Empfehlungen zur intensivmedizinischen Therapie von Patienten mit COVID-19 – 3. Version

Kluge, Stefan; Janssens, Uwe; Welte, Tobias; Weber‐Carstens, Steffen; Schälte, Gereon; Salzberger, Bernd; Gastmeier, Petra; Wepler, Martin; Westhoff, M.; Pfeifer, Michael; Hoffmann, Florian; Böttiger, Bernd W.; Marx, Gernot; Karagiannidis, C.

doi:10.1007/s00101-020-00833-3

Cited by 22 publications

(9 citation statements)

References 86 publications

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“…In the first weeks of the pandemic, lopinavir-ritonavir and hydroxychloroquine were frequently used due to some promising reports but later did not show clinical benefit compared to standard of care in randomized studies [ 19 , 20 ]. After the RECOVERY study demonstrated that low-dose dexamethasone reduced mortality in hospitalized COVID-19 patients who require respiratory support [ 21 ], German guidelines were adjusted accordingly [ 22 ], and dexamethasone was widely used at our hospital during the second phase of the pandemic. Studies on the efficacy of remdesivir in hospitalized COVID-19 patients have shown conflicting results.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Clinical Course of COVID-19 Patients Treated at a German Tertiary Center during the First and Second Waves in the Year 2020

Brehm

Heyer

Roedl

et al. 2021

JCM

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In this study, we directly compared coronavirus disease 2019 (COVID-19) patients hospitalized during the first (27 February–28 July 2020) and second (29 July–31 December 2020) wave of the pandemic at a large tertiary center in northern Germany. Patients who presented during the first (n = 174) and second (n = 331) wave did not differ in age (median [IQR], 59 years [46, 71] vs. 58 years [42, 73]; p = 0.82) or age-adjusted Charlson Comorbidity Index (median [IQR], 2 [1, 4] vs. 2 [0, 4]; p = 0.50). During the second wave, a higher proportion of patients were treated as outpatients (11% [n = 20] vs. 20% [n = 67]), fewer patients were admitted to the intensive care unit (43% [n = 75] vs. 29% [n = 96]), and duration of hospitalization was significantly shorter (median days [IQR], 14 [8, 34] vs. 11 [5, 19]; p < 0.001). However, in-hospital mortality was high throughout the pandemic and did not differ between the two periods (16% [n = 27] vs. 16% [n = 54]; p = 0.89). While novel treatment strategies and increased knowledge about the clinical management of COVID-19 may have resulted in a less severe disease course in some patients, in-hospital mortality remained unaltered at a high level. These findings highlight the unabated need for efforts to hamper severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) transmission, to increase vaccination coverage, and to develop novel treatment strategies to prevent mortality and decrease morbidity.

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Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Clinical Course of COVID-19 Patients Treated at a German Tertiary Center during the First and Second Waves in the Year 2020

Brehm

Heyer

Roedl

et al. 2021

JCM

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“…Most policy documents were from high income countries (HIC) such as USA, Italy, Canada and UK. Specifically, 136 policy documents (64.15%) were from HIC [ 26 , 28 – 33 , 37 – 40 , 42 – 46 , 48 – 58 , 60 , 61 , 63 , 71 – 74 , 76 , 77 , 79 – 82 , 85 – 94 , 99 – 107 , 110 , 112 , 113 , 116 , 117 , 119 , 121 – 124 , 127 , 129 , 130 , 132 , 135 , 137 – 139 , 143 – 145 , 147 – 154 , 156 , 158 , 159 , 161 , 163 – 165 , 167 – 172 , 174 – 176 , 179 – 182 , 184 , 185 , 188 – 204 , 206 , 207 , 220 , 222 , 223 , 226 , 228 , 229 , 233 ], 39 policy documents (18.40%) were from lower middle income countries (LMIC) [ …”

Section: Resultsmentioning

confidence: 99%

“…The policy documents were divided as such because workers are usually provided masks/PPE as a part of safety protocol across different working environments such as healthcare setting, shopping centers, transportation centers etc. Among policy documents that were not targeted at workers, the target groups were: “patients” ( n = 6; 2.80%) [ 55 , 56 , 94 , 100 , 132 , 217 ] and “population wide” ( n = 30; 14.15%) [ 24 , 33 , 50 , 52 , 59 , 75 , 84 , 89 , 95 , 111 , 114 , 118 , 129 , 140 , 141 , 154 , 165 , 172 , 191 , 196 , 205 , 208 , 209 , 212 , 214 – 216 , 224 , 229 , 232 ].…”

Section: Resultsmentioning

confidence: 99%

Assessment of health equity consideration in masking/PPE policies to contain COVID-19 using PROGRESS-plus framework: a systematic review

et al. 2021

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Introduction There is increasing evidence that COVID-19 has unmasked the true magnitude of health inequity worldwide. Policies and guidance for containing the infection and reducing the COVID-19 related deaths have proven to be effective, however the extent to which health inequity factors were considered in these policies is rather unknown. The aim of this study is to measure the extent to which COVID-19 related policies reflect equity considerations by focusing on the global policy landscape around wearing masks and personal protection equipment (PPE). Methods A systematic search for published documents on COVID-19 and masks/PPE was conducted across six databases: PubMed, EMBASE, CINAHL, ERIC, ASSIA and Psycinfo. Reviews, policy documents, briefs related to COVID-19 and masks/PPE were included in the review. To assess the extent of incorporation of equity in the policy documents, a guidance framework known as ‘PROGRESS-Plus’: Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus (age, disability etc.) was utilized. Results This review included 212 policy documents. Out of 212 policy documents, 190 policy documents (89.62%) included at least one PROGRESS-plus component. Most of the policy documents (n = 163, 85.79%) focused on “occupation” component of the PROGRESS-plus followed by personal characteristics associated with discrimination (n = 4;2.11%), place of residence (n = 2;1.05%) and education (n = 1;0.53%). Subgroup analysis revealed that most of the policy documents (n = 176, 83.01%) were focused on “workers” such as healthcare workers, mortuary workers, school workers, transportation workers, essential workers etc. Of the remaining policy documents, most were targeted towards whole population (n = 30; 14.15%). Contrary to “worker focused” policy documents, most of the ‘whole population focused’ policy documents didn’t have a PROGRESS-plus equity component rendering them equity limiting for the society. Conclusion Our review highlights even if policies considered health inequity during the design/implementation, this consideration was often one dimensional in nature. In addition, population wide policies should be carefully designed and implemented after identifying relevant equity related barriers in order to produce better outcomes for the whole society.

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“…Die Kriterien für die rote Kategorie basieren auf Empfehlungen für eine intensivmedizinische Behandlung, die maßgeblich durch erhöhte Atemfrequenz > 30/min, Hypoxämie sowie Dyspnoe beschrieben werden [ 3 , 4 , 9 , 10 ]. Dies unterstützt auch das Ergebnis von Fistera et al., die im Rahmen einer Validierung eines Modells zur sicheren und effizienten Triage an der Uniklinik Essen feststellten, dass Patienten mit einem auffälligen CT und normalen Vitalparametern nach Hause entlassen werden konnten, während Patienten mit einer erhöhten Atemfrequenz, einer reduzierten Sättigung oder einer Ruhedyspnoe stationär überwacht werden mussten [ 2 ].…”

Section: Details Der Entscheidungshilfeunclassified

“…14 % einen schweren und in ca. 5 % einen kritischen Verlauf [ 3 , 7 ]. Eine der Herausforderungen für den Rettungsdienst ist es, die schwer und kritisch Erkrankten von denjenigen zu differenzieren, die ggf.…”

Section: Introductionunclassified

Entscheidungshilfe zur Patientenzuweisung bei Verdacht auf COVID-19

Thies

Urban

Kraus

et al. 2021

Notfall Rettungsmed

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ZusammenfassungWährend einer Pandemielage sind Patienten mit Verdacht auf COVID-19 auch im Rahmen von Rettungsdienstalarmierungen zu versorgen. Um ein adäquates Vorgehen zu etablieren, ist die Entscheidungshilfe zur Patientenzuweisung bei Verdacht auf COVID-19 für die Rettungsdienstmitarbeiter sowie für die Notärzte im bayerischen Rettungsdienst erstellt worden. Die Entscheidungshilfe schließt die aktuellen Leitlinien und Empfehlungen zum Thema COVID-19 ein. Für die Darstellung der Entscheidungshilfe wurde ein Flussdiagramm in DIN-A4-Format gewählt, welches nach dem im Rettungsdienst etablierten ABCDE-Schema (A-Airway, B-Breathing, C-Circulation, D-Disability, E-Environment/Exposure)aufgebaut ist. Das Flussdiagramm ermöglicht eine Kategorisierung der Patienten in drei Stufen, welche anhand von (Vital‑)Parametern und Kriterien wie Risikofaktoren und spezifischen Rahmenbedingungen erfolgt. Ziel ist es, Notärzten und Rettungsdienstmitarbeitern eine Orientierungshilfe für die Beurteilung der Patienten sowie daraus entstehende Transportentscheidung mit gegebenenfalls geeigneter Zielklinik an die Hand zu geben.

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Empfehlungen zur intensivmedizinischen Therapie von Patienten mit COVID-19 – 3. Version

Cited by 22 publications

References 86 publications

Patient Characteristics and Clinical Course of COVID-19 Patients Treated at a German Tertiary Center during the First and Second Waves in the Year 2020

Patient Characteristics and Clinical Course of COVID-19 Patients Treated at a German Tertiary Center during the First and Second Waves in the Year 2020

Assessment of health equity consideration in masking/PPE policies to contain COVID-19 using PROGRESS-plus framework: a systematic review

Entscheidungshilfe zur Patientenzuweisung bei Verdacht auf COVID-19

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