TY - GEN T1 - Resolucion 8430 de 1993, Octubre 4, por la cual se establecen las normas cientifico tecnicas y administrativas para la investigacion en salud A1 - Ministerio de Salud y Protección Social de Colombia Y1 - 1993/// PB - Ministerio de salud ER - TY - RPRT T1 - Lineamientos para el manejo clínico de pacientes con infección por nuevo coronavirus Covid-19 A1 - Ministerio de Salud y Protección Social de Colombia Y1 - 2020/// SP - 1 EP - 32 UR - https://www.minsalud.gov.co/Ministerio/Institucional/Procesos y procedimientos/PSSS03.pdf ER - TY - JOUR T1 - Coronavirus Disease 2019 (COVID-19) Information for Cardiologists　- Systematic Literature Review and Additional Analysis. A1 - Sugimoto, Tadafumi A1 - Mizuno, Atsushi A1 - Kishi, Takuya A1 - Ito, Naoya A1 - Matsumoto, Chisa A1 - Fukuda, Memori A1 - Kagiyama, Nobuyuki A1 - Shibata, Tatsuhiro A1 - Ohmori, Takashi A1 - Oishi, Shogo A1 - Fuse, Jun A1 - Kida, Keisuke A1 - Kawai, Fujimi A1 - Ishida, Mari A1 - Sanada, Shoji A1 - Komuro, Issei A1 - Node, Koichi Y1 - 2020/05// KW - Betacoronavirus KW - Cardiologists KW - Cardiovascular Diseases KW - Coronavirus Infections KW - Critical Care KW - Extracorporeal Membrane Oxygenation KW - Humans KW - Intensive Care Units KW - International Cooperation KW - Pandemics KW - Personal Protective Equipment KW - Pneumonia, Viral KW - Prognosis KW - Risk KW - epidemiology KW - physiopathology KW - therapy KW - virology JF - Circulation journal : official journal of the Japanese Circulation Society VL - 84 LA - eng IS - 6 SP - 1039 EP - 1043 DO - 10.1253/circj.CJ-20-0302 N2 - BACKGROUND: Despite the rapidly increasing attention being given to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, more commonly known as coronavirus disease 2019 (COVID-19), the relationship between cardiovascular disease and COVID-19 has not been fully described.Methods and Results:A systematic review was undertaken to summarize the important aspects of COVID-19 for cardiologists. Protection both for patients and healthcare providers, indication for treatments, collaboration with other departments and hospitals, and regular update of information are essentials to front COVID-19 patients. CONCLUSIONS: Because the chief manifestations of COVID-19 infection are respiratory and acute respiratory distress syndrome, cardiologists do not see infected patients directly. Cardiologists need to be better prepared regarding standard disinfection procedures, and be aware of the indications for extracorporeal membrane oxygenation and its use in the critical care setting. ER - TY - JOUR T1 - Coronavirus pathogenesis and the emerging pathogen severe acute respiratory syndrome coronavirus. A1 - Weiss, Susan R A1 - Navas-Martin, Sonia Y1 - 2005/12// KW - Animals KW - Cats KW - Cattle KW - Coronavirus KW - Coronavirus Infections KW - Disease Models, Animal KW - Humans KW - Mice KW - SARS Virus KW - Severe Acute Respiratory Syndrome KW - Viral Proteins KW - Viral Vaccines KW - Virion KW - genetics KW - metabolism KW - pathogenicity KW - prevention & control KW - therapeutic use KW - therapy KW - ultrastructure KW - virology JF - Microbiology and molecular biology reviews : MMBR VL - 69 LA - eng IS - 4 SP - 635 EP - 664 DO - 10.1128/MMBR.69.4.635-664.2005 N2 - Coronaviruses are a family of enveloped, single-stranded, positive-strand RNA viruses classified within the Nidovirales order. This coronavirus family consists of pathogens of many animal species and of humans, including the recently isolated severe acute respiratory syndrome coronavirus (SARS-CoV). This review is divided into two main parts; the first concerns the animal coronaviruses and their pathogenesis, with an emphasis on the functions of individual viral genes, and the second discusses the newly described human emerging pathogen, SARS-CoV. The coronavirus part covers (i) a description of a group of coronaviruses and the diseases they cause, including the prototype coronavirus, murine hepatitis virus, which is one of the recognized animal models for multiple sclerosis, as well as viruses of veterinary importance that infect the pig, chicken, and cat and a summary of the human viruses; (ii) a short summary of the replication cycle of coronaviruses in cell culture; (iii) the development and application of reverse genetics systems; and (iv) the roles of individual coronavirus proteins in replication and pathogenesis. The SARS-CoV part covers the pathogenesis of SARS, the developing animal models for infection, and the progress in vaccine development and antiviral therapies. The data gathered on the animal coronaviruses continue to be helpful in understanding SARS-CoV. ER - TY - JOUR T1 - Extracorporeal Membrane Oxygenation (ECMO) in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19) Pneumonia and Acute Respiratory Distress Syndrome (ARDS). A1 - Ma, Xiaochun A1 - Liang, Menglin A1 - Ding, Min A1 - Liu, Weiming A1 - Ma, Huibo A1 - Zhou, Xiaoming A1 - Ren, Hongsheng Y1 - 2020/08// JF - Medical science monitor : international medical journal of experimental and clinical research VL - 26 LA - eng SP - e925364 EP - e925364 DO - 10.12659/MSM.925364 N2 - Traced back to December 2019, an unexpected outbreak of a highly contagious new coronavirus pneumonia (COVID-19) has rapidly swept around China and the globe. There have now been an estimated 2 580 000 infections and more than 170 000 fatal cases around the world. The World Health Organization (WHO) estimated that approximately 14% of infections developed into severe disease, 5% were critically ill, and the mortality rate of critically ill patients is reported to be over 50%. The shortage of specific anti-viral treatment and vaccines remains a huge challenge. In COVID-19, refractory hypoxemia is common among the critically ill with acute respiratory distress syndrome (ARDS) despite invasive mechanical ventilation, and is further complicated by respiratory and circulatory failure. This difficult situation calls for the use of extracorporeal membrane oxygenation (ECMO) for assisting respiration and circulation if necessary. This article reviews the pertinent clinical literature, technical guidance, and expert recommendations on use of ECMO in critically ill cases of COVID-19. Here, we present basic knowledge and opinions about COVID-19 and ECMO, review the evidence on ECMO use in Middle East Respiratory Syndrome (MERS) and H1N1 influenza, share the technical guidance and recommendations on use of ECMO in COVID-19, summarize the current use of ECMO against COVID-19 in China, and discuss the issues in use of ECMO in COVID-19. ER - TY - GEN T1 - What has happened to care during the COVID-19 pandemic? A1 - Torres-González, J I A1 - Arias-Rivera, S A1 - Velasco-Sanz, T A1 - Mateos, Dávila A A1 - Planas, Pascual B A1 - Zaragoza-García, I A1 - Raurell-Torredà, M Y1 - 2020/// JF - Enfermeria intensiva VL - 31 LA - eng IS - 3 SP - 101 EP - 104 DO - 10.1016/j.enfi.2020.07.001 ER - TY - JOUR T1 - A sporadic COVID-19 pneumonia treated with extracorporeal membrane oxygenation in Tokyo, Japan: A case report. A1 - Nakamura, Kazuha A1 - Hikone, Mayu A1 - Shimizu, Hiroshi A1 - Kuwahara, Yusuke A1 - Tanabe, Maki A1 - Kobayashi, Mioko A1 - Ishida, Takuto A1 - Sugiyama, Kazuhiro A1 - Washino, Takuya A1 - Sakamoto, Naoya A1 - Hamabe, Yuichi Y1 - 2020/07// KW - Antiviral Agents KW - Betacoronavirus KW - Coronavirus Infections KW - Critical Care KW - Drug Combinations KW - Extracorporeal Membrane Oxygenation KW - Humans KW - Infection Control KW - Japan KW - Lopinavir KW - Male KW - Middle Aged KW - Pandemics KW - Pneumonia, Viral KW - Respiration, Artificial KW - Ritonavir KW - complications KW - therapeutic use KW - therapy KW - virology JF - Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy VL - 26 LA - eng IS - 7 SP - 756 EP - 761 DO - 10.1016/j.jiac.2020.03.018 N2 - INTRODUCTION: An ongoing outbreak of a novel coronavirus disease (coronavirus disease 2019, COVID-19) has become a global threat. While clinical reports from China to date demonstrate that the majority of cases remain relatively mild and recover with supportive care, it is also crucial to be well prepared for severe cases warranting intensive care. Initiating appropriate infection control measures may not always be achievable in primary care or in acute-care settings. CASE: A 45-year-old man was admitted to the intensive care unit due to severe pneumonia, later confirmed as COVID-19. His initial evaluation in the resuscitation room and treatments in the intensive care unit was performed under droplet and contact precaution with additional airborne protection using the N95 respirator mask. He was successfully treated in the intensive care unit with mechanical ventilation and extracorporeal membrane oxygenation for respiratory support; and antiretroviral treatment with lopinavir/ritonavir. His total intensive care unit stay was 15 days and was discharged on hospital day 24. CONCLUSIONS: Strict infection control precautions are not always an easy task, especially under urgent care in an intensive care unit. However, severe cases of COVID-19 pneumonia, or another novel infectious disease, could present at any moment and would be a continuing challenge to pursue appropriate measures. We need to be well prepared to secure healthcare workers from exposure to infectious diseases and nosocomial spread, as well as to provide necessary intensive care. ER - TY - JOUR T1 - Middle East respiratory syndrome coronavirus neutralising serum antibodies in dromedary camels: a comparative serological study. A1 - Reusken, Chantal B E M A1 - Haagmans, Bart L A1 - Müller, Marcel A A1 - Gutierrez, Carlos A1 - Godeke, Gert-Jan A1 - Meyer, Benjamin A1 - Muth, Doreen A1 - Raj, V Stalin A1 - Smits-De Vries, Laura A1 - Corman, Victor M A1 - Drexler, Jan-Felix A1 - Smits, Saskia L A1 - El Tahir, Yasmin E A1 - De Sousa, Rita A1 - van Beek, Janko A1 - Nowotny, Norbert A1 - van Maanen, Kees A1 - Hidalgo-Hermoso, Ezequiel A1 - Bosch, Berend-Jan A1 - Rottier, Peter A1 - Osterhaus, Albert A1 - Gortázar-Schmidt, Christian A1 - Drosten, Christian A1 - Koopmans, Marion P G Y1 - 2013/10// KW - Animals KW - Antibodies, Neutralizing KW - Antibodies, Viral KW - Camelids, New World KW - Camelus KW - Cattle KW - Coronavirus KW - Female KW - Goats KW - Humans KW - Immunoglobulin G KW - Male KW - Sheep KW - blood KW - classification KW - immunology JF - The Lancet. Infectious diseases VL - 13 LA - eng IS - 10 SP - 859 EP - 866 DO - 10.1016/S1473-3099(13)70164-6 N2 - BACKGROUND: A new betacoronavirus-Middle East respiratory syndrome coronavirus (MERS-CoV)-has been identified in patients with severe acute respiratory infection. Although related viruses infect bats, molecular clock analyses have been unable to identify direct ancestors of MERS-CoV. Anecdotal exposure histories suggest that patients had been in contact with dromedary camels or goats. We investigated possible animal reservoirs of MERS-CoV by assessing specific serum antibodies in livestock. METHODS: We took sera from animals in the Middle East (Oman) and from elsewhere (Spain, Netherlands, Chile). Cattle (n=80), sheep (n=40), goats (n=40), dromedary camels (n=155), and various other camelid species (n=34) were tested for specific serum IgG by protein microarray using the receptor-binding S1 subunits of spike proteins of MERS-CoV, severe acute respiratory syndrome coronavirus, and human coronavirus OC43. Results were confirmed by virus neutralisation tests for MERS-CoV and bovine coronavirus. FINDINGS: 50 of 50 (100%) sera from Omani camels and 15 of 105 (14%) from Spanish camels had protein-specific antibodies against MERS-CoV spike. Sera from European sheep, goats, cattle, and other camelids had no such antibodies. MERS-CoV neutralising antibody titres varied between 1/320 and 1/2560 for the Omani camel sera and between 1/20 and 1/320 for the Spanish camel sera. There was no evidence for cross-neutralisation by bovine coronavirus antibodies. INTERPRETATION: MERS-CoV or a related virus has infected camel populations. Both titres and seroprevalences in sera from different locations in Oman suggest widespread infection. FUNDING: European Union, European Centre For Disease Prevention and Control, Deutsche Forschungsgemeinschaft. ER - TY - JOUR T1 - Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. A1 - Grasselli, Giacomo A1 - Zangrillo, Alberto A1 - Zanella, Alberto A1 - Antonelli, Massimo A1 - Cabrini, Luca A1 - Castelli, Antonio A1 - Cereda, Danilo A1 - Coluccello, Antonio A1 - Foti, Giuseppe A1 - Fumagalli, Roberto A1 - Iotti, Giorgio A1 - Latronico, Nicola A1 - Lorini, Luca A1 - Merler, Stefano A1 - Natalini, Giuseppe A1 - Piatti, Alessandra A1 - Ranieri, Marco Vito A1 - Scandroglio, Anna Mara A1 - Storti, Enrico A1 - Cecconi, Maurizio A1 - Pesenti, Antonio Y1 - 2020/04// KW - Adolescent KW - Adult KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Betacoronavirus KW - Comorbidity KW - Coronavirus Infections KW - Critical Care KW - Critical Illness KW - Female KW - Hospital Mortality KW - Hospitalization KW - Humans KW - Intensive Care Units KW - Italy KW - Male KW - Middle Aged KW - Pandemics KW - Pneumonia, Viral KW - Positive-Pressure Respiration KW - Respiration, Artificial KW - Retrospective Studies KW - Sex Distribution KW - Young Adult KW - epidemiology KW - mortality KW - physiopathology KW - statistics & numerical data KW - therapy JF - JAMA VL - 323 LA - eng IS - 16 SP - 1574 EP - 1581 DO - 10.1001/jama.2020.5394 N2 - IMPORTANCE: In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited. OBJECTIVE: To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy. DESIGN, SETTING, AND PARTICIPANTS: Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020. EXPOSURES: SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs. MAIN OUTCOMES AND MEASURES: Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network. RESULTS: Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio2 was greater than 50% in 89% of patients. The median Pao2/Fio2 was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged ≤63 years) and older patients (n = 514 aged ≥64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0]; P = .94). Median Fio2 was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, -10% [95% CI, -14% to 6%]; P = .006), and median Pao2/Fio2 was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, -8 to 22]; P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68]; P < .001) and had lower Pao2/Fio2 (median [IQR], 146 [105-214] vs 173 [120-222]; median difference, -27 [95% CI, -42 to -12]; P = .005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n = 786; age ≥64 years) had higher mortality than younger patients (n = 795; age ≤63 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%]; P < .001). CONCLUSIONS AND RELEVANCE: In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%. ER - TY - JOUR T1 - Optimal search strategies for detecting clinically sound prognostic studies in EMBASE: an analytic survey. A1 - Wilczynski, Nancy L A1 - Haynes, R Brian Y1 - 2005/// KW - Abstracting and Indexing KW - Databases, Bibliographic KW - Humans KW - Information Storage and Retrieval KW - Prognosis KW - Vocabulary, Controlled KW - methods JF - Journal of the American Medical Informatics Association : JAMIA VL - 12 LA - eng IS - 4 SP - 481 EP - 485 DO - 10.1197/jamia.M1752 N2 - BACKGROUND: Clinical end users of EMBASE have a difficult time retrieving articles that are both scientifically sound and directly relevant to clinical practice. Search filters have been developed to assist end users in increasing the success of their searches. Many filters have been developed for the literature on therapy and reviews for use in MEDLINE, but little has been done for use in EMBASE with no filter development for studies of prognosis. The objective of this study was to determine how well various methodologic textwords, index terms, and their Boolean combinations retrieve methodologically sound literature on the prognosis of health disorders in EMBASE. METHODS: An analytic survey was conducted, comparing hand searches of 55 journals with retrievals from EMBASE for 4,843 candidate search terms and 8,919 combinations. All articles were rated using purpose and quality indicators, and clinically relevant prognostic articles were categorized as "pass" or "fail" according to explicit criteria for scientific merit. Candidate search strategies were run in EMBASE, the retrievals being compared with the hand search data. The sensitivity, specificity, precision, and accuracy of the search strategies were calculated. RESULTS: Of the 1,064 articles about prognosis, 148 (13.9%) met basic criteria for scientific merit. Combinations of search terms reached peak sensitivities of 98.7% with specificity at 50.6%. Compared with best single terms, best multiple terms increased sensitivity for sound studies by 12.2% (absolute increase), while decreasing specificity (absolute decrease 5.1%) when sensitivity was maximized. Combinations of search terms reached peak specificities of 93.4% with sensitivity at 50.7%. Compared with best single terms, best multiple terms increased specificity for sound studies by 7.1% (absolute increase), while decreasing sensitivity (absolute decrease 8.8%) when specificity was maximized. CONCLUSION: Empirically derived search strategies combining indexing terms and textwords can achieve high sensitivity or specificity for retrieving sound prognostic studies from EMBASE. ER - TY - JOUR T1 - Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. A1 - Munshi, Laveena A1 - Walkey, Allan A1 - Goligher, Ewan A1 - Pham, Tai A1 - Uleryk, Elizabeth M A1 - Fan, Eddy Y1 - 2019/02// JF - The Lancet. Respiratory medicine VL - 7 LA - eng IS - 2 SP - 163 EP - 172 CY - England DO - 10.1016/S2213-2600(18)30452-1 N2 - BACKGROUND: Use of extracorporeal membrane oxygenation (ECMO) in adults with severe acute respiratory distress syndrome has increased in the past 10 years. However, the efficacy of venovenous ECMO in people with acute respiratory distress syndrome is uncertain according to the most recent data. We aimed to estimate the effect of venovenous ECMO on mortality from acute respiratory distress syndrome. METHODS: In this systematic review and meta-analysis, we searched MEDLINE (including MEDLINE In-Process and Epub Ahead of Print), Embase and the Wiley search platform in the Cochrane database for randomised controlled trials and observational studies with matching of conventional mechanical ventilation with and without venovenous ECMO in adults with acute respiratory distress syndrome. Titles, abstracts, and full-text articles were screened in duplicate by two investigators. Data for study design, patient characteristics, interventions, and study outcomes were abstracted independently and in duplicate. Studies were weighted with the inverse variance method and data were pooled via random-effects modelling. We calculated risk ratios (RRs) and 95% CIs to summarise results. The primary outcome was 60-day mortality across randomised controlled trials. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines were used to rate the quality of evidence FINDINGS: We included five studies, two randomised controlled trials and three observational studies with matching techniques (total N=773 patients). In the primary analysis, which included two randomised controlled trials with a total population of 429 patients, 60-day mortality was significantly lower in the venovenous ECMO group than in the control group (73 [34%] of 214 vs 101 [47%] of 215; RR 0·73 [95% CI 0·58-0·92]; p=0·008; I(2) 0%). The GRADE level of evidence for this outcome was moderate. Three studies included data for the incidence of major haemorrhage in the ECMO group. 48 (19%) of the 251 patients in these three studies had major haemorrhages. INTERPRETATION: Compared with conventional mechanical ventilation, use of venovenous ECMO in adults with severe acute respiratory distress syndrome was associated with reduced 60-day mortality. However, venovenous ECMO was also associated with a moderate risk of major bleeding. These findings have important implications surrounding decision making for management of severe acute respiratory distress syndrome at centres providing venov… ER - TY - JOUR T1 - The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. A1 - Ferguson, Niall D A1 - Fan, Eddy A1 - Camporota, Luigi A1 - Antonelli, Massimo A1 - Anzueto, Antonio A1 - Beale, Richard A1 - Brochard, Laurent A1 - Brower, Roy A1 - Esteban, Andrés A1 - Gattinoni, Luciano A1 - Rhodes, Andrew A1 - Slutsky, Arthur S A1 - Vincent, Jean-Louis A1 - Rubenfeld, Gordon D A1 - Thompson, B Taylor A1 - Ranieri, V Marco Y1 - 2012/10// KW - Berlin KW - Humans KW - Prognosis KW - Reproducibility of Results KW - Respiratory Distress Syndrome, Adult KW - Risk Factors KW - classification KW - diagnosis JF - Intensive care medicine VL - 38 LA - eng IS - 10 SP - 1573 EP - 1582 DO - 10.1007/s00134-012-2682-1 N2 - PURPOSE: Our objective was to revise the definition of acute respiratory distress syndrome (ARDS) using a conceptual model incorporating reliability and validity, and a novel iterative approach with formal evaluation of the definition. METHODS: The European Society of Intensive Care Medicine identified three chairs with broad expertise in ARDS who selected the participants and created the agenda. After 2 days of consensus discussions a draft definition was developed, which then underwent empiric evaluation followed by consensus revision. RESULTS: The Berlin Definition of ARDS maintains a link to prior definitions with diagnostic criteria of timing, chest imaging, origin of edema, and hypoxemia. Patients may have ARDS if the onset is within 1 week of a known clinical insult or new/worsening respiratory symptoms. For the bilateral opacities on chest radiograph criterion, a reference set of chest radiographs has been developed to enhance inter-observer reliability. The pulmonary artery wedge pressure criterion for hydrostatic edema was removed, and illustrative vignettes were created to guide judgments about the primary cause of respiratory failure. If no risk factor for ARDS is apparent, however, objective evaluation (e.g., echocardiography) is required to help rule out hydrostatic edema. A minimum level of positive end-expiratory pressure and mutually exclusive PaO(2)/FiO(2) thresholds were chosen for the different levels of ARDS severity (mild, moderate, severe) to better categorize patients with different outcomes and potential responses to therapy. CONCLUSIONS: This panel addressed some of the limitations of the prior ARDS definition by incorporating current data, physiologic concepts, and clinical trials results to develop the Berlin definition, which should facilitate case recognition and better match treatment options to severity in both research trials and clinical practice. ER - TY - JOUR T1 - Neurological manifestations and COVID-19: Experiences from a tertiary care center at the Frontline. A1 - Pinna, Pranusha A1 - Grewal, Parneet A1 - Hall, Julianne P A1 - Tavarez, Tachira A1 - Dafer, Rima M A1 - Garg, Rajeev A1 - Osteraas, Nicholas D A1 - Pellack, Danielle R A1 - Asthana, Anjali A1 - Fegan, Kelsey A1 - Patel, Vikram A1 - Conners, James J A1 - John, Sayona A1 - Silva, Ivan Da Y1 - 2020/08// KW - Betacoronavirus KW - Chicago KW - Comorbidity KW - Coronavirus Infections KW - Female KW - Humans KW - Male KW - Middle Aged KW - Nervous System Diseases KW - Pandemics KW - Pneumonia, Viral KW - Retrospective Studies KW - Tertiary Care Centers KW - Time Factors KW - epidemiology KW - physiopathology JF - Journal of the neurological sciences VL - 415 LA - eng SP - 116969 EP - 116969 DO - 10.1016/j.jns.2020.116969 N2 - OBJECTIVE: To report neurological manifestations seen in patients hospitalized with Coronavirus disease 2019 (COVID-19) from a large academic medical center in Chicago, Illinois. METHODS: We retrospectively reviewed data records of 50 patients with COVID-19 who were evaluated by the neurology services from March 1, 2020 - April 30, 2020. Patients were categorized into 2 groups based on timing of developing neurological manifestations: the "Neuro first" group had neurological manifestations upon initial assessment, and the "COVID first" group developed neurological symptoms greater than 24 h after hospitalization. The demographics, comorbidities, disease severity and neurological symptoms and diagnoses of both groups were analyzed. Statistical analysis was performed to compare the two groups. RESULTS: A total of 50 patients (48% African American and 24% Latino) were included in the analysis. Most common neurological manifestations observed were encephalopathy (n = 30), cerebrovascular disease (n = 20), cognitive impairment (n = 13), seizures (n = 13), hypoxic brain injury (n = 7), dysgeusia (n = 5), and extraocular movement abnormalities (n = 5). The "COVID-19 first" group had more evidence of physiologic disturbances on arrival with a more severe/critical disease course (83.3% vs 53.8%, p 0.025). CONCLUSION: Neurologic manifestations of COVID-19 are highly variable and can occur prior to the diagnosis of or as a complication of the viral infection. Despite similar baseline comorbidities and demographics, the COVID-19 patients who developed neurologic symptoms later in hospitalization had more severe disease courses. Differently from previous studies, we noted a high percentage of African American and Latino individuals in both groups. ER - TY - JOUR T1 - Specific Considerations for Venovenous Extracorporeal Membrane Oxygenation During Coronavirus Disease 2019 Pandemic. A1 - Guihaire, Julien A1 - Owyang, Clark G A1 - Madhok, Jai A1 - Laverdure, Florent A1 - Gaillard, Maïra A1 - Girault, Antoine A1 - Lebreton, Guillaume A1 - Mercier, Olaf Y1 - 2020/// JF - ASAIO journal (American Society for Artificial Internal Organs : 1992) VL - 66 LA - eng IS - 10 SP - 1069 EP - 1072 CY - United States DO - 10.1097/MAT.0000000000001251 N2 - Extracorporeal membrane oxygenation (ECMO) is recognized as organ support for potentially reversible acute respiratory distress syndrome (ARDS). However, limited resource during the outbreak and the coagulopathy associated with coronavirus disease 2019 (COVID-19) make the utilization of venovenous (VV) ECMO highly challenging. We herein report specific considerations for cannulation configurations and ECMO management during the pandemic. High blood flow and anticoagulation at higher levels than usual practice for VV ECMO may be required because of thrombotic hematologic profile of COVID-19. Among our first 24 cases (48.8 ± 8.9 years), 17 patients were weaned from ECMO after a mean duration of 19.0 ± 10.1 days and 16 of them have been discharged from ICU. ER - TY - JOUR T1 - Venovenous extra-corporeal membrane oxygenation for severe acute respiratory distress syndrome: a matched cohort study. A1 - Liu, Song-Qiao A1 - Huang, Ying-Zi A1 - Pan, Chun A1 - Guo, Lan-Qi A1 - Wang, Xiao-Ting A1 - Yu, Wen-Kui A1 - Wu, Yun-Fu A1 - Yan, Jie A1 - Zhao, Hong-Sheng A1 - Liu, Ling A1 - Guo, Feng-Mei A1 - Xu, Jing-Yuan A1 - Yang, Yi A1 - Qiu, Hai-Bo Y1 - 2019/09// JF - Chinese medical journal VL - 132 LA - eng IS - 18 SP - 2192 EP - 2198 DO - 10.1097/CM9.0000000000000424 N2 - BACKGROUND: Although the use of extra-corporeal membrane oxygenation (ECMO) has been rapidly increasing, the benefit of ECMO in patients with acute respiratory distress syndrome (ARDS) remains unclear. Our objective was to investigate the effect of venovenous ECMO (VV-ECMO) on adult patients with severe ARDS. METHODS: We conducted a multi-center, retrospective, cohort study in the intensive care units (ICUs) of six teaching hospitals between January 2013 and December 2018. Patients with severe ARDS who received VV-ECMO support were included. The detailed demographic data and physiologic data were used to match ARDS patients without ECMO. The primary endpoint was the 28-day mortality. RESULTS: Ninety-nine patients with severe ARDS supported by VV-ECMO and 72 patients without ECMO were included in this study. The acute physiology and chronic health evaluation II score was 23.1 ± 6.3 in the ECMO group and 24.8 ± 8.5 in the control group (P = 0.1195). The sequential organ failure assessment score was 12.8 ± 3.4 in the ECMO group and 13.7 ± 3.5 in the control group (P = 0.0848). The 28-day mortality of patients with ECMO support was 39.4%, and that of the control group was 55.6%. The survival analysis curve showed that the 28-day mortality in the ECMO group was significantly lower than that in the control group (P = 0.0097). Multivariate Cox regression analysis showed that the independent predictors of the 28-day mortality were the requirement of vasopressors before ECMO (hazard ratio [HR]: 1.006; 95% confidence interval [CI]: 1.001-1.013; P = 0.030) and duration of mechanical ventilation before ECMO (HR: 3.299; 95% CI: 1.264-8.609; P = 0.034). CONCLUSIONS: This study showed that ECMO improved the survival of patients with severe ARDS. The duration of mechanical ventilation and the requirement of vasopressors before ECMO might be associated with an increased risk of death. ER - TY - GEN T1 - Extracorporeal membrane oxygenation therapy in the COVID-19 pandemic. A1 - Pravda, Nili Schamroth A1 - Pravda, Miri Schamroth A1 - Kornowski, Ran A1 - Orvin, Katia Y1 - 2020/04// JF - Future cardiology LA - eng DO - 10.2217/fca-2020-0040 ER - TY - JOUR T1 - Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. A1 - Zhou, Fei A1 - Yu, Ting A1 - Du, Ronghui A1 - Fan, Guohui A1 - Liu, Ying A1 - Liu, Zhibo A1 - Xiang, Jie A1 - Wang, Yeming A1 - Song, Bin A1 - Gu, Xiaoying A1 - Guan, Lulu A1 - Wei, Yuan A1 - Li, Hui A1 - Wu, Xudong A1 - Xu, Jiuyang A1 - Tu, Shengjin A1 - Zhang, Yi A1 - Chen, Hua A1 - Cao, Bin Y1 - 2020/03// JF - Lancet (London, England) VL - 395 LA - eng IS - 10229 SP - 1054 EP - 1062 DO - 10.1016/S0140-6736(20)30566-3 N2 - BACKGROUND: Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. METHODS: In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. FINDINGS: 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. INTERPRETATION: The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. FUNDING: Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects… ER - TY - JOUR T1 - Coronavirus as a possible cause of severe acute respiratory syndrome. A1 - Peiris, J S M A1 - Lai, S T A1 - Poon, L L M A1 - Guan, Y A1 - Yam, L Y C A1 - Lim, W A1 - Nicholls, J A1 - Yee, W K S A1 - Yan, W W A1 - Cheung, M T A1 - Cheng, V C C A1 - Chan, K H A1 - Tsang, D N C A1 - Yung, R W H A1 - Ng, T K A1 - Yuen, K Y Y1 - 2003/04// KW - Adult KW - Aged KW - Coronavirus KW - Coronavirus Infections KW - Disease Progression KW - Female KW - Hong Kong KW - Humans KW - Male KW - Microscopy, Electron KW - Middle Aged KW - Nasopharynx KW - Opportunistic Infections KW - Reverse Transcriptase Polymerase Chain Reaction KW - Risk Factors KW - Severe Acute Respiratory Syndrome KW - Virus Cultivation KW - classification KW - diagnosis KW - isolation & purification KW - transmission KW - ultrastructure KW - virology JF - Lancet (London, England) VL - 361 LA - eng IS - 9366 SP - 1319 EP - 1325 DO - 10.1016/s0140-6736(03)13077-2 N2 - BACKGROUND: An outbreak of severe acute respiratory syndrome (SARS) has been reported in Hong Kong. We investigated the viral cause and clinical presentation among 50 patients. METHODS: We analysed case notes and microbiological findings for 50 patients with SARS, representing more than five separate epidemiologically linked transmission clusters. We defined the clinical presentation and risk factors associated with severe disease and investigated the causal agents by chest radiography and laboratory testing of nasopharyngeal aspirates and sera samples. We compared the laboratory findings with those submitted for microbiological investigation of other diseases from patients whose identity was masked. FINDINGS: Patients' age ranged from 23 to 74 years. Fever, chills, myalgia, and cough were the most frequent complaints. When compared with chest radiographic changes, respiratory symptoms and auscultatory findings were disproportionally mild. Patients who were household contacts of other infected people and had older age, lymphopenia, and liver dysfunction were associated with severe disease. A virus belonging to the family Coronaviridae was isolated from two patients. By use of serological and reverse-transcriptase PCR specific for this virus, 45 of 50 patients with SARS, but no controls, had evidence of infection with this virus. INTERPRETATION: A coronavirus was isolated from patients with SARS that might be the primary agent associated with this disease. Serological and molecular tests specific for the virus permitted a definitive laboratory diagnosis to be made and allowed further investigation to define whether other cofactors play a part in disease progression. ER - TY - GEN T1 - Extracorporeal membrane oxygenation for COVID-19: effective weapon or futile effort? A1 - Pavone, Natalia A1 - Burzotta, Francesco A1 - Massetti, Massimo Y1 - 2020/10// JF - Minerva cardioangiologica VL - 68 LA - eng IS - 5 SP - 365 EP - 367 CY - Italy DO - 10.23736/S0026-4725.20.05377-3 ER - TY - JOUR T1 - Declaration of Helsinki. Ethical principles for medical research involving human subjects A1 - World Medical Association Y1 - 2009/// PB - Walter de Gruyter JF - Jahrbuch Für Wissenschaft Und Ethik VL - 14 IS - 1 SP - 233 EP - 238 ER - TY - JOUR T1 - The critical care response to a hospital outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: an observational study. A1 - Al-Dorzi, Hasan M A1 - Aldawood, Abdulaziz S A1 - Khan, Raymond A1 - Baharoon, Salim A1 - Alchin, John D A1 - Matroud, Amal A A1 - Al Johany, Sameera M A1 - Balkhy, Hanan H A1 - Arabi, Yaseen M Y1 - 2016/12// JF - Annals of intensive care VL - 6 LA - eng IS - 1 SP - 101 EP - 101 DO - 10.1186/s13613-016-0203-z N2 - BACKGROUND: Middle East respiratory syndrome coronavirus (MERS-CoV) has caused several hospital outbreaks, including a major outbreak at King Abdulaziz Medical City, a 940-bed tertiary-care hospital in Riyadh, Saudi Arabia (August-September 2015). To learn from our experience, we described the critical care response to the outbreak. METHODS: This observational study was conducted at the Intensive Care Department which covered 5 ICUs with 60 single-bedded rooms. We described qualitatively and, as applicable, quantitatively the response of intensive care services to the outbreak. The clinical course and outcomes of healthcare workers (HCWs) who had MERS were noted. RESULTS: Sixty-three MERS patients were admitted to 3 MERS-designated ICUs during the outbreak (peak census = 27 patients on August 25, 2015, and the last new case on September 13, 2015). Most patients had multiorgan failure. Eight HCWs had MERS requiring ICU admission (median stay = 28 days): Seven developed acute respiratory distress syndrome, four were treated with prone positioning, four needed continuous renal replacement therapy and one had extracorporeal membrane oxygenation. The hospital mortality of ICU MERS patients was 63.4 % (0 % for the HCWs). In response to the outbreak, the number of negative-pressure rooms was increased from 14 to 38 rooms in 3 MERS-designated ICUs. Patients were managed with a nurse-to-patient ratio of 1:0.8. Infection prevention practices were intensified. As a surrogate, surface disinfectant and hand hygiene gel consumption increased by ~30 % and 17 N95 masks were used per patient/day on average. Family visits were restricted to 2 h/day. Although most ICU staff expressed concerns about acquiring MERS, all reported to work normally. During the outbreak, 27.0 % of nurses and 18.4 % of physicians working in the MERS-designated ICUs reported upper respiratory symptoms, and were tested for MERS-CoV. Only 2/196 (1.0 %) ICU nurses and 1/80 (1.3 %) physician tested positive, had mild disease and recovered fully. The total sick leave duration was 138 days for nurses and 30 days for physicians. CONCLUSIONS: Our hospital outbreak of MERS resulted in 63 patients requiring organ support and prolonged ICU stay with a high mortality rate. The ICU response required careful facility and staff management and proper infection control and prevention practices. ER - TY - JOUR T1 - PRISMA declaration: A proposal to improve the publication of systematic reviews and meta-analyses A1 - Urrútia, Gerard A1 - Bonfill, Xavier Y1 - 2010/// JF - Medicina Clinica VL - 135 IS - 11 SP - 507 EP - 511 DO - 10.1016/j.medcli.2010.01.015 N2 - Medicina Clinica, 1 + (2010) 507-511. doi:10.1016/j.medcli.2010.01.015 ER - TY - JOUR T1 - Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. A1 - Combes, Alain A1 - Hajage, David A1 - Capellier, Gilles A1 - Demoule, Alexandre A1 - Lavoué, Sylvain A1 - Guervilly, Christophe A1 - Da Silva, Daniel A1 - Zafrani, Lara A1 - Tirot, Patrice A1 - Veber, Benoit A1 - Maury, Eric A1 - Levy, Bruno A1 - Cohen, Yves A1 - Richard, Christian A1 - Kalfon, Pierre A1 - Bouadma, Lila A1 - Mehdaoui, Hossein A1 - Beduneau, Gaëtan A1 - Lebreton, Guillaume A1 - Brochard, Laurent A1 - Ferguson, Niall D A1 - Fan, Eddy A1 - Slutsky, Arthur S A1 - Brodie, Daniel A1 - Mercat, Alain Y1 - 2018/05// JF - The New England journal of medicine VL - 378 LA - eng IS - 21 SP - 1965 EP - 1975 CY - United States DO - 10.1056/NEJMoa1800385 N2 - BACKGROUND: The efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) remains controversial. METHODS: In an international clinical trial, we randomly assigned patients with very severe ARDS, as indicated by one of three criteria - a ratio of partial pressure of arterial oxygen (Pao(2)) to the fraction of inspired oxygen (Fio(2)) of less than 50 mm Hg for more than 3 hours; a Pao(2):Fio(2) of less than 80 mm Hg for more than 6 hours; or an arterial blood pH of less than 7.25 with a partial pressure of arterial carbon dioxide of at least 60 mm Hg for more than 6 hours - to receive immediate venovenous ECMO (ECMO group) or continued conventional treatment (control group). Crossover to ECMO was possible for patients in the control group who had refractory hypoxemia. The primary end point was mortality at 60 days. RESULTS: At 60 days, 44 of 124 patients (35%) in the ECMO group and 57 of 125 (46%) in the control group had died (relative risk, 0.76; 95% confidence interval [CI], 0.55 to 1.04; P=0.09). Crossover to ECMO occurred a mean (±SD) of 6.5±9.7 days after randomization in 35 patients (28%) in the control group, with 20 of these patients (57%) dying. The frequency of complications did not differ significantly between groups, except that there were more bleeding events leading to transfusion in the ECMO group than in the control group (in 46% vs. 28% of patients; absolute risk difference, 18 percentage points; 95% CI, 6 to 30) as well as more cases of severe thrombocytopenia (in 27% vs. 16%; absolute risk difference, 11 percentage points; 95% CI, 0 to 21) and fewer cases of ischemic stroke (in no patients vs. 5%; absolute risk difference, -5 percentage points; 95% CI, -10 to -2). CONCLUSIONS: Among patients with very severe ARDS, 60-day mortality was not significantly lower with ECMO than with a strategy of conventional mechanical ventilation that included ECMO as rescue therapy. (Funded by the Direction de la Recherche Clinique et du Développement and the French Ministry of Health; EOLIA ClinicalTrials.gov number, NCT01470703 .). ER - TY - ICOMM T1 - Early Data on Intubated COVID-19 Patients Reveals Severe Mortality A1 - RT Staff Y1 - 2020/// JF - Critical Care, ICU & Ventilation, Other Infections UR - https://rtmagazine.com/disorders-diseases/critical-care/icu-ventilation/early-data-on-ventilated-covid-19-patients-reveals-severe-mortality/ ER - TY - ICOMM T1 - Actualización Epidemiológica: Enfermedad por coronavirus (COVID-19) A1 - Organización Panamericana de la Salud OPS A1 - OMS, Organización Mundial de la Salud Y1 - 2020/// UR - https://www.paho.org/es/documentos/actualizacion-epidemiologica-enfermedad-por-coronavirus-covid-19-23-junio-2020 ER - TY - JOUR T1 - Establishment and Management of Mechanical Circulatory Support During the COVID-19 Pandemic. A1 - Pham, Duc Thinh A1 - Toeg, Hadi A1 - De Paulis, Ruggero A1 - Atluri, Pavan Y1 - 2020/07// KW - Betacoronavirus KW - Coronavirus Infections KW - Extracorporeal Membrane Oxygenation KW - Humans KW - Pandemics KW - Pneumonia, Viral KW - Risk KW - Survival Rate KW - epidemiology KW - isolation & purification KW - mortality KW - pathology KW - virology JF - Circulation VL - 142 LA - eng IS - 1 SP - 10 EP - 13 DO - 10.1161/CIRCULATIONAHA.120.047415 ER - TY - JOUR T1 - Bases Genéticas y Moleculares del COVID-19 (SARS-CoV-2). Mecanismos de Patogénesis y de Respuesta Inmune A1 - Pastrian-Soto, Gabriel Y1 - 2020/// PB - Universidad de La Frontera JF - International journal of odontostomatology VL - 14 IS - 3 SP - 331 EP - 337 ER - TY - JOUR T1 - Clinical Presentation and Outcomes of Middle East Respiratory Syndrome in the Republic of Korea. A1 - Choi, Won Suk A1 - Kang, Cheol-In A1 - Kim, Yonjae A1 - Choi, Jae-Phil A1 - Joh, Joon Sung A1 - Shin, Hyoung-Shik A1 - Kim, Gayeon A1 - Peck, Kyong Ran A1 - Chung, Doo Ryeon A1 - Kim, Hye Ok A1 - Song, Sook Hee A1 - Kim, Yang Ree A1 - Sohn, Kyung Mok A1 - Jung, Younghee A1 - Bang, Ji Hwan A1 - Kim, Nam Joong A1 - Lee, Kkot Sil A1 - Jeong, Hye Won A1 - Rhee, Ji-Young A1 - Kim, Eu Suk A1 - Woo, Heungjeong A1 - Oh, Won Sup A1 - Huh, Kyungmin A1 - Lee, Young Hyun A1 - Song, Joon Young A1 - Lee, Jacob A1 - Lee, Chang-Seop A1 - Kim, Baek-Nam A1 - Choi, Young Hwa A1 - Jeong, Su Jin A1 - Lee, Jin-Soo A1 - Yoon, Ji Hyun A1 - Wi, Yu Mi A1 - Joung, Mi Kyong A1 - Park, Seong Yeon A1 - Lee, Sun Hee A1 - Jung, Sook-In A1 - Kim, Shin-Woo A1 - Lee, Jae Hoon A1 - Lee, Hyuck A1 - Ki, Hyun Kyun A1 - Kim, Yeon-Sook Y1 - 2016/06// JF - Infection & chemotherapy VL - 48 LA - eng IS - 2 SP - 118 EP - 126 DO - 10.3947/ic.2016.48.2.118 N2 - BACKGROUND: From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015. MATERIALS AND METHODS: We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV infection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay. RESULTS: The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death. CONCLUSION: The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes. ER - TY - JOUR T1 - Importancia del abordaje paliativo interprofesional en el paciente crítico A1 - Velasco-Sanz, Tamara Raquel A1 - Estella-García, A A1 - del Barrio-Linares, Miriam A1 - Velasco-Bueno, José Manuel A1 - Saralegui-Reta, Iñaki A1 - Rubio-Sanchiz, Olga A1 - Raurell-Torredà, Marta Y1 - 2019/// JF - Enferm Intensiva. VL - 30 IS - 1 SP - 1 EP - 3 ER - TY - JOUR T1 - Developing optimal search strategies for detecting clinically sound and relevant causation studies in EMBASE. A1 - Haynes, R Brian A1 - Kastner, Monika A1 - Wilczynski, Nancy L Y1 - 2005/03// KW - Causality KW - Databases, Bibliographic KW - Empirical Research KW - Evidence-Based Medicine KW - Humans KW - Information Storage and Retrieval KW - Periodicals as Topic KW - Quality Control KW - Research Design KW - Sensitivity and Specificity KW - Subject Headings KW - User-Computer Interface KW - methods KW - standards KW - statistics & numerical data JF - BMC medical informatics and decision making VL - 5 LA - eng SP - 8 EP - 8 DO - 10.1186/1472-6947-5-8 N2 - BACKGROUND: Evaluating the existence and strength of an association between a putative cause and adverse clinical outcome is complex and best done by assessing all available evidence. With the increasing burden of chronic disease, greater time demands on health professionals, and the explosion of information, effective retrieval of best evidence has become both more important and more difficult. Optimal search retrieval can be hampered by a number of obstacles, especially poor search strategies, but using empirically tested methodological search filters can enhance the accuracy of searches for sound evidence concerning etiology. Although such filters have previously been developed for studies of relevance to causation in MEDLINE, no empirically tested search strategy exists for EMBASE. METHODS: An analytic survey was conducted, comparing hand searches of journals with retrievals from EMBASE for candidate search terms and combinations. 6 research assistants read all issues of 55 journals indexed in EMBASE. All articles were rated using purpose and quality indicators and categorized into clinically relevant original studies, review articles, general papers, or case reports. The original and review articles were then categorized as 'pass' or 'fail' for scientific merit according to explicit criteria in the areas of causation (etiology) and other clinical topics. Candidate search strategies were developed for causation, then run in a subset of 55 EMBASE journals, the retrievals being compared with the hand search data. The sensitivity, specificity, precision, and accuracy of the search strategies were calculated. RESULTS: Of the 1489 studies classified as causation, 14% were methodologically sound. When search terms were combined, sensitivity reached 92%. Compared with the best single-term strategy, the best combination of terms resulted in an absolute increase in sensitivity (19%) and specificity (5.2%). Maximizing specificity for combined terms resulted in an increase of 7.1% compared with the single term but this came at an expense of sensitivity (39% absolute decrease). A search strategy that optimized the trade-off between sensitivity and specificity achieved 81.9% for sensitivity and 81.4% for specificity. CONCLUSION: We have discovered search strategies that retrieve high quality studies of causation from EMBASE with high sensitivity, high specificity, or an optimal balance of each. ER - TY - JOUR T1 - Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. A1 - Alshahrani, Mohammed S A1 - Sindi, Anees A1 - Alshamsi, Fayez A1 - Al-Omari, Awad A1 - El Tahan, Mohamed A1 - Alahmadi, Bayan A1 - Zein, Ahmed A1 - Khatani, Naif A1 - Al-Hameed, Fahad A1 - Alamri, Sultan A1 - Abdelzaher, Mohammed A1 - Alghamdi, Amenah A1 - Alfousan, Faisal A1 - Tash, Adel A1 - Tashkandi, Wail A1 - Alraddadi, Rajaa A1 - Lewis, Kim A1 - Badawee, Mohammed A1 - Arabi, Yaseen M A1 - Fan, Eddy A1 - Alhazzani, Waleed Y1 - 2018/01// JF - Annals of intensive care VL - 8 LA - eng IS - 1 SP - 3 EP - 3 DO - 10.1186/s13613-017-0350-x N2 - BACKGROUND: Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS-CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. METHODS: We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. RESULTS: Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05). CONCLUSIONS: ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV. ER - TY - JOUR T1 - Utility of extracorporeal membrane oxygenation in COVID-19. A1 - Khan, Rizwan A1 - Anandamurthy, Balaram A1 - McCurry, Kenneth A1 - Krishnan, Sudhir Y1 - 2020/05// JF - Cleveland Clinic journal of medicine LA - eng DO - 10.3949/ccjm.87a.ccc014 N2 - Extracorporeal membrane oxygenation (ECMO) is a means of cardiopulmonary support for refractory respiratory and cardiac failure. ECMO is a resource-intensive therapy that can be considered in highly selected patients. Expert centers should employ an evidence-based ARDS treatment algorithm and a multidisciplinary approach to recommending ECMO upon failure of conventional therapy. Caring for ECMO patients requires adequate infection control and safety precautions for healthcare workers. ER - TY - JOUR T1 - C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. A1 - Huang, Ian A1 - Pranata, Raymond A1 - Lim, Michael Anthonius A1 - Oehadian, Amaylia A1 - Alisjahbana, Bachti Y1 - 2020/// KW - Biomarkers KW - C-Reactive Protein KW - Coronavirus Infections KW - Ferritins KW - Fibrin Fibrinogen Degradation Products KW - Humans KW - Pandemics KW - Pneumonia, Viral KW - Procalcitonin KW - Sensitivity and Specificity KW - Severity of Illness Index KW - analysis KW - blood KW - mortality KW - physiopathology JF - Therapeutic advances in respiratory disease VL - 14 LA - eng SP - 1753466620937175 EP - 1753466620937175 DO - 10.1177/1753466620937175 N2 - BACKGROUND: Patients critically ill with coronavirus disease-2019 (COVID-19) feature hyperinflammation, and the associated biomarkers may be beneficial for risk stratification. We aimed to investigate the association between several biomarkers, including serum C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and serum ferritin, and COVID-19 severity. METHODS: We performed a comprehensive systematic literature search through electronic databases. The outcome of interest for this study was the composite poor outcome, which comprises mortality, acute respiratory distress syndrome, need for care in an intensive care unit, and severe COVID-19. RESULTS: A total of 5350 patients were pooled from 25 studies. Elevated CRP was associated with an increased composite poor outcome [risk ratio (RR) 1.84 (1.45, 2.33), p < 0.001; I(2): 96%] and its severe COVID-19 (RR 1.41; I(2): 93%) subgroup. A CRP ⩾10 mg/L has a 51% sensitivity, 88% specificity, likelihood ratio (LR) + of 4.1, LR- of 0.5, and an area under curve (AUC) of 0.84. An elevated PCT was associated with an increased composite poor outcome [RR 3.92 (2.42, 6.35), p < 0.001; I(2): 85%] and its mortality (RR 6.26; I(2): 96%) and severe COVID-19 (RR 3.93; I(2): 63%) subgroups. A PCT ⩾0.5 ng/ml has an 88% sensitivity, 68% specificity, LR+ of 2.7, LR- of 0.2, and an AUC of 0.88. An elevated D-dimer was associated with an increased composite poor outcome [RR 2.93 (2.14, 4.01), p < 0.001; I(2): 77%], including its mortality (RR 4.15; I(2): 83%) and severe COVID-19 (RR 2.42; I(2): 58%) subgroups. A D-dimer >0.5 mg/L has a 58% sensitivity, 69% specificity, LR+ of 1.8, LR- of 0.6, and an AUC of 0.69. Patients with a composite poor outcome had a higher serum ferritin with a standardized mean difference of 0.90 (0.64, 1.15), p < 0.0001; I(2): 76%. CONCLUSION: This meta-analysis showed that an elevated serum CRP, PCT, D-dimer, and ferritin were associated with a poor outcome in COVID-19. The reviews of this paper are available via the supplemental material section. ER - TY - ICOMM T1 - Reporte de Situacion COVID-19 Colombia No. 109-26 de julio de 2020 A1 - Organización Panamericana de la Salud OPS A1 - Organización Mundial de la Salud OMS Y1 - 2020/// UR - https://www.paho.org/es/documentos/reporte-situacion-covid-19-colombia-no-109-26-julio-2020 ER - TY - JOUR T1 - Manejo del paciente crítico COVID-19 en UCI A1 - Bobes, Andrea Albajar Y1 - 2021/// ER - TY - GEN T1 - The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses A1 - Wells, George A A1 - Shea, Beverley A1 - O’Connell, Det al A1 - Peterson, Joan A1 - Welch, Vivian A1 - Losos, Michael A1 - Tugwell, Peter Y1 - 2000/// PB - Oxford ER - TY - JOUR T1 - IFN-α2a or IFN-β1a in combination with ribavirin to treat Middle East respiratory syndrome coronavirus pneumonia: a retrospective study. A1 - Shalhoub, Sarah A1 - Farahat, Fayssal A1 - Al-Jiffri, Abdullah A1 - Simhairi, Raed A1 - Shamma, Omar A1 - Siddiqi, Nauman A1 - Mushtaq, Adnan Y1 - 2015/07// JF - The Journal of antimicrobial chemotherapy VL - 70 LA - eng IS - 7 SP - 2129 EP - 2132 DO - 10.1093/jac/dkv085 N2 - OBJECTIVES: Middle East respiratory syndrome coronavirus (MERS-CoV) is associated with significant mortality. We examined the utility of plasma MERS-CoV PCR as a prognostic indicator and compared the efficacies of IFN-α2a and IFN-β1a when combined with ribavirin in reducing MERS-CoV-related mortality rates. METHODS: We retrospectively analysed 32 patients with confirmed MERS-CoV infection, admitted between April 2014 and June 2014, by positive respiratory sample RT-PCR. Plasma MERS-CoV RT-PCR was performed at the time of diagnosis for 19 patients. RESULTS: The overall mortality rate was 69% (22/32). Ninety percent (9/10) of patients with positive plasma MERS-CoV PCR died compared with 44% (4/9) of those with negative plasma MERS-CoV PCR. Mortality rate in patients who received IFN-α2a was 85% (11/13) compared with 64% (7/11) in those who received IFN-β1a (P = 0.24). The mortality rate in patients with renal failure (14), including 8 on haemodialysis, was 100%. Age >50 years and diabetes mellitus were found to be significantly associated with mortality (OR = 26.1; 95% CI 3.58-190.76; P = 0.001 and OR = 15.74; 95% CI 2.46-100.67; P = 0.004, respectively). The median duration of viral shedding in patients who recovered was 11 days (range 6-38 days). Absence of fever was noted in 5/32 patients. CONCLUSIONS: Plasma MERS-CoV RT-PCR may serve as an effective tool to predict MERS-CoV-associated mortality. Older age and comorbid conditions may have contributed to the lack of efficacy of IFN-α2a or IFN-β1a with ribavirin in treating MERS-CoV. Absence of fever should not exclude MERS-CoV. ER - TY - GEN T1 - ECMO for ARDS due to COVID-19. A1 - Ñamendys-Silva, Silvio A Y1 - 2020/// KW - Betacoronavirus KW - China KW - Coronavirus KW - Coronavirus Infections KW - Extracorporeal Membrane Oxygenation KW - Humans KW - Pandemics KW - Pneumonia, Viral KW - Respiratory Distress Syndrome, Adult JF - Heart & lung : the journal of critical care VL - 49 LA - eng IS - 4 SP - 348 EP - 349 DO - 10.1016/j.hrtlng.2020.03.012 ER - TY - CHAP T1 - Features, Evaluation, and Treatment of Coronavirus (COVID-19). A1 - Cascella, Marco A1 - Rajnik, Michael A1 - Cuomo, Arturo A1 - Dulebohn, Scott C A1 - Di Napoli, Raffaela Y1 - 2020/01// LA - eng N2 - According to the World Health Organization (WHO), viral diseases continue to emerge and represent a serious issue to public health. In the last twenty years, several viral epidemics such as the severe acute respiratory syndrome coronavirus (SARS-CoV) from 2002 to 2003, and H1N1 influenza in 2009, have been recorded. Most recently, the Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia in 2012. In a timeline that reaches the present day, an epidemic of cases with unexplained low respiratory infections detected in Wuhan, the largest metropolitan area in China's Hubei province, was first reported to the WHO Country Office in China, on December 31, 2019. Published literature can trace the beginning of symptomatic individuals back to the beginning of December 2019. As they were unable to identify the causative agent, these first cases (n=29) were classified as "pneumonia of unknown etiology." The Chinese Center for Disease Control and Prevention (CDC) and local CDCs organized an intensive outbreak investigation program. The etiology of this illness was attributed to a novel virus belonging to the coronavirus (CoV) family. On February 11, 2020, the WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, announced that the disease caused by this new CoV was a "COVID-19," which is the acronym of "coronavirus disease 2019". In the past twenty years, two additional CoVs epidemics have occurred. SARS-CoV provoked a large-scale epidemic beginning in China and involving two dozen countries with approximately 8000 cases and 800 deaths (fatality rate of 9,6%), and the MERS-CoV that began in Saudi Arabia and has approximately 2,500 cases and 800 deaths (fatality rate of 35%) and still causes as sporadic cases. This new virus is very contagious and has quickly spread globally. In a meeting on January 30, 2020, per the International Health Regulations (IHR, 2005), the outbreak was declared by the WHO a Public Health Emergency of International Concern (PHEIC) as it had spread to 18 countries with four countries reporting human-to-human transmission. An additional landmark occurred on February 26, 2020, as the first case of the disease, not imported from China, was recorded in the United States (US).  Initially, the new virus was called 2019-nCoV. Subsequently, the task of experts of the International Committee on Taxonomy of Viruses (ICTV) termed it the SARS-CoV-2 virus as it is very similar to the one that caused the SARS outbreak (SARS-CoVs).  The CoVs have become the major pathogens of emerging respiratory disease outbreaks. They are a large family of single-stranded RNA viruses (+ssRNA) that can be isolated in different animal species. For reasons yet to be explained, these viruses can cross species barriers and can cause, in humans, illness ranging from the common cold to more severe diseases such as MERS and SARS. Interestingly, these latter viruses have probably originated from bats and then moving into other mammalian hosts — the Himalayan palm civet for SARS-CoV, and the dromedary camel for MERS-CoV — before jumping to humans. The dynamics of SARS-Cov-2 are currently unknown, but there is speculation that it also has an animal origin. The potential for these viruses to grow to become a pandemic worldwide represents a serious public health risk. Concerning COVID-19, the WHO raised the threat to the CoV epidemic to the "very high" level, on February 28, 2020. On March 11, as the number of COVID-19 cases outside China has increased 13 times and the number of countries involved has tripled with more than 118,000 cases in 114 countries and over 4,000 deaths, WHO declared the COVID-19 a pandemic. World governments are at work to establish countermeasures to stem the devastating effects and it has been estimated that strict shutdowns may have saved 3 million lives across 11 European countries. Health organizations coordinate information flows and issues directives and guidelines to best mitigate the impact of the threat. At the same time, scientists around the world work tirelessly, and information about the transmission mechanisms, the clinical spectrum of disease, new diagnostics, and prevention and therapeutic strategies are rapidly developing. Many uncertainties remain with regard to both the virus-host interaction and the evolution of the pandemic, with specific reference to the times when it will reach its peak. At the moment, the therapeutic strategies to deal with the infection are only supportive, and prevention aimed at reducing transmission in the community is our best weapon. Aggressive isolation measures in China have led to a progressive reduction of cases. From China, the disease spread to Europe. In Italy, in geographic regions of the north, initially, and subsequently throughout the peninsula, political and health authorities have made incredible efforts to contain a shock wave that has severely tested the health system. Afterward, the COVID-19 quickly crossed the ocean and as of June 20, 2020, about 2,282,000 cases (with 121,000 deaths) have been recorded in the US, whereas Brazil with more than 1,000,000 cases and about 50,000 deaths is the most affected state in South America and the second in the world after the US. Although over time the lethality rate (total number of deaths for a given disease in relation to the total number of patients) of COVID-19 has been significantly lower than that of the SARS and MERS epidemics, the transmission of the SARS-CoV-2 virus is much larger than that of the previous viruses, with a much higher total number of deaths. It has been estimated that about one in five individuals worldwide could be at increased risk of severe COVID-19 disease if they become infected, due to underlying health conditions. In the midst of the crisis, the authors have chosen to use the "Statpearls" platform because, within the PubMed scenario, it represents a unique tool that may allow them to make updates in real-time. The aim, therefore, is to collect information and scientific evidence and to provide an overview of the topic that will be continuously updated. ER - TY - JOUR T1 - Performance of pneumonia severity index and CURB-65 in predicting 30-day mortality in patients with COVID-19. A1 - Satici, Celal A1 - Demirkol, Mustafa Asim A1 - Sargin Altunok, Elif A1 - Gursoy, Bengul A1 - Alkan, Mustafa A1 - Kamat, Sadettin A1 - Demirok, Berna A1 - Surmeli, Cemile Dilsah A1 - Calik, Mustafa A1 - Cavus, Zuhal A1 - Esatoglu, Sinem Nihal Y1 - 2020/09// KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Betacoronavirus KW - Child KW - Coronavirus Infections KW - Female KW - Humans KW - Male KW - Middle Aged KW - Pandemics KW - Pneumonia, Viral KW - Prognosis KW - ROC Curve KW - Retrospective Studies KW - Severity of Illness Index KW - Time Factors KW - Turkey KW - Young Adult KW - epidemiology KW - mortality JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases VL - 98 LA - eng SP - 84 EP - 89 DO - 10.1016/j.ijid.2020.06.038 N2 - OBJECTIVE: The aim of the study was to analyze the usefulness of CURB-65 and the pneumonia severity index (PSI) in predicting 30-day mortality in patients with COVID-19, and to identify other factors associated with higher mortality. METHODS: A retrospective study was performed in a pandemic hospital in Istanbul, Turkey, which included 681 laboratory-confirmed patients with COVID-19. Data on characteristics, vital signs, and laboratory parameters were recorded from electronic medical records. Receiver operating characteristic analysis was used to quantify the discriminatory abilities of the prognostic scales. Univariate and multivariate logistic regression analyses were performed to identify other predictors of mortality. RESULTS: Higher CRP levels were associated with an increased risk for mortality (OR: 1.015, 95% CI: 1.008-1.021; p < 0.001). The PSI performed significantly better than CURB-65 (AUC: 0.91, 95% CI: 0.88-0.93 vs AUC: 0.88, 95% CI: 0.85-0.90; p = 0.01), and the addition of CRP levels to PSI did not improve the performance of PSI in predicting mortality (AUC: 0.91, 95% CI: 0.88-0.93 vs AUC: 0.92, 95% CI: 0.89-0.94; p = 0.29). CONCLUSION: In a large group of hospitalized patients with COVID-19, we found that PSI performed better than CURB-65 in predicting mortality. Adding CRP levels to PSI did not improve the 30-day mortality prediction. ER - TY - JOUR T1 - Critically Ill Patients With the Middle East Respiratory Syndrome: A Multicenter Retrospective Cohort Study. A1 - Arabi, Yaseen M A1 - Al-Omari, Awad A1 - Mandourah, Yasser A1 - Al-Hameed, Fahad A1 - Sindi, Anees A A1 - Alraddadi, Basem A1 - Shalhoub, Sarah A1 - Almotairi, Abdullah A1 - Al Khatib, Kasim A1 - Abdulmomen, Ahmed A1 - Qushmaq, Ismael A1 - Mady, Ahmed A1 - Solaiman, Othman A1 - Al-Aithan, Abdulsalam M A1 - Al-Raddadi, Rajaa A1 - Ragab, Ahmed A1 - Al Mekhlafi, Ghaleb A A1 - Al Harthy, Abdulrahman A1 - Kharaba, Ayman A1 - Ahmadi, Mashael Al A1 - Sadat, Musharaf A1 - Mutairi, Hanan Al A1 - Qasim, Eman Al A1 - Jose, Jesna A1 - Nasim, Maliha A1 - Al-Dawood, Abdulaziz A1 - Merson, Laura A1 - Fowler, Robert A1 - Hayden, Frederick G A1 - Balkhy, Hanan H Y1 - 2017/10// JF - Critical care medicine VL - 45 LA - eng IS - 10 SP - 1683 EP - 1695 CY - United States DO - 10.1097/CCM.0000000000002621 N2 - OBJECTIVES: To describe patient characteristics, clinical manifestations, disease course including viral replication patterns, and outcomes of critically ill patients with severe acute respiratory infection from the Middle East respiratory syndrome and to compare these features with patients with severe acute respiratory infection due to other etiologies. DESIGN: Retrospective cohort study. SETTING: Patients admitted to ICUs in 14 Saudi Arabian hospitals. PATIENTS: Critically ill patients with laboratory-confirmed Middle East respiratory syndrome severe acute respiratory infection (n = 330) admitted between September 2012 and October 2015 were compared to consecutive critically ill patients with community-acquired severe acute respiratory infection of non-Middle East respiratory syndrome etiology (non-Middle East respiratory syndrome severe acute respiratory infection) (n = 222). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Although Middle East respiratory syndrome severe acute respiratory infection patients were younger than those with non-Middle East respiratory syndrome severe acute respiratory infection (median [quartile 1, quartile 3] 58 yr [44, 69] vs 70 [52, 78]; p < 0.001), clinical presentations and comorbidities overlapped substantially. Patients with Middle East respiratory syndrome severe acute respiratory infection had more severe hypoxemic respiratory failure (PaO2/FIO2: 106 [66, 160] vs 176 [104, 252]; p < 0.001) and more frequent nonrespiratory organ failure (nonrespiratory Sequential Organ Failure Assessment score: 6 [4, 9] vs 5 [3, 7]; p = 0.002), thus required more frequently invasive mechanical ventilation (85.2% vs 73.0%; p < 0.001), oxygen rescue therapies (extracorporeal membrane oxygenation 5.8% vs 0.9%; p = 0.003), vasopressor support (79.4% vs 55.0%; p < 0.001), and renal replacement therapy (48.8% vs 22.1%; p < 0.001). After adjustment for potential confounding factors, Middle East respiratory syndrome was independently associated with death compared to non-Middle East respiratory syndrome severe acute respiratory infection (adjusted odds ratio, 5.87; 95% CI, 4.02-8.56; p < 0.001). CONCLUSIONS: Substantial overlap exists in the clinical presentation and comorbidities among patients with Middle East respiratory syndrome severe acute respiratory infection from other etiologies; therefore, a high index of suspicion combined with diagnostic testing is essential component of severe acute respiratory infection investigation … ER - TY - JOUR T1 - Efficacy and safety of antiviral treatment for COVID-19 from evidence in studies of SARS-CoV-2 and other acute viral infections: a systematic review and meta-analysis. A1 - Liu, Wei A1 - Zhou, Pengxiang A1 - Chen, Ken A1 - Ye, Zhikang A1 - Liu, Fang A1 - Li, Xiaotong A1 - He, Na A1 - Wu, Ziyang A1 - Zhang, Qi A1 - Gong, Xuepeng A1 - Tang, Qiyu A1 - Du, Xin A1 - Ying, Yingqiu A1 - Xu, Xiaohan A1 - Zhang, Yahui A1 - Liu, Jinyu A1 - Li, Yun A1 - Shen, Ning A1 - Couban, Rachel J A1 - Ibrahim, Quazi I A1 - Guyatt, Gordon A1 - Zhai, Suodi Y1 - 2020/07// KW - Amides KW - Antiviral Agents KW - Betacoronavirus KW - Chloroquine KW - Coronavirus Infections KW - Evidence-Based Medicine KW - Humans KW - Hydroxychloroquine KW - Indoles KW - Influenza, Human KW - Lopinavir KW - Observational Studies as Topic KW - Pandemics KW - Pneumonia, Viral KW - Pyrazines KW - Ribavirin KW - Ritonavir KW - drug effects KW - drug therapy KW - pharmacology JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne VL - 192 LA - eng IS - 27 SP - E734 EP - E744 DO - 10.1503/cmaj.200647 N2 - BACKGROUND: Antiviral medications are being given empirically to some patients with coronavirus disease 2019 (COVID-19). To support the development of a COVID-19 management guideline, we conducted a systematic review that addressed the benefits and harms of 7 antiviral treatments for COVID-19. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed and 3 Chinese databases (CNKI, WANFANG and SinoMed) through Apr. 19, medRxiv and Chinaxiv through Apr. 27, and Chongqing VIP through Apr. 30, 2020. We included studies of ribavirin, chloroquine, hydroxychloroquine, umifenovir (arbidol), favipravir, interferon and lopinavir/ritonavir. If direct evidence from COVID-19 studies was not available, we included indirect evidence from studies of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) for efficacy outcomes and other acute respiratory viral infections for safety outcomes. RESULTS: In patients with nonsevere COVID-19 illness, the death rate was extremely low, precluding an important effect on mortality. We found only very low-quality evidence with little or no suggestion of benefit for most treatments and outcomes in both nonsevere and severe COVID-19. An exception was treatment with lopinavir/ritonavir, for which we found low-quality evidence for a decrease in length of stay in the intensive care unit (risk difference 5 d shorter, 95% confidence interval [CI] 0 to 9 d) and hospital stay (risk difference 1 d shorter, 95% CI 0 to 2 d). For safety outcomes, evidence was of low or very low quality, with the exception of treatment with lopinavir/ritonavir for which moderate-quality evidence suggested likely increases in diarrhea, nausea and vomiting. INTERPRETATION: To date, persuasive evidence of important benefit in COVID-19 does not exist for any antiviral treatments, although for each treatment evidence has not excluded important benefit. Additional randomized controlled trials involving patients with COVID-19 will be needed before such treatments can be administered with confidence. ER - TY - ICOMM T1 - Coronavirus fisiopatología Covid-19. Parte 1 A1 - Veller, Rodrigo Niccolas A1 - Veller, Juan Diego Y1 - 2020/// UR - https://www.drvellermed.com/coronavirus-fisiopatologia-covid-19-parte-1/ ER - TY - JOUR T1 - Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 in Shanghai, China. A1 - Li, Xin A1 - Guo, Zhen A1 - Li, Bailing A1 - Zhang, Xiaolin A1 - Tian, Rui A1 - Wu, Wei A1 - Zhang, Zhongwei A1 - Lu, Yunfei A1 - Chen, Nan A1 - Clifford, Sean P A1 - Huang, Jiapeng Y1 - 2020/05// KW - Adult KW - Aged KW - Aged, 80 and over KW - Betacoronavirus KW - China KW - Coronavirus Infections KW - Extracorporeal Membrane Oxygenation KW - Female KW - Humans KW - Male KW - Middle Aged KW - Pandemics KW - Pneumonia, Viral KW - Respiration, Artificial KW - Retrospective Studies KW - Treatment Outcome KW - therapy JF - ASAIO journal (American Society for Artificial Internal Organs : 1992) VL - 66 LA - eng IS - 5 SP - 475 EP - 481 DO - 10.1097/MAT.0000000000001172 N2 - Severe cases of coronavirus disease 2019 (COVID-19) cannot be adequately managed with mechanical ventilation alone. The role and outcome of extracorporeal membrane oxygenation (ECMO) in the management of COVID-19 is currently unclear. Eight COVID-19 patients have received ECMO support in Shanghai with seven with venovenous (VV) ECMO support and one veno arterial (VA) ECMO during cardiopulmonary resuscitation. As of March 25, 2020, four patients died (50% mortality), three patients (37.5%) were successfully weaned off ECMO after 22, 40, and 47 days support, respectively, but remain on mechanical ventilation. One patient is still on VV ECMO with mechanical ventilation. The partial pressure of oxygen/fractional of inspired oxygen ratio before ECMO initiation was between 54 and 76, and all were well below 100. The duration of mechanical ventilation before ECMO ranged from 4 to 21 days. Except the one emergent VA ECMO during cardiopulmonary resuscitation, other patients were on ECMO support for between 18 and 47 days. In conclusion, ensuring effective, timely, and safe ECMO support in COVID-19 is key to improving clinical outcomes. Extracorporeal membrane oxygenation support might be an integral part of the critical care provided for COVID-19 patients in centers with advanced ECMO expertise. ER - TY - JOUR T1 - Extracorporeal membrane oxygenation for critically ill patients with coronavirus-associated disease 2019: an updated perspective of the European experience. A1 - Marullo, Antonino G A1 - Cavarretta, Elena A1 - Biondi-Zoccai, Giuseppe A1 - Mancone, Massimo A1 - Peruzzi, Mariangela A1 - Piscioneri, Fernando A1 - Sartini, Patrizio A1 - Versaci, Francesco A1 - Morelli, Andrea A1 - Miraldi, Fabio A1 - Frati, Giacomo Y1 - 2020/04// JF - Minerva cardioangiologica LA - eng DO - 10.23736/S0026-4725.20.05328-1 N2 - BACKGROUND: Infection due to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), i.e. Coronavirus-associated disease 2019 (COVID-2019), may occasionally lead to acute respiratory distress syndrome (ARDS), requiring in the most severe cases extracorporeal membrane oxygenation (ECMO). Yet, limited data, if any, are currently available on the role of ECMO in critically ill patients with COVID-19. We aimed at providing a snapshot analysis of ECMO for COVID-19 in Europe. METHODS: Freely available data on ECMO in COVID-19 patients reported by the European Extracorporeal Life Support Organization (EuroELSO) were extracted and analyzed after conversion into long format. The primary outcome was the incidence of death during ECMO. Bootstrapping and logistic regression was used for inferential estimates. RESULTS: Details from a total of 333 patients treated in 90 institutions spanning 17 countries were obtained, with 22% women and mean age of 52 years. Death rate was 17.1% (95% confidence interval: 13.1% to 21.1%), even if significant between-center differences were found, with some institutions reporting 100% case fatality. Exploratory inferential analysis showed no nominally statistically significant association between death and gender (p=0.788), but a significant association was found with age, mainly due to increased case fatality in subjects >60 years (odds ratio: 4.80 [95% confidence interval 1.64 to 14.04], p=0.004). CONCLUSIONS: ECMO may play an important role in critically ill patients with COVID-19 refractory to less invasive treatments. The increased risk of early death in older patients may be used to prioritize ECMO indication in resource-conscious settings, if confirmed externally. ER - TY - JOUR T1 - COVID-19 and ECMO: the interplay between coagulation and inflammation-a narrative review. A1 - Kowalewski, Mariusz A1 - Fina, Dario A1 - Słomka, Artur A1 - Raffa, Giuseppe Maria A1 - Martucci, Gennaro A1 - Lo Coco, Valeria A1 - De Piero, Maria Elena A1 - Ranucci, Marco A1 - Suwalski, Piotr A1 - Lorusso, Roberto Y1 - 2020/05// KW - Betacoronavirus KW - Blood Coagulation KW - Coronavirus Infections KW - Cytokine Release Syndrome KW - Extracorporeal Membrane Oxygenation KW - Pandemics KW - Pneumonia, Viral KW - Severe Acute Respiratory Syndrome KW - Thrombocytopenia KW - blood KW - physiopathology KW - therapy JF - Critical care (London, England) VL - 24 LA - eng IS - 1 SP - 205 EP - 205 DO - 10.1186/s13054-020-02925-3 N2 - Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has presently become a rapidly spreading and devastating global pandemic. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) may serve as life-saving rescue therapy for refractory respiratory failure in the setting of acute respiratory compromise such as that induced by SARS-CoV-2. While still little is known on the true efficacy of ECMO in this setting, the natural resemblance of seasonal influenza's characteristics with respect to acute onset, initial symptoms, and some complications prompt to ECMO implantation in most severe, pulmonary decompensated patients. The present review summarizes the evidence on ECMO management of severe ARDS in light of recent COVID-19 pandemic, at the same time focusing on differences and similarities between SARS-CoV-2 and ECMO in terms of hematological and inflammatory interplay when these two settings merge. ER - TY - JOUR T1 - Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. A1 - Peek, Giles J A1 - Mugford, Miranda A1 - Tiruvoipati, Ravindranath A1 - Wilson, Andrew A1 - Allen, Elizabeth A1 - Thalanany, Mariamma M A1 - Hibbert, Clare L A1 - Truesdale, Ann A1 - Clemens, Felicity A1 - Cooper, Nicola A1 - Firmin, Richard K A1 - Elbourne, Diana Y1 - 2009/10// KW - Adolescent KW - Adult KW - Aged KW - Cost-Benefit Analysis KW - Extracorporeal Membrane Oxygenation KW - Female KW - Humans KW - Male KW - Middle Aged KW - Respiration, Artificial KW - Respiratory Insufficiency KW - Treatment Outcome KW - Young Adult KW - economics KW - therapy JF - Lancet (London, England) VL - 374 LA - eng IS - 9698 SP - 1351 EP - 1363 DO - 10.1016/S0140-6736(09)61069-2 N2 - BACKGROUND: Severe acute respiratory failure in adults causes high mortality despite improvements in ventilation techniques and other treatments (eg, steroids, prone positioning, bronchoscopy, and inhaled nitric oxide). We aimed to delineate the safety, clinical efficacy, and cost-effectiveness of extracorporeal membrane oxygenation (ECMO) compared with conventional ventilation support. METHODS: In this UK-based multicentre trial, we used an independent central randomisation service to randomly assign 180 adults in a 1:1 ratio to receive continued conventional management or referral to consideration for treatment by ECMO. Eligible patients were aged 18-65 years and had severe (Murray score >3.0 or pH <7.20) but potentially reversible respiratory failure. Exclusion criteria were: high pressure (>30 cm H(2)O of peak inspiratory pressure) or high FiO(2) (>0.8) ventilation for more than 7 days; intracranial bleeding; any other contraindication to limited heparinisation; or any contraindication to continuation of active treatment. The primary outcome was death or severe disability at 6 months after randomisation or before discharge from hospital. Primary analysis was by intention to treat. Only researchers who did the 6-month follow-up were masked to treatment assignment. Data about resource use and economic outcomes (quality-adjusted life-years) were collected. Studies of the key cost generating events were undertaken, and we did analyses of cost-utility at 6 months after randomisation and modelled lifetime cost-utility. This study is registered, number ISRCTN47279827. FINDINGS: 766 patients were screened; 180 were enrolled and randomly allocated to consideration for treatment by ECMO (n=90 patients) or to receive conventional management (n=90). 68 (75%) patients actually received ECMO; 63% (57/90) of patients allocated to consideration for treatment by ECMO survived to 6 months without disability compared with 47% (41/87) of those allocated to conventional management (relative risk 0.69; 95% CI 0.05-0.97, p=0.03). Referral to consideration for treatment by ECMO led to a gain of 0.03 quality-adjusted life-years (QALYs) at 6-month follow-up [corrected]. A lifetime model predicted the cost per QALY of ECMO to be pound19 252 (95% CI 7622-59 200) at a discount rate of 3.5%. INTERPRETATION: We recommend transferring of adult patients with severe but potentially reversible respiratory failure, whose Murray score exceeds 3.0 or who have a pH of less than 7.20 on optimum conventional management, to a centre with an ECMO-based management protocol to significantly improve survival without severe disability. This strategy is also likely to be cost effective in settings with similar services to those in the UK. FUNDING: UK NHS Health Technology Assessment, English National Specialist Commissioning Advisory Group, Scottish Department of Health, and Welsh Department of Health. ER - TY - JOUR T1 - Clinical Pearls in Venovenous Extracorporeal Life Support for Adult Respiratory Failure. A1 - Tay, Chee Kiang A1 - Sung, Kiick A1 - Cho, Yang Hyun Y1 - 2018/// KW - Adult KW - Extracorporeal Membrane Oxygenation KW - Humans KW - Respiratory Insufficiency KW - methods KW - therapy JF - ASAIO journal (American Society for Artificial Internal Organs : 1992) VL - 64 LA - eng IS - 1 SP - 1 EP - 9 DO - 10.1097/MAT.0000000000000657 N2 - Extracorporeal life support (ECLS) has been widely utilized to treat neonatal respiratory failure for two decades. However, its uptake in the case of adult respiratory failure has been slow because of a paucity of quality evidence and a sluggish tempo of ECLS-related technological advances. In recent years, interest in ECLS has been piqued after encouraging results were reported from its use during the 2009 H1N1 influenza pandemic. In a world constantly under threat from another influenza epidemic or deadly novel respiratory infection, e.g., the severe acute respiratory syndrome (SARS) virus, the Middle East respiratory syndrome coronavirus (MERS-CoV), the role of venovenous (VV) ECLS as a treatment modality for acute respiratory distress syndrome (ARDS) cannot be overemphasized. In hopes of standardizing practice, the Extracorporeal Life Support Organization (ELSO) has published books and guidelines on ECLS. However, high-level evidence to guide clinical decisions is still expediently needed in this field. Relying on the available literature and our experience in the recent South Korean MERS-CoV outbreak, we hope to highlight key physiologic and clinical points in VV ECLS for adult respiratory failure in this review. ER - TY - BOOK T1 - Hensley's practical approach to cardiothoracic anesthesia A1 - Gravlee, Glenn P Y1 - 2018/// PB - Lippincott Williams & Wilkins SP - 968 EP - 969 SN - 1496372689 ER - TY - JOUR T1 - Consenso ECMO colombiano para paciente con falla respiratoria grave asocia da a COVID-19 A1 - Salazar, Leonardo Alberto A1 - Uribe, Juan David A1 - Henao, Claudia Marcela Poveda A1 - Santacruz, Carlos Miguel A1 - Bejarano, Estefanía Giraldo A1 - Bautista, Diego Fernando A1 - Rey, José Alejandro A1 - Giraldo-Ramírez, Nelson Y1 - 2020/// PB - Elsevier JF - Acta Colombiana de Cuidado Intensivo ER - TY - JOUR T1 - ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. A1 - Sterne, Jonathan Ac A1 - Hernán, Miguel A A1 - Reeves, Barnaby C A1 - Savović, Jelena A1 - Berkman, Nancy D A1 - Viswanathan, Meera A1 - Henry, David A1 - Altman, Douglas G A1 - Ansari, Mohammed T A1 - Boutron, Isabelle A1 - Carpenter, James R A1 - Chan, An-Wen A1 - Churchill, Rachel A1 - Deeks, Jonathan J A1 - Hróbjartsson, Asbjørn A1 - Kirkham, Jamie A1 - Jüni, Peter A1 - Loke, Yoon K A1 - Pigott, Theresa D A1 - Ramsay, Craig R A1 - Regidor, Deborah A1 - Rothstein, Hannah R A1 - Sandhu, Lakhbir A1 - Santaguida, Pasqualina L A1 - Schünemann, Holger J A1 - Shea, Beverly A1 - Shrier, Ian A1 - Tugwell, Peter A1 - Turner, Lucy A1 - Valentine, Jeffrey C A1 - Waddington, Hugh A1 - Waters, Elizabeth A1 - Wells, George A A1 - Whiting, Penny F A1 - Higgins, Julian Pt Y1 - 2016/10// JF - BMJ (Clinical research ed.) VL - 355 LA - eng SP - i4919 EP - i4919 DO - 10.1136/bmj.i4919 N2 - Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (individuals or clusters of individuals) to comparison groups. The tool will be particularly useful to those undertaking systematic reviews that include non-randomised studies. ER - TY - JOUR T1 - Origin and evolution of pathogenic coronaviruses. A1 - Cui, Jie A1 - Li, Fang A1 - Shi, Zheng-Li Y1 - 2019/03// KW - Alphacoronavirus KW - Animals KW - Chiroptera KW - Coronavirus KW - Coronavirus Infections KW - Evolution, Molecular KW - Genetic Variation KW - Genome, Viral KW - Humans KW - Middle East Respiratory Syndrome Coronavirus KW - Phylogeny KW - SARS Virus KW - Severe Acute Respiratory Syndrome KW - Swine KW - genetics KW - pathogenicity KW - virology JF - Nature reviews. Microbiology VL - 17 LA - eng IS - 3 SP - 181 EP - 192 DO - 10.1038/s41579-018-0118-9 N2 - Severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) are two highly transmissible and pathogenic viruses that emerged in humans at the beginning of the 21st century. Both viruses likely originated in bats, and genetically diverse coronaviruses that are related to SARS-CoV and MERS-CoV were discovered in bats worldwide. In this Review, we summarize the current knowledge on the origin and evolution of these two pathogenic coronaviruses and discuss their receptor usage; we also highlight the diversity and potential of spillover of bat-borne coronaviruses, as evidenced by the recent spillover of swine acute diarrhoea syndrome coronavirus (SADS-CoV) to pigs. ER - TY - BOOK T1 - Cochrane handbook for systematic reviews of interventions A1 - Higgins, Julian P T A1 - Thomas, James A1 - Chandler, Jacqueline A1 - Cumpston, Miranda A1 - Li, Tianjing A1 - Page, Matthew J A1 - Welch, Vivian A Y1 - 2019/// PB - John Wiley & Sons SN - 1119536618 ER - TY - JOUR T1 - Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. A1 - Mandell, Lionel A A1 - Wunderink, Richard G A1 - Anzueto, Antonio A1 - Bartlett, John G A1 - Campbell, G Douglas A1 - Dean, Nathan C A1 - Dowell, Scott F A1 - File, Thomas M Jr A1 - Musher, Daniel M A1 - Niederman, Michael S A1 - Torres, Antonio A1 - Whitney, Cynthia G Y1 - 2007/03// KW - Anti-Bacterial Agents KW - Community-Acquired Infections KW - Diagnosis, Differential KW - Health Workforce KW - Humans KW - Pneumonia, Bacterial KW - Societies, Medical KW - Streptococcus pneumoniae KW - United States KW - Vaccination KW - diagnosis KW - drug therapy KW - isolation & purification KW - prevention & control KW - therapeutic use JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America VL - 44 Suppl 2 LA - eng IS - Suppl 2 SP - S27 EP - 72 DO - 10.1086/511159 ER - TY - JOUR T1 - ACE2: from vasopeptidase to SARS virus receptor. A1 - Turner, Anthony J A1 - Hiscox, Julian A A1 - Hooper, Nigel M Y1 - 2004/06// KW - Animals KW - Blood Vessels KW - Humans KW - Isoenzymes KW - Peptide Hormones KW - Peptide Hydrolases KW - Peptidyl-Dipeptidase A KW - Receptors, Virus KW - SARS Virus KW - genetics KW - metabolism KW - physiology JF - Trends in pharmacological sciences VL - 25 LA - eng IS - 6 SP - 291 EP - 294 DO - 10.1016/j.tips.2004.04.001 N2 - The zinc metallopeptidase angiotensin-converting enzyme 2 (ACE2) is the only known human homologue of the key regulator of blood pressure angiotensin-converting enzyme (ACE). Since its discovery in 2000, ACE2 has been implicated in heart function, hypertension and diabetes, with its effects being mediated, in part, through its ability to convert angiotensin II to angiotensin-(1-7). Unexpectedly, ACE2 also serves as the cellular entry point for the severe acute respiratory syndrome (SARS) virus and the enzyme is therefore a prime target for pharmacological intervention on several disease fronts. ER - TY - ICOMM T1 - Enfermedad por el Coronavirus ‎‎(COVID-19)‎ A1 - Organización Panamericana de la Salud OPS A1 - Organización Mundial de la Salud OMS Y1 - 2020/// UR - https://www.paho.org/es/tag/enfermedad-por-coronavirus-covid-19 ER - TY - JOUR T1 - Initial ELSO Guidance Document: ECMO for COVID-19 Patients with Severe Cardiopulmonary Failure. A1 - Bartlett, Robert H A1 - Ogino, Mark T A1 - Brodie, Daniel A1 - McMullan, David M A1 - Lorusso, Roberto A1 - MacLaren, Graeme A1 - Stead, Christine M A1 - Rycus, Peter A1 - Fraser, John F A1 - Belohlavek, Jan A1 - Salazar, Leonardo A1 - Mehta, Yatin A1 - Raman, Lakshmi A1 - Paden, Matthew L Y1 - 2020/05// JF - ASAIO journal (American Society for Artificial Internal Organs : 1992) VL - 66 LA - eng IS - 5 SP - 472 EP - 474 DO - 10.1097/MAT.0000000000001173 N2 - Disclaimer: ECMO has, and will certainly continue, to play a role in the management of COVID-19 patients. It should be emphasized that this initial guidance is based on the current best evidence for ECMO use during this pandemic. Guidance documents addressing additional portions of ECMO care are currently being assembled for rapid publication and distribution to ECMO centers worldwide. ER - TY - JOUR T1 - Ribavirin and interferon alfa-2a for severe Middle East respiratory syndrome coronavirus infection: a retrospective cohort study. A1 - Omrani, Ali S A1 - Saad, Mustafa M A1 - Baig, Kamran A1 - Bahloul, Abdelkarim A1 - Abdul-Matin, Mohammed A1 - Alaidaroos, Amal Y A1 - Almakhlafi, Ghaleb A A1 - Albarrak, Mohammed M A1 - Memish, Ziad A A1 - Albarrak, Ali M Y1 - 2014/11// JF - The Lancet. Infectious diseases VL - 14 LA - eng IS - 11 SP - 1090 EP - 1095 DO - 10.1016/S1473-3099(14)70920-X N2 - BACKGROUND: Middle East respiratory syndrome coronavirus (MERS-CoV) infection is associated with high mortality and has no approved antiviral therapy. We aimed to compare ribavirin and interferon alfa-2a treatment for patients with severe MERS-CoV infection with a supportive therapy only. METHODS: In this retrospective cohort study, we included adults (aged ≥16 years) with laboratory-confirmed MERS-CoV infection and pneumonia needing ventilation support, diagnosed between Oct 23, 2012, and May 1, 2014, at the Prince Sultan Military Medical City (Riyadh, Saudi Arabia). All patients received appropriate supportive care and regular clinical and laboratory monitoring, but patients diagnosed after Sept 16, 2013, were also given oral ribavirin (dose based on calculated creatinine clearance, for 8-10 days) and subcutaneous pegylated interferon alfa-2a (180 μg per week for 2 weeks). The primary endpoint was 14-day and 28-day survival from the date of MERS-CoV infection diagnosis. We used χ(2) and Fischer's exact test to analyse categorical variables and the t test to analyse continuous variables. FINDINGS: We analysed 20 patients who received ribavirin and interferon (treatment group; initiated a median of 3 days [range 0-8] after diagnosis) and 24 who did not (comparator group). Baseline clinical and laboratory characteristics were similar between groups, apart from baseline absolute neutrophil count, which was significantly lower in the comparator group (5·88 × 10(9)/L [SD 3·95] vs 9·88 × 10(9)/L [6·63]; p=0·023). 14 (70%) of 20 patients in the treatment group had survived after 14 days, compared with seven (29%) of 24 in the comparator group (p=0·004). After 28 days, six (30%) of 20 and four (17%) of 24, respectively, had survived (p=0·54). Adverse effects were similar between groups, apart from reduction in haemoglobin, which was significantly greater in the treatment group than in the comparator group (4·32 g/L [SD 2·47] vs 2·14 g/L [1·90]; p=0·002). INTERPRETATION: In patients with severe MERS-CoV infection, ribavirin and interferon alfa-2a therapy is associated with significantly improved survival at 14 days, but not at 28 days. Further assessment in appropriately designed randomised trials is recommended. FUNDING: None. ER - TY - JOUR T1 - Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. A1 - Pham, Tài A1 - Combes, Alain A1 - Rozé, Hadrien A1 - Chevret, Sylvie A1 - Mercat, Alain A1 - Roch, Antoine A1 - Mourvillier, Bruno A1 - Ara-Somohano, Claire A1 - Bastien, Olivier A1 - Zogheib, Elie A1 - Clavel, Marc A1 - Constan, Adrien A1 - Marie Richard, Jean-Christophe A1 - Brun-Buisson, Christian A1 - Brochard, Laurent Y1 - 2013/02// JF - American journal of respiratory and critical care medicine VL - 187 LA - eng IS - 3 SP - 276 EP - 285 CY - United States DO - 10.1164/rccm.201205-0815OC N2 - RATIONALE: Many patients with severe acute respiratory distress syndrome (ARDS) caused by influenza A(H1N1) infection receive extracorporeal membrane oxygenation (ECMO) as a rescue therapy. OBJECTIVES: To analyze factors associated with death in ECMO-treated patients and the influence of ECMO on intensive care unit (ICU) mortality. METHODS: Data from patients admitted for H1N1-associated ARDS to French ICUs were prospectively collected from 2009 to 2011 through the national REVA registry. We analyzed factors associated with in-ICU death in ECMO recipients, and the potential benefit of ECMO using a propensity score-matched (1:1) cohort analysis. MEASUREMENTS AND MAIN RESULTS: A total of 123 patients received ECMO. By multivariate analysis, increasing values of age, lactate, and plateau pressure under ECMO were associated with death. Of 103 patients receiving ECMO during the first week of mechanical ventilation, 52 could be matched to non-ECMO patients of comparable severity, using a one-to-one matching and using control subjects only once. Mortality did not differ between the two matched cohorts (odds ratio, 1.48; 95% confidence interval, 0.68-3.23; P = 0.32). Interestingly, the 51 ECMO patients who could not be matched were younger, had lower Pa(o(2))/Fi(o(2)) ratio, had higher plateau pressure, but also had a lower ICU mortality rate than the 52 matched ECMO patients (22% vs. 50%; P < 0.01). CONCLUSIONS: Under ECMO, an ultraprotective ventilation strategy minimizing plateau pressure may be required to improve outcome. When patients with severe influenza A(H1N1)-related ARDS treated with ECMO were compared with conventionally treated patients, no difference in mortality rates existed. The unmatched, severely hypoxemic, and younger ECMO-treated patients had, however, a lower mortality. ER - TY - JOUR T1 - Pharmacologic Treatments and Supportive Care for Middle East Respiratory Syndrome. A1 - Kain, Taylor A1 - Lindsay, Patrick J A1 - Adhikari, Neill K J A1 - Arabi, Yaseen M A1 - Van Kerkhove, Maria D A1 - Fowler, Robert A Y1 - 2020/06// JF - Emerging infectious diseases VL - 26 LA - eng IS - 6 SP - 1102 EP - 1112 DO - 10.3201/eid2606.200037 N2 - Available animal and cell line models have suggested that specific therapeutics might be effective in treating Middle East respiratory syndrome (MERS). We conducted a systematic review of evidence for treatment with pharmacologic and supportive therapies. We developed a protocol and searched 5 databases for studies describing treatment of MERS and deaths in MERS patients. Risk of bias (RoB) was assessed by using ROBINS-I tool. We retrieved 3,660 unique citations; 20 observational studies met eligibility, and we studied 13 therapies. Most studies were at serious or critical RoB; no studies were at low RoB. One study, at moderate RoB, showed reduced mortality rates in severe MERS patients with extracorporeal membrane oxygenation; no other studies showed a significant lifesaving benefit to any treatment. The existing literature on treatments for MERS is observational and at moderate to critical RoB. Clinical trials are needed to guide treatment decisions. ER - TY - JOUR T1 - Risk factors and interventions associated with mortality or survival in adult COVID-19 patients admitted to critical care: a systematic review and meta-analysis A1 - Taylor, E H A1 - Hofmeyr, Ross A1 - Torborg, Alexandra A1 - Tonder, Charme A1 - Boden, Regan A1 - Earle, E A1 - Nejthardt, Marcin A1 - Kabambi, Freddy A1 - Isaacs, M A1 - Usenbo, A A1 - Gerber, Carmen A1 - van der Spuy, Karen A1 - Mrara, Busisiwe A1 - Ndhlovu, T A1 - Chen, Aaron A1 - Swanevelder, Justiaan A1 - Coetzee, Johan A1 - Biccard, Bruce Y1 - 2020/06// JF - Southern African Journal of Anaesthesia and Analgesia VL - 26 DO - 10.36303/SAJAA.2020.26.3.2428 ER - TY - JOUR T1 - Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version). A1 - Jin, Ying-Hui A1 - Zhan, Qing-Yuan A1 - Peng, Zhi-Yong A1 - Ren, Xue-Qun A1 - Yin, Xun-Tao A1 - Cai, Lin A1 - Yuan, Yu-Feng A1 - Yue, Ji-Rong A1 - Zhang, Xiao-Chun A1 - Yang, Qi-Wen A1 - Ji, Jianguang A1 - Xia, Jian A1 - Li, Yi-Rong A1 - Zhou, Fu-Xiang A1 - Gao, Ya-Dong A1 - Yu, Zhui A1 - Xu, Feng A1 - Tu, Ming-Li A1 - Tan, Li-Ming A1 - Yang, Min A1 - Chen, Fang A1 - Zhang, Xiao-Ju A1 - Zeng, Mei A1 - Zhu, Yu A1 - Liu, Xin-Can A1 - Yang, Jian A1 - Zhao, Dong-Chi A1 - Ding, Yu-Feng A1 - Hou, Ning A1 - Wang, Fu-Bing A1 - Chen, Hao A1 - Zhang, Yong-Gang A1 - Li, Wei A1 - Chen, Wen A1 - Shi, Yue-Xian A1 - Yang, Xiu-Zhi A1 - Wang, Xue-Jun A1 - Zhong, Yan-Jun A1 - Zhao, Ming-Juan A1 - Li, Bing-Hui A1 - Ma, Lin-Lu A1 - Zi, Hao A1 - Wang, Na A1 - Wang, Yun-Yun A1 - Yu, Shao-Fu A1 - Li, Lu-Yao A1 - Huang, Qiao A1 - Weng, Hong A1 - Ren, Xiang-Ying A1 - Luo, Li-Sha A1 - Fan, Man-Ru A1 - Huang, Di A1 - Xue, Hong-Yang A1 - Yu, Lin-Xin A1 - Gao, Jin-Ping A1 - Deng, Tong A1 - Zeng, Xian-Tao A1 - Li, Hong-Jun A1 - Cheng, Zhen-Shun A1 - Yao, Xiaomei A1 - Wang, Xing-Huan Y1 - 2020/09// JF - Military Medical Research VL - 7 LA - eng IS - 1 SP - 41 EP - 41 DO - 10.1186/s40779-020-00270-8 N2 - The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued "A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)"; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM) agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID-19 patients. ER - TY - JOUR T1 - Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. A1 - Barbaro, Ryan P A1 - Odetola, Folafoluwa O A1 - Kidwell, Kelley M A1 - Paden, Matthew L A1 - Bartlett, Robert H A1 - Davis, Matthew M A1 - Annich, Gail M Y1 - 2015/04// JF - American journal of respiratory and critical care medicine VL - 191 LA - eng IS - 8 SP - 894 EP - 901 DO - 10.1164/rccm.201409-1634OC N2 - RATIONALE: Recent pediatric studies suggest a survival benefit exists for higher-volume extracorporeal membrane oxygenation (ECMO) centers. OBJECTIVES: To determine if higher annual ECMO patient volume is associated with lower case-mix-adjusted hospital mortality rate. METHODS: We retrospectively analyzed an international registry of ECMO support from 1989 to 2013. Patients were separated into three age groups: neonatal (0-28 d), pediatric (29 d to <18 yr), and adult (≥18 yr). The measure of hospital ECMO volume was age group-specific and adjusted for patient-level case-mix and hospital-level variance using multivariable hierarchical logistic regression modeling. The primary outcome was death before hospital discharge. A subgroup analysis was conducted for 2008-2013. MEASUREMENTS AND MAIN RESULTS: From 1989 to 2013, a total of 290 centers provided ECMO support to 56,222 patients (30,909 neonates, 14,725 children, and 10,588 adults). Annual ECMO mortality rates varied widely across ECMO centers: the interquartile range was 18-50% for neonates, 25-66% for pediatrics, and 33-92% for adults. For 1989-2013, higher age group-specific ECMO volume was associated with lower odds of ECMO mortality for neonates and adults but not for pediatric cases. In 2008-2013, the volume-outcome association remained statistically significant only among adults. Patients receiving ECMO at hospitals with more than 30 adult annual ECMO cases had significantly lower odds of mortality (adjusted odds ratio, 0.61; 95% confidence interval, 0.46-0.80) compared with adults receiving ECMO at hospitals with less than six annual cases. CONCLUSIONS: In this international, case-mix-adjusted analysis, higher annual hospital ECMO volume was associated with lower mortality in 1989-2013 for neonates and adults; the association among adults persisted in 2008-2013. ER - TY - COMP T1 - GRADEpro GDT: GRADEpro Guideline Development Tool [Software] A1 - McMaster University Y1 - 2015/// PB - Evidence Prime, Inc. ER - TY - JOUR T1 - Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome and Posterior Probability of Mortality Benefit in a Post Hoc Bayesian Analysis of a Randomized Clinical Trial. A1 - Goligher, Ewan C A1 - Tomlinson, George A1 - Hajage, David A1 - Wijeysundera, Duminda N A1 - Fan, Eddy A1 - Jüni, Peter A1 - Brodie, Daniel A1 - Slutsky, Arthur S A1 - Combes, Alain Y1 - 2018/12// JF - JAMA VL - 320 LA - eng IS - 21 SP - 2251 EP - 2259 CY - United States DO - 10.1001/jama.2018.14276 N2 - IMPORTANCE: Bayesian analysis of clinical trial data may provide useful information to aid in study interpretation, especially when trial evidence suggests that the benefits of an intervention are uncertain, such as in a trial that evaluated early extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS). OBJECTIVE: To demonstrate the potential utility of Bayesian analyses by estimating the posterior probability, under various assumptions, that early ECMO was associated with reduced mortality in patients with very severe ARDS in a randomized clinical trial (RCT). DESIGN AND EVIDENCE: A post hoc Bayesian analysis of data from an RCT (ECMO to Rescue Lung Injury in Severe ARDS [EOLIA]) that included 249 patients with very severe ARDS who had been randomized to receive early ECMO (n = 124; mortality at 60 days, 35%) vs initial conventional lung-protective ventilation with the option for rescue ECMO (n = 125, mortality at 60 days, 46%). The trial was designed to detect an absolute risk reduction (ARR) of 20%, relative risk (RR) of 0.67. Statistical prior distributions were specified to represent varying levels of preexisting enthusiasm or skepticism for ECMO and by Bayesian meta-analysis of previously published studies (with downweighting to account for differences and quality between studies). The RR, credible interval (CrI), ARR, and probability of clinically important mortality benefit (varying from RR less than 1 to RR less than 0.67 and ARR from 2% or more to 20% or more) were estimated with Bayesian modeling. FINDINGS: Combining a minimally informative prior distribution with the findings of the EOLIA trial, the posterior probability of RR less than 1 for mortality at 60 days after randomization was 96% (RR, 0.78 [95% CrI, 0.56-1.04]); the posterior probability of RR less than 0.67 was 18%, the probability of ARR of 2% or more was 92%, and the probability of ARR of 20% or more was 2%. With a moderately enthusiastic prior, equivalent to information from a trial of 264 patients with an RR of 0.78, the estimated RR was 0.78 (95% CrI, 0.63-0.96), the probability of RR less than 1 was 99%, the probability of RR less than 0.67 was 8%, the probability of ARR of 2% or more was 97%, and the probability of ARR of 20% or more was 0%. With a strongly skeptical prior, equivalent to information from a trial of 264 patients with an RR of 1.0, the estimated RR was 0.88 (95% CrI, 0.71-1.09), the probability of RR less than 1 was … ER - TY - JOUR T1 - Resumen: Consenso colombiano de atención, diagnóstico y manejo de la infección por SARS-COV-2/COVID-19 en establecimientos de atención de la salud A1 - Trujillo, Carlos Humberto Saavedra Y1 - 2020/// JF - Infectio VL - 24 IS - 3 ER - TY - ICOMM T1 - Extracorporeal Membrane Oxygenation A1 - National Institute of Health NIH Y1 - 2020/// JF - COVID-19 Treatment Guidelines UR - https://www.covid19treatmentguidelines.nih.gov/critical-care/extracorporeal-membrane-oxygenation/ ER - TY - JOUR T1 - Ventilación artificial mecánica en la enfermedad por coronavirus COVID-19: toda una historia de ingenio como en sus orígenes A1 - Abdo-Cuza, Anselmo A1 - Suárez-López, Juliette A1 - García-Gil, Alfonso Y1 - 2020/// JF - Rev Hosp Emilio Ferreya VL - 1 SP - e19 EP - e21 ER - TY - JOUR T1 - Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). A1 - Noah, Moronke A A1 - Peek, Giles J A1 - Finney, Simon J A1 - Griffiths, Mark J A1 - Harrison, David A A1 - Grieve, Richard A1 - Sadique, M Zia A1 - Sekhon, Jasjeet S A1 - McAuley, Daniel F A1 - Firmin, Richard K A1 - Harvey, Christopher A1 - Cordingley, Jeremy J A1 - Price, Susanna A1 - Vuylsteke, Alain A1 - Jenkins, David P A1 - Noble, David W A1 - Bloomfield, Roxanna A1 - Walsh, Timothy S A1 - Perkins, Gavin D A1 - Menon, David A1 - Taylor, Bruce L A1 - Rowan, Kathryn M Y1 - 2011/10// KW - Adult KW - Case-Control Studies KW - Cohort Studies KW - Extracorporeal Membrane Oxygenation KW - Female KW - Hospital Mortality KW - Humans KW - Influenza A Virus, H1N1 Subtype KW - Influenza, Human KW - Intention to Treat Analysis KW - Male KW - Middle Aged KW - Pandemics KW - Patient Transfer KW - Referral and Consultation KW - Respiratory Distress Syndrome KW - Survival Analysis KW - United Kingdom KW - Young Adult KW - complications KW - epidemiology KW - etiology KW - mortality KW - therapy JF - JAMA VL - 306 LA - eng IS - 15 SP - 1659 EP - 1668 DO - 10.1001/jama.2011.1471 N2 - CONTEXT: Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients with severe acute respiratory distress syndrome (ARDS), but its role has remained controversial. ECMO was used to treat patients with ARDS during the 2009 influenza A(H1N1) pandemic. OBJECTIVE: To compare the hospital mortality of patients with H1N1-related ARDS referred, accepted, and transferred for ECMO with matched patients who were not referred for ECMO. DESIGN, SETTING, AND PATIENTS: A cohort study in which ECMO-referred patients were defined as all patients with H1N1-related ARDS who were referred, accepted, and transferred to 1 of the 4 adult ECMO centers in the United Kingdom during the H1N1 pandemic in winter 2009-2010. The ECMO-referred patients and the non-ECMO-referred patients were matched using data from a concurrent, longitudinal cohort study (Swine Flu Triage study) of critically ill patients with suspected or confirmed H1N1. Detailed demographic, physiological, and comorbidity data were used in 3 different matching techniques (individual matching, propensity score matching, and GenMatch matching). MAIN OUTCOME MEASURE: Survival to hospital discharge analyzed according to the intention-to-treat principle. RESULTS: Of 80 ECMO-referred patients, 69 received ECMO (86.3%) and 22 died (27.5%) prior to discharge from the hospital. From a pool of 1756 patients, there were 59 matched pairs of ECMO-referred patients and non-ECMO-referred patients identified using individual matching, 75 matched pairs identified using propensity score matching, and 75 matched pairs identified using GenMatch matching. The hospital mortality rate was 23.7% for ECMO-referred patients vs 52.5% for non-ECMO-referred patients (relative risk [RR], 0.45 [95% CI, 0.26-0.79]; P = .006) when individual matching was used; 24.0% vs 46.7%, respectively (RR, 0.51 [95% CI, 0.31-0.81]; P = .008) when propensity score matching was used; and 24.0% vs 50.7%, respectively (RR, 0.47 [95% CI, 0.31-0.72]; P = .001) when GenMatch matching was used. The results were robust to sensitivity analyses, including amending the inclusion criteria and restricting the location where the non-ECMO-referred patients were treated. CONCLUSION: For patients with H1N1-related ARDS, referral and transfer to an ECMO center was associated with lower hospital mortality compared with matched non-ECMO-referred patients. ER - TY - JOUR T1 - Extra-respiratory manifestations of COVID-19. A1 - Lai, Chih-Cheng A1 - Ko, Wen-Chien A1 - Lee, Ping-Ing A1 - Jean, Shio-Shin A1 - Hsueh, Po-Ren Y1 - 2020/08// KW - Betacoronavirus KW - Coronavirus Infections KW - Humans KW - Pandemics KW - Pneumonia, Viral KW - isolation & purification KW - physiopathology KW - virology JF - International journal of antimicrobial agents VL - 56 LA - eng IS - 2 SP - 106024 EP - 106024 DO - 10.1016/j.ijantimicag.2020.106024 N2 - Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global health threat. Although most patients with COVID-19 manifest fever and respiratory tract symptoms, SARS-CoV-2 infection may also involve other organs/systems and present with extra-respiratory manifestations, including cardiac, gastrointestinal, hepatic, renal, neurological, olfactory, gustatory, ocular, cutaneous and haematological symptoms. Occasionally, these extra-respiratory symptoms/signs represent the initial presentation of SARS-CoV-2 infection, prior to fever or respiratory manifestations. Therefore, this comprehensive review of the extra-respiratory manifestations of COVID-19 is intended to help clinicians better understand the range of clinical presentations associated with SARS-CoV-2 infection, allowing the consideration of COVID-19 in differential diagnoses. A screening test for SARS-CoV-2 should be performed when patients have these extra-respiratory manifestations. In addition, clinicians should be alerted to the adverse effects of anti-SARS-CoV-2 agents that can mimic the extra-respiratory manifestations of COVID-19. Moreover, some extra-respiratory manifestations, such as ocular and gastrointestinal involvement, may be caused by direct invasion of SARS-CoV-2. Therefore, protective measures should be taken while managing the associated clinical specimens. Finally, several extra-respiratory manifestations, such as cardiac involvement, acute kidney injury, coagulation disorders and thrombotic complications, could be associated with a poor prognosis. ER - TY - BOOK T1 - Principios de medicina interna A1 - Kasper, Dennis L A1 - Fauci, A A1 - Hauser, S A1 - Longo, D A1 - Jameson, J L A1 - Loscalzo, J Harrison Y1 - 2016/// PB - McGraw-Hill Educación SN - 6071513359 ER - TY - JOUR T1 - Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study. A1 - Shalhoub, Sarah A1 - Al-Hameed, Fahad A1 - Mandourah, Yasser A1 - Balkhy, Hanan H A1 - Al-Omari, Awad A1 - Al Mekhlafi, Ghaleb A A1 - Kharaba, Ayman A1 - Alraddadi, Basem A1 - Almotairi, Abdullah A1 - Al Khatib, Kasim A1 - Abdulmomen, Ahmed A1 - Qushmaq, Ismael A1 - Mady, Ahmed A1 - Solaiman, Othman A1 - Al-Aithan, Abdulsalam M A1 - Al-Raddadi, Rajaa A1 - Ragab, Ahmed A1 - Al Harthy, Abdulrahman A1 - Al Qasim, Eman A1 - Jose, Jesna A1 - Al-Ghamdi, Ghassan A1 - Merson, Laura A1 - Fowler, Robert A1 - Hayden, Frederick G A1 - Arabi, Yaseen M Y1 - 2018/// JF - PloS one VL - 13 LA - eng IS - 11 SP - e0206831 EP - e0206831 DO - 10.1371/journal.pone.0206831 N2 - BACKGROUND: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) leads to healthcare-associated transmission to patients and healthcare workers with potentially fatal outcomes. AIM: We aimed to describe the clinical course and functional outcomes of critically ill healthcare workers (HCWs) with MERS. METHODS: Data on HCWs was extracted from a multi-center retrospective cohort study on 330 critically ill patients with MERS admitted between (9/2012-9/2015). Baseline demographics, interventions and outcomes were recorded and compared between survivors and non-survivors. Survivors were approached with questionnaires to elucidate their functional outcomes using Karnofsky Performance Status Scale. FINDINGS: Thirty-Two HCWs met the inclusion criteria. Comorbidities were recorded in 34% (11/32) HCW. Death resulted in 8/32 (25%) HCWs including all 5 HCWs with chronic renal impairment at baseline. Non-surviving HCW had lower PaO2/FiO2 ratios 63.5 (57, 116.2) vs 148 (84, 194.3), p = 0.043, and received more ECMO therapy compared to survivors, 9/32 (28%) vs 4/24 (16.7%) respectively (p = 0.02).Thirteen of the surviving (13/24) HCWs responded to the questionnaire. Two HCWs confirmed functional limitations. Median number of days from hospital discharge until the questionnaires were filled was 580 (95% CI 568, 723.5) days. CONCLUSION: Approximately 10% of critically ill patients with MERS were HCWs. Hospital mortality rate was substantial (25%). Patients with chronic renal impairment represented a particularly high-risk group that should receive extra caution during suspected or confirmed MERS cases clinical care assignment and during outbreaks. Long-term repercussions of critical illness due to MERS on HCWs in particular, and patients in general, remain unknown and should be investigated in larger studies. ER - TY - JOUR T1 - "Hydroxychloroquine in patients with COVID-19: A Systematic Review and meta-analysis.". A1 - Singh, Awadhesh Kumar A1 - Singh, Akriti A1 - Singh, Ritu A1 - Misra, Anoop Y1 - 2020/// KW - Anti-Bacterial Agents KW - Betacoronavirus KW - Coronavirus Infections KW - Humans KW - Hydroxychloroquine KW - Observational Studies as Topic KW - Pandemics KW - Pneumonia, Viral KW - Treatment Outcome KW - Viral Load KW - adverse effects KW - drug effects KW - drug therapy KW - mortality KW - therapeutic use JF - Diabetes & metabolic syndrome VL - 14 LA - eng IS - 4 SP - 589 EP - 596 DO - 10.1016/j.dsx.2020.05.017 N2 - BACKGROUNDS AND AIMS: The role of hydroxychloroquine (HCQ) in the treatment of COVID-19 is not fully known. We studied the efficacy of HCQ compared to the control in COVID-19 subjects on - a. viral clearance measured by reverse transcriptase polymerase chain reaction (RT-PCR) and, b. death due to all cause. METHODS: PubMed, Scopus, Cochrane and MedRxiv database were searched using the specific keywords up to April 30, 2020. Studies that met our objectives were assessed for the risk of bias applying various tools as indicated. Three studies each that reported the outcome of viral clearance by RT-PCR and death due to all cause, were meta-analyzed by applying inverse variance-weighted averages of logarithmic risk ratio (RR) using a random effects model. Heterogeneity and publication bias were assessed using the I(2) statistic and funnel plots, respectively. RESULTS: Meta-analysis of 3 studies (n = 210) on viral clearance assessed by RT-PCR showed no benefit (RR, 1.05; 95% CI, 0.79 to 1.38; p = 0.74), although with a moderate heterogeneity (I(2) = 61.7%, p = 0.07). While meta-analysis of 3 studies (n = 474) showed a significant increase in death with HCQ, compared to the control (RR, 2.17; 95% 1.32 to 3.57; p = 0.002), without any heterogeneity (I(2) = 0.0%, p = 0.43). CONCLUSIONS: No benefit on viral clearance but a significant increase in mortality was observed with HCQ compared to control in patients with COVID-19. ER - TY - JOUR T1 - Evidence based management guideline for the COVID-19 pandemic - Review article. A1 - Nicola, Maria A1 - O'Neill, Niamh A1 - Sohrabi, Catrin A1 - Khan, Mehdi A1 - Agha, Maliha A1 - Agha, Riaz Y1 - 2020/05// JF - International journal of surgery (London, England) VL - 77 LA - eng SP - 206 EP - 216 DO - 10.1016/j.ijsu.2020.04.001 N2 - COVID-19 has now been declared a pandemic. To date, COVID-19 has affected over 2.5 million people worldwide, resulting in over 170,000 reported deaths. Numerous preventative strategies and non-pharmaceutical interventions have been employed to mitigate the spread of disease including careful infection control, the isolation of patients, and social distancing. Management is predominantly focused on the provision of supportive care, with oxygen therapy representing the major treatment intervention. Medical therapy involving corticosteroids and antivirals have also been encouraged as part of critical management schemes. However, there is at present no specific antiviral recommended for the treatment of COVID-19, and no vaccine is currently available. Despite the strategic implementation of these measures, the number of new reported cases continues to rise at a profoundly alarming rate. As new findings emerge, there is an urgent need for up-to-date management guidelines. In response to this call, we review what is currently known regarding the management of COVID-19, and offer an evidence-based review of current practice. ER - TY - JOUR T1 - The role of ECMO in COVID-19: Can it provide rescue therapy in those who are critically ill? A1 - Savarimuthu, Sugeevan A1 - BinSaeid, Jalal A1 - Harky, Amer Y1 - 2020/06// JF - Journal of cardiac surgery VL - 35 LA - eng IS - 6 SP - 1298 EP - 1301 DO - 10.1111/jocs.14635 N2 - Arising from the city of Wuhan, Hubei province in China, a novel coronavirus named severe acute respiratory syndrome coronavirus 2 has been rapidly spreading since its first presentation in late 2019. The World Health Organization declared a pandemic on the 11th March 2020, and as of 29th of April 2020 more than 3 million cases have been reported worldwide with over 225 000 confirmed deaths. Where mechanical ventilation may not be enough, extracorporeal membrane oxygenation (ECMO) could play a role as a form of rescue therapy and may provide beneficial results in the hands of skilled clinicians in centers with experience of using ECMO appropriately in selected patients. Our understanding of COVID-19 is ever-changing and the need for intensive care beds is rising, which means that ECMO will surely play a key role in the near future. ER - TY - JOUR T1 - GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. A1 - Guyatt, Gordon H A1 - Oxman, Andrew D A1 - Vist, Gunn E A1 - Kunz, Regina A1 - Falck-Ytter, Yngve A1 - Alonso-Coello, Pablo A1 - Schünemann, Holger J Y1 - 2008/04// JF - BMJ (Clinical research ed.) VL - 336 LA - eng IS - 7650 SP - 924 EP - 926 DO - 10.1136/bmj.39489.470347.AD N2 - Guidelines are inconsistent in how they rate the quality of evidence and the strength of recommendations. This article explores the advantages of the GRADE system, which is increasingly being adopted by organisations worldwide ER - TY - JOUR T1 - Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. A1 - Schmidt, Matthieu A1 - Bailey, Michael A1 - Sheldrake, Jayne A1 - Hodgson, Carol A1 - Aubron, Cecile A1 - Rycus, Peter T A1 - Scheinkestel, Carlos A1 - Cooper, D Jamie A1 - Brodie, Daniel A1 - Pellegrino, Vincent A1 - Combes, Alain A1 - Pilcher, David Y1 - 2014/06// KW - Adult KW - Australia KW - Extracorporeal Membrane Oxygenation KW - Female KW - France KW - Humans KW - Male KW - Middle Aged KW - New Zealand KW - Predictive Value of Tests KW - Respiratory Distress Syndrome, Adult KW - Risk Factors KW - Severity of Illness Index KW - Survival Rate KW - Treatment Outcome KW - United States KW - diagnosis KW - economics KW - epidemiology KW - mortality KW - nursing KW - therapy JF - American journal of respiratory and critical care medicine VL - 189 LA - eng IS - 11 SP - 1374 EP - 1382 DO - 10.1164/rccm.201311-2023OC N2 - RATIONALE: Increasing use of extracorporeal membrane oxygenation (ECMO) for acute respiratory failure may increase resource requirements and hospital costs. Better prediction of survival in these patients may improve resource use, allow risk-adjusted comparison of center-specific outcomes, and help clinicians to target patients most likely to benefit from ECMO. OBJECTIVES: To create a model for predicting hospital survival at initiation of ECMO for respiratory failure. METHODS: Adult patients with severe acute respiratory failure treated by ECMO from 2000 to 2012 were extracted from the Extracorporeal Life Support Organization (ELSO) international registry. Multivariable logistic regression was used to create the Respiratory ECMO Survival Prediction (RESP) score using bootstrapping methodology with internal and external validation. MEASUREMENTS AND MAIN RESULTS: Of the 2,355 patients included in the study, 1,338 patients (57%) were discharged alive from hospital. The RESP score was developed using pre-ECMO variables independently associated with hospital survival on logistic regression, which included age, immunocompromised status, duration of mechanical ventilation before ECMO, diagnosis, central nervous system dysfunction, acute associated nonpulmonary infection, neuromuscular blockade agents or nitric oxide use, bicarbonate infusion, cardiac arrest, PaCO2, and peak inspiratory pressure. The receiver operating characteristics curve analysis of the RESP score was c = 0.74 (95% confidence interval, 0.72-0.76). External validation, performed on 140 patients, exhibited excellent discrimination (c = 0.92; 95% confidence interval, 0.89-0.97). CONCLUSIONS: The RESP score is a relevant and validated tool to predict survival for patients receiving ECMO for respiratory failure. ER - TY - JOUR T1 - The Role of Cytokines including Interleukin-6 in COVID-19 induced Pneumonia and Macrophage Activation Syndrome-Like Disease. A1 - McGonagle, Dennis A1 - Sharif, Kassem A1 - O'Regan, Anthony A1 - Bridgewood, Charlie Y1 - 2020/06// KW - Betacoronavirus KW - Coronavirus Infections KW - Humans KW - Interleukin-1 KW - Interleukin-6 KW - Lymphohistiocytosis, Hemophagocytic KW - Macrophage Activation Syndrome KW - Pandemics KW - Pneumonia, Viral KW - Respiratory Distress Syndrome, Adult KW - complications KW - immunology KW - pathogenicity KW - pathology JF - Autoimmunity reviews VL - 19 LA - eng IS - 6 SP - 102537 EP - 102537 DO - 10.1016/j.autrev.2020.102537 N2 - Severe COVID-19 associated pneumonia patients may exhibit features of systemic hyper-inflammation designated under the umbrella term of macrophage activation syndrome (MAS) or cytokine storm, also known as secondary haemophagocytic lymphohistocytosis (sHLH). This is distinct from HLH associated with immunodeficiency states termed primary HLH -with radically different therapy strategies in both situations. COVID-19 infection with MAS typically occurs in subjects with adult respiratory distress syndrome (ARDS) and historically, non-survival in ARDS was linked to sustained IL-6 and IL-1 elevation. We provide a model for the classification of MAS to stratify the MAS-like presentation in COVID-19 pneumonia and explore the complexities of discerning ARDS from MAS. We discuss the potential impact of timing of anti-cytokine therapy on viral clearance and the impact of such therapy on intra-pulmonary macrophage activation and emergent pulmonary vascular disease. ER - TY - JOUR T1 - The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. A1 - Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA, et al. Y1 - 2020/04// KW - Animals KW - Betacoronavirus KW - Classification KW - Coronaviridae KW - Coronavirus Infections KW - Genetic Variation KW - Genome KW - Humans KW - Nidovirales KW - Open Reading Frames KW - Pandemics KW - Phylogeny KW - Pneumonia KW - SARS Virus KW - Severe Acute Respiratory Syndrome KW - Terminology as Topic KW - Viral KW - World Health Organization KW - Zoonoses KW - classification KW - epidemiology KW - genetics KW - methods KW - transmission KW - virology JF - Nature microbiology VL - 5 LA - eng IS - 4 SP - 536 EP - 544 DO - 10.1038/s41564-020-0695-z N2 - The present outbreak of a coronavirus-associated acute respiratory disease called coronavirus disease 19 (COVID-19) is the third documented spillover of an animal coronavirus to humans in only two decades that has resulted in a major epidemic. The Coronaviridae Study Group (CSG) of the International Committee on Taxonomy of Viruses, which is responsible for developing the classification of viruses and taxon nomenclature of the family Coronaviridae, has assessed the placement of the human pathogen, tentatively named 2019-nCoV, within the Coronaviridae. Based on phylogeny, taxonomy and established practice, the CSG recognizes this virus as forming a sister clade to the prototype human and bat severe acute respiratory syndrome coronaviruses (SARS-CoVs) of the species Severe acute respiratory syndrome-related coronavirus, and designates it as SARS-CoV-2. In order to facilitate communication, the CSG proposes to use the following naming convention for individual isolates: SARS-CoV-2/host/location/isolate/date. While the full spectrum of clinical manifestations associated with SARS-CoV-2 infections in humans remains to be determined, the independent zoonotic transmission of SARS-CoV and SARS-CoV-2 highlights the need for studying viruses at the species level to complement research focused on individual pathogenic viruses of immediate significance. This will improve our understanding of virus–host interactions in an ever-changing environment and enhance our preparedness for future outbreaks. ER - TY - JOUR T1 - Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. A1 - Davies, Andrew A1 - Jones, Daryl A1 - Bailey, Michael A1 - Beca, John A1 - Bellomo, Rinaldo A1 - Blackwell, Nikki A1 - Forrest, Paul A1 - Gattas, David A1 - Granger, Emily A1 - Herkes, Robert A1 - Jackson, Andrew A1 - McGuinness, Shay A1 - Nair, Priya A1 - Pellegrino, Vincent A1 - Pettilä, Ville A1 - Plunkett, Brian A1 - Pye, Roger A1 - Torzillo, Paul A1 - Webb, Steve A1 - Wilson, Michael A1 - Ziegenfuss, Marc Y1 - 2009/11// KW - Adult KW - Australia KW - Comorbidity KW - Extracorporeal Membrane Oxygenation KW - Female KW - Humans KW - Influenza A Virus, H1N1 Subtype KW - Influenza, Human KW - Intensive Care Units KW - Length of Stay KW - Male KW - New Zealand KW - Pregnancy KW - Pregnancy Complications, Infectious KW - Respiration, Artificial KW - Respiratory Distress Syndrome KW - Survival Analysis KW - complications KW - etiology KW - mortality KW - therapy JF - JAMA VL - 302 LA - eng IS - 17 SP - 1888 EP - 1895 DO - 10.1001/jama.2009.1535 N2 - CONTEXT: The novel influenza A(H1N1) pandemic affected Australia and New Zealand during the 2009 southern hemisphere winter. It caused an epidemic of critical illness and some patients developed severe acute respiratory distress syndrome (ARDS) and were treated with extracorporeal membrane oxygenation (ECMO). OBJECTIVES: To describe the characteristics of all patients with 2009 influenza A(H1N1)-associated ARDS treated with ECMO and to report incidence, resource utilization, and patient outcomes. DESIGN, SETTING, AND PATIENTS: An observational study of all patients (n = 68) with 2009 influenza A(H1N1)-associated ARDS treated with ECMO in 15 intensive care units (ICUs) in Australia and New Zealand between June 1 and August 31, 2009. MAIN OUTCOME MEASURES: Incidence, clinical features, degree of pulmonary dysfunction, technical characteristics, duration of ECMO, complications, and survival. RESULTS: Sixty-eight patients with severe influenza-associated ARDS were treated with ECMO, of whom 61 had either confirmed 2009 influenza A(H1N1) (n = 53) or influenza A not subtyped (n = 8), representing an incidence rate of 2.6 ECMO cases per million population. An additional 133 patients with influenza A received mechanical ventilation but no ECMO in the same ICUs. The 68 patients who received ECMO had a median (interquartile range [IQR]) age of 34.4 (26.6-43.1) years and 34 patients (50%) were men. Before ECMO, patients had severe respiratory failure despite advanced mechanical ventilatory support with a median (IQR) Pao(2)/fraction of inspired oxygen (Fio(2)) ratio of 56 (48-63), positive end-expiratory pressure of 18 (15-20) cm H(2)O, and an acute lung injury score of 3.8 (3.5-4.0). The median (IQR) duration of ECMO support was 10 (7-15) days. At the time of reporting, 48 of the 68 patients (71%; 95% confidence interval [CI], 60%-82%) had survived to ICU discharge, of whom 32 had survived to hospital discharge and 16 remained as hospital inpatients. Fourteen patients (21%; 95% CI, 11%-30%) had died and 6 remained in the ICU, 2 of whom were still receiving ECMO. CONCLUSIONS: During June to August 2009 in Australia and New Zealand, the ICUs at regional referral centers provided mechanical ventilation for many patients with 2009 influenza A(H1N1)-associated respiratory failure, one-third of whom received ECMO. These ECMO-treated patients were often young adults with severe hypoxemia and had a 21% mortality rate at the end of the study period. ER - TY - JOUR T1 - Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. A1 - Chen, Nanshan A1 - Zhou, Min A1 - Dong, Xuan A1 - Qu, Jieming A1 - Gong, Fengyun A1 - Han, Yang A1 - Qiu, Yang A1 - Wang, Jingli A1 - Liu, Ying A1 - Wei, Yuan A1 - Xia, Jia'an A1 - Yu, Ting A1 - Zhang, Xinxin A1 - Zhang, Li Y1 - 2020/02// JF - Lancet (London, England) VL - 395 LA - eng IS - 10223 SP - 507 EP - 513 DO - 10.1016/S0140-6736(20)30211-7 N2 - BACKGROUND: In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. METHODS: In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. FINDINGS: Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. INTERPRETATION: The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. FUNDING: National Key R&D Program of China. ER - TY - ICOMM T1 - Preguntas y respuestas sobre la enfermedad por coronavirus (COVID-19) A1 - Organización Mundial de la Salud OMS Y1 - 2020/// JF - Nuevo coronavirus 2019 UR - https://www.who.int/es/emergencies/diseases/novel-coronavirus-2019/advice-for-public/q-a-coronaviruses ER - TY - JOUR T1 - Performance of the CURB-65 Score in Predicting Critical Care Interventions in Patients Admitted With Community-Acquired Pneumonia. A1 - Ilg, Annette A1 - Moskowitz, Ari A1 - Konanki, Varun A1 - Patel, Parth V A1 - Chase, Maureen A1 - Grossestreuer, Anne V A1 - Donnino, Michael W Y1 - 2019/07// KW - Aged KW - Aged, 80 and over KW - Clinical Decision Rules KW - Community-Acquired Infections KW - Confusion KW - Critical Care KW - Emergency Service, Hospital KW - Female KW - Hospital Mortality KW - Hospitalization KW - Humans KW - Hypotension KW - Intensive Care Units KW - Male KW - Middle Aged KW - Outcome Assessment, Health Care KW - Pneumonia KW - Predictive Value of Tests KW - Respiratory Rate KW - Retrospective Studies KW - Uremia KW - diagnosis KW - epidemiology KW - etiology KW - mortality KW - physiology KW - standards KW - statistics & numerical data JF - Annals of emergency medicine VL - 74 LA - eng IS - 1 SP - 60 EP - 68 DO - 10.1016/j.annemergmed.2018.06.017 N2 - STUDY OBJECTIVE: Confusion, uremia, elevated respiratory rate, hypotension, and aged 65 years or older (CURB-65) is a clinical prediction rule intended to stratify patients with pneumonia by expected mortality. We assess the predictive performance of CURB-65 for the proximal endpoint of receipt of critical care intervention in emergency department (ED) patients admitted with community-acquired pneumonia. METHODS: We performed a retrospective analysis of electronic health records from a single tertiary center for ED patients admitted as inpatients with a primary diagnosis of pneumonia from 2010 to 2014. Patients with a history of malignancy, tuberculosis, bronchiectasis, HIV, or readmission within 14 days were excluded. We assessed the predictive accuracy of CURB-65 for receipt of critical care interventions (ie, vasopressors, large-volume intravenous fluids, invasive catheters, assisted ventilation, insulin infusions, or renal replacement therapy) and inhospital mortality. Logistic regression was performed to assess the increase in odds of critical care intervention or inhospital mortality by increasing CURB-65 score. RESULTS: There were 2,322 patients admitted with community-acquired pneumonia in the study cohort; 630 (27.1%) were admitted to the ICU within 48 hours of ED triage and 343 (14.8%) received a critical care intervention. Of patients with a CURB-65 score of 0 to 1, 181 (15.6%) were admitted to the ICU, 74 (6.4%) received a critical care intervention, and 7 (0.6%) died. Of patients with a CURB-65 score of 2, 223 (27.0%) were admitted to the ICU, 127 (15.4%) received a critical care intervention, and 47 (5.7%) died. Among patients with CURB-65 score greater than or equal to 3, 226 (67.0%) were admitted to the ICU, 142 (42.1%) received a critical care intervention, and 43 (12.8%) died. The areas under the receiver operating characteristic for CURB-65 as a predictor of critical care intervention and mortality were 0.73 and 0.77, whereas sensitivity of CURB-65 score greater than or equal to 2 in predicting critical care intervention was 78.4%; for mortality, 92.8%. CONCLUSION: Patients with CURB-65 score less than or equal to 2 were often admitted to the ICU and received critical care interventions. Given this finding and the relatively low sensitivity of CURB-65 for critical care intervention, clinicians should exercise caution when using CURB-65 to guide disposition. Future ED-based clinical prediction rules may benefit from calibration to proximal endpoints. ER - TY - JOUR T1 - Acute Respiratory Distress Syndrome With and Without Extracorporeal Membrane Oxygenation: A Score Matched Study. A1 - Tsai, Hsiao-Chi A1 - Chang, Chih-Hsiang A1 - Tsai, Feng-Chun A1 - Fan, Pei-Chun A1 - Juan, Kuo-Chang A1 - Lin, Chan-Yu A1 - Yang, Huang-Yu A1 - Kao, Kuo-Chin A1 - Fang, Ji-Tseng A1 - Yang, Chih-Wei A1 - Chang, Su-Wei A1 - Chen, Yung-Chang Y1 - 2015/08// JF - The Annals of thoracic surgery VL - 100 LA - eng IS - 2 SP - 458 EP - 464 CY - Netherlands DO - 10.1016/j.athoracsur.2015.03.092 N2 - BACKGROUND: Acute respiratory distress syndrome (ARDS) is a life-threatening medical condition. Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for patients with ARDS and refractory hypoxia. This study compared the characteristics and outcomes of ARDS patients who did or did not receive ECMO matched with Acute Physiology and Chronic Health Evaluation II (APACHE II) score and age. METHODS: This retrospective, case-control study enrolled patients with ARDS admitted to the intensive care unit of a tertiary referral hospital between January 2007 and December 2012. Overall, 216 patients with ARDS-81 receiving ECMO (ECMO group) and 135 not receiving ECMO (non-ECMO group)-were enrolled in this study. Patients were paired when the difference in their APACHE II scores was within 3 points and their age difference was 3 years. In total, 126 patients could not be matched and were thus excluded. Eventually, of the 90 patients with ARDS enrolled in this study, 45 ECMO group patients were matched with 45 non-ECMO group patients. The demographic data, reasons for intensive care unit admission, and laboratory variables were evaluated. RESULTS: The primary etiology of ARDS was infection (72.2%). The APACHE II score and age-matched group receiving ECMO therapy had higher inhospital survival rates. Moreover, the patients receiving ECMO therapy had significantly lower 6-month mortality rates than did the non-ECMO group. CONCLUSIONS: Patients with ARDS who received ECMO treatment had higher inhospital survival rates than did those with a similar disease severity and at a similar age who did not receive ECMO. ER - TY - JOUR T1 - The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. A1 - Lauer, Stephen A A1 - Grantz, Kyra H A1 - Bi, Qifang A1 - Jones, Forrest K A1 - Zheng, Qulu A1 - Meredith, Hannah R A1 - Azman, Andrew S A1 - Reich, Nicholas G A1 - Lessler, Justin Y1 - 2020/05// KW - Adult KW - Betacoronavirus KW - China KW - Coronavirus Infections KW - Female KW - Humans KW - Infectious Disease Incubation Period KW - Male KW - Middle Aged KW - Pandemics KW - Pneumonia, Viral KW - Retrospective Studies KW - epidemiology KW - transmission JF - Annals of internal medicine VL - 172 LA - eng IS - 9 SP - 577 EP - 582 DO - 10.7326/M20-0504 N2 - BACKGROUND: A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for surveillance and control activities. OBJECTIVE: To estimate the length of the incubation period of COVID-19 and describe its public health implications. DESIGN: Pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020. SETTING: News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China. PARTICIPANTS: Persons with confirmed SARS-CoV-2 infection outside Hubei province, China. MEASUREMENTS: Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization. RESULTS: There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine. LIMITATION: Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases. CONCLUSION: This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases. PRIMARY FUNDING SOURCE: U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation. ER - TY - JOUR T1 - From SARS to MERS, Thrusting Coronaviruses into the Spotlight. A1 - Song, Zhiqi A1 - Xu, Yanfeng A1 - Bao, Linlin A1 - Zhang, Ling A1 - Yu, Pin A1 - Qu, Yajin A1 - Zhu, Hua A1 - Zhao, Wenjie A1 - Han, Yunlin A1 - Qin, Chuan Y1 - 2019/01// KW - Animals KW - China KW - Chiroptera KW - Coronavirus Infections KW - Disease Models, Animal KW - Genome, Viral KW - Humans KW - Mice KW - Middle East KW - Middle East Respiratory Syndrome Coronavirus KW - SARS Virus KW - Severe Acute Respiratory Syndrome KW - Spike Glycoprotein, Coronavirus KW - Viral Vaccines KW - Zoonoses KW - drug therapy KW - epidemiology KW - genetics KW - immunology KW - pathogenicity KW - prevention & control KW - transmission KW - virology JF - Viruses VL - 11 LA - eng IS - 1 DO - 10.3390/v11010059 N2 - Coronaviruses (CoVs) have formerly been regarded as relatively harmless respiratory pathogens to humans. However, two outbreaks of severe respiratory tract infection, caused by the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV), as a result of zoonotic CoVs crossing the species barrier, caused high pathogenicity and mortality rates in human populations. This brought CoVs global attention and highlighted the importance of controlling infectious pathogens at international borders. In this review, we focus on our current understanding of the epidemiology, pathogenesis, prevention, and treatment of SARS-CoV and MERS-CoV, as well as provides details on the pivotal structure and function of the spike proteins (S proteins) on the surface of each of these viruses. For building up more suitable animal models, we compare the current animal models recapitulating pathogenesis and summarize the potential role of host receptors contributing to diverse host affinity in various species. We outline the research still needed to fully elucidate the pathogenic mechanism of these viruses, to construct reproducible animal models, and ultimately develop countermeasures to conquer not only SARS-CoV and MERS-CoV, but also these emerging coronaviral diseases. ER - TY - GEN T1 - Use of extracorporeal technology during pandemics: ethical and staffing considerations. A1 - Kissoon, Niranjan A1 - Bohn, Desmond Y1 - 2010/11// JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies VL - 11 LA - eng IS - 6 SP - 757 EP - 758 CY - United States DO - 10.1097/PCC.0b013e3181e288a4 ER - TY - GEN T1 - Dynamic relationship between D-dimer and COVID-19 severity. A1 - Li, Yong A1 - Zhao, Kun A1 - Wei, Hongcheng A1 - Chen, Wensen A1 - Wang, Wei A1 - Jia, Ling A1 - Liu, Qiongfang A1 - Zhang, Jinpeng A1 - Shan, Tao A1 - Peng, Zhihang A1 - Liu, Yun A1 - Yan, Xiaoxiang Y1 - 2020/07// KW - Adult KW - Aged KW - Betacoronavirus KW - Clinical Laboratory Techniques KW - Coronavirus Infections KW - Female KW - Fibrin Fibrinogen Degradation Products KW - Humans KW - Male KW - Middle Aged KW - Pandemics KW - Pneumonia, Viral KW - Severity of Illness Index KW - blood KW - diagnosis KW - metabolism KW - therapy JF - British journal of haematology VL - 190 LA - eng IS - 1 SP - e24 EP - e27 DO - 10.1111/bjh.16811 N2 - Since December 2019, the seriousness of coronavirus disease 2019 (COVID‐19) pandemic has been on escalation (Lu, et al 2020). Coagulopathy is common in critically ill patients with COVID‐19 (Tang, et al 2020b). Systemic microvascular thrombosismay occur in most deaths, which was further identified by a recent autopsy (Luo 2020). However, less has been known about the coagulation parameter D‐dimer in the progression of COVID‐19. In this study, we describe 279 COVID‐19 patients recruited from three hospitals in Hubei Province, China, and then investigate the dynamic relationship between D‐dimer level and the progression of COVID‐19. ER - TY - JOUR T1 - Extracorporeal Membrane Oxygenation for Severe MERS-CoV: a retrospective observational study [958] A1 - Alshahrani, Mohammed A1 - Sindi, Anees A1 - Alahmadi, Bayan A1 - Zein, Ahmed A1 - Alamri, Sultan A1 - Arabi, Yaseen A1 - Alshamsi, Fayez A1 - Al-Hazzani, Waleed Y1 - 2016/// PB - LWW JF - Critical Care Medicine VL - 44 IS - 12 SP - 315 EP - 315 ER - TY - JOUR T1 - Preparing for the Most Critically Ill Patients With COVID-19: The Potential Role of Extracorporeal Membrane Oxygenation A1 - MacLaren, Graeme A1 - Fisher, Dale A1 - Brodie, Daniel Y1 - 2020/04// JF - JAMA VL - 323 IS - 13 SP - 1245 EP - 1246 DO - 10.1001/jama.2020.2342 N2 - The novel coronavirus has now infected tens of thousands of people in China and has spread rapidly around the globe. The World Health Organization (WHO) has declared the disease, coronavirus disease 2019 (COVID-19), a Public Health Emergency of International Concern and released interim guidelines on patient management. Early reports that emerged from Wuhan, the epicenter of the outbreak, demonstrated that the clinical manifestations of infection were fever, cough, and dyspnea, with radiological evidence of viral pneumonia. Approximately 15% to 30% of these patients developed acute respiratory distress syndrome (ARDS). The WHO interim guidelines made general recommendations for treatment of ARDS in this setting, including that consideration be given to referring patients with refractory hypoxemia to expert centers capable of providing extracorporeal membrane oxygenation (ECMO). ER - TY - ICOMM T1 - Coronavirus A1 - Organización Mundial de la Salud OMS Y1 - 2020/// UR - https://www.who.int/es/health-topics/coronavirus ER - TY - JOUR T1 - Epidemiology, Genetic Recombination, and Pathogenesis of Coronaviruses. A1 - Su, Shuo A1 - Wong, Gary A1 - Shi, Weifeng A1 - Liu, Jun A1 - Lai, Alexander C K A1 - Zhou, Jiyong A1 - Liu, Wenjun A1 - Bi, Yuhai A1 - Gao, George F Y1 - 2016/06// KW - Coronavirus KW - Coronavirus Infections KW - Cross Infection KW - Disease Outbreaks KW - Ecology KW - Evolution, Molecular KW - Humans KW - Middle East KW - Middle East Respiratory Syndrome Coronavirus KW - Phylogeny KW - Recombination, Genetic KW - Republic of Korea KW - Respiratory Tract Diseases KW - SARS Virus KW - Saudi Arabia KW - Severe Acute Respiratory Syndrome KW - classification KW - epidemiology KW - genetics KW - pathogenicity KW - transmission KW - virology JF - Trends in microbiology VL - 24 LA - eng IS - 6 SP - 490 EP - 502 DO - 10.1016/j.tim.2016.03.003 N2 - Human coronaviruses (HCoVs) were first described in the 1960s for patients with the common cold. Since then, more HCoVs have been discovered, including those that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), two pathogens that, upon infection, can cause fatal respiratory disease in humans. It was recently discovered that dromedary camels in Saudi Arabia harbor three different HCoV species, including a dominant MERS HCoV lineage that was responsible for the outbreaks in the Middle East and South Korea during 2015. In this review we aim to compare and contrast the different HCoVs with regard to epidemiology and pathogenesis, in addition to the virus evolution and recombination events which have, on occasion, resulted in outbreaks amongst humans. ER - TY - ICOMM T1 - Manejo clínico de la infección respiratoria aguda grave presuntamente causada por el nuevo coronavirus (2019-nCoV) Orientaciones provisionales A1 - OMS, Organización Mundial de la Salud Y1 - 2020/// JF - Recomendaciones provisionales para el manejo clínico de la infección respiratoria aguda grave presuntamente causada por el nuevo coronavirus (2019-nCoV): Orientaciones SP - 1 EP - 11 UR - https://apps.who.int/iris/bitstream/handle/10665/330938/WHO-nCoV-Clinical-2020.3-spa.pdf ER - TY - ICOMM T1 - ELSO Guidelines for ECMO Centers v1.8 A1 - Organization, Extracorporeal Life Support Y1 - 2014/// JF - Center and Training Guidelines UR - https://www.elso.org/Portals/0/IGD/Archive/FileManager/faf3f6a3c7cusersshyerdocumentselsoguidelinesecmocentersv1.8.pdf ER -