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The following results are related to COVID-19. Are you interested to view more results? Visit OpenAIRE - Explore.
27 Research products, page 1 of 3

  • COVID-19
  • Publications
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  • 2018-2022
  • CA
  • CHEST Journal

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  • Publication . Article . 2020
    Open Access
    Authors: 
    Nisha Andany; Nick Daneman;
    Publisher: Elsevier BV
  • Open Access
    Authors: 
    Valerie G. Press; Andrea S. Gershon; Frank C. Sciurba; Denitza P. Blagev;
    Publisher: Elsevier BV
  • 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: 
    Marco Confalonieri; Francesco Salton; Paola Confalonieri; Bram Rochwerg; G. Umberto Meduri;
    Publisher: Elsevier BV
  • Open Access English
    Authors: 
    Katherine Callaway Kim; Mina Tadrous; Sandra L. Kane-Gill; Ian J. Barbash; Scott D. Rothenberger; Katie J. Suda;
    Publisher: American College of Chest Physicians. Published by Elsevier Inc.

    BACKGROUND: Drug supply disruptions have increased during the COVID-19 pandemic, especially for medicines used in the ICU. Despite reported shortages in wealthy countries, global analyses of ICU drug purchasing during COVID-19 are limited. RESEARCH QUESTION: Has COVID-19 impacted global drug purchases of first-, second-, and third-choice agents used in intensive care? STUDY DESIGN AND METHODS: We conducted a cross-sectional time series study in a global pharmacy sales dataset comprising approximately 60% of the world's population. We analyzed pandemic-related changes in units purchased per 1,000 population for 69 ICU agents. Interventional autoregressive integrated moving average models tested for significant changes when the pandemic was declared (March 2020) and during its first stage from April through August 2020, globally and by development status. RESULTS: Relative to 2019, ICU drug purchases increased by 23.6% (95% CI, 7.9%-37.9%) in March 2020 (P < .001) and then decreased by 10.3% (95% CI, -16.9% to -3.5%) from April through August (P = .006). Purchases for second-choice medicines changed the most, especially in developing countries (eg, 45.8% increase in March 2020). Despite similar relative changes (P = .88), absolute purchasing rates in developing nations remained low. The observed decrease from April through August 2020 was significant only in developed countries (-13.1%; 95% CI, -17.4% to -4.4%; P < .001). Country-level variation seemed unrelated to expected demand and health-care infrastructure. INTERPRETATION: Purchases for intensive care medicines increased globally in the month of the COVID-19 pandemic declaration, but before peak infection rates. These changes were most pronounced for second-choice agents, suggesting that inexpensive, generic medicines may be purchased more easily in anticipation of pandemic-related ICU surges. Nevertheless, disparities in access persisted. Trends seemed unrelated to expected demand, and decreased purchasing from April through August 2020 may suggest overbuying. National and international policies are needed to ensure equitable drug purchasing during future pandemics.

  • Publication . Article . 2021
    Open Access English
    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.

  • Publication . Article . 2022
    Closed Access
    Authors: 
    Prabjit Barn; Karen Rideout; Winnie Lo; Dennis Josey; Zackari Vint; Cindy Sha; Clayon Hamilton; Alison M. Hoens; Erin M. Shellington; Phalgun B. Joshi; +1 more
    Publisher: Elsevier BV

    Partnering with patients and community stakeholders to identify, design, undertake, and evaluate research is increasingly common. We describe our experience with creating and developing an ongoing Community Stakeholder Committee to guide lung health research for disease prevention and healthcare improvement. This committee is central to the integrated knowledge translation approach of Legacy for Airway Health, which is dedicated to preventing and improving care for lung diseases. Patient engagement in research (PEIR) aims to improve the relevance, quality, and implementation of research activities. Meaningful patient and community engagement in research remains challenging to implement. The committee was established in October 2019, just prior to the COVID-19 pandemic, and quickly adapted from in-person to virtual engagement activities. This change led to an increased focus on relationship-building and mutual support alongside other research and training activities. We conducted a baseline evaluation survey after one year (October 2020) using a modified version of the Patient Engagement in Research Scale (PEIRS-22). While individual scores suggested varied levels of meaningful engagement within the committee, overall results indicated strong personal relationships and a sense of feeling valued and respected, as well as a desire for increased opportunities to contribute to research within the program. Overall, this experience offers lessons learned about the importance of spending time and effort to build relationships, particularly in a virtual context, and shows that meaningful engagement can be done even when personal contact is limited. These efforts are illustrated in successful grant applications, research involvement, and stronger personal relationships.

  • Open Access
    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.

  • Open Access English
    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.

  • Open Access
    Authors: 
    Jeffrey R. Dichter; Asha V. Devereaux; Charles L. Sprung; Vikramjit Mukherjee; Jason Persoff; Karyn D. Baum; Douglas Ornoff; Amit Uppal; Tanzib Hossain; Kiersten N. Henry; +75 more
    Publisher: Elsevier BV

    Abstract Background Following the publication of 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic.1 Gaps in prior pandemic planning were identified and require modification in the midst of ongoing surge throughout the world. Methods The Task Force for Mass Critical Care (TFMCC) adopted a modified version of established rapid guideline methodologies from the World Health Organization2 and the Guidelines International Network-McMaster Guideline Development Checklist.3 With a consensus development process incorporating expert opinion to define important questions and extract evidence, TFMCC developed relevant pandemic surge suggestions in a structured manner, incorporating peer-reviewed literature, “gray” evidence from lay media sources, and anecdotal experiential evidence. Results Ten suggestions were identified regarding staffing, load-balancing, communication, and technology. Staffing models are suggested with resilience strategies to support critical care staff. Intensive care unit (ICU) surge strategies and strain indicators are suggested to enhance ICU prioritization tactics to maintain contingency level care and avoid crisis triage, with early transfer strategies to further load-balance care. We suggest intensivists and hospitalists be engaged with the incident command structure to ensure two-way communication, situational awareness, and the use of technology to support critical care delivery and families of patients in intensive care units (ICUs). Conclusions A subcommittee from the Task Force for Mass Critical Care offers interim evidence-informed operational strategies to assist hospitals and communities to plan for and respond to surge capacity demands from COVID-19.

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.
27 Research products, page 1 of 3
  • Publication . Article . 2020
    Open Access
    Authors: 
    Nisha Andany; Nick Daneman;
    Publisher: Elsevier BV
  • Open Access
    Authors: 
    Valerie G. Press; Andrea S. Gershon; Frank C. Sciurba; Denitza P. Blagev;
    Publisher: Elsevier BV
  • 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: 
    Marco Confalonieri; Francesco Salton; Paola Confalonieri; Bram Rochwerg; G. Umberto Meduri;
    Publisher: Elsevier BV
  • Open Access English
    Authors: 
    Katherine Callaway Kim; Mina Tadrous; Sandra L. Kane-Gill; Ian J. Barbash; Scott D. Rothenberger; Katie J. Suda;
    Publisher: American College of Chest Physicians. Published by Elsevier Inc.

    BACKGROUND: Drug supply disruptions have increased during the COVID-19 pandemic, especially for medicines used in the ICU. Despite reported shortages in wealthy countries, global analyses of ICU drug purchasing during COVID-19 are limited. RESEARCH QUESTION: Has COVID-19 impacted global drug purchases of first-, second-, and third-choice agents used in intensive care? STUDY DESIGN AND METHODS: We conducted a cross-sectional time series study in a global pharmacy sales dataset comprising approximately 60% of the world's population. We analyzed pandemic-related changes in units purchased per 1,000 population for 69 ICU agents. Interventional autoregressive integrated moving average models tested for significant changes when the pandemic was declared (March 2020) and during its first stage from April through August 2020, globally and by development status. RESULTS: Relative to 2019, ICU drug purchases increased by 23.6% (95% CI, 7.9%-37.9%) in March 2020 (P < .001) and then decreased by 10.3% (95% CI, -16.9% to -3.5%) from April through August (P = .006). Purchases for second-choice medicines changed the most, especially in developing countries (eg, 45.8% increase in March 2020). Despite similar relative changes (P = .88), absolute purchasing rates in developing nations remained low. The observed decrease from April through August 2020 was significant only in developed countries (-13.1%; 95% CI, -17.4% to -4.4%; P < .001). Country-level variation seemed unrelated to expected demand and health-care infrastructure. INTERPRETATION: Purchases for intensive care medicines increased globally in the month of the COVID-19 pandemic declaration, but before peak infection rates. These changes were most pronounced for second-choice agents, suggesting that inexpensive, generic medicines may be purchased more easily in anticipation of pandemic-related ICU surges. Nevertheless, disparities in access persisted. Trends seemed unrelated to expected demand, and decreased purchasing from April through August 2020 may suggest overbuying. National and international policies are needed to ensure equitable drug purchasing during future pandemics.

  • Publication . Article . 2021
    Open Access English
    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.

  • Publication . Article . 2022
    Closed Access
    Authors: 
    Prabjit Barn; Karen Rideout; Winnie Lo; Dennis Josey; Zackari Vint; Cindy Sha; Clayon Hamilton; Alison M. Hoens; Erin M. Shellington; Phalgun B. Joshi; +1 more
    Publisher: Elsevier BV

    Partnering with patients and community stakeholders to identify, design, undertake, and evaluate research is increasingly common. We describe our experience with creating and developing an ongoing Community Stakeholder Committee to guide lung health research for disease prevention and healthcare improvement. This committee is central to the integrated knowledge translation approach of Legacy for Airway Health, which is dedicated to preventing and improving care for lung diseases. Patient engagement in research (PEIR) aims to improve the relevance, quality, and implementation of research activities. Meaningful patient and community engagement in research remains challenging to implement. The committee was established in October 2019, just prior to the COVID-19 pandemic, and quickly adapted from in-person to virtual engagement activities. This change led to an increased focus on relationship-building and mutual support alongside other research and training activities. We conducted a baseline evaluation survey after one year (October 2020) using a modified version of the Patient Engagement in Research Scale (PEIRS-22). While individual scores suggested varied levels of meaningful engagement within the committee, overall results indicated strong personal relationships and a sense of feeling valued and respected, as well as a desire for increased opportunities to contribute to research within the program. Overall, this experience offers lessons learned about the importance of spending time and effort to build relationships, particularly in a virtual context, and shows that meaningful engagement can be done even when personal contact is limited. These efforts are illustrated in successful grant applications, research involvement, and stronger personal relationships.

  • Open Access
    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.

  • Open Access English
    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.

  • Open Access
    Authors: 
    Jeffrey R. Dichter; Asha V. Devereaux; Charles L. Sprung; Vikramjit Mukherjee; Jason Persoff; Karyn D. Baum; Douglas Ornoff; Amit Uppal; Tanzib Hossain; Kiersten N. Henry; +75 more
    Publisher: Elsevier BV

    Abstract Background Following the publication of 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic.1 Gaps in prior pandemic planning were identified and require modification in the midst of ongoing surge throughout the world. Methods The Task Force for Mass Critical Care (TFMCC) adopted a modified version of established rapid guideline methodologies from the World Health Organization2 and the Guidelines International Network-McMaster Guideline Development Checklist.3 With a consensus development process incorporating expert opinion to define important questions and extract evidence, TFMCC developed relevant pandemic surge suggestions in a structured manner, incorporating peer-reviewed literature, “gray” evidence from lay media sources, and anecdotal experiential evidence. Results Ten suggestions were identified regarding staffing, load-balancing, communication, and technology. Staffing models are suggested with resilience strategies to support critical care staff. Intensive care unit (ICU) surge strategies and strain indicators are suggested to enhance ICU prioritization tactics to maintain contingency level care and avoid crisis triage, with early transfer strategies to further load-balance care. We suggest intensivists and hospitalists be engaged with the incident command structure to ensure two-way communication, situational awareness, and the use of technology to support critical care delivery and families of patients in intensive care units (ICUs). Conclusions A subcommittee from the Task Force for Mass Critical Care offers interim evidence-informed operational strategies to assist hospitals and communities to plan for and respond to surge capacity demands from COVID-19.