Stony Brook Medication’s Surgical procedure Staff Assaults COVID-19 From Each Angle | | SBU Information

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Highlights:
SBM developed an anticoagulation protocol to assist forestall blood clots in COVID-19 sufferers. The ICU group says most Stony Brook sufferers enrolled within the medical trial have been capable of come off a ventilator with many even being launched from the ICU and are actually residence recovering.
The group prolonged the protocol additional into the post-discharge interval in order that sufferers are protected against blood clot formation with anticoagulants till they’re absolutely recovered from their extreme COVID-19 an infection.
Stony Brook College Hospital’s Surgical procedure-Essential Care group discovered secretions can create an obstruction within the endotracheal tube (ETT) of COVID-19 sufferers on a ventilator for a number of days. Holding this tube clear can forestall the intense penalties of the ventilator not delivering the right charge, stress and quantity to the affected person.
STONY BROOK, NY, Might 15, 2020—Because the starting of the coronavirus outbreak, Stony Brook Medication (SBM) has been on the forefront of creating new procedures to assist enhance the outcomes of COVID-19 sufferers. 
At Stony Brook Medication, greater than 1,200 sufferers have been hospitalized for the therapy of COVID-19 for the reason that starting of the outbreak in New York State. Amongst these sufferers, greater than 25 % have required admission to the ICU, and the overwhelming majority of these required mechanical air flow. Greater than half of the COVID-19 intensive care unit sufferers being hospitalized at Stony Brook Medication are being cared for by surgical school and surgical residents, with the core group monitoring this illness around-the-clock from the very begin. 
In response to Mark Talamini, MD, Chair, Division of Surgical procedure, SBM’s surgical group has been capable of save extra lives and considerably scale back mortality charges by figuring out points early within the pandemic and shortly pivoting to guard these at highest danger.
Listed below are among the group’s findings which have helped to enhance outcomes:
Anticoagulation protocol rolled out for hospitalized COVID-19 sufferers
Stony Brook Medication’s Vascular and ICU COVID-19 group, led by Apostolos Okay. Tassiopoulos, MD, developed an anticoagulation protocol in mid-March, which was first launched with a medical trial and now’s applied hospital huge. Anticoagulants are medicines that assist forestall blood clots.
“Our group developed an aggressive protocol for anticoagulation therapy that might escalate primarily based on D-dimer ranges,” stated Dr. Tassioupoulos. D-dimer ranges are measurements of the protein fragments produced within the physique when a blood clot will get dissolved within the physique.
“A major improve in D-dimer ranges has been famous in hospitalized COVID-19 sufferers and there are early stories which have linked larger D-dimer ranges to worse outcomes,” stated Dr. Tassiopoulos. “We consider that the rise in D-dimer ranges displays a extra extreme prothrombotic state — which implies there is a rise within the danger of harmful blood clots forming within the massive or small blood vessels of the physique.”
Blood clots can result in life-threatening circumstances, corresponding to end-organ perform deterioration; deep vein thrombosis (DVT) resulting in deadly pulmonary embolism (PE); and life- or limb-threatening thromboses within the arteries inflicting strokes, coronary heart assaults or amputations in in any other case low-risk sufferers.
At Stony Brook, each COVID-19 constructive affected person or affected person underneath investigation (PUI) for the illness who’s admitted to the hospital has a D-dimer stage drawn and, primarily based on this preliminary end result, the affected person is positioned on the suitable anticoagulation routine. D-dimer ranges are watched day by day, and the anticoagulation therapy is appropriately adjusted.
Dr. Tassiopoulos says most sufferers at Stony Brook enrolled in our anticoagulation medical trial protocol have been capable of come off the ventilator and lots of have been launched from the ICU and are actually residence recovering, together with one affected person who was severely immunocompromised with a number of danger elements.
The group has now prolonged the protocol additional into the post-discharge interval in order that sufferers are protected against blood clot formation with anticoagulants till they’re absolutely recovered from their extreme COVID-19 an infection.
Obstruction attributable to tissue sloughing from the lungs of COVID-19 sufferers
Led by Essential Care and Emergency Surgeon Jerry A. Rubano, MD, together with his colleagues from Stony Brook’s Division of Trauma, Emergency Surgical procedure and Surgical Essential Care; Vascular and Endovascular Surgical procedure; Pathology; Anesthesiology; and Pulmonary and Essential Care Medication, the group discovered there’s a potential sloughing of the tissues within the lungs of COVID-19 sufferers on a ventilator for a number of days. In response to Dr. Rubano the secretions develop into so tenacious that they will create an obstruction within the endotracheal tube (ETT) that connects the affected person’s trachea to the ventilator. His group discovered early identification of impending full obstruction can forestall critical penalties and permit for instant enchancment in oxygenation and air flow. This obstruction happens, they discovered, far more generally in COVID-19 sufferers.
When taking a look at a consultant pattern, the pathology report demonstrated excessive density consolidations with proof of sloughing (the shedding of cell tissues) from the tracheobronchial (respiratory) tree and the pulmonary parenchyma, a portion of the lung. This may trigger severely impeded air flow in intubated sufferers who’re a number of days into the vital course of the illness because of what seems to be tissue sloughing with ensuing endotracheal tube obstruction.
“In the course of the hospitalization of COVID-19 sufferers in our ICU, we’ve discovered that there might be substantial variations of their required ventilatory help,” defined Dr. Rubano. “Thorough evaluation in a subset of those sufferers yielded concern for acute airway obstruction within the ETT tube. When these partial or full occlusions had been eliminated, there was virtually instant enchancment in oxygenation and air flow.”
The group just lately revealed its findings within the Annals of Surgical procedure.



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