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1.
Ars pharm ; 61(2): 63-79, abr.-jun. 2020. tab, ilus, graf
Artículo en Español | IBECS | ID: ibc-188101

RESUMEN

INTRODUCCIÓN: En diciembre de 2019, se detectaron los primeros casos de enfermedad respiratoria causada por un coronavirus emergente, al que se denominó SARS-CoV-2, que en los primeros meses de 2020 se ha extendido por todo el mundo con características de pandemia. MÉTODO: Se examinaron las publicaciones más relevantes en relación con los objetivos de la revisión. RESULTADOS: La enfermedad, conocida como COVID-19, cursa con tos, fiebre y dificultad respiratoria. Las formas más graves, que afectan principalmente a personas de edad avanzada y con determinadas comorbilidades, se manifiestan por afectación de la función respiratoria, que requiere ventilación mecánica, y síndrome de respuesta inflamatoria sistémica, que puede conducir a un choque séptico con fallo multiorgánico, y altas tasas de mortalidad. En esta revisión se examina el estado actual de conocimientos sobre las características y origen del SARS-CoV-2, su replicación, y la patogénesis, clínica, diagnóstico, tratamiento y prevención de COVID-19. CONCLUSIONES: Las características del SARS-CoV-2 y la clínica de COVID-19 son bien conocidas. La PCR es la técnica de referencia para el diagnóstico de laboratorio; se dispone de ensayos para detección de antígenos y de anticuerpos, con margen de optimización. Los protocolos de tratamiento incluyen la corrección de la respuesta inflamatoria sistémica y administración de agentes antivirales. Existen vacunas en desarrollo


INTRODUCTION: In December 2019, the first cases of respiratory disease caused by an emerging coronavirus were detected. The causative agento f the outbreak was called SARS-CoV-2, and in the first months of 2020 it spread throughout the world as a pandemic. METHOD: The most relevant publications concerned with the aims of the review were examined. RESULTS: The disease, known as COVID-19. Patients show cough, fever, and respiratory distress. The most severe forms, mainly affecting the elderly and associated with various comorbidities, are manifested by impaired respiratory function, requiring mechanical ventilation, and systemic inflammatory response syndrome, which can lead to septic shock with multi-organ failure and high mortality rates. This review examines the current state of knowledge about the characteristics and origin of SARS-CoV-2, its replication, and the pathogenesis, clinical, diagnosis, treatment, and prevention of COVID-19. CONCLUSIONS: The characteristics of SARS-CoV-2 and the clinical manifestations of COVID-19 are well known. PCR is the reference technique for laboratory diagnosis; assays for the detection of antigens and antibodies are available, with optimization possibilities. Treatment protocols include attenuation of the systemic inflammatory response and administration of antiviral agents. There are vaccines in development


Asunto(s)
Humanos , Infecciones por Coronavirus , Neumonía Viral , Betacoronavirus/patogenicidad , Pandemias , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Neumonía Viral/terapia
2.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-47374

RESUMEN

Este mapa apresenta uma visão geral da evidência sobre a aplicação das MTCI com base na caracterização de 125 estudos de revisão e estudos clínicos controlados, distribuídos em uma matriz com 57 intervenções sobre uma série de desfechos clínicos agrupados em 3 categorias: Melhora da imunidade/efeito antiviral para vírus respiratórios; Manejo complementar dos sintomas de infecções respiratórias; e Contribuições à Saúde Mental/Emocional em situações de trauma. As intervenções representam especialmente medicamentos fitoterápicos, medicina e terapias tradicionais chinesas, terapias mente-corpo como meditação e yoga, probióticos e outros suplementos nutricionais além de formulações dinamizadas da homeopatia.


Asunto(s)
Betacoronavirus , Neumonía Viral/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Resultado del Tratamiento , Medicina Basada en la Evidencia/métodos , Medicina China Tradicional/métodos
3.
Recurso de Internet en Español | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-47375

RESUMEN

Este mapa presenta una visión general sobre posibles contribuciones de las MTCI a varias dimensiones de la pandemia por COVID-19. Dichas contribuciones se organizaron en tres categorías: Mejora de la inmunidad y efecto antiviral ante diferentes virus respiratorios; tratamiento complementario de los síntomas de las infecciones respiratorias; y salud mental en situaciones de crisis. Para el mapa se caracterizaron 125 estudios de revisión y estudios clínicos controlados, distribuidos en una matriz con 57 intervenciones para las tres categorías mencionadas. Las intervenciones representan especialmente medicinas herbales/ fitoterapia, medicina tradicional china, terapias de cuerpo-mente como la meditación y el yoga, probióticos y otros suplementos nutricionales además de formulaciones de homeopatía.


Asunto(s)
Betacoronavirus , Neumonía Viral/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Resultado del Tratamiento , Medicina Basada en la Evidencia/métodos , Medicina China Tradicional/métodos
4.
Recurso de Internet en Inglés | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-47376

RESUMEN

This map presents an overview of the evidence on the application of TCIM based on the characterization of 125 review studies and controlled clinical studies distributed in a matrix with 57 interventions on a series of clinical outcomes grouped into 3 major categories: Improved immunity/antiviral effect for respiratory viruses; Complementary management of symptoms of respiratory infections; and Mental health. The interventions represent especially herbal medicines, traditional Chinese medicine and therapies, mind-body therapies like meditation and yoga, probiotics and other nutritional supplements besides homeopathy formulations.


Asunto(s)
Betacoronavirus , Neumonía Viral/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Resultado del Tratamiento , Medicina Basada en la Evidencia/métodos , Medicina China Tradicional/métodos
5.
Euro Surveill ; 25(17)2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32372754

RESUMEN

We analysed the first 84 coronavirus disease (COVID-19) patients hospitalised in an infectious and tropical disease unit in Florence, Italy, over 30 days after the start of the COVID-19 outbreak in Italy. A 12% reduction in the rate of intensive care unit transfer was observed after the implementation of intensity care measures in the regular ward such as increasing the nurse/patient ratio, presence of critical care physicians and using high flow nasal cannulae oxygenation.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Coronavirus , Unidades de Cuidados Intensivos/organización & administración , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Distribución por Edad , Anciano , Betacoronavirus , Cánula , Estudios de Cohortes , Comorbilidad , Trazado de Contacto , Infecciones por Coronavirus/diagnóstico , Cuidados Críticos , Brotes de Enfermedades , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Transferencia de Pacientes , Neumonía Viral/diagnóstico , Unidades de Cuidados Respiratorios , Distribución por Sexo , Resultado del Tratamiento
7.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(5): 484-485, 2020 May 06.
Artículo en Chino | MEDLINE | ID: mdl-32388946

RESUMEN

At present, the prevention and control of COVID-19 in China has entered a critical period. Recently, various areas outside Hubei Province have gradually begun to resume work and production, but the development of the epidemic situation is still uncertain and complex. A few days ago, researchers gradually began to pay attention to asymptomatic infection of 2019-novel coronavirus and described the disease process of asymptomatic infection and the possibility of being a source of infection. This provided a scientific basis for further optimizing and improving epidemic prevention and control measures. Paying attention to the screening and self-protection of high-risk groups and strengthening the level of detection should be helpful to the detection and management of asymptomatic infection.


Asunto(s)
Infecciones Asintomáticas , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Betacoronavirus , China , Control de Enfermedades Transmisibles , Humanos , Tamizaje Masivo , Pandemias
8.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(2): 147-157, 2020 May 25.
Artículo en Chino | MEDLINE | ID: mdl-32391658

RESUMEN

The current epidemic situation of coronavirus disease 2019 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 in Zhejiang province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance" strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinary personalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in 10%patients' blood samples at acute period and 50%of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifying cytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance" strategy effectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviral effects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favored the balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short period of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbial dysbiosis with decreased probiotics such as Lactobacillus and Bifidobacterium, so nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore,we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.


Asunto(s)
Infecciones por Coronavirus , Manejo de la Enfermedad , Pandemias , Neumonía Viral , Betacoronavirus/aislamiento & purificación , China/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Diagnóstico Precoz , Heces/virología , Humanos , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Neumonía Viral/virología , Esputo/virología
9.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(2): 209-214, 2020 May 25.
Artículo en Chino | MEDLINE | ID: mdl-32391666

RESUMEN

OBJECTIVE: To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of coronavirus disease 2019 (COVID-19). METHODS: The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Municipal Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed. RESULTS: In the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged. There was no cross-infection occurred in suspected patients during the hospitalization. There were no deaths and no medical staff infections. CONCLUSIONS: The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved with MDT, particularly for complicated cases.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Comunicación Interdisciplinaria , Pandemias , Grupo de Atención al Paciente , Neumonía Viral , Betacoronavirus/aislamiento & purificación , China , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Humanos , Grupo de Atención al Paciente/normas , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Estudios Retrospectivos , Resultado del Tratamiento
10.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(2): 232-239, 2020 May 25.
Artículo en Chino | MEDLINE | ID: mdl-32391670

RESUMEN

Acute respiratory failure due to acute hypoxemia is the major manifestation in severe coronavirus disease 2019 (COVID-19). Rational and effective respiratory support is crucial in the management of COVID-19 patients. High-flow nasal cannula (HFNC) has been utilized widely due to its superiority over other non-invasive respiratory support techniques. To avoid HFNC failure and intubation delay, the key issues are proper patients, timely application and improving compliance. It should be noted that elder patients are vulnerable for failed HFNC. We applied HFNC for oxygen therapy in severe and critical ill COVID-19 patients and summarized the following experiences. Firstly, to select the proper size of nasal catheter, to locate it at suitable place, and to confirm the nose and the upper respiratory airway unobstructed. Secondly, an initial ow of 60 L/min and 37℃ should be given immediately for patients with obvious respiratory distress or weak cough ability; otherwise, low-level support should be given first and the level gradually increased. Thirdly, to avoid hypoxia or hypoxemia, the treatment goal of HFNC should be maintained the oxygen saturation (SpO2) above 95% for patients without chronic pulmonary disease. Finally, patients should wear a surgical mask during HFNC treatment to reduce the risk of virus transmission through droplets or aerosols.


Asunto(s)
Infecciones por Coronavirus/terapia , Oxígeno , Neumonía Viral/terapia , Anciano , Betacoronavirus/aislamiento & purificación , Cánula , Humanos , Oxígeno/administración & dosificación , Pandemias
11.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(2): 245-248, 2020 May 25.
Artículo en Chino | MEDLINE | ID: mdl-32391672

RESUMEN

OBJECTIVE: To explore the feasibility of radical resection for cancer patients complicated with coronavirus disease 2019 (COVID-19). METHODS: The management and clinical outcome of a sigmoid cancer patient with COVID-19 were analyzed. RESULTS: The inflammation indicators and fever of this patient were effectively controlled and the lung lesions remained stable after active anti-viral treatment, then the radical colorectomy was performed after the viral negative conversion for twice. CONCLUSIONS: The case indicates that radical resection can be performed in SARS-CoV-2 patients with twice-negative SARS-CoV-2 nucleic acid testing results.


Asunto(s)
Neoplasias del Colon , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Betacoronavirus/aislamiento & purificación , Neoplasias del Colon/complicaciones , Neoplasias del Colon/cirugía , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Manejo de la Enfermedad , Humanos , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Resultado del Tratamiento
12.
Mil Med Res ; 7(1): 22, 2020 05 05.
Artículo en Inglés | MEDLINE | ID: mdl-32370766

RESUMEN

The coronavirus disease (COVID-19) pandemic has led to a global struggle to cope with the sheer numbers of infected persons, many of whom require intensive care support or eventually succumb to the illness. The outbreak is managed by a combination of disease containment via public health measures and supportive care for those who are affected. To date, there is no specific anti-COVID-19 treatment. However, the urgency to identify treatments that could turn the tide has led to the emergence of several investigational drugs as potential candidates to improve outcome, especially in the severe to critically ill. While many of these adjunctive drugs are being investigated in clinical trials, professional bodies have attempted to clarify the setting where the use of these drugs may be considered as off-label or compassionate use. This review summarizes the clinical evidence of investigational adjunctive treatments used in COVID-19 patients as well as the recommendations of their use from guidelines issued by international and national organizations in healthcare.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Guías de Práctica Clínica como Asunto , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Humanos , Inmunización Pasiva , Pandemias , Neumonía Viral/diagnóstico , Índice de Severidad de la Enfermedad
13.
BMJ ; 369: m1642, 2020 May 05.
Artículo en Inglés | MEDLINE | ID: mdl-32371466

RESUMEN

OBJECTIVE: To examine the psychological effects on clinicians of working to manage novel viral outbreaks, and successful measures to manage stress and psychological distress. DESIGN: Rapid review and meta-analysis. DATA SOURCES: Cochrane Central Register of Controlled Trials, PubMed/Medline, PsycInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to late March 2020. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Any study that described the psychological reactions of healthcare staff working with patients in an outbreak of any emerging virus in any clinical setting, irrespective of any comparison with other clinicians or the general population. RESULTS: 59 papers met the inclusion criteria: 37 were of severe acute respiratory syndrome (SARS), eight of coronavirus disease 2019 (covid-19), seven of Middle East respiratory syndrome (MERS), three each of Ebola virus disease and influenza A virus subtype H1N1, and one of influenza A virus subtype H7N9. Of the 38 studies that compared psychological outcomes of healthcare workers in direct contact with affected patients, 25 contained data that could be combined in a pairwise meta-analysis comparing healthcare workers at high and low risk of exposure. Compared with lower risk controls, staff in contact with affected patients had greater levels of both acute or post-traumatic stress (odds ratio 1.71, 95% confidence interval 1.28 to 2.29) and psychological distress (1.74, 1.50 to 2.03), with similar results for continuous outcomes. These findings were the same as in the other studies not included in the meta-analysis. Risk factors for psychological distress included being younger, being more junior, being the parents of dependent children, or having an infected family member. Longer quarantine, lack of practical support, and stigma also contributed. Clear communication, access to adequate personal protection, adequate rest, and both practical and psychological support were associated with reduced morbidity. CONCLUSIONS: Effective interventions are available to help mitigate the psychological distress experienced by staff caring for patients in an emerging disease outbreak. These interventions were similar despite the wide range of settings and types of outbreaks covered in this review, and thus could be applicable to the current covid-19 outbreak.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Personal de Salud/psicología , Pandemias , Neumonía Viral , Cuarentena/psicología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Femenino , Humanos , Masculino , Neumonía Viral/epidemiología , Neumonía Viral/terapia
14.
Anaesthesist ; 69(5): 323-330, 2020 05.
Artículo en Alemán | MEDLINE | ID: mdl-32350543

RESUMEN

Due to the current COVID-19 pandemic there is a need for a rapid increase in intensive care and ventilation capacities. Delivery times for additional intensive care respirators are currently not foreseeable. An option to increase ventilation capacities not only for COVID-19, but for all patients requiring mechanical ventilation is to use home respirators. Home respirators are turbine respirators, so they can usually be operated without high-pressure oxygen connections and can therefore also be used in areas outside the classical intensive care medical infrastructure. Due to their limited technical features, home respirators are not suitable for the treatment of severely affected patients but can be used for weaning after respiratory improvement, which means that intensive care respirators are available again more quickly. Respiratory therapists are specially trained nurses or therapists in the field of out of hospital ventilation and can independently use home ventilation respirators, for example for weaning in the intensive care unit. Thus, they relieve intensive care nursing staff in the pandemic. Due to the COVID-19 pandemic medical students from the Oldenburg University are currently being trained in operating home respirators to provide basic support in the hospital if necessary.


Asunto(s)
Infecciones por Coronavirus , Servicios de Atención de Salud a Domicilio , Pandemias , Neumonía Viral , Ventiladores Mecánicos , Betacoronavirus , Creación de Capacidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Educación Médica , Humanos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Índice de Severidad de la Enfermedad , Estudiantes de Medicina , Desconexión del Ventilador
16.
Artículo en Inglés | MEDLINE | ID: mdl-32370275

RESUMEN

The number of COVID-19 (Coronavirus Disease of 2019) cases in Jordan is rising rapidly. A serious threat to the healthcare system appears on the horizon. Our study aims to evaluate preparedness of Jordanian frontline doctors to the worsening scenario. It has a questionnaire-based cross-sectional structure. The questionnaire was designed to evaluate preparedness according to knowledge about virus transmission and protective measures, adherence to protection guidelines, and psychological impacts affecting doctors. Institutional factors affecting doctors' readiness like adopting approach protocols and making protection equipment available were investigated; 308 doctors from different healthcare facilities participated (response rate: 53.9%). Approximately 25% of doctors (n = 77) previously took care of COVID-19 patients, and 173 (56.2%) have institutional COVID-19 approach protocols. Only 57 doctors (18.5%) reported all PPE (Personal Protective Equipment) available. The self-reported score of preparedness to deal with COVID-19 patients was 4.9 ± 2.4. Doctors having institutional protocols for dealing with COVID-19 cases and those with sustained availability of PPE reported higher scores of preparedness (5.5 ± 2.3 and 6.2 ± 2.1 with p < 0.001, respectively). Correlations with knowledge score, adherence to PPE score, and psychological impacts were investigated. The study revealed multiple challenges and insufficiencies that can affect frontline doctors' preparedness. Policy makers are urged to take these findings into consideration and to act promptly.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Brotes de Enfermedades , Conocimientos, Actitudes y Práctica en Salud , Médicos/psicología , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Adulto , Estudios Transversales , Femenino , Instituciones de Salud , Humanos , Jordania/epidemiología , Masculino , Pandemias , Equipo de Protección Personal/provisión & distribución , Médicos/estadística & datos numéricos , Encuestas y Cuestionarios
17.
Crit Care ; 24(1): 198, 2020 05 06.
Artículo en Inglés | MEDLINE | ID: mdl-32375845

RESUMEN

In December 2019, an outbreak of coronavirus disease 2019 (COVID-19) was identified in Wuhan, China. The World Health Organization (WHO) declared this outbreak a significant threat to international health. COVID-19 is highly infectious and can lead to fatal comorbidities especially acute respiratory distress syndrome (ARDS). Thus, fully understanding the characteristics of COVID-19-related ARDS is conducive to early identification and precise treatment. We aimed to describe the characteristics of COVID-19-related ARDS and to elucidate the differences from ARDS caused by other factors. COVID-19 mainly affected the respiratory system with minor damage to other organs. Injury to the alveolar epithelial cells was the main cause of COVID-19-related ARDS, and endothelial cells were less damaged with therefore less exudation. The clinical manifestations were relatively mild in some COVID-19 patients, which was inconsistent with the severity of laboratory and imaging findings. The onset time of COVID-19-related ARDS was 8-12 days, which was inconsistent with ARDS Berlin criteria, which defined a 1-week onset limit. Some of these patients might have a relatively normal lung compliance. The severity was redefined into three stages according to its specificity: mild, mild-moderate, and moderate-severe. HFNO can be safe in COVID-19-related ARDS patients, even in some moderate-severe patients. The more likely cause of death is severe respiratory failure. Thus, the timing of invasive mechanical ventilation is very important. The effects of corticosteroids in COVID-19-related ARDS patients were uncertain. We hope to help improve the prognosis of severe cases and reduce the mortality.


Asunto(s)
Lesión Pulmonar Aguda/diagnóstico por imagen , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Síndrome de Dificultad Respiratoria del Adulto/diagnóstico por imagen , Síndrome de Dificultad Respiratoria del Adulto/terapia , Lesión Pulmonar Aguda/epidemiología , Lesión Pulmonar Aguda/terapia , Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Creatina Quinasa/sangre , Femenino , Humanos , L-Lactato Deshidrogenasa/sangre , Masculino , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Radiografía , Respiración Artificial , Síndrome de Dificultad Respiratoria del Adulto/clasificación , Síndrome de Dificultad Respiratoria del Adulto/epidemiología , Índice de Severidad de la Enfermedad , Factores de Tiempo
20.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(3): 337-341, 2020 Mar 30.
Artículo en Chino | MEDLINE | ID: mdl-32376592

RESUMEN

OBJECTIVE: To analyze the clinical characteristics of patients with severe or critical coronavirus disease 2019 (COVID-19) receiving tracheal intubation. METHODS: We analyzed clinical characteristics of 18 severely or critically ill patients with COVID-19 undergoing tracheal intubation. The general demographic and clinical data of the patients including their age, gender, pre- intubation state of consciousness and the ventilation mode were recorded. The anesthesiologists performing the tracheal intubation procedure evaluated and recorded the tracheal intubation conditions of the patients. The changes in the vital signs of the patients before anesthesia induction and after intubation were recorded. RESULTS: The average ages of these patients were 70.39±8.02 years. Fifteen patients (83.33%) received non- invasive ventilation before tracheal intubation, and 13 patients (72.22%) were conscious before tracheal intubation. After induction of anesthesia, the blood pressure and heart rate of the patients decreased significantly (P < 0.05). Most of the patients (94.44%) were in excellent or good conditions for tracheal intubation, and the first-attempt success rate of tracheal intubation was 100%. Five patients died within 3 weeks following the intubation. Tracheotomy was performed in one patient. Twelve patients were still on endotracheal mechanical ventilation in the intensive care unit, and one of them received ECMO treatment due to poor oxygenation. A total of 16 experienced anesthesiologists participated in tracheal intubation, all with third-level protection during the operation, and no medical staff infection has been detected so far. CONCLUSIONS: For patients with severe and critical COVID-19 and indications of tracheal intubation, we recommend early intubation with invasive respiratory support to improve the treatment efficacy and reduce the mortality. Anesthetic agents should be used carefully during tracheal intubation to ensure patients' safety. The medical staff should have a high-level protection during the intubation to maximally ensure their safety.


Asunto(s)
Infecciones por Coronavirus/terapia , Intubación Intratraqueal , Neumonía Viral/terapia , Anciano , Betacoronavirus , Humanos , Persona de Mediana Edad , Pandemias
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