Background and objectivesRecent randomized controlled trials (RCTs) have indicated potential therapeutic benefits with high-dose dexamethasone (HDD) or tocilizumab (TCZ) plus standard care in moderate to severe coronavirus disease 2019 (COVID-19) with acute respiratory distress syndrome (ARDS). No study has compared these two against each other. We aimed to compare the efficacy and safety of HDD against TCZ in moderate to severe COVID-ARDS. MethodsPatients admitted with moderate to severe COVID-19 ARDS with clinical worsening within 48 hours of standard care were randomly assigned to receive either HDD or TCZ plus standard care. The primary outcome was ventilator-free days (VFDs) at 28 days. The main secondary outcomes were 28-day all-cause mortality and the incidence of adverse events. Our initial plan was to perform an interim analysis of the first 42 patients. ResultsVFDs were significantly lower in the HDD arm (median difference: 28 days; 95% confidence interval (CI): 19.35-36.65; Cohen's d = 1.14; p < 0.001). We stopped the trial at the first interim analysis due to high 28-day mortality in the HDD arm (relative risk (RR) of death: 6.5; p = 0.007; NNT (harm) = 1.91). The incidence of secondary infections was also significantly high in the HDD arm (RR: 5.5; p = 0.015; NNT (harm) = 2.33). ConclusionsIn our study population, HDD was associated with a very high rate of mortality and adverse events. We would not recommend HDD to mitigate the cytokine storm in moderate to severe COVID-19 ARDS. TCZ appears to be a much better and safer alternative.

BackgroundSurvivors of COVID-19 pneumonia may have residual lung injury and poor physical and mental health even after discharge. We hypothesized that COVID-19 severe acute respiratory distress syndrome (ARDS) patients needing mechanical ventilation may be at a greater risk of deterioration in pulmonary function, mental health, and quality of life (QOL). This study analyses the differences in pulmonary function, mental health, and QOL after recovery, in patients having received non-invasive oxygen therapy versus invasive mechanical ventilation during ICU stay. MethodsPatients aged >18 years, who had completed 3 months post ICU discharge, with moderate to severe COVID-19 ARDS, were consecutively enrolled from May 1 to July 31, 2021. Patients were allocated into Group Ahaving required high flow nasal cannula (HFNC)/non-invasive ventilation (NIV) and Group B -having received invasive mechanical ventilation. Pulmonary function tests, 6-minute walk test (6-MWT), and health-related quality of life were compared. ResultsOf the 145 eligible patients, 31 were lost to follow-up and 21 died. Seventy-four patients were allocated into Groups A (57 patients) and B (17 patients). In Group A, abnormal forced expiratory volume in first second (FEV 1 ), forced vital capacity (FVC), forced expiratory flow in mid-half of FVC (FEF 25-75 ), and peak expiratory flow rate (PEFR) values were obtained in 27 (47.37%), 43 (75.44%), 11 (19.3%), and 25 (43.86%) patients, and in Group B, in 13 (76.47%), 17 (100%), 1 (5.88%), and 8 (47%) patients, respectively. No patient had abnormal FEV 1 /FVC. All Group B patients had a restrictive pattern in spirometry as compared to 77% in Group A. Group B had a lower arterial partial pressure of oxygen (PaO 2 ) (p=0.0019), % predicted FVC (p<0.0001), % predicted FEV 1 (p=0.001), and 6-MWT distance (p<0.001). The physical component score in the short-form survey 12 questionnaire was higher in group A, p<0.001, whereas the mental component score was comparable. ConclusionsPatients requiring invasive mechanical ventilation (MV) have a greater risk of impaired pulmonary function and reduced QOL post-ICU discharge. This warrants a greater need for following these patients for better rehabilitation.

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Background: Appropriate and cautious doffing is vital to prevent self-contamination and infection from the highly contagious SARS-CoV-2 virus. In current study satisfaction levels of front-line health care workers regarding doffing assisted by a novel real-time remote audio-visual aided approach was assessed.Methods: A questionnaire-based survey was carried out among 158 health care workers. The questionnaire was developed and validated to assess the participants’ satisfaction level regarding the instructions being given remotely for doffing through the real-time remote audio-visual aided technique pertaining to the various facilities available for doffing, remote communication for doffing steps, audio-visual technical issues, rectification of the breach in safety and the level of anxiety.Results: The survey received a 79% response rate. 74.6% of the respondents were highly satisfied. 61.9% agreed on the adequacy of doffing space, 70.9% strongly agreed/agreed regarding the availability of adequate equipment, 78.5% strongly agreed/agreed with the instructions. The overall median (IQR) satisfaction score was 9 (8-10).Conclusions: Real-time remote audio-visual aided doffing approach is a simple, technology-aided strategy that is shown to enhance the satisfaction and motivation of the health care workers. This can potentially help in reducing the number of personnel required in directly monitoring doffing leading to freeing up more people to work with the patients while reducing unnecessary exposure. This translates to effective utilisation of resources. The high satisfaction associated with the use of this system boosts the feasibility of its implementation in every tertiary care setup.

Background Transurethral resection of bladder tumors (TURBT) surgeries requires post‐resection catheterization for continuous irrigation of the bladder. This indwelling catheter is associated with distressing catheter‐related bladder discomfort (CRBD) and increases postoperative pain and agitation. Objectives To prove the hypothesis that transurethral 100 mg lidocaine irrigation at the end of TURBT can reduce the frequency of moderate‐to‐severe postoperative CRBD. Methods 116 patients scheduled for TURBT were screened, 94 were recruited and completed the study. American Society of Anesthesiologists Physical Status I–II adult patients, 20–75 years of age undergoing elective TURBT surgery under general anesthesia were included. Transurethral normal saline with 0.01% lidocaine (100 mg in 1 L NS) was used for irrigation 30 min before the completion of surgery in group L, while only normal saline was used for transurethral irrigation in group N. The main outcomes were frequency of CRBD, pain and patient satisfaction at 0, 1, 2, and 6 h postoperatively. Results A total of 94 patients were analyzed in the study. The incidence of moderate–severe CRBD was significantly lower in group L as compared to group C at 0, 1, and 2 h (65.9% vs. 31.9%, p = 0.01; 31.9% vs. 10.6%, p = 0.012; 21.3% vs. 2.1%, p = 0.004, respectively). At the 6‐h mark, the incidence of CRBD was lower in group L, although this did not achieve statistical significance (6.38% vs. 2.1%; p = 0.613). Conclusion Irrigation with 0.01% lidocaine (100 mg) towards the end of TURBT reduces the incidence of moderate–severe CRBD by 52% and increases patient satisfaction.