COVID ICU Research Articles

Outcome of Covid-19 Related Ards Patients at a Tertiary Care Hospital

Background: In covid-19 related ARDS patients, early approach to proper health care facility and non-invasive ventilation lead to better outcome. Objective: To determine the outcome of covid-19 related ARDS patients at a tertiary care hospital, Rahim Yar Khan. Methodology: This retrospective study was carried out at department of ICU & anesthesiology in collaboration with department of Pulmonology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. A total of 74 (confirmed positive PCR) covid-19 ARDS patients with age of 18-90 years of either sex were admitted in covid ICU from June – December 2020. Patients with negative PCR for covid-19 or who presented in gasping condition or received dead were excluded from the study. Outcomes were labelled as recovered (survivors) or died (non-survivors) and treatment outcome was observed in both groups those who were on non-invasive ventilation (NIV) and on invasive mechanical ventilation (IMV). Data was analyzed by using SPSS version 23.0 Results: Out of 74 patients, 60 (81.08%) were male and 14 (18.02%) were female. Middle and old age patients were more affected as compared to young age group (p-value 0.01) and more than half 41 (55.40%) patients went in to severe ARDS. Regarding treatment outcome 44 (59.5%) patients received NIV and 30 (40.5%) patients received IMV. Survival rate better (35.4%) among the patients on NIV as compared to those on IMV (6.7%) respectively. Conclusion: Survival was better among the covid-19 ARDS patients who received NIV as compared to those on IMV. Keeping an eye on respiratory rate and SpO2 is the main factor for the early recognition of ARDS development and severity.

Preventing Exposure to SARS Cov-2 in Operation Theater Technology and Intensive Care Units

Health problems in the whole world are started to increase due to new viruses, with the beginning of 20th century. Wuhan coronavirus (which is also known as nCoV-2019) is one of current examples of such type of viruses. The people infected with this disease are likely to get genuinely unwell and need care on an ICU. A number of cultural and civic norms were monitored throughout this examination. Most standards follow a common logic that unquestionably follows the previously demonstrated method to system design. Indians are advised to look at the extremely comprehensive, tastefully prepared Guidelines of the Indian Society for Anesthesia. In this study our focus on the preventing to COVID-19 in OTT and ICU with its basic and necessary conditions which are required to secure the patients as well as the medicals staff. And also determine the products for health information.

Trends of a syndromic approached based respiratory PCR during the second wave of the COVID 19 pandemic in a tertiary care center in Mumbai

PurposeThe clinical presentation of COVID 19 disease caused by Severe Acute Respiratory Syndrome Related Coronavirus – 2 (SARS-CoV2) is similar to other causes of upper respiratory viral infections caused by influenza, epidemic corona viruses, Parainfluenza virus etc. This study was undertaken to study the presence of different pathogens in the nasopharyngeal samples of symptomatic patients visiting the COVID OPD or the Emergency services over six month duration.Methods & MaterialsThis was a prospective study from Dec 2020 to May 2021 conducted in a 220 bed tertiary care hospital in Mumbai. We are a designated COVID care hospital with 55 isolation beds including 16 beds in the COVID ICU, a dedicated OPD for symptomatic patients and Emergency services (EMS). The test was performed on a syndromic approach based respiratory PCR with 22 targets inclusive of SARS-CoV2. Nasal and a pharyngeal swab samples (NPS) were collected and the results of the test were available in 1.5 hours from sample receipt to the lab.ResultsA total of 335 patient samples were received during the study period for the syndromic approach based PCR. 133 (39.7%) of the symptomatic patients had a positive test result. 87(26%) SARS-CoV2 and 27(8.05%) Rhinovirus/Enterovirus (RhV/EV) were the two common viruses that were identified during the study duration. Other viruses, like Parainfluenza 3 (PIV3), Coronavirus 229E (229E), Coronavirus HKU1 (HKU1), Influenza AH3 (AH3), H1N1, Coronavirus OC43 (OC43) and Adenovirus were also identified. We observed co-infections 1 each of RhV/EV+AH3, RhV/EV + OC43, SARS-CoV2 +PIV3 and 2 cases of SARS-CoV2+HKU1. The trend indicated the appearance of the 2nd wave of SARS-CoV2 infection that Mumbai experienced between 1st March to 15th May 2021. Other pathogens were mostly seen in the symptomatic population especially before and after the 2nd wave.ConclusionOur study documented the appearance of the second wave in Mumbai between 1st March to 15th May 2021. Approximately,34.5% of patients has other respiratory pathogens detected in the syndromic PCR. This is the 1st study from Mumbai documenting the types of respiratory pathogens and co infections seen during the 2nd wave of the COVID 19 pandemic in Mumbai.

Airway management practices in COVID ICU during the first and second phases of COVID-19 pandemic: Experience from a tertiary care hospital of Western Uttar Pradesh

Airway management practices in COVID ICU during the first and second phases of COVID-19 pandemic: Experience from a tertiary care hospital of Western Uttar Pradesh

Drug utilization study in patients affected with COVID-19 in a dedicated COVID hospital

Background: There exists a treatment dilemma regarding the optimal and effective use of therapeutic drugs (hydroxychloroquine/chloroquine/azithromycin) for COVID-19. Furthermore, with changing guidelines, the data on drug utilization patterns across India are limited. Hence, this study was conducted to assess the prescription pattern and drug utilization trends in COVID-19 patients with the aim to study the drug utilization pattern in patients affected with COVID-19 in a dedicated COVID-19 hospital. Aims and Objectives: The objectives of the study are as follows: (1) To study drug utilization patterns according to the severity of the disease. (2) To study the prevalence of adverse drug reactions (ADRs). Materials and Methods: Data were collected retrospectively from 100 medical records of patients ≥18 years irrespective of sex admitted in the COVID ward and ICU of a dedicated COVID hospital from May to August 2020. Pregnant and lactating women were excluded from the study. ADRs reported were also analyzed. Results: About 71% were mild in this study, 18% were moderate, and 11% were severe COVID-19 patients. Overall, the most common drugs prescribed were multivitamins, followed by pantoprazole, paracetamol, and azithromycin. Hydroxychloroquine was prescribed in 22%, favipiravir in 7%, and remdesivir in 3% of cases. The majority of moderate COVID patients received injectables piperacillin-tazobactam, methylprednisolone, and enoxaparin. The mean number of medications, duration of admission, and number of days on oxygen were higher and significant in moderate compared to mild and severe COVID patients. Overall, ADRs were encountered in 9% of cases. Conclusion: The prescribed pattern of drugs was by the national standard guidelines. Multivitamins, followed by pantoprazole, paracetamol, and azithromycin dominated the prescription pattern. Polypharmacy was encountered, which needs to be addressed for the rational use of drugs.

Is COVID 19 Pandemic Adding More of Diabetic Population: A Study In Central India

ABSTRACT Background– COVID 19 is associated with high prevalence of diabetes along with other comorbidities which also increase the severity and mortality risk in COVID 19 disease. Recently many studies have shown the association between COVID 19 and new onset diabetes. This study was done with objectives1.To find out the incidence of new onset of hyperglycemia/diabetes in COVID 19 patients and 2.To develop screening policy for detection of new onset hyperglycemia in COVID-19 patients Materials and methods- This study is a hospital based observational cross sectional and prospective, cohort study conducted in the COVID ICU of Dedicated COVID Hospital, Bundelkhand Government Medical College, Sagar (M.P.) India, a teaching tertiary care centre. Out of 1562 COVID 19 positive patients admitted with moderate to severe pneumonia from JULY 2020 to JANUARY 2021, 487 patients were hyperglycemic at the time of admission. Patients were categorized into two subgroups: 1.Patients with previously confirmed diabetes or Prediabetes and 2.Hyperglycemia with no existing diabetes. Patients in this later subgroup were our follow up subjects for this study; their blood sugar level was monitored regularly during their stay in hospital & a correlation of COVID 19 and hyperglycemia was observed. Results- In present study Incidence of new onset hyperglycemia was 16.8%; 262 out of 1562. Of all 1562 patients admitted in hospital, 660 (44.7%) were found to be hyperglycemic. Among 660 patients, 436 (66.06%) patients were already known diabetic or pre-diabetic and 262 (16.8) were with newly onset hyperglycemia. 15 out of 262 (5.7%) patients were expired during their disease course, 157(60%) remained hyperglycemic while 90 (34.3) had attained normoglycemia without anti-diabetic drugs. Conclusion- COVID 19 disease is causative factor for new onset hyperglycemia /new onset diabetes

The Association of Blood Groups and COVID-19 Infection in Pakistani Population with Respect to Age and Gender in a Case-Control Study

Background: Age may be one of the determinants that increases the probability of COVID-19 infection. Furthermore, gender has been recognized as a major predictor of COVID-19 illness, with males having a larger proportion of severe COVID-19 disease than females. Some biological markers in the host have also been discovered as putative COVID-19 infection indicators. The kind of markers have recently been discovered as a major determinant for COVID-19 infection among these parameters. Objective: To detect if COVID-19 infection is associated with blood type with respect to age and gender. Methods: It was a case-control study that took place at COVID ICU of Hussain Lakhni Hospital, Karachi, Pakistan from Jun 2021 to Dec 2021. Cases (n=511) were individuals ranging in age from 15 to 80 years old, of either gender, who had COVID-19 infection confirmed by a real-time PCR test. Healthy people (n=511) served as controls. Data on age, gender, weight, height, BMI, residence, educational status, socio-economic status, comorbid and ABO blood type of patients were collected. The data were analyzed using statistical software SPSS version 23. Results: The mean age of the subjects was 54.01±11.16 years, 57% were males and 43% were females. COVID-19 infection was 2.84 times higher in people with blood type A (OR=2.84, 95% CI=1.68-4.79) and 2.19 times higher in people with blood group B (OR=2.19, 95% CI=1.29-3.72, p=0.003) than in people with blood group O. In age group≥50 years, the odds of COVID-19 infection were 1.88 times higher in individuals with blood type B as compared to blood group O (aOR=1.88, 95% CI=1.01-3.52). Among females, the odds of COVID-19 infection were 2.51 folds higher in individuals with blood type A as compared to blood group O (aOR=2.51, 95% CI=1.05-6.05). On the multivariable model, no association of blood group with COVID-19 was observed for sub-group of age <50 years and male gender. Conclusion: Individuals with blood group A have higher liability to acquire COVID-19 than blood group O. In older age, the chances of getting COVID-19 are more in blood type B, and in females, the chances of getting COVID-19 are higher in blood type A.

Thrombotic Events in Covid-19: Incidence and their Association with Lab Parameters, Vaccination Status and Mortality

Background & Objectives: Major arterial or venous thrombotic complications occur frequently with COVID-19. This risk seems to be present despite no known underlying thrombophilia and even adequate anticoagulation does not diminish its risk. Whilst pulmonary embolism may seem to be the most common thrombotic complication, others may also occur. A vaccination link to thrombotic events in COVID-19 has not been studied to the best of our knowledge. Methods: In this retrospective cross-sectional study we determined the incidence of total thrombotic events, individual Venous Thromboembolisms (VTE) and Arterial Thromboembolisms (ATE) that occurred in patients requiring ICU admission for COVID-19 in one of Bahrain’s main COVID ICU facilities for a period of 6 months. We also aim to determine mortality rate in this group of patients, links with specific baseline characteristics, laboratory parameters and patient vaccination status. Results: We studied 1597 patients over 6 months, 6% of patients were found to have VTE or ATE with a cumulative incidence of 6.5% thrombotic events. Elevated D dimer >1 was associated with an increased risk of thrombosis and an increased risk of mortality. There was a higher risk of thrombotic events in unvaccinated individuals. All-cause mortality in COVID-19 patients complicated with thrombosis and mortality solely secondary to thrombotic event were both significantly higher in unvaccinated individuals. Conclusions: Based on the findings of this study, unvaccinated individuals are at significantly higher risk of developing thrombotic events. This will assist in enabling physicians to lower their threshold of diagnosing such events. The urgency of lab parameters the swift management of other risk factors and the importance of vaccination against COVID-19 can be further studied. Keywords: COVID-19, Venous Thromboembolisms, Arterial Thromboembolisms, Mortality, D dimer, Vaccination status

Voices from a COVID ICU: It's Like We're at War and No One on the Outside Knows.

Voices from a COVID ICU: It's Like We're at War and No One on the Outside Knows.

Airway management practices in COVID ICU during the first and second phases of the pandemic: our experience

Various airway management devices and techniques have been revised and recommended to be used in COVID patients.1 In India, during the first wave (April 2020 to November 2020)2 the intubation strategy included: consultant-led intubation teams, the use of video laryngoscope (VL) and aerosol box (AB).3 During the second wave (April 2021 to June 2021),2 the intubation procedures were modified according to the availability of the resources, manpower, and some experience gained from the first wave.
 Key words: Airway management; COVID-19; Pandemic; Intensive care
 Citation: Nazir N, Saxena A. Airway management practices in COVID ICU during the first and second phases of the pandemic: our experience. . Anaesth. pain intensive care 2021;25(6):834–835;
 DOI: 10.35975/apic.v25i6.1716 

Does Frailty influence Inhospital Management and Outcomes of COVID-19 in Older Adults in the US?

Older age has been consistently associated with adverse COVID-19 outcomes. Frailty, a syndrome characterized by declining function across multiple body systems is common in older adults and may increase vulnerability to adverse outcomes among COVID-19 patients. However, the impacts of frailty on COVID-19 management, severity, or outcomes have not been well characterized in a large, representative US population. Using the National COVID Cohort Collaborative, a multi-institutional US repository for COVID-19 research, we calculated the Hospital Frailty Risk Score (HFRS), a validated EHR-based frailty score, among COVID-19 inpatients age ≥ 65. We examined patient demographics and comorbidities, length of stay (LOS), systemic corticosteroid and remdesivir use, ICU admission, and inpatient mortality across subgroups by HFRS score. Among 58,964 inpatients from 53 institutions (51% male, 65% White, 18% Black, 9% Hispanic, mean age 75, mean Charlson comorbidity count 3.0, and median LOS 7 days), 38,692 (66%), 4,180 (7%), 3,531 (6%), 3,525 (6%) and 7,862 (13%) had HFRS scores of 0-1, 2, 3, 4, and >=5 , respectively. Frailty was only moderately correlated with age and comorbidity (ρ=0.178 and 0.348, respectively, p<0.001). Overall, 34% received systemic corticosteroid and 19% received remdesivir. We observed 4% ICU admissions and 16% inpatient death. Among non-ICU admissions, after adjusting for demographics and comorbidities, frailty (HFRS ≥ 2) was associated with 79% greater systemic corticosteroid use and 22% greater remdesivir use, whereas a higher HRFS score was marginally associated with higher rates of severe COVID disease, inpatient death, or ICU admission.

Long-term ocular damage after recovery from COVID-19: lack of evidence at three months

ImportanceA small number of COVID-19 patients has been reported to suffer from acute keratoconjunctivitis. In very rare cases, acute inflammatory retinal vein occlusion, papillophlebitis or retinopathy have been observed.ObjectiveTo determine possible long-term effects on the eye, especially on the retina, in patients who had suffered from COVID-19 at least 3 months after recovery.DesignProspective cross-sectional study.SettingHospital of the Ludwig Maximilians University, Munich.ParticipantsPatients who had been tested positive for SARS-CoV-2 or for anti-SARS-CoV-2 IgG serum antibodies in the Hospital of the Ludwig Maximilians University, Munich between May and September.MethodsPatients who had tested positive were either hospitalized or discharged into home quarantine via the emergency room. Three months after recovery, they were invited to participate voluntarily for this study during their follow-up in our clinic. A complete ophthalmological exam including functional and imaging end points (including optical coherence tomography (OCT), OCT angiography) was performed.Main outcomes and measuresVisual acuity, slit lamp, bio microscopy and fundoscopy, multimodal imaging findings.ResultsIn total, 21 patients were examined. The mean age (SD) of the patients was 48.7 (18.3) years. Of these, 14 (66.6%) were hospitalized and 7 (33.3) were discharged home. Two hospitalized patients (9.5%) received invasive ventilation.During the infection, 14 of the 21 patients (66.6%) were in regular care whereas 2 patients (9.5%) received intensive care ventilation for 8.5 (SD) (0.7) days on average in the COVID ICU. Ophthalmological examination of the previously hospitalized group took place 111.4 (23.2) days after recovery and discharge from the hospital, while non-hospitalized patients were examined after mean 123.4 (44.7) days. All patients showed normal findings for anterior and posterior segment of both eyes. OCT and OCT-A showed no evidence of retinal damage, or vascular or microvascular events.Conclusion and relevanceThis study with a small prospective cohort of 21 patients indicates that there might be no evidence of ocular complications at 3 months after recovery from COVID-19, without previous eye involvement. Further studies with more participants with and without acute ocular symptoms are necessary for final evidence.

A Candidate Systematic Approach to Investigate ROBUST, SUPERIORLY BROAD, IMMUNE RESPONSE, 8 Months Following Severe COVID Infection, ICU Hospitalization, Viral Clearance, Rehabilitation, and Recovery with No Vaccine Booster Dose or Reinfection

A Candidate Systematic Approach to Investigate ROBUST, SUPERIORLY BROAD, IMMUNE RESPONSE, 8 Months Following Severe COVID Infection, ICU Hospitalization, Viral Clearance, Rehabilitation, and Recovery with No Vaccine Booster Dose or Reinfection

COVID-19 Associated Cerebral Mucormycosis

A 33-year-old female was admitted to COVID ICU after testing positive for the disease with 7 days history of fever, cough, inability to open as well as pain in the left eye, and inability to speak with right sided hemiparesis. She was known diabetic and hypertensive. Clinical examination showed presence of multiple pus points in left infratemopral region. Its microscopic examination showed wide area of necrosis along with cluster of mucormycosis.

Quality care in COVID ICU patients-beyond medicine

Quality care in COVID ICU patients-beyond medicine - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/j.ijca.2021.107, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

Airway management practices in Covid ICU during the first and second phase of Covid-19 pandemic: experience from a tertiary care hospital of Western Uttar Pradesh, India

Airway management practices in Covid ICU during the first and second phase of Covid-19 pandemic: experience from a tertiary care hospital of Western Uttar Pradesh, India

Challenges in managing an emergency and trauma ICU during COVID-19 pandemic: Perspective from a tertiary care centre in western Uttar Pradesh (India).

In December 2019, a novel coronavirus (now named COVID-19) was identified as a causative agent for a cluster of pneumonia cases in Wuhan, China.1 Till March 2020, India was one among 50 countries which identified patients tested positive for COVID-19.2 One day curfew was imposed in the country on March 22, 2020 to forewarn the people about the danger the country was going to face. The government of India announced a nationwide lockdown for 21 days from March 25, 2020 with subsequent second, third and fourth lockdowns. This was done to reduce the transmission of disease and flatten the curve. The preparations to manage COVID-19 pandemic crisis began in Jawaharlal Nehru Medical College Hospital Aligarh, a tertiary care centre in western Uttar Pradesh by 15th of March 2020. In April 2020, it was declared as Level 2 COVID care hospital to deal with complicated and critical cases. The establishment of flu clinic, exclusive COVID-19 isolation ward, teleconsultation and widespread screening of patients by Reverse transcriptase polymerase chain reaction (RT PCR) were some measures undertaken to deal with the crisis. The increased burden of patients presenting with bronchopneumonia necessitated augmentation of the existent infrastructure and better utilization of resources. Emergency and trauma centre, JNMCH, AMU Aligarh was also no exception and reorganising emergency trauma ICU as COVID-19 suspect ICU made the functioning of the entire hospital a lot smoother during this unsustainable crisis situation. However, there were several challenges to overcome while designating an emergency and trauma ICU as COVID-19 suspect ICU. There is ample amount of literature available discussing the strategies for preparing a dedicated COVID ICU, however there is relative scarcity of literature on the challenges in managing an emergency and trauma ICU (ETC – ICU) during the pandemic. In this review, we discuss the strategies and planning for converting an emergency and trauma ICU into a COVID suspect ICU in a tertiary care centre in western Uttar Pradesh (India) during the pandemic and the challenges faced. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.26-31

Prevalence of Bacterial co-infections and super infections in cancer patients hospitalized with COVID-19 in ICU: a retrospective cohort study

Prevalence of Bacterial co-infections and super infections in cancer patients hospitalized with COVID-19 in ICU: a retrospective cohort study

A Study of Red Blood Cell Indices among Covid 19 Individuals in Tertiary Care Triage Centre

Background: SARS-CoV-2 infection is characterized by the development and progression of inflammatoryresponses. The exploration of prognostic predictors for patients with COVID-19 is vital for prompt clinicalintervention. Our study aims to explore the predictive value of hematological parameters in categorizationof patients with COVID-19.We aimed to investigate associations between hematological parameters anddisease severity in patients with SARS-CoV-2infection.The red blood cell distribution width (RDW),an indicator of anisocytosis has emerged as a potential tool for risk stratification of critically ill patients.Materials and Methods: Retrospective study after getting approval from Institutional ethics committeewas performed with data obtained from triage OPD in Chengalpattu Medical College &amp; Hospital. Thedemographic, clinical, laboratory profile of COVID 19 positive patients who attended Triage OPD for aperiod of one month were collected. 3000 RT-PCR confirmed COVID positive patients of age group 20to 70 years of both genders were included in the study. COVID 19 positive paediatric cases, antenatal andpostnatal mothers, postoperative cases and sick cases admitted in COVID ICU were excluded from thestudy. Symptoms, associated co-morbidities and severity of COVID 19 were tabulated. Complete BloodCount measured by Automated Sysmex Analyser at the time of reporting to triage was noted. Red bloodcell indices were analysed using SPSS 21.0 version. Results: There was statistically significant increase inRDW and decrease in MCV among patients with co-morbidity and severe illness compared to those withmild disease. There is no statistically significant difference in Red blood cell indices between patients withand without symptoms and patients without co-morbidities. Conclusion: RDW was found to be a screeningtool to identify patients with severe COVID-19 and the results of this study suggest that RDW should be partof routine laboratory assessment and monitoring of COVID-19.

Infección grave por SARS-CoV-2: valoración clínica y evaluación funcional biomecánica al mes del alta hospitalaria

ObjectiveTo describe by an observational cross-sectional study the clinical and functional situation, at one month after hospital discharge, of patients admitted with COVID-19 in the hospital ICU between March and December 2020. Material and methods59 patients were studied using different clinical scales and biomechanical analysis tests (hand dynamometry, fall risk assessment, gait and balance analysis). ResultsAt one month after discharge, patients reported persistent symptoms: dyspnea (47.5%), arthromyalgia (45%) and cough (22%). In the EQ-5D-5L questionnaire up to 73% of patients reported levels of anxiety or depression. 74.6% and 69.5% presented alterations in the strength of the right and left hand, respectively. The risk of falls in 38% of patients was moderate to very high. The somatosensory index remained within normal parameters, while the vestibular and, to a lesser extent, the visual indexes were altered. In gait, 81.4% of patients showed no abnormalities outside the normal range, with a normal average walking speed. ConclusionsIn the short term after severe COVID-19, patients have persistent symptomatology, anxiety/depression, impaired balance with increased risk of falls and loss of grip strength in both hands.