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1.
Dtsch Med Wochenschr ; 146(13-14): 927-932, 2021 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-34256411

RESUMO

Acute COVID-19 pneumonia may result in persistent changes with various imaging and histopathological patterns, including organizing pneumonia and pulmonary fibrosis. In addition, SARS-CoV-2 infection is associated with increased risk of pulmonary vascular endothelialitis and thrombosis. Herein, current findings on pulmonary consequences of COVID-19 with implications for clinical management are summarized based on a selective literature review.


Assuntos
COVID-19/complicações , Pneumonia em Organização Criptogênica/complicações , Pneumonia Viral/complicações , Fibrose Pulmonar/complicações , Doença Aguda , COVID-19/diagnóstico por imagem , COVID-19/terapia , Pneumonia em Organização Criptogênica/diagnóstico por imagem , Pneumonia em Organização Criptogênica/terapia , Seguimentos , Humanos , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/terapia , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/terapia
3.
BMC Emerg Med ; 21(1): 67, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: covidwho-1255904

RESUMO

BACKGROUND: Coronavirus disease highly contagious, is prevalent in all age and sex groups infecting the respiratory system. The present study seeks to investigate the epidemiology and effective factors in mortality of patients with COVID-19 in Ardabil province, northwestern Iran. METHODS: In a retrospective study, the hospitalized patients with laboratory-diagnosed COVID-19 between February to August 2020 were enrolled. The data registration portal was designated according to Iranian Ministry of Health and Medical Education guidelines. In this portal, demographic information, clinical presentation, laboratory and imaging data were registered for patients in all hospitals in the same format. The Hosmer-Lemeshow strategy was used for variable selection in a multiple model. RESULTS: Of the patients involved 2812(50.3%) were male and 150 (2.7%) had contact with a confirmed case of COVID-19 in the last 14 days. Pre-existing comorbidity was reported in 1310 (23.4%) patients. Of all patients, 477(8.5%) died due to COVID-19. the result of the multiple logistic regression model indicated that after adjusting for other factors, higher age (OR = 3.11), fever or chills (OR = 1.61), shortness of breath (OR = 1.82), fatigue (OR = 0.71), headache (OR = 0.64), runny nose (OR = 1.54), Skeletal muscle pain (OR = 1.53), hospitalization (OR = 5.66), and hospitalization in ICU (OR = 5.12) were associated with death. CONCLUSIONS: Hospitalization had the strongest effect on mortality followed by hospitalization in ICU, and higher age. This study showed that having some extra-pulmonary symptoms in contrast with pulmonary symptoms can predict as good prognostic factors.


Assuntos
COVID-19/mortalidade , Hospitalização/estatística & dados numéricos , Pneumonia Viral/mortalidade , Adulto , Distribuição por Idade , Fatores Etários , Idoso , COVID-19/terapia , Comorbidade , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco
4.
Pan Afr Med J ; 38: 273, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1248412

RESUMO

Coronavirus 2019 disease (COVID-19) is a deadly disease that was first seen in Wuhan, China, and primarily affects the respiratory system, but also has different systemic involvements. It has caused 89 million cases and 1.9 million deaths worldwide. COVID-19 positive renal transplant recipients have a higher mortality rate than COVID-19 patients in the normal population. There is no specific treatment and follow-up protocol for COVID-19 infection in transplant recipients. COVID-19 treatment and immunosuppressive therapy choices are controversial. Recently, pulse steroid therapies have been used in cases with severe COVID-19 pneumonia. Convalescent plasma therapy is used limitedly in COVID-19 patients. Our 49-year-old male patient has been a recipient of a renal transplant from a cadaver for 6 years. We aimed to make an additional contribution by presenting our patient to the literature whose COVID-19 PCR-RT test performed in the emergency department due to the complaints of fever, shortness of breath, and cough for five days was positive and had moderate COVID-19 pneumonia in thorax tomography and had serious clinical and radiological improvement after pulsed methylprednisolone and convalescent plasma therapy in the early period.


Assuntos
COVID-19/terapia , Metilprednisolona/administração & dosagem , Pneumonia Viral/terapia , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/tratamento farmacológico , Terapia Combinada , Glucocorticoides/administração & dosagem , Humanos , Imunização Passiva , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/etiologia , Pulsoterapia , Transplantados , Resultado do Tratamento
6.
Saudi Med J ; 42(6): 589-611, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-1257242

RESUMO

Extracorporeal membrane oxygenation (ECMO) is considered as a supportive treatment that provides circulatory and ventilatory support and can be thought off as a bridge to organ recovery. Since 2009, it has been applied as a rescue treatment for patients with severe adult respiratory distress syndrome (ARDS) mainly due to viral causes. In December 2019, several patients presented with a constellation of symptoms of viral pneumonia in China. A new strain of the corona virus family, called COVID-19, has been discovered to be the cause of this severe mysterious illness that was named severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2). This new virus continued to spread across the globe leading to the World Health Organization announcing it as a pandemic in the early 2020. By the end of March 2021, the number of COVID-19 cases worldwide exceeded 126 million cases. In Saudi Arabia, the first confirmed case of COVID-19 was reported in the 2nd March 2020. By the end of March 2021, the total number of confirmed COVID-19 cases in Saudi Arabia is just above 360,000. In anticipation of the need of ECMO for the treatment of patients with SARS­CoV­2 based on the previous Middle East respiratory syndrome coronavirus pandemic experience, the Saudi Extra-Corporeal Life Support (ECLS) chapter that is under the umbrella of the Saudi Critical Care Society (SCCS) convened a working group of ECMO experts. The mission of this group was to formulate a guidance for the use of ECMO as a last resort for patients with severe ARDS, especially with COVID-19 based on available evidence. The ECLS-SCCS chapter wanted to generate a document that can be used to simple guide, with a focus on safety, to provide ECMO service for patients with severe ARDS with a special focus on SARS­CoV­2.


Assuntos
COVID-19/terapia , Oxigenação por Membrana Extracorpórea/métodos , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Síndrome do Desconforto Respiratório/terapia , Adulto , Animais , COVID-19/virologia , Humanos , SARS-CoV-2/isolamento & purificação , Arábia Saudita
7.
Healthc Manage Forum ; 34(4): 205-210, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: covidwho-1261245

RESUMO

During the COVID-19 pandemic, healthcare systems have been under extreme levels of stress due to increases in patient distress and patient deaths. While additional research and public health funding initiatives can alleviate these systemic issues, it is also important to consider the ongoing mental health and well-being of professionals working in healthcare. By surveying healthcare workers working in Canada during the COVID-19 pandemic, we found that there was an elevated level of depressive symptomatology in that population. We also found that when employees were provided with accurate and timely information about the pandemic, and additional protective measures in the workplace, they were less likely to report negative effects on well-being. We recommend that healthcare employers take these steps, as well as providing targeted mental health interventions, in order to maintain the mental health of their employees, which in turn will provide better healthcare at the population level.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Pessoal de Saúde/psicologia , Saúde Mental , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Adulto , Canadá/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/virologia , SARS-CoV-2 , Gestão da Segurança
8.
Ital J Pediatr ; 47(1): 119, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: covidwho-1255950

RESUMO

BACKGROUND: SARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring. MATERIALS AND METHODS: Sixty-five children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs. RESULTS: During the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. One patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days. CONCLUSION: Our experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.


Assuntos
COVID-19/terapia , Continuidade da Assistência ao Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Telefone , Adolescente , Biomarcadores/sangue , COVID-19/epidemiologia , Teste para COVID-19 , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Itália/epidemiologia , Masculino , Alta do Paciente , Pneumonia Viral/virologia , SARS-CoV-2 , Eliminação de Partículas Virais
9.
Am J Manag Care ; 27(6): 234-240, 2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1289744

RESUMO

OBJECTIVES: To determine (1) factors linked to hospitalizations among managed care patients (MCPs), (2) outcome improvement with use of outpatient off-label treatment, and (3) outcome comparison between MCPs and a mirror group. STUDY DESIGN: Retrospective cohort study comparing MCPs with an age- and gender-matched mirror group in Florida from April 1, 2020, to May 31, 2020. METHODS: A total of 38,193 MCPs in a Florida primary care group were monitored for COVID-19 incidence, hospitalization, and mortality. The highest-risk patients were managed by the medical group's COVID-19 Task Force. As part of a population health program, the COVID-19 Task Force contacted patients, conducted medical encounters, and tracked data including comorbidities and medical outcomes. The MCPs enrolled in the medical group were compared with a mirror group from the state of Florida. RESULTS: The mean (SD) age among the MCPs was 67.9 (15.2) years, and 60% were female. Older age and hypertension were the most important factors in predicting COVID-19. Obesity, chronic kidney disease (CKD), and congestive heart failure (CHF) were linked to higher rates of hospitalizations. Patients prescribed off-label outpatient medications had 73% lower likelihood of hospitalization (P < .05). Compared with the mirror group, MCPs had 60% lower COVID-19 mortality (P < .05). CONCLUSIONS: MCPs have risk factors similar to the general population for COVID-19 incidence and progression, including older age, hypertension, obesity, CHF, and CKD. Outpatient treatment with off-label medicines decreased hospitalizations. A comprehensive population health program decreased COVID-19 mortality.


Assuntos
COVID-19/terapia , Programas de Assistência Gerenciada/organização & administração , Pneumonia Viral/terapia , Idoso , COVID-19/mortalidade , Comorbidade , Feminino , Florida/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Uso Off-Label , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
10.
Ital J Pediatr ; 47(1): 119, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078420

RESUMO

BACKGROUND: SARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring. MATERIALS AND METHODS: Sixty-five children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs. RESULTS: During the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. One patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days. CONCLUSION: Our experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.


Assuntos
COVID-19/terapia , Continuidade da Assistência ao Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Telefone , Adolescente , Biomarcadores/sangue , COVID-19/epidemiologia , Teste para COVID-19 , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Itália/epidemiologia , Masculino , Alta do Paciente , Pneumonia Viral/virologia , SARS-CoV-2 , Eliminação de Partículas Virais
11.
Saudi Med J ; 42(6): 589-611, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34078721

RESUMO

Extracorporeal membrane oxygenation (ECMO) is considered as a supportive treatment that provides circulatory and ventilatory support and can be thought off as a bridge to organ recovery. Since 2009, it has been applied as a rescue treatment for patients with severe adult respiratory distress syndrome (ARDS) mainly due to viral causes. In December 2019, several patients presented with a constellation of symptoms of viral pneumonia in China. A new strain of the corona virus family, called COVID-19, has been discovered to be the cause of this severe mysterious illness that was named severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2). This new virus continued to spread across the globe leading to the World Health Organization announcing it as a pandemic in the early 2020. By the end of March 2021, the number of COVID-19 cases worldwide exceeded 126 million cases. In Saudi Arabia, the first confirmed case of COVID-19 was reported in the 2nd March 2020. By the end of March 2021, the total number of confirmed COVID-19 cases in Saudi Arabia is just above 360,000. In anticipation of the need of ECMO for the treatment of patients with SARS­CoV­2 based on the previous Middle East respiratory syndrome coronavirus pandemic experience, the Saudi Extra-Corporeal Life Support (ECLS) chapter that is under the umbrella of the Saudi Critical Care Society (SCCS) convened a working group of ECMO experts. The mission of this group was to formulate a guidance for the use of ECMO as a last resort for patients with severe ARDS, especially with COVID-19 based on available evidence. The ECLS-SCCS chapter wanted to generate a document that can be used to simple guide, with a focus on safety, to provide ECMO service for patients with severe ARDS with a special focus on SARS­CoV­2.


Assuntos
COVID-19/terapia , Oxigenação por Membrana Extracorpórea/métodos , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Síndrome do Desconforto Respiratório/terapia , Adulto , Animais , COVID-19/virologia , Humanos , SARS-CoV-2/isolamento & purificação , Arábia Saudita
12.
Pan Afr Med J ; 38: 273, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34122700

RESUMO

Coronavirus 2019 disease (COVID-19) is a deadly disease that was first seen in Wuhan, China, and primarily affects the respiratory system, but also has different systemic involvements. It has caused 89 million cases and 1.9 million deaths worldwide. COVID-19 positive renal transplant recipients have a higher mortality rate than COVID-19 patients in the normal population. There is no specific treatment and follow-up protocol for COVID-19 infection in transplant recipients. COVID-19 treatment and immunosuppressive therapy choices are controversial. Recently, pulse steroid therapies have been used in cases with severe COVID-19 pneumonia. Convalescent plasma therapy is used limitedly in COVID-19 patients. Our 49-year-old male patient has been a recipient of a renal transplant from a cadaver for 6 years. We aimed to make an additional contribution by presenting our patient to the literature whose COVID-19 PCR-RT test performed in the emergency department due to the complaints of fever, shortness of breath, and cough for five days was positive and had moderate COVID-19 pneumonia in thorax tomography and had serious clinical and radiological improvement after pulsed methylprednisolone and convalescent plasma therapy in the early period.


Assuntos
COVID-19/terapia , Metilprednisolona/administração & dosagem , Pneumonia Viral/terapia , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/tratamento farmacológico , Terapia Combinada , Glucocorticoides/administração & dosagem , Humanos , Imunização Passiva , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/etiologia , Pulsoterapia , Transplantados , Resultado do Tratamento
13.
BMC Emerg Med ; 21(1): 67, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078273

RESUMO

BACKGROUND: Coronavirus disease highly contagious, is prevalent in all age and sex groups infecting the respiratory system. The present study seeks to investigate the epidemiology and effective factors in mortality of patients with COVID-19 in Ardabil province, northwestern Iran. METHODS: In a retrospective study, the hospitalized patients with laboratory-diagnosed COVID-19 between February to August 2020 were enrolled. The data registration portal was designated according to Iranian Ministry of Health and Medical Education guidelines. In this portal, demographic information, clinical presentation, laboratory and imaging data were registered for patients in all hospitals in the same format. The Hosmer-Lemeshow strategy was used for variable selection in a multiple model. RESULTS: Of the patients involved 2812(50.3%) were male and 150 (2.7%) had contact with a confirmed case of COVID-19 in the last 14 days. Pre-existing comorbidity was reported in 1310 (23.4%) patients. Of all patients, 477(8.5%) died due to COVID-19. the result of the multiple logistic regression model indicated that after adjusting for other factors, higher age (OR = 3.11), fever or chills (OR = 1.61), shortness of breath (OR = 1.82), fatigue (OR = 0.71), headache (OR = 0.64), runny nose (OR = 1.54), Skeletal muscle pain (OR = 1.53), hospitalization (OR = 5.66), and hospitalization in ICU (OR = 5.12) were associated with death. CONCLUSIONS: Hospitalization had the strongest effect on mortality followed by hospitalization in ICU, and higher age. This study showed that having some extra-pulmonary symptoms in contrast with pulmonary symptoms can predict as good prognostic factors.


Assuntos
COVID-19/mortalidade , Hospitalização/estatística & dados numéricos , Pneumonia Viral/mortalidade , Adulto , Distribuição por Idade , Fatores Etários , Idoso , COVID-19/terapia , Comorbidade , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco
14.
Healthc Manage Forum ; 34(4): 205-210, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34098760

RESUMO

During the COVID-19 pandemic, healthcare systems have been under extreme levels of stress due to increases in patient distress and patient deaths. While additional research and public health funding initiatives can alleviate these systemic issues, it is also important to consider the ongoing mental health and well-being of professionals working in healthcare. By surveying healthcare workers working in Canada during the COVID-19 pandemic, we found that there was an elevated level of depressive symptomatology in that population. We also found that when employees were provided with accurate and timely information about the pandemic, and additional protective measures in the workplace, they were less likely to report negative effects on well-being. We recommend that healthcare employers take these steps, as well as providing targeted mental health interventions, in order to maintain the mental health of their employees, which in turn will provide better healthcare at the population level.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Pessoal de Saúde/psicologia , Saúde Mental , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Adulto , Canadá/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/virologia , SARS-CoV-2 , Gestão da Segurança
15.
Am J Manag Care ; 27(6): 234-240, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34156216

RESUMO

OBJECTIVES: To determine (1) factors linked to hospitalizations among managed care patients (MCPs), (2) outcome improvement with use of outpatient off-label treatment, and (3) outcome comparison between MCPs and a mirror group. STUDY DESIGN: Retrospective cohort study comparing MCPs with an age- and gender-matched mirror group in Florida from April 1, 2020, to May 31, 2020. METHODS: A total of 38,193 MCPs in a Florida primary care group were monitored for COVID-19 incidence, hospitalization, and mortality. The highest-risk patients were managed by the medical group's COVID-19 Task Force. As part of a population health program, the COVID-19 Task Force contacted patients, conducted medical encounters, and tracked data including comorbidities and medical outcomes. The MCPs enrolled in the medical group were compared with a mirror group from the state of Florida. RESULTS: The mean (SD) age among the MCPs was 67.9 (15.2) years, and 60% were female. Older age and hypertension were the most important factors in predicting COVID-19. Obesity, chronic kidney disease (CKD), and congestive heart failure (CHF) were linked to higher rates of hospitalizations. Patients prescribed off-label outpatient medications had 73% lower likelihood of hospitalization (P < .05). Compared with the mirror group, MCPs had 60% lower COVID-19 mortality (P < .05). CONCLUSIONS: MCPs have risk factors similar to the general population for COVID-19 incidence and progression, including older age, hypertension, obesity, CHF, and CKD. Outpatient treatment with off-label medicines decreased hospitalizations. A comprehensive population health program decreased COVID-19 mortality.


Assuntos
COVID-19/terapia , Programas de Assistência Gerenciada/organização & administração , Pneumonia Viral/terapia , Idoso , COVID-19/mortalidade , Comorbidade , Feminino , Florida/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Uso Off-Label , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
17.
J Investig Med High Impact Case Rep ; 9: 23247096211016228, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1225749

RESUMO

Spontaneous pneumomediastinum is reported in patients with coronavirus disease-2019 (COVID-19) and influenza infection independently, usually associated with noninvasive and mechanical ventilation. We report a case of spontaneous pneumomediastinum in a patient with COVID-19 and influenza coinfection. A 58-year-old male admitted with shortness of breath, diagnosed with COVID-19 and influenza infection. A computed tomography angiogram showed pneumomediastinum. He was treated conservatively with 15 L of oxygen, remdesivir, convalescent plasma, and oseltamivir. The case is being reported for its uniqueness since this is the first documented case of spontaneous pneumomediastinum in COVID-19 and influenza coinfection.


Assuntos
COVID-19/complicações , Influenza Humana/complicações , Enfisema Mediastínico/virologia , Pneumonia Viral/complicações , Antivirais/uso terapêutico , COVID-19/diagnóstico , COVID-19/terapia , Coinfecção , Terapia Combinada , Quimioterapia Combinada , Humanos , Imunização Passiva , Influenza Humana/diagnóstico , Influenza Humana/terapia , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/terapia , Pessoa de Meia-Idade , Oxigenoterapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , SARS-CoV-2
18.
Semin Dial ; 34(3): 257-262, 2021 05.
Artigo em Inglês | MEDLINE | ID: covidwho-1221637

RESUMO

The COVID-19 pandemic significates an enormous number of patients with pneumonia that get complicated with severe acute respiratory distress syndrome (ARDS), some of them with refractory hypercapnia and hypoxemia that need mechanical ventilation (MV). Those patients who are not candidate to extracorporeal membrane oxygenation (ECMO), the extracorporeal removal of CO2 (ECCO2 R) can allow ultra protective MV to limit the transpulmonary pressures and avoid ventilatory induced lung injury (VILI). We report a first case of prolonged ECCO2 R support in 38 year male with severe COVID-19 pneumonia refractory to conventional support. He was admitted tachypneic and oxygen saturation 71% without supplementary oxygen. The patient's clinical condition worsens with severe respiratory failure, increasing the oxygen requirement and initiating MV in the prone position. After 21 days of protective MV, PaCO2 rise to 96.8 mmHg, making it necessary to connect to an ECCO2 R system coupled continuous veno-venous hemodialysis (CVVHD). However, due to the lack of availability of equipment in the context of the pandemic, a pediatric gas exchange membrane adapted to CVVHD allowed to maintain the removal of CO2 until completing 27 days, being finally disconnected from the system without complications and with a satisfactory evolution.


Assuntos
COVID-19/terapia , Dióxido de Carbono/metabolismo , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Terapia de Substituição Renal , Insuficiência Respiratória/terapia , Insuficiência Respiratória/virologia , Adulto , Humanos , Masculino , Pandemias , SARS-CoV-2
19.
Ren Fail ; 43(1): 911-918, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: covidwho-1246489

RESUMO

BACKGROUND: Early reports indicate that AKI is common during COVID-19 infection. Different mortality rates of AKI due to SARS-CoV-2 have been reported, based on the degree of organic dysfunction and varying from public to private hospitals. However, there is a lack of data about AKI among critically ill patients with COVID-19. METHODS: We conducted a multicenter cohort study of 424 critically ill adults with severe acute respiratory syndrome (SARS) and AKI, both associated with SARS-CoV-2, admitted to six public ICUs in Brazil. We used multivariable logistic regression to identify risk factors for AKI severity and in-hospital mortality. RESULTS: The average age was 66.42 ± 13.79 years, 90.3% were on mechanical ventilation (MV), 76.6% were at KDIGO stage 3, and 79% underwent hemodialysis. The overall mortality was 90.1%. We found a higher frequency of dialysis (82.7% versus 45.2%), MV (95% versus 47.6%), vasopressors (81.2% versus 35.7%) (p < 0.001) and severe AKI (79.3% versus 52.4%; p = 0.002) in nonsurvivors. MV, vasopressors, dialysis, sepsis-associated AKI, and death (p < 0.001) were more frequent in KDIGO 3. Logistic regression for death demonstrated an association with MV (OR = 8.44; CI 3.43-20.74) and vasopressors (OR = 2.93; CI 1.28-6.71; p < 0.001). Severe AKI and dialysis need were not independent risk factors for death. MV (OR = 2.60; CI 1.23-5.45) and vasopressors (OR = 1.95; CI 1.12-3.99) were also independent risk factors for KDIGO 3 (p < 0.001). CONCLUSION: Critically ill patients with SARS and AKI due to COVID-19 had high mortality in this cohort. Mortality was largely determined by the need for mechanical ventilation and vasopressors rather than AKI severity.


Assuntos
Injúria Renal Aguda/terapia , Injúria Renal Aguda/virologia , COVID-19/complicações , Estado Terminal , Diálise Renal , Injúria Renal Aguda/mortalidade , Idoso , Brasil/epidemiologia , COVID-19/mortalidade , COVID-19/terapia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
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