Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease

American Journal of Respiratory and Critical Care Medicine, Год журнала: 2020, Номер 203(1), С. 24 - 36

Опубликована: Ноя. 4, 2020

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised many questions about the management of patients with chronic obstructive pulmonary disease (COPD) and whether modifications their therapy are required. It recognizing differentiating (COVID-19) from COPD given similarity symptoms. Global Initiative for Chronic Obstructive Lung Disease (GOLD) Science Committee used established methods literature review to present an overview during COVID-19 pandemic. is unclear at increased risk becoming infected SARS-CoV-2. During periods high community prevalence COVID-19, spirometry should only be when it essential diagnosis and/or assess lung function status interventional procedures or surgery. Patients follow basic infection control measures, including social distancing, hand washing, wearing a mask face covering. remain up date appropriate vaccinations, particularly annual influenza vaccination. Although data limited, inhaled corticosteroids, long-acting bronchodilators, roflumilast, macrolides continue as indicated stable management. Systemic steroids antibiotics in exacerbations according usual indications. Differentiating symptoms underlying those exacerbation may challenging. If there suspicion testing SARS-CoV-2 considered. who developed moderate-to-severe hospitalization pneumonia, treated evolving pharmacotherapeutic approaches appropriate, remdesivir, dexamethasone, anticoagulation. Managing failure include oxygen supplementation, prone positioning, noninvasive ventilation, protective strategy distress syndrome. asymptomatic mild followed protocols. moderate worse monitored more frequently accurately than COPD, particular attention need therapy.

Язык: Английский

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Posttraumatic Stress Disorder in Critical Illness Survivors

Critical Care Medicine, Год журнала: 2015, Номер 43(5), С. 1121 - 1129

Опубликована: Фев. 5, 2015

To conduct a systematic review and metaanalysis of the prevalence, risk factors, prevention/treatment strategies for posttraumatic stress disorder symptoms in critical illness survivors.PubMed, Embase, CINAHL, PsycINFO, Cochrane Library from inception through March 5, 2014.Eligible studies met following criteria: 1) adult general/nonspecialty ICU, 2) validated instrument greater than or equal to 1 month post-ICU, 3) sample size 10 patients.Duplicate independent data abstraction all eligible titles/abstracts/full-text articles.The search identified 2,817 titles/abstracts, with 40 articles on 36 unique cohorts (n = 4,260 patients). The Impact Event Scale was most common instrument. Between 6 months post-ICU (six studies; n 456), pooled mean (95% CI) score 20 (17-24), prevalences clinically important were 25% (18-34%) 44% (36-52%) using thresholds 35 20, respectively. 7 12 (five 698), 17 (9-24), 17% (10-26%) 34% (22-50%), ICU factors included benzodiazepine administration memories frightening experiences. Posttraumatic associated worse quality life. In European-based studies: an diary significant reduction symptoms, self-help rehabilitation manual symptom at 2 months, but not months; nurse-led follow-up clinic did reduce symptoms.Clinically occurred one fifth survivors 1-year follow-up, higher prevalence those who had comorbid psychopathology, received benzodiazepines, early European studies, diaries reduced symptoms.

Язык: Английский

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Clinical review: intensive care unit acquired weakness

Critical Care, Год журнала: 2015, Номер 19(1)

Опубликована: Июнь 29, 2015

A substantial number of patients admitted to the ICU because an acute illness, complicated surgery, severe trauma, or burn injury will develop a de novo form muscle weakness during stay that is referred as "intensive care unit acquired weakness" (ICUAW). This ICUAW evoked by critical illness can be due axonal neuropathy, primary myopathy, both. Underlying pathophysiological mechanisms comprise microvascular, electrical, metabolic, and bioenergetic alterations, interacting in complex way culminating loss strength and/or atrophy. typically symmetrical affects predominantly proximal limb muscles respiratory muscles, whereas facial ocular are often spared. The main risk factors for include high severity upon admission, sepsis, multiple organ failure, prolonged immobilization, hyperglycemia, also older have higher risk. role corticosteroids neuromuscular blocking agents remains unclear. diagnosed awake cooperative bedside manual testing scored Medical Research Council sum score. In cases atypical clinical presentation evolution, additional electrophysiological may required differential diagnosis. cornerstones prevention aggressive treatment early mobilization, preventing hyperglycemia with insulin, avoiding use parenteral nutrition first week illness. Weak clearly worse outcomes consume more healthcare resources. Recovery usually occurs within weeks months, although it incomplete persisting up 2 years after discharge. Prognosis appears compromised when cause involves polyneuropathy, isolated myopathy better prognosis. addition, has shown contribute 1-year mortality. Future research should focus on new preventive therapeutic strategies this detrimental complication clarifying how contributes poor longer-term

Язык: Английский

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Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study

The Lancet Respiratory Medicine, Год журнала: 2014, Номер 2(5), С. 369 - 379

Опубликована: Апрель 7, 2014

Язык: Английский

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Sepsis-induced immune dysfunction: can immune therapies reduce mortality?

Journal of Clinical Investigation, Год журнала: 2016, Номер 126(1), С. 23 - 31

Опубликована: Янв. 3, 2016

Sepsis is a systemic inflammatory response induced by an infection, leading to organ dysfunction and mortality. Historically, sepsis-induced lethality were attributed the interplay between antiinflammatory responses. With advances in intensive care management goal-directed interventions, early sepsis mortality has diminished, only surge later after "recovery" from acute events, prompting search for alterations immune function. well known alter innate adaptive responses sustained periods clinical "recovery," with immunosuppression being prominent example of such alterations. Recent studies have centered on immune-modulatory therapy. These efforts are focused defining reversing persistent cell that associated long events resolved.

Язык: Английский

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Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study

The Lancet Respiratory Medicine, Год журнала: 2021, Номер 9(11), С. 1275 - 1287

Опубликована: Окт. 9, 2021

The impact of COVID-19 on physical and mental health employment after hospitalisation with acute disease is not well understood. aim this study was to determine the effects COVID-19-related employment, identify factors associated recovery, describe recovery phenotypes. Post-hospitalisation (PHOSP-COVID) a multicentre, long-term follow-up adults (aged ≥18 years) discharged from hospital in UK clinical diagnosis COVID-19, involving an assessment between 2 7 months discharge, including detailed recording symptoms, physiological biochemical testing. Multivariable logistic regression done for primary outcome patient-perceived age, sex, ethnicity, body-mass index, comorbidities, severity illness as covariates. A post-hoc cluster analysis outcomes breathlessness, fatigue, health, cognitive impairment, performance using clustering large applications k-medoids approach. registered ISRCTN Registry (ISRCTN10980107). We report findings 1077 patients March 5 Nov 30, 2020, who underwent at median 5·9 (IQR 4·9–6·5) discharge. Participants had mean age 58 years (SD 13); 384 (36%) were female, 710 (69%) white 288 (27%) received mechanical ventilation, 540 (50%) least two comorbidities. At follow-up, only 239 (29%) 830 participants felt fully recovered, 158 (20%) 806 new disability (assessed by Washington Group Short Set Functioning), 124 (19%) 641 experienced health-related change occupation. Factors recovering female middle (40–59 years), or more severe illness. magnitude persistent burden substantial but weakly Four clusters identified different severities impairment (n=767): very (131 patients, 17%), (159, 21%), moderate along (127, mild (350, 46%). Of used analysis, all closely related except impairment. Three (3%) 113 cluster, nine (7%) 129 36 99 114 (43%) 267 reported feeling recovered. Persistently elevated serum C-reactive protein positively severity. admission 6 discharge (eg, illness), four impairments related, whereas independent. In care, proactive approach needed across spectrum, interdisciplinary working, wide access holistic services, potential stratify care. Research Innovation National Institute Health Research.

Язык: Английский

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Post-intensive care syndrome: An overview

Journal of Translational Internal Medicine, Год журнала: 2017, Номер 5(2), С. 90 - 92

Опубликована: Июнь 1, 2017

Abstract Survival of critically unwell patients has improved in the last decade due to advances critical care medicine. Some these survivors develop cognitive, psychiatric and /or physical disability after treatment intensive unit (ICU), which is now recognized as post syndrome (PICS). Given limited awareness about PICS medical faculty this aspect often overlooked may lead reduced quality life cause a lot suffering their families. Efforts should be directed towards preventing by minimizing sedation early mobilization during ICU.All evaluated for those having signs symptoms it managed multidisciplinary team includes physician, neuro-psychiatrist, physiotherapist respiratory therapist, with use pharmacological non-apharmacological interventions. This can achieved through an organizational change improvement, knowing high rate incidence its adverse effects on survivor’s daily activities effect family.

Язык: Английский

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European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care

Resuscitation, Год журнала: 2021, Номер 161, С. 220 - 269

Опубликована: Март 24, 2021

Язык: Английский

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COVID-19: ICU delirium management during SARS-CoV-2 pandemic

Critical Care, Год журнала: 2020, Номер 24(1)

Опубликована: Апрель 28, 2020

Abstract The novel coronavirus, SARS-CoV-2-causing Coronavirus Disease 19 (COVID-19), emerged as a public health threat in December 2019 and was declared pandemic by the World Health Organization March 2020. Delirium, dangerous untoward prognostic development, serves barometer of systemic injury critical illness. early reports 25% encephalopathy from China are likely gross underestimation, which we know occurs whenever delirium is not monitored with valid tool. Indeed, patients COVID-19 at accelerated risk for due to least seven factors including (1) direct central nervous system (CNS) invasion, (2) induction CNS inflammatory mediators, (3) secondary effect other organ failure, (4) sedative strategies, (5) prolonged mechanical ventilation time, (6) immobilization, (7) needed but unfortunate environmental social isolation quarantine without family. Given insights into pathobiology virus, well emerging interventions utilized treat critically ill patients, prevention management will prove exceedingly challenging, especially intensive care unit (ICU). main focus during lies within organizational issues, i.e., lack ventilators, shortage personal protection equipment, resource allocation, prioritization limited options, end-of-life care. However, standard ICU management, must remain highest quality possible an eye towards long-term survival minimization issues related post-intensive syndrome (PICS). This article discusses how professionals (e.g., physicians, nurses, physiotherapists, pharmacologists) can use our knowledge resources limit burden on reducing modifiable despite imposed heavy workload difficult clinical challenges posed pandemic.

Язык: Английский

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Post‐intensive care syndrome: its pathophysiology, prevention, and future directions

Acute Medicine & Surgery, Год журнала: 2019, Номер 6(3), С. 233 - 246

Опубликована: Апрель 25, 2019

Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to rapid increase the number of patients intensive care units ( ICU s). Innovative advances medical technology enabled lifesaving s, but there remain various problems improve their long‐term prognoses. Post‐intensive syndrome PICS ) refers physical, cognition, mental impairments that occur during stay, after discharge or hospital discharge, as well prognosis patients. Its concept also applies pediatric ‐p) status family ‐F). Intensive unit‐acquired weakness, characterized by acute symmetrical limb muscle weakness admission, belongs physical three domains . Prevention requires performance ABCDEFGH bundle, which incorporates prevention delirium, early rehabilitation, intervention, follow‐up from time admission discharge. Diary, nutrition, nursing care, environmental management for healing important This review outlines pathophysiology, prevention, future directions

Язык: Английский

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