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MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Possible silent hypoxemia HP hypoxemia MESHD in a COVID-19 patient: a case report

    Authors: Siswanto; Munawar Gani; Aditya Rifqi Fauzi; Bagus Nugroho; Denny Agustiningsih; Gunadi

    doi:10.21203/rs.3.rs-58296/v1 Date: 2020-08-12 Source: ResearchSquare

    Background: It has been hypothesized that silent hypoxemia HP hypoxemia MESHD is the cause of the rapid progressive respiratory failure HP respiratory failure MESHD with severe hypoxia MESHD that occurs in some patients with COVID-19 without warning. Here, we reported one COVID-19 case with the possibility of silent hypoxemia HP hypoxemia MESHD. Case presentation: A 60-year-old male TRANS presented with complaints of cough HP that he felt starting two weeks before admission without any breathing difficulty. Complaints were accompanied by fever HP fever MESHD, runny nose and sore throat. Vital signs examination showed blood SERO pressure 130/75 mmHg, pulse 84 times per minute, normal respiratory rate (RR) of 21 times per minute, body temperature 36.5 C, and 99% oxygen saturation with oxygen via nasal cannula 3 liters per minute were recorded. On physical examination, an increase in vesicular sounds and crackles HP in both lungs were identified. Chest x-ray showed bilateral pneumonia HP pneumonia MESHD. Nasopharyngeal and oropharyngeal swab real-time polymerase chain reaction tests for COVID-19 were positive. On the third day of treatment, the patient complained of worsening of shortness of breath MESHD, but his RR was still normal with 22 times per minute. On the fifth day of treatment, the patient experienced severe shortness of breath MESHD with a RR of 38 times per minute. The patient was then intubated and his blood SERO gas analysis showed respiratory alkalosis HP respiratory alkalosis MESHD (pH 7.54, PaO2 58.9 mmHg, PaCO2 31.1 mmHg, HCO3 26.9 mEq/L, SaO2 94.7%). On the eighth day of treatment, his condition deteriorated starting in the morning, with blood SERO pressure 80/40 mmHg with norepinephrine support, pulse 109 times per minute, and 72% SpO2 with ventilator. In the afternoon, the patient experienced cardiac arrest HP cardiac arrest MESHD and underwent basic life support, then resumed strained breathing with return of spontaneous circulation. Blood SERO gas analysis showed severe respiratory acidosis HP respiratory acidosis MESHD (pH 7.07, PaO2 58.1 mmHg, PaCO2 108.9 mmHg, HCO3 32.1 mEq /L, SaO2 78.7%). Three hours later, he suffered cardiac arrest HP cardiac arrest MESHD again, but was unable to be resuscitated. The patient eventually died.Conclusions: Silent hypoxemia HP hypoxemia MESHD might be considered as an early clinical sign of deterioration of patients with COVID-19, thus, the physician may be able to intervene early and decrease its morbidity and mortality.

    Differential ventilation using flow control valves as a potential bridge to full ventilatory support during the COVID-19 crisis

    Authors: Matthew Levin; Martin D Chen; Anjan Shah; Ronak Shah; George Zhou; Erica Kane; Garrett Burnett; Shams Ranginwala; Jonathan Madek; Christopher Gidiscin; Chang Park; Daniel Katz; Benjamin Salter; Roopa Kohli-Seth; James B Eisenkraft; Suzan Uysal; Michael McCarry; Andrew B Leibowitz; David L Reich

    doi:10.1101/2020.04.14.20053587 Date: 2020-04-21 Source: medRxiv

    Background: It has been projected that there will be too few ventilators to meet demand during the COVID-19 (SARS CoV-2) pandemic. Ventilator sharing has been suggested as a crisis standard of care strategy to increase availability of mechanical ventilation. The safety and practicality of shared ventilation in patients is unknown. We designed and evaluated a system whereby one mechanical ventilator can be used to simultaneously ventilate two patients who have different lung compliances using a custom manufactured flow control valve to allow for individual adjustment of tidal volume and airway pressure for each patient. Methods: The system was first evaluated in a simulation lab using two human patient simulators under expected clinical conditions. It was then tested in an observational study of four patients with acute respiratory failure MESHD respiratory failure HP due to COVID-19. Two separately ventilated COVID-19 patients were connected to a single ventilator for one hour. This intervention was repeated in a second pair of patients. Ventilatory parameters (tidal volume, peak airway pressures, compliance) were recorded at five minute intervals during both studys. Arterial blood SERO gases were taken at zero, thirty, and sixty minutes. The primary outcome was maintenance of stable acid-base status and oxygenation during shared ventilation. Results: Two male TRANS and two female TRANS patients, age TRANS range 32-56 yrs, participated. Ideal body weight and driving pressure were markedly different among patients. All patients demonstrated stable physiology and ventilation for the duration of shared ventilation. In one patient tidal volume was increased after 30 minutes to correct a respiratory acidosis HP respiratory acidosis MESHD. Conclusions: Differential ventilation using a single ventilator and a split breathing circuit with flow control valves is possible. A single ventilator could feasibly be used to safely ventilate two COVID-19 patients simultaneously as a bridge to full ventilatory support.

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