The swallowing telerehabilitation in COVID-19 (Preprint)

2020 ◽  
Author(s):  
Tomoo Mano ◽  
Shigeto Soyama
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Protective Equipment ◽  
Video Conference ◽  
Rehabilitation Professionals ◽  
Swallowing Rehabilitation ◽  
Swallowing Difficulty ◽  
The Individual

UNSTRUCTURED Direct swallowing rehabilitation is not recommended for patients who is positive or suspected for the severe acute respiratory syndrome coronavirus 2（SARS-CoV-2），because SARS-CoV-2 is extremely infectious and may transmit to the individual performing rehabilitation. Some of patients in the intensive care unit and on mechanical ventilation undergo the swallowing difficulty. To feed normally again and be discharged, an assessment of dysphagia and eventual targeted swallowing training by specialized rehabilitation professionals are provided. We analysis the benefit of telerehabilitation, and we experienced the case with COVID-19 of contactless swallowing rehabilitation using video conference software on the tablet-type devices. Telerehabilitation offers the risk reduction of infection and the prevention the shortage of personal protective equipment. Protecting the medical staff from nosocomial infection of COVID-19 is therefore extremely important, and we suggest telerehabilitation as a useful approach in the swallowing rehabilitation.

scholarly journals 375. COVID 19 infection in a Massachusetts community hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S257-S258
Author(s):  
Raul Davaro ◽  
alwyn rapose
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Essential Hypertension ◽  
Severe Acute Respiratory Syndrome ◽  
High Mortality ◽  
Case Series ◽  
World Health ◽  
Minimal Risk ◽  
The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

scholarly journals Age, Frailty, Resuscitation and Intensive Care: With Reference to COVID-19

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 36
Author(s):  
David G Smithard ◽  
Nadir Abdelhameed ◽  
Thwe Han ◽  
Angelo Pieris
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Distributive Justice ◽  
Older Age ◽  
Distribution Of Resources ◽  
Utilitarian Approach ◽  
The Individual

Discussion regarding cardiopulmonary resuscitation and admission to an intensive care unit is frequently fraught in the context of older age. It is complicated by the fact that the presence of multiple comorbidities and frailty adversely impact on prognosis. Cardiopulmonary resuscitation and mechanical ventilation are not appropriate for all. Who decides and how? This paper discusses the issues, biases, and potential harms involved in decision-making. The basis of decision making requires fairness in the distribution of resources/healthcare (distributive justice), yet much of the printed guidance has taken a utilitarian approach (getting the most from the resource provided). The challenge is to provide a balance between justice for the individual and population justice.

scholarly journals COVID-19 on a Patient with Familial Hypercholesterolemia

2020 ◽  
Vol 5 (10) ◽  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Familial Hypercholesterolemia ◽  
Distress Syndrome ◽  
Main Symptom ◽  
Entire World ◽  
Novel Coronavirus

Covid-19 is disease caused by a novel coronavirus also known as severe acute respiratory syndrome coronavirus 2, a name that describes the disease if causes. It was first detected in Wuhan, China in December of 2019 where it arose to spread in the entire world to cause the global COVID-19 Pandemic. This virus causes severe bilateral pneumonia and acute respiratory distress syndrome which requires to be managed in intensive care unit requiring mechanical ventilation. We present a 77-year old Covid-19 patient with familial hypercholesterolemia and stroke who presented with the main symptom of confusion. After exclusion of our first differential that was stroke, we tested the patient for Covid-19 and resulted positive. After treatment with oxygen, steroids and antibiotics, the patient recovered and was discharged. An important lesion from this patient was that the presentation of Covid-19 has various types and manifestations.

scholarly journals Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199153
Author(s):  
Ameer Al-Hadidi ◽  
Morta Lapkus ◽  
Patrick Karabon ◽  
Begum Akay ◽  
Paras Khandhar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Noninvasive Positive Pressure Ventilation ◽  
Pediatric Intensive Care ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Positive Pressure ◽  
P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

scholarly journals A Timely Call to Arms: COVID-19, the Circadian Clock, and Critical Care

2021 ◽  
Vol 36 (1) ◽  
pp. 55-70
Author(s):  
Jeffrey Haspel ◽  
Minjee Kim ◽  
Phyllis Zee ◽  
Tanja Schwarzmeier ◽  
Sara Montagnese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Human Physiology ◽  
Critical Care ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Circadian Clock ◽  
Clinical Course ◽  
Disease Expression ◽  
Severe Manifestation ◽  
Novel Coronavirus

We currently find ourselves in the midst of a global coronavirus disease 2019 (COVID-19) pandemic, caused by the highly infectious novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we discuss aspects of SARS-CoV-2 biology and pathology and how these might interact with the circadian clock of the host. We further focus on the severe manifestation of the illness, leading to hospitalization in an intensive care unit. The most common severe complications of COVID-19 relate to clock-regulated human physiology. We speculate on how the pandemic might be used to gain insights on the circadian clock but, more importantly, on how knowledge of the circadian clock might be used to mitigate the disease expression and the clinical course of COVID-19.

scholarly journals Derivation and validation of a search algorithm to retrospectively identify mechanical ventilation initiation in the intensive care unit

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Nathan J Smischney ◽  
Venu M Velagapudi ◽  
James A Onigkeit ◽  
Brian W Pickering ◽  
Vitaly Herasevich ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Search Algorithm

scholarly journals More skilled clinical management of COVID-19 patients modified mortality in an intermediate respiratory intensive care unit in Italy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Giovanna E. Carpagnano ◽  
Giovanni Migliore ◽  
Salvatore Grasso ◽  
Vito Procacci ◽  
Emanuela Resta ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Clinical Management ◽  
Average Length ◽  
Limited Attention ◽  
Average Length Of Stay ◽  
Before And After ◽  
Respiratory Intensive Care Unit ◽  
Transferred Patients

Abstract Background Some studies investigated epidemiological and clinical features of laboratory-confirmed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the virus causing coronavirus disease 2019 (COVID-19), but limited attention has been paid to the follow-up of hospitalized patients on the basis of clinical setting and the expertise of clinical management. Methods In the present single-centered, retrospective, observational study, we reported findings from 87 consecutive laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory syndrome hospitalized in an intermediate Respiratory Intensive Care Unit (RICU), subdividing the patients in two groups according to the admission date (before and after March 29, 2020). Results With improved skills in the clinical management of COVID-19, we observed a significant lower mortality in the T2 group compared with the T1 group and a significantly difference in terms of mortality among the patients transferred in Intensive Care Unit (ICU) from our intermediate RICU (100% in T1 group vs. 33.3% in T2 group). The average length of stay in intermediate RICU of ICU-transferred patients who survived in T1 and T2 was significantly longer than those who died (who died 3.3 ± 2.8 days vs. who survived 6.4 ± 3.3 days). T Conclusions The present findings suggested that an intermediate level of hospital care may have the potential to modify survival in COVID-19 patients, particularly in the present phase of a more skilled clinical management of the pandemic.

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