The Contribution of COVID-19-Forced Transformations in Critical Care Delivery to Patient Mortality: Still an Underexplored Association

Oud, Lavi

doi:10.14740/jocmr4531

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…During the global pandemic, as many as 67% of COVID-19 patients developed ARDS; this life-threatening complication carries a reported mortality rate of up to 40% 8,9. A 2023 study of mortality data during the first year of the COVID 19 pandemic in the United States reported an approximately 5-fold increase in deaths attributed to ARDS 10. From 2014 to 2019, ARDS-related mortality in the United States averaged 10,500 deaths per year, but this rate increased to 51,184 in 2020.…”

Section: Introductionmentioning

confidence: 99%

Reducing Facial Hospital-Acquired Pressure Injuries Related to Prone Positioning in the Intensive Care Unit

Hughes

2023

Journal of Wound, Ostomy &Amp; Continence Nursing

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PURPOSE: The purpose of this quality improvement (QI) initiative was to evaluate the effects of a repositioning intervention bundle on the occurrences and severity of hospital-acquired pressure injuries (HAPIs) of the face in patients with COVID-19–related acute respiratory distress syndrome (ARDS) managed by ventilation and placed in a prone position. PARTICIPANTS AND SETTING: Eighteen critically ill, ventilated patients were placed in a prone position for extended periods (range, 1-13 days). The study setting was critical care units in a 504-bed nonprofit teaching hospital located in the Northeastern United States. APPROACH: Standard of care for the prevention of pressure injury (PI) in ventilated patients placed in a prone position at our facility included use of foam dressings over bony prominences on the face and the application of tape to secure the endotracheal (ET) tube as compared to commercial ET tube securement devices. We also placed a fluidized pillow with pillowcase wrapped with an absorbent pad under the head to absorb secretions. We added 2 interventions to our facility's existing HAPI prevention bundle. The first was a repositioning strategy; ventilated and prone patients were lifted by their shoulders by critical care RNs while their ET tube was stabilized by a respiratory therapist every 6 hours. The RNs then repositioned the patient's head and arms to the opposite side into a swimmer's position (head lying to the side with one cheek in contact with the fluidized pillow). The second intervention was micromovement of the head performed by an RN every 4 hours. OUTCOMES: Prior to implementation of the QI initiative, data collected during the early pandemic demonstrated that multiple patients developed facial PIs secondary to prone positioning; a majority were full-thickness or unstageable PIs, whereas a minority were partial-thickness PIs (stage 2). Following implementation of the QI initiative, data indicated that 5 of 18 (28%) patients placed in a prone position had HAPIs of the face; 4 (22%) of the HAPIs were stage 1 or 2 and 1 was unstageable. Patients were placed in a prone position from 1 to 13 days. All facial HAPIs developed within the first 2 days of placement in a prone position. IMPLICATIONS FOR PRACTICE: The addition of an RN and a respiratory therapist repositioning intervention and micromovements of the head every 4 hours by the RN to an existing pressure prevention bundle during prone positioning led to a clinically relevant reduction in the severity of facial HAPIs. As a result, care for these patients has been changed to incorporate the repositioning interventions implemented during this QI project.

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Section: Introductionmentioning

confidence: 99%

Reducing Facial Hospital-Acquired Pressure Injuries Related to Prone Positioning in the Intensive Care Unit

Hughes

2023

Journal of Wound, Ostomy &Amp; Continence Nursing

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“…ARDS is diagnosed in about 33% of hospitalized COVID-19 patients 1 and reported in about 10.8% of all COVID-19-related deaths. 2 Early PP has been noted to improve oxygenation and overall outcomes in patients with moderate to severe ARDS needing mechanical ventilation 3 and is associated with a lower incidence of intubation. 4,5 Complications due to prolonged PP have been reported, including endotracheal tube dislodgement, temporary desaturations, brachial plexus injuries, decubitus ulcers, ischemic optic neuropathy, and compressive neuropathies.…”

Section: Introductionmentioning

confidence: 99%

“…The most devastating of them is ARDS, with prolonged hospitalization and deaths. ARDS is diagnosed in about 33% of hospitalized COVID‐19 patients 1 and reported in about 10.8% of all COVID‐19‐related deaths 2 . Early PP has been noted to improve oxygenation and overall outcomes in patients with moderate to severe ARDS needing mechanical ventilation 3 and is associated with a lower incidence of intubation 4,5 …”

Section: Introductionmentioning

confidence: 99%

Unilateral foot drop due to prone positioning in COVID‐19: A case report

Arora,

Bode,

Avula

et al. 2023

Clinical Case Reports

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Key Clinical MessageUnderstanding the complications arising from prone positioning following mechanical ventilation during management of acute respiratory distress from COVID‐19.AbstractAcute respiratory distress syndrome (ARDS) resulting from coronavirus disease 2019 (COVID‐19) has been one of the well‐known complications of the disease since it was first reported in 2020. Mechanical ventilation for severe ARDS has been widely utilized for the management of such patients. Prone positioning (PP) is associated with improved oxygenation and overall outcomes in both intubated and non‐intubated patients. However, there are several complications associated with this procedure, including compressive neuropathies. In this article, we report a case of unilateral foot drop following mechanical ventilation and PP during the management of ARDS from COVID‐19.

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“…We do this for LNPs, since they are the leading nanoparticle format currently under development in industry, with tens of billions invested in the last few years 43,44 . We chose to target the lungs because many formulations with both affinity and physicochemical targeting have been created with the goal of ameliorating alveolar diseases, especially acute respiratory distress syndrome (ARDS), the alveolar inflammatory disease that was the primary cause of death during the COVID-19 pandemic, and still causes >75,000 deaths each year from non-COVID types of ARDS [45][46][47][48][49][50] .…”

Section: Introductionmentioning

confidence: 99%

A combination of physicochemical tropism and affinity moiety targeting of lipid nanoparticles enhances organ targeting

Zamora,

Omo-Lamai,

Patel

et al. 2023

Preprint

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Two camps have emerged in the targeting of nanoparticles to specific organs and cell types: affinity moiety targeting, which conjugates nanoparticles to antibodies or similar molecules that bind to known surface markers on cells; and physicochemical tropism, which achieves specific organ uptake based on the nanoparticle’s physical or chemical features (e.g., binding to endogenous proteins). Because these camps are largely non-overlapping, the two targeting approaches have not been directly compared or combined. Here we do both, using intravenous (IV) lipid nanoparticles (LNPs) whose original design goal was targeting to the lungs’ endothelial cells. For an affinity moiety, we utilized PECAM antibodies, and for physicochemical tropism, we used cationic lipids, both having been heavily studied for lung targeting. Surprisingly, the two methods yield nearly identical levels of lung uptake. However, aPECAM LNPs display much greater specificity for endothelial cells. Intriguingly, LNPs that possess both targeting methods had >2-fold higher lung uptake than either method alone. The combined-targeting LNPs also achieved greater uptake in already inflamed lungs, and greater uptake in alveolar epithelial cells. To understand how the macro-scale route of delivery affects organ targeting, we compared IV injection vs. intra-arterial (IA) injection into the carotid artery. We found that IA combined-targeting LNPs achieve 35% of the injected dose per gram (%ID/g) in the brain, a level superior to any other reported targeting method. Thus, combining affinity moiety targeting and physicochemical tropism provides benefits that neither targeting method achieves alone.Graphical Abstract

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The Contribution of COVID-19-Forced Transformations in Critical Care Delivery to Patient Mortality: Still an Underexplored Association

Cited by 3 publications

References 16 publications

Reducing Facial Hospital-Acquired Pressure Injuries Related to Prone Positioning in the Intensive Care Unit

Reducing Facial Hospital-Acquired Pressure Injuries Related to Prone Positioning in the Intensive Care Unit

Unilateral foot drop due to prone positioning in COVID‐19: A case report

A combination of physicochemical tropism and affinity moiety targeting of lipid nanoparticles enhances organ targeting

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