Conventional and comprehensive oral hygiene procedures using Chlorhexidine 0.2% in patients with mechanical ventilator

Background: Ventilator-Associated Pneumonia (VAP) in the intensive care unit patients is related to the oropharyngeal bacteria colonization. The purpose of this study was to compare the number of oropharyngeal bacterial colonies after conventional and comprehensive oral hygiene procedures in patients with mechanical ventilators.Methods: This study uses an experimental design on 32 subjects with mechanical ventilators. Conventional group/K group (n=16) used 0.2% chlorhexidine gluconate antiseptic conventionally using a sterile gauze while the comprehensive group/L group (n=16) used 0.2% chlorhexidine gluconate antiseptic comprehensively using a toothbrush every 12 hours. Bacterial Isolation is done using swab technique. The number of bacterial colonies and bacterial identification before and after oral hygiene procedure was examined. The data were statistically analyzed using the Wilcoxon test and the Mann Whitney test using SPSS 19.0 software.Results: There was a significant decrease in the number of oropharyngeal bacterial colonies before and after oral hygiene both in the conventional group (p=0.002) and comprehensive group (p=0.002). However, there was no significant difference between the number of bacterial colonies in the two groups before (p=0.269) and after the oral hygiene procedure (p=0.295). The most common bacterium in the conventional and comprehensive group are Enterobacter gergoviae and Escherichia coli, respectively. Klebsiella pneumonia have decreased the most after conventional oral hygiene while Pseudomonas aeruginosa has decreased the most after comprehensive oral hygiene.Conclusions: Conventional and comprehensive oral hygiene significantly reduces the number of oropharyngeal bacterial colonies. Both techniques can be used as oral hygiene techniques with relatively similar results

Characteristics and outcomes of patients with severe COVID-19 in Indonesia: Lessons from the first wave.

BackgroundIndonesia's national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic.MethodsThis is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes.ResultsFrom 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered.ConclusionsThe mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response

Number of cases and their outcome by month.

(A) Overall in-hospital mortality. (B) In-hospital mortality of mechanically ventilated patients; The bar graphs show the number of cases, and the line graphs show mortality (percentage).</p

Differences in the time course from symptom onset between survivors and deaths with additional bar for patients with unknown final outcome.

Differences in the time course from symptom onset between survivors and deaths with additional bar for patients with unknown final outcome.</p

Changes of laboratory parameters in the first week of ICU stay, stratified by outcome with 95% confidence intervals depicted by shaded regions.

(A)White Blood Cell Count, (B) Lymphocyte Count, (C) Neutrophil Count, (D) C-Reactive Protein, (E) Platelet Count; ICU intensive care unit.</p

Complications during ICU stay.

BackgroundIndonesia’s national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic.MethodsThis is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes.ResultsFrom 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered.ConclusionsThe mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response.</div

Treatments.

BackgroundIndonesia’s national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic.MethodsThis is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes.ResultsFrom 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered.ConclusionsThe mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response.</div

Other outcomes.

BackgroundIndonesia’s national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic.MethodsThis is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes.ResultsFrom 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered.ConclusionsThe mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response.</div