ABSTRACT
Coronavirus disease 2019 (COVID-19) resulted in a global pandemic and has overwhelmed health care systems worldwide. In this scientific statement, we describe the epidemiology, pathophysiology, clinical presentations, treatment, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and multisystem inflammatory syndrome in children and young adults with a focus on cardiovascular manifestations and complications. We review current knowledge about the health consequences of this illness in children and young adults with congenital and acquired heart disease, the public health burden and health disparities of this infection in these populations, and vaccine-associated myocarditis.
Subject(s)
COVID-19 , American Heart Association , COVID-19/complications , Child , Humans , Pandemics , SARS-CoV-2 , Systemic Inflammatory Response Syndrome , United States/epidemiology , Young AdultABSTRACT
INTRODUCTION: Prevention of ventilator associated pneumonia (VAP) is the focus in critical care units. Immunocompromised patients, older adults, and postoperative patients are at greater risk for VAP. With the dynamic changes in the empirical world, updated evidence must be used to guide the standard of practice. This literature review assimilates the recent evidence for VAP prevention. METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-analysis framework guided the selection of the included research articles. Medline, EBSCO host, CINAHL, UpToDate and Google Scholar databases explored, for relevant publications between 2010 and 2020. The quality of evidence for the 14 studies selected were rated using the hierarchy of quantitative research designs. RESULTS: Evidence-based VAP preventive strategies are prevention of aspiration, minimizing ventilator days, reducing the pathogen load, safe endotracheal suction practices, and pharmaceutical preventive measures. The mandates for VAP preventive measures among coronavirus disease 2019 (COVID-19) patients is included. CONCLUSION: Though some of these themes identify with the past, the nuances in their implementation are highlights of this review. The review reiterates the need to revisit ambiguous practices implemented for VAP prevention. Adherence to evidence-based practices, by education, training, and reduction of workload is the key to VAP prevention.
Subject(s)
COVID-19 , Pneumonia, Ventilator-Associated , Aged , Humans , Intensive Care Units , Pneumonia, Ventilator-Associated/prevention & control , SARS-CoV-2ABSTRACT
BACKGROUND: Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. OBJECTIVES: This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. METHODS: Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. RESULTS: From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. CONCLUSIONS: COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.