Air Hunger and Psychological Trauma in Ventilated Patients with COVID-19. An Urgent Problem.
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ABSTRACT:
SUBMITTER: Worsham CM
PROVIDER: S-EPMC7393786 | biostudies-literature | 2020 Aug
REPOSITORIES: biostudies-literature
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Air Hunger and Psychological Trauma in Ventilated Patients with COVID-19. An Urgent Problem.
Worsham Christopher M CM Banzett Robert B RB Schwartzstein Richard M RM
Annals of the American Thoracic Society 20200801 8
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Project description:The COVID-19 pandemic has a great impact on society as a whole. Yet the pandemic and associated mandatory lockdown in several countries may have increased the vulnerability of certain populations. The present study aimed to document the frequency of clinical level of psychological distress and COVID-19 related post-traumatic stress symptoms in youth during the first wave of the pandemic. The study more specifically explored the role of prior trauma and adverse life events as a vulnerability factor for negative outcomes. A sample of 4914 adolescents and young adults from the province of Quebec, Canada was recruited online through social networks during the first wave of COVID-19. Results revealed that 26.6% of youth displayed serious psychological distress and 20.3% probable PTSD symptoms. The number of past traumas and adversity experienced showed a dose-response relation with the prevalence of psychological distress and PTSD. After controlling for socio-demographic characteristics and COVID-19 related variables (exposure, fear, suspicion of having the infection), participants with a history of five traumas and more presented a two-fold risk of serious psychological distress and probable PTSD. Emotion dysregulation was also associated with an increased risk of symptoms while resilience was linked to a reduced risk of distress.
| S-EPMC9682866 | biostudies-literature
Project description:IntroductionDuring the COVID-19 pandemic, nurses have faced various nurse-specific traumas in their workplaces, but there is limited understanding of the resulting outcomes and factors that contribute to them.ObjectiveTo address this gap, the study employed the middle-range theory of nurses' psychological trauma (NPT) to examine these relationships among frontline nurses working in critical care areas.MethodsIn a quantitative cross-sectional study, the study compared nurses identified as probable cases of posttraumatic stress disorder (PTSD) with those identified as not probable cases. The study investigated the nurse-specific traumas they experienced, their individual personality traits, and the buffers they possessed. The study also sought to identify specific types of nurse-specific traumas that could be associated with negative outcomes, such as alcohol and drug use.ResultsIt was found that PTSD-probable nurses reported higher levels of trauma from disasters and system/medically induced trauma compared to not-probable nurses. They also experienced more nonwork-related humankind traumas and displayed lower resilience. Furthermore, PTSD-probable nurses identified with trait urgency and trait avoidance motivation. Additionally, trauma from disasters was associated with alcohol use.ConclusionThe study highlights the elevated levels of trauma, lower resilience, and specific psychological traits associated with PTSD-probable nurses, emphasizing the need for targeted interventions and support to mitigate the negative outcomes experienced by frontline nurses.
| S-EPMC10655673 | biostudies-literature
Project description:Personal cloud, termed as the difference in air pollutant concentrations between breathing zone and room sites, represents the bias in approximating personal inhalation exposure that is linked to accuracy of health risk assessment. This study performed a two-week field experiment in a naturally ventilated office during the COVID-19 pandemic to assess occupants' exposure to common air pollutants and to determine factors contributing to the personal cloud effect. During occupied periods, indoor average concentrations of endotoxin (0.09 EU/m3), TVOC (231 μg/m3), CO2 (630 ppm), and PM10 (14 μg/m3) were below the recommended limits, except for formaldehyde (58 μg/m3). Personal exposure concentrations, however, were significantly different from, and mostly higher than, concentrations measured at room stationary sampling sites. Although three participants shared the same office, their personal air pollution clouds were mutually distinct. The mean personal cloud magnitude ranged within 0-0.05 EU/m3, 35-192 μg/m3, 32-120 ppm, and 4-9 μg/m3 for endotoxin, TVOC, CO2, and PM10, respectively, and was independent from room concentrations. The use of hand sanitizer was strongly associated with an elevated personal cloud of endotoxin and alcohol-based VOCs. Reduced occupancy density in the office resulted in more pronounced personal CO2 clouds. The representativeness of room stationary sampling for capturing dynamic personal exposures was as low as 28% and 5% for CO2 and PM10, respectively. The findings of our study highlight the necessity of considering the personal cloud effect when assessing personal exposure in offices.
| S-EPMC10080864 | biostudies-literature
Project description:ObjectiveTo determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS).DesignObservational study.SettingTertiary-care university hospital.ParticipantsOne hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS.InterventionsThe authors collected demographic, mechanical ventilation, imaging, laboratory, and outcome data. Primary outcome was the incidence of PNX/PMD. Multiple logistic regression analyses were performed to identify predictors of PNX/PMD.Measurements and main resultsPNX/PMD occurred in a total of 28 patients (24.1%), with 22 patients developing PNX (19.0%) and 13 developing PMD (11.2%). Mean time to development of PNX/PMD was 14 ± 11 days from intubation. The authors found no significant difference in mechanical ventilation parameters between patients who developed PNX/PMD and those who did not. Mechanical ventilation parameters were within recommended limits for protective ventilation in both groups. Ninety-five percent of patients with PNX/PMD had the Macklin effect (linear collections of air contiguous to the bronchovascular sheaths) on a baseline computed tomography scan, and tended to have a higher lung involvement at intensive care unit (ICU) admission (Radiographic Assessment of Lung Edema score 32.2 ± 13.4 v 18.7 ± 9.8 in patients without PNX/PMD, p = 0.08). Time from symptom onset to intubation and time from total bilirubin on day two after ICU admission were the only independent predictors of PNX/PMD. Mortality was 60.7% in patients who developed PNX/PMD versus 38.6% in those who did not (p = 0.04).ConclusionPNX/PMD occurs frequently in COVID-19 patients with ARDS requiring mechanical ventilation, and is associated with increased mortality. Development of PNX/PMD seems to occur despite use of protective mechanical ventilation and has a radiologic predictor sign.
| S-EPMC8054543 | biostudies-literature
Project description: Not available
| S-EPMC7527144 | biostudies-literature
Project description:Potential interactions between the SARS-CoV-2 virus and the human oral microbiota are currently investigated widely. Patients with COVID-19 requiring mechanical ventilation in an intensive care unit (ICU) setting are at high risk of developing severe complications, including ventilator-associated pneumonia, thus making oral health management important. The aim of this study was to evaluate the oral health status and assess the dysbiosis of cultivable oral bacteriota in COVID-19 patients hospitalized in an ICU with acute respiratory distress within 36 h following intubation. In this prospective cohort study, we recruited 56 adult COVID-19 patients that qualified for mechanical ventilation in the Temporary ICU for COVID-19 Patients of the University Hospital in Krakow. On admission to the ICU, oral health of patients was assessed using the modified Beck Oral Assessment Score (BOAS). Four oral habitats were sampled, namely the buccal mucosa, tongue, buccal dental surface and gingival pocket. Microorganisms were identified by MALDI/TOF mass spectrometry. The mean age of the study population was 66.5 ± 12.7 years, there were 24 (42.9%) females. All patients included in this study were intubated and ventilated in the ICU, with a corresponding high mortality rate (76.8%). On admission to ICU, 76.8% subjects scored 11-20 on the BOAS scale (median 12 [IQR 10-14]), indicating moderate or severe dysfunction of oral health. Potentially pathogenic bacteria were identified in the oral microbiota samples, including Acinetobacter baumannii, Enterococcus faecalis, Escherichia coli and Klebsiella pneumoniae in 23.2%, 39.3%, 17.9%, and 19.6% of patients, respectively. Lactobacillus spp. were present in 57.1% subjects. The mean CFU counts of all bacteria strains in dental brushes were 9.3E+5 (1.4E+6) and in gingival pockets 7.6E+5 (1.4E+6). The highest CFU counts were observed for Enterococcus spp. and, Lactobacillus spp., although these did not differ significantly from CFU counts of Streptococcus spp. and Staphylococcus spp. In this report we comprehensively characterized the oral health condition and cultivable oral bacteriota in COVID-19 patients hospitalized in an ICU with acute respiratory distress within 36 h following intubation. The oral bacteriota showed significant qualitative and quantitative dysbiosis. Hospitalization in an ICU and mechanical ventilation are important factors leading to oral dysbiosis in SARS-CoV-2 patients.
| S-EPMC9651008 | biostudies-literature
Project description:Severe COVID-19 can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers. This presentation is consistent with cytokine release syndrome in chimeric antigen receptor T cell therapy, for which IL-6 blockade is approved treatment. We assessed effectiveness and safety of IL-6 blockade with tocilizumab in a single-center cohort of patients with COVID-19 requiring mechanical ventilation. The primary endpoint was survival probability post-intubation; secondary analyses included an ordinal illness severity scale integrating superinfections. Outcomes in patients who received tocilizumab compared to tocilizumab-untreated controls were evaluated using multivariable Cox regression with propensity score inverse probability weighting (IPTW). 154 patients were included, of whom 78 received tocilizumab and 76 did not. Median follow-up was 47 days (range 28-67). Baseline characteristics were similar between groups, although tocilizumab-treated patients were younger (mean 55 vs. 60 years), less likely to have chronic pulmonary disease (10% vs. 28%), and had lower D-dimer values at time of intubation (median 2.4 vs. 6.5 mg/dL). In IPTW-adjusted models, tocilizumab was associated with a 45% reduction in hazard of death [hazard ratio 0.55 (95% CI 0.33, 0.90)] and improved status on the ordinal outcome scale [odds ratio per 1-level increase: 0.59 (0.36, 0.95)]. Though tocilizumab was associated with an increased proportion of patients with superinfections (54% vs. 26%; p<0.001), there was no difference in 28-day case fatality rate among tocilizumab-treated patients with versus without superinfection [22% vs. 15%; p=0.42]. In this cohort of mechanically ventilated COVID-19 patients, tocilizumab was associated with a decreased likelihood of death despite higher superinfection occurrence. Randomized controlled trials are urgently needed to confirm these findings.
| S-EPMC7302290 | biostudies-literature
Project description:BackgroundSevere coronavirus disease 2019 (COVID-19) can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers, consistent with cytokine release syndrome for which IL-6 blockade is an approved treatment.MethodsWe assessed effectiveness and safety of IL-6 blockade with tocilizumab in a single-center cohort of patients with COVID-19 requiring mechanical ventilation. The primary endpoint was survival probability postintubation; secondary analyses included an ordinal illness severity scale integrating superinfections. Outcomes in patients who received tocilizumab compared with tocilizumab-untreated controls were evaluated using multivariable Cox regression with propensity score inverse probability of treatment weighting (IPTW).Results154 patients were included, of whom 78 received tocilizumab and 76 did not. Median follow-up was 47 days (range, 28-67). Baseline characteristics were similar between groups, although tocilizumab-treated patients were younger (mean: 55 vs 60 years), less likely to have chronic pulmonary disease (10% vs 28%), and had lower D-dimer values at time of intubation (median: 2.4 vs 6.5 mg/dL). In IPTW-adjusted models, tocilizumab was associated with a 45% reduction in hazard of death (HR, .55; 95% CI, .33-.90) and improved status on the ordinal outcome scale [OR per 1-level increase, .58; .36-.94). Although tocilizumab was associated with an increased proportion of patients with superinfections (54% vs 26%; P < .001), there was no difference in 28-day case fatality rate among tocilizumab-treated patients with versus without superinfection (22% vs 15%; P = .42). Staphylococcus aureus accounted for ~50% of bacterial pneumonia.ConclusionsIn this cohort of mechanically ventilated COVID-19 patients, tocilizumab was associated with lower mortality despite higher superinfection occurrence.
| S-EPMC7454462 | biostudies-literature
Project description:ObjectiveWe determined the prevalences of hyperoxemia and excessive oxygen use, and the epidemiology, ventilation characteristics and outcomes associated with hyperoxemia in invasively ventilated patients with coronavirus disease 2019 (COVID-19).MethodsPost hoc analysis of a national, multicentre, observational study in 22 ICUs. Patients were classified in the first two days of invasive ventilation as 'hyperoxemic' or 'normoxemic'. The co-primary endpoints were prevalence of hyperoxemia (PaO2 > 90 mmHg) and prevalence of excessive oxygen use (FiO2 ≥ 60% while PaO2 > 90 mmHg or SpO2 > 92%). Secondary endpoints included ventilator settings and ventilation parameters, duration of ventilation, length of stay (LOS) in ICU and hospital, and mortality in ICU, hospital, and at day 28 and 90. We used propensity matching to control for observed confounding factors that may influence endpoints.ResultsOf 851 COVID-19 patients, 225 (26.4%) were classified as hyperoxemic. Excessive oxygen use occurred in 385 (45.2%) patients. Acute respiratory distress syndrome (ARDS) severity was lowest in hyperoxemic patients. Hyperoxemic patients were ventilated with higher positive end-expiratory pressure (PEEP), while rescue therapies for hypoxemia were applied more often in normoxemic patients. Neither in the unmatched nor in the matched analysis were there differences between hyperoxemic and normoxemic patients with regard to any of the clinical outcomes.ConclusionIn this cohort of invasively ventilated COVID-19 patients, hyperoxemia occurred often and so did excessive oxygen use. The main differences between hyperoxemic and normoxemic patients were ARDS severity and use of PEEP. Clinical outcomes were not different between hyperoxemic and normoxemic patients.
| S-EPMC10155497 | biostudies-literature
Project description:COVID-19 has created a general state of worry and distress, especially among vulnerable groups such as those with psychiatric diagnoses. Worldwide, psychiatric care provision has drastically suffered during the pandemic, with many patients unable to access proper care, which may have implications for increased mental health consequences in patients with psychiatric disorders (e.g., relapse and suicide). This cross-sectional study used structural equation modeling to investigate COVID-19-related trauma and distress among Arab psychiatric population during COVID-19 quarantine. Patients with pre-existing psychiatric disorders (N = 168) completed an online survey that comprised the Depression Anxiety Stress Scale 21 (DASS-21), the Impact of Event Scale-Revised (IES-R), and a questionnaire on COVID-19-related attitudes/perceptions, sources of information, used protective measures, and socio-demographic information. Respondents commonly reported feeling down-hearted/blue, trouble concentrating, along with symptoms of avoidance and rumination related to the pandemic. Patients with depression and sleep disorders expressed higher COVID-19-related trauma than patients with other disorders. Perceived physical health mediated the effect of co-morbid chronic physical disorders on COVID-19 trauma, psychological distress, perceived vulnerability to COVID-19, and perceived likelihood of recovery in case of contracting COVID-19. Perceived physical health and perceived vulnerability to COVID-19 were strong direct predictors of COVID-19-related trauma and psychological distress. Staying at home negatively predicted COVID-19 trauma and exerted an indirect negative effect on psychological distress via COVID-19 trauma. COVID-19 trauma, age, and marital status directly predicted psychological distress, with COVID-19 trauma being the strongest predictor. Educational level, income, having family members working in the medical field, keeping up to date with the news on deaths/infected cases or the development of COVID-19 drugs or vaccines, satisfaction with available information on COVID-19, and using different protective measures were not associated with significant differences in COVID-19 trauma and psychological distress scores. Immuno-psychiatric interventions should be designed to target COVID-19-trauma and distress among younger single patients with perceived poor physical health, especially those diagnosed with depression and sleep disorders.
| S-EPMC8777039 | biostudies-literature