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The following results are related to COVID-19. Are you interested to view more results? Visit OpenAIRE - Explore.
13 Research products, page 1 of 2

  • COVID-19
  • Publications
  • 2019-2023
  • Open Access
  • 030228 respiratory system
  • CA
  • CHEST Journal
  • COVID-19

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  • Publication . Article . 2020
    Open Access
    Authors: 
    Lisa Burry; Jeffrey F. Barletta; David Williamson; Salmaan Kanji; Ryan C. Maves; Jeffrey R. Dichter; Michael D. Christian; James A. Geiling; Brian L. Erstad;
    Publisher: Elsevier BV

    Critical drug shortages have been widely documented during the coronavirus disease 2019 (COVID-19) pandemic, particularly for IV sedatives used to facilitate mechanical ventilation. Surges in volume of patients requiring mechanical ventilation coupled with prolonged ventilator days and the high sedative dosing requirements observed quickly led to the depletion of "just-in-time" inventories typically maintained by institutions. This manuscript describes drug shortages in the context of global, manufacturing, regional and institutional perspectives in times of a worldwide crisis such as a pandemic. We describe etiologic factors that lead to drug shortages including issues related to supply (eg, manufacturing difficulties, supply chain breakdowns) and variables that influence demand (eg, volatile prescribing practices, anecdotal or low-level data, hoarding). In addition, we describe methods to mitigate drug shortages as well as conservation strategies for sedatives, analgesics and neuromuscular blockers that could readily be applied at the bedside. The COVID-19 pandemic has accentuated the need for a coordinated, multi-pronged approach to optimize medication availability as individual or unilateral efforts are unlikely to be successful.

  • Open Access
    Authors: 
    Najib T. Ayas; Kristin Fraser; Eleni Giannouli; Patrick J. Hanly; Tetyana Kendzerska; Sherri L. Katz; Brandy N. Lachmann; Annie C. Lajoie; Caroline Minville; Debra Morrison; +4 more
    Project: CIHR
  • Open Access English
    Authors: 
    Ryan C. Maves; James Downar; Jeffrey R. Dichter; John L. Hick; Asha V. Devereaux; James A. Geiling; Niranjan Kissoon; Nathaniel Hupert; Alexander S. Niven; Mary A. King; +13 more
    Publisher: Elsevier BV

    Public health emergencies have the potential to place enormous strain on health systems. The current pandemic of the novel 2019 coronavirus disease has required hospitals in numerous countries to expand their surge capacity to meet the needs of patients with critical illness. When even surge capacity is exceeded, however, principles of critical care triage may be needed as a means to allocate scarce resources, such as mechanical ventilators or key medications. The goal of a triage system is to direct limited resources towards patients most likely to benefit from them. Implementing a triage system requires careful coordination between clinicians, health systems, local and regional governments, and the public, with a goal of transparency to maintain trust. We discuss the principles of tertiary triage and methods for implementing such a system, emphasizing that these systems should serve only as a last resort. Even under triage, we must uphold our obligation to care for all patients as best possible under difficult circumstances.

  • Open Access English
    Authors: 
    Andrew Kouri; Samir Gupta; Azadeh Yadollahi; Clodagh M. Ryan; Andrea S. Gershon; Teresa To; Susan M. Tarlo; Roger S. Goldstein; Kenneth R. Chapman; Chung-Wai Chow;
    Publisher: Elsevier BV

    To reduce the spread of the severe acute respiratory syndrome coronavirus 2, many pulmonary function testing (PFT) laboratories have been closed or have significantly reduced their testing capacity. Because these mitigation strategies may be necessary for the next 6 to 18 months to prevent recurrent peaks in disease prevalence, fewer objective measurements of lung function will alter the diagnosis and care of patients with chronic respiratory diseases. PFT, which includes spirometry, lung volume, and diffusion capacity measurement, is essential to the diagnosis and management of patients with asthma, COPD, and other chronic lung conditions. Both traditional and innovative alternatives to conventional testing must now be explored. These may include peak expiratory flow devices, electronic portable spirometers, portable exhaled nitric oxide measurement, airwave oscillometry devices, and novel digital health tools such as smartphone microphone spirometers and mobile health technologies along with integration of machine learning approaches. The adoption of some novel approaches may not merely replace but could improve existing management strategies and alter common diagnostic paradigms. With these options comes important technical, privacy, ethical, financial, and medicolegal barriers that must be addressed. However, the coronavirus disease 19 pandemic also presents a unique opportunity to augment conventional testing by including innovative and emerging approaches to measuring lung function remotely in patients with respiratory disease. The benefits of such an approach have the potential to enhance respiratory care and empower patient self-management well beyond the current global pandemic.

  • Open Access English
    Authors: 
    Christopher Licskai; Connie L. Yang; Francine M. Ducharme; Dhenuka Radhakrishnan; Delanya Podgers; Clare D. Ramsey; Tania Samanta; Andréanne Côté; Masoud Mahdavian; M. Diane Lougheed;
    Publisher: Elsevier BV
    Project: CIHR
  • Open Access English
    Authors: 
    Mohit Bhutani; Paul Hernandez; Jean Bourbeau; Gail Dechman; Erika Penz; Raymond Aceron; Marla K. Beauchamp; Joshua Wald; Michael K. Stickland; Sharla-Rae Olsen; +1 more
    Publisher: Elsevier BV
    Project: NSERC
  • Open Access English
    Authors: 
    Peter J. Mazzone; Michael K. Gould; Douglas A. Arenberg; Alexander Chen; Humberto Choi; Frank C. Detterbeck; Farhood Farjah; Kwun M. Fong; Jonathan M. Iaccarino; Sam M. Janes; +14 more
    Publisher: Elsevier BV

    Abstract Background The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. Methods An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. Results Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non–small-cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non–small-cell lung cancer. Conclusions There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.

  • Open Access English
    Authors: 
    Nathan Doggett; Chung-Wai Chow; Samira Mubareka;
    Publisher: Elsevier BV

    Background During medical procedures with the potential to produce aerosols such as bronchoscopy, intubation or cardiopulmonary resuscitation, healthcare workers (HCWs) may be exposed to infectious bioaerosols. This is of particular concern when high consequence pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are circulating. Thus far thousands of HCWs have been infected, 14.8% of these have severe disease and several have died1. However, the determinants of aerosol generation during such procedures and their relative risk to HCWs remain poorly characterized. Research Question. We sought to characterize aerosols produced during airway intubation using an uninfected translational animal model and in human subjects undergoing elective aerosol-generating procedures. We also determined the particle size distribution of generated particles. Study Design and Methods. Aerosol generation was measured during highly controlled experimental (pig) intubations (N=16) and elective bronchoscopies in uninfected patients (N=49) using an optical particle counter (OPC). Recovery of normal respiratory flora was used as a surrogate for pathogen dispersion. Results There was a small but significant (p = 0.03) decrease in 0.3 μm particles during highly controlled pig intubations compared to baseline. The concentration of 1.0 μm and 5.0 μm aerosol particles did not significantly change though oral bacteria were collected from the air. For elective patient bronchoscopies, there was a significant decrease in the generation of larger particles (1.0 μm and 5.0 μm) compared to baseline (p < 0.01), however, 18 of 39 (46%) of patients showed increased aerosol production in 0.3 μm sized particles, 4 of whom demonstrated significant increases. Interpretation. While the total amount of aerosols produced during intubation and bronchoscopy did not increase significantly relative to pre-procedural levels, a small number of participants showed a significant increase in submicron particle emission, meriting further research to delineate determinants of fine particle production during aerosol-generating procedures.

  • Publication . Article . 2021
    Open Access
    Authors: 
    Daniel Garros; Wendy Austin; Peter Dodek;
    Publisher: Elsevier BV

    Worldwide, health-care professionals are experiencing unprecedented stress related to the coronavirus disease 2019 pandemic. Responding to a new virus for which there is no effective treatment yet and no vaccine is beyond challenging. Moral distress, which is experienced when clinicians are unable to act in the way that they believe they should, is often experienced when they are dealing with end-of-life care issues and insufficient resources. Both factors have been widespread during this pandemic, particularly when patients are dying alone and there is a lack of personal protection equipment that plagues many overburdened health-care systems. We explore here, guided by evidence, the concept and features of moral distress and individual resilience. Mitigation strategies involve individual and institutional responsibilities; the importance of solidarity, peer support, psychological first aid, and gratitude are highlighted.

  • Open Access
    Authors: 
    Rich Branson; Jeffrey R. Dichter; Henry A. Feldman; Asha V. Devereaux; David J. Dries; Joshua O. Benditt; Tanzib Hossain; Marya Ghazipura; Mary King; Marie R. Baldisseri; +11 more
    Publisher: Elsevier BV

    Background Early in the COVID-19 pandemic, there was serious concern that the United States (US) would encounter a short fall of mechanical ventilators. In response, the US government, utilizing the Defense Production Act ordered the development of 200,000 ventilators from 11 different manufacturers. These ventilators have different capabilities and it is not evident whether all are able to support COVID-19 patients. Research question Evaluate ventilator requirements for affected COVID-19 patients, assess the clinical performance of current SNS ventilators employed during the pandemic, and finally compare ordered ventilators functionality based on COVID-19 patient needs. Study design and methods Current published literature, publicly available documents, and lay press articles were reviewed by a diverse team of disaster experts. Data was assembled into tabular format which formed the basis for analysis and future recommendations. Results COVID-19 patients often develop severe hypoxemic acute respiratory failure and ARDS requiring high levels of ventilator support. Current SNS ventilators were unable to fully support all COVID-19 patients, and only about half of newly ordered ventilators have the capacity to support the most severely affected patients; ventilators with less capacity for providing high level support are still of significant value in caring for many patients. Interpretation Current SNS ventilators and those on order are capable of supporting most but not all COVID-19 patients. Technologic, logistic, and educational challenges encountered from current SNS ventilators are summarized, with potential next generation SNS ventilator updates offered. Clinical trial registration N/A.

Advanced search in Research products
Research products
arrow_drop_down
Searching FieldsTerms
Any field
arrow_drop_down
includes
arrow_drop_down
Include:
The following results are related to COVID-19. Are you interested to view more results? Visit OpenAIRE - Explore.
13 Research products, page 1 of 2
  • Publication . Article . 2020
    Open Access
    Authors: 
    Lisa Burry; Jeffrey F. Barletta; David Williamson; Salmaan Kanji; Ryan C. Maves; Jeffrey R. Dichter; Michael D. Christian; James A. Geiling; Brian L. Erstad;
    Publisher: Elsevier BV

    Critical drug shortages have been widely documented during the coronavirus disease 2019 (COVID-19) pandemic, particularly for IV sedatives used to facilitate mechanical ventilation. Surges in volume of patients requiring mechanical ventilation coupled with prolonged ventilator days and the high sedative dosing requirements observed quickly led to the depletion of "just-in-time" inventories typically maintained by institutions. This manuscript describes drug shortages in the context of global, manufacturing, regional and institutional perspectives in times of a worldwide crisis such as a pandemic. We describe etiologic factors that lead to drug shortages including issues related to supply (eg, manufacturing difficulties, supply chain breakdowns) and variables that influence demand (eg, volatile prescribing practices, anecdotal or low-level data, hoarding). In addition, we describe methods to mitigate drug shortages as well as conservation strategies for sedatives, analgesics and neuromuscular blockers that could readily be applied at the bedside. The COVID-19 pandemic has accentuated the need for a coordinated, multi-pronged approach to optimize medication availability as individual or unilateral efforts are unlikely to be successful.

  • Open Access
    Authors: 
    Najib T. Ayas; Kristin Fraser; Eleni Giannouli; Patrick J. Hanly; Tetyana Kendzerska; Sherri L. Katz; Brandy N. Lachmann; Annie C. Lajoie; Caroline Minville; Debra Morrison; +4 more
    Project: CIHR
  • Open Access English
    Authors: 
    Ryan C. Maves; James Downar; Jeffrey R. Dichter; John L. Hick; Asha V. Devereaux; James A. Geiling; Niranjan Kissoon; Nathaniel Hupert; Alexander S. Niven; Mary A. King; +13 more
    Publisher: Elsevier BV

    Public health emergencies have the potential to place enormous strain on health systems. The current pandemic of the novel 2019 coronavirus disease has required hospitals in numerous countries to expand their surge capacity to meet the needs of patients with critical illness. When even surge capacity is exceeded, however, principles of critical care triage may be needed as a means to allocate scarce resources, such as mechanical ventilators or key medications. The goal of a triage system is to direct limited resources towards patients most likely to benefit from them. Implementing a triage system requires careful coordination between clinicians, health systems, local and regional governments, and the public, with a goal of transparency to maintain trust. We discuss the principles of tertiary triage and methods for implementing such a system, emphasizing that these systems should serve only as a last resort. Even under triage, we must uphold our obligation to care for all patients as best possible under difficult circumstances.

  • Open Access English
    Authors: 
    Andrew Kouri; Samir Gupta; Azadeh Yadollahi; Clodagh M. Ryan; Andrea S. Gershon; Teresa To; Susan M. Tarlo; Roger S. Goldstein; Kenneth R. Chapman; Chung-Wai Chow;
    Publisher: Elsevier BV

    To reduce the spread of the severe acute respiratory syndrome coronavirus 2, many pulmonary function testing (PFT) laboratories have been closed or have significantly reduced their testing capacity. Because these mitigation strategies may be necessary for the next 6 to 18 months to prevent recurrent peaks in disease prevalence, fewer objective measurements of lung function will alter the diagnosis and care of patients with chronic respiratory diseases. PFT, which includes spirometry, lung volume, and diffusion capacity measurement, is essential to the diagnosis and management of patients with asthma, COPD, and other chronic lung conditions. Both traditional and innovative alternatives to conventional testing must now be explored. These may include peak expiratory flow devices, electronic portable spirometers, portable exhaled nitric oxide measurement, airwave oscillometry devices, and novel digital health tools such as smartphone microphone spirometers and mobile health technologies along with integration of machine learning approaches. The adoption of some novel approaches may not merely replace but could improve existing management strategies and alter common diagnostic paradigms. With these options comes important technical, privacy, ethical, financial, and medicolegal barriers that must be addressed. However, the coronavirus disease 19 pandemic also presents a unique opportunity to augment conventional testing by including innovative and emerging approaches to measuring lung function remotely in patients with respiratory disease. The benefits of such an approach have the potential to enhance respiratory care and empower patient self-management well beyond the current global pandemic.

  • Open Access English
    Authors: 
    Christopher Licskai; Connie L. Yang; Francine M. Ducharme; Dhenuka Radhakrishnan; Delanya Podgers; Clare D. Ramsey; Tania Samanta; Andréanne Côté; Masoud Mahdavian; M. Diane Lougheed;
    Publisher: Elsevier BV
    Project: CIHR
  • Open Access English
    Authors: 
    Mohit Bhutani; Paul Hernandez; Jean Bourbeau; Gail Dechman; Erika Penz; Raymond Aceron; Marla K. Beauchamp; Joshua Wald; Michael K. Stickland; Sharla-Rae Olsen; +1 more
    Publisher: Elsevier BV
    Project: NSERC
  • Open Access English
    Authors: 
    Peter J. Mazzone; Michael K. Gould; Douglas A. Arenberg; Alexander Chen; Humberto Choi; Frank C. Detterbeck; Farhood Farjah; Kwun M. Fong; Jonathan M. Iaccarino; Sam M. Janes; +14 more
    Publisher: Elsevier BV

    Abstract Background The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. Methods An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. Results Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non–small-cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non–small-cell lung cancer. Conclusions There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.

  • Open Access English
    Authors: 
    Nathan Doggett; Chung-Wai Chow; Samira Mubareka;
    Publisher: Elsevier BV

    Background During medical procedures with the potential to produce aerosols such as bronchoscopy, intubation or cardiopulmonary resuscitation, healthcare workers (HCWs) may be exposed to infectious bioaerosols. This is of particular concern when high consequence pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are circulating. Thus far thousands of HCWs have been infected, 14.8% of these have severe disease and several have died1. However, the determinants of aerosol generation during such procedures and their relative risk to HCWs remain poorly characterized. Research Question. We sought to characterize aerosols produced during airway intubation using an uninfected translational animal model and in human subjects undergoing elective aerosol-generating procedures. We also determined the particle size distribution of generated particles. Study Design and Methods. Aerosol generation was measured during highly controlled experimental (pig) intubations (N=16) and elective bronchoscopies in uninfected patients (N=49) using an optical particle counter (OPC). Recovery of normal respiratory flora was used as a surrogate for pathogen dispersion. Results There was a small but significant (p = 0.03) decrease in 0.3 μm particles during highly controlled pig intubations compared to baseline. The concentration of 1.0 μm and 5.0 μm aerosol particles did not significantly change though oral bacteria were collected from the air. For elective patient bronchoscopies, there was a significant decrease in the generation of larger particles (1.0 μm and 5.0 μm) compared to baseline (p < 0.01), however, 18 of 39 (46%) of patients showed increased aerosol production in 0.3 μm sized particles, 4 of whom demonstrated significant increases. Interpretation. While the total amount of aerosols produced during intubation and bronchoscopy did not increase significantly relative to pre-procedural levels, a small number of participants showed a significant increase in submicron particle emission, meriting further research to delineate determinants of fine particle production during aerosol-generating procedures.

  • Publication . Article . 2021
    Open Access
    Authors: 
    Daniel Garros; Wendy Austin; Peter Dodek;
    Publisher: Elsevier BV

    Worldwide, health-care professionals are experiencing unprecedented stress related to the coronavirus disease 2019 pandemic. Responding to a new virus for which there is no effective treatment yet and no vaccine is beyond challenging. Moral distress, which is experienced when clinicians are unable to act in the way that they believe they should, is often experienced when they are dealing with end-of-life care issues and insufficient resources. Both factors have been widespread during this pandemic, particularly when patients are dying alone and there is a lack of personal protection equipment that plagues many overburdened health-care systems. We explore here, guided by evidence, the concept and features of moral distress and individual resilience. Mitigation strategies involve individual and institutional responsibilities; the importance of solidarity, peer support, psychological first aid, and gratitude are highlighted.

  • Open Access
    Authors: 
    Rich Branson; Jeffrey R. Dichter; Henry A. Feldman; Asha V. Devereaux; David J. Dries; Joshua O. Benditt; Tanzib Hossain; Marya Ghazipura; Mary King; Marie R. Baldisseri; +11 more
    Publisher: Elsevier BV

    Background Early in the COVID-19 pandemic, there was serious concern that the United States (US) would encounter a short fall of mechanical ventilators. In response, the US government, utilizing the Defense Production Act ordered the development of 200,000 ventilators from 11 different manufacturers. These ventilators have different capabilities and it is not evident whether all are able to support COVID-19 patients. Research question Evaluate ventilator requirements for affected COVID-19 patients, assess the clinical performance of current SNS ventilators employed during the pandemic, and finally compare ordered ventilators functionality based on COVID-19 patient needs. Study design and methods Current published literature, publicly available documents, and lay press articles were reviewed by a diverse team of disaster experts. Data was assembled into tabular format which formed the basis for analysis and future recommendations. Results COVID-19 patients often develop severe hypoxemic acute respiratory failure and ARDS requiring high levels of ventilator support. Current SNS ventilators were unable to fully support all COVID-19 patients, and only about half of newly ordered ventilators have the capacity to support the most severely affected patients; ventilators with less capacity for providing high level support are still of significant value in caring for many patients. Interpretation Current SNS ventilators and those on order are capable of supporting most but not all COVID-19 patients. Technologic, logistic, and educational challenges encountered from current SNS ventilators are summarized, with potential next generation SNS ventilator updates offered. Clinical trial registration N/A.