In January 2020, the outbreak of the coronavirus (Covid-19) was declared a public health emergency by the World Health Organization.

The infection rate has proven to be dramatically high due to its volatility, quickly reaching a pandemic stage, affecting billions of people and global economy. Health systems in all affected countries have been caught off-guard, saturating beds and Intensive Care Units (ICU).

Many hospitals and pharma companies are currently carrying out multiple studies aimed at helping to understand and fight the disease on one hand, while looking also at how to improve patient care in the hospitals. Although many of the studies are quite recent and are still adding clinical subjects to confirm initial findings, some interesting findings are being observed re. the use of EEG-based anaesthesia monitors.

Studies have been carried out In the Chinese Jinyintan Hospital in Wuhan, where it has been observed that a majority (67-85%) of critically ill patients admitted in ICU with confirmed infection of severe acute respiratory syndrome (SARS-Covid-2) have developed the acute respiratory distress syndrome (ARDS) [1,2]. The growing volume of ICU patients requiring long term continuous monitoring due to the development of these severe conditions on Covid-19 infected patients could in our opinion become a continuous trend as long as there is no definitive cure.

Recently, another study has been carried out using a new mechanical respiration index to directly quantify the potential for lung recruitment, as the characteristics for patients with ARDS remain unknown. This is the first study that describes mechanical respiration-based lung recruitment and also evaluates the effect of body position [3].

The study was carried out on mechanically ventilated patients with ARDS associated with SARS-CoV2 and, although the sample is limited, a series of interesting results have been obtained. Among them, it can be highlighted that an alternate body position (i.e. prone) increases the lung recruitment capability.

Furthermore, according to observations made by ICU specialists and Anaesthesiologists in hospitals, it has been observed that the use of qCON sensors is giving better results than some other sensors on the market during the prone position, in which the patient lies flat with the chest down. The key to the better results are based on the design of the qCON single strip sensor that is totally flat and manufactured with fully flexible soft material and being totally non-invasive. Even when the head weight of the patient is fully placed on the sensor, the effect of injuries to the forehead skin is mitigated. This makes the qCON monitor and sensor an ideal solution for any type of surgery or ICU patient requiring to be in the Prone position.

Figure 1. Prone position

This advantage, detected with Covid-19 patients has also already been highlighted by many hospitals during their general use, being also extensible to any situation of critical patients being admitted in intensive care units for long duration such as trauma or other complex ICU -stay, e.g. related to cardiac-, pulmonary-, transplant-operations, etc.

With a simple use of the qCON OEM technology and its sensors, the comfort of the patient is increased, while minimizing injuries that can be derived from the prolonged use of sensors.

ARDS cases require deep sedation in early stages until the patient’s respiratory situation improves. A deep level of sedation must be carefully controlled and should not be maintained longer than necessary, in order to avoid drug accumulation and complications derived from over-sedation. In addition there are often situations where sedated patients are administered with a mix of anti-viral and other drugs. In particular the use of Anti-viral drugs may alter the effect of the provided anaesthesia for the patient, increasing the importance of constant patient state monitoring.

In a situation of critical state of the patient combined with the use of multiple drugs, the use of the qCON – EEG monitor will help to regulate better the administered drugs and maintain the patient at a correct level of sedation. Note: the QM qCON monitor provides a simple to read index, where the sedation state is defined between the values 80 to 60, while 75 is the ideal value.

Figure 2. qCON index detects the different clinical states of the patient, helping to maintain adequate levels of drugs

As manufacturer, Quantium Medical recommends to strictly follow hygienic measures valid for Covid-19. It is crucial to clean the device and the patient cable after each use, following the manufacturer’s instructions. The sensors should be taken out of their hermetically sealed pouches immediately before their use to avoid contact with any another surface. The guidelines regarding the single use of sensors must be followed strictly in order to avoid contact with other patients, while disposing appropriately of the sensor immediately after use.

The Quantium medical proprietary technology with qCON and qNOX parameters provides a patient monitoring solution utilizing an EEG single strip-sensor. Widely used during general anaesthesia in surgery and sedation state of patients in Intensive Care Units (ICU), it allows the specialists to have real time targeted information at any given moment for the state of the patients.

References:

1. Huang C, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506.

2. Yang X, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020.

3. Pan C, et al. Lung Recruitability in SARS-CoV-2 Associated Acute Respiratory Distress Syndrome: A Single-center, Observational Study. March 23, 2020.

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