Bilateral COVID-19 pneumonia is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and usually leads to life-threatening acute respiratory distress syndrome (ARDS). ...Treatment of patients with ARDS is difficult and usually involves protective mechanical ventilation and various types of recruitment maneuvers. A segmental lung recruitment maneuver by independent lung ventilation has been described as a successful recruitment maneuver in patients with lobar pneumonia, and may, therefore, be useful for the treatment of patients with bilateral COVID-19 pneumonia complicated by ARDS in the critical phase of the disease when all other therapeutic options have been exhausted. The aim of this case series was to present a case report of four mechanically ventilated patients with severe bilateral COVID-19 pneumonia complicated by ARDS using the segmental lung recruitment maneuver. The effect of the segmental lung recruitment maneuver was assessed by the increase in PaO
/FiO
ratio and the lung ultrasound (LUS) scoring system (0 points-presence of sliding lungs with A-lines or one or two isolated B-lines; 1 point-moderate loss of lung ventilation with three to five B lines; 2 points-severe loss of lung ventilation with more than five B lines (B pattern); and 3 points-lung consolidation) determined 12, 24, and 48 h after segmental lung recruitment. In three of four patients with bilateral COVID-19 pneumonia complicated by ARDS, an increase in the PaO
/FiO
ratio and an improvement in the LUS scoring system were observed 48 h after segmental lung recruitment. In conclusion, the segmental lung recruitment maneuver in patients with bilateral COVID-19 complicated by ARDS is an effective method of lung recruitment and may be a useful treatment method.
: The COVID-19 disease has significantly burdened the healthcare system, including all units of severe patient treatment. Non-intensive care units were established to rationalize the capacity within ...the Intensive Care Unit (ICU) and to create a unit where patients with Acute Respiratory Distress Syndrome (ARDS) could be treated with non-invasive Continuous Positive Air Pressure (CPAP) outside the ICU. This unicentric retrospective study aimed to assess the efficacy of NIV Treatment in Patients of the fourth pandemic wave and how its application affects the frequency and mortality of ICU-treated patients at University Hospital Rijeka compared to earlier waves of the COVID-19 pandemic. Furthermore, the study showcases the effect of the Patient/Nurse ratio (P/N ratio) on overall mortality in the ICU.
: The study was conducted on two groups of patients with respiratory insufficiency in the second and third pandemic waves, treated in the COVID Respiratory Centre (CRC) (153 patients). We also reviewed a cohort of patients from the fourth pandemic wave who were initially hospitalized in a COVID-6 non-intensive unit from 1 October 2021 to 1 November 2022 (102 patients), and some of them escalated to CRC.
: The introduction of the CPAP non-invasive ventilation method as a means of hypoxic respiratory failure treatment in non-intensive care units has decreased the strain, overall number of admissions, and CRC patient mortality. The overall fourth wave mortality was 29.4%, compared to the 58.2% overall mortality of the second and third waves.
: As a result, this has decreased CRC patient admissions and, by itself, overall mortality.
Lung atelectasis are nonventilated parts of lung tissue and occur as a result of the collapse of the pulmonary parenchyma (alveoli). Various therapeutic procedures for inflating the collapsed ...pulmonary parenchyma, such as bronchial aspiration and/or standard recruitment maneuvers, are not always successful.
We report a case of a 23-year-old Croatian man with a parapharyngeal abscess on the left side of the neck with spreading of infection in the mediastinum and left side of the thorax and consequent major atelectasis of the left lung. The patient was mechanically ventilated. We decided to apply a new method in which a pulmonary artery catheter was placed (guided by bronchoscope) on the entrance to the lower left bronchus. The pulmonary artery catheter balloon was inflated to achieve bronchial closure. Using another respirator, we ventilated the affected lobe separately with continuously high pressure of 30 cmH
O. After 30 minutes, we removed the pulmonary artery catheter from the lower left bronchus and placed it in the upper left bronchus and repeated the procedure. Our method allowed a significantly longer duration (30 minutes) of continuously high pressure of 30 cmH
O separately to only one of the total of five lobes of the lungs while the other four lobes were simultaneously ventilated continuously with protective ventilation mode.
Use of a pulmonary artery catheter and two respirators in our patient's case proved to be a successful method for recruiting the atelectatic lung while maintaining protective ventilation of the lung segments without atelectasis.
Estimation of the epidemiology curve for the COVID-19 pandemic can be a very computationally challenging task. Thus far, there have been some implementations of artificial intelligence (AI) methods ...applied to develop epidemiology curve for a specific country. However, most applied AI methods generated models that are almost impossible to translate into a mathematical equation. In this paper, the AI method called genetic programming (GP) algorithm is utilized to develop a symbolic expression (mathematical equation) which can be used for the estimation of the epidemiology curve for the entire U.S. with high accuracy. The GP algorithm is utilized on the publicly available dataset that contains the number of confirmed, deceased and recovered patients for each U.S. state to obtain the symbolic expression for the estimation of the number of the aforementioned patient groups. The dataset consists of the latitude and longitude of the central location for each state and the number of patients in each of the goal groups for each day in the period of 22nd January 2020-3rd December 2020. The obtained symbolic expressions for each state are summed up to obtain symbolic expressions for estimation of each of the patient groups (confirmed, deceased and recovered). These symbolic expressions are combined to obtain the symbolic expression for the estimation of the epidemiology curve for the entire U.S. The obtained symbolic expressions for the estimation of the number of confirmed, deceased and recovered patients for each state achieved R2 score in the ranges 0.9406-0.9992, 0.9404-0.9998 and 0.9797-0.99955, respectively. These equations are summed up to formulate symbolic expressions for the estimation of the number of confirmed, deceased and recovered patients for the entire U.S. with achieved R2 score of 0.9992, 0.9997 and 0.9996, respectively. Using these symbolic expressions, the equation for the estimation of the epidemiology curve for the entire U.S. is formulated which achieved R2 score of 0.9933. Investigation showed that GP algorithm can produce symbolic expressions for the estimation of the number of confirmed, recovered and deceased patients as well as the epidemiology curve not only for the states but for the entire U.S. with very high accuracy.
Anemija zbog manjka željeza ili sideropenična anemija najčešći je oblik anemije u populaciji. Sideropenična anemija može nastati uslijed gastrointestinalnih bolesti, ginekoloških i drugih kroničnih ...krvarenja, može biti dio kliničke slike nefroloških i drugih bolesti i stanja, može doprinositi srčanom zatajenju u kardioloških bolesnika te pogoršavati ishode operativnih zahvata. Zbog navedenoga potreban je timski rad u liječenju sideropenične anemije, važno je otkriti i liječiti uzrok koji je doveo do gubitka željeza te liječiti anemiju nadoknadom željeza. Cilj je ovog rada prikazati pregled literature i klinička iskustva različitih nehematoloških specijalističkih usmjerenja u liječenju sideropenične anemije parenteralnim pripravcima željeza u različitim tercijarnim centrima u Hrvatskoj. U radu su opisani pristupi i postupnici u zbrinjavanju sideropenije i sideropenične anemije parenteralnim željezom iz aspekta gastroenterologa, ginekologa, nefrologa, kardiologa te anesteziologa, sa specifičnostima pojedinih bolesti i pristupa njihovom liječenju. U zaključku, novi visokodozni pripravci parenteralnog željeza unaprijedili su mogućnosti liječenja sideropenične anemije i primjenjuju se sve više u dnevnim bolnicama i odjelima različitih struka u Hrvatskoj, a ne samo u hematološkim dnevnim bolnicama ili odjelima.
The COVID-19 pandemic is caused by the betacoronavirus SARS-CoV-2. In November 2021, the Omicron variant was discovered and immediately classified as a variant of concern (VOC), since it shows ...substantially more mutations in the spike protein than any previous variant, especially in the receptor-binding domain (RBD). We analyzed the binding of the Omicron RBD to the human angiotensin-converting enzyme-2 receptor (ACE2) and the ability of human sera from COVID-19 patients or vaccinees in comparison to Wuhan, Beta, or Delta RBD variants.
All RBDs were produced in insect cells. RBD binding to ACE2 was analyzed by ELISA and microscale thermophoresis (MST). Similarly, sera from 27 COVID-19 patients, 81 vaccinated individuals, and 34 booster recipients were titrated by ELISA on RBDs from the original Wuhan strain, Beta, Delta, and Omicron VOCs. In addition, the neutralization efficacy of authentic SARS-CoV-2 wild type (D614G), Delta, and Omicron by sera from 2× or 3× BNT162b2-vaccinated persons was analyzed.
Surprisingly, the Omicron RBD showed a somewhat weaker binding to ACE2 compared to Beta and Delta, arguing that improved ACE2 binding is not a likely driver of Omicron evolution. Serum antibody titers were significantly lower against Omicron RBD compared to the original Wuhan strain. A 2.6× reduction in Omicron RBD binding was observed for serum of 2× BNT162b2-vaccinated persons. Neutralization of Omicron SARS-CoV-2 was completely diminished in our setup.
These results indicate an immune escape focused on neutralizing antibodies. Nevertheless, a boost vaccination increased the level of anti-RBD antibodies against Omicron, and neutralization of authentic Omicron SARS-CoV-2 was at least partially restored. This study adds evidence that current vaccination protocols may be less efficient against the Omicron variant.
Klinički se virus prezentira od vrlo blagih simptoma, blage prehlade pa sve do pneumonije koja može dovesti do akutnoga respiratornog zatajenja i u kasnijoj fazi multiorganskog zatajivanja sa ...smrtnošću od 2 do 10 %. Kod hospitaliziranih bolesnika intersticijska upala pluća i ARDS javljaju se obično tijekom drugog tjedna liječenja, 7 − 9 dana od početka bolesti. Neinvazivna ventilacijska potpora nije se pokazala učinkovitom u liječenju ovog tipa ARDS-a uz postojeći dodatni rizik od pojačanog širenja bolesti na medicinsko osoblje (otvoreni sustav ventilacije), a odgađanje invazivne ventilacijske potpore često dovodi do pogoršanja stanja bolesnika. Bolesnici sa saturacijom 75 − 80 % i PaO2/FiO2 < 150 zahtijevaju invazivno ventilacijsko liječenje. Kod ovih bolesnika može se javiti fulminantna kardiomiopatija čak i u stadijima oporavka od bolesti. Još nije jasno izaziva li infekcija virusnu kardiomiopatiju ili je srčana disfunkcija posljedica citokinske oluje. Pravovremeno odvajanje od mehaničke ventilacije ključni je dio uspješnog liječenja COVID-19 bolesnika iz razloga što je uopće respiratorna potpora bila u većini slučajeva granično indicirana. Produženom ventilacijom bolesnika, dužom od 5 do 7 dana stvaraju se uvjeti za naseljavanje drugih patogena počesto rezistentnih bakterija i gljivica koje nailaze na izrazito oslabljen imunološki odgovor domaćina čime je put prema sepsi značajno skraćen i ubrzan. Za kontroliranje i uspješno liječenje najtežih COVID-19 respiratornih infekcija važna je dobra organizacija jedinica intenzivnog liječenja uz jasno definirane protokole. U takvoj jedinici mora raditi dovoljan broj medicinskog osoblja, prvenstveno najiskusniji liječnici intenzivisti, medicinski tehničari koji su ujedno i najvažnije osoblje.
Abstract Study Objective To evaluate the role of a brief ultrasound examination (US) in detecting the correct position of the left double-lumen endotracheal tube (LDLT). Design Prospective, ...randomized clinical study. Setting Operating room of a university hospital. Patients 50 elective adult thoracic surgery patients who required a LDLT during anesthesia. Intervention and Measurements Patients were randomized to two groups: Group A, who underwent clinical assessment of the LDLT position, and Group B, who were examined clinically and by ultrasound. All 50 patients underwent the same conventional procedure of LDLT placement. In all patients, clinical assessment of LDLT positioning was made by observing chest wall expansion and checking lung compliance by manual ventilation and by auscultation of both lungs. In Group B, a very brief ultrasound (15-30 sec) examination was added. Ultrasound examination included visualization of the pleural movements (“lung sliding”) and motion of the diaphragm from both sides before and after selective clamping of the bronchial and tracheal limbs. In both groups, a second anesthesiologist performed bronchoscopy to estimate actual LDLT position. Main Results Sensitivity and negative predictive values in detecting proper LDLT positioning for both methods were 100%. For the clinical assessment alone (Group A), specificity was 22%, accuracy was 72%, and positive predictive value, 70%; for the clinical and ultrasound assessment (Group B), specificity was 50%, accuracy was 88%, and positive predictive value, 86%. Conclusion A brief ultrasound examination added to clinical assessment ensured more precise placement of LDLT than did clinical assessment alone.
PDF
