Background In patients with COVID-19-related acute respiratory failure (ARF), awake prone positioning (AW-PP) reduces the need for intubation in patients treated with high-flow nasal oxygen (HFNO). However, the effects of different exposure times on clinical outcomes remain unclear. We evaluated the effect of AW-PP on the risk of endotracheal intubation and in-hospital mortality in patients with COVID-19-related ARF treated with HFNO and analyzed the effects of different exposure times to AW-PP. Methods This multicenter prospective cohort study in six ICUs of 6 centers in Argentine consecutively included patients > 18 years of age with confirmed COVID-19-related ARF requiring HFNO from June 2020 to January 2021. In the primary analysis, the main exposure was awake prone positioning for at least 6 h/day, compared to non-prone positioning (NON-PP). In the sensitivity analysis, exposure was based on the number of hours receiving AW-PP. Inverse probability weighting–propensity score (IPW-PS) was used to adjust the conditional probability of treatment assignment. The primary outcome was endotracheal intubation (ETI); and the secondary outcome was hospital mortality. Results During the study period, 580 patients were screened and 335 were included; 187 (56%) tolerated AW-PP for [median (p25–75)] 12 (9–16) h/day and 148 (44%) served as controls. The IPW–propensity analysis showed standardized differences < 0.1 in all the variables assessed. After adjusting for other confounders, the OR (95% CI) for ETI in the AW-PP group was 0.36 (0.2–0.7), with a progressive reduction in OR as the exposure to AW-PP increased. The adjusted OR (95% CI) for hospital mortality in the AW-PP group ≥ 6 h/day was 0.47 (0.19–1.31). The exposure to prone positioning ≥ 8 h/d resulted in a further reduction in OR [0.37 (0.17–0.8)]. Conclusion In the study population, AW-PP for ≥ 6 h/day reduced the risk of endotracheal intubation, and exposure ≥ 8 h/d reduced the risk of hospital mortality.
Despite treatment with potent and effective combination antiretroviral medications, the incidence of non-Hodgkin lymphoma (NHL) in the population living with HIV/AIDS remains significantly higher than that in noninfected individuals. The majority of the HIV-infected patients with NHL present with advanced stage extranodal disease of the B-cell phenotype. Lymphomas are the second most common tumors involving the heart in HIV-infected patients. Although the heart may serve as the primary focus of the lymphoma, in most HIV-related cases, cardiac lymphomatous involvement is part of a metastatic process that originated elsewhere.
Tn order to assess the impact of the recent upsurge in pediatric drug research, the 1980 edition of the Physicians Desk Reference was reviewed for data and indications pertaining to pediatric and obstetric usage. A total of 1.133 entries were reviewed. Of these 71.9% were oral preparations, 20% parenteral, 1.6% various other routes of administration and 6.5% included multiple routes. Dosing data based on weight or surface area was provided in 27.8% of entries. Specific pediatric dosing data was provided in 40.9% of entries while pediatric usage was specifically contraindicated in 8.9% of entries. In 39.1% of entries no mention was made of pediatric usage and in 11.1% it was mentioned, but without clear recommendations or data. In 2.6% of entries use in pregnancy was approved while 10.3% contained a definite contraindication for such use. The remaining entries either failed to mention use in pregnancy (31.8%) or mentioned use in pregnancy but without definite recommendation (55.3%). Use in breast feeding mothers was mentioned in 27.9% of entries with data provided in 107 entries and a definite contraindication in 104. Data on overdose management was provided in 29.8% of entries. Marked variability was noted between drug classes and manufacturers in terms of the information provided. It is clear from the above analysis that a continued emphasis is needed by manufacturers on providing solid data pertaining to drug usage in pediatrics and obstetrics. York. Butorphanol (B), a new synthetic agonist-antagonist type analgesic, was evaluated in 34 patients aged 4-12 years requiring a parenteral medication for relief of pain following elective surgical procedures. B was administered IM when, in the estimate of the patient or the recovery room staff, an analgesic was required. Doses of B ranged from 0.01 mglkg to 0.02 mglkg, with most patients receiving 0.015 mglkg. Scores of pain intensity (0-3) and relief (0-4) were done prior to dosing and at hourly intervals for six hours following the dose, or until additional medication was required. Surgery inoluded orthopedic (12), abdominal (5))noncardiac thoracic ( 3 ) ) genitourinary (11) and miscellaneous (2) procedures. There were 19 male and 15 female patients. 16/34 patiems continued to experience good pain relief at the end of the six hour observation period. The mean length of time to remedication was 5.0 hr. with a 6 hr. maximum given. The range was 2-6 hr. At any given dose, pain relief tended to be better and more prolonged in the younger patients. This may derive from the increased sedation seen with B in the younger children. There was no significant difference between the three doses used in degree or duration of analgesic effect. Except for one patient who experienced transient urinary retention, sedation was the only significant side effect seen. This is the first reported dose ranging study of pain therapy in children. B, at a dose of 0.01-0.02 mglkg, provided good relief of post-operative pain in children. . . -60-hydr~x~cbrtisol (~~oHF), a normally occurring pol...
Introduction:The use of high-flow nasal oxygen (HFNO) is a simple method that can reduce intubation in patients with hypoxemic acute respiratory failure (ARF). Early and prolonged prone position has demonstrated benefits on mortality in mechanically ventilated patients and on intubation in awake patients with ARF. However, strategies to achieve adherence to awake prone positioning (APP) have not been previously described.Case and outcomes: We present six patients with ARF due to COVID-19 treated with HFNO and APP. The median (p25-75) of PaFiO 2 upon admission was 121 (112-175). The average duration of APP on the first day was 16 h (SD 5 h). Duration (median p25-75) in APP for the following 20 days was 13 (10-18) h/day. Several strategies such as the presence of a health care team, recreational activities, adaptation of the circadian rhythm, oral nutritional support, and analgesics were used to improve prone tolerance. None of the patients suffered from delirium, all were ambulating on discharge from the ICU and none require intubation. Conclusion:The case series presented show the feasibility of prolonged use of HFNO and APP in patients with COVID-19 and severe persistent hypoxemia and described strategies to enhance adherence.
50 neonates with RLF identified between 1/75 and 12/79 were compared with a group of matched controls without RLF. There was a significantly greater number of hours of oxygen exposure in the RLF group over the control group. Analysis of duration of exposure to Fi0 2 above room air is presented. No significant association was found with duration of exposure to Fi02). 5. RLF neonates were exposed to significantly longer periods of Fi02 less than .S than controls. Increased duration of oxygen exposure at any Fi02 seems to influence RLF development more than the actual magnitude of the FiOo. RLF CONTROL P* 'ichrs. S.D.
50 neonates with RLF identified between 1/75 and 12/79 were compared with a group of matched controls without RLF. There was a significantly greater number of hours of oxygen exposure in the RLF group over the control group. Analysis of duration of exposure to Fi0 2 above room air is presented. No significant association was found with duration of exposure to Fi02). 5. RLF neonates were exposed to significantly longer periods of Fi02 less than .S than controls. Increased duration of oxygen exposure at any Fi02 seems to influence RLF development more than the actual magnitude of the FiOo. RLF CONTROL P* 'ichrs. S.D.
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