SummaryTen healthy volunteers received oxygen for 1 min, 2 min and 3 min at 10 l.min À1 via a face mask, or humidified oxygen at 60 l.min

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Background The ability to forecast the progression and severity of coronavirus disease 2019 (COVID-19) disease is critical for effective management. Objective To determine whether hematological parameters can predict severe COVID-19 at the time of hospital admission. Patients and methods The study was conducted on 298 admitted COVID-19 patients. They were categorized into severe or nonsevere groups. Blood picture was done with analysis of red-cell distribution width (RDW), neutrophil–lymphocyte ratio (NLR), RDW-to-platelet ratio, and platelet–lymphocyte ratio (PLR). Other investigations like D-dimer, ferritin, C-reactive protein, kidney, and liver functions were assessed and compared between the groups. Results Males were predominant in the severe group (65.7%). Compared with the nonsevere group, the severe group had a higher median age (59 vs. 37 years). The severe group showed significantly lower counts for lymphocytes and platelets (P=0.000), while the total leukocytic count and neutrophils were significantly higher compared with the nonsevere group. Also, the severe group showed significantly higher ratios regarding NLR and PLR (P=0.021 and 0.000, respectively). RDW and RDW-to-platelet ratio values were not significantly different between both groups. While assessing the risk factors for severe COVID-19, the highest odds ratio was observed for NLR, odds ratio: 1.954 (confidence interval: 1.404–2.718). A cut-off point of NLR more than 1.67 had high sensitivity 81.3 and 60.2% specificity with high accuracy; area under the curve=0.780. PLR at a cutoff more than 176 showed 70.5% sensitivity and 62% specificity with high accuracy area under the curve=0.760. Conclusion NLR and PLR could be used as simple, readily available, and cost-effective biomarkers predicting the severity of cases of COVID-19. Hematologic parameter values mostly alter amid the course of the illness.

Background High-flow nasal cannula (HFNC) is a device for conveying oxygen therapy. Emerging clinical evidence supports that it may be a compatible alternative for noninvasive ventilation (NIV) in patients with acute hypoxemic respiratory failure (ARF). Objective To compare the outcome of NIV versus HFNC oxygen therapy in preventing escalation to invasive mechanical ventilation in patients with ARF. Patients and methods A randomized controlled trial was conducted. One hundred consecutive patients who had ARF were allocated randomly to HFNC and NIV groups. The patients’ need for endotracheal intubation, dyspnea score, comfort scores, gasometric, in-hospital mortality, and vital sign parameters were the outcome measures. Patients’ baseline characteristics and the serial changes after HFNC or NIV therapy were measured. Results The HFNC group had 18% endotracheal intubation rate and 18% in-hospital mortality versus 50% and 48% for the NIV group (P=0.001). The median values of visual analog scale at 24, 48, 72, and 96 h were lower in the NIV group (P=0.000 for all). The median modified Borg scale at 24, 48, 72, and 96 h was lower in the HFNC group (P=0.00, 0.024, 0.040, and 0.001, respectively). The HFNC group had a significantly lower respiratory rate. Significant differences in baseline vital sign parameters between the NIV and HFNC groups were noticed after 1, 6, 24, and 48 h follow-up. Conclusion Delivering oxygen by HFNC is a new and efficient option for treating adults with ARF. HFNC showed a reduced rate of escalation to invasive mechanical ventilation and in-hospital mortality in comparison to NIV.

Background Transthoracic ultrasound (TUS) can potentially give important complementary information in particular conditions like bedside rapid diagnostic evaluation of dyspneic patients who commonly present to emergency (ER) units. Objective Assessing the significance and diagnostic utility of B-lines and pleural line abnormalities detected on TUS among patients presented to the ER unit for the assessment of dyspnea against high-resolution computed tomography findings. Patients and methods A prospective observational study including 240 consecutive patients was conducted. TUS was done for patients presenting to the ER for the assessment of dyspnea. B-lines and the pleural line were evaluated by a linear and convex transducers. Sonographic findings were reported against high-resolution computed tomography findings, which was considered the gold standard. Results Slightly rough, fringed, irregular, interrupted, wavy, coexistence of more than one abnormal type of pleural line were detected in 30.8%, 35.4%, 19.2%, 17.9%, and 30% of cases, respectively. Warrick score classified patients with interstitial lung disease to mild (44.6%), moderate (36.3%), and severe (19.2%). Diffusing capacity for carbon monoxide (DLCO% predicted) and total lung capacity (TLC% predicted) predicted showed negative correlation with Warrick score (r=−0.66, r=−0.48 respectively, P≤0.001 for both) and positive correlation with distance between B lines (r=0.31 and 0.30 respectively, P≤0.001 for both). Warrick score at a cutoff more than 7 showed 96.3% sensitivity and 64.3% specificity. Distance between B lines at cutoff more than 3 mm had 100% sensitivity and 40.4% specificity. Cutoff more than 3 for B lines number/scan showed 92.6% sensitivity and 31% specificity. Pleural thickness at cutoff more than 2 mm showed 100% sensitivity and 34% specificity. Abolished lung sliding showed 96.3% sensitivity and 50% specificity. Conclusion TUS is an important tool for the diagnosis and assessment of pulmonary disorders. B-lines number and distance, pleural line abnormalities, lung sliding, and pleural thickness added diagnostic value for the ER assessment of dyspneic patients.