TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI最新文献

{"title":"Efficacy and Safety Profile of Human Serum Albumin in Patients with Ascites Due to Cirrhosis A Systematic Review and Meta-Analysis","authors":"D. Shrestha, P. Budhathoki, Y. Sedhai, R. Baniya, S. Awal, J. Yadav, L. Awal","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2578","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2578","url":null,"abstract":"","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133035729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Positive Pressure Ventilation During Tracheal Intubation Before and During the COVID-19 Pandemic","authors":"O. Krol, M. Semler, M. Brewer, J. Dargin, A. Davis, K. Doerschug, B. Driver, S. Dutta, J. Gaillard, S. Ghamande, K. Gibbs, A. Ginde, C. Hughes, D. Janz, D. Page, M. Prekker, T. Rice, D. Russell, W. Self, S. Trent, D. Vonderhaar, J. West, H. White, M. Whitson, J. Casey, A. Khan, Pragmatic Critical Care Research Group","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2605","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2605","url":null,"abstract":"Rationale: Positive pressure ventilation (PPV) during tracheal intubation of critically ill adults reduces the risk of peri-procedural hypoxemia. Patients with COVID-19 are at increased risk of hypoxemia during tracheal intubation, but expert guidelines have recommended against the use of PPV for patients with suspected or known COVID-19 based on a concern that PPV may increase aerosolization and the risk of infection of healthcare providers. Evidence informing the impact of these recommendations on the airway management practices for patients with COVID-19 is currently limited. Methods: We conducted a survey of perceived intubation practices in 21 emergency departments (EDs) and intensive care units (ICUs) participating in either of two randomized trials (clinicaltrials.gov identifiers: NCT03928925 and NCT03787732) within the Pragmatic Critical Care Research Group between 9-3-2020 and 10-21-2020. At each site, the site investigator provided information on perceived airway management practices among patients intubated prior to the COVID-19 pandemic and during the pandemic. The primary outcome for this analysis was the use of any PPV, either bag-mask ventilation (BMV) or non-invasive ventilation (NIV), between induction and laryngoscopy. Results: We received responses from 19 of 21 sites (90%). Use of BMV was reported in a median of 35% of intubations [IQR: 0-67%] prior to the pandemic compared with a median of 0% of intubations [IQR: 0-20%] performed among patients with known or suspected COVID-19 (p=0.004). Investigators reported using NIV in a median of 10% of intubations [IQR: 0-25%] prior to the pandemic, compared to 10% [IQR 0-30%] of intubations among patients with known or suspected COVID-19 (p=0.20). Receipt of any positive pressure was reported in 50% [IQR: 0-85%] of intubations prior to the pandemic, compared to 30% [IQR: 0-55%] of intubations among patients with known or suspected COVID-19 (p=0.06) (Figure 1). Conclusions: Based on reported practices at 19 EDs and ICUs participating in either of two ongoing clinical trials, we found that the perceived use of BMV between induction and laryngoscopy decreased in patients with known or suspected COVID-19 while the perceived use of NIV did not change. Despite recommendations to avoid its use, perceived use of PPV remains common among patients with suspected or known COVID-19. This reflects the tension between balancing risk to providers and patients for a condition that places both groups at high risk of peri-procedural complications.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127243646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Mortality in ICU Patients with Severe COVID-19 and Renal Failure - The Lahey Experience","authors":"R. Webster, E. S. Kerns, Y. Lei, A. M. Segal, A. Campagna","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2583","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2583","url":null,"abstract":"Rationale: Coronavirus disease 2019 (COVID-19) is currently the third leading cause of death in the United States. During the Spring of 2020, the Commonwealth of Massachusetts, USA experienced a surge of COVID-19 ICU cases. Many of these patients developed acute renal failure (ARF) requiring renal replacement therapy (RRT) with hemodialysis (HD) or continuous veno-venous hemofiltration (CVVH) which taxed our hospital's supply of equipment and staff. The goal of our study was to identify predictors of mortality in ICU patients requiring RRT in the setting of COVID-19, should rationing of ICU care became necessary. Methods: Between March 2020 and April 2020, we prospectively collected data on patients admitted to the Lahey ICUs with severe COVID-19 who required RRT and assessed patient characteristics and mortality. Results: Thirty ICU patients were identified with severe COVID-19 requiring RRT. Twenty-seven patients (90%) required acute initiation of CVVH, while three (10%) only utilized intermittent HD during their hospitalization. Only ten (33%) survived their hospitalization. No significant difference was found between survivors and patients who died with respect to age, comorbidities (BMI, CKD, HTN, DM, alcohol use, heart disease, malignancy, COPD, asthma) or baseline creatinine. All 30 patients (100%) required mechanical ventilation (MV) and 25 (83%) developed shock requiring vasopressors prior to initiation of RRT. Seventy percent of survivors (7/10) had been on either an ACE-inhibitor (ACEI) or an Angiotensin Receptor Blocker (ARB) prior to hospitalization, compared to only 20% (4/20) who died (p=0.0147) Survivors were treated with hydroxychloroquine (HC) significantly more frequently (10/10 vs 8/20;p=0.0016) and treated with systemic corticosteroids (CS) significantly less frequently (5/10 vs 20/20;p=0.0018) than those who died. There was no difference in survival between those who received Vancomycin or Tocilizumab and those who did not. The median hospital stay was significantly longer for survivors (46 days) than for those who died (19 days;p =0.0003). Conclusion: The need for RRT in ICU patients with COVID-19 was associated with significant mortality (66%) and a significant need for MV (100%) and vasopressors (83%). The use of an ACEI or ARB prior to admission was significantly associated with improved survival, the use of CS was associated with higher mortality, and the use of HC was associated with improved survival. These latter findings go against current theories of COVID pathophysiology and may be a result of the small number of patients in our study.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115971608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Disease and Severe Hypoxemia Are Associated with Higher Rates of Non-Invasive Respiratory Support Failure in COVID-19 Pneumonia","authors":"J.G. Wang, B. Liu, B. Percha, S. Pan, N. Goel, K. Mathews, C. Gao, P. Tandon, M. Tomlinson, E. Yoo, D. Howell, E. Eisenberg, L. Naymagon, D. Tremblay, K. Chokshi, S. Dua, A. Dunn, C. Powell, S. Bose","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2611","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2611","url":null,"abstract":"RATIONALE Acute hypoxemic respiratory failure (AHRF) is the major complication of coronavirus disease 2019 (COVID-19), yet optimal respiratory support strategies are uncertain. We aimed to describe outcomes with highflow oxygen delivered through nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) in COVID-19 AHRF and identify individual factors associated with non-invasive respiratory support failure. METHODS We conducted a retrospective cohort study of hospitalized adults with COVID-19 within a large academic health system in New York City early in the pandemic to describe outcomes with HFNC and NIPPV. Patients were categorized into the HFNC cohort if they received HFNC but not NIPPV, whereas the NIPPV cohort included patients who received NIPPV with or without HFNC. We described rates of HFNC and NIPPV success, defined as live discharge without endotracheal intubation (ETI). Further, using Fine-Gray sub-distribution hazard models, we identified demographic and patient characteristics associated with HFNC and NIPPV failure, defined as the need for ETI and/or in-hospital mortality. RESULTS Of the 331 patients in the HFNC cohort, 154 (46.5%) patients were successfully discharged without requiring ETI. Of the 177 (53.5%) who experienced HFNC failure, 100 (56.5%) required ETI and 135 (76.3%) patients ultimately died. Among the 747 patients in the NIPPV cohort, 167 (22.4%) patients were successfully discharged without requiring ETI, and 8 (1.1%) were censored. Of the 572 (76.6%) patients who failed NIPPV, 338 (59.1%) required ETI and 497 (86.9%) ultimately died. In adjusted models, significantly increased risk of HFNC and NIPPV failure was observed among patients with co-morbid cardiovascular disease (sub-distribution hazard ratio (sHR) 1.82;95% confidence interval (CI), 1.17-2.83 and sHR 1.40;95% CI 1.06-1.84, respectively). Conversely, a higher oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) at HFNC and NIPPV initiation was associated with reduced risk of failure (sHR, 0.32;95% CI 0.19-0.54, and sHR 0.34;95% CI 0.21-0.55, respectively). CONCLUSIONS A subset of patients with COVID-19 AHRF was effectively managed with non-invasive respiratory modalities and achieved successful hospital discharge without requiring ETI. Notably, patients with co-morbid cardiovascular disease and more severe hypoxemia experienced lower success rates with both HFNC and NIPPV. Identification of specific patient factors may help inform more selective use of non-invasive respiratory strategies, and allow for a more personalized approach to the management of COVID-19 AHRF in pandemic settings.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130690284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Recovery After Acute Kidney Injury in Mechanically Ventilated Patients with COVID-19 Infection","authors":"V. Perez Gutierrez, V. Shah, M. Gandhi, A. Sarwal, E. Gomez, S. Murthy, V. Menon","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2616","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2616","url":null,"abstract":"Introduction: Mechanical ventilation in COVID-19 infection range between 5-20% and the incidence of Acute kidney injury (AKI) from 20.2-36.6%. The mortality rate in the AKI subset ranges from 54.8-90% in various studies(1-5). The AKI group tends to be promptly admitted to ICU and require mechanical ventilation due to burned of the disease(4). Methods: A retrospective cohort study with SARS-CoV2 positive by RT-PCR on Mechanical Ventilation. Subjects with End stage renal disease, death <24 hours following endotracheal intubation, intubated out of our institution were excluded. AKI was defined according with KDIGO guideline. Renal recovery was defined creatine level that does not meet criteria for AKI stage 1. Kaplan-Maier curve and long-rank test were applied for survival analysis. Cox Proportional. Hazzard Regression was conducted to determine risk factors for Mortality simultaneously. A significant p-value was considered as <0.05. Result: Of 347 patients on mechanical ventilation included to the study, 183(52.7%) where admitted with AKI and 148(42.7%) develop AKI during the hospital course. The rate of mortality in the AKI group was higher compared with patient without AKI(80.7% vs. 31.3%, p<0.000). Subjects with AKI stage 1 had median time of survival 48.5 (95%CI,[36.8-60.1]) days;AKI stage 2 had median time of 13.6 (95%CI,[3.7-23.5]) days;and AKI stage 3 had median time of 10.0 (95%CI,[8.8-11.1]) days. Significant differences were found by Long Rank tests (p=0.000). AKI increased mortality risk in patient on mechanical ventilation (HR, 2.9[1.2-7.0], p=0.018). After adjustment, we determined that Renal recovery at the end of hospital course has comparable mortality risk with subjects without AKI (aHR, 0.82,[0.28-2.38], p<0.70). Increased mortality risk was noted among patient with partially renal recovery (aHR, 8.55,[3.37-21.6], p<0.000) and without recovery (aHR, 7.07,[2.71-18.39], p<0.000). Discussion: Mortality rate in patients with AKI on mechanical ventilation was high but did not differ from other studies in NYC(6) .Various pathophysiological mechanisms are associated with AKI in COVID-19 infection;prerenal azotemia, acute tubular injury, glomerular disease and thrombotic microangiopathy has been reported(7). At any study of COVID-19, patients with AKI are more likely to be admitted in ICU, required mechanical ventilation or died;and the outcomes get worse with higher AKI stages or if progress to Acute kidney disease(4,8). Our cohort found a comparable mortality risk between patients without AKI and whose recover renal function after adequate management. It is imperative to closely monitor patient that develop AKI and inquired in modifiable precipitant factors to prevent progression and facilitate renal recovery. (Table Presented).","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125355121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine Critical Care in Rural Hospitals During the COVID-19 Pandemic","authors":"M. Bursey, M. Lyon","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2585","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2585","url":null,"abstract":"RATIONALE: The COVID-19 pandemic has caused urban and suburban hospitals to exceed their inpatient capacities, often requiring long periods of transfer diversion. This has had a dramatic impact on the rural hospitals of Georgia by forcing those facilities to care for critically ill patients that would have normally been transferred to referral hospitals for higher levels of care. Many rural facilities have the equipment to care for critically ill patients, but lack physicians trained and experienced in the management of critical illness. To mitigate this, Augusta University (AU) instituted a telemedicine program to provide critical care services to rural hospitals while keeping patients in their rural communities for optimal family and social support. METHODS: The telemedicine critical care program was started in three rural hospitals, but rapidly expanded to three more hospitals based on initial successes. These sites are staffed predominately by primary care physicians with no critical care trained physicians available. Telemedicine services were provided by AU Emergency Physicians with a Critical Care trained physician providing medical oversight. Telemedicine consults were initiated either in the ED or after the patient was admitted to the hospital. Evaluations were continued daily until the patient was discharged, transferred, or transitioned to comfort care. If a patient's care requirements exceeded the capability of a rural site despite critical care telemedicine involvement, AU accepted all transfers regardless of diversion status. RESULTS: From July 20, 2020 through December 20, 2020, 213 patients were evaluated and treated using the telemedicine program. The average length of consultation was 5.1 days. 70.0% of patients were discharged from the rural facilities and 10.3% were provided end-of-life care without transfer. Only 19.7% were transferred to the tertiary hospital. The transfer rate from the rural hospitals decreased by approximately 80% as compared to prior. Mortality and discharge outcomes amongst patients in the telemedicine program were no worse than those at the tertiary referral center. CONCLUSION: The telemedicine critical care program has been received enthusiastically by the participating rural hospitals, and additional sites are seeking to join. It has allowed these hospitals to safely care for substantially more complex patients while still guaranteeing expeditious transfer in the event local capability is exceeded. This approach provides for enhanced patient care and safety while keeping patients close to their families and communities. It has been instrumental in helping to resolve healthcare disparities between rural and suburban/urban Georgia during the COVID pandemic.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114726636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway Pressure Release Ventilation as a Rescue Ventilatory Strategy in COVID-19 Patients","authors":"O. Mahmoud, D. Patadia, J. Salonia","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2612","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2612","url":null,"abstract":"INTRODUCTION Airway Pressure Release Ventilation (APRV) is a pressure controlled intermittent mandatory mode of ventilation characterized by inverse ratio ventilation and high mean airway pressure. Several studies have showed that APRV can improve oxygenation and lung recruitment in patients with ARDS. Although most patients with COVID-19 meet the Berlin criteria, hypoxic respiratory failure due to COVID-19 may differ from traditional ARDS as patients often present with severe, refractory hypoxemia and significant variation in respiratory system compliance. To date, no studies investigating APRV in this population have been published.The aim of this study was to evaluate the effectiveness of APRV as a rescue mode of ventilation in critically ill patients diagnosed with COVID-19 and refractory hypoxemia.METHODS We conducted a retrospective analysis of patients admitted with COVID-19 who developed refractory hypoxemia (PaO2/FIO2 ratio (P/F ratio) <200) while on mechanical ventilation and were treated with a trial of APRV for at least 8 hours. P/F ratio, ventilatory ratio and ventilation outputs before and during APRV were compared.Student's t-test and Wilcoxon signed-rank test were used to compare parametric and nonparametric data, respectively.RESULTS There were 60 patients who met the inclusion criteria. Mean age was 65, 36.6% of the patients were female and in-hospital mortality was 80%. We found that APRV significantly improved the P/F ratio (103 [75-154.23] vs 131.75 [94.15-221, p 0.0001]) and decreased the FiO2 requirements (80[60-100] vs 100[75-100], p 0.0034). PaCO2 (45.8 [41-56.75]mmHg vs 54[42-73]mmHg p 0.0051), and Ventilatory ratio (2.32 [1.92-3.15] vs 2.85 [2.07-3.85], p 0.0054) were also improved during the APRV trial. There was an increase in tidal volume per predicted body weight during APRV (7.86 [7.06-9.85] mL/Kg vs 6.58 [5.69-7.86] mL/Kg, p< 0.0001]) and a decrease in total minute ventilation (10.87±3.11 L/min vs 12.39±2.99 L/min, p 0.0005). On multivariate analysis, higher I:E and airway pressure were associated with greater improvement of P/F ratio.CONCLUSION Patients with COVID-19 and severe hypoxemia have a high in-hospital mortality.APRV may benefit these patients as it maximizes alveolar recruitment resulting in improved oxygenation, alveolar ventilation and CO2 clearance.These effects are more pronounced for higher airway pressure and I:E ratio. APRV was associated with an increase in tidal volume.However, tidal volumes remained within the recommended limits of lung protective ventilation.This study contributes to the growing evidence on the positive effects of APRV on oxygenation and ventilation.Prospective studies are urgently needed to evaluate the potential benefits of APRV on clinical outcomes in patients with COVID-19 and severe hypoxemia.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126216520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Quantitative Study of Particle Dispersion Due to Respiratory Support Modalities in Pre-Hospital and In-Hospital Critical Care Environments","authors":"H. Avari, R. Hiebert, M. Peddle, A. Ryzynski, J.A. Smith, J. Nardi, R. Pinto, S. Plenderleith, H. Mbareche, H. Tien, R. Fowler, S. Mubareka","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2600","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2600","url":null,"abstract":"RATIONALE: Patients with COVID-19 may require supplemental oxygen and non-invasive respiratory support devices during pre-hospital aeromedical transport as well as in-hospital intensive care units. It is unclear whether these therapies increase the dispersion of potentially infectious bioaerosols and placing health workers at increased risk. METHODS: The studies were conducted in two environments: (1) fixed-wing air ambulance cruising at 25,000 ft;(2) a simulated critical care unit in hospital. A breathing patient simulator consisting of a medical mannequin exhaling nebulized particles from the lower respiratory tract was connected to a ventilator to simulate a patient with mild-moderate respiratory distress. Aerosolized saline and DNA bacteriophage φX174 were used to model aerosol dispersion in the aeromedical and simulated intensive care unit, respectively. Dispersion of 1.0 μm particles were measured in key locations, due to the three respiratory support modalities including;non-invasive bilevel positive pressure ventilation (BiPAP);high-flow nasal oxygen (HFNO);and nasal prongs. In the simulated intensive care unit study, viability of aerosolized bacteriophage φX174 was quantified using plaque assays (Fig. 1) RESULTS: In both environments, particle concentrations were highest close to the simulator's mouth and declined with distance from the mouth. In the aeromedical environment, nasal prongs (with a surgical mask) were associated with the highest particle concentrations and BiPAP the lowest. In that environment, at a location near the mouth, particle concentrations associated with HFNO with a surgical mask (5.5 × 104 particles/L of sampled air) and BiPAP (7.5 × 103 particles/L) were significantly lower when compared to nasal prongs with a surgical mask (1.2 × 105 particles/L) (each P < 0.05). In the simulated intensive care unit, HFNO was associated with the highest particle concentrations and BiPAP the lowest. In this environment, at a location near the mouth, particle concentrations as well as bacteriophage viability associated with nasal prongs (7.4 × 104 particles/L and 1.6 × 104 PFU/L) and BiPAP (1.1 × 104 particles/L and 1.9 × 102 PFU/L) were significantly lower when compared to HFNO (5.3 × 105 particles/L and 2.6 × 104 PFU/L) (each P < 0.05). CONCLUSIONS: These findings highlight the comparable risk of dispersing particles among respiratory support devices and the importance of appropriate infection prevention and control practices and personal protective equipment for healthcare workers when caring for patients with transmissible respiratory viral infections such as COVID-19. These findings also suggest a comparable risk associated with use of nasal prongs and HFNO in both environments.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128004439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Pentoxyphyline in Alcoholic Hepatitis: A Systematic Review and Meta-Analysis","authors":"D. Shrestha, Y. Sedhai, P. Budhathoki, R. Baniya, O. Shrestha, S. Karki, N. Thapa","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2581","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2581","url":null,"abstract":"","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124240202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Mortality Difference Across COVID-19 Intubation Strategies","authors":"J. Krishnan, M. Rajan, B. Baer, C. Ezeomah, S. Hill, M. Alshak, K. Hoffman, R. Slepian, F. J. Martínez, E. Schenck, M. Safford","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2587","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2587","url":null,"abstract":"Rationale: The optimal timing of invasive mechanical ventilation (IMV) among patients with COVID-19 related acute respiratory failure (ARF) is unknown. Use of high flow nasal cannula (HFNC) support could potentially avoid the need for IMV and related risks. However, patients failing HFNC may be at increased risk for peri-intubation complications such as cardiac arrest. At NewYork-Presbyterian Weill Cornell Medical Center (NYP-WCMC) and Lower Manhattan Hospital (LMH), an early IMV strategy prior to March 26th 2020. We subsequently switched to a prolonged observation strategy, supporting patients with non-invasive devices including HFNC. In this study, we compared in-hospital mortality in patients with ARF managed with early IMV strategy versus a prolonged observation strategy. Methods: This is a retrospective cohort study using the Weill Cornell COVID-19 Registry, which included 1869 patients admitted with a COVID-19 positive PCR test up until May 15, 2020. Patients at risk for intubation due to ARF, defined by requiring &gt; 6 liters/min nasal cannula, were included. Patients who met ARF criteria prior to March 26, 2020 were in the early IMV strategy group, and those who met criteria on or after March 26, 2020 were in the prolonged observation strategy group. In-hospital mortality with intubation strategy as the main exposure was modelled with cox proportional hazards regression. Confounders included age, sex, BMI, comorbidities, severity of illness (SOFA) and hospital strain (difference between daily admissions and discharges). Both SOFA and hospital strain were calculated for each patient on the day that they developed ARF for modelling purposes. Results: We identified 774 patients at risk for intubation due to ARF (table), 141 were in the early IMV group and 633 were in the prolonged observation strategy group. Death occurred in 33.3% of patients in the early IMV group compared to 34.8% in the prolonged observation group. Patients in the early IMV group had a longer length of stay among survivors (27.2 ± 26.1 days vs 21.6 ± 22.8 days, p = .0213). Age-adjusted hazard ratio for death comparing early IMV versus prolonged observation was 1.35 (95% CI 0.86-2.12, which decreases to 0.87 (95% CI 0.52-1.45) after adjusting for confounders. Conclusion: In this retrospective observational study with a modest sized sample, early IMV strategy was not associated with excess mortality compared to prolonged observation. In resource constrained settings, prolonged observation with HFNC support is a reasonable hospital-level strategy in patients with ARF.","PeriodicalId":388725,"journal":{"name":"TP50. TP050 COVID: NONPULMONARY CRITICAL CARE, MECHANICAL VENTILATION, BEHAVIORAL SCIENCES, AND EPI","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122667783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}