Objectives: This study describes three surges of COVID-19 hypoxemic respiratory failure and our experience with using iCPAP in patients with cardiovascular diseases at a tertiary cardiac care centre. Methodology: This observational study was conducted from March 23rd 2020 to May 31st 2021, at The National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. This is an analysis of data from the PRICE Network Registry. Data was collected for all adult patients with cardiovascular diseases admitted with acute hypoxemic respiratory failure and a confirmed diagnosis of SARS CoV-2. Results: Among 362 patients with 'severe’ or 'critical’ COVID-19 were hospitalized; 163 (45%) in the 1st surge, 92 (25.4%) in the 2nd and 107 (29.6 %) in the 3rd surge. All-cause mortality was 118 (32.6%). iCPAP was used in 39% (141) patients, 19% (69) patients required oxygen only, 25.4% (92) were on BiPAP support and 16.6% (60) were intubated. ‘iCPAP failure’ occurred in 48/141 (34%) patients. iCPAP failure occurred in patients with higher APACHE II scores (16.3 ±5.7 v/s 21.3±6, p ≤0.001), lower ROX index on admission (5.0±2.2 vs. 10.4±5.4, p≤0.001), lesser degree of improvement in ROX index at 48 hours (Day 3 ROX 18.7±8.9 vs. 9.9±6.3, p≤0.001). Mortality rate on iCPAP was 44 (31.2%). Conclusion: COVID-19 outcomes in a resource-limited setting in patients having cardiovascular diseases, appear comparable to global reports. A modification of standard CPAP (iCPAP) appeared to be safe and effective. This modification of standard CPAP (iCPAP) identifies an option for resource-limited or resource-exhausted critical care units.

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INTRODUCTION: Delirium has been described as a risk factor for increased mortality and longer stays in the Intensive Care Unit (ICU). There is insufficient information regarding delirium in patients after Acute Coronary Syndrome admitted to the ICU. The objective of this study was to determine the prevalence and the frequency of subtypes (hypoactive and hyperactive) of delirium, identify an at risk phenotype and compute outcomes.