Thanks Dr Prashant Ved for the update . Wuhan had been the epicenter of COVID- 19 .Experience of doctors there is much more in handling COVID-19 patients. This regimen had been followed successfully in Wuhan. Most critically ill patients with COVID- 19 respond well to prone ventilation, with a rapid improvement of Oxygenation and lung mechanics .Prone ventilation is recommended as a routine strategy for patients with PaO2/FiO2 <150 mmHg or with obvious imaging manifestations with out contraindications. Time course recommended for prone ventilation is more than 16 hours each time .The prone ventilation can be stopped once PaO2/FiO2 is greater than 150 mmHg for than 4 hours in the supine position. Prone ventilation while awake may be attempted for patients who have not been intubated or have no obvious respiratory distress but with impaired oxygenation or have consolidation in gravity dependent lung zones on lung images .Procedures for at least 4 hours each time is recommended. Prone position can be considered several times per day depending upon the effects and tolerance. Thanks
Yeah and the ECMO technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion to sustain life. So in Wuhan this technique is also used.
Prone position gives better and more oxygen saturation as compred to supine position.valuable position
Prone position for better oxygenation of patients on ventilator is a known method
Really very effective method sir.....thanks for reminding us again....
Good. Thanks. Informative
Valuable and information post.
Very useful information
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x-ray chest of first case of Corona virus pneumonia patient aged 61 years male who died during treatment in WUHAN city of China.Dr. Ramesh Dutt Gautam38 Likes33 Answers
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Treatment for severe acute respiratory distress syndrome from COVID-19 In The Lancet Respiratory Medicine, Kollengode Ramanathan and colleagues provide excellent recommendations for the use of extracorporeal membrane oxygenation (ECMO) for patients with respiratory failure from acute respiratory distress syndrome (ARDS) secondary to coronavirus disease 2019 (COVID-19). The authors describe pragmatic approaches to the challenges of delivering ECMO to patients with COVID-19, including training health-care personnel, resolving equipment and facilities issues, implementing systems for infection control and personal protection, providing overall support for health-care staff, and mitigating ethical issues. For patients with COVID-19 who require endotracheal intubation, use of low tidal volume (6 mL/kg per predicted bodyweight) with a plateau airway pressure of less than 30 cm H2O, and increasing the respiratory rate to 35 breaths per min as needed, is the mainstay of lung-protective ventilation. If the hypoxaemia progresses to a PaO2:FiO2 ratio of less than 100–150 mm Hg, there are several therapeutic options. The level of positive end-expiratory pressure can be increased by 2–3 cm H2O every 15–30 min to improve oxygen saturation to 88–90%, with the goal of maintaining a plateau airway pressure of less than 30 cm H2O. Lower driving pressures (plateau airway pressure minus positive end-expiratory pressure) with a target of 13–15 cm H2O can also be used. To read more- https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30127-2/fulltext Source- The Lancet Authors- Michael A Matthay, J Matthew Aldrich, Jeffrey E GottsDr. Sriram Attri27 Likes21 Answers
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A team of investigators hailing from eight institutions in China and the United States — including the Chinese People’s Liberation Army General Hospital in Beijing, and the University of California – Davis — recently looked at the data of 85 patients who died of multiple organ failure after having received care for severe COVID-19. All individuals whose data the study used received care at either the Hanan Hospital or the Wuhan Union Hospital between January 9 and February 15, 2020. The researchers who conducted the study uncovered a series of factors that the majority of these patients shared. The majority were older males The research team was able to access and analyze the deceased patients’ medical histories, including whether they had any underlying, chronic conditions. The researchers were also able to find out what symptoms the patients experienced once they had contracted the virus and access information from laboratory tests and CT scans, as well as information about the medical treatment they received while in the hospitals. They found that 72.9% of those who died with COVID-19 were male, with a median age of 65.8 years and underlying chronic conditions, such as heart problems or diabetes. “The greatest number of deaths in our cohort were in males over 50 with noncommunicable chronic diseases,” the investigators note. Some important observations In terms of other potentially relevant information, the research team found that 81.2% of the study individuals “had very low eosinophil [a type of white blood cells, which are specialized immune cells that help fight infection] counts on admission [to the hospital].” Among the complications that the patients experienced while hospitalized with COVID-19, some of the most common were respiratory failure, shock, acute respiratory distress syndrome, and cardiac arrhythmia, or irregular heartbeat. To read more-https://www.medicalnewstoday.com/articles/what-factors-did-people-who-died-with-covid-19-have-in-common#Some-important-observationsDr. Vaibhav Goyal6 Likes2 Answers
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Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. Coronavirus disease 2019 (COVID-19) is a pandemic with no specific therapeutic agents and substantial mortality. It is critical to find new treatments. Objective: To determine whether convalescent plasma transfusion may be beneficial in the treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design, Setting, and Participants Case series of 5 critically ill patients with laboratory-confirmed COVID-19 and acute respiratory distress syndrome (ARDS) who met the following criteria: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment; Pao2/Fio2 <300; and mechanical ventilation. All 5 were treated with convalescent plasma transfusion. Clinical outcomes were compared before and after convalescent plasma transfusion. Main Outcomes and Measures Changes of body temperature, Sequential Organ Failure Assessment (SOFA) score (range 0-24, with higher scores indicating more severe illness), Pao2/Fio2, viral load, serum antibody titer, routine blood biochemical index, ARDS, and ventilatory and extracorporeal membrane oxygenation (ECMO) supports before and after convalescent plasma transfusion. Results All 5 patients (age range, 36-65 years; 2 women) were receiving mechanical ventilation at the time of treatment and all had received antiviral agents and methylprednisolone. Following plasma transfusion, body temperature normalized within 3 days in 4 of 5 patients, the SOFA score decreased, and Pao2/Fio2 increased within 12 days (range, 172-276 before and 284-366 after). Viral loads also decreased and became negative within 12 days after the transfusion, and SARS-CoV-2–specific ELISA and neutralizing antibody titers increased following the transfusion (range, 40-60 before and 80-320 on day 7). ARDS resolved in 4 patients at 12 days after transfusion, and 3 patients were weaned from mechanical ventilation within 2 weeks of treatment. Of the 5 patients, 3 have been discharged from the hospital (length of stay: 53, 51, and 55 days), and 2 are in stable condition at 37 days after transfusion. Conclusions and Relevance In this preliminary uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, administration of convalescent plasma containing neutralizing antibody was followed by improvement in their clinical status. The limited sample size and study design preclude a definitive statement about the potential effectiveness of this treatment, and these observations require evaluation in clinical trials. To read more- https://jamanetwork.com/journals/jama/fullarticle/2763983 Source-The Journal of the American Medical Association (JAMA)Dr. Somesh Sharma8 Likes4 Answers
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Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) is the pathogenic agent of Covid-19, a disease first reported in a small cluster in Wuhan, Hubei Province, China, in December 2019, and subsequently spread all over the world. Due to its high contagiousness and aggressive course, it has been declared by World Health Organization (WHO) a Public Health Emergency of International Concern (A public health emergency, 2019). The course of the disease is often mild, undistinguishable from a common flu, but in a considerable number of cases may require hospitalization, eventually leading to an acute respiratory distress syndrome (ARDS) and death. Air pollution represents one of the most well-known causes of prolonged inflammation, eventually leading to an innate immune system hyper-activation. In a small cohort of mice exposed for three months to particulate matter ≤2.5 μm in diameter (PM2.5), IL-4, TNF-α and transforming growth factor (TGF)-β1 were significantly increased in both serum and lung parenchyma, as well as leucocytes and macrophages In conclusion, it is well known that pollution impairs the first line of defense of upper airways, namely cilia (Cao et al., 2020), thus a subject living in an area with high levels of pollutant is more prone to develop chronic respiratory conditions and suitable to any infective agent. Moreover, as we previously pointed out, a prolonged exposure to air pollution leads to a chronic inflammatory stimulus, even in young and healthy subjects. This, in our opinion, may partly explain a higher prevalence and lethality of a novel, very contagious, viral agent such as SARS-CoV-2, among a population living in areas with a higher level of air pollution, particularly if we consider the relatively high average age of this population. Among elderly living in such a region and affected by other comorbidities, the cilia and upper airways defenses could have been weakened both by age and chronic exposure to air pollution, which, in turn, could facilitate virus invasion by allowing virus reaching lower airways. Subsequently, a dysregulated, weak immune system, triggered by chronic air pollution exposure may lead to ARDS and eventually death, particularly in case of severe respiratory and cardiovascular comorbidities. To read more- https://www.sciencedirect.com/science/article/pii/S0269749120320601?via%3DihubMeenakshi Bisht6 Likes3 Answers