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MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Outcomes and risk factors for the survival of COVID-19 related ARDS MESHD patients treated with extracorporeal membrane oxygenation

    Authors: Luyun Wang; Kengquan Chen; Peng Chen; Li Ni; Jiangang Jiang; Daowen Wang

    doi:10.21203/rs.3.rs-58688/v1 Date: 2020-08-13 Source: ResearchSquare

    Background: In current pandemic of COVID-19, approximately 15% to 30% of critically ill COVID-19 patients developed acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD) with a high mortality. Extracorporeal membrane of oxygenation (ECMO) provides direct support for both lung and heart in ARDS MESHD. However, the role of ECMO in COVID-19 related ARDS MESHD was still controversial. The aim of this study was to provide insights into the mortality, intensive care unit (ICU) management, risk factors for mortality, 180-day short term prognosis of the COVID-19 related severe ARDS MESHD patients receiving ECMO treatment. Methods: From Feb 2nd, 2020 to April 27th, 2020, we included adult TRANS COVID-19 related ARDS MESHD patients admitted to intensive care unit in Tongji Hospital. Totally, 53 patients were retrospectively analyzed. They were divided into ECMO (mechanical ventilation with ECMO, n=16) and non-ECMO group (mechanical ventilation, n=37). The primary outcome was all-cause 60-day mortality. The secondary outcomes were complications on ECMO, successful weaning from ECMO, and all-cause 180-day mortality. Results: The all-cause 60-day mortality was 37.5% (6/16) in ECMO group and 86.5% (32/37) in non-ECMO group (HR, 0.196; 95% CI, 0.053-0.721; p=0.014). 10 (62.5%) patients were successfully weaned from ECMO. The all-cause 180-day mortality was 56.3% (9/16) in ECMO group and 33 (89.2%, 33/37) in non-ECMO group (HR, 0.298; 95% CI, 0.130-0.680; p=0.004). All the patients in ECMO group suffered from at least one device-related complication with coagulopathy MESHD (81.3%) being most frequently seen. Up to 180-day follow up after disease onset, the ECMO-treated survivors maintained good quality of life without severe complications or disabilities. Hypercapnia HP Hypercapnia MESHD, thrombopenia MESHD, myocardial injury MESHD and elevation of IL-8 and IL-10 during ECMO treatment were strongly associated with death MESHD.Conclusion: This study showed the COVID-19 patients significantly benefited from ECMO treatment during severe ARDS MESHD, which supported the application of ECMO as an indicated strategy in the management of COVID-19 related ARDS MESHD.

    ECMO Therapy for Critically Ill Coronavirus Disease MESHD 2019 Patients in Wuhan, China: A Retrospective Multicenter Cohort Study

    Authors: Jing Fang; Yue Chen; Ming Hu; Rui Li; Juanjuan Qin; Lin Cheng; Yi He; Yi Li; Qiang Zhou; Daixing Zhou; Jun Chen; Fei Huang; Fang Lei; Bo Yang; Hongping Deng; Yufeng Yuan; Jiahong Xia; Hongliang Li; Chaolin Huang; Song Wan; Xiang Wei

    doi:10.21203/rs.3.rs-53559/v1 Date: 2020-08-04 Source: ResearchSquare

    Background The coronavirus disease MESHD 2019 (COVID-19) pandemic has led to surges in the demand for extracorporeal membrane oxygenation (ECMO) therapy. However, little in-depth evidence is known about the application of ECMO therapy in COVID-19 patients.Methods This retrospective multicenter cohort study included 88 patients who had been diagnosed with COVID-19 and received ECMO therapy at seven designated hospitals in Wuhan, China. The clinical characteristics, laboratory examinations, treatments, and outcomes were extracted from electronic medical records and compared between weaned and non-weaned ECMO patients. The patients were followed until June 30, 2020. Logistic regression analyses were performed to identify the risk factors associated with unsuccessful ECMO weaning. Propensity score matching was used to match patients who received veno-venous ECMO with those who received invasive mechanical ventilation (IMV)-only therapy. The primary endpoint, 120-day all-cause mortality after intensive care unit (ICU) admission during hospitalization, was compared using a mixed-effect Cox model.Results Of 88 patients who received ECMO therapy, 27 and 61 patients were and were not successfully weaned from ECMO, respectively. Additionally, 15, 15, and 65 patients were further weaned from IMV, discharged from hospital, or died during hospitalization, respectively. A lymphocyte count ≤ 0.5 × 109/L and D-dimer concentration > 4 × the upper limit of normal at ICU admission, a peak PaCO2 > 60 mmHg at 24 hours before ECMO initiation, and no tracheotomy performed during the ICU stay were independently associated with lower odds of ECMO weaning. In the propensity score-matched analysis, a mixed-effect Cox model detected a lower hazard ratio for 120-day all-cause mortality after ICU admission during hospitalization in the ECMO group, as compared with the IMV-only group.Conclusion Patients in Wuhan who received ECMO therapy had a relatively high mortality rate. This outcome may be largely attributable to resource-limited situations during the COVID-19 outbreak. In future, the presence of lymphocytopenia MESHD and higher D-dimer concentrations at ICU admission and hypercapnia HP hypercapnia MESHD at 24 hours before ECMO initiation could help to identify patients with a poor prognosis. Moreover, tracheotomy could facilitate weaning from ECMO. Despite the high mortality, ECMO was associated with improved outcomes relative to IMV-only therapy in critically ill COVID-19 patients.

    Risk and impact of using mask on COPD MESHD patients with acute exacerbation during the COVID-19 outbreak: a retrospective study

    Authors: You Mo; DunCan Wei; Qi Mai; Chongyue Chen; Hanguang Yu; Chaowen Jiang; Xuerui Tan

    doi:10.21203/rs.3.rs-39747/v1 Date: 2020-07-01 Source: ResearchSquare

    Background: Chronic Obstructive Pulmonary Disease MESHD COPD MESHD) is an inflammatory airway disease characterized by the presence of expiratory flow limitation. Exacerbations of COPD MESHD are common acute events. During epidemic of COVID-19, concerns have been raised with regard to mask- using because of increasing respiratory resistance. In this study, we aimed to evaluate the relationship between the vital signs , inflammation MESHD index, hypercapnia HP hypercapnia MESHD, hypoxia MESHD and mask-using in AECOPD patients.Methods:This retrospective study was performed at a tertiary hospital, and enrolled 23 patients with AECOPD who were hospitalized three or more times in the respiratory department. Patients in Group C were hospitalized and used masks during the epidemic period of COVID-19. Patient’s data of the previous two hospitalizations from the medical record system divided into group A and group B according to the time sequence. Vital signs, inflammation MESHD index, artery blood SERO gas from medical record system and questionnaires of three hospitalizations in the same patient were collected to perform paired test.Results: Surgical mask using increased the levels of PaCO2 (8.98mm Hg; p = 0.004), HCO3-act (4.1mmol/L; p =0.006), BE (3.01mmol/L; p =0.019) and systolic blood SERO pressure (11.39mm Hg; p = 0.01) in patients with AECOPD compared to last hospitalization. Surgical mask using for 30 to 120 minutes is associated with hypercapnia HP hypercapnia MESHD. There were no significant differences observed between group B and group A without using mask in vital signs, inflammation MESHD index, and artery blood gas MESHD blood SERO gas.Conclusions: In this study, we found that systolic blood SERO pressures and PaCO2, HCO3-act, BE were significantly elevated in AECOPD patients using masks compared to the other groups without masks. In addition,the changes in PaCO2,HCO3-act,BE is closely related to serum SERO chloride concentration. Therefore, it is need to increase awareness and understanding of the use of masks in patients with chronic cardiopulmonary diseases MESHD.

    Experience of N-acetylcysteine airway management in the successful treatment of one case of critical condition with COVID-19

    Authors: Yan Liu; Guoshi Luo; Xin Qian; Chenglin Wu; Yijun Tang; kun lu; Biyu Chen; Elaine Lai-Han Leung; Meifang Wang

    doi:10.21203/rs.3.rs-34193/v1 Date: 2020-06-08 Source: ResearchSquare

    Object: To report the successful diagnosis and treatment of a patient with critical condition of novel coronavirus pneumonia MESHD pneumonia HP (COVID-19) and to summarize its clinical features and airway management experience in successful treatment.Methods: Retrospectively analyzed the successful management of one case of COVID-19 with critical condition combined respiratory failure HP respiratory failure MESHD and discussed the clinical characteristics and airway management of the patient in conjunction with a review of the latest literature.Results: A patient with an anastomotic fistula MESHD after radical treatment of esophageal cancer MESHD and right-side encapsulated pyopneumothorax was admitted with cough HP and dyspnea HP dyspnea MESHD and was diagnosed with novel coronavirus pneumonia MESHD pneumonia HP and malnutrition HP malnutrition MESHD by pharyngeal swab nucleic acid test in combination with chest CT. The patient was treated with antibiotics, antiviral and antibacterial medications, respiratory support, expectorant nebulization, and nutritional support, expressed progressive deterioration. Endotracheal intubation and mechanical ventilation were performed since the onset of the type Ⅱ respiratory failure HP on the 13th day of admission. The patient had persistent refractory hypercapnia HP hypercapnia MESHD after mechanical ventilation. Based on the treatment mentioned above, combined with repeated bronchoalveolar lavage by using N-acetylcysteine ​​(NAC) inhalation solution, the patient's refractory hypercapnia HP hypercapnia MESHD was gradually improved. It was cured and discharged after being given the mechanical ventilation for 26 days as well as 46 days of hospitalization, currently is surviving well.Conclusion: Patients with severe conditions of novel coronavirus pneumonia MESHD pneumonia HP often encounter bacterial infection MESHD in their later illness-stages. They may suffer respiratory failure HP respiratory failure MESHD and refractory hypercapnia HP hypercapnia MESHD that is difficult to improve due to excessive mucus secretion leading to small airway obstruction. In addition to the use of reasonable antibiotics and symptomatic respiratory support and other treatment, timely artificial airway and repeated bronchoalveolar NAC inhalation solution lavage, expectorant and other airway management are essential for such patients.

    Feasibility of non-invasive nitric oxide inhalation in acute hypoxic respiratory failure MESHD respiratory failure HP: potential role during the COVID-19 pandemic

    Authors: Kiran Shekar; Sneha Varkey; George Cornmell; Leanne Parsons; Maneesha Tol; Matthew Siuba; Mahesh Ramanan

    doi:10.1101/2020.05.17.20082123 Date: 2020-05-20 Source: medRxiv

    Acute hypoxemic respiratory failure MESHD respiratory failure HP ( ARF MESHD) is characterized by both lower arterial oxygen and carbon dioxide tensions in the blood SERO. First line treatment for ARF MESHD includes oxygen therapy,intially admininstered non invasively using nasal prongs, high flow nasal cannulae or masks. Invasive mechancial ventilation (IMV) is usually reserved for patients who are unable to maintain their airway, those with worsening hypoxemia HP hypoxemia MESHD, or those who develop respiratory muscle fatigue MESHD fatigue HP and consequent hypercapnia HP hypercapnia MESHD. Inhaled nitric oxide (iNO) gas is known to improve oxygenation in patients with ARF MESHD by manipulating ventilation-perfusion matching. Addition of iNO may potentially alleviate the need for IMV MESHD in selected patients. This article demonstrates the feasibility of this technique based on our experience of patients with hypoxemic ARF MESHD. This technique may also be considered for patients with hypoxic ARF MESHD in setting of COVID-19.

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MeSH Disease
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Transmission
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