ABSTRACT
BACKGROUND: Hospital-based occupational health (HBOH) is uniquely positioned to not only prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, but to care for healthcare workers (HCWs) sick with coronavirus disease 2019 (COVID-19). AIMS: The primary objective of this study is to describe a system where HBOH services were adapted to provide a monitoring programme whereby HCWs with SARS-CoV-2 received daily evaluations and treatment options in order to improve access to care, and to report the clinical outcomes and predictors of hospitalization in HCWs enrolled in the programme. A secondary objective is to compare clinical outcomes to data on national HCWs with COVID-19. METHODS: This retrospective cohort study used survey data collected on HCWs at a university health system with COVID-19 from 1 March 2020 through 1 December 2021. A firth regression model was used to examine the unadjusted and adjusted association between clinical factors and hospitalization. RESULTS: The study cohort included 4814 HCWs with COVID-19. Overall hospitalizations were 119 (2%), and there were six deaths (0.12%). Predictors of hospitalization include several co-morbidities and symptoms. A total of 1835 HCWs monitored before vaccine or monoclonal antibody availability were compared with data on U.S. HCWs in a similar time period. The monitored HCWs had a lower rate of co-morbidities (19% versus 44%, Pâ <â 0.001), a lower hospitalization rate (3% versus 8% Pâ <â 0.001) and case-fatality rate (0.11% versus 0.95% Pâ <â 0.001). CONCLUSIONS: This monitoring strategy for COVID-19 may be feasible for HBOH systems to implement and improve access to care, but more data are needed to determine if it improves outcomes.
Subject(s)
COVID-19 , Occupational Health , Humans , COVID-19/epidemiology , SARS-CoV-2 , Retrospective Studies , Health PersonnelABSTRACT
OBJECTIVE: To compare tracheal intubation conditions in morbidly obese patients 60 seconds after administration of succinylcholine or rocuronium doses based on real weight or ideal weight. METHOD: We evaluated patients with a body mass index (BMI) of 40 kg x m(-2) or more but no other indications of difficult-intubation risk. Induction was performed under fentanyl and propofol at doses calculated based on real weight. Patients were assigned to 1 of 4 groups for tracheal intubation. Group 1 received 1 mg of succinylcholine per kilogram of ideal weight, group 2 received 1 mg of succinylcholine per kilogram of real weight, group 3 received 0.6 mg of rocuronium per kilogram of ideal weight, and group 4 received 0.6 mg of rocuronium per kilogram of real weight. Tracheal intubation was performed 60 seconds later and intubation conditions were recorded using a clinical scoring system. RESULTS: Eighty patients with a mean BMI of 47.5 kg x m(-2) were enrolled. The difficult intubation rate was 3.75%. All patients were intubated. Laryngoscopy conditions and position and movement of vocal cords were similar in all 4 groups. Reaction to cuff inflation revealed intergroup differences; group 3 presented slight limb movements, diaphragm movement, and sustained cough for more than 10 seconds. CONCLUSION: These results suggest that administration of succinylcholine calculated based on real weight or ideal weight and rocuronium based on real weight can provide clinically acceptable conditions for tracheal intubation in morbidly obese patients with no other difficult-intubation criteria.
Subject(s)
Androstanols/pharmacology , Intubation, Intratracheal , Neuromuscular Depolarizing Agents/pharmacology , Neuromuscular Nondepolarizing Agents/pharmacology , Obesity, Morbid/surgery , Succinylcholine/pharmacology , Vocal Cords/drug effects , Adult , Androstanols/administration & dosage , Body Weight , Cough/chemically induced , Diaphragm/drug effects , Dose-Response Relationship, Drug , Female , Humans , Hypoxia/prevention & control , Intraoperative Complications/etiology , Intraoperative Complications/prevention & control , Male , Middle Aged , Movement/drug effects , Muscle Relaxation/drug effects , Neuromuscular Depolarizing Agents/administration & dosage , Neuromuscular Nondepolarizing Agents/administration & dosage , Respiratory Aspiration/prevention & control , Risk , Rocuronium , Succinylcholine/administration & dosageABSTRACT
OBJETIVOS: Comparar las condiciones de intubacióntraqueal en obesos mórbidos a los 60 segundos, tras laadministración de succinilcolina y rocuronio calculadossegún el peso real o el peso ideal.MÉTODO: Evaluamos pacientes con Índice de MasaCorporal (IMC) igual o superior a 40 kg/m2 y sin otroscriterios de intubación difícil. Inducción con fentanil ypropofol, calculados según el peso real. Asignados a unode cuatro grupos para la intubación traqueal: Grupo I: 1mg.kg1 de succinilcolina según el peso ideal; Grupo II: 1mg.kg1 de succinilcolina según el peso real; Grupo III:0,6 mg.kg1 de rocuronio según el peso ideal y Grupo IV:0,6 mg.kg1 rocuronio según el peso real. 60 segundos después,se realizó la intubación traqueal, con registro de lascondiciones de intubación de acuerdo con escala clínica.RESULTADOS: Se incluyeron 80 pacientes con IMCmedio de 47,5 kg m2. La incidencia de intubación difícilfue de 3,75%. Todos los pacientes fueron intubados. Lascondiciones de laringoscopia, la posición y los movimientosde las cuerdas vocales fueron semejantes en loscuatro grupos. La reacción al insuflado del neumotaponamientomostró diferencias, con desventaja para elGIII, que presentó movimientos leves de los miembros,movimiento diafragmático y tos sostenida durante másde 10 segundos.CONCLUSIÓN: Estos resultados sugieren que la administraciónde succinilcolina calculada según el peso real oel peso ideal y de rocuronio calculado según el peso realpueden ofrecer condiciones clínicamente aceptables parala intubación traqueal en pacientes obesos mórbidos sincriterios de intubación difícil (AU)
OBJETIVE: To compare tracheal intubation conditionsin morbidly obese patients 60 seconds after administrationof succinylcholine or rocuronium doses based onreal weight or ideal weight.METHOD: We evaluated patients with a body massindex (BMI) of 40 kg·m-2 or more but no other indicationsof difficult-intubation risk. Induction was performedunder fentanyl and propofol at doses calculated based onreal weight. Patients were assigned to 1 of 4 groups fortracheal intubation. Group 1 received 1 mg ofsuccinylcholine per kilogram of ideal weight, group 2received 1 mg of succinylcholine per kilogram of realweight, group 3 received 0.6 mg of rocuronium perkilogram of ideal weight, and group 4 received 0.6 mg ofrocuronium per kilogram of real weight. Trachealintubation was performed 60 seconds later and intubationconditions were recorded using a clinical scoring system.RESULTS: Eighty patients with a mean BMI of 47.5kg·m-2 were enrolled. The difficult intubation rate was3.75%. All patients were intubated. Laryngoscopyconditions and position and movement of vocal cordswere similar in all 4 groups. Reaction to cuff inflationrevealed intergroup differences; group 3 presented slightlimb movements, diaphragm movement, and sustainedcough for more than 10 seconds.CONCLUSION: These results suggest that administrationof succinylcholine calculated based on real weightor ideal weight and rocuronium based on real weight canprovide clinically acceptable conditions for trachealintubation in morbidly obese patients with no other difficult-intubation criteria (AU)
