Objective To explore the vascular access infection (VAI) incidence of hemodialysis patients during the the maximum spread of the COVID-19 epidemic (epidemic period) compared with the corresponding period with no local cases of COVID-19 (control period). Methods A single-center, retrospective study was carried out. Adult patients who underwent hemodialysis at the Department of Blood Purification Center, the Affiliated Hospital of Xuzhou Medical University during the epidemic period between December 7, 2022 and February 23, 2023 and the control period between December 7, 2020 and February 23, 2021 were selected. The incidence of local access site infection (LASI) and access related bloodstream infection (ARBSI) in included patients were observed and compared. ResultsA total of 1 401 patients were included. Among them, there were 737 cases during the epidemic period and 664 cases during the control period. There was no statistically significant difference in the age, gender, and duration of catheterization among patients of different periods and pathway types (P>0.05). There was no statistically significant difference in the occurrence of LASI between the epidemic period and the control period (χ2=1.800, P=1.180). There was a statistically significant difference in the occurrence of ARBSI between the epidemic period and the control period [χ2=4.610, relative risk (RR)=2.575, 95% confidence interval (CI) (1.053, 6.298), P=0.032]. There was no statistically significant difference in the incidence of LASI and ARBSI at different stages in patients with arteriovenous fistula and unnel-cuffed catheters (TCC) (P＞0.05). There were statistically significant differences in the incidence of LASI [χ2=4.898, RR=3.832, 95%CI (1.058, 13.885), P=0.027] and ARBSI [χ2=7.150, RR=4.684, 95%CI (1.333, 16.460), P=0.005] among non cuffed catheters (NCC) patients at different stages. TCC patients might experience LASI (P<0.05) during the epidemic period and ARBSI (P<0.05) during the control period compared with the arteriovenous fistula patients; both central venous catheterization and NCC patients might experience LASI and ARBSI during the control period (P<0.05). Conclusion Targeting COVID-19 prevention may be associated with the reduction of vascular access infection in hemodialysis patients, in particular in NCC patients.
During the new coronavirus disease 2019 (COVID-19) pandemic, there has been controversy over whether emergency surgical management should be performed or not in the patients with COVID-19. Stanford type A aortic dissection is a very urgent life-threatening disease, and guidelines recommend surgical treatment for patients with type A aortic dissection in the first instance. However, intraoperative extracorporeal circulation can be fatal to patients recovering from COVID-19. During the pandemic, extracorporeal membrane oxygenation (ECMO) has played an important role in supporting COVID-19 patients with acute respiratory failure. This article reports a successful V-V ECMO treatment for a Stanford type A aortic dissection patient, who suffered respiratory failure caused by COVID-19 after emergency surgery.
Most patients with coronavirus disease 2019 (COVID-19) have a good prognosis, but a certain proportion of the elderly and people with underlying diseases are still prone to develop into severe and critical COVID-19. Kidney is one of the common target organs of COVID-19. Acute kidney injury (AKI) is a common complication of severe COVID-19 patients, especially critical COVID-19 patients admitted to intensive care units. AKI associated with COVID-19 is also an independent risk factor for poor prognosis in patients. This article mainly focuses on the epidemiological data, possible pathogenesis, diagnostic criteria, and prevention and treatment based on the 5R principle of AKI associated with COVID-19. It summarizes the existing evidence to explore standardized management strategies for AKI associated with COVID-19.
After the promulgation of the “Ten New Measures” for coronavirus disease 2019 (COVID-19) pandemic, the Nursing Department of West China Hospital of Sichuan University promptly analyzed the development and changes of the epidemic situation and the key and difficult points of nursing manpower emergency management, and constructed a “1+2+4+X” nursing manpower emergency management model for COVID-19 patients, including establishing a dedicated management team, assessing manpower needs, constructing a nursing manpower management model, on-site and online training, and dynamic monitoring and adjustment. From December 7th, 2022 to February 1st, 2023, the Nursing Department mobilized a total of 693 nurses, covering 4 temporary intensive care units and 30 temporary general wards. The hospital-wide qualification rate of airway humidification management for patients in temporary general wards was 94.9%, the qualification rate of artificial airway fixation was 97.9%, and the compliance of bed head elevation was 100.0%. The “1+2+4+X” nursing manpower emergency management model constructed is helpful for the reasonable scheduling of nursing manpower during the epidemic period and provides a reference for the emergency deployment of nursing manpower for the treatment of infectious disease epidemics in large medical institutions in the future.
Objective To explore the impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. MethodsThe Medline, EMbase, CENTRAL, CNKI, Wanfang Data, VIP and China Biology Medicine from inception to May 2023 were searched by computer for studies about impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. The data were extracted from all the relevant literatures, and the quality of the data was assessed using the Newcastle-Ottawa Scale (NOS). All statistical analyses were conducted by the Stata 11.0 software. Results A total of 10 studies (NOS score ranging from 5 to 9 points) involving 643 patients were enrolled. The pooled results demonstrated that the pooled mortality of heart transplant recipients from SARS-CoV-2-positive donors was 4% (95%CI 2% to 5%). And the incidence of composite outcome, regarding graft failure, rejection and death as poor prognosis, was 7% (95%CI 5% to 9%). Besides, compared with recipients from SARS-CoV-2-negative donors, the pooled odds ratio (OR) value of death of SARS-CoV-2-positive donors was 0.68 (95%CI 0.38 to 1.22, Z=1.28, P=0.200). The pooled OR value of rejection rate was 0.41 (95%CI 0.27 to 0.64, Z=3.97, P<0.005). For the composite outcome, the pooled OR value was 0.50 (95%CI 0.37 to 0.69, Z=4.30, P<0.005). In addition, there was no statistical difference in the length of hospital stay between heart transplant recipients from SARS-CoV-2-positive donors and negative donors (SMD=–0.03, 95%CI –0.22 to 0.15, Z=0.36, P=0.720). Conclusion The application of heart from SARS-CoV-2-positive donor for transplantation is safe and feasible. However, further prospective studies with longer follow-up are still needed to verify its impact on long-term outcomes.
Objective To explore the thromboembolic events and mortality in patients with different types of severe pneumonia, and to analyze the related high-risk factors. Methods A total of 161 severe pneumonia patients who admitted in intensive care unit from January 2018 to February 2023 were included in the study. The patients were divided into a COVID-19 group (n=88) and a community-acquired pneumonia (CAP) group (n=73) according to the type of pneumonia, and divided into a thrombosis group and a non-thrombosis group according to the occurrence of thrombosis. The patients were followed-up until discharge or in-hospital death, registering the occurrence of thrombotic events. Results During the in-hospital stay, 32.9% of CAP and 36.4% of COVID-19 patients experienced thrombotic events (P>0.05). In CAP group all the events (including 24 paitents) were venous thromboses, while in COVID-19 group 31 patients were venous and 3 were arterial thromboses (2 were cerebral infarction, and 1 with myocardial infarction). There were statistically significant difference in gender, age, venous thromboembolism score (VTE score), activated partial thromboplastin time (APTT), and procalcitonin (PCT) between the TE group and the Non-TE group. Logistic regression analysis showed that thrombotic events was associated with sex, age and APTT; gender (female: OR=2.47, 95%CI 1.13 - 5.39, P<0.05) and age (OR=1.04, 95%CI 1.01 - 1.07, P<0.05) were positively associated with thrombotic events. During the in-hospital follow-up, 44.3% of CAP patients and 42.5% of COVID-19 patients died (P>0.05). Receiver operator characteristic (ROC) curve analysis showed that APACHEⅡ score was more accurate in predicting mortality of severe pneumonia, and the area under the ROC curve (AUC) was 0.77 (95%CI 0.70 - 0.84, sensitivity 74.3%, specificity 68.1%), the AUC of the VTE score was 0.61 (95%CI 0.53 - 0.70, Sensitivity 31.4%, specificity 81.7%); the AUC of the creatinine was 0.64 (95%CI 0.56 - 0.73, sensitivity 72.9%, specificity 51.2%). While the Kappa value for kidney disease was 0.409 (P<0.05) presenting moderate consistency. Conclusions The incidence of thromboembolic events and mortality are high in patients with different types of severe pneumonia. Thrombophilia was associated with sex, age, and APTT. APACHEⅡ score, VTE score, and creatinine value were independent risk factors for predicting death from severe pneumonia.
From December 2022 to January 2023, 4 lung transplant recipients (3 males and 1 female, aged 52-60 years, all received transplantation less than 1 year) were hospitalized in the Department of Thoracic Surgery of the First Affiliated Hospital of Xi'an Jiaotong University due to COVID-19 after surgery. The clinical manifestations were mostly characterized by elevated body temperature accompanied by shortness of breath, and indicators such as heart rate, oxygen saturation, and oxygenation index could reflect the severity of the condition. The therapy was timely adjusted to immunosuppressive drugs, upgraded oxygen therapy, anti-bacterial and anti-fungal therapy, prone ventilation, general treatment, and anticoagulant therapy, depending on the situation. Finally, 3 patients were cured and discharged from hospital, and 1 died.