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Overview

MeSH Disease

Human Phenotype

Transmission

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Seroprevalence

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    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.

    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.

The ZB MED preprint Viewer preVIEW includes all COVID-19 related preprints from medRxiv and bioRxiv, from ChemRxiv, from ResearchSquare, from arXiv and from Preprints.org and is updated on a daily basis (7am CET/CEST).
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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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