Articles: mechanical-ventilation.
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We report for the first time therapy-resistant hypernatremia (plasma sodium concentration ≥150 mmol per liter) developing in 6 of 12 critically ill coronavirus disease 2019 (COVID-19) patients age 57-84 years requiring mechanical ventilation. There was no correlation between plasma sodium concentrations and sodium input. ⋯ These findings are consistent with abnormally increased renal sodium reabsorption, possibly caused by increased angiotensin II activity secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced downregulation of angiotensin-converting enzyme 2 (ACE2) receptors. As hypernatremia was associated with increased length of intensive care unit stay, special attention should be paid to the electrolyte status of COVID-19 patients.
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While Okinawa has been facing outbreak of the coronavirus disease 2019 (COVID-19) pandemic, healthcare collapse should be prevented by sufficient supply of ventilators for caring the rapidly growing number of critically ill patients with COVID-19. We estimated the number of invasive and noninvasive ventilators that would be required in Okinawa at the peak of the COVID-19 outbreak based on recent data of COVID-19 cases in Okinawa and data on the proportion of patients with COVID-19 in the ICU requiring ventilation. Based on our results using the current supply of all ventilators, demand for ventilators could be prepared for patients with COVID-19 who would require it and demand for noninvasive ventilators could also be prepared for those with COVID-19 who would require it. The higher supply over the demand would be achieved by flattening the epidemic curve by implementing public health interventions to delay and suppress the epidemic peak in Okinawa.
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J. Korean Med. Sci. · Jun 2020
Randomized Controlled TrialComparison of Postextubation Outcomes Associated with High-Flow Nasal Cannula vs. Conventional Oxygen Therapy in Patients at High Risk of Reintubation: a Randomized Clinical Trial.
Liberation and extubation are important for patients supported by mechanical ventilation. Extubation success is related to the duration of an intensive care unit (ICU) stay and mortality rate. High-flow nasal cannula (HFNC) oxygen therapy has physiological and clinical benefits in respiratory care. The present study compared clinical outcomes associated with HFNC and conventional oxygen therapy (COT) among patients at high risk for reintubation. ⋯ Among patients at high risk for reintubation, compared with COT, HFNC did not reduce the risk of reintubation within 72 hours.
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Primary Objective: The primary objective is to reduce initiation of mechanical ventilator dependency in patients with moderate to severe CoViD- 19. This will be measured as the difference between the control group and active group for subjects admitted to the hospital for CoViD-19. Secondary Objectives: • To evaluate cytokine trends / Prevent cytokine storms • To evaluate supplemental oxygen requirements • To decrease mortality of CoViD-19 patients • Delay onset of ventilation TRIAL DESIGN: The study is a single centre, 2-arm, prospective, randomized (ratio 1:1), controlled trial with parallel groups design to compare the reduction of respiratory distress in a CoViD-19 population, using the intervention of the gammaCore®-Sapphire device plus standard of care (active) vs. standard of care alone (SoC) - the control group. The gammaCore® treatments will be used acutely and prophylactically. The active and control groups will be matched for disease and severity. ⋯ The total number of patients to be included in the study is 90, with 45 in each study group TRIAL STATUS: The protocol version is 8.0 from 07th April 2020. The recruitment began 20th April 2020 and is expected to be complete 31st July 2020.
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An amendment to this paper has been published and can be accessed via the original article.