Increasing Supportive Care for Patients With COVID-19-Related Respiratory Deterioration in Non-ICU Settings

BACKGROUND

Prepandemic hospital guidelines were unable to support an acute influx of patients with respiratory deterioration. New processes for general care practice were needed to facilitate patient care.

PURPOSE

To develop and evaluate guidelines to safely treat patients with COVID-19 respiratory deterioration in the general care setting.

METHODS

A quality improvement project with 2 PDSA (Plan-Do-Study-Act) cycles was used to develop guidelines for high-flow oxygen and prone positioning, along with frequent monitoring and collaboration with virtual critical care support.

RESULTS

Over 6 months, 126 patients with COVID-19 were cared for on general care units. Zero intubations occurred on the general care units, with 211 patient hospital days spent in general care that previously would have required an intensive care unit bed.

CONCLUSIONS

Patients in the general care setting with respiratory decline can safely be managed with appropriate monitoring criteria, oxygen device settings, and nursing support unitizing technology.

Mathematical modeling of calcium signaling during sperm hyperactivation

Mammalian sperm must hyperactivate in order to fertilize oocytes. Hyperactivation is characterized by highly asymmetrical flagellar bending. It serves to move sperm out of the oviductal reservoir and to penetrate viscoelastic fluids, such as the cumulus matrix. It is absolutely required for sperm penetration of the oocyte zona pellucida. In order for sperm to hyperactivate, cytoplasmic Ca(2+) levels in the flagellum must increase. The major mechanism for providing Ca(2+) to the flagellum, at least in mice, are CatSper channels in the plasma membrane of the principal piece of the flagellum, because sperm from CatSper null males are unable to hyperactivate. There is some evidence for the existence of other types of Ca(2+) channels in sperm, but their roles in hyperactivation have not been clearly established. Another Ca(2+) source for hyperactivation is the store in the redundant nuclear envelope of sperm. To stabilize levels of cytoplasmic Ca(2+), sperm contain Ca(2+) ATPase and exchangers. The interactions between channels, Ca(2+) ATPases, and exchangers are poorly understood; however, mathematical modeling can help to elucidate how they work together to produce the patterns of changes in Ca(2+) levels that have been observed in sperm. Mathematical models can reveal interesting and unexpected relationships, suggesting experiments to be performed in the laboratory. Mathematical analysis of Ca(2+) dynamics has been used to develop a model for Ca(2+) clearance and for CatSper-mediated Ca(2+) dynamics. Models may also be used to understand how Ca(2+) patterns produce flagellar bending patterns of sperm in fluids of low and high viscosity and elasticity.