) in PFR at 24 hours from baseline or helmet initiation (dPFR-24) were significantly associated with NIV success in univariate analysis but similar significance could not be reflected in multivariate analysis perhaps due to a small sample size of the study. The PFR-24 cutoff of 161 mm Hg and dPFR-24 cutoff of -1.44 mm Hg discriminate NIV success and failure groups with the area under curve (confidence interval) of 0.78 (0.62-0.95); p = 0.015 and 0.74 (0.55-0.93); p = 0.039, respectively. Helmet interface NIV may be a safe and effective tool for the management of patients with severe COVID-19 pneumonia with acute respiratory failure. More studies are needed to further evaluate the role of helmet NIV especially in patients with initial PFR <150 mm Hg to define PFR/dPFR cutoff at the earliest time point for prediction of helmet-NIV success. How to cite this article Jha OK, Kumar S, Mehra S, Sircar M, Gupta R. Helmet NIV in Acute Hypoxemic Respiratory Failure due to COVID-19: Change in PaO2/FiO2 Ratio a Predictor of Success. Indian J Crit Care Med 2021;25(10):1137-1146.
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Affiliation(s)
- Onkar K Jha
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Sunny Kumar
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Saurabh Mehra
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Mrinal Sircar
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Rajesh Gupta
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
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Velásquez N, Leahy R, Restrepo NJ, Lupu Y, Sear R, Gabriel N, Jha OK, Goldberg B, Johnson NF. Online hate network spreads malicious COVID-19 content outside the control of individual social media platforms. Sci Rep 2021; 11:11549. [PMID: 34131158 PMCID: PMC8206165 DOI: 10.1038/s41598-021-89467-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/26/2021] [Indexed: 12/14/2022] Open
Abstract
We show that malicious COVID-19 content, including racism, disinformation, and misinformation, exploits the multiverse of online hate to spread quickly beyond the control of any individual social media platform. We provide a first mapping of the online hate network across six major social media platforms. We demonstrate how malicious content can travel across this network in ways that subvert platform moderation efforts. Machine learning topic analysis shows quantitatively how online hate communities are sharpening COVID-19 as a weapon, with topics evolving rapidly and content becoming increasingly coherent. Based on mathematical modeling, we provide predictions of how changes to content moderation policies can slow the spread of malicious content.
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Affiliation(s)
- N Velásquez
- Institute for Data, Democracy and Politics, George Washington University, Washington, DC, 20052, USA
- ClustrX LLC, Washington, DC, USA
| | - R Leahy
- Institute for Data, Democracy and Politics, George Washington University, Washington, DC, 20052, USA
- ClustrX LLC, Washington, DC, USA
| | - N Johnson Restrepo
- Institute for Data, Democracy and Politics, George Washington University, Washington, DC, 20052, USA
- ClustrX LLC, Washington, DC, USA
| | - Y Lupu
- ClustrX LLC, Washington, DC, USA
- Department of Political Science, George Washington University, Washington, DC, 20052, USA
| | - R Sear
- Department of Computer Science, George Washington University, Washington, DC, 20052, USA
| | - N Gabriel
- Physics Department, George Washington University, Washington, DC, 20052, USA
| | - O K Jha
- Physics Department, George Washington University, Washington, DC, 20052, USA
| | | | - N F Johnson
- Institute for Data, Democracy and Politics, George Washington University, Washington, DC, 20052, USA.
- ClustrX LLC, Washington, DC, USA.
- Physics Department, George Washington University, Washington, DC, 20052, USA.
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Ramachandran L, Jha OK, Sircar M. High-flow Tracheal Oxygenation: A New Tool for Difficult Weaning. Indian J Crit Care Med 2021; 25:224-227. [PMID: 33707904 PMCID: PMC7922460 DOI: 10.5005/jp-journals-10071-23724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
High-flow tracheal oxygenation (HFTO), a modification of high-flow nasal cannula (HFNC), has been used in tracheostomized patients but only rarely for weaning. We present two cases on prolonged mechanical ventilation (PMV) where HFTO assisted weaning.
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Affiliation(s)
- Lakshman Ramachandran
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Onkar K Jha
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Mrinal Sircar
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
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Abstract
BACKGROUND AND AIMS Hypoxemic patients undergoing fiber-optic bronchoscopy (FOB) are at risk of worsening of respiratory failure requiring mechanical ventilation due to FOB procedure itself and its complications. As patients with respiratory failure are frequently managed by non-invasive ventilation (NIV); feasibility of FOB through NIV mask has been evaluated in some studies to avoid intubation. We describe here our own case series. MATERIALS AND METHODS Clinical data of 28 FOB done through NIV mask in 27 intensive care unit (ICU) patients over 6 years period at our center was collected retrospectively and analysed. RESULTS Study comprises 27 (17 male; 52±21.6 years age) hypoxemic (PaO2 71.3±14.2, on NIV and oxygen supplementation) patients. All FOB were done at bedside, 15 of them were given sedation for the procedure. Twenty four patients had bronchoalveolar lavage (BAL); three underwent bronchial biopsies, four brush cytology and seven transbronchial biopsies. In 10 patients lung or lobar collapse was reversed. There was no significant change between pre and post bronchoscopy ABG parameters except for improved post FOB PaO2 (p = 0.0032) and SpO2 (p = 0.0046). One patient (3.57%) developed late pneumothorax and 3 patients (10.7%) had bleeding after biopsy. Prior to bronchoscopy 17 (16 BIPAP, 1 CPAP) patients were already on NIV. Two patients required mechanical ventilation 6 hours after FOB due to subsequent clinical deterioration but could be weaned off later. One patient died on third day after FOB from acute myocardial infarction. CONCLUSION Hypoxemic patients in ICU can safely undergo bedside diagnostic and simple therapeutic bronchoscopy with NIV support while mostly avoiding intubation and with low complication rates. HOW TO CITE THIS ARTICLE Sircar M, Jha OK, Chabbra GS, Bhattacharya S. Noninvasive Ventilation-assisted Bronchoscopy in High-risk Hypoxemic Patients. Indian J Crit Care Med 2019;23(8):363-367.
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Affiliation(s)
- Mrinal Sircar
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Onkar K Jha
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Gurmeet S Chabbra
- Department of Respiratory and Sleep Medicine, QRG Central Hospital and Research Centre, Faridabad, Haryana, India
| | - Sandip Bhattacharya
- Department of Critical Care, Asian Institute of Medical Sciences, Faridabad, Haryana, India
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