ObjectiveTo systematically review the application of extracorporeal membrane oxygenation (ECMO) in patients with coronavirus disease 2019 (COVID-19).MethodsPubMed, The Cochrane Library, EMbase, CBM, WanFang Data and CNKI databases were searched for studies on ECMO for COVID-19 from December 1st, 2019 to December 31st, 2020. Two researchers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 24 studies were included, involving 1 576 acute respiratory distress syndrome (ARDS) patients with COVID-19. The overall mortality of patients was 27.3% (430/1 576). The rate of ECMO treatment was 4.68% (379/1576), and the survival rate was 69.4% (263/379). The mean duration of mechanical ventilation prior to ECMO treatment for ARDS patients ranged from 2.07±0.40 to 15.89±13.0 days, compared with 1.64±0.78 days and 29.9±3.60 days for ECMO treatment. Of the 11 studies included in the meta-analysis, 84.0% (405/482) patients with ARDS received conventional treatment with COVID-19, and 16.0% (77/482) received ECMO treatment on the basis of conventional treatment with ARDS. Results of meta-analysis showed that there was statistically significant difference in the survival rate of ARDS patients with COVID-19 treated with conventional therapy combined with ECMO or with conventional therapy alone (RR=1.27, 95%CI 1.00 to 1.62, P=0.05).ConclusionsThis study suggests that the survival rate of COVID-19 patients after ECMO treatment has a tendency to improve. Due to the limitation of quantity and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.
Since the outbreak of coronavirus disease 2019 (COVID-19), health authorities at all levels have issued many prevention and control schemes, guidelines, and notices, and medical institutions have also formulated hospital-level COVID-19 prevention and control measures accordingly. However, the epidemic prevention and control work can only be done well when the prevention and control measures are effectively implemented. West China Hospital of Sichuan University has adopted the two-level (hospital-level and department-level) supervision. By clarifying the content and frequency of two-level supervision and adopting multiple forms of supervision, a complete supervision system covering the whole hospital has been formed. Through supervision, risk points in prevention and control were identified and continuous improvement was carried out to promote the implementation of prevention and control measures. This paper introduces the application of two-level supervision in COVID-19 prevention and control in West China Hospital of Sichuan University, providing a reference for peers.
ObjectiveTo explore the application effect of the new in-hospital blood glucose management model for patients with stroke and diabetes mellitus during the epidemic of coronavirus disease 2019.MethodsA total of 120 patients with stroke and diabetes mellitus who were admitted to Mianyang Central Hospital and were consulted by the Department of Endocrinology between October 1st 2019 and April 12th 2020 were recruited. Patients who used the traditional consultation model for blood glucose management between October 1st 2019 and January 19th 2020 were classified as the control group (60 cases). Patients who were managed by the virtual ward of remote blood glucose management combined with the video consultation mode between January 20th 2020 and April 12th 2020 were classified as the observation group (60 cases). The basic conditions, the time to reach target blood glucose, the completion time of the consultation, the accuracy of blood glucose related data, the satisfaction rate of the consultation, the rate of reaching target blood glucose, the incidence of hypoglycemia, the blood glucose fluctuation (standard deviation of blood glucose level, maximum blood glucose fluctuation range), the incidence of nosocomial infections, diabetes mellitus diagnosis and treatment related expenses, and average hospitalization expenses of the two groups were compared.ResultsThere was no significant difference in the basic conditions between the two groups of patients (P>0.05). The time to reach target blood glucose [(5.38±2.16) vs. (8.18±2.63) d], completion time ofthe consultation [(4.33±1.51) vs. (17.97±3.23) h], incidence of hypoglycemia (6.67% vs. 21.67%), standard deviation of blood glucose level [(2.16±0.34) vs. (2.52±0.34) mmol/L] and maximum blood glucose fluctuation range [(5.72±1.36) vs. (6.34±1.51) mmol/L] of the observation group were lower than those of the control group, the accuracy rate of blood glucose related data (100.00% vs. 83.33%), satisfaction rate of the consultation (93.33% vs. 73.33%) and rate of reaching target blood glucose (88.33% vs. 70.00%) of the observation group were higher than those of the control group, and the differences were statistically significant (P<0.05). There was no significant difference in the incidence of nosocomial infections, diabetes mellitus diagnosis and treatment related expenses, or average hospitalization expenses between the two groups of patients (P>0.05).ConclusionDuring the epidemic of coronavirus disease 2019, the combined video consultation model of remote blood glucose virtual ward for patients with stroke and diabetes mellitus has a good application effect, which has certain feasibility and clinical promotion value.
ObjectiveTo describe clinical significance of eosinopenia in patients with coronavirus disease 2019 (COVID-19).MethodsThis was a retrospective study conducted in three tertiary hospitals from Anhui province, China. A total of 59 patients with COVID-19 were consecutively reviewed from January 23, 2020 to March 10, 2020.ResultsThe median age of patients with COVID-19 was 39 years old, and 32 were male, 30 with eosinopenia. Cough, sputum and fatigue were more common symptoms in eosinopenia patients compared with non-eosinopenia patients. The counts of blood lymphocytes (median: 101 cells/μL) in eosinopenia patients were significantly less than those of non-eosinopenia patients (median: 167 cells/μL, P<0.001). COVID-19 patients with eosinopenia had a higher proportion of corticosteroids therapy than patients with non-eosinopenia (50.0% vs. 13.8%, respectively, P=0.005). Decreased blood lymphocytes count was an independent risk factor for eosinopenia in COVID-19 patients (odds ratio 6.566, 95%CI 1.101 - 39.173, P=0.039).ConclusionsBlood eosinopenia is frequent in COVID-19 patients. Patients with eosinopenia have different clinical features compared to patients with non-eosinopenia. Decreased lymphocyte count is an independent risk factor for eosinopenia in COVID-19 patients.
Objective To investigate the clinical characteristics of patients with COVID-19 associated pulmonary aspergillosis (CAPA). Methods The clinical data of patients diagnosed with CAPA admitted to the First Affiliated Hospital of Soochow University from December 16, 2022 to February 2, 2023 were collected and analyzed. Results Among the 43 enrolled patients,16 patients required invasive mechanical ventilation, 44.19% (19/43) of them with critical novel coronavirus pneumonia, and 86.05% (37/43) had underlying diseases. The peak period of CAPA was 14 - 28 days after SARS-CoV-2 infection (48.84%, 21/43). In the laboratory results, 86.05% (37/43) of patients had varying degrees of lymphocyte reduction, with a lymphocyte count of 0.63 (0.33, 0.96) × 109/L, the median levels of procalcitonin, CRP, and erythrocyte sedimentation rate were all higher than the reference values. 38.89% (14/36) of patients tested positive for serum GM test, and 75.00% (9/12) of patients tested positive for bronchoalveolar lavage fluid GM test. Aspergillus fumigatus is the most common strain. Voriconazole is the most commonly used antifungal drug (86.05%), and other drugs used include caspofungin, posaconazole, isavuconazonium, and amphotericin B. Two patients received local treatment with amphotericin B under bronchoscopy. After treatment, 27 patients improved and were discharged. Conclusions The symptoms, signs, and imaging manifestations of CAPA are not significantly specific, and are prone to misdiagnosis and missed diagnosis. The mortality rate is high. For patients suspected of CAPA and those with CAPA risk factors, relevant examinations should be promptly improved to improve diagnosis and treatment efficiency.
ObjectiveTo investigate the clinical efficacy, side effects, influence on viral nucleic acid conversion and prognosis of glucocorticoid used in patients with coronavirus disease 2019.MethodsEighty-seven patients with severe and critical coronavirus disease 2019 were included to observe respiratory symptoms, blood oxygen saturation, pulmonary imaging absorption, weaning status, complicated bacterial infection and double infection, and prognosis after glucocorticoid use. Whether glucocorticoid use affects the patient's viral nucleic acid was analyzed.ResultsOf the 87 patients included, 55 were severe, 32 were critical, and 38 died, which included 30 critical patients. Seventy-seven patients accepted short-term glucocorticoid, and 10 patients accepted long-term glucocorticoid due to diffuse lung lesions and poor absorption. Eleven patients had bacterial infection and 4 cases had double infection. In 10 patients with long-term use of glucocorticoids, the lung lesions relieved, no double infection was found, but 1 patient maintained nucleic acid positive even after 5 weeks’ treatment.ConclusionsThe use of appropriate glucocorticoids is beneficial to the improvement of disease status and disease absorption in patients with coronavirus disease 2019. Long-term oral administration of glucocorticoids in patients with diffuse lung lesions may be beneficial to disease absorption.
This article discusses the concret implementation of day surgery in Ophthalmology Center, Beijing Tongren Hospital, Capital Medical University during the coronavirus disease 2019 epidemic and under the regular prevention and control, so as to provide a basis for ensuring the safety and effectiveness of clinical work in the special period. According to the requirements of health administration departments and the hospital for the prevention and control of epidemic, combining with the characteristics of concret work, the Ophthalmology Center carried out and accurately implemented a series of prevention and control management measures, and obtained good results in the clinical work on the basis of comprehensive security protection. From February to October, 2020, there were a total of 16 507 cases who underwent the day surgery in the Ophthalmology Center, with no surgical infection or suspected case of coronavirus disease 2019. The safety and quality management of epidemic prevention and control has played an active and effective role in the active development of day surgery in this center. The safe and optimized diagnosis and treatment process has reassured the patients and their families, and the strict implementation of protective measures by medical staff has ensured the safety of surgery and the work being proceed with smooth progress and high efficacy.
ObjectiveTo explore the effects of corticosteroid on peripheral blood T lymphocyte subsets in patients with coronavirus disease 2019 (COVID-19).MethodsThis was a retrospective study and 376 patients were included in the study. The patients were classified into three type: moderate type (118 patients), severe type (215 patients), critical type (43 patients). Six critical patients died. T lymphocyte subsets were analyzed and compared among these patients. In severe patients, T lymphocyte subsets were compared between no corticosteroid therapy patients (178 patients) and patients who were treated with corticosteroid for 3 to 5 days (37 patients).Results(1) In contrast with those in moderate patients, in severe patients total lymphocytes [(1359.2±597.9)×106 vs. (1703.7±702.4)×106/L, LSD-t=4.786, P<0.001], total T lymphocytes [(949.2±454.0)×106 vs. (1235.5±555.7)×106/L, LSD-t=5.175, P<0.001] and CD8+ T cells [(336.8±189.8)×106 vs. (461.7±242.8)×106/L, LSD-t=5.332, P<0.001] decreased significantly, and CD4+/CD8+ ratio (1.81±0.92 vs. 1.64±0.74, LSD-t=1.574, P=0.116) was increased. In contrast with those in severe patients, in critical patients CD4+/CD8+ ratio (2.23±1.24 vs. 1.81±0.92, LSD-t=2.627, P=0.009) increased and CD8+ T cells [(232.5±159.8)×106/L vs. (336.8±189.8)×106/L, LSD-t=2.867, P=0.004] decreased significantly, total lymphocytes [(1161.1±583.7)×106/L vs. (1359.2±597.9)×106/L, LSD-t=1.772, P=0.077], total T lymphocytes [(790.5±419.3)×106/L vs. (949.2±454.0)×106/L, LSD-t=1.846, P=0.066] also decreased but without significant difference. There was no significant difference between dead and survived critical patients. (2) In severe type, in contrast with no corticosteroid therapy patients, 37 patients were therapy with corticosteroid for 3 to 5 days, and their total T lymphocytes [(770.6±480.3)×106 vs. (986.3±440.7)×106/L, t=2.666, P=0.008] and CD4+/CD8+ ratio (1.30±0.73 vs. 1.91±0.92, t=3.771, P<0.001) were decreased significantly.ConclusionsIn COVID-19 patients, lymphocytes, T lymphocytes and CD8+ T cells are decreased, but CD4+/CD8+ ratio is increased, and these changes are positively related to the severity of the disease. After corticosteroid therapy, the increase of CD4+/CD8+ ratio is relieved, but T lymphocytes are decreased further.
Since its discovery in early 2020, the coronavirus disease 2019 (COVID-19) has spread rapidly around the world and is now a global challenge. As early respiratory rehabilitation can improve the patient’s respiratory function and quality of life, it deserves proper attention. Aimed to provide reference for the clinical rehabilitation, this paper summarizes the rehabilitation goals, rehabilitation treatments, nutrition therapy and psychotherapy for different types of COVID-19, on the basis of brief describing the etiological, pathological mechanism, clinical features and medical treatment.
ObjectiveTo explore the impact of different monochromatic reconstruction on image quality of early lesions of coronavirus disease 2019 (COVID-19).MethodsThe chest spectral CT images of 11 patients confirmed as COVID-19 in West China Hospital of Sichuan University between January and February 2020 were retrospectively analyzed. A total of 34 inflammatory lesions were found in the 11 cases. Seven groups of images were reconstructed from the raw data for each patient, including the conventional polychromatic image and different monochromatic images of 40-140 keV (with intervals of 20 keV). CT and standard deviation (SD) values of all lesions were measured to calculate the signal-noise ratio (SNR) and contrast-noise ratio (CNR). The image quality was subjectively scored by two radiologists, and the differences in image quality among different monochromatic groups and the polychromatic group were compared.ResultsWith the increase of X-ray energy, the CT values and SD values of reconstructed images in monochromatic groups gradually decreased, and the SNRs and CNRs gradually increased, and the differences between adjacent two groups were all statistically significant (P<0.001). In the range of 80-140 keV, the SD values of different monochromatic groups were lower than that of the polychromatic group, and the SNRs and CNRs were higher than those of the polychromatic group, and the pairwise comparison results showed statistically significant differences (P<0.001). The 120 keV-reconstructed image had the highest subjective score, and the difference from that of the polychromatic image was statistically significant (P<0.05).ConclusionsDifferent monochromatic reconstruction of spectral CT can significantly reduce the image noise in early COVID-19 lesions, and improve the image quality. Combining subjective and objective evaluation of images, the 120 keV-reconstructed monochromatic image shows the best early lesions of COVID-19 and is of great significance for early clinical screening.