Technologies to Optimize the Care of Severe COVID-19 Patients for Health Care Providers Challenged by Limited Resources

Abstract

Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. 1 When a patient requires intubation and invasive ventilation, the outcome is poor, 2–4 and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. 2 In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.

Covid-19: The Rollercoaster of Fibrin(Ogen), D-Dimer, Von Willebrand Factor, P-Selectin and Their Interactions with Endothelial Cells, Platelets and Erythrocytes

“…This is mainly because the patient cohort is so extremely diverse and because many may have preexisting thrombotic disease and cardiovascular comorbidities [155]. Point-of-care devices and diagnostics like the thromboelastograph (TEG) (that gives an indication of fibrinogen levels) or point-of-care ultrasound (POCUS) [163] allows for frequent testing of the coagulation/bleeding profiles as well as blood clot fibrinolysis of patients at the bedside [163]. TEG is particularly useful to also assess fibrinolysis, in COVID-19 patients [156].…”

Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis

“…There has been an increased interest to utilize thromboelastography (TEG) or rotational thromboelastometry (ROTEM) in critically ill COVID-19 patients where both tests may be useful to inform individualized clinical decision-making regarding VTE prophylaxis among COVID-19 patients [38]. Viscoelastic observations with TEG among critically ill COVID-19 patients in the intensive care unit revealed hypercoagulable state with decreased R time and K time as well as elevated fibrinogen activity greater than a 73° angle and maximum amplitude more than 65 mm with heparinase correction [39,40].…”

Viscoelastic Tests in the Evaluation of Haemostasis Disturbances in SARS-CoV2 Infection

“…46 Post-mortem data supports hypercoagulability through the presence of micro-thrombi in several systems. 4 Activation of coagulation and/or fibrinolysis occurs in COVID-19 as part of the acute inflammatory response. 4 CAC may, in some way, be specific to SARS-CoV-2, representing new features that need to be clarified through further research.…”

“…3 Post-mortem studies corroborate that explanation, highlighting marked pathological changes involving lung microvasculature, disseminated micro-thrombi and haemorrhagic necrosis. 4 Severe COVID-19 is also associated with an increased risk of deep vein thrombosis (DVT) and cartridge-based fully automated closed system, including four assays (Table 1, Fig. 1).…”