Healthcare Accountability Lab University of Milan, Italy; and Department of Respiratory Diseases and Department of Pediatrics First Hospital of Wenzhou Medical University Zhejiang, China *See also p. e343. The authors have disclosed that they do not have any potential conflicts of interest. The authors acknowledge that nonspecific funding source has been used for this article.
To study the ability of volume-controlled ventilation and medicated (normal saline plus surfactant) bronchoalveolar lavage in aspiration to reduce the duration of intubation and improve gas exchange.: Randomized controlled clinical trial.Pediatric intensive care unit.Twenty children, 1 month to 16 yrs old, who were intubated and mechanically ventilated, were randomized within 6 hrs of aspiration to receive volume-controlled ventilation plus medicated bronchoalveolar lavage (treatment group) or the same ventilation and bronchosuction (control group).Volume-controlled ventilation and positive end-expiratory pressure (10-12 cm H2O) were applied. Medicated bronchoalveolar lavage was performed using five aliquots of 5 mL of saline plus 10 mg/mL Curosurf (porcine surfactant, Chiesi Pharmaceutical SpA, Parma, Italy) in infants, five boluses of 10 mL of saline plus 5 mg/mL Curosurf in children, and four boluses of 25 mL of saline with 2.4 mg/mL Curosurf in adolescents for each affected lobe. One hour after bronchoalveolar lavage, 240 mg of Curosurf was administered locally.All patients survived. In the treatment group, days of intubation were 4.6 (+/-1.07), oxygenation index and Pao2/Fio2 improved significantly at 24 hrs, and statistical reduction in tidal volume mL/kg was observed from 36 hrs. In the control group, days of intubation were 11.8 (+/-3.22) (p < .0001), no improvement in oxygenation was noted, and pneumonia was observed in seven children (70%).Even though this was an unblinded small clinical trial and low tidal volume strategy was not employed at an early stage after lung injury, there is some evidence that bronchoalveolar lavage with normal saline and surfactant may have clinical value in treating severe aspiration syndrome in children. More clinical studies are warranted to overcome study limitations and potential bias.
Background: The rapid outbreak of coronavirus disease 2019 (COVID-19) posed a serious threat to China, followed by compulsive measures taken against the national emergency to control its further spread. This study was designed to describe residents' knowledge, attitudes, and practice behaviors (KAP) during the outbreak of COVID-19. Methods: An anonymous online questionnaire was randomly administrated to residents in mainland China between Mar 7 and Mar 16, 2020. Residents' responses to KAP were quantified by descriptive and stratified analyses. A Multiple Logistic Regression model was employed to identify risk factors associated with KAP scores. Results: A total of 10,195 participants were enrolled from 32 provinces of China. Participants of the ≥61 years group had higher KAP scores [adjusted Odds Ratio (ORadj) = 4.8, 95% Confidence Interval (CI): 3.0–7.7, P < 0.0001], and the married participants and those in low-income families had higher scores of KAP (ORadj = 1.2, 95% CI: 1.1–1.3; ORadj = 1.8, 95% CI: 1.6–2.2, respectively, both P < 0.0001). The participants living with more than two family members had higher scores in an increasing ORs when the family members increased (ORadj = 1.3, 95% CI: 1.1–1.6, P = 0.013; ORadj = 1.3, 95% CI: 1.1–1.6, P = 0.003; ORadj = 1.3, 95% CI: 1.0–1.6, P = 0.02; for groups of 2, 3–4 and ≥5, respectively). Conclusions: Out of the enrolled participants who completed the survey, 85.5% responded positively toward the mandatory public health interventions implemented nationwide by the Chinese authorities. These effective practices seem to be related to a proper attitude generated by the increased knowledge and better awareness of the risks related to the COVID-19 pandemic and the consequent need for safe and responsible behavior.
1 Healthcare Accountability Lab, University of Milan, Milan, Italy 2 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China *See also p. 302. The authors have disclosed that they do not have any potential conflicts of interest.
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