Adapting in the COVID-19 Era.

How to cite this article: Papathanakos G, Andrianopoulos I, Papathanasiou A, Lepida D, Koulouras V. Adapting in the COVID-19 Era. Indian J Crit Care Med 2020;24(12):1286-1287.

The contribution of left heart disease in COPD patients with pulmonary hypertension.

BACKGROUND: Pulmonary hypertension (PH), regardless of its etiology, is associated with an impaired outcome in patients with chronic obstructive pulmonary disease (COPD). The aim of our study was to determine the incidence, cause, and effect of PH as detected by echocardiography in COPD patients. METHODS: Patients with confirmed COPD of any stage were evaluated by echocardiography for the likelihood of PH according to the proposed criteria. Patients with possible/likely to have PH underwent right heart catheterization, upon agreement, to confirm the presence, severity, and cause of PH. RESULTS: Of 91 patients, 39 were in stable condition (group A) and 52 with COPD exacerbation (group B). Group B patients presented with PH and left ventricular diastolic dysfunction more often than group A patients. One of two fulfilled the criteria for possible/likely PH. The incidence of likely/possible PH was significantly higher in group B. Nineteen group B patients with likely/possible PH underwent RHC, and PH was confirmed in 15 cases and in 73.3% was associated with left heart disease. The presence of possible/likely PH was associated with a statistically significant increase in mortality compared to those with unlikely PH. CONCLUSIONS: The use of echocardiographic criteria for the presence of PH is adequate for the screening of COPD patients. Patients with acute exacerbation of COPD and possible/likely PH demonstrate worse mortality compared to patients unlikely to have PH.

Shame feeling in the Intensive Care Unit patient's family members.

OBJECTIVE: To investigate the levels of internal and external shame among family members of critically ill patients. RESEARCH METHODOLOGY/ DESIGN: This prospective study was conducted in 2012/2013 on family members of Intensive Care Unit patients using the Others As Shamer Scale and the Experiential Shame Scale questionnaires. SETTING: Greek university hospital. RESULTS: Two hundred and twenty-three family members mean-aged (41.5±11.9) were studied, corresponding to 147 ICU patients. Out of these 223, 81 (36.3%) were men and 142 (63.7%) were women, while 79 (35.4%) lived with the patient. Family members who lived with the patient experienced higher internal and external shame compared to those who did not live with the patient (p=0.046 and p=0.028 respectively). Elementary and Junior High School graduates scored significantly higher than the other grades graduates in total Others As Shamer Scale, inferiority and emptiness scale (p<0.001). CONCLUSION: Intensive Care Unit patients' family members are prone to shame feelings, especially when being of low educational level. Health professionals have to take into consideration the possible implications for the patients and their care.

Targeting occult heart failure in intensive care unit patients with acute chronic obstructive pulmonary disease exacerbation: effect on outcome and quality of life.

PURPOSE: To estimate the prevalence of previously undiagnosed heart failure in mechanically ventilated patients with severe exacerbation of chronic obstructive pulmonary disease (COPD) and to evaluate the impact of specific heart failure treatment on patients' outcome. MATERIALS AND METHODS: In this prospective study, we included 107 consecutive patients with COPD without known history of cardiac disease who were admitted to the intensive care unit (ICU) because of hypercapnic respiratory failure leading to mechanical ventilation. RESULTS: Patients were divided into 4 groups according to the echocardiographic findings: patients with isolated right or left ventricular failure, biventricular failure, and normal heart function. Three of 4 patients demonstrated findings of heart failure. In 41%, the presence of previously unrecognized left ventricular dysfunction was revealed. Patients with isolated left ventricular dysfunction experienced less days on mechanical ventilation, less intensive care unit days, improved quality of life, and decreased in-hospital and 6-month mortality compared with patients with normal heart. CONCLUSIONS: In mechanically ventilated patients with severe exacerbation of COPD, unrecognized left or right ventricular failure is common. Among patients with isolated left ventricular failure, the early detection and appropriate treatment improves long-term quality of life and may decrease the short- and 6-month morbidity and mortality.