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      Efectos del decúbito prono en el tratamiento de síndrome respiratorio agudo en pacientes con Covid-19 Translated title: Effects of the prone position in the treatment of acute respiratory syndrome in patients with COVID-19

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          Abstract

          Resumen Objetivo principal: Medir los efectos del decúbito prono sobre los parámetros ventilatorios en el tratamiento de pacientes con síndrome respiratorio agudo secundario a COVID-19. Metodología: Estudio descriptivo, transversal, prospectivo, se analizaron 103 pacientes con síndrome respiratorio agudo secundario (SDRA) a COVID-19. Se colocó a los pacientes en decúbito prono (DP) por 16 horas continuas y se monitorizaron parámetros ventilatorios como presión arterial de oxígeno (PaO2), saturación de oxígeno (SatO2) y relación entre presión parcial de oxígeno y fracción inspirada de oxígeno (PaO2/FiO2). Resultados principales: La concentración de FiO2 disminuyó de 100% en posición supina a 69% en prono, la PaO2/FiO2 se incrementó de 74 a 122 milímetros de mercurio (mmHg), la PaO2 basal se registró en 51 mmHg y posterior al cambio de posición fue de 89 mmHg, igualmente la SatO2 mejoró de 84% a 93%. Conclusión principal: El DP puede mejorar significativamente los valores de PaO2, SatO2, así como la relación PaO2/FiO2, y en general, el estado clínico del paciente con SDRA.

          Translated abstract

          Abstract Objective: To measure the effects of the prone position on ventilatory parameters in the treatment of patients with acute respiratory syndrome secondary to COVID-19. Methods: Through a descriptive, cross-sectional, prospective study, a sample of 103 patients with acute respiratory syndrome (ARDS) secondary to COVID-19 was studied. The patients were placed in the prone position indefinitely and clinical ventilatory parameters were monitored such as blood pressure oxygen (PaO2), oxygen saturation (SatO2) and relationship between partial pressure of oxygen and inspired fraction of oxygen (PaO2 / FiO2). Results: The concentration of FiO2 decreased from 100% in the supine position to 69% in the prone position, the PaO2 / FiO2 increased from 74 to 122 millimeters of mercury (mmHg), the basal PaO2 was recorded at 51 mmHg and after the change in position it was of 89 mmHg, also the SatO2 improved from 84% to 93%. Conclusions: The prone position can significantly improve the PaO2, SatO2 values, as well as the PaO2 / FiO2 ratio, and in general, the clinical status of the patient with ARDS.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak

            Hussin A Rothan, Siddappa Byrareddy (2020)
            Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Based on the large number of infected people that were exposed to the wet animal market in Wuhan City, China, it is suggested that this is likely the zoonotic origin of COVID-19. Person-to-person transmission of COVID-19 infection led to the isolation of patients that were subsequently administered a variety of treatments. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. Special attention and efforts to protect or reduce transmission should be applied in susceptible populations including children, health care providers, and elderly people. In this review, we highlights the symptoms, epidemiology, transmission, pathogenesis, phylogenetic analysis and future directions to control the spread of this fatal disease.
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              The many estimates of the COVID-19 case fatality rate

              Dimple D. Rajgor, Meng Har Lee, Sophia Archuleta … (2020)
              Since the outbreak of coronavirus disease 2019 (COVID-19) began in December, a question at the forefront of many people's minds has been its mortality rate. Is the mortality rate of COVID-19 higher than that of influenza, but lower than that of severe acute respiratory syndrome (SARS)? The trend in mortality reporting for COVID-19 has been typical for emerging infectious diseases. The case fatality rate (CFR) was reported to be 15% (six of 41 patients) in the initial period, 1 but this estimate was calculated from a small cohort of hospitalised patients. Subsequently, with more data emerging, the CFR decreased to between 4·3% and 11·0%,2, 3 and later to 3·4%. 4 The rate reported outside China in February was even lower (0·4%; two of 464). 5 This pattern of decreasing CFRs is not surprising during the initial phase of an outbreak. Hard outcomes such as the CFR have a crucial part in forming strategies at national and international levels from a public health perspective. It is imperative that health-care leaders and policy makers are guided by estimates of mortality and case fatality. However, several factors can restrict obtaining an accurate estimate of the CFR. The virus and its clinical course are new, and we still have little information about them. Health care capacity and capability factors, including the availability of health-care workers, resources, facilities, and preparedness, also affect outcomes. For example, some countries are able to invest resources into contact tracing and containing the spread through quarantine and isolation of infected or suspected cases. In Singapore, where these measures have been implemented, the CFR of 631 cases (as of March 25, 2020) is 0·3%. In other places, testing might not be widely available, and proactive contact tracing and containment might not be employed, resulting in a smaller denominator and skewing to a higher CFR. The CFR can increase in some places if there is a surge of infected patients, which adds to the strain on the health-care system and can overwhelm its medical resources. A major challenge with accurate calculation of the CFR is the denominator: the number of people who are infected with the virus. Asymptomatic cases of COVID-19, patients with mild symptoms, or individuals who are misdiagnosed could be left out of the denominator, leading to its underestimation and overestimation of the CFR. A unique situation has arisen for quite an accurate estimate of the CFR of COVID-19. Among individuals onboard the Diamond Princess cruise ship, data on the denominator are fairly robust. The outbreak of COVID-19 led passengers to be quarantined between Jan 20, and Feb 29, 2020. This scenario provided a population living in a defined territory without most other confounders, such as imported cases, defaulters of screening, or lack of testing capability. 3711 passengers and crew were onboard, of whom 705 became sick and tested positive for COVID-19 and seven died, 6 giving a CFR of 0·99%. If the passengers onboard were generally of an older age, the CFR in a healthy, younger population could be lower. 7 Although highly transmissible, the CFR of COVID-19 appears to be lower than that of SARS (9·5%) and Middle East respiratory syndrome (34·4%), 8 but higher than that of influenza (0·1%).9, 10
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                Author and article information

                Journal
                Journal ID (publisher-id): index
                Title: Index de Enfermería
                Abbreviated Title: Index Enferm
                Publisher: Fundación Index (Granada, Granada, Spain )
                ISSN (Print): 1132-1296
                ISSN (Electronic): 1699-5988
                Publication date (Print and electronic): September 2021
                Volume: 30
                Issue: 3
                Pages: 184-188
                Affiliations
                [1] Apodaca orgnameInstituto Mexicano del Seguro Social orgdiv1Hospital General de Zona No. 67 Mexico
                [2] Apodaca orgnameConsorcio de Enfermería y Promotores de la Salud, A.C. México
                Article
                Publisher ID: S1132-12962021000200007 Publisher ID: S1132-1296(21)03000300007
                SO-VID: d8f3b26a-9f9b-4350-b721-8410afeca2ee
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                Date accepted : 14 December 2020
                Date received : 26 October 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 16, Pages: 5
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                SciELO Spain

                Categories
                Subject: Originales

                Keywords: Prone position,Acute respiratory syndrome,COVID-19,Mechanical ventilation,Decúbito prono,Síndrome respiratorio agudo,Ventilación mecánica
                Data availability:
                Keywords: Prone position, Acute respiratory syndrome, COVID-19, Mechanical ventilation, Decúbito prono, Síndrome respiratorio agudo, Ventilación mecánica

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