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Article ; Online: Patient Care Rounds in the Intensive Care Unit During COVID-19.

Wang, Hanyin / Poehler, Jessica L / Ziegler, Jenna L / Weiler, Chad C / Khan, Syed Anjum

Joint Commission journal on quality and patient safety

2020 Volume 46, Issue 10, Page(s) 600–601

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Family ; Humans ; Intensive Care Units ; Pandemics ; Patient Care ; Pneumonia, Viral ; SARS-CoV-2 ; Teaching Rounds/methods ; Telemedicine
Keywords	covid19
Language	English
Publishing date	2020-07-04
Publishing country	Netherlands
Document type	Letter
ZDB-ID	1189890-2
ISSN	1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
ISSN (online)	1938-131X ; 1549-425X
ISSN	1553-7250 ; 1070-3241 ; 1549-3741
DOI	10.1016/j.jcjq.2020.06.006
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Article: Patient Care Rounds in the Intensive Care Unit During COVID-19

Wang, Hanyin / Poehler, Jessica L / Ziegler, Jenna L / Weiler, Chad C / Khan, Syed Anjum

Jt Comm J Qual Patient Saf

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #626780
Database	COVID19

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Article ; Online: Patient Care Rounds in the Intensive Care Unit During COVID-19

Wang, Hanyin / Poehler, Jessica L. / Ziegler, Jenna L. / Weiler, Chad C. / Khan, Syed Anjum

The Joint Commission Journal on Quality and Patient Safety

2020 Volume 46, Issue 10, Page(s) 600–601

Keywords	Leadership and Management ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ZDB-ID	1189890-2
ISSN	1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
ISSN (online)	1938-131X ; 1549-425X
ISSN	1553-7250 ; 1070-3241 ; 1549-3741
DOI	10.1016/j.jcjq.2020.06.006
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Patterns of repeated diagnostic testing for COVID-19 in relation to patient characteristics and outcomes.

Salerno, S / Zhao, Z / Prabhu Sankar, S / Salvatore, M / Gu, T / Fritsche, L G / Lee, S / Lisabeth, L D / Valley, T S / Mukherjee, B

Journal of internal medicine

2020 Volume 289, Issue 5, Page(s) 726–737

Abstract: ... We then studied repeated testing patterns in patients with severe COVID-19-related outcomes.: Results: Patient ... the characteristics of patients who underwent repeated testing for COVID-19 and determine if repeated testing was ... health outcomes for patients presenting for a COVID-19 diagnostic test were collected. We examined ...

Abstract	Background: Whilst the COVID-19 diagnostic test has a high false-negative rate, not everyone initially negative is re-tested. Michigan Medicine, a primary regional centre, provided an ideal setting for studying testing patterns during the first wave of the pandemic. Objectives: To identify the characteristics of patients who underwent repeated testing for COVID-19 and determine if repeated testing was associated with downstream outcomes amongst positive cases. Methods: Characteristics, test results, and health outcomes for patients presenting for a COVID-19 diagnostic test were collected. We examined whether patient characteristics differed with repeated testing and estimated a false-negative rate for the test. We then studied repeated testing patterns in patients with severe COVID-19-related outcomes. Results: Patient age, sex, body mass index, neighbourhood poverty levels, pre-existing type 2 diabetes, circulatory, kidney, and liver diseases, and cough, fever/chills, and pain symptoms 14 days prior to a first test were associated with repeated testing. Amongst patients with a positive result, age (OR: 1.17; 95% CI: (1.05, 1.34)) and pre-existing kidney diseases (OR: 2.26; 95% CI: (1.41, 3.68)) remained significant. Hospitalization (OR: 7.88; 95% CI: (5.15, 12.26)) and ICU-level care (OR: 6.93; 95% CI: (4.44, 10.92)) were associated with repeated testing. The estimated false-negative rate was 23.8% (95% CI: (19.5%, 28.5%)). Conclusions: Whilst most patients were tested once and received a negative result, a meaningful subset underwent multiple rounds of testing. These results shed light on testing patterns and have important implications for understanding the variation of repeated testing results within and between patients.
MeSH term(s)	Age Factors ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/physiopathology ; COVID-19/therapy ; COVID-19 Nucleic Acid Testing/methods ; COVID-19 Nucleic Acid Testing/standards ; COVID-19 Nucleic Acid Testing/statistics & numerical data ; Comorbidity ; Diagnostic Errors/prevention & control ; False Negative Reactions ; Female ; Hospitalization/statistics & numerical data ; Humans ; Intensive Care Units/statistics & numerical data ; Kidney Diseases/epidemiology ; Male ; Michigan/epidemiology ; Middle Aged ; Public Reporting of Healthcare Data ; SARS-CoV-2/isolation & purification ; Severity of Illness Index ; Socioeconomic Factors
Language	English
Publishing date	2020-12-19
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	96274-0
ISSN	1365-2796 ; 0954-6820
ISSN (online)	1365-2796
ISSN	0954-6820
DOI	10.1111/joim.13213
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Article ; Online: Increasing rhinovirus prevalence in paediatric intensive care patients since the SARS-CoV2 pandemic.

Gil, Eliza / Roy, Sunando / Best, Tim / Hatcher, James / Breuer, Judith

Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology

2023 Volume 166, Page(s) 105555

Abstract: ... intensive care units (PICU) during the first national lockdown and then rapidly re-emerged with a fast-increasing ... at increased incidence year-round.: Conclusions: The incidence of HRV infection amongst GOSH PICU patients ... Results: Following a reduction in the incidence of HRV infection during the first national lockdown ...

Abstract	Background: Rhinovirus (HRV) is a significant seasonal pathogen in children. The emergence of SARS-CoV2, and the social restrictions introduced in, disrupted viral epidemiology. Here we describe the experience of Great Ormond Street Hospital (GOSH), where HRV almost entirely disappeared from the paediatric intensive care units (PICU) during the first national lockdown and then rapidly re-emerged with a fast-increasing incidence, leading to concerns about possible nosocomial transmission in a vulnerable population. Objectives: To describe alterations in HRV infection amongst PICU patients at GOSH since the emergence of SARS-COV2 STUDY DESIGN: 10,950 nasopharyngeal aspirate viral PCR samples from GOSH PICU patients from 2019 to 2023 were included. 3083 returned a positive result for a respiratory virus, with 1530 samples positive for HRV. 66 HRV isolates from August 2020 - Jan 2021, the period of rapidly increasing HRV incidence, were sequenced. Electronic health record data was retrospectively collected for the same period. Results: Following a reduction in the incidence of HRV infection during the first national lockdown, multiple genotypes of HRV emerged amongst GOSH PICU patients, with the incidence of HRV infection rapidly surging to levels higher than that seen prior to the emergence of SARS-CoV2 and continuing to circulate at increased incidence year-round. Conclusions: The incidence of HRV infection amongst GOSH PICU patients is markedly higher than prior to the emergence of SARS-CoV2, a pattern not seen in other respiratory viruses. The increased burden of HRV-infection in vulnerable PICU patients has both clinical and infection prevention and control Implications.
MeSH term(s)	Child ; Humans ; Infant ; Prevalence ; RNA, Viral/genetics ; Rhinovirus/genetics ; Picornaviridae Infections/epidemiology ; Pandemics ; Retrospective Studies ; Respiratory Tract Infections ; COVID-19/epidemiology ; SARS-CoV-2/genetics ; Communicable Disease Control ; Enterovirus Infections/epidemiology ; Critical Care
Chemical Substances	RNA, Viral
Language	English
Publishing date	2023-07-30
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1446080-4
ISSN	1873-5967 ; 1386-6532
ISSN (online)	1873-5967
ISSN	1386-6532
DOI	10.1016/j.jcv.2023.105555
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Article ; Online: Tracheobronchial Slough, a Potential Pathology in Endotracheal Tube Obstruction in Patients With Coronavirus Disease 2019 (COVID-19) in the Intensive Care Setting.

Rubano, Jerry A / Jasinski, Patrick T / Rutigliano, Daniel N / Tassiopoulos, Apostolos K / Davis, James E / Beg, Tazeen / Poovathoor, Shaji / Bergese, Sergio D / Ahmad, Sahar / Jawa, Randeep S / Vosswinkel, James A / Talamini, Mark A

Annals of surgery

2020 Volume 272, Issue 2, Page(s) e63–e65

Abstract: ... Approximately 25% of hospitalized patients require admission to the intensive care unit, with the majority ... All of the patients were admitted to one of our COVID-19 ICUs. Each was staffed by a board certified intensivist ... With institutional IRB approval, we examined a subset of our mechanically ventilated COVID-19 patients ...

Abstract	Background: A novel coronavirus (COVID-19) erupted in the latter part of 2019. The virus, SARS-CoV-2 can cause a range of symptoms ranging from mild through fulminant respiratory failure. Approximately 25% of hospitalized patients require admission to the intensive care unit, with the majority of those requiring mechanical ventilation. High density consolidations in the bronchial tree and in the pulmonary parenchyma have been described in the advanced phase of the disease. We noted a subset of patients who had a sudden, significant increase in peak airway, plateau and peak inspiratory pressures. Partial or complete ETT occlusion was noted to be the culprit in the majority of these patients. Methods: With institutional IRB approval, we examined a subset of our mechanically ventilated COVID-19 patients. All of the patients were admitted to one of our COVID-19 ICUs. Each was staffed by a board certified intensivist. During multidisciplinary rounds, all arterial blood gas (ABG) results, ventilator settings and ventilator measurements are discussed and addressed. ARDSNet Protocols are employed. In patients with confirmed acute occlusion of the endotracheal tube (ETT), acute elevation in peak airway and peak inspiratory pressures are noted in conjunction with desaturation. Data was collected retrospectively and demographics, ventilatory settings and ABG results were recorded. Results: Our team has observed impeded ventilation in intubated patients who are several days into the critical course. Pathologic evaluation of the removed endotracheal tube contents from one of our patients demonstrated a specimen consistent with sloughed tracheobronchial tissues and inflammatory cells in a background of dense mucin. Of 110 patients admitted to our adult COVID-19 ICUs, 28 patients required urgent exchange of their ETT. Conclusion: Caregivers need to be aware of this pathological finding, recognize, and to treat this aspect of the COVID-19 critical illness course, which is becoming more prevalent.
MeSH term(s)	Adult ; Betacoronavirus ; Bronchi/injuries ; COVID-19 ; Coronavirus Infections/therapy ; Female ; Humans ; Intensive Care Units ; Intubation, Intratracheal/adverse effects ; Male ; Pandemics ; Pneumonia, Viral/therapy ; Respiration, Artificial/adverse effects ; SARS-CoV-2 ; Trachea/injuries
Keywords	covid19
Language	English
Publishing date	2020-07-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000004031
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Article ; Online: Addressing Palliative Care Needs of COVID-19 Patients in New Orleans, LA

Palliative Medicine Reports, Vol , Iss , Pp - (2020)

A Team-Based Reflective Analysis

2020

Abstract: ... a team-based structured protocol to categorize severity of COVID-19 intensive care unit (ICU) admissions ... discussion. Conclusions: We found that standardizing palliative care consultation on all COVID-19 positive ... were placed on all COVID-19 positive patients admitted to the ICU between March 29, 2020, and May 1 ...

Abstract	Background: New Orleans, Louisiana served as a central location for a surge of novel coronavirus cases during the months of March 2020 to May 2020. To provide guidance to palliative care teams naive to the palliative care demand associated with a surge of coronavirus cases, we document our protocol to best optimize palliative care resources. This report aims to present this information and reflect upon what was most beneficial/least beneficial to serve as a roadmap for palliative teams facing this pandemic. Objective: To pilot a team-based structured protocol to categorize severity of COVID-19 intensive care unit (ICU) admissions and subsequently collaborate with the palliative interdisciplinary team to assess physical, spiritual, and psychosocial needs. Design: New ICU consults were categorized into color-coded clinical severity ?pots? during daily ICU interdisciplinary rounds. Clinical decision making and communication with patient/next of kin were based on ?pot? classification. Settings/Subjects: Palliative medicine consults were placed on all COVID-19 positive patients admitted to the ICU between March 29, 2020, and May 1, 2020. Measurements: A retrospective chart review was performed to analyze the effect of palliative care consultation on completion of goals-of-care conversations and the life-sustaining treatment (LST) document, an advance directive form specific to the Veterans Affairs hospital system between March 29, 2020 and May 1, 2020. Results: Of the palliative consults evaluated by a palliative provider, 74% resulted in completion of a LST document, 58% resulted in video contact with family members, and 100% incorporated a goals-of-care discussion. Conclusions: We found that standardizing palliative care consultation on all COVID-19 positive ICU admissions subjectively alleviated the burden on ICU providers and staff in the midst of a crisis, resulted in increased documentation of patient goals-of-care preferences/LSTs, facilitated clinical updates to family members, and better distributed clinical ...
Keywords	Medicine (General) ; R5-920
Subject code	610 ; 650
Language	English
Publishing date	2020-07-01T00:00:00Z
Publisher	Mary Ann Liebert
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Addressing Palliative Care Needs of COVID-19 Patients in New Orleans, LA: A Team-Based Reflective Analysis

Burke, Rebecca V. / Rome, Robin / Constanza, Kelly / Amedee, Malaika / Santos, Charles / Leigh, Alexandra

Palliative medicine reports

Abstract: ... a team-based structured protocol to categorize severity of COVID-19 intensive care unit (ICU) admissions ... discussion Conclusions: We found that standardizing palliative care consultation on all COVID-19 positive ICU ... pots" during daily ICU interdisciplinary rounds Clinical decision making and communication with patient ...

Abstract	Background: New Orleans, Louisiana served as a central location for a surge of novel coronavirus cases during the months of March 2020 to May 2020 To provide guidance to palliative care teams naive to the palliative care demand associated with a surge of coronavirus cases, we document our protocol to best optimize palliative care resources This report aims to present this information and reflect upon what was most beneficial/least beneficial to serve as a roadmap for palliative teams facing this pandemic Objective: To pilot a team-based structured protocol to categorize severity of COVID-19 intensive care unit (ICU) admissions and subsequently collaborate with the palliative interdisciplinary team to assess physical, spiritual, and psychosocial needs Design: New ICU consults were categorized into color-coded clinical severity "pots" during daily ICU interdisciplinary rounds Clinical decision making and communication with patient/next of kin were based on "pot" classification Settings/Subjects: Palliative medicine consults were placed on all COVID-19 positive patients admitted to the ICU between March 29, 2020, and May 1, 2020 Measurements: A retrospective chart review was performed to analyze the effect of palliative care consultation on completion of goals-of-care conversations and the life-sustaining treatment (LST) document, an advance directive form specific to the Veterans Affairs hospital system between March 29, 2020 and May 1, 2020 Results: Of the palliative consults evaluated by a palliative provider, 74% resulted in completion of a LST document, 58% resulted in video contact with family members, and 100% incorporated a goals-of-care discussion Conclusions: We found that standardizing palliative care consultation on all COVID-19 positive ICU admissions subjectively alleviated the burden on ICU providers and staff in the midst of a crisis, resulted in increased documentation of patient goals-of-care preferences/LSTs, facilitated clinical updates to family members, and better distributed clinical burden among palliative team members
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #733417
Database	COVID19

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Article: Tracheobronchial Slough, a Potential Pathology in Endotracheal Tube Obstruction in Patients With Coronavirus Disease 2019 (COVID-19) in the Intensive Care Setting

Ann Surg

Abstract	BACKGROUND: A novel coronavirus (COVID-19) erupted in the latter part of 2019. The virus, SARS-CoV-2 can cause a range of symptoms ranging from mild through fulminant respiratory failure. Approximately 25% of hospitalized patients require admission to the intensive care unit, with the majority of those requiring mechanical ventilation. High density consolidations in the bronchial tree and in the pulmonary parenchyma have been described in the advanced phase of the disease. We noted a subset of patients who had a sudden, significant increase in peak airway, plateau and peak inspiratory pressures. Partial or complete ETT occlusion was noted to be the culprit in the majority of these patients. METHODS: With institutional IRB approval, we examined a subset of our mechanically ventilated COVID-19 patients. All of the patients were admitted to one of our COVID-19 ICUs. Each was staffed by a board certified intensivist. During multidisciplinary rounds, all arterial blood gas (ABG) results, ventilator settings and ventilator measurements are discussed and addressed. ARDSNet Protocols are employed. In patients with confirmed acute occlusion of the endotracheal tube (ETT), acute elevation in peak airway and peak inspiratory pressures are noted in conjunction with desaturation. Data was collected retrospectively and demographics, ventilatory settings and ABG results were recorded. RESULTS: Our team has observed impeded ventilation in intubated patients who are several days into the critical course. Pathologic evaluation of the removed endotracheal tube contents from one of our patients demonstrated a specimen consistent with sloughed tracheobronchial tissues and inflammatory cells in a background of dense mucin. Of 110 patients admitted to our adult COVID-19 ICUs, 28 patients required urgent exchange of their ETT. CONCLUSION: Caregivers need to be aware of this pathological finding, recognize, and to treat this aspect of the COVID-19 critical illness course, which is becoming more prevalent.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #325875
Database	COVID19

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Article ; Online: Antimicrobial stewardship program, COVID-19, and Infection control. Spread of carbapenem-resistant klebsiella pneumoniae colonization in ICU COVID-19 patients. What did not work ?

Tiri, Beatrice / Sensi, Emanuela / Marsiliani, Viola / Cantarini, Mizar / Priante, Giulia / Vernelli, Carlo / Martella Lucia, Assunta / Costantini, Monya / Mariottini, Alessandro / Andreani, Paolo / Bruzzone, Paolo / Suadoni, Fabio / Francucci Marsilio, 8 / Cirocchi, Roberto / and Cappanera, Stefano

2020

Abstract: ... in our teaching hospital of Terni, an ASP has been implemented in an intensive care unit (ICU) setting, with the “daily-ICU ... disease 2019 (COVID-19) arrived and the same ICU was reserved only for COVID-19 patients ... of the great attention and training of all staff on infection control measures in the COVID-19 era, we would ...

Abstract	The Italian burden of disease associated with infections due to antibiotic-resistant bacteria has been very high, largely attributed to Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp). The implementation of infection control measures and antimicrobial stewardship programs (ASP) has been shown to reduce healthcare-related infections caused by multidrug resistance (MDR) germs. Since 2016, in our teaching hospital of Terni, an ASP has been implemented in an intensive care unit (ICU) setting, with the “daily-ICU round strategy” and particular attention to infection control measures. We performed active surveillance for search patients colonized by Carbapenem-Resistant Enterobacteriaceae (CRE). In March 2020, coronavirus disease 2019 (COVID-19) arrived and the same ICU was reserved only for COVID-19 patients. In our retrospective observational study, we analyzed the bimonthly incidence of CRE colonization patients and the incidence of CRE acquisition in our ICU during the period of January 2019 to June 2020. In consideration of the great attention and training of all staff on infection control measures in the COVID-19 era, we would have expected a clear reduction in CRE acquisition, but this did not happen. In fact, the incidence of CRE acquisition went from 6.7% in 2019 to 50% in March–April 2020. We noted that 67% of patients that had been changed in posture with prone position were colonized by CRE, while only 37% of patients that had not been changed in posture were colonized by CRE. In our opinion, the high intensity of care, the prone position requiring 4–5 healthcare workers (HCWs), equipped with personal protective equipment (PPE) in a high risk area, with extended and prolonged contact with the patient, and the presence of 32 new HCWs from other departments and without work experience in the ICU setting, contributed to the spread of CR-Kp in our ICU, determining an increase in CRE acquisition colonization.
Keywords	Carbapenem-Resistant Klebsiella pneumoniae ; antimicrobial stewardship ; CRE colonization ; COVID-19 ; intensive care unit ; covid19
Subject code	616
Language	English
Publisher	M D P I AG
Publishing country	it
Document type	Article ; Online
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