Upper extremity deep vein thrombosis in COVID-19: Incidence and correlated risk factors in a cohort of non-ICU patients

Background Venous thromboembolism is a frequent complication of COVID-19 infection. Less than 50% of pulmonary embolism (PE) is associated with the evidence of deep venous thrombosis (DVT) of the lower extremities. DVT may also occur in the venous system of the upper limbs especially if provoking conditions are present such as continuous positive airway pressure (CPAP). The aim of this study was to evaluate the incidence of UEDVT in patients affected by moderate-severe COVID-19 infection and to identify potential associated risk factors for its occurrence. Methods We performed a retrospective analysis of all patients affected by moderate-severe COVID-19 infection admitted to our unit. In accordance with the local protocol, all patients had undergone a systematic screening for the diagnosis of UEDVT, by vein compression ultrasonography (CUS). All the patients were receiving pharmacological thromboprophylaxis according to international guidelines recommendations. Univariate and multivariate analyses were used to identify risk factors associated with UEDVT. Results 257 patients were included in the study, 28 patients were affected by UEDVT with an incidence of 10.9% (95% CI, 7.1–14.7). At univariate analysis UEDVT appeared to be significantly associated (p< 0.05) with pneumonia, ARDS, PaO2/FiO2, D-dimer value higher than the age adjusted cut off value and need for CPAP ventilation. Multivariate analysis showed a significant association between UEDVT and the need for CPAP ventilation (OR 5.95; 95% IC 1.33–26.58). Increased mortality was found in patients affected by UEDVT compared to those who were not (OR 3.71; 95% CI, 1.41–9.78). Conclusions UEDVT can occur in COVID-19 patients despite adequate prophylaxis especially in patients undergoing helmet CPAP ventilation. Further studies are needed to identify the correct strategy to prevent DVT in these patients.

Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial

Continuous positive airway pressure (CPAP) during anaesthesia induction improves oxygen saturation (SpO2) outcomes in adults subjected to airway manipulation, and could similarly support oxygenation in children. We evaluated whether CPAP ventilation and passive CPAP oxygenation in children would defer a SpO2 decrease to 95% after apnoea onset compared to the regular technique in which no positive airway pressure is applied. In this double-blind, parallel, randomised controlled clinical trial, 68 children aged 2–6 years with ASA I–II who underwent surgery under general anaesthesia were divided into CPAP and control groups (n = 34 in each group). The intervention was CPAP ventilation and passive CPAP oxygenation using an anaesthesia workstation. The primary outcome was the elapsed time until SpO2 decreased to 95% during a follow-up period of 300 s from apnoea onset (T1). We also recorded the time required to regain baseline levels from an SpO2 of 95% aided by positive pressure ventilation (T2). The median T1 was 278 s (95% confidence interval [CI]: 188–368) in the CPAP group and 124 s (95% CI: 92–157) in the control group (median difference: 154 s; 95% CI: 58–249; p = 0.002). There were 17 (50%) and 32 (94.1%) primary events in the CPAP and control groups, respectively. The hazard ratio was 0.26 (95% CI: 0.14–0.48; p<0.001). The median for T2 was 21 s (95% CI: 13–29) and 29 s (95% CI: 22–36) in the CPAP and control groups, respectively (median difference: 8 s; 95% CI: -3 to 19; p = 0.142). SpO2 was significantly higher in the CPAP group than in the control group throughout the consecutive measures between 60 and 210 s (with p ranging from 0.047 to <0.001). Thus, in the age groups examined, CPAP ventilation and passive CPAP oxygenation deferred SpO2 decrease after apnoea onset compared to the regular technique with no positive airway pressure.

Noninvasive High-Frequency Shock Ventilation Based on Chest X-Ray Reconstruction Algorithm for Neonatal Respiratory Distress Syndrome

Objective. To explore the use of the noninvasive high-frequency oscillatory ventilation and CPAP ventilation mode in the treatment of neonatal respiratory distress syndrome and to compare the treatment effect and the incidence of complications and whether it can reduce the time to go to the hospital and the number of hospital stays. Methods. Seventy-four children with RDS treated in hospital were selected and divided into the noninvasive high-frequency group (NHFV group, 36 children) and noninvasive positive pressure ventilation group (NCPAP group, 38 cases), and they were compared with the changes in arterial blood gas, the occurrence of complications, and the time on the machine before and after the operation on 12, 24, 48, and 72 hours. Results. In the NHFV group, PO2, a/APO2, and SaO2 were higher than those in the NCPAP group at 12, 24, 48, and 72 h after the respiratory support was given, and the differences were statistically significant (all P < 0.05 ). PaCO2 in the NHFV group was given respiratory support. After support, the results at 12, 24, 48, and 72 h were lower than those in the NCPAP group, and the difference was statistically significant (both P < 0.05 ). The children in both groups were cured and discharged from the hospital, with air leakage, persistent pulmonary hypertension, and bronchopulmonary dysplasia; there were no statistically significant differences in the incidence of complications such as retinopathy, pulmonary hemorrhage, and intracranial hemorrhage ( P > 0.05 ). The NHFV group had less tracheal intubation, operation time, and hospital stays than the NCPAP group. The differences were significant. Statistical significance was at P < 0.05 . Conclusion. Noninvasive high-frequency ventilation is effective in the treatment of RDS, and compared with the CPAP ventilation mode, it can reduce CO2 retention, increase the oxygenation index, and reduce time of operation and length of hospital stay in children with RDS. It is worthy of clinical promotion and application.

The LeVe CPAP System for oxygen-efficient CPAP respiratory support: Development and pilot evaluation

Background: The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has placed a significant demand on healthcare providers (HCPs) to provide respiratory support for patients with moderate to severe symptoms. Continuous Positive Airway Pressure (CPAP) non-invasive ventilation can help patients with moderate symptoms to avoid the need for invasive ventilation in intensive care. However, existing CPAP systems can be complex (and thus expensive) or require high levels of oxygen, limiting their use in resource-stretched environments. Technical Development + Testing: The LeVe (Light) CPAP system was developed using principles of frugal innovation to produce a solution of low complexity and high resource efficiency. The LeVe system exploits the air flow dynamics of electric fan blowers which are inherently suited to delivery of positive pressure at appropriate flow rates for CPAP. Laboratory evaluation demonstrated that performance of the LeVe system was equivalent to other commercially available systems used to deliver CPAP. Pilot Evaluation: The LeVe CPAP system was tested to evaluate safety and acceptability in a group of ten healthy volunteers at Mengo Hospital in Kampala, Uganda. The study demonstrated that the system can be used safely without inducing hypoxia or hypercapnia and that its use was well tolerated by users, with no adverse events reported. Conclusions: CPAP ventilation systems provide an important treatment option for COVID-19 patients. To deliver this for the high patient numbers associated with the COVID-19 pandemic, healthcare providers require resource efficient solutions. We have shown that this can be achieved through frugal engineering of a CPAP ventilation system, in a system which is safe for use and well tolerated in healthy volunteers. This approach may also benefit other respiratory conditions which often go unaddressed in LMICs for want of context-appropriate technology.

Analysis of Respiratory Mechanisms in Chronic Obstructive Pulmonary Disease Patients Under the Effects of Penehyclidine Hydrochloride Combined with Continuous Positive Airway Pressure Ventilation

Objective: Our aim was to evaluate the respiratory mechanical effects of penehyclidine hydrochloride combined with intraoperative pulmonary continuous positive airway pressure (CPAP) ventilation on pulmonary function and postoperative pulmonary complications in patients with chronic obstructive pulmonary disease (COPD) during one-lung ventilation. Methods: Eighty patients with COPD who underwent thoracoscopic surgery under general anesthesia were selected and their conditions were validated using chest X-rays. They were then divided into 4 groups in the light of the random number table (n = 20), the regular group (group-C), the penehyclidine hydrochloride group (Group-P), CPAP ventilation group (Group A) and combination group (PA group). All patients underwent mechanical ventilation after double lumen bronchial intubation, inhaled oxygen concentration 100%, oxygen flow 2 L/min, VT 6~8 ml/kg, RR 10~14 times/min, single lung ventilation (OLV) RR 12~16 times/min, maintaining PETCO2 40~45 mmHg. Before the endotracheal intubation, the P group and the PA group were intravenously infused with penehyclidine hydrochloride 0.01 mg/kg. After the start of the incision, each group was changed to OLV. During the OLV of groups A and PA, the lungs of the operation side were CPAP. The pressure is 2 cm H2O. The respiratory mechanics parameters (Ppeak, Pplat , Raw, Cdyn) were monitored immediately before the incision (T1), OLV 60 min (T2), and OLV 120 min (T3). The blood gas analysis of the radial artery was collected at T2, and the OI, RI was calculated. VD/VT , Aa DO2; venous blood was collected at 120 minutes (OL) of OLV, serum concentrations IL-10, TNF-α, IL-6 were detected by EELISA; pulmonary complications occurred within 72 hours after operation. Results: Compared with group C, the serum concentrations TNF-α, IL-6, IL-10, Ppeak, Pplat , Raw, RI, VD/VT, A-aDO2 and pulmonary complications were lower in group P and PA. Cdyn and OI increased (P < 0.05). The serum concentrations IL-10, TNF-α, IL-6 in group A decreased, the incidence of RI, VD/VT, A-aDO2 and pulmonary complications decreased, and OI increased (P < 0.05); compared with group-P or group-A, the concentration of serum IL-10, TNF-α, IL-6 in the PA group, RI, VD/VT, A-aDO2 and pulmonary complications decreased, and OI increased (P < 0.05). Conclusion: Compared with the single application, penehyclidine hydrochloride combined with CPAP ventilation can improve lung function, inhibit inflammation and reduce lung injury in patients with COPD during thoracoscopic surgery, and help to improve prognosis.

Kangaroo Mother Care Reduces Noninvasive Ventilation and Total Oxygen Support Duration in Extremely Low Birth Weight Infants

Objective Evidence on the safety and influence of kangaroo mother care (KMC) in extremely low birth weight infants (ELBWIs) on ventilation is lacking. Study Design This is a retrospective cohort study performed in 145 ELBWIs on noninvasive mechanical ventilation from a tertiary center. Results The duration of nasal intermittent positive pressure ventilation (nIPPV) and continuous positive airway pressure (CPAP) ventilation was significantly shorter in infants with KMC compared with infants without (21 vs. 13.5 days, p = 0.001 and 29.5 days vs. 20.5 days, p = 0.001, respectively). The frequency of apnea during hospital stay was fewer in KMC infants, compared with no KMC (23 vs. 20 times, p = 0.002). Multiple linear regression analysis showed that KMC was an independent protective factor for shortening nIPPV/CPAP duration (β = −9.90, 95% confidence interval [CI] [−13.20, −6.60], p < 0.001), total supplemental oxygen support (β = −10.52, 95% CI [−16.73, −4.30], p = 0.001), and reducing times of apneas (β = −5.88, 95% CI [−8.56, −3.21], p < 0.001). Conclusion KMC benefits ELBWIs by shortening nIPPV/CPAP ventilation duration and total supplemental oxygen support, and reducing the frequency of apneas.

Non-Invasive CPAP Ventilation in Acute Carbon Monoxide Poisoning

Oxygen is the main treatment of carbon monoxide (CO) poisoning. In two simultaneous cases, the efficacy of conventional and continuous positive airway pressure (CPAP)-administered oxygen therapy was compared. A 63-year-old man and his 58-year-old wife were brought to the emergency department with complaints of dizziness, headache, and nausea. The man had a history of congestive heart failure and additionally had shortness of breath. Initial carboxyhemoglobin (COHb) values were 26% in the male patient and 24% in his wife. For the female patient, oxygen therapy was performed with a reservoir balloon mask; a CPAP device was used for the male patient. The COHb levels decreased below five percent after approximately two hours in the male patient and at the end of five hours in his wife. In follow-up, symptomatic relief was achieved in both patients and no additional complications were observed. According to our experience, CPAP ventilation can be a new and effective method for oxygen therapy in CO poisoning.