Hong Kong Journal of Emergency Medicine最新文献

{"title":"Hong Kong Poison Information Centre: Annual report 2019","authors":"T. Chow, C. Chan, Sze Hong Ng, M. Tse","doi":"10.1177/10249079211038841","DOIUrl":"https://doi.org/10.1177/10249079211038841","url":null,"abstract":"Background: The Hong Kong Poison Information Centre (HKPIC) provides consultation service to health care professionals and collect epidemiological data on poisoning in Hong Kong since 2005. Objective: To report and analyse the data of Hong Kong Poison Information Centre on poisoning in 2019. Methods: This was a retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2019. Results: A total of 4016 poisoned cases were analysed, which involved 1698 men (42.3%), 2312 women (57.6%) and 6 sex-unspecified patients (0.1%). Majority of cases (77.3%) were between 13 and 69 years of age, and 10.5% were teenagers 13–19 years of age. Self-harm/suicidal attempt (42.1%), unintentional exposure (18.1%) and abusive substance use (11.1%) were common reasons of poisoning. Excluding ethanol, which was the common co-ingestant, the five most common types of poison were benzodiazepines, paracetamol, household products, zopiclone and Chinese herbal medicine. While most patients were managed with supportive treatment, 16.5% and 16.8% of the consultation cases were treated with decontamination and antidotes, respectively. Majority of cases recovered uneventfully, but 1.0% died and 4.7% had a major outcome. A total of six interesting cases and two outbreaks were discussed in this report. Conclusion: This 14th annual report provided updated epidemiological information on the pattern of poisoning in Hong Kong and highlighted a number of important changes compared with our previous reports.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"29 1","pages":"236 - 247"},"PeriodicalIF":0.6,"publicationDate":"2021-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45872623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized non-inferiority pilot study on the use of methoxyflurane (Penthrox®) for pain control in the emergency department","authors":"K. Wong, J. S. K. Lau, A. Siu, Pui Gay Kan","doi":"10.1177/10249079211040695","DOIUrl":"https://doi.org/10.1177/10249079211040695","url":null,"abstract":"Background: Patients commonly visit the emergency department for pain after musculoskeletal injury, but the problem of oligoanalgesia is prevalent. Methoxyflurane (Penthrox®) is an inhalational analgesic for moderate to severe trauma-associated pain in stable and conscious patients. It is a fast-acting, effective analgesic that can be readily administered via a non-invasive route, making it an attractive agent for managing acute pain in the emergency departments. Objectives: The aim was to assess the analgesic efficacy of methoxyflurane in patients with acute traumatic pain by comparing it to ketorolac, a standard analgesic treatment for moderate pain in emergency departments in Hong Kong. Methods: This was a single-center, open-label, randomized controlled, parallel-group, non-inferiority pilot study that enrolled adult patients with moderate trauma-associated pain in an emergency department in Hong Kong. Patients were randomized 1:1 to the methoxyflurane group or the ketorolac group. The primary outcome was the change in pain intensity measured by visual analogue scale from baseline to 5, 15, 30, and 60 min after drug administration. Results: Twenty patients received methoxyflurane, and twenty patients received ketorolac. There were significant reductions in pain score over 60 min in both groups. The pain reduction at 5 min was significantly greater for the methoxyflurane group (−13.912 mm; 95% confidence interval = −20.008 to −7.817) than for the ketorolac group (−4.888 mm; 95% confidence interval = −10.983 to 1.208), with the treatment effect (−9.025 mm; 95% confidence interval = −17.656 to −0.393; p = 0.041) demonstrating superiority of methoxyflurane. The treatment effect at 15 and 30 min demonstrated non-inferiority of methoxyflurane versus ketorolac. Conclusion: Methoxyflurane provided non-inferior analgesia in the first 30 min with a faster onset of action when compared with ketorolac in moderate traumatic pain. It can be considered a non-invasive, rapid-acting, and effective first-line alternative to currently available analgesics for traumatic pain in emergency settings.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"29 1","pages":"203 - 211"},"PeriodicalIF":0.6,"publicationDate":"2021-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45995309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flexible endoscopy versus direct laryngoscopy for localising impacted pharyngeal foreign bodies in emergency department: A randomised cross-over manikin pilot study","authors":"Chi-Kit Sin, Bun Young","doi":"10.1177/10249079211033373","DOIUrl":"https://doi.org/10.1177/10249079211033373","url":null,"abstract":"Background: Direct laryngoscopy is often poorly tolerated in patients with foreign body ingestion. The use of flexible endoscopes, which are reported to be better tolerated, was described. However, studies on endoscopy usage by emergency physicians are lacking. Objective: This study evaluates whether using a bronchoscope is as effective as the direct laryngoscopy for localising pharyngeal foreign bodies by emergency physicians. Methods: This was a randomised cross-over manikin study conducted on 32 emergency physicians. Four foreign bodies were placed at the oropharynx, vallecula, arytenoid and post-cricoid area of a manikin. Participants, being randomised into two groups, examined the pharynx with a bronchoscope and a direct laryngoscope in designated orders. The primary outcome was the complete visualisation rate defined as visualising all the four foreign bodies within the time limit. Secondary outcomes included participants-rated difficulty scores, device preferences, the time needed for complete visualisation and cumulative success rates. Results: Complete visualisation rate was significantly higher using the bronchoscope (93.8%) than the direct laryngoscope (62.5%) p = 0.02. The overall difficulty score was lower using the bronchoscope (median 4, interquartile range: 3–5) than the direct laryngoscope (median 6, interquartile range: 5–8), p < 0.001. The bronchoscope was the preferred method for overall examination (71.9%) over the direct laryngoscope (28.1%), p = 0.001. There were no significant differences in times needed for complete examination for the bronchoscope (median 73.6 s, interquartile range: 54.7–97.7 s) and the direct laryngoscope (median 82.2 s, interquartile range: 40.1–120 s), p = 0.9, and cumulative success rates, p = 0.081. Conclusion: The bronchoscope was associated with an increased complete visualisation rate and was the easier and preferred method for pharyngeal examination.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"160 - 166"},"PeriodicalIF":0.6,"publicationDate":"2021-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10249079211033373","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47996939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trans-tracheal ultrasound: A feasible method for endotracheal tube position reconfirmation during COVID-19 pandemic","authors":"Jen-Tang Sun, Sheng-En Chu, C. Fan, Shyh-Shyong Sim","doi":"10.1177/10249079211030807","DOIUrl":"https://doi.org/10.1177/10249079211030807","url":null,"abstract":"Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Dear sir, Reconfirmation of endotracheal tube (ETT) position in intubated patients is mandated especially after transportation. To date, end-tidal CO2 (ETCO2) is recommended for ETT position confirmation. Nevertheless, using a portable or continuous ETCO2 monitor, frequent connect and disconnect of the ETT expose medical staffs to potential aerosol transmissible disease. This idea raises our concern during COVID-19 pandemic. In our practice, during emergent endotracheal intubation, we performed trans-tracheal ultrasound (TTU) to confirm ETT position (Figure 1(a)). We performed TTU again to confirm the ETT position after patient’s transportation. We found that there is accumulation of subglottic secretion just above the cuff of the ETT, especially 30 min after the patient was intubated (Figure 1(b) and (c), video). A routine oral suction performed by nurse staff failed to cleanse the accumulated secretion. Similar findings repeated in many cases, indicating (1) the accumulation of subglottic secretion facilitates direct ultrasound visualization of ETT and (2) routine oral suction could not effectively reduce the accumulated secretion. As the accumulation of subglottic secretion facilitates direct ultrasound visualization of ETT, we propose the usage of bedside TTU in timely reconfirmation of ETT position after transportation, in order to prevent frequent connection of ETT with ETCO2 monitor, especially during the COVID-19 pandemic. Our previous study proposed the usage of tracheal ultrasound exam for real-time confirming tube placement during emergent intubation.1 Currently, there is no study in validating the usage of ultrasonography for reconfirming ETT position. We strongly encourage further study to validate the usage of TTU in reconfirming ETT position after transportation. Micro-aspiration of subglottic secretions through the ETT cuff is considered a significant cause of ventilatorassociated pneumonia (VAP).2 Our another finding showed that routine oral suction could not clear up subglottic secretion in intubated patients. In the aspect of micro-aspiration, maintaining strict oral hygiene may have a little help in preventing VAP.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"383 - 384"},"PeriodicalIF":0.6,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10249079211030807","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42250764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of fibre-optic-guided endotracheal intubation through a supraglottic airway device versus hyperangulated video laryngoscopy by emergency physicians: A randomised controlled study in cadavers","authors":"C. Groombridge, Amit Maini, J. Mathew, Peter Fritz, Yesul Kim, M. Fitzgerald, D. Smit, G. O'Reilly","doi":"10.1177/10249079211034272","DOIUrl":"https://doi.org/10.1177/10249079211034272","url":null,"abstract":"Background: After failed endotracheal intubation, using direct laryngoscopy, rescued using a supraglottic airway device, the choice of subsequent method to secure a definitive airway is not clearly determined. Objective: The aim of this study was to compare the time to intubation using a fibre-optic airway scope, to guide an endotracheal tube through the supraglottic airway device, with a more conventional approach using a hyperangulated video laryngoscope. Methods: A single-centre randomised controlled trial was undertaken. The population studied were emergency physicians working in an adult major trauma centre. The intervention was intubation through a supraglottic airway device guided by a fibre-optic airway scope. The comparison was intubation using a hyperangulated video laryngoscope. The primary outcome was time to intubation. The trial was registered with ANZCTR.org.au (ACTRN12621000018819). Results: Four emergency physicians completed intubations using both of the two airway devices on four cadavers for a total of 32 experiments. The mean time to intubation was 14.0 s (95% confidence interval = 11.1–16.8) in the hyperangulated video laryngoscope group compared with 29.2 s (95% confidence interval = 20.7–37.7) in the fibre-optic airway scope group; a difference of 15.2 s (95% confidence interval = 8.7–21.7, p < 0.001). All intubations were completed within 2 min, and there were no equipment failures or evidence of airway trauma. Conclusion: Successful intubation of the trachea without airway trauma by emergency physicians in cadavers is achievable by either fibre-optic airway scope via a supraglottic airway device or hyperangulated video laryngoscope. Hyperangulated video laryngoscope was statistically but arguably not clinically significantly faster than fibre-optic airway scope via supraglottic airway device.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"167 - 171"},"PeriodicalIF":0.6,"publicationDate":"2021-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10249079211034272","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49651219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors for in-flight medical interventions during helicopter interfacility transport in Hong Kong","authors":"A. Cheung, R. Lam, P. W. Y. Fok, Ethan Pak Hang Ng, Vi Ka Chaang, T. Rainer","doi":"10.1177/10249079211030110","DOIUrl":"https://doi.org/10.1177/10249079211030110","url":null,"abstract":"Introduction: Interfacility transport with helicopter from remote island clinics to urban hospitals account for a significant portion of the Hong Kong Government Flying Service missions. Currently, doctor and nurse escorts are deployed as volunteers only during the daytime from every Friday to Monday and on public holidays. While most transport runs smoothly, patient deterioration can occur during flight, warranting medical interventions on-board. Yet, little is known about the pattern and any clinical predictors of such interventions during helicopter interfacility transport missions. Methods: We collected Government Flying Service callout records from 1 January to 31 December 2016, and retrieved demographic, clinical and operational data. Interfacility transport mission was dispatched based on ‘Casualty Evacuation’ categories, which range from A+ (unstable), A (borderline) to B (stable). Univariate and multivariable logistic regression were used to identify independent predictors for in-flight medical interventions. Results: Of 1734 callout records, 386 interfacility transport missions escorted by volunteer doctors or nurses or both had complete flight medical records for analysis and 14.9% required in-flight medical interventions. Most interventions were related to oxygen therapy, intravenous fluid and administration of medications. Multivariable logistic regression showed that an age ⩾70 years, Casualty Evacuation A+ category, and any pre-flight emergency medical interventions were independent predictors for in-flight medical interventions. Conclusion: This study identified a few clinical predictors of in-flight medical interventions in an urban helicopter interfacility transport missions setting. Crewman training that focuses on the relevant procedural capabilities and clinical judgement is necessary to address the in-flight medical needs of interfacility transport missions.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"29 1","pages":"296 - 304"},"PeriodicalIF":0.6,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10249079211030110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46499402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does respiratory variation in inferior vena cava diameter predict fluid responsiveness in adult patients? A systematic review and meta-analysis of diagnostic accuracy studies","authors":"Ebru Unal Akoğlu, H. Akoğlu","doi":"10.1177/10249079211029781","DOIUrl":"https://doi.org/10.1177/10249079211029781","url":null,"abstract":"Objectives: To systematically review the diagnostic utility of the respiratory variation of the inferior vena cava diameter measured using ultrasonography for predicting fluid responsiveness in adult patients and compare the three commonly used equations, inferior vena cava distensibility, inferior vena cava collapsibility and inferior vena cava variability. Methods: We searched PubMed, Scopus, Web of Science and Cochrane library, and included studies investigating the diagnostic accuracy of the respiratory variation of the inferior vena cava measured using ultrasonography compared to a reference standard for measuring cardiac output after a fluid challenge for fluid responsiveness, and stratified participants as fluid responsive or not. We included studies conducted in the emergency department or intensive care unit. We excluded studies on paediatric, prehospital, cancer, pregnant, dialysis patients or healthy volunteers. Results: We retrieved 270 records and excluded 171 because of irrelevance, patient population or publication type. We screened the abstracts of 99 studies and then the full texts of 42 studies. Overall, 21 studies with 1321 patients were included, of whom 689 (52%) were fluid responsive. The mean threshold value for positive inferior vena cava distensibility, inferior vena cava collapsibility and inferior vena cava variability was 17%, 35% and 12%, respectively. The heterogeneity between studies was high. Bivariate diagnostic random-effects meta-analysis was used to calculate the summary receiver operating characteristics curves. The overall accuracy, sensitivity and specificity of respiratory variation of the inferior vena cava diameter were 0.85, 0.72 and 0.81, respectively. The accuracy of inferior vena cava distensibility and inferior vena cava collapsibility was similar. The diagnostic utility of respiratory variation of the inferior vena cava diameter was lower but not statistically significant in mechanically ventilated patients compared with spontaneous breathing for predicting fluid responsiveness. Conclusion: The respiratory variation of the inferior vena cava diameter has moderate diagnostic utility for predicting fluid responsiveness independent of the equation used.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"30 1","pages":"291 - 304"},"PeriodicalIF":0.6,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10249079211029781","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43262581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bringing sepsis care back to the emergency department: New prognostic tools and extended role of emergency physicians","authors":"K. Hung, R. P. Lam, C. Lui","doi":"10.1177/10249079211019870","DOIUrl":"https://doi.org/10.1177/10249079211019870","url":null,"abstract":"Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Despite recent advances in diagnosis and treatment, sepsis remains a significant common final pathway to death in patients with infection worldwide. The constant threat of sepsis to mankind has been amplified during the COVID-19 pandemic. Yet, the effort to fight sepsis is undermined by health inequalities. How to advance prevention, survival, and survivorship of sepsis and COVID-19 was the theme of the World Sepsis Congress 2021 in April 2021 (https://www. worldsepsiscongress.org). It highlights a number of key questions clinicians of our generation need to answer. Emergency departments (EDs) are at the forefront in combating community-acquired infection and sepsis. However, over the years, the role of emergency physicians has weakened with interventions hindered because of the most recent definition of sepsis that heavily relies on laboratory test results to confirm organ dysfunction (the Sepsis-3 definition), a lack of reliable sepsis screening and prognostic tools outside the intensive care unit (ICU), limited ED access to imaging studies to identify the source of infection and ED overcrowding. Technological advances such as novel sepsis biomarkers may help clinicians to make a more precise diagnosis, but the turnaround time, added cost and complexity are creating a force to move sepsis care away from the hands of emergency physicians, especially in resource-poor settings. There is a need to bring sepsis care back to the ED. To achieve this, we need better prognostic tools that are best based on routinely collected clinical or laboratory parameters. We also need to extend the role of emergency physicians in managing severe infection including bloodstream infection. A number of articles featured in this edition represent such endeavours to explore how emergency physicians can improve sepsis care in the ED. One of the key issues is to recognise tissue hypoperfusion quickly with easily available clinical or laboratory parameters in order to avert multi-organ failure and reduce sepsis mortality. In a systemic review and meta-analysis of 13 clinical studies that involved 940 patients, Wang et al. found that the venous-to-arterial carbon dioxide pressure changes and the arteriovenous oxygen content difference ratio (Pcv-aCO2/Ca-vO2), a marker for global anaerobic metabolism, is an important predictor for mortality in patients with sepsis or septic shock. A higher ratio of PcvaCO2/Ca-vO2 was associated with a higher 28-day mortality (risk ratio = 1.89, 95% confidence interval = 1.48–2.41) and a higher Sequenti","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"197 - 198"},"PeriodicalIF":0.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10249079211019870","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44665206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reciprocal Abstracts","authors":"N. Wabe, Craig Scowen, Alex, Eigenstetter, Robert Lindeman, Andrew Georgiou","doi":"10.1177/10249079211047362","DOIUrl":"https://doi.org/10.1177/10249079211047362","url":null,"abstract":"Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). https://doi.org/10.1177/10249079211020925 Hong Kong Journal of Emergency Medicine 2021, Vol. 28(4) 260–263 © The Author(s) 2021 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/10249079211020925 journals.sagepub.com/home/hkj","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"385 - 387"},"PeriodicalIF":0.6,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46454428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prone positioning in non-intubated patients with coronavirus – A single-centre experience in Hong Kong","authors":"M. Man, S. Lam, H. Shum, K. Li, Swan Lau, V. Ip, W. Yan","doi":"10.1177/10249079211022914","DOIUrl":"https://doi.org/10.1177/10249079211022914","url":null,"abstract":"Introduction: Significant ventilator-associated pneumonia and mortality were found in COVID-19 patients who required mechanical ventilation which calls for non-invasive means in managing respiratory failure. Methods: We retrospectively reviewed patients admitted to the intensive care unit of Pamela Youde Nethersole Eastern Hospital in Hong Kong with severe acute respiratory syndrome coronavirus 2 infection from 28 November to 15 December 2020. Patients’ laboratory, respiratory parameters and outcome data were recorded and analysed. Results: Eleven received prone ventilation. The median age was 67 (inter-quartile range: 59–72) years, and median COVID-19 GRAM score was 151 (inter-quartile range: 133–181), representing a high-risk group. There were significant improvements 1 h after awake proning in SpO2 (95% vs 92%, p = 0.008), FiO2 (0.4 vs 0.5, p = 0.003), SpO2/FiO2 (240 vs 184, p = 0.005), respiratory rate (19 vs 26, p = 0.006) and respiratory rate – oxygenation index (13.22 vs 7.67, p = 0.003; Table 1). Although not reaching statistical significance, the median PaO2, PaCO2 and PaO2/FiO2 improved after proning. The overall intubation rate was 22% and intensive care unit mortality was 22%, which is in contrast to 65.5% and 27.6%, respectively, in the first three waves. Although did not reach statistical significance, those received prone ventilation tend to have a lower ICU mortality (9.1% vs 42.9%, p = 0.245) and hospital mortality (18.2% vs 42.9%, p = 0.326). Conclusion: Awake proning potentially minimizes complications from invasive ventilation and provides a low-cost low-risk treatment option in COVID-19 patients with respiratory failure. This is particularly important when healthcare resources are strained at times of a pandemic.","PeriodicalId":50401,"journal":{"name":"Hong Kong Journal of Emergency Medicine","volume":"28 1","pages":"379 - 382"},"PeriodicalIF":0.6,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10249079211022914","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43666322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}