Patients with COVID-19 frequently experience a coagulopathy associated with a high incidence of thrombotic events leading to poor outcomes. Here, biomarkers of coagulation (such as D-dimer, fibrinogen, platelet count), inflammation (such as interleukin-6) and immunity (such as lymphocyte count) as well as clinical scoring systems (such as SOFA, ISTH DIC and SIC score) can be helpful in predicting clinical course, need for hospital resources (such as ICU beds, intubation and ventilator therapy, and ECMO) and patient’s outcome in patients with COVID-19. However, therapeutic options are actually limited to unspecific supportive therapy. Whether viscoelastic testing can provide additional value in predicting clinical course, need for hospital resources and patient’s outcome or in guiding anticoagulation in COVID-19 associated coagulopathy is still incompletely understood and currently under investigation (eg, in the ROHOCO study). This paper summarizes what we know already about COVID-19 associated coagulopathy and – perhaps even more importantly – characterizes important knowledge gaps.
This retrospective observational case series describes a single centre’s preparations and experience of 53 emergency tracheal intubations in patients with COVID-19 respiratory failure. The findings of a contemporaneous online survey exploring technical and nontechnical aspects of airway management, completed by intubation team members, are also presented. Preparations included developing a COVID-19 intubation standard operating procedure and checklist, dedicated airway trolleys, a consultant-led mobile intubation team, and an airway education programme. Tracheal intubation was successful in all patients. Intubation first-pass success rate was 85%, first-line videolaryngoscopy use 79%, oxygen desaturation 49%, and hypotension 21%. Performance was consistent across all clinical areas. The main factor impeding first-pass success was larger diameter tracheal tubes. The majority of intubations was performed by consultant anaesthetists. Nonconsultant intubations demonstrated higher oxygen desaturation rates (75% vs. 45%, p = 0.610 ) and lower first-pass success (0% vs. 92%, p < 0.001 ). Survey respondents (n = 29) reported increased anxiety at the start of the pandemic, with statistically significant reduction as the pandemic progressed (median: 4/5 very high vs. 2/5 low anxiety, p < 0.001 ). Reported procedural/environmental challenges included performing tasks in personal protective equipment (62%), remote-site working (48%), and modification of normal practices (41%)—specifically, the use of larger diameter tracheal tubes (21%). Hypoxaemia was identified by 90% of respondents as the most challenging patient-related factor during intubations. Our findings demonstrate that a consultant-led mobile intubation team can safely perform tracheal intubation in critically ill COVID-19 patients across all clinical areas, aided by thorough preparation and training, despite heightened anxiety levels.
Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus has spread quickly and become a public health emergency of global concern. Originating in the Wuhan district of China, which has reportedly been declared free of it now, the rest of the world continues to struggle with its severity and spread. While a lot of scientific publications and clinical data are available, newer clinical investigations and experiences continue to evolve, thereby depicting the dynamic nature of the disease and the knowledge around it. Researchers and clinical professionals continue to collect scientific information, clinical data, and evidence to help build a knowledge pool and guidance for the health care professionals to manage those affected with this pandemic disease. As significant and new data emerge, a lot of already available information gets confirmed and updated, while some of it also getting rejected or disapproved. In this article, we aim to put together the scientific and clinical information that is proven so far and the areas where more data or evidence is needed before a clear understanding can be achieved and guidance can be developed.
INTRODUCTION AND OBJECTIVE: To assess clinical characteristics and surgical outcomes of triaged patients undergoing oncological and non-oncological surgery during the first wave of Covid-19 crisis.METHODS: We conducted a cohort-controled, nonrandomized, study in a Covid-19 reference centre in south-eastern France. Participants were consecutive surgical patients after triage and application to prevent from Covid-19 (Tab1). Data were collected prospectively during the propagation period from March 15 th to May1 st and compared with control data from outside the Covid-19 period. Primary endpoint was intensive care unit (ICU) admissions for surgery-related complications. Rates of surgery-specific death, postponed operations, positive PCR testing and Clavien-Dindo complications were assessed. Cancer and non-cancer subgroups during Covid-19 were also compared.RESULTS: After triage, 96 of 142 elective surgeries were postponed. Altogether, 71 patients, median age 68 yo [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75], sex ratio M/F of 4/1, had surgery, among whom, 48 (68%) had uro-oncological surgery (Tab 2). No patients developed Covid-19 pneumonia in the post-surgery period. Three (4%) were admitted to the ICU, one of whom died from multi-organ failure due to septic shock caused by klebsiella pneumonia following a delay in treatment. Three Covid-19 RT-PCR were done and all were negative. There was no difference in mortality rates or ICU admission rates between control and Covid-era patients (Tab 3).CONCLUSIONS: Surgery after triage during the Covid-19 pandemic was not associated with worse short-term outcomes. Urological cancers could be operated on safely in our context but delays in care for aggressive genitourinary diseases could be lifethreatening. Altogether, two-thirds of elective surgeries were postponed and now need to be rescheduled, thus increasing the work-load in our centre.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.