By mid-November 2022, 6.6 million people had died from coronavirus disease 2019 and more than 600 million had been infected with its pathogen. 1 Early in the pandemic, the spread of the disease varied by region; by1 July 2020, fewer than 20 cases per million population per week were reported in Australia but more than 400 per million in the Americas, 300 per million in Europe, and nearly 200 per million per week in the Middle East. 2 Where the prevalence of COVID-19 was high, multisite and population-based reports described reduced emergency department (ED) activity of varying degrees. [3][4][5][6][7] In the United States, three multisite studies that compared ED activity in 2020 with activity during the corresponding period of 2019 found reductions in all-cause ED presentation numbers of 26% to 64%. [3][4][5] Studies that compared weekly presentation numbers immediately before and after the declaration of the pandemic found declines ranging from 16% to 66%. [6][7] The characteristics of ED presentations had also changed; there were fewer presentations by children, 3 with non-emergency conditions, 8 or with life-threatening conditions such as acute myocardial infarction and stroke, 9 and more by people with infectious respiratory conditions. [3][4] The few publications that describe the impact of COVID-19 on ED activity in Australia 10-12 have typically assessed only short periods and did not take underlying seasonality and progressive trends into account. As the number of COVID-19 cases in Australia during 2020-21 was lower than in many countries, local data are needed to assess the impact of COVID-19 and related public health measures on ED activity. We therefore examined ED presentation numbers in Queensland during the COVID-19 pandemic to mid-2021. MethodsWe undertook a retrospective analysis of presentations to public hospital EDs in Queensland (2020 population: about 5.2 million people across 1.85 million square kilometres) during 1 January 2018 -30 June 2021. Following the declaration of the COVID-19 pandemic by the World Health Organization on 11 March 2020, an array of public health measures were introduced at various times in Queensland, including closure of schools and non-essential businesses, quarantine for returning overseas travellers, and restrictions on movement in public spaces. Data collection and cleaningWe analysed routinely collected administrative health data from 105 EDs that report to the Emergency Data Collection, a
Our results suggest that it may be feasible to adopt a conservative approach as the first-line treatment of primary spontaneous pneumothorax in clinically stable patients. However, given the limitations of this study, a large randomised controlled trial is required to conclusively prove this assertion.
Aim Hospitalization, often with intervention, is the recommended management algorithm by multiple international respiratory societies for management of a secondary spontaneous pneumothorax (SSP). Over recent years we adopted a conservative approach to SSPs. We undertook a retrospective cohort study of SSP to establish the safety profile of a conservative approach for these previously unstudied patients. Methods We reviewed all cases of SSP presenting to our institution from 2012 to 2019 using the 2010 British Thoracic Society definition of an SSP. Age, gender, smoking status, underlying lung disease, pneumothorax size estimate (using the Collins method), nature of intervention, inpatient duration, and any additional complications were recorded. The χ 2 ‐test and Mann–Whitney U ‐test were used for comparison of categorical variables and categorical/continuous variables, respectively. Results Eighty‐two cases were included in the final analysis. Of them, 64 had an interpleural distance at the hilum of 1cm or greater, meeting British Thoracic Society criteria for a pleural intervention. Of these 64 patients, 25 (39%) were managed conservatively. No patient managed conservatively required a subsequent intervention. When stratified for conservative or invasive management, there was no significant difference in age, gender, smoking status, or presence of underlying lung disease between the groups. There was a significant difference in size of the pneumothorax with conservative management having smaller pneumothoraces (37% versus 54%, P < 0.001) and a shorter inpatient stay (conservative, 7.9 days; intercostal catheter, 9 days; P = 0.004). Conclusion We have demonstrated success with conservative management of SSPs where a significant proportion of them met accepted criteria for a pleural intervention.
Introduction Right ventricular (RV) and pulmonary vascular dysfunction appear to be common in sepsis. RV performance is frequently assessed in isolation, yet its close relationship to afterload means combined analysis with right ventricular outflow tract (RVOT) Doppler and RV–pulmonary arterial (RV–PA) coupling may be more informative than standard assessment techniques. Data on feasibility and utility of these parameters in sepsis are lacking and were explored in this study. Methods This is a retrospective study over a 3-year period of one-hundred and thirty-one patients admitted to ICU with sepsis who underwent transthoracic echocardiography (TTE) with RVOT pulsed wave Doppler. RVOT Doppler flow and RV–PA coupling was evaluated alongside standard measurements of RV systolic function and pulmonary pressures. RVOT Doppler analysis included assessment of pulmonary artery acceleration time (PAAT), velocity time integral and presence of notching. RV–PA coupling was assessed using tricuspid annular planar systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio. Results PAAT was measurable in 106 (81%) patients, and TAPSE/PASP was measurable in 77 (73%). Seventy-three (69%) patients had a PAAT of ≤ 100 ms suggesting raised pulmonary vascular resistance (PVR) is common. RVOT flow notching occurred in 15 (14%) of patients. TRV was unable to be assessed in 24 (23%) patients where measurement of PAAT was possible. RV dysfunction (RVD) was present in 28 (26%), 26 (25%) and 36 (34%) patients if subjective assessment, TAPSE < 17 mm and RV dilatation definitions were used, respectively. There was a trend towards shorter PAAT with increasing severity of RVD. RV–PA uncoupling defined as a TAPSE/PASP < 0.31 mm/mmHg was present in 15 (19%) patients. As RV dilatation increased the RV–PA coupling ratio decreased independent of LV systolic function, whereas TAPSE appeared to be more susceptible to changes in LV systolic function. Conclusion Raised PVR and RV–PA uncoupling is seen in a significant proportion of patients with sepsis. Non-invasive assessment with TTE is feasible. The role of these parameters in assisting improved definitions of RVD, as well as their therapeutic and prognostic utility against standard parameters, deserves further investigation.
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