We report a case series of seven mechanically ventilated patients with acute respiratory distress syndrome (ARDS) caused by coronavirus disease (COVID-19) who received early treatment with high-dose, short-term systemic corticosteroids to prevent cytokine overproduction. Of the seven patients, four were male and median age was 69 years. They were intubated within seven days after admission when their respiratory status rapidly worsened. At that time, we administered 1000 or 500 mg/day for three days of methylprednisolone intravenously, followed by 1 mg/kg and tapered off. The median duration for the total administration of corticosteroids was 13 days. This high-dose, short-term corticosteroid therapy enabled extubation of the patients within seven days. Many questions on the clinical management of COVID-19 remain unanswered, and data on corticosteroid therapy as a choice of treatment are mixed. We present the clinical course of our cases, review the previous evidence, and discuss management. Case SeriesAt St. Luke's International Hospital in Japan in March 2020, seven were admitted to the ICU with COVID-19-related ARDS when their oxygenation had been deteriorating rapidly. The diagnosis of COVID-19 is made by detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA by real-time polymerase chain reaction. High-flow oxygen therapy such as

Rationale The long-term effects of using a high-flow nasal cannula for chronic hypercapnic respiratory failure caused by chronic obstructive pulmonary disease remain unclear. Objectives To assess whether long-term high-flow nasal cannula use reduces the number of exacerbations and improves other physiological parameters in patients with chronic hypercapnic respiratory failure caused by chronic obstructive pulmonary disease. Methods We enrolled 104 participants (aged ⩾40 yr) with daytime hypercapnia (Global Initiative for Chronic Obstructive Lung Disease stages 2–4) receiving long-term oxygen therapy (⩾16 h/d for ⩾1 mo) and randomly assigned them to high-flow nasal cannula/long-term oxygen therapy and long-term oxygen therapy groups. The primary endpoint was the moderate or severe exacerbation rate. We compared changes from baseline in arterial blood gas values, peripheral oxygen saturation, pulmonary function, health-related quality-of-life scores, and the 6-minute-walk test. Measurements and Main Results High-flow nasal cannula use significantly reduced the rate of moderate/severe exacerbations (unadjusted mean count 1.0 vs. 2.5, a ratio of the adjusted mean count between groups [95% confidence interval] of 2.85 [1.48–5.47]) and prolonged the duration without moderate or severe exacerbations. The median time to first moderate or severe exacerbation in the long-term oxygen therapy group was 25 (14.1–47.4) weeks; this was not reached in the high-flow nasal cannula/long-term oxygen therapy group. High-flow nasal cannula use significantly improved health-related quality of life scores, peripheral oxygen saturation, and specific pulmonary function parameters. No safety concerns were identified. Conclusions A high-flow nasal cannula is a reasonable therapeutic option for patients with stable hypercapnic chronic obstructive pulmonary disease and a history of exacerbations. Clinical trial registered with www.umin/ac.jp (UMIN000028581) and www.clinicaltrials.gov (NCT03282019).

Objectives To determine the prevalence of burnout according to job category after the first wave of COVID‐19 in Japan and to explore its association with certain factors. Methods An online cross‐sectional survey of health care workers (HCWs) from June 15 to July 6, 2020, was conducted at a tertiary hospital in Tokyo, Japan. Demographic characteristics, results of the Japanese version of the Maslach Burnout Inventory‐General Survey, types of anxiety and stress, changes in life and work after the peak of the pandemic, and types of support aimed at reducing the physical or mental burden, were determined. Results Of 672 HCWs, 149 (22.6%) met the overall burnout criteria. Burnout was more prevalent in women (OR, 3.11; 95% CI, 1.45‐6.67, P = .003), anxiety due to unfamiliarity with personal protective equipment (PPE) (OR, 1.98; 95% CI, 1.20‐3.27, P = .007), and decreased sleep duration (OR, 1.96; 95% CI, 1.20‐3.20, P = .008). Conversely, participants who felt that the delivery of COVID‐19‐related information (OR, .608; 95% CI, .371‐.996, P = .048) and PPE education opportunities (OR, .484; 95% CI, .236‐.993, P = .048) and messages of encouragement at the workplace (OR, .584; 95% CI, .352‐.969; p = .037) was helpful experienced less burnout. Conclusions There is a need to focus on the above factors to maintain the mental health of HCWs. The delivery of COVID‐19‐related information and educational interventions for PPE and messages of encouragement at the workplace may be needed to reduce the mental burden.

Background: Corticosteroids have been reported to reduce the mortality rates in patients with coronavirus disease 2019 (COVID-19). Additionally, the role of high-dose methylprednisolone pulse therapy in reducing mortality in critically ill patients has also been documented. The purpose of this study is to identify patients with COVID-19 who are suitable for methylprednisolone pulse therapy.Methods: This was a retrospective study that included patients with COVID-19 receiving methylprednisolone pulse therapy (>250 mg/day for 3 days) with subsequent tapering doses at our hospital between June 2020 and January 2021. We examined the differences in background clinical factors between the surviving group and the deceased group.Results: Of 156 patients that received steroid therapy, 17 received methylprednisolone pulse therapy. Ten patients recovered (surviving group) and seven patients died (deceased group). The median age of the surviving and deceased groups was 64.5 years (range, 57-85) and 79 years (73-90), respectively, with a significant difference (p=0.004). Five of the deceased patients (71%) had developed serious complications associated with the cause of death, including pneumothorax, pneumomediastinum, COVID-19-associated pulmonary aspergillosis, cytomegalovirus infection, and bacteremia. On the other hand, of the 10 survivors, only one elderly person had cytomegalovirus infection and the rest recovered without complications.Conclusion: Administration of methylprednisolone pulse therapy with subsequent tapering may be an effective treatment in patients with COVID-19 up to the age of early 70s; however, severe complications may be seen in elderly patients.

Background Despite being minimally invasive, bronchoscopy does not always result in pathological specimens being obtained. Therefore, we investigated whether virtual bronchoscopic navigation (VBN) findings were associated with the rate of diagnosis of primary lung cancer by bronchoscopy in patients with peripheral lung lesions. Methods This study included patients with suspected malignant peripheral lung lesions who underwent bronchoscopy at St. Luke’s International Hospital between October 2013 and March 2020. Patients diagnosed with primary lung cancer were grouped according to whether their pathology could be diagnosed by bronchoscopy, and their clinical factors were compared. In addition, the distance between the edge of the lesion and the nearest branch (“distance by VBN”) was calculated. The distance by VBN and various clinical factors were compared with the diagnostic rates of primary lung cancer. Results The study included 523 patients with 578 lesions. After excluding 55 patients who underwent multiple bronchoscopies, 381 patients were diagnosed with primary lung cancer. The diagnostic rate by bronchoscopy was 71.1% (271/381). Multivariate analysis revealed that the lesion diameter (odds ratio [OR] 1.107), distance by VBN (OR 0.94) and lesion structure (solid lesion or ground-glass nodule; OR 2.988) influenced the risk of a lung cancer diagnosis. The area under the receiver operating characteristic curve for diagnosis based on lesion diameter and distance by VBN was 0.810. Conclusion The distance by VBN and lesion diameter were predictive of the diagnostic rates of primary lung cancer by bronchoscopy in patients with peripheral lung lesions.