Serupedvardsen3675
of breath, and recovery are critically important outcomes to be consistently reported in coronavirus disease 2019 trials.
Increasing time to mechanical ventilation and high-flow nasal cannula use may be associated with mortality in coronavirus disease 2019. We examined the impact of time to intubation and use of high-flow nasal cannula on clinical outcomes in patients with coronavirus disease 2019.
Retrospective cohort study.
Six coronavirus disease 2019-specific ICUs across four university-affiliated hospitals in Atlanta, Georgia.
Adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who received high-flow nasal cannula or mechanical ventilation.
None.
Among 231 patients admitted to the ICU, 109 (47.2%) were treated with high-flow nasal cannula and 97 (42.0%) were intubated without preceding high-flow nasal cannula use. Of those managed with high-flow nasal cannula, 78 (71.6%) ultimately received mechanical ventilation. In total, 175 patients received mechanical ventilation; 44.6% were female, 66.3% were Black, and the median age was 66 years (interquartile range, 56-75 yr). Seveespiratory failure can be managed similarly to hypoxic respiratory failure of other etiologies.
In this cohort of critically ill patients with coronavirus disease 2019, neither time from ICU admission to intubation nor high-flow nasal cannula use were associated with increased mortality. This study provides evidence that coronavirus disease 2019 respiratory failure can be managed similarly to hypoxic respiratory failure of other etiologies.
There are over 4,000 trials conducted in people with coronavirus disease 2019. However, the variability of outcomes and the omission of patient-centered outcomes may diminish the impact of these trials on decision-making. The aim of this study was to generate a consensus-based, prioritized list of outcomes for coronavirus disease 2019 trials.
In an online survey conducted in English, Chinese, Italian, Portuguese, and Spanish languages, adults with coronavirus disease 2019, their family members, health professionals, and the general public rated the importance of outcomes using a 9-point Likert scale (7-9, critical importance) and completed a Best-Worst Scale to estimate relative importance. Participant comments were analyzed thematically.
International.
Adults 18 years old and over with confirmed or suspected coronavirus disease 2019, their family members, members of the general public, and health professionals (including clinicians, policy makers, regulators, funders, and researchers).
None.
Noneritized by all stakeholder groups. Patients/family members gave higher priority to many patient-reported outcomes compared with health professionals.
Life-threatening respiratory and other organ outcomes were consistently highly prioritized by all stakeholder groups. Patients/family members gave higher priority to many patient-reported outcomes compared with health professionals.
To describe the risk factors for and outcomes after myoclonus in a cohort of patients with coronavirus disease 2019.
Multicenter case series.
Three tertiary care hospitals in Massachusetts, Georgia, and Virginia.
Eight patients with clinical myoclonus in the setting of coronavirus disease 2019.
Outcomes in patients with myoclonus were variable, with one patient who died during the study period and five who were successfully extubated cognitively intact and without focal neurologic deficits. In five cases, the myoclonus completely resolved within 2 days of onset, while in three cases, it persisted for 10 days or longer. Seven patients experienced significant metabolic derangements, hypoxemia, or exposure to sedating medications that may have contributed to the development of myoclonus. One patient presented with encephalopathy and developed prolonged myoclonus in the absence of clear systemic provoking factors.
Our findings suggest that myoclonus may be observed in severe acute respiratory syndrome coronavirus 2 infected patients, even in the absence of hypoxia. This association warrants further evaluation in larger cohorts to determine whether the presence of myoclonus may aid in the assessment of disease severity, neurologic involvement, or prognostication.
Our findings suggest that myoclonus may be observed in severe acute respiratory syndrome coronavirus 2 infected patients, even in the absence of hypoxia. This association warrants further evaluation in larger cohorts to determine whether the presence of myoclonus may aid in the assessment of disease severity, neurologic involvement, or prognostication.
To determine whether a modifiable risk factor, endotracheal tube size, is associated with the diagnosis of postextubation aspiration in survivors of acute respiratory failure.
Prospective cohort study.
ICUs at four academic tertiary care medical centers.
Two hundred ten patients who were at least 18 years old, admitted to an ICU, and mechanically ventilated with an endotracheal tube for longer than 48 hours were enrolled.
Within 72 hours of extubation, all patients received a flexible endoscopic evaluation of swallowing examination that entailed administration of ice, thin liquid, thick liquid, puree, and cracker boluses. Patient demographics, treatment variables, and hospital outcomes were abstracted from the patient's medical records. PFI-3 Endotracheal tube size was independently selected by the patient's treating physicians.
For each flexible endoscopic evaluation of swallowing examination, laryngeal pathology was evaluated, and for each bolus, a Penetration Aspiration Scale score was assigned. Aspialler endotracheal tubes may reduce the risk of postextubation aspiration.
Lipoprotein(a) [Lp(a)] has been emerged as a risk factor for coronary artery disease (CAD), but there is currently insufficient data on the relationship between Lp(a) and premature CAD (PCAD). Thus, this study aimed to examine the association between Lp(a) and PCAD in a Chinese cohort.
Data on 2433 individuals (male <55 years old and female <65 years old) who underwent coronary angiography from March 2016 to February 2019 were included in this study and were divided into the PCAD group (n = 1751) and non-CAD group (n = 682) according to the angiography results. Their clinical and laboratory parameters were collected, and plasma Lp(a) level was measured by immunoturbidimetry. The severity of CAD was evaluated using Gensini score (GS) and divided into three subgroups. The relationship between plasma Lp(a) levels and the presence and severity of PCAD was analyzed.
The level of plasma Lp(a) in the PCAD group was significantly higher than that in the non-CAD group (P < 0.001). The plasma Lp(a) concentration in the highest GS group was significantly higher than that in the lowest GS group (P < 0.
