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  1. Article ; Online: Predictors of CPAP outcome in hospitalised COVID-19 patients

    Ahmed, Yasser Noeman / Gokaraju, Sriya / Powrie, Duncan / Amran, Dora / El Sayed, Iman / Roshdy, Ashraf

    medRxiv

    Abstract: Introduction: Throughout March - April 2020, many patients with COVID-19 presented to Southend University Hospital with Acute Hypoxaemic Respiratory Failure (AHRF). Patients were managed in a Specialist Respiratory High Dependency Unit. We present our ... ...

    Abstract Introduction: Throughout March - April 2020, many patients with COVID-19 presented to Southend University Hospital with Acute Hypoxaemic Respiratory Failure (AHRF). Patients were managed in a Specialist Respiratory High Dependency Unit. We present our experience on the usage of continuous positive airway pressure (CPAP) therapy and possible indicators of its success in this patient group. Methods: Data from patients (n=89) requiring mechanical ventilation during the months of March to April 2020, were retrospectively collected and analysed. 37 patients received IMV (Invasive Mechanical Ventilation) without a CPAP trial beforehand. 52 patients underwent a CPAP trial, of which 21 patients successfully avoided intubation and ITU admission. Results: The 52 patients, prior to receiving CPAP had significant respiratory failure as evidenced by a low PaO2: FiO2 (PFR) (mean +/- SD 123 +/- 60 mmHg) and mean SpO2:FiO2 (SFR) (mean +/- SD: 140+/- 50). The main indicators of CPAP success were: higher SFR before and after CPAP, lower respiratory rate (RR) , lower Neutrophil to Lymphocyte ratio (NLR) and higher PFR prior to CPAP. Discussion: CPAP proved successful in 40% of COVID-19 patients presenting with AHRF. SFR, PFR, RR and NLR are predictors of such success. SFR can be used for effective real time monitoring of patients before and after CPAP to identify likelihood of success. Based on our results, we have suggested a modified CPAP management protocol in COVID-19. These findings can guide future studies and will allow improved triage of patients to either CPAP or IMV, in the event of a future COVID peak.
    Keywords covid19
    Language English
    Publishing date 2020-06-16
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2020.06.14.20130880
    Database COVID19

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  2. Article ; Online: A very sudden onset of tracheomalacia with an unknown cause.

    Javaid, Mahvesh Rana / Tan, Kai Lee / Ahmed, Yasser Noeman

    BMJ case reports

    2013  Volume 2013

    MeSH term(s) Aged ; Humans ; Male ; Tomography, X-Ray Computed ; Tracheomalacia/diagnosis ; Tracheomalacia/diagnostic imaging ; Tracheomalacia/etiology
    Language English
    Publishing date 2013-05-24
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2013-009375
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Clinical characteristics and Outcomes of 500 patients with COVID Pneumonia : Results from a Single center (Southend University Hospital)

    Koduri, Gouri / Gokaraju, Sriya / Darda, Maria / Warrier, Vinod / Duta, Irina / Hayes, Fiona / El Sayed, Iman / Ahmed, Yasser Noeman

    medRxiv

    Abstract: Objectives To characterise the clinical features of hospitalised COVID 19 patients in a single centre during the first epidemic wave and explore potential predictive variables associated with outcomes such as mortality and the need for mechanical ... ...

    Abstract Objectives To characterise the clinical features of hospitalised COVID 19 patients in a single centre during the first epidemic wave and explore potential predictive variables associated with outcomes such as mortality and the need for mechanical ventilation, using baseline clinical parameters. Methodology We conducted a retrospective review of electronic records for demographic, clinical and laboratory data, imaging and outcomes for 500 hospitalised patients between February 20th and May 7th 2020 from Southend University Hospital, Essex, UK. Multivariate logistic regression models were used to identify risk factors relevant to outcome. Results The mean age of the cohort admitted to hospital with Covid-19, was 69.4 and 290 (58%) were over 70. The majority were Caucasians, 437 (87%) with less than 2 co-morbidities 280(56%). Most common were hypertension 186(37 %), Cardiovascular disease 178(36 %) and Diabetes 128 (26 %), represented in a larger proportion on the mortality group. Mean CFS was 4 with Non Survivors had significantly higher CFS 5 vs 3 in survivors, p<0.001. In addition, Mean CRP was significantly higher 150 vs 90, p<0.001 in Non Survivors. We observed the baseline predictors for mortality were age, CFS and CRP. Conclusions In this single centre study, older and frailer patients with more comorbidities and a higher baseline CRP and creatinine were risk factors for worse outcomes. Integrated frailty and age based risk stratification are essential, in addition to monitoring SFR (Sp02/Fi02) and inflammatory markers throughout the disease course to allow for early intervention to improve patient outcomes.
    Keywords covid19
    Language English
    Publishing date 2020-08-14
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2020.08.13.20163030
    Database COVID19

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