Accuracy of a modified 4Ts score in predicting heparin-induced thrombocytopenia in critically ill patients: A pilot study

Background and Objectives: On 24 March 2020, the United States Food and Drug Administration (FDA) announced the approval of convalescent plasma therapy for critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an emergency investigational new drug. This pilot study from Romania aimed to determine if convalescent plasma transfusion can be beneficial in the treatment of selected critically ill patients diagnosed with a SARS-CoV-2 infection. Materials and Methods: Donor and receiver eligibility for critically ill coronavirus disease 2019 (COVID-19) patients was based on Romanian guidelines issued at the time of the study. Here, we describe the evolution of a total of five eligible patients diagnosed with COVID-19 who received convalescent plasma (CP) in Romania. Results: In spite of our efforts and convalescent plasma administration, three of the five patients did not survive, while the other two recovered completely. Over the course of our five-day laboratory record, the surviving patients had significantly lower values for C-reactive protein, interleukin-6, and white blood cells. Conclusions: This pilot study provides insufficient evidence to determine the efficacy of convalescent plasma use as a therapeutic option for critically ill COVID-19 patients.

Download Full-text

Determining rhythmicity and determinism of temperature curves in septic and non-septic critically ill patients through chronobiological and recurrence quantification analysis: a pilot study

Intensive Care Medicine Experimental ◽

10.1186/s40635-019-0267-9 ◽

2019 ◽

Vol 7 (1) ◽

Cited By ~ 2

Author(s):

Vasilios E. Papaioannou ◽

Eleni N. Sertaridou ◽

Ioanna G. Chouvarda ◽

George C. Kolios ◽

Ioannis N. Pneumatikos

Keyword(s):

Pilot Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Recurrence Quantification Analysis ◽

Recurrence Quantification ◽

Quantification Analysis

Download Full-text

Endotoxin Activity in Patients With Extracorporeal Membrane Oxygenation Life Support: An Observational Pilot Study

Frontiers in Medicine ◽

10.3389/fmed.2021.772413 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chen-Tse Lee ◽

Chih-Hsien Wang ◽

Wing-Sum Chan ◽

Yun-Yi Tsai ◽

Tzu-Jung Wei ◽

...

Keyword(s):

Pilot Study ◽

Extracorporeal Membrane Oxygenation ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Life Support ◽

Median Difference ◽

Endotoxin Activity ◽

Va Ecmo ◽

Vv Ecmo

Background: Extracorporeal membrane oxygenation (ECMO) life support has become an integral part of intensive care. The endotoxin activity assay (EAA) is a useful test to measure endotoxemia severity in whole blood. To date, no information is available regarding the EAA levels and their effect on clinical outcomes in critically ill patients with ECMO support.Methods: This prospective observational pilot study enrolled adult critically ill patients with ECMO support from August 2019 to December 2020. The EAA levels were measured within 24 h (T1), and at 25–48 (T2), 49–72 (T3), and 73–96 h (T4) after ECMO initiation. This study primarily aimed to investigate the incidence of high EAA levels (≥0.6) at each time point. Subsequent exploratory analyses were conducted to compare the EAA levels of venoarterial ECMO (VA-ECMO) patients between 30-day survivors and non-survivors. Post-hoc analysis was performed to compare the clinical outcomes of VA-ECMO patients with elevated EAA levels at T3 (vs. T1) and those without elevated EAA levels.Results: A total of 39 VA-ECMO patients and 15 venovenous ECMO (VV-ECMO) patients were enrolled. At T1, the incidence of high EAA level (≥0.6) was 42% in VV-ECMO patients and 9% in VA-ECMO patients (P = 0.02). At T2, the incidence of high EAA level was 40% in VV-ECMO patients and 5% in VA-ECMO patients (P = 0.005). In VA-ECMO patients, EAA levels at T3 were significantly higher in 30-day non-survivors than in survivors (median [interquartile range]: 0.49 [0.37–0.93] vs. 0.31 [0.19–0.51], median difference 0.16 [95% confidence interval [CI], 0.02–0.31]; P = 0.024). Moreover, VA-ECMO patients with elevated EAA levels at T3 (vs. T1) had lower 30-day survival than patients without elevated EAA levels (39 vs. 83%, P = 0.026) and fewer ECMO free days by day 30 (median: 3 vs. 23 days, median difference 12 days [95% CI, 0–22]; P = 0.028).Conclusions: A certain proportion of patients experienced high EAA levels (≥0.6) after VV-ECMO or VA-ECMO initiation. VA-ECMO patients with an elevated EAA level at 49–72 h were associated with poor clinical outcomes.

Download Full-text

Atypical Sleep Architecture Evaluated by Abnormal N3 Level Using Polysomnography in Critically Ill Patients. A Pilot Study

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6673 ◽

2019 ◽

Author(s):

T. Kotani ◽

R. Miyashita ◽

M. Mori ◽

D.J. Levendowski

Keyword(s):

Pilot Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Sleep Architecture

Download Full-text

Therapeutic plasma exchange in adult critically ill patients with life-threatening SARS-CoV-2 disease: A pilot study

Journal of Critical Care ◽

10.1016/j.jcrc.2020.07.001 ◽

2020 ◽

Vol 60 ◽

pp. 328-333 ◽

Cited By ~ 7

Author(s):

Fahad Faqihi ◽

Abdulrahman Alharthy ◽

Mohammed Alodat ◽

Demetrios J. Kutsogiannis ◽

Peter G. Brindley ◽

...

Keyword(s):

Pilot Study ◽

Plasma Exchange ◽

Critically Ill ◽

Critically Ill Patients ◽

Therapeutic Plasma Exchange ◽

Life Threatening

Download Full-text

Continuous Glucose Monitoring in Critically Ill Patients With COVID-19: Results of an Emergent Pilot Study

Journal of Diabetes Science and Technology ◽

10.1177/1932296820964264 ◽

2020 ◽

Vol 14 (6) ◽

pp. 1065-1073

Author(s):

Archana R. Sadhu ◽

Ivan Alexander Serrano ◽

Jiaqiong Xu ◽

Tariq Nisar ◽

Jessica Lucier ◽

...

Keyword(s):

Blood Glucose ◽

Pilot Study ◽

Insulin Therapy ◽

Critically Ill ◽

Continuous Glucose Monitoring ◽

Critically Ill Patients ◽

Point Of Care ◽

Glucose Monitoring ◽

Blood Glucose Monitoring ◽

Target Range

Background: Amidst the coronavirus disease 2019 (COVID-19) pandemic, continuous glucose monitoring (CGM) has emerged as an alternative for inpatient point-of-care blood glucose (POC-BG) monitoring. We performed a feasibility pilot study using CGM in critically ill patients with COVID-19 in the intensive care unit (ICU). Methods: Single-center, retrospective study of glucose monitoring in critically ill patients with COVID-19 on insulin therapy using Medtronic Guardian Connect and Dexcom G6 CGM systems. Primary outcomes were feasibility and accuracy for trending POC-BG. Secondary outcomes included reliability and nurse acceptance. Sensor glucose (SG) was used for trends between POC-BG with nursing guidance to reduce POC-BG frequency from one to two hours to four hours when the SG was in the target range. Mean absolute relative difference (MARD), Clarke error grids analysis (EGA), and Bland-Altman (B&A) plots were calculated for accuracy of paired SG and POC-BG measurements. Results: CGM devices were placed on 11 patients: Medtronic ( n = 6) and Dexcom G6 ( n = 5). Both systems were feasible and reliable with good nurse acceptance. To determine accuracy, 437 paired SG and POC-BG readings were analyzed. For Medtronic, the MARD was 13.1% with 100% of readings in zones A and B on Clarke EGA. For Dexcom, MARD was 11.1% with 98% of readings in zones A and B. B&A plots had a mean bias of −17.76 mg/dL (Medtronic) and −1.94 mg/dL (Dexcom), with wide 95% limits of agreement. Conclusions: During the COVID-19 pandemic, CGM is feasible in critically ill patients and has acceptable accuracy to identify trends and guide intermittent blood glucose monitoring with insulin therapy.

Download Full-text