In a large health system in the United States, investigators examined whether mortality, receipt of mechanical ventilation, and patient acuity changed over time among adult patients with COVID-19–related critical illness admitted to intensive care units.

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A 24/7 telemedicine respiratory therapist (eRT) service was set up as part of the established University of Pennsylvania teleICU (PENN E-LERT®) service during the COVID-19 pandemic, serving five hospitals and 320 critical care beds to deliver effective remote care in lieu of a unit-based RT. The eRT interventions were components of an evidence-based care bundle and included ventilator liberation protocols, low tidal volume protocols, tube patency, and an extubation checklist. In addition, the proactive rounding of patients, including ventilator checks, was included. A standardized data collection sheet was used to facilitate the review of medical records, direct audio–visual inspection, or direct interactions with staff. In May 2020, a total of 1548 interventions took place, 93.86% of which were coded as “routine” based on established workflows, 4.71% as “urgent”, 0.26% “emergent”, and 1.17% were missing descriptors. Based on the number of coded interventions, we tracked the number of COVID-19 patients in the system. The average intervention took 6.1 ± 3.79 min. In 16% of all the interactions, no communication with the bedside team took place. The eRT connected with the in-house respiratory therapist (RT) in 66.6% of all the interventions, followed by house staff (9.8%), advanced practice providers (APP; 2.8%), and RN (2.6%). Most of the interaction took place over the telephone (88%), secure text message (16%), or audio-video telemedicine ICU platform (1.7%). A total of 5115 minutes were spent on tasks that a bedside clinician would have otherwise executed, reducing their exposure to COVID-19. The eRT service was instrumental in several emergent and urgent critical interventions. This study shows that an eRT service can support the bedside RT providers, effectively monitor best practice bundles, and carry out patient–ventilator assessments. It was effective in certain emergent situations and reduced the exposure of RTs to COVID-19. We plan to continue the service as part of an integrated RT service and hope to provide a framework for developing similar services in other facilities.

that the increased margin favored the TAD by 20% as compared to the SGD (SGD0.51-TAD 0.31). Mann-Whitney test was used to evaluate differences in cost per dressing type U=118, p 001, and number of dressing changes required by dressing type U=601, p=.01. Both results favored the TAD. Kendall's tau correlation revealed that the costs were significantly greater in patients who received SGD τ (79), p<.001. Skin irritation was measured using a color scale and skin tears were measured using the Payne-Martin skin tear assessment tool. Patients did not differ by dressing type in the development of skin irritation (U = 763, p= .693), or development of skin tears (U = 761.5, p = .584). Conclusions: Based on these findings use of TAD can be recommended as not inferior to the current practice of using gauze and tape.Introduction: Children requiring ECLS for acute respiratory failure from critical pertussis pneumonia have an extremely poor prognosis. The purpose of this study is to assess the influence of clinical factors including initial ECLS mode (VV-venovenous or VA-venoarterial) and duration of pre-ECLS mechanical ventilation on outcome in this critically ill patient population. Methods: The Extracorporeal Life Support Organization's registry was retrospectively queried for pediatric patients (age 30 days to 18 years) with the diagnosis of pertussis from 1986 to 2012. Demographic, clinical, and outcome data were extracted. Only first runs were included. Patients were divided into survivors and nonsurvivors. Regression analysis was used to assess the impact of various clinical factors as well as ECLS mode and the duration of pre-ECLS mechanical ventilation on mortality. Results are expressed as an odds ratio (OR) and 95% confidence interval (CI); p<0.05 was considered significant. Results: There were 146 patients with 52 survivors (35.6%) and 94 non-survivors (64.4%). There were no significant differences between the groups with respect to age, weight, gender, race, and pre-ECLS ventilation type, and pre-ECLS hemodynamics. There were 18.5% VV and 79.5% VA primary cannulations. There was no difference between the survivors and non-survivors with respect to ECLS mode (33.3% vs. 36.2%, p=.96). Survivors had a longer duration of pre-ECLS ventilation (95 ± 65 vs. 82 ± 125, p=0.003). In multivariate regression models, lower pre-ECLS peak inspiratory pressure (PIP) (OR 0.96, 95%CI 0.92-1.00, p=0.047), higher pre-ECLS SaO2 (OR 1.06, 95%CI 1.02-1.10, p=0.004), no vasodilator drug use (OR 4.51, p=0.041), and higher HCO3 (OR 1.08, 95%CI 1.01-1.16, p=0.018) showed a significant increased odds of survival. ECLS mode (VA: OR 1.2, 95% CI 0.28-5.1, p=0.81) and duration of pre-ECLS mechanical ventilation (OR 1.0, 95% CI 1.0-1.01, p=0.233) did not. Conclusions: Children requiring ECLS for pertussis pneumonia have a low survival which is best predicted by the severity of physiologic derangement. Early initiation of ECLS may not improve outcome, however this may reflect earlier utilization of ECLS in more critically ill patients. Additionall...