O2 Therapy Research Articles

Oxygen Sources and Delivery Devices: Essentials during COVID-19

The coronavirus disease of 2019 (COVID-19) is an ongoing pandemic which is known to predominantly affect the respiratory system. Oxygen (O2) therapy has a profound role in the treatment of COVID-19 patients. The pandemic has drawn special attention to ensure uninterrupted O2 supply to all hospitals, especially those catering to COVID-19 patients. During the pandemic, a rational use of O2 therapy is essential. This includes optimal supplemental O2 therapy, careful monitoring of patients, and escalation as well as de-escalation of O2 therapy when indicated. We summarize the various sources of O2 to health-care establishments and various O2 delivery devices which are of paramount importance to ensure seamless O2 supply in the pandemic scenario.

Para-clinical and Epidemiological Features of COVID-19 in Deceased Patients: A Comparison with Treated Patients

Background: Patients with COVID-19 have shown a wide variety of symptoms and mortality rates in different communities. Objectives: This study aimed to compare the epidemiological, clinical, and paraclinical features of patients with COVID-19 who have overcome the disease with patients who died. Methods: All hospitalized patients admitted to Special Corona Hospital who had a positive real-time PCR test for SARS-CoV-2 from January to March 2020 were included in the study. Clinical characteristics, date of disease onset, hospital admission date, and the severity of COVID-19 were obtained from each patient's medical records. Independent sample t-test was used to compare continuous variables between the groups of the discharged and expired patients. The independence between categorical variables and the outcome was assessed by Chi-square or Fisher's exact tests. Results: The order of essential variables for admission as the starting time are pH, WBC count, loss of consciousness, neutrophil count, base excess (BE), HCO3, age, BUN, O2 saturation, and lymphocyte count. Conclusions: In the current study, the mortality rate of COVID-19 was 30% and was significantly associated with critical disease intensity, fever, chills, loss of consciousness, ischemic heart disease (IHD) history, Parkinson's disease, invasive O2 therapy, and troponin level.

Experimental study on oxygen concentrator with wide product flow rate range: individual parametric effect and process improvement strategy

Improvement on oxygen (O2) concentrator using pressure swing adsorption (PSA) technology according to variable product demands is of great significance, which, for instance, provides the key step for success in practical O2 therapy for COVID-19 patients who need to be delivered with a wide product flow rate range (1–15 standard liter per minute (SLPM)) of medical O2 (purity > 82%). This work studied the individual effects of major PSA process parameters on O2 production performance at the product flow rate of 3.46–19.88 SLPM (0.64–3.68 SLPM per kilogram of adsorbent (SLPM/kg)), based on a self-designed two-bed PSA unit with a modified Skarstom cycle using Li-LSX zeolite adsorbents. The improvement strategies were accordingly proposed based upon influential mechanisms of each parameter: 1) at lower product flow rates (≤2.00 SLPM/kg), increasing the purge flow rate and decreasing the adsorption pressure to suppress excess O2 adsorption, and decreasing the feed flow rate to ensure low energy consumption; 2) at higher product flow rates (≥2.00 SLPM/kg), decreasing the purge flow rate and increasing the adsorption pressure to eliminate N2 breakthrough and O2-rich product waste, and appropriately increasing the feed flow rate to enhance cost-effectiveness. An improved set of parameters rendered O2 purity (95.67–74.86%), recovery (11.28–49.05%), productivity (0.47–2.04 mmol/kg/s) increased by up to 3.52–20.08%, 0.36–20.47%, 6.82–19.61%, and energy consumption (4.07–0.95 kWh/kgO2) decreased by up to 10.56–18.10%, in comparison to two conventional sets, respectively. The results are beneficial for developing intellectualized and flexibly-controlled O2 concentrators for practical applications.

Acquired decrease of the C3b/C4b receptor (CR1, CD35) and increased C4d deposits on erythrocytes from ICU COVID-19 patients

In order to study the mechanisms of COVID-19 damage following the complement activation phase occurring during the innate immune response to SARS-CoV-2, CR1 (the regulating complement activation factor, CD35, the C3b/C4b receptor), C4d deposits on Erythrocytes (E), and the products of complement activation C3b/C3bi, were assessed in 52 COVID-19 patients undergoing O2 therapy or assisted ventilation in ICU units in Rheims France. An acquired decrease of CR1 density on E from COVID-19 patients was observed (Mean = 418, SD = 162, N = 52) versus healthy individuals (Mean = 592, SD = 287, N = 400), Student’s t-test p < 10−6, particularly among fatal cases, and in parallel with several parameters of clinical severity. Large deposits of C4d on E in patients were well above values observed in normal individuals, mostly without concomitant C3 deposits, in more than 80% of the patients. This finding is reminiscent of the increased C4d deposits on E previously observed to correlate with sub endothelial pericapillary deposits in organ transplant rejection, and with clinical SLE flares. Conversely, significant C3 deposits on E were only observed among ¼ of the patients. The decrease of CR1/E density, deposits of C4 fragments on E and previously reported detection of virus spikes or C3 on E among COVID-19 patients, suggest that the handling and clearance of immune complex or complement fragment coated cell debris may play an important role in the pathophysiology of SARS-CoV-2. Measurement of C4d deposits on E might represent a surrogate marker for assessing inflammation and complement activation occurring in organ capillaries and CR1/E decrease might represent a cumulative index of complement activation in COVID-19 patients.Taken together, these original findings highlight the participation of complement regulatory proteins and indicate that E are important in immune pathophysiology of COVID-19 patients. Besides a potential role for monitoring the course of disease, these observations suggest that novel therapies such as the use of CR1, or CR1-like molecules, in order to down regulate complement activation and inflammation, should be considered.

Clinical Features of Patients with Home Isolation Sars-Cov-2 Infection: A Multicenter Retrospective Study in Southern Italy.

To describe epidemiological and clinical features of patients confirmed as having SARS-CoV-2 infection and managed in isolation at home. We performed a multicenter retrospective study enrolling all SARS-CoV-2-positive adults evaluated from 28 February to 31 May 2020 at one of nine COVID-19 Units in southern Italy: we included patients receiving care at home and those admitted to hospital. We defined patients with not-severe disease if they were asymptomatic or experienced a mild infection that did not need oxygen (O2) therapy and those with a severe infection if hospitalized and required O2 therapy. We enrolled 415 patients with SARS-CoV-2 infection: 77 were managed in isolation at home, 338 required hospital management. The 77 patients in home isolation were less frequently male than hospitalized patients (55% vs. 64%; <0.01) and were younger (median age 45 years (IQR:19) vs. 62 (IQR 22); p < 0.01), had a lower Charlson comorbidity index (median 0 (IQR2) vs. 6 (IQR 3); p < 0.01), and included fewer subjects with an underlying chronic disease (36% vs. 59%; p < 0.01). According to a binomial logistic regression analysis, a younger age (OR: 0.96 (95% IC: 0.94–0.98), p < 0.01) and a low Charlson comorbidity index (OR: 0.66 (95% IC: 0.54–0.83); p < 0.01) were independent factors associated with at-home management. The identification of subjects with SARS-CoV-2 infection who could be managed in home isolation is useful in clinical practice. A younger age and no comorbidities were identified as factors independently associated with home management.

Risk Factors and Outcomes of Early Pulmonary Hypertension in Preterm Neonate

Early onset pulmonary arterial hypertension in preterm is not uncommon and is associated with bronchopulmonary dysplasia and severe intraventricular hemorrhage. Inhaled nitric oxide was used to treat in majority of cases with good response and survival is high. Approximately 8-23% of premature infants develop pulmonary hypertension (PH), and this diagnosis confers a higher possibility of mortality. As a result, professional societies recommend PH screening in premature infants. However, the risk factors for and the outcomes of PH may differ depending on the timing of its diagnosis, and little evidence is available to determine at-risk infants in the referral neonatal population.Aim of this work: was to examine the risk factors and neonatal outcomes of early onset PAH (EOPAH) diagnosed in the first 2 weeks of age in preterm infants in a large perinatal center. Methods: This study was conducted on sequentially admitted preterm neonates in Benha children Hospital (130). A prospective observational study on neonates were admitted to neonatal intensive care unit allover 6 months since 1st of July to the end of December 2019. All the neonates were evaluated by echocardiogram between 72 hours and 14 days for early detection of pulmonary hypertension. Results: Regarding Early pulmonary arterial hypertension, Cases with early pulmonary arterial hypertension were 30 (23.1%) and Cases without early pulmonary arterial hypertension were 100 (76.9%). mean value of weight among Cases with early pulmonary arterial hypertension was lower than among Cases without early pulmonary arterial hypertension (1.68, 2.07) p value= 0.000 , we found that, regarding Maternal risk factors among cases with early pulmonary arterial hypertension, BA were 2 (6.7%), over weight mother was 3 (10%), hypertension was 1 (3.3%), prom was 1 (3.3%), irrelevant was 21 (70%) and Smoker mother were 2 (6.7%). regarding outcome, the percentage of die was higher among Cases with early pulmonary arterial hypertension than Cases without early pulmonary arterial hypertension (26.7%, 2%). P value= 0.000 .regarding fundus examination results was abnormal was 3 (10%) among cases with early pulmonary arterial hypertension. Regarding degree of pulmonary hypertension mild was 19 (63.3%), moderate was 10 (33.3%) and sever was 1 (3.3%). Conclusion: Our study shows that clinically significant EOPAH is present in 23.1% of preterm infants of less than 36 weeks GA. Our results shows that lower birth weights are associated with pulmonary hypertension. The mortality rate among the infants who affected with pulmonary hypertension was high. Regarding O2 Therapy, the percentage of Invasive MV was higher among Cases with early pulmonary arterial hypertension Hearing and fundus impairment occurred among cases with early pulmonary arterial hypertension.

Survival and 30-day hospital outcome in hospitalized coronavirus disease 2019-infected patients in Upper Egypt

Background Determining the clinical features and outcomes of patients diagnosed with coronavirus disease 2019 (COVID-19) is fundamental to improve the understanding and adequate management of the novel illness. This study aims to identify the determinants of survival and the outcome within 30 days in hospitalized patients with COVID-19 infection in Upper Egypt. Patients and methods A total of 1064 cases were consecutively admitted to isolation hospitals in Upper Egypt. All cases had confirmed COVID-19 infection. The electronic records of the patients were retrospectively revised and the demographic data, clinical manifestations, quick sequential organ failure assessment (qSOFA) score on admission, and 30-day outcome (ICU admission, death, recovery, or still in hospital) were analyzed. Overall cumulative survival rates in all patients and those more than or less than 50 years were calculated. Results Overall, 49.2% of the study population were males, whereas 50.8% were females, with mean age of 49.4±17.8 years. On admission, 83.9% were stable with qSOFA score less than 1, 3% required noninvasive mechanical ventilation, and 2.1% required O2 therapy. Within 30 days, 203 (19.1%) cases required admission to ICU. Death was recorded in 11.7% of cases, 28.7% recovered, and 59.7% were still under treatment. Determinants of ICU admission and survival in the current study were age more than 50 years, qSOFA more than 1, and need for O2 therapy or noninvasive ventilation. The cumulative survival was 75.3%, with the mean survival of 28.1, and 95.2% overall survival rate was recorded in those aged less than or equal to 50 years. Conclusions Age older than 50 years old, those with preexisting diabetes mellitus, initial qSOFA score, requirement for O2 therapy, and noninvasive ventilation from the first day of hospital admission may be associated with unfavorable 30-day in-hospital outcome of COVID-19.

Use of Remdesivir to Treat COVID-19 after Orthotopic Heart Transplant

PurposeGuidance for managing orthotopic heart transplant (OHT) recipients with COVID-19 infection is limited. There have been 80 published cases of OHT recipients with COVID-19 infection to date, and they show a higher incidence of infection and greater mortality (26-41%) than that observed in the general population. Remdesivir, an inhibitor of viral RNA-dependent RNA polymerase, decreases median recovery time from infection in the general population, but was not used in any OHT patients. We sought to determine the effectiveness of remdesivir to treat COVID-19 in OHT recipients.MethodsOut of 400 OHT patients followed at UCSD, 1.8% (n=7) have tested positive for COVID-19. Four of these patients were treated with remdesivir. Three patients with milder symptoms did not require treatment.ResultsOHT recipients with COVID-19 infection were a median 55 years of age (range 28-62 years), 71% (5/7) were male, and they were a median of 3 years post-transplant (range 2-5 years). All patients were taking tacrolimus, 85% (6/7) were also taking mycophenolate mofetil (MMF) or 14% (1/7) were taking mammalian target of rapamycin (mTOR) inhibitors. All patients had positive nasopharyngeal COVID-19 PCR and were admitted for observation. MMF and mTOR inhibitors were held on admission while tacrolimus was continued. Four patients (57%) developed hypoxia requiring supplemental oxygen or had pulmonary infiltrates on chest x ray and were treated with remdesivir. Patients received an intravenous (IV) infusion of 200 mg loading dose followed by 100 mg IV daily over 4 days (total 5 doses). Two patients were also treated with IV antibiotics for bacterial pneumonia (n=1) or urinary tract infection (n=1). Three of the four patients treated with remdesivir had complete resolution of fevers, hypoxia and symptoms after a 5-day course. The fourth patient had continued hypoxia requiring supplemental O2 therapy and received an additional 5 days of remdesivir 100 mg IV daily (10-day total course) with subsequent resolution of symptoms. No patients were intubated or admitted to intensive care and all 7 patients survived to hospital discharge and had negative COVID-19 PCR at outpatient follow up. No other COVID-19 directed therapies were used.ConclusionCompared to 80 patients in prior published cases, our experience suggests that prompt administration of remdesivir improves outcomes in OHT patients with COVID-19 infection.

Hyperbaric Oxygen Therapy to Treat Acute Sport-Related Traumatic Brain Injuries: A Case Series

We report on hyperbaric oxygen (HBO2) therapy used to improve postinjury outcomes in eight acutely concussed high school student-athletes (5 males, 3 females, mean age = 16.0 ± 1.2 years). Patients were randomly assigned into one of three intervention groups: (a) HBO2 therapy; (b) hyperbaric therapy with compressed medical-grade air (HBA); or (c) normobaric 100% O2 therapy. All patients completed five 1-hr treatments within the first 10 days following his or her concussion. Main outcome measures included mental status examination, symptom burden, and the number of days from injury until the physician permitted the student-athlete to return to activity. Patients receiving HBO2 treatment experienced the greatest absolute symptom reduction over the five treatment sessions. No meaningful differences were found in mental status examination. All participants returned to activity in a similar timeframe. HBO2 therapy may be an effective option for the acute treatment of postconcussion symptoms, particularly in young athletes presenting with a high symptom burden.

English

BACKGROUND Retinopathy of prematurity (ROP) is a vasculopathy affecting the premature retina. In India ROP is increasing due to the increased premature deliveries, well improved neonatal care and better neonatal survival rate. ROP screening by an experienced ophthalmologist plays an important role in screening, identifying and management of at-risk premature infants. Nowadays, the gold standard treatment is laser photocoagulation of avascular retina and anti-vascular endothelial growth factor (VEGF) depending on the severity of disease. METHODS This observational study included 152 babies who were referred to the Department of Ophthalmology at Great Eastern Medical School (GEMS), Srikakulam for ROP screening. The screening of eyes was done with a binocular indirect ophthalmoscope with 20 D lens. Eyes were examined by application of topical anaesthetic drops after applying topical tropicamide drops till full dilatation was noted. ROP was staged and treatment was given accordingly. RESULTS Totally 152 infants were screened for ROP in the Department of Ophthalmology. Babies with gestational age between 26 weeks and 36 weeks were included in the present study. Babies with birth weight between 900 gm and 2000 gm were also included in the study. Of the 152 babies which were included in the study, 54 babies presented with different stages of ROP. The incidence of ROP in the present study was found out to be 35.5 %. When incidence of ROP was noted with respect to birthweight, in extremely low birth weight (ELBW) babies, incidence was found out to be 71.4 %; in very low birth weight (VLBW) babies incidence rate was found to be 48.4 %. When incidence of ROP was noted with respect to gestational age ROP incidence was found to be 65.2 % in babies with gestational age of &lt; 32 weeks. There was no association with gender in the incidence of ROP. When ROP incidence was noted in babies who received O2 therapy 59.2 % babies who received O2 therapy developed ROP. CONCLUSIONS In our study, at our institute the incidence of ROP was 35.5 %. With appropriate screening for the babies at risk we can prevent the development of ROP and further complications. According to study results our recommendations are that initial screening should to be done as early as 4 weeks of postnatal age or 34 - 35 weeks post conceptional age and to be followed till term gestation. In the present study we found that usage of anti VEGF came out with promising outcome results. The procedure of anti VEGF was relatively safe and easy with a smaller number of complications when compared to laser photocoagulation. KEYWORDS Retinopathy of Prematurity, Laser Photocoagulation, Indirect Ophthalmoscope, Tropicamide, Anti VEGF

Incidence, Risk Factors and Screening Evaluation of Retinopathy of Prematurity in High Birthweight Infants: A Large Cohort Study in Turkey

ABSTRACT Purpose To report and evaluate the incidence and risk factors of retinopathy of prematurity (ROP) and to assess the sensitivity and specificity of Turkish national screening guideline (NSG) in heavier infants with a birth weight (BW) of >1500 g. Methods The data of 1784 preterm infants with BW>1500 g, who were screened between 2009 and 2016 in a university hospital in Turkey, were analyzed retrospectively. The rates of any stage and severe (treatment-requiring) ROP incidence were investigated. The possible protective and risk factors were evaluated with univariate analyses and logistic regression analysis. Results The rate of any stage ROP was 14.1% (n = 251). Severe ROP was observed in 11 infants (0.6%), and 2 of the infants (0.1%) had a gestational age (GA)>32 weeks, which fell outside of the NSG. In logistic regression analysis, BW, GA, O2 therapy duration, and exchange transfusion were determined to be independent risk factors (respectively, p < .001, p < .001, P = .055, and P = .033). Furthermore, antenatal steroid therapy was determined to have a highly significant protective effect on ROP development (p < .001). The sensitivity of Turkish NSG in identifying severe ROP increased from 82% to 100% with the inclusion of risk factors in addition to GA and BW. Conclusion This study shows the presence of severe ROP in mature and heavy infants in Turkey. The positive effect of antenatal steroid use and the negative impact of exchange transfusion have been demonstrated for ROP development in mature infants. Possible risk factors should be evaluated with GA and BW to avoid missing severe ROP.

High-Flow Oxygen Therapy in Tracheostomized Subjects With Prolonged Mechanical Ventilation: A Randomized Crossover Physiologic Study.

High-flow oxygen therapy via tracheostomy (HFT) can be used in tracheostomized patients during ventilator disconnection. The physiologic effects of this technique are unknown. We hypothesized that HFT would reduce inspiratory effort and improve breathing pattern compared to conventional oxygen therapy via T-tube. This study aimed to evaluate the physiologic effects of HFT compared to conventional O2 in patients with prolonged mechanical ventilation. A randomized crossover physiologic study was conducted in adult tracheostomized patients who experienced temporary periods of ventilator disconnection. Subjects were ventilated with pressure support ventilation (PSV) for 15 min and were then randomly assigned to HFT or conventional O2 via T-tube for 30 min. After a washout period, subjects were switched to the other system. Esophageal pressure (Pes), breathing frequency, blood pressure, heart rate, [Formula: see text], and transcutaneously measured pressure of carbon dioxide ([Formula: see text]) were recorded. The primary outcome was inspiratory effort as determined by the simplified esophageal pressure-time product (sPTPes). Secondary outcomes were Pes swing, breathing frequency, heart rate, mean arterial pressure, [Formula: see text], and [Formula: see text] between groups. Twenty-two subjects were enrolled: sPTPes per minute was significantly higher with HFT and conventional O2 compared to PSV (153.5 ± 97.9, 163.5 ± 111.3, and 86.8 ± 51.1 cm H2O × s/min, respectively, P = .001), but it was not different between HFT and conventional O2 (P = .72). Breathing frequency increased significantly after switching from PSV to HFT and conventional O2 (23 ± 4 vs 26 ± 6 and 23 ± 4 vs 27 ± 5 breaths/min, respectively, P = .001). [Formula: see text] was higher with conventional O2 compared to HFT (P = .02). No differences in [Formula: see text], mean arterial pressure, or heart rate were observed between HFT and conventional O2. Inspiratory effort and breathing frequency increased significantly during unassisted breathing compared to PSV in tracheostomized subjects, but HFT via tracheostomy provided no measurable additional physiologic benefit compared to O2 therapy via T-tube.

Extent of Pharmacotherapy in Covid-19: An Observational Study in a Dedicated Hospital in Bangladesh

Objective: With the rapid increase in the rate of infection, repurposing use of many drugs like antivirals, antibiotics, LMWH, steroid, oxygen therapy were considered as an option to find promising anti-COVID therapeutics. In this study, we aim to observe the extent and variety of drugs used in different clinical categories of COVID-19 patients admitted to hospital in Bangladesh. To observe the requirement of oxygen therapy according to severity was also a prime objective to reveal the overall trend, frequency, and pattern of pharmacotherapy in a COVID-dedicated hospital.&#x0D; Materials and method: A total of 1348 patients were admitted, of whom 473 were included in this single-center retrospective study. The critical group consists of 99 ICU patients, the severe group has 38, moderate was 82 and mild group 254 cases, admitted in the general ward. Hospital records of each patient were screened and information about drug and supportive therapy were collected manually by the researchers in the data collection sheet. Data express in MS excel spreadsheet and result expressed in percentage.&#x0D; Results: Critical group received remdesivir (85.86%), favipiravir (27.28%), meropenem (92.93%), moxifloxacin (87.88%) dexamethasone (41.48%), Low Molecular Weight Heparin (98.99%). They also received supportive O2 therapy like High Flow Nasal Cannula (67.68%), Non-Invasive Ventilation (26.67%), and mechanical ventilator (6.06%). A severe group of patients receives the same group of drugs 97.27%, 5.26%, 60.53%, 47.37%, methylprednisolone (55.26%), and 100% LMWH. A moderate group of the patient received favipiravir (97.56%), cephalosporin (64.67%), LMWH (89.02%) and low flow O2 (97.36%) in a higher percentage. All patients of the mild group received doxycycline, ivermectin. Total 33 patients transfuse convalescent plasma.&#x0D; Conclusion: Antiviral, broad-spectrum antibiotics, anti-protozoal, LMWH, corticosteroid, and oxygen therapy are the available treatment option against different clinical categories of admitted COVID-19 patients.&#x0D; Keywords: COVID-19, antiviral, antibiotic, steroid, O2 therapy

Incidence and risk factors of retinopathy of prematurity in a tertiary neonatal intensive care unit: Assiut University Hospital, Upper Egypt

Purpose This prospective study aimed to identify the incidence of retinopathy of prematurity (ROP) in premature infants in a neonatal ICU in a tertiary care hospital and to evaluate the risk factors predisposing to it.Patients and methods All preterm babies admitted to the neonatal ICU, during the study period, with gestational age (GA) less than 37 weeks and low birth weight (LBW) of less than or equal to 2.00 kg, were included in this study. Examination and follow-up of patients were done by binocular indirect ophthalmoscopy using a 28 D lens with a speculum and scleral depressor to examine the retinal periphery after efficient pupillary dilatation.Results Of 216 screened neonates, 66 (30.6%) developed ROP. Of these, 27 (40.9%) had stage 1, 35 (53.0%) had stage 2, and four (6.1%) had stage 3 ROP. The incidence was high in the GA group less than 28 (86.7%) weeks and in LBW neonates (100.0%). ROP was associated with LBW (1280±435 g, P<0.001), GA (30.4±1.9 weeks, P=0.005), sepsis (P=0.006), anemia (P=0.007), blood transfusion (P=0.018), bronchopulmonary dysplasia (P=0.001), and O2 therapy (P=0.006) as well as its duration (P<0.0001) by multiple logistic regression analysis.Conclusion ROP incidence in our tertiary care hospital was 30.6%. The main risk factors for ROP development were low GA, LBW, anemia, blood transfusion, sepsis, bronchopulmonary dysplasia, and O2 therapy and its duration. Prevention of prematurity, control of infection, reduction of blood sampling to prevent occurrence of anemia with subsequent blood transfusion, and judicious use of O2 therapy may be promising factors that may decrease the incidence and severity of ROP.

Bilevel positive airway pressure ventilation for non-COPD acute hypercapnic respiratory failure patients: A systematic review and meta-analysis.

The effectiveness of bi-level positive airway pressure (BiPAP) in patients with acute hypercapnic respiratory failure (AHRF) due to etiologies other than chronic obstructive pulmonary disease (COPD) is unclear. To systematically review the evidence regarding the effectiveness of BiPAP in non-COPD patients with AHRF. The Cochrane Library, MEDLINE, EMBASE, and CINAHL Plus were searched according to prespecified criteria (PROSPERO-CRD42018089875). Randomized controlled trials (RCTs) assessing the effectiveness of BiPAP versus continuous positive airway pressure (CPAP), invasive mechanical ventilation, or O2 therapy in adults with non-COPD AHRF were included. The primary outcomes of interest were the rate of endotracheal intubation (ETI) and mortality. Risk-of-bias assessment was performed, and data were synthesized and meta-analyzed where appropriate. Two thousand four hundred and eighty-five records were identified after removing duplicates. Eighty-eight articles were identified for full-text assessment, of which 82 articles were excluded. Six studies, of generally low or uncertain risk-of-bias, were included involving 320 participants with acute cardiogenic pulmonary edema (ACPO) and solid tumors. No significant differences were seen between BiPAP ventilation and CPAP with regard to the rate of progression to ETI (risk ratio [RR] = 1.49, 95% confidence interval [CI], 0.63–3.62, P = 0.37) and in-hospital mortality rate (RR = 0.71, 95% CI, 0.25–1.99, P = 0.51) in patients with AHRF due to ACPO. The efficacy of BiPAP appears similar to CPAP in reducing the rates of ETI and mortality in patients with AHRF due to ACPO. Further research on other non-COPD conditions which commonly cause AHRF such as obesity hypoventilation syndrome is needed.

Prognostic Implications of CT Feature Analysis in Patients with COVID-19: a Nationwide Cohort Study.

BackgroundFew studies have classified chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) and analyzed their correlations with prognosis. The present study aimed to evaluate retrospectively the clinical and chest CT findings of COVID-19 and to analyze CT findings and determine their relationships with clinical severity.MethodsChest CT and clinical features of 271 COVID-19 patients were assessed. The presence of CT findings and distribution of parenchymal abnormalities were evaluated, and CT patterns were classified as bronchopneumonia, organizing pneumonia (OP), or diffuse alveolar damage (DAD). Total extents were assessed using a visual scoring system and artificial intelligence software. Patients were allocated to two groups based on clinical outcomes, that is, to a severe group (requiring O2 therapy or mechanical ventilation, n = 55) or a mild group (not requiring O2 therapy or mechanical ventilation, n = 216). Clinical and CT features of these two groups were compared and univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors.ResultsAge, lymphocyte count, levels of C-reactive protein, and procalcitonin were significantly different in the two groups. Forty-five of the 271 patients had normal chest CT findings. The most common CT findings among the remaining 226 patients were ground-glass opacity (98%), followed by consolidation (53%). CT findings were classified as OP (93%), DAD (4%), or bronchopneumonia (3%) and all nine patients with DAD pattern were included in the severe group. Uivariate and multivariate analyses showed an elevated procalcitonin (odds ratio [OR], 2.521; 95% confidence interval [CI], 1.001–6.303, P = 0.048), and higher visual CT scores (OR, 1.137; 95% CI, 1.042–1.236; P = 0.003) or higher total extent by AI measurement (OR, 1.048; 95% CI, 1.020–1.076; P < 0.001) were significantly associated with a severe clinical course.ConclusionCT findings of COVID-19 pneumonia can be classified into OP, DAD, or bronchopneumonia patterns and all patients with DAD pattern were included in severe group. Elevated inflammatory markers and higher CT scores were found to be significant predictors of poor prognosis in patients with COVID-19 pneumonia.

A krónikus obstruktív tüdőbetegség és kezelési lehetőségei

[Chronic obstructive pulmonary disease (COPD) is prognosticated to become the 3rd most prevalent cause of early lethality. It’s main etiology is long-term smoking which induces chronic inflammation and obstruction of the airways as well as elastolysis of the pulmonary interstitium which lead to emphysema. Increased resistance of the intrathoracic airways and emphysema induce hyperinflation of the lung and chest which increases the work-load of the respi­ratory muscles. COPD patients are typically hypoxaemic and normocapnic. Finally, fatigue of the respiratory muscles cause the development of global respiratory failure (hypercapnia and severe hypoxaemia). Most effective intervention is smoking cessation. Maintanance treatment includes inhalational long-acting bronchodilators with or without inhalational corticosteroids. Acute exacerbation is treated with O2 supplementation, inhalational bronchodilators, systemic steroids and/or antiobiotics. Frequency and severity of acute exacerbations prognosticate shorter survival. In chronic respiratory failure long-term home O2 therapy can be provided.]

Hydrogen Gas Therapy: From Preclinical Studies to Clinical Trials.

Mounting evidence indicates that hydrogen gas (H2) is a versatile therapeutic agent, even at very low, non-combustible concentrations. The Chinese National Health and Medical Commission recently recommended the use of inhaled H2 in addition to O2 therapy in the treatment of COVID-19-associated pneumonia, and its effects extend to anti-tumor, anti-inflammatory and antioxidant actions. In this review, we have highlighted key findings from preclinical research and recent clinical studies demonstrating that H2 reduces the organ damage caused by ischemia-reperfusion. We have also outlined the critical role this effect plays in a variety of medical emergencies, including myocardial infarction, hemorrhagic shock, and out-of-hospital cardiac arrest, as well as in organ transplantation. H2 is compared with established treatments such as targeted temperature management, and we have also discussed its possible mechanisms of action, including the recently identified suppression of TNF-α-mediated endothelial glycocalyx degradation by inhaled H2. In addition, our new method that enables H2 gas to be easily transported to emergency settings and quickly injected into an organ preservation solution at the site of donor organ procurement have been described. H2 is an easily administered, inexpensive and well-tolerated agent that is highly effective for a wide range of conditions in emergency medicine, as well as for preserving donated organs.

Portable Oxygen Therapy: Is the 6-Minute Walking Test Overestimating the Actual Oxygen Needs?

The appropriate titration for the personalized oxygen needs of patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia is a determining factor in the success of long-term oxygen therapy. There are no standardized procedures to assist in determining the patient’s needs during the physical activities of daily life. Despite that effort tests are a wide broad approach, further research concerning the development of protocols to titrate O2 therapy is needed. The main objective of this study was to assess whether the level of oxygen titrated through the 6-minute walking test (6MWT) for patients with COPD and exertional hypoxemia is adequate to meet the patients’ demand during their activities of daily living. Physiological and subjective variables were estimated for a study population during two walking tests: a 6MWT and a 20-minute walking circuit (20MWC), designed ad-hoc to reproduce daily physical activities more truthfully. The results indicate that in a significant proportion of patients, the 6MWT might not accurately predict their oxygen needs at a domiciliary environment. Therefore, the titration of the portable O2 therapy could not be optimal in these cases, with the detrimental impact on the patient’s health (hyperoxia episodes), the autonomy of the oxygen device, and the decrease of time out of the home.

Management of lung transplantation in the COVID-19 era-An international survey.

It is unknown if solid organ transplant recipients are at higher risk for severe COVID-19. The management of a lung transplantation (LTx) program and the therapeutic strategies to adapt the immunosuppressive regimen and antiviral measures is a major issue in the COVID-19 era, but little is known about worldwide practice. We sent out to 180 LTx centers worldwide in June 2020 a survey with 63 questions, both regarding the management of a LTx program in the COVID-19 era and the therapeutic strategies to treat COVID-19 LTx recipients. We received a total of 78 responses from 15 countries. Among participants, 81% declared a reduction of the activity and 47% restricted LTx for urgent cases only. Sixteen centers observed deaths on waiting listed patients and eight centers performed LTx for COVID-19 disease. In 62% of the centers, COVID-19 was diagnosed in LTx recipients, most of them not severe cases. The most common immunosuppressive management included a decreased dose or pausing of the cell cycle inhibitors. Remdesivir, hydroxychloroquine, and azithromycin were the most proposed antiviral strategies. Most of the centers have been affected by the COVID-19 pandemic and proposed an active therapeutic strategy to treat LTx recipients with COVID-19.