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Background: Geriatric patients with COVID-19 have had poor clinical outcomes globally, especially during the first wave of the pandemic. In Taiwan, the first wave of the COVID-19 pandemic occurred from May to July 2021. This retrospective study aimed to compare the characteristics and outcomes between geriatric and younger patients with COVID-19 infection. Methods: A total of 257 confirmed COVID-19 cases who were hospitalized from May to June 2021 were included. Their characteristics and outcomes, including in-hospital mortality, use of mechanical ventilation, and hospital stay, were collected for analysis. Results: There were 98 elderly patients (aged ≥ 65 years, median, 72.5 (interquartile range, 69.0-78.0) years) and 159 younger patients (aged < 65 years, median 55.0 (46.0-60.0) years). The elderly patients had a significantly higher Charlson comorbidity score (4.0 (3.0-5.0) vs. 1.0 (1.0-2.0), p < 0.001), and significantly higher D-dimer, procalcitonin, ferritin, and creatinine levels, but lower albumin level than the younger patients. The elderly group also had higher in-hospital mortality (7.1% vs. 1.9%, p < 0.05), were more likely to develop severe disease (83.7% vs. 67.9%, p < 0.01), and had a longer hospital stay (15.0 (11.0-23.0) vs. 12.0 (9.0-16.5) days, p < 0.001). Nevertheless, the elderly patients did not have a higher risk of using high-flow nasal cannulas (17.3% vs. 15.1%, p = 0.63) or mechanic ventilation (23.5% vs. 17.0%, p = 0.20). Conclusion: Elderly COVID-19 patients had significant higher risks of severe disease, mortality, and longer duration of hospitalization, possible due higher rates of comorbidities and pro-inflammatory status. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) can cause acute respiratory failure and acute respiratory distress syndrome (ARDS). The prone position (PP) is widely used in patients with severe hypoxemia due to ARDS as it improves oxygenation. The aim of this study was to investigate whether improvements in gas exchange and lung mechanics with the PPwere associated with survival in ventilated COVID-19 patients. Methods: Fourteen ventilated patients who were placed in the PP were included from May to June 2021. Clinical manifestations and lung mechanics parameters were collected. Results: The overall intensive care unit (ICU) mortality rate was 42.9%. Nonsurvivors were older (p = 0.014) and had higher Charlson comorbidity index (2.1 ± 1.5 vs. 4.8 ± 2.4, p = 0.035) and Sepsis-related Organ Failure Assessment (SOFA) (3.3 ± 1.0 vs. 7.3 ± 3.5, p = 0.019) scores compared to survivors. There was no difference in PaO2/FiO2 (P/F ratio) at baseline between the survivors and nonsurvivors. The improvement in P/F ratio (p = 0.0037) and reduction in driving pressure (Pdrive) (p = 0.046) on the second day after first PP were correlated with lower mortality. Significant predictors of successfully stopping prone treatment included a reduction in Pdrive at the first hour, lower tidal volume (Vt) at the fourth hour, and P/F ratio improvement on the second day after PP. Conclusion: Improvement in P/F ratio and reduction in driving pressure on the second day after PP were correlated with reduced mortality. Three parameters could predict successful resumption of the supine position. [ABSTRACT FROM AUTHOR]

Introduction: Sleep typically becomes more disturbed with age. Similarly, the quantity and quality of sleep in patients undergoing critical care in the intensive care unit is usually disrupted. The aim of the current study was to evaluate the sleep conditions of elderly adults with prolonged mechanical ventilation (PMV) in a respiratory care center (RCC). Methods: It was a three-stage prospective observational study, which aimed to evaluate the patient's subjective sleep quality, their circadian rhythm, and objective sleep parameters. The Richards-Campbell sleep questionnaire (RCSQ), 24-hour body temperature measurements, and 24-hour polysomnography (PSG) were used to assess these features, respectively in patients undergoing PMV therapy. Results: Eight elderly participants completed 30 RCSQ surveys, and the average total score was 52.9 = 20.3. Among the 19 elderly subjects who had their 24-hour body temperatures measured, only 21.1% were assessed as having a normal body temperature circadian rhythm. A total of 6 elderly patients underwent 24-hour PSG and their mean recording time was 22.8 = 0.8 hours. The total sleep time was 411.1 = 247.6 minutes, and the time spent in sleep stages N1, N2, N3 and REM was 23.1%, 70.1%, 3.3% and 3.5% of total sleep, respectively. The majority of sleep (61.5 = 14.5% of total sleep) occurred intermittently during the day as opposed to at night. Sleep efficiency was 33.7 = 26.9% at night. Conclusions: Elderly patients receiving PMV in the RCC presented with poor subjective sleep quality, disrupted circadian rhythms, and disturbed and fragmented sleep. [ABSTRACT FROM AUTHOR]

Aim: Pandemic emerging infectious disease threatened to old people with severe mortality, so advanced ICU core ability is urgent needed for residents through a simulation-based education. This study aims to assess the ICU core abilities of R2 residents through video-learning and practice in simulated intensive care scenarios to solve future tasks. Methods: A workshop was created including pre-course test, discussion of video-learning, five simulated participatory learning scenarios with critical care and ethical issues. All participants were able to read the teaching material and online instructions before discussion and to manipulate the simulationbased scenarios. A post-course feedback questionnaire was conducted for self-evaluation. Results: Workshop participants included 33 R2 residents, six trainers, four nurses and three standardized patients. The scores of the written tests in the IABP/TPM and abdominal echo scenarios were worse than those in the simulation test (p < 0.01), while the scores of written tests in the hypothermia, chief resident leadership were better than those in the simulation test (p < 0.01). Not only did the training workshop earn their satisfaction with discussion of video learning class (4.85/5) and simulation-based education (4.76/5), but it also fostered their core abilities to function in the medical intensive care unit (Likert scale values ranged from 2.97 to 3.42, p < 0.01). Conclusion: In this workshop, combination of the video-learning with written-test, simulation-based education with assessment not only improved the validity of integrated critical care, but also highlighted individual deficiencies. In the future, teachers can more easily provide preliminary remediation before students qualify as R3 residents. [ABSTRACT FROM AUTHOR]