Requirement For Oxygen Support Research Articles

The Effects of Oral Nutritional Support on the Ability of the COVID-19 Patients to Recover: A Prospective, Open, Multicenter, Comparative in Two Groups, Observational Study

Background. Nutritional insufficiency and decreased muscle mass of patients diagnosed with COVID-19 leads to prolonged respiratory support, stay in ICU and hospital, as well as reduced muscle strength and quality of life in the recovery period after a viral pneumonia caused by COVID-19. Aims: To study the effects of oral nutritional support on the physical health recovery of COVID-19 patients. Materials and methods. A prospective, open, multicenter, comparative observative study of two groups, observational study was initiated to evaluate the effects of oral nutritional support (ONS) by Nutridrink 200 ml on the ability of COVID-19 patients to recover. The patients with these criteria were included in the study: aged 1869; a confirmed COVID-19 infection; requires respiratory support; ability to consume more than 60% of food from the total required; presence of a signed consent form. One group received supplementary oral nutritional support (ONS) everyday for 28 days from the day of inclusion. The other group received standard diet. The primary endpoint was the evaluation of quality of life using the SF-36 questionnaire and the changes in the hand grip strength between the 3rd and 1st visits. Secondary endpoints of the study were length of stay in hospital and duration of respiratory support in the hospital. Results. 205 patients with a COVID-19 infection were included in the study. The final number of patients included in the study was 185 patients. Median age was 55 years old. The majority of patients were male 57.84% (107 patients). Upon evaluation of the physical component of quality of life using the SF-36 questionnaire, we obtained a statistically significant difference between the control and study groups on the 4th visit 44.285.45 and 46.586.76 respectively (p=0.012). Muscle strength was statistically different in the control (4.011.15 daN) and study (6.12.06 daN) groups (p 0.0001). The duration of respiratory support was significantly lower in the study group, 6.71.30 days as opposed to 8.141.52 days in the control group (p 0.0001). Also, in the group with oral nutritional support, there was a statistically significant decrease in the length of stay in hospital. In the control group, the average length of stay in hospital was 16.472.93 days, whereas in the study group it was 13.162.69 days (p 0.0001). Conclusion. Oral nutritional support given to oxygen dependent COVID-19 patients improves rehabilitation potential including preservation of muscle mass and function, reducing oxygen support requirements and length of stay in hospital.

Adherence to Healthy Diet and Risk and Severity of SARS-CoV-2 Infections: A Community Survey Study Within the COVID Symptom Study Application

ObjectivesTo examine the association of adherence to a healthy diet with risk and severity of SARS-CoV-2 infections.MethodsWe included participants from the COVID Symptom Study smartphone application enrolled in March 2020 from the UK and the US who provided information about their sociodemographic characteristics and risk factors for COVID-19 at baseline, and subsequently reported any symptoms they were experiencing over follow-up. We administered a supplementary diet and lifestyle survey between August and September 2020 to ascertain diet quality before the pandemic using a validated 35-item short food frequency questionnaire. We defined incident predicted cases of COVID-19 over follow-up using a validated symptom-based model and a severe case of COVID-19 asa report of hospitalization with requirement of oxygen support. We used Cox models to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for predicted COVID-19 and severe COVID-19 after adjusting for potential sociodemographic and behavioral confounders.ResultsOver 4,044,344 person-months of follow-up, we recorded 33,360 incident COVID-19 cases. Compared with individuals in the lowest quartile of the diet quality score, high diet quality was associated with a reduced risk of predicted COVID-19 (adjusted HR 0.94, 95% CI 0.91 to 0.97) and reduced risk of severe COVID-19 (adjusted HR 0.80, 95% CI 0.65 to 0.99). We found evidence of significant interactions between diet quality and socioeconomic status on COVID-19 risk, in which the attributable risk proportion of the joint effect due to the interaction was 30% (95% CI 2.8 to 57.2). Among participants with higher levels of socioeconomic deprivation, COVID-19 incidence rate per 1,000 person-months was 7.5% for those with low diet quality (95% CI 7.1 to 7.8) compared with 5.5% for those with a high diet quality (95% CI 5.2 to 5.9).ConclusionsThese findings suggest that adherence to a healthy diet is associated with lower risk of COVID-19 infection and severity. The apparent beneficial association of a high-quality diet may be particularly evident among individuals with a higher levels of socioeconomic deprivation.Funding SourcesZoe Global, UK Government Department of Health and Social Care, Wellcome Trust, Massachusetts Consortium on Pathogen Readiness

Clinical outcomes of using remdesivir in patients with moderate to severe COVID-19: A prospective randomised study.

Background and Aims:When the world was frantically searching for a drug effective against the coronavirus disease (COVID)-19, remdesivir, a broad-spectrum anti-viral medication, became a part of the COVID treatment. We planned a study to evaluate improvement in clinical outcomes with remdesivir treatment for five days.Methods:Participants more than 40-years old and with moderate to severe COVID-19 but not on mechanical ventilation were randomly assigned into two groups-remdesivir group (34 cases) to receive the study drug intravenous (IV) remdesivir for five days plus the standard care (SC) and non-remdesivir group (36 cases) to receive the SC but not to receive the study drug. Follow-up was continued for 12 days after the beginning of treatment or until discharge/death. Patient's clinical status was assessed by laboratory investigations and physical examination (from day 1 to day 12 on a 4-point ordinal scale and from day 12 to 24 on a 6-point ordinal scale). Oxygen support requirements and adverse events were recorded. The data were entered and analysed using Statistical Package for the Social Sciences (SPSS) version 22.0.Results:High-flow oxygen support and non-invasive ventilation was required at baseline by lesser patients in the remdesivir group. In the end, both groups had similar outcomes after adjustment for baseline clinical status. There was no statistical difference in mortality between the two groups (p = 0.749). Patients in both groups had an equal time to recovery. There was no difference in the occurrence of adverse effects of remdesivir between the two groups.Conclusion:Remdesivir therapy for five days did not produce improvement in clinical outcomes in moderate to severe COVID-19 cases.

Utility of visual coronary artery calcification on non-cardiac gated thoracic CT in predicting clinical severity and outcome in COVID-19

BackgroundAssessment of visual-coronary artery calcification on non-cardiac gated CT in COVID-19 patients could provide an objective approach to rapidly identify and triage clinically severe patients for early hospital admission to avert worse prognosis. PurposeTo ascertain the role of semi-quantitative scoring in visual-coronary artery calcification score (V-CACS) for predicting the clinical severity and outcome in patients with COVID-19. Materials and methodsWith institutional review board approval this study included 67 COVID-19 confirmed patients who underwent non-cardiac gated CT chest in an inpatient setting. Two blinded radiologist (Radiologist-1 &2) assessed the V-CACS, CT Chest severity score (CT-SS). The clinical data including the requirement for oxygen support, assisted ventilation, ICU admission and outcome was assessed, and patients were clinically subdivided depending on clinical severity. Logistic regression analyses were performed to identify independent predictors. ROC curves analysis is performed for the assessment of performance and Pearson correlation were performed to looks for the associations. ResultsV-CACS cut off value of 3 (82.67% sensitivity and 54.55% specificity; AUC 0.75) and CT-SS with a cut off value of 21.5 (95.7% sensitivity and 63.6% specificity; AUC 0.87) are independent predictors for clinical severity and also the need for ICU admission or assisted ventilation. The pooling of both CT-SS and V-CACS (82.67% sensitivity and 86.4% specificity; AUC 0.92) are more reliable in terms of predicting the primary outcome of COVID-19 patients. On regression analysis, V-CACS and CT-SS are individual independent predictors of clinical severity in COVID-19 (Odds ratio, 1.72; 95% CI, 0.99–2.98; p = 0.05 and Odds ratio, 1.22; 95% CI, 1.08–1.39; p = 0.001 respectively). The area under the curve (AUC) for pooled V-CACS and CT-SS was 0.96 (95% CI 0.84–0.98) which correctly predicted 82.1% cases. ConclusionLogistic regression model using pooled Visual-Coronary artery calcification score and CT Chest severity score in non-cardiac gated CT can predict clinical severity and outcome in patients with COVID-19.

Chest CT severity score to forecast clinical requirement of oxygen support in Covid-19 patients

Objectives: All over the world, attempts are made at the early prediction of disease severity of ongoing COVID-19 pandemic and catching early those patients who are likely to develop severe disease and may undergo cytokine storm. Though clinical and laboratory parameters are mainstay in diagnosing severe disease and oxygen requirements, high resolution computed tomographic (HRCT) scanning of the chest is one such promising tool to help identify such a subset of patients very early in the course of COVID-19 disease. The purpose of this research is to find an answer to a question can chest CT severity score (CTSS) on HRCT thorax scan forecast clinical requirements of oxygen support in covid-19 patients? Methods: During the period from May 2020 to October 15, 2020, 250 patients with confirmed RT-PCR diagnosis of COVID-19 on first or repeat sample and who also underwent HRCT scan of the chest, were retrospectively assigned chest CT severity score (CTSS). Patients were categorized into mild and severe score groups and from data obtained, analysis of how many patients from both groups progress to require oxygen support and intubation? Results: Out of a total of 250 patients, 175 patients were males and 75 patients were females. The average CT severity score (CTSS) was 19.5. 150 patients belong to mild CTSS group while 100 to severe CTSS group. Overall 180 patients required oxygen support, 100 belong to severe CTSS group while 80 belong to mild CTSS group. In mild CTSS group, 80 patients required low-flow oxygen. In severe CTSS group, 5 patients required low-flow oxygen, 75 required high-flow oxygen and 20 patients needed intubation. 8 out of 20 intubated patients succumbed to death. Overall 28 mortalities were reported of which 22 belong to severe CTSS group. With the Receiver operator characteristics (ROC) analysis, we found the cut off of CTS score. At the score of greater than 13 showed the significant effect on oxygen support with area under curve (AUC) 0.996 (95% CI 0.98 to 1; P 26) with in-hospital mortality. The Area under curve (AUC) 0.78 (95% CI 0.73 to 0.83; P

Legionella pneumophila in Patients with Pneumonia at a Referral Hospital, New Delhi, India, 2015–2020

Legionnaires' disease (LD) is an established cause of pneumonia, and the disease remains largely underdiagnosed. Even though LD has been reported from many parts of the world, only sporadic cases have been reported in India. During February 2015-January 2020, we enrolled 597 patients with radiographically confirmed pneumonia and tested respiratory secretions for Legionella spp. by using real-time PCR, and culture. A commercial urinary antigen test (UAT) was also used to detect the Legionella pneumophila (Lp) serogroup 1 antigen in urine. An LD case was defined as a patient with pneumonia and positive results for Legionella spp. infections determined by real-time PCR (from any respiratory specimen) or culture or UAT. Demographic data, risk factors, clinical, radiological, and outcome data of Lp-positive and Lp-negative patients were compared using logistic regression. Over the study period, 14 (2.3%) patients were positive for Legionella spp. infections by real-time PCR and UAT; eight (57%) were admitted to the intensive care unit, and four (28.6%) in-hospital deaths occurred. Bivariate analysis showed that renal disease, neurological conditions, confusion, leukocytosis, and requirement of oxygen support were more common in the Lp-positive group than in the Lp-negative group. However, multivariate analysis failed to confirm most of these differences; renal disease was the only independent variable remaining significant. All test methods have intrinsic limitations in identifying Legionella; therefore, more than one testing method should be used. Application of molecular assays including real-time PCR has great value because of its high sensitivity, specificity, and rapid diagnostic potency. Increased awareness and improved diagnostic testing could facilitate early detection of cases, pathogen-directed therapy, and improved outcomes for patients.

Blockage of interleukin-1\u03b2 with canakinumab in patients with Covid-19

There is the urgent need to study the effects of immunomodulating agents as therapy for Covid-19. An observational, cohort, prospective study with 30 days of observation was carried out to assess clinical outcomes in 88 patients hospitalized for Covid-19 pneumonia and treated with canakinumab (300 mg sc). Median time from diagnosis of Covid-19 by viral swab to administration of canakinumab was 7.5 days (range 0–30, IQR 4–11). Median PaO2/FiO2 increased from 160 (range 53–409, IQR 122–210) at baseline to 237 (range 72–533, IQR 158–331) at day 7 after treatment with canakinumab (p < 0.0001). Improvement of oxygen support category was observed in 61.4% of cases. Median duration of hospitalization following administration of canakinumab was 6 days (range 0–30, IQR 4–11). At 7 days, 58% of patients had been discharged and 12 (13.6%) had died. Significant differences between baseline and 7 days were observed for absolute lymphocyte counts (mean 0.60 vs 1.11 × 109/L, respectively, p < 0.0001) and C-reactive protein (mean 31.5 vs 5.8 mg/L, respectively, p < 0.0001).Overall survival at 1 month was 79.5% (95% CI 68.7–90.3). Oxygen-support requirements improved and overall mortality was 13.6%. Confirmation of the efficacy of canakinumab for Covid-19 warrants further study in randomized controlled trials.

Sulodexide in the Treatment of Patients with Early Stages of COVID-19: A Randomized Controlled Trial

Background: Targeting endothelial cells has been suggested for the treatment of patients with COVID-19 and sulodexide has pleiotropic properties within the vascular endothelium that can prove beneficial to the same. We aimed to evaluate the effect of sulodexide when used in the early clinical stages of COVID-19. Methods: We conducted a single-centre, outpatient setting, randomized controlled trial with a parallel-group design in Mexico. Including patients within three days of clinical symptom onset, who were at a high risk of severe clinical progression due to chronic comorbidities. Participants were randomly allocated to receive an oral dose of sulodexide (500 LRU twice a day) or the placebo for 21 days. Primary outcomes were need and length of hospitalisation, need and length of oxygen support and mortality. Results: Between June 5 and August 30, 2020, 243 patients were included in the “per-protocol” analysis. One hundred twenty-four of them received sulodexide, while 119 received placeboes. At 21 days follow-up, 22 of 124 patients required hospitalisation in the sulodexide group compared to 35 of 119 in the placebo group [relative risk (RR), 0·6; 95% confidence interval (CI), 0·37-0·96; p=0·03]. Fewer patients required oxygen support in the sulodexide group [37 of 124 vs. 50 of 119; RR, 0·71; 95% CI, 0·5 to 1; p=0·05], and for fewer days (9±7·2 in the sulodexide group vs. 11·5±9·6 in the placebo group; p=0·02). There was no between-group difference concerning the length of hospital stay or mortality. Interpretation: Early intervention in COVID-19 patients with sulodexide reduced hospital admissions and oxygen support requirements, although with no significant effect on mortality. This has beneficial implications in the patient well-being, making sulodexide a favourable medication until an effective vaccine or an antiviral becomes available. Trial Registration: Listed in the ISRCTN registry under ID ISRCTN59048638.Funding: Researcher independently initiated, partially funded by Alfasigma, Mexico. Declaration of Interests: AGO has received speaker fees, honoraria and travel reimbursement from Alfasigma Mexico for research outside of this submitted study. All other authors declare no competing interests.Ethics Approval Statement: We conducted this trial according to the Declaration of Helsinki and it was board reviewed by the Universidad Autonoma de Baja California Faculty of Medicine Mexicali Ethics and Investigation Committee, being designated with approval number FMM/CEI/0011/2020-2.

TOCILIZUMAB USE IN SEVERE COVID-19: A SINGLE CENTER EXPERIENCE

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Severe acute respiratory syndrome coronavirus-2 (SAR-CoV-2) is a novel virus that causes coronavirus disease 2019 (COVID-19). Previous studies have detected high levels of pro-inflammatory cytokines in COVID-19 patients, including interleukin-6 (IL-6). Tocilizumab is a humanized monoclonal antibody against IL-6 receptors and has been identified as a potential therapeutic agent for COVID-19. We aim to describe the treatment response of critically ill COVID-19 patients who received tocilizumab. METHODS: Following institutional review board approval, we identified 67 critically ill patients with laboratory confirmed COVID-19 infection who received tocilizumab. Decisions regarding clinical management, including tocilizumab administration, were made solely at the discretion of the treating provider. De-identified patient data was retrospectively collected and analyzed using Stata version 15.1 (StatCorp). Data reported in this study are those which are available through April 25 2020. RESULTS: We identified 67 critically ill patients with COVID-19 who were given tocilizumab (mean age 57 years (53-61), 71% male). At the time of tocilizumab administration, 42 patients required invasive mechanical ventilation, 11 required non-invasive mechanical ventilation, 11 required high flow nasal cannula and 3 patients required non rebreather mask or nasal cannula oxygen support. Three days after tocilizumab administration, 53 patients had no change in oxygen support requirements, 13 patients had reduced oxygen support requirements, and 2 patients required higher levels of oxygen support. For patients who remained on mechanical ventilation, there was a decrease in mean FIO2 requirement by 8.98%. There was a significant decrease in mean IL-6 by 129, CRP by 63, WBC by 1.71. Seven days after tocilizumab administration, 39 patients had no change in oxygen support requirements, 27 patients had reduced oxygen support requirements and 1 patient required higher levels of oxygen support. For patients who required mechanical ventilation, there was a decrease in mean FIO2 requirement by 13.36%. There was a significant decrease in mean IL-6 by 130, CRP by 107, WBC level by 2.87. There was no significant change in daily max temperature at day 3 or 7. CONCLUSIONS: In this cohort of 67 patients treated with tocilizumab for severe COVID-19, improvement in oxygen support requirements was seen in 13 patients at day 3 and 27 patients at day 7. Improvement in FIO2 and several markers of inflammation including WBC, CRP and IL-6 were seen at day 3 and 7. Further studies such as randomized placebo controlled trials of tocilizumab will be required to better measure its efficacy and safety in patients with COVID-19. CLINICAL IMPLICATIONS: Tocilizumab use in critically ill patients may reduce oxygen support requirements and laboratory markers of inflammation. Further studies are required to establish efficacy and safety. DISCLOSURES: No relevant relationships by Yasmin Herrera, source=Web Response No relevant relationships by Kam Sing Ho, source=Web Response No relevant relationships by Raymonde Jean, source=Web Response No relevant relationships by Joseph Poon, source=Web Response

Appropriate use of tocilizumab in COVID-19 infection

ObjectiveThis study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations. MethodsAll patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, d-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations. ResultsForty-three patients were included: 70% were male; the median age was 64 years (minimum–maximum: 27–94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, d-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones. ConclusionEarlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and d-dimer, and decrease in % lymphocytes.

Individualized prediction nomograms for disease progression in mild COVID-19.

The coronavirus disease 2019 (COVID‐19) has evolved into a pandemic rapidly. The majority of COVID‐19 patients are with mild syndromes. This study aimed to develop models for predicting disease progression in mild cases. The risk factors for the requirement of oxygen support in mild COVID‐19 were explored using multivariate logistic regression. Nomogram as visualization of the models was developed using R software. A total of 344 patients with mild COVID‐19 were included in the final analysis, 45 of whom progressed and needed high‐flow oxygen therapy or mechanical ventilation after admission. There were 188 (54.7%) males, and the average age of the cohort was 52.9 ± 16.8 years. When the laboratory data were not included in multivariate analysis, diabetes, coronary heart disease, T ≥ 38.5℃ and sputum were independent risk factors of progressive COVID‐19 (Model 1). When the blood routine test was included the CHD, T ≥ 38.5℃ and neutrophil‐to‐lymphocyte ratio were found to be independent predictors (Model 2). The area under the receiver operator characteristic curve of model 2 was larger than model 1 (0.872 vs 0.849, P = .023). The negative predictive value of both models was greater than 96%, indicating they could serve as simple tools for ruling out the possibility of disease progression. In conclusion, two models comprised common symptoms (fever and sputum), underlying diseases (diabetes and coronary heart disease) and blood routine test are developed for predicting the future requirement of oxygen support in mild COVID‐19 cases.

Respiratory support for adult patients with COVID-19.

The COVID‐19 pandemic is creating unique strains on the healthcare system. While only a small percentage of patients require mechanical ventilation and ICU care, the enormous size of the populations affected means that these critical resources may become limited. A number of non‐invasive options exist to avert mechanical ventilation and ICU admission. This is a clinical review of these options and their applicability in adult COVID‐19 patients. Summary recommendations include: (1) Avoid nebulized therapies. Consider metered dose inhaler alternatives. (2) Provide supplemental oxygen following usual treatment principles for hypoxic respiratory failure. Maintain awareness of the aerosol‐generating potential of all devices, including nasal cannulas, simple face masks, and venturi masks. Use non‐rebreather masks when possible. Be attentive to aerosol generation and the use of personal protective equipment. (3) High flow nasal oxygen is preferred for patients with higher oxygen support requirements. Non‐invasive positive pressure ventilation may be associated with higher risk of nosocomial transmission. If used, measures special precautions should be used reduce aerosol formation. (4) Early intubation/mechanical ventilation may be prudent for patients deemed likely to progress to critical illness, multi‐organ failure, or acute respiratory distress syndrome (ARDS).

A multicenter prospective study of neonatal outcomes at less than 32 weeks associated with indications for maternal admission and delivery

Counseling for patients with impending premature delivery traditionally has been based primarily on the projected gestational age at delivery. There are limited data regarding how the indications for the preterm birth affect the neonatal outcome and whether this issue should be taken into account in decisions regarding management and patient counseling. We performed a prospective study of pregnancies resulting in premature delivery at less than 32 weeks to determine the influence of both the indications for admission and their associated indications for delivery on neonatal mortality and complications of prematurity. This is a multicenter, prospective study in 10 hospitals where all data from the neonatal intensive care unit routinely was imported to a deidentified data warehouse. Maternal data were collected prospectively at or near the time of delivery. Eligible subjects included singleton deliveries in these hospitals between 23 0/7 and 31 6/7 weeks. The primary hypothesis of the study was to determine whether there was a difference in the primary outcome, which was defined as neonatal composite morbidity, between those neonates delivered after admission for premature labor vs premature rupture of membranes, because these were expected to be the 2 most frequent diagnoses leading to premature birth. The sample size was calculated based on a 10% difference in outcomes for these 2 entities. We based this hypothesis on the knowledge that premature rupture of membranes has a greater incidence of intra-amniotic infection and inflammation than premature labor and that outcomes for premature neonates are worse when delivery is associated with intra-amniotic infection. Additional outcomes were analyzed for all other indications for admission and delivery. Composite morbidity was defined as ≥1 of the following: respiratory distress syndrome (oxygen requirement, clinical diagnosis, and consistent chest radiograph), bronchopulmonary dysplasia (requirement for oxygen support at 28 days of life), severe intraventricular hemorrhage (grades 3 or 4), periventricular leukomalacia, blood culture-proven sepsis present within 72 hours of birth, necrotizing enterocolitis, or neonatal death before discharge from the hospital. A secondary composite of serious neonatal morbidity also was defined prospectively. The study included 1089 mother/baby pairs. Composite morbidity between those with premature labor (77.2%) and premature rupture of membranes (73.2%) was not significantly different (P= .29). A few neonatal complications were associated with indications for admission and delivery, but on logistic regression adjusting for gestational age and other confounders, suspected intrauterine growth restriction was the only indication for admission or delivery associated with an increase in serious morbidity (odds ratio 4.5, [2.1 to 9.8], P < .003). Other factors not related to the indications for admission including cesarean delivery, and low 5-minute Apgar were associated with an increase in morbidity. Studies of many single factors related to the indications for preterm delivery have been shown to be associated with adverse neonatal outcome. In this study evaluating all of the most frequent indications, however, we found only suspected intrauterine growth restriction as an indication for admission and delivery was found to be so. Thus, it seems that in almost all situations counseling patients can be based primarily on gestational age along with other factors including estimated fetal weight, sex, race, plurality, and completion of a course of antenatal corticosteroids.

The Analgesic Effect of 8 and 16 mg Lornoxicam Administered Before Shock Wave Lithotripsy: A Randomized, Double-Blind, Controlled Study

To evaluate the efficacy of 2 different doses of intravenous lornoxicam for pain relief during shock wave lithotripsy (SWL). In this randomized, controlled, double-blind study, 60 ASA I-II patients undergoing SWL were randomly divided into 3 groups. Fifteen minutes before SWL, 4 mL of saline solution was given to the patients in group I, 8 mg lornoxicam in group II, and 16 mg lornoxicam in group III. All groups received 1 mcg/kg fentanyl intravenously 3 minutes before SWL. Pain scores, blood pressure, heart rate, respiratory rate, and oxygen saturation were noted before SWL, at 1 minute and every 5 minutes during the procedure. Also, additional fentanyl consumption, oxygen support requirements, time for recovery room discharge, adverse effects, and patient satisfaction were recorded. The mean blood pressure, heart rate, and SpO(2) values were significantly lower in group I at 5 and 10 minutes (P < .01). The mean visual analogue scale scores and fentanyl consumption were higher in group I (P < .001). The additional meperidine requirement was higher in group I (P = .014). In group I, oxygen requirement was higher and recovery room period was longer than in the other 2 groups (P < .001), and 2 patients from group I had respiratory depression develop. The incidence of nausea and vomiting was higher in group I (P < .05). The patients' satisfaction scores were higher in groups II and III than in group I (P = .001). Eight milligrams of intravenously administered lornoxicam 15 minutes before SWL provides pain relief and patient satisfaction during the procedure, reducing opioid requirements as well as decreasing the incidence of side effects.