scholarly journals Outcome of treatment with non‐invasive ventilation in a tertiary care hospital

2019 ◽  
Vol 28 (S1) ◽  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

scholarly journals Risk of COVID-19 Infection in Healthcare Workers Exposed During Use of Non-invasive Ventilation in a Tertiary Care Hospital in OmanRisk of COVID-19 Infection in Healthcare Workers Exposed During Use of Non-invasive Ventilation in a Tertiary Care Hospital in Oman

2021 ◽  
Vol 36 (2) ◽  
pp. e236-e236
Author(s):  
Adil Al Lawati ◽  
Faryal Khamis ◽  
Samiha Al Habsi ◽  
Khazina Al Dalhami
Keyword(s):  
High Risk ◽  
Healthcare Workers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Significant Risk ◽  
High Risk Population ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Objectives: Healthcare workers (HCWs), especially those working on the front line, are considered to be at high risk of nosocomial acquisition of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). Little is known about the effectiveness of the recommended protective methods as few reports have described spread of the disease in hospital settings among this high-risk population. We describe the hospital-based transmission of SARS-CoV-2 related to non-invasive ventilation (NIV) in one of the main tertiary care hospitals in Oman. Methods: All exposed patients and HCWs from Royal Hospital were screened, quarantined, and underwent telephone interviews to stratify their risk factors, clinical symptoms, and exposure risk assessment. Results: A total of 46 HCWs and patients tested positive for SARS-CoV-2 after exposure to an index case who received 48 hours of NIV before diagnosing COVID-19 infection. Over half of the exposed (56.5%; n = 26) were nurses, 26.1% (n = 12) were patients, and 15.2% (n = 7) were doctors. None of the HCWs required hospitalization. Sore throat, fever, and myalgia were the most common symptoms. Conclusions: NIV poses a significant risk for SARS-CoV-2 transmission within hospital settings if appropriate infection control measures are not taken.

scholarly journals Time to Act: Set Up for Non-Invasive ventilation in Tertiary Care Hospital

1970 ◽  
Vol 9 (1) ◽  
pp. 54-55
Author(s):  
SS Dhakal ◽  
N Bhatta ◽  
S Rijal
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Set Up

DOI: 10.3126/hren.v9i1.4365Health Renaissance, 2011: Vol.9 No.1:54-55

scholarly journals Serological testing reveals the hidden COVID-19 burden among healthcare workers experiencing a SARS-CoV-2 nosocomial outbreak.

2021 ◽  
Author(s):  
Yu Nakagama ◽  
Yuko Komase ◽  
Katherine Candray ◽  
Sachie Nakagama ◽  
Fumiaki Sano ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Nucleic Acid Amplification ◽  
Care Hospital ◽  
Case Detection ◽  
Serological Testing ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Serological Diagnostics

We describe the results of testing healthcare workers from a tertiary care hospital in Japan, which had experienced a COVID-19 outbreak during the first peak of the pandemic, for SARS-CoV-2 specific antibody seroconversion. Using two chemiluminescent immunoassays and a confirmatory surrogate virus neutralization test, serological testing unveiled that a surprising 42.2% (27/64) of overlooked COVID-19 diagnoses had occurred when case detection had relied solely on SARS-CoV-2 nucleic acid amplification testing. This undetected portion of the COVID-19 iceberg beneath the surface may potentially have led to silent transmissions and triggered the spread. A questionnaire-based risk assessment was further indicative of exposures to specific aerosol-generating procedures, i.e. non-invasive ventilation, having had conveyed the highest transmission risks and served as the origin of outbreak. Our observations are supportive of a multi-tiered testing approach, including the use of serological diagnostics, in order to accomplish exhaustive case detection along the whole COVID-19 spectrum.

scholarly journals LO02: Development of the HEARTRISK6 Scale for emergency department patients with acute heart failure

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S7
Author(s):  
I. Stiell ◽  
A. McRae ◽  
B. Rowe ◽  
J. Dreyer ◽  
L. Mielniczuk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Tertiary Care ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Risk Patients ◽  
Risk Scale

Introduction: We previously derived (N = 559) and validated (N = 1,100) the 10-item Ottawa Heart Failure Risk Scale (OHFRS), to assist with disposition decisions for patients with acute heart failure (AHF) in the emergency department (ED). In the current study we sought to use a larger dataset to develop a more concise and more accurate risk scale. Methods: We analyzed data from the prior two studies and from a new cohort. For all 3 groups we conducted prospective cohort studies that enrolled patients who required treatment for AHF at 8 tertiary care hospital EDs. Patients were followed for 30 days. The primary outcome was short-term serious outcome (SSO), defined as death within 30 days, intubation or non-invasive ventilation (NIV) after admission, myocardial infarction, or relapse resulting in hospital admission within 14 days. The fully pre-specified logistic regression model with 13 predictors (where age, pCO2, and SaO2 were modeled using spline functions) was fitted to 10 multiple imputation datasets. Harrell's fast stepdown procedure reduced the number of variables. We calculated the potential impact on sensitivity (95% CI) for SSO and hospital admissions, and estimated a sample size of 2,000 patients. Results: The 1,986 patients had mean age 77.3 years, male 54.1%, EMS arrival 41.2%, IV NTG 3.3%, ED NIV 5.4%, admission on initial visit 49.5%. Overall there were 236 (11.9%) SSOs including 61 deaths (3.1%), meaning that current admission practice sensitivity for SSO was only 59.7%. The final HEARTRISK6 scale is comprised of 6 variables (points) (C-statistic 0.68): Valvular heart disease (2) Antiarrhythmic medication (2) ED non-invasive ventilation (3) Creatinine 80–150 (1); ≥150 (3) Troponin ≥3x URL (2) Walk test failed (1). The probability of SSO ranged from 4.8% for a total score of 0 to 62.4% for a score of 10, showing good calibration. Choosing a HEARTRISK6 total point admission threshold of ≥3 would yield sensitivity of 70.8% (95%CI 64.5-76.5) for SSO with a slight decrease in admissions to 47.9%. Choosing a threshold of ≥2 would yield a sensitivity of 84.3% (95%CI 79.0-88.7) but require 66.6% admissions. Conclusion: Using a large prospectively collected dataset, we created a more concise and more sensitive risk scale to assist with admission decisions for patients with AHF in the ED. Implementation of the HEARTRISK6 scale should lead to safer and more efficient disposition decisions, with more high-risk patients being admitted and more low-risk patients being discharged.

scholarly journals Correlation of days of illness on which oseltamivir was started with outcome in swine flu patients, in Government Medical College, Aurangabad (Jan-2015 to May 2015)

2015 ◽  
Vol 1 (6) ◽  
pp. 245
Author(s):  
Mangala S. Borkar ◽  
Sagar P. Patil ◽  
Vimlesh R. Pandey ◽  
Gajanan A. Surwade ◽  
Uddhav S. Khaire
Keyword(s):  
Tertiary Care ◽  
Time Lag ◽  
Cross Sectional Study ◽  
Swine Flu ◽  
Care Hospital ◽  
Government Medical College ◽  
Invasive Ventilation ◽  
Cross Sectional ◽  
Medical College ◽  
Non Invasive Ventilation

<p class="abstract"><strong><span lang="EN-US">Background:</span></strong><span lang="EN-US"> Since 2009, Government Medical College, Aurangabad, a tertiary care hospital in the Marathwada region of Maharashtra, India, has been regularly admitting cases of pneumonia and ARDS, that are labeled as swine flu suspects.</span> Oseltamivir is effective in swine flu cases if given within 48 hours and better, within 24 hours of start of illness. However most of our patients do not get oseltamivir within 48 hours. Hence we decided to compare the outcome in patients who received oseltamivir within 48 hours and after that.</p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong><span lang="EN-US"> This is an observational, cross-sectional study comparing the time lag between the start of symptoms and getting the first dose of oseltamivir. 59 H1N1 positive patients were admitted to the swine flu ward between January to May 2015. We compared the two groups, one that received oseltamivir within 48 hours of start of symptoms and one that received after 48 hours and compared it with the outcome, i. e survival or death.</span></p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>38 patients (64.40%) in our study belonged to the age group of 31-50. Out of 59 positive patients, only 7 received oseltamivir within 48 hours, of whom 4 died. 52 received oseltamivir after 48 hours of whom 20 died. All the 11 who were given non-invasive ventilation, whereas only 1 of the 25 on invasive ventilation survived.  </p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>Oseltamavir does not appear to have made a difference for survival whether it was given within 48 hours as compared to after 48 hours of onset of symptoms. However, these two groups were not comparable.</p>

scholarly journals PL01: Creation of a risk scoring system for emergency department patients with acute heart failure

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S5-S5
Author(s):  
I. Stiell ◽  
J. Perry ◽  
C. Clement ◽  
S. Sibley ◽  
A. McRae ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Risk Patients ◽  
Risk Scoring ◽  
Risk Scale

Introduction: Acute heart failure (AHF) is a common emergency department (ED) presentation and may be associated with poor outcomes. Conversely, many patients rapidly improve with ED treatment and may not need hospital admission. Because there is little evidence to guide disposition decisions by ED and admitting physicians, we sought to create a risk score for predicting short-term serious outcomes (SSO) in patients with AHF. Methods: We conducted prospective cohort studies at 9 tertiary care hospital EDs from 2007 to 2019, and enrolled adult patients who required treatment for AHF. Each patient was assessed for standardized real-time clinical and laboratory variables, as well as for SSO (defined as death within 30 days or intubation, non-invasive ventilation (NIV), myocardial infarction, coronary bypass surgery, or new hemodialysis after admission). The fully pre-specified, logistic regression model with 13 predictors (age, pCO2, and SaO2 were modeled using spline functions with 3 knots and heart rate and creatinine with 5 knots) was fitted to the 10 multiple imputation datasets. Harrell's fast stepdown procedure reduced the number of variables. We calculated the potential impact on sensitivity (95% CI) for SSO and hospital admissions and estimated a sample size of 170 SSOs. Results: The 2,246 patients had mean age 77.4 years, male sex 54.5%, EMS arrival 41.1%, IV NTG 3.1%, ED NIV 5.2%, admission on initial visit 48.6%. Overall there were 174 (7.8%) SSOs including 70 deaths (3.1%). The final risk scale is comprised of five variables (points) and had c-statistic of 0.76 (95% CI: 0.73-0.80): 1.Valvular heart disease (1) 2.ED non-invasive ventilation (2) 3.Creatinine 150-300 (1) ≥300 (2) 4.Troponin 2x-4x URL (1) ≥5x URL (2) 5.Walk test failed (2) The probability of SSO ranged from 2.0% for a total score of 0 to 90.2% for a score of 10, showing good calibration. The model was stable over 1,000 bootstrap samples. Choosing a risk model total point admission threshold of >2 would yield a sensitivity of 80.5% (95% CI 73.9-86.1) for SSO with no change in admissions from current practice (48.6% vs 48.7%). Conclusion: Using a large prospectively collected dataset, we created a concise and sensitive risk scale to assist with admission decisions for patients with AHF in the ED. Implementation of this risk scoring scale should lead to safer and more efficient disposition decisions, with more high-risk patients being admitted and more low-risk patients being discharged.

scholarly journals Role Of NIV In COPD Exacerbation One Year Experience From A Tertiary Care Hospital

JMS SKIMS ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 59-64
Author(s):  
Irfan Ahmed ◽  
Javid Ahmad Wani ◽  
Showkat Ali Mufti
Keyword(s):  
Tertiary Care ◽  
Respiratory Acidosis ◽  
Care Hospital ◽  
Pharmacologic Treatment ◽  
Non Invasive ◽  
Accident And Emergency ◽  
Non Invasive Ventilation ◽  
Successful Group ◽  
One Year ◽  
Exacerbation Of Copd

Introduction: Non-invasive ventilation (NIV) refers to delivery of mechanical ventilation with techniques that do not need an invasive endotracheal airway. The main indications are acute exacerbation of COPD, cardiogenic pulmonary edema, pulmonary infiltrates in immunecompromised patients, and weaning of previously intubated stable patients with COPD1. NIV has its best indication in moderate to severe respiratory acidosis in patients with AECOPD. For this indication, studies conducted in intensive care units (ICU's), in wards, and in Accident and Emergency Departments confirmed its effectiveness in preventing endotracheal intubation and reducing mortality 2.Objectives: To see the outcome of NIV in patients of AECOPD with respiratory acidosis. Materials and Methods: The study was conducted in Department Of Emergency Medicine, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, J and K, India over a period of one year from October 2015 to September 2016 during which 153 patients of AECOPD were treated with NIV.Results: The study included 153 patients of AECOPD who received NIV, besides standard pharmacologic treatment. 124 (81.04%) patients improved while as 29(18.96%) did not. The patients in the successful group experienced significant improvement in their HR, RR, pH, PaCO2 and PaO2 from 116.2±12.3, 32.4±4.3, 7.27±0.06, 80.7±12.5, and 52.8±10.6 at admission to 102.4±8.3, 26.4±4.4, 7.31±0.07, 70.4±16.4 and 58.6±11.5 , respectively, after 1 hour of NIV. This change in HR, RR, pH, PaCO2 and PaO2 was statistically significant.Conclusion: The study concludes that in patients with AECOPD with moderate- severe respiratory acidosis NIV should be the first line of treatment, besides the standard pharmacologic treatment. JMS 2016; 19(2):59-64

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