Global lessons learned from COVID-19 mass casualty incidents

Schultz, Marcus J.; Roca, Oriol; Shrestha, Gentle Sunder

doi:10.1016/j.bja.2021.10.040

Cited by 8 publications

(7 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Oxygen consumption has been an important issue during the COVID19 pandemic [ 32 ]. Some strategies aiming to reduce the oxygen consumption have been used, such as using more conservative or lower oxygen targets, the use of oxygen-saving systems or oxygen concentrators, such as the Double-Trunk Mask, which, placed over a low-flow oxygen mask, may decrease the total oxygen flow required [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…The fact that no significant difference in total oxygen consumption was found might be explained by our relatively short recording time and the fact that the study was underpowered to detect differences in this particular outcome. Thus, it seems reasonable to think closed-loop oxygen control system might be a way to spare oxygen, especially in high oxygen-demand periods such as COVID-19 [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study)

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background We aimed to assess the efficacy of a closed-loop oxygen control in critically ill patients with moderate to severe acute hypoxemic respiratory failure (AHRF) treated with high flow nasal oxygen (HFNO). Methods In this single-centre, single-blinded, randomized crossover study, adult patients with moderate to severe AHRF who were treated with HFNO (flow rate ≥ 40 L/min with FiO2 ≥ 0.30) were randomly assigned to start with a 4-h period of closed-loop oxygen control or 4-h period of manual oxygen titration, after which each patient was switched to the alternate therapy. The primary outcome was the percentage of time spent in the individualized optimal SpO2 range. Results Forty-five patients were included. Patients spent more time in the optimal SpO2 range with closed-loop oxygen control compared with manual titrations of oxygen (96.5 [93.5 to 98.9] % vs. 89 [77.4 to 95.9] %; p < 0.0001) (difference estimate, 10.4 (95% confidence interval 5.2 to 17.2). Patients spent less time in the suboptimal range during closed-loop oxygen control, both above and below the cut-offs of the optimal SpO2 range, and less time above the suboptimal range. Fewer number of manual adjustments per hour were needed with closed-loop oxygen control. The number of events of SpO2 < 88% and < 85% were not significantly different between groups. Conclusions Closed-loop oxygen control improves oxygen administration in patients with moderate-to-severe AHRF treated with HFNO, increasing the percentage of time in the optimal oxygenation range and decreasing the workload of healthcare personnel. These results are especially relevant in a context of limited oxygen supply and high medical demand, such as the COVID-19 pandemic. Trial registration The HILOOP study was registered at www.clinicaltrials.gov under the identifier NCT04965844.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study)

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…Amongst published studies, the physiological effects of high-flow oxygen have been well elucidated. The ability to deliver high fractions of inspired oxygen, with low levels of positive pressure in the airways yielding a mild positive end-expiratory pressure effect and flushing out the upper airways, generates a washout of dead space [35][36][37][38][39][40]. The first pilot studies of HFNO conducted in adult ICU-admitted patients with acute respiratory failure included patients with CAP.…”

Section: Evidence Overview and Rationalementioning

confidence: 99%

ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia

et al. 2023

View full text Add to dashboard Cite

BackgroundSevere community-acquired pneumonia (sCAP) is associated with high morbidity and mortality, and while European and non-European guidelines are available for community-acquired pneumonia, there are no specific guidelines for sCAP.Materials and methodologyThe European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Latin American Thoracic Association (ALAT) launched a task force to develop the first international guidelines for sCAP. The panel comprised a total of 18 European and four non-European experts, as well as two methodologists. Eight clinical questions for sCAP diagnosis and treatment were chosen to be addressed. Systematic literature searches were performed in several databases. Meta-analyses were performed for evidence synthesis, whenever possible. The quality of evidence was assessed with GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Evidence to Decision frameworks were used to decide on the direction and strength of recommendations.ResultsRecommendations issued were related to diagnosis, antibiotics, organ support, biomarkers and co-adjuvant therapy. After considering the confidence in effect estimates, the importance of outcomes studied, desirable and undesirable consequences of treatment, cost, feasibility, acceptability of the intervention and implications to health equity, recommendations were made for or against specific treatment interventions.ConclusionsIn these international guidelines, ERS, ESICM, ESCMID and ALAT provide evidence-based clinical practice recommendations for diagnosis, empirical treatment and antibiotic therapy for sCAP, following the GRADE approach. Furthermore, current knowledge gaps have been highlighted and recommendations for future research have been made.

show abstract

“…Фторхінолони є протимікробними препаратами з бактерицидною активністю, яка залежить від концентрації. Для фторхінолонів фармакокінетичні/фармакодинамічні показники, які корелюють із клінічною та бактеріологічною ефективністю, -це відношення пікової концентрації лікарського засобу до його мінімальної інгібувальної концентрації (С max /МІК) і відношення 24-годинної площі впливу під кривою залежності концентрації вільного лікарського засобу від часу до МІК (fAUC 0-24 /МІК) [18][19][20]. fAUC 0-24 /МІК має найсильніший зв'язок із терапевтичною ефективністю для моксифлоксацину та кількох фторхінолонів.…”

Section: результати та їх обговоренняunclassified

Severe community-acquired pneumonia: principles of diagnostics and intensive therapy

Chernii

2023

View full text Add to dashboard Cite

BACKGROUND. Pneumonia is an important medical and social problem due to its high prevalence, high rates of disability and mortality, and significant economic losses due to this disease. In Ukraine in 2017, the incidence of pneumonia among adults was 384.0 cases per 100,000 population, and the mortality rate was 11.7 per 100,000 population, i. e. more than 3 % of those who had pneumonia died. Community-acquired pneumonia (CAP) is the leading cause of morbidity and mortality from pneumonia among all age groups worldwide: 3-4 million people suffer from CAP with high morbidity and mortality. OBJECTIVE. To analyze the pathogenesis, diagnosis, and treatment of severe CAP from the modern literature data to optimize the treatment of this group of patients. MATERIALS AND METHODS. Bibliosemantic, comparative, and system analysis methods were used. The proposed recommendations are based on the analysis of modern literature, the results of randomized studies, and meta-analyses devoted to the investigation of the problem of diagnosis and management of severe CAP. RESULTS AND DISCUSSION. The problems of pathogenesis, diagnosis, and treatment of severe CAP were analyzed using modern literature data to optimize the treatment of this group of patients. CAP can be caused by various pathogens, such as Streptococcus pneumoniae, Haemophilus influenzae, atypical bacteria (eg, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella species), and viruses. It is quite difficult to establish the etiology of pneumonia even with the use of modern microbiological technologies, therefore, in many countries of the world, a classification is used that takes into account the conditions of the occurrence of the disease, the features of the infection of the lung tissue, as well as the immune reactivity of the patient’s organism. This classification makes it possible to predict the probable causative agent of the disease with a fairly high degree of probability. The diagnosis of CAP is considered established in the presence of radiologically confirmed focal infiltration of lung tissue and at least two of the following clinical signs: acute onset of the disease with a body temperature >38 °C, cough with sputum, physical signs (muffled or dull percussion sound, weakened and/or harsh bronchial breathing, a focus of sonorous small vesicular rales and/or crepitations), leukocytosis (>10×109 /L), and/or shift to rod nuclear cells (>10 % of them). The severity of CAP is assessed clinically, as well as using the criteria given in the scales to determine the need for the patient to be hospitalized or admitted to the intensive care unit (ICU). Patients with CAP requiring mechanical ventilation or with septic shock should be admitted to the ICU. CONCLUSIONS. Severe CAP is associated with high morbidity and mortality, and although there are European and non-European guidelines for CAP, there are no specific guidelines for severe CAP. These international guidelines from ERS, ESICM, ESCMID, and ALAT present evidence-based clinical recommendations for the diagnosis, empiric treatment, and antibiotic therapy of severe CAP according to the GRADE approach. In addition, existing knowledge gaps were identified and recommendations for future research were provided.

show abstract

Global lessons learned from COVID-19 mass casualty incidents

Cited by 8 publications

References 28 publications

Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study)

Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study)

ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia

Severe community-acquired pneumonia: principles of diagnostics and intensive therapy

Contact Info

Product

Resources

About