The mortality rates of COVID-19 vary across the globe. While some risk factors for poor prognosis of the disease are known, regional differences are suspected. We reviewed the risk factors for critical outcomes of COVID-19 according to the location of the infected patients, from various literature databases from January 1 through June 8, 2020. Candidate variables to predict the outcome included patient demographics, underlying medical conditions, symptoms, and laboratory findings. The risk factors in the overall population included sex, age, and all inspected underlying medical conditions. Symptoms of dyspnea, anorexia, dizziness, fatigue, and certain laboratory findings were also indicators of the critical outcome. Underlying respiratory disease was associated higher risk of the critical outcome in studies from Asia and Europe, but not North America. Underlying hepatic disease was associated with a higher risk of the critical outcome from Europe, but not from Asia and North America. Symptoms of vomiting, anorexia, dizziness, and fatigue were significantly associated with the critical outcome in studies from Asia, but not from Europe and North America. Hemoglobin and platelet count affected patients differently in Asia compared to those in Europe and North America. Such regional discrepancies should be considered when treating patients with COVID-19.

The appropriate strategy for enteral feeding remains a matter of debate. We hypothesized that continuous enteral feeding would result in higher rates of achieving target nutrition during the first 7 days compared with intermittent enteral feeding. We conducted an unblinded, single-center, parallel-group, randomized controlled trial involving adult patients admitted to the medical intensive care unit who required mechanical ventilation to determine the efficacy and safety of continuous enteral feeding for critically ill patients compared with intermittent enteral feeding. The primary endpoint was the achievement of ≥80% of the target nutrition requirement during the first 7 days after starting enteral feeding. A total of 99 patients were included in the modified intention-to-treat analysis (intermittent enteral feeding group, n = 49; continuous enteral feeding group, n = 50). The intermittent enteral feeding group and continuous enteral feeding group received 227 days and 226 days of enteral feeding, respectively. The achievement of ≥80% of the target nutrition requirement occurred significantly more frequently in the continuous enteral feeding group than in the intermittent enteral feeding group (65.0% versus 52.4%, respectively; relative risk, 1.24; 95% confidence interval, 1.06–1.45; p = 0.008). For patients undergoing mechanical ventilation, continuous enteral feeding significantly improved the achievement of target nutrition requirements.

Lung ultrasound has proven to be useful in detecting pneumothorax, interstitial syndrome, and lung consolidations. It is easily applied at the bedside, real time and free of radiation hazards. Recently, the use of lung ultrasound has moved from being a diagnostic tool to a monitoring tool for lung aeration quantification. This article reviews the use of lung ultrasound in monitoring acute pulmonary edema, acute respiratory distress syndrome and pneumonia, and how it can be used to monitor changes during application of mechanical ventilation or other treatment for respiratory failure.

Background The mortality rates of the coronavirus disease 2019 (COVID-19) differ across the globe. While some risk factors for poor prognosis of the disease are known, regional differences are suspected. We reviewed the risk factors for critical outcomes in extensive number of studies according to the study location. Methods We searched the PubMed, Embase, Cochrane Library, and Web of Science literature databases from January 1, 2020 to June 8, 2020. We defined the critical outcome as death, admission to the intensive care unit, or critical type of COVID-19. Candidate variables to predict the critical outcome included patient demographics, underlying medical condition, symptoms, and laboratory findings. Pooled relative risks (RRs) and standardized mean differences were calculated for each variable and were also determined according to the study’s continent. Results A total of 80 studies were included from Asia (n = 48), Europe (n = 22), and North America (n = 10). The risk factors for the critical outcome in the overall population included male sex, age, and all inspected underlying medical conditions. Symptoms of dyspnea, anorexia, dizziness, fatigue, and certain laboratory findings were also indicators of the critical outcome. Subgroup analysis was performed according to study location, and we found several discrepancies. Underlying respiratory disease was associated higher risk of the critical outcome in studies from Asia (pooled RR 2.16 [1.60–2.92] and Europe (pooled RR 1.50 [1.32–1.69]), but not North America. Underlying hepatic disease was associated with a higher risk of the critical outcome from Europe (pooled RR 1.34 [1.15–1.56]), but not from Asia and North America. Symptoms of vomiting (pooled RR 2.43 [1.60–3.69]), anorexia (pooled RR 2.38 [1.45–3.91]), dizziness (pooled RR 2.23 [1.51–3.28]), and fatigue (pooled RR 1.92 [1.23–3.02]) were significantly associated with the critical outcome in studies from Asia, but not from Europe and North America. Hemoglobin and platelet count affected patients differently in Asia compared to those in Europe and North America. Conclusions There are several discrepancies among risk factors for critical outcomes among patients with COVID-19 according to the location of the infected patient.