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Summary of 20 tracheal intubation by anesthesiologists for patients with severe COVID-19 pneumonia: retrospective case series.
20例重症COVID-19肺炎患者麻醉医师气管插管总结: 回顾性病例系列。
- 影响因子:1.29
- DOI:10.1007/s00540-020-02778-8
- 作者列表:"Zhang L","Li J","Zhou M","Chen Z
- 发表时间:2020-08-01
Abstract
:SARS-CoV-2 pandemic is announced and it is very important to share our experience to the critical care community in the early stage. Urgent intubation team was organized by anesthesiologists and was dispatched upon request. We have retrospectively reviewed medical charts of 20 critically ill patients with Covid-19 pneumonia who required tracheal intubation from February 17 to March 19 in Wuhan No.1 hospital, China. We collected their demographics, vital signs, blood gas analysis before and after tracheal intubation, and 7-day outcome after tracheal intubation. Out of 20 patients, 90% were over 60 years old and 15 were with at least one comorbidity. All meet the indication for tracheal intubation announced by treatment expert group. We had successfully intubated all patients using personal protective equipment without circulatory collapse during tracheal intubation. During the observational period, none of 17 anesthesiologists were infected. Although intubation improved SPO2, reduced PaCO2 and blood lactate, seven of 20 patients died within 7-days after tracheal intubation. Non-survivors showed significantly lower SPO2 and higher PaCO2 and blood lactate compared to survivors. For those who are anticipated to deteriorate severe pneumonia with poor prognosis, earlier respiratory support with tracheal intubation may be advised to improve outcome.
摘要
: 宣布SARS-CoV-2大流行,在早期阶段向重症护理社区分享我们的经验非常重要。紧急插管小组由麻醉医生组织,并应要求派遣。我们回顾性分析了中国武汉市第一医院2月17日至3月19日20例需要气管插管的Covid-19肺炎危重患者的病历。我们收集了他们的人口统计学、生命体征、气管插管前后的血气分析以及气管插管后7天的结果。在20名患者中,90% 的患者超过60岁,15名患者至少有一种合并症。均符合治疗专家组公布的气管插管指征。我们使用个人防护设备成功地为所有患者插管,在气管插管期间没有循环衰竭。在观察期间,17名麻醉医师均未感染。尽管插管改善了SPO2,降低了PaCO2和血乳酸,但20例患者中有7例在气管插管后7天内死亡。与存活者相比,非存活者表现出显著较低的SPO2和较高的PaCO2和血乳酸。对于那些预期会恶化预后不良的重症肺炎患者,建议尽早给予气管插管呼吸支持以改善预后。
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METHODS:BACKGROUND:There is a commonly held belief that overweight women are more likely to offer contaminated urine samples (UAs) in the emergency department (ED) than women with normal body mass index (BMI). However, there is a paucity of research evaluating this potential concern. OBJECTIVE:We hypothesized that patients with higher BMI would be more likely to provide contaminated urine samples than women with low BMI. METHODS:This was a prospective, observational, cohort study evaluating consenting, adult, women that provided a clean catch, mid-stream sample at an inner-city ED. UAs were ordered at the discretion of the caring physician, cultures based on standardized parameters. The primary outcome parameter was the presence of UA contamination as defined by our microbiology lab. Demographic/historical data and BMI were recorded on a structured data sheet. Categorical data were analyzed by chi-square; continuous data by t-tests. Multivariable logistic regression was performed to control for confounding. RESULTS:There were 350 patients in the study group; 22% overweight, 35% obese, 17% morbidly obese, mean BMI 31. 5, and 60% provided contaminated specimens. The mean BMIs of the subjects with contaminated vs. uncontaminated UAs were significantly different (32.7 ± 10.2 vs 29.7 ± 8.8, p < 0.01). Within our multiple variable logistic regression model, obese and morbidly obese patients were more likely to provide contaminated UAs, while there were no significant associations for contamination with other variables except for hypertension (OR = 1.85, p = 0.02). CONCLUSION:Obesity was significantly associated with contamination of clean catch mid-stream samples in our population.
METHODS:OBJECTIVE:To determine whether the performance of a new quantum dots-based point-of-care test (POCT) devices is qualified for procalcitonin testing. METHODS:Finger-prick and venous blood specimens from 153 patients were measured with a quantum dots-based POCT device; the results were compared with those from the reference method. RESULTS:The quantum dots-based POCT device correlated well with the reference method in measuring plasma, venous whole blood, and finger-prick blood. No significant bias was observed (-0.08 ng/mL). At 0.5 ng per mL cutoff value, the concordances were 96.6%, 94.6%, and 90.5% for plasma, venous whole blood, and finger-prick blood, respectively. And at 2 ng per mL cutoff value, the concordances were 98.0%, 96.6%, and 95.3%, respectively. CONCLUSIONS:The quantum dots-based POCT device measured procalcitonin with multiple specimen types, high sensitivity, wide detection range, and short turnaround time. It would allow a more widespread use of procalcitonin and help lessen the burden of overcrowding in healthcare facilities in China.
METHODS:CONTEXT.—:The Paris System for Reporting Urinary Cytology has been disseminated since its inception in 2013; however, the daily practice patterns of urinary tract cytopathology are not well known. OBJECTIVE.—:To assess urinary tract cytopathology practice patterns across a variety of pathology laboratories to aid in the implementation and future update of the Paris System for Reporting Urinary Cytology. DESIGN.—:A questionnaire was designed to gather information about urinary tract cytopathology practices and mailed in July 2014 to 2116 laboratories participating in the College of American Pathologists interlaboratory comparison program. The participating laboratories' answers were summarized. RESULTS.—:Of the 879 of 2116 laboratories (41%) that participated, 745 (84.8%) reported processing urinary tract specimens in house. The laboratories reported processing various specimen types: voided urine, 735 of 738 (99.6%); bladder washing/barbotage, 639 of 738 (86.6%); and catheterized urine specimens, 653 of 738 (88.5%). Some laboratories used multiple preparation methods, but the most commonly used preparation techniques for urinary tract specimens were ThinPrep (57.4%) and Cytospin (45.5%). Eighty-eight of 197 laboratories (44.7%) reported preparing a cell block, but with a low frequency. Adequacy criteria were used by 295 of 707 laboratories (41.7%) for voided urine, and 244 of 707 (34.5%) assessed adequacy for bladder washing/barbotage. More than 95% of the laboratories reported the use of general categories: negative, atypical, suspicious, and positive. Polyomavirus was classified as negative in 408 of 642 laboratories (63.6%) and atypical in 189 of 642 (29.4%). One hundred twenty-eight of 708 laboratories (18.1%) performed ancillary testing, and of these, 102 of 122 (83.6%) reported performing UroVysion. CONCLUSIONS.—:Most laboratories use the ThinPrep method followed by the Cytospin technique; therefore, the criteria published in The Paris System for Reporting Urinary Cytology, based mostly on ThinPrep and SurePath, should be validated for Cytospin, and relevant information should be included in the revised edition of The Paris System for Reporting Urinary Cytology.
临床化学检测,用于诊断或治疗疾病的实验室检测,常用的检查物有:血液、尿液、组织和体液等。