scholarly journals Corona Virus Disease 2019 in situ arterial and venous thrombosis in critically ill patients: a case series

2020 ◽  
Author(s):  
Mireya Castro-Verdes ◽  
Antonia Gkouma ◽  
John Wort ◽  
Carole Ridge ◽  
Saeed Mirsadraee ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Virus Disease ◽  
Case Series ◽  
Bleeding Risk ◽  
Conventional Mechanical Ventilation ◽  
Cross Sectional ◽  
Cardiorespiratory Failure ◽  
Corona Virus

Abstract Background Corona Virus Disease 2019 (COVID-19) pneumonitis associated with severe respiratory failure carries a high mortality. Coagulopathy has emerged as a significant contributor to thrombotic complications. Case summary We describe two cases of severe COVID-19 pneumonitis refractory to conventional mechanical ventilation and proning position, transferred to our specialist centre for cardiorespiratory failure. Cross-sectional imaging demonstrated concurrent venous and aortic thrombosis with end-organ ischaemic changes. One patient received thrombolysis with a partial response. This could not be offered to the other patient due to a recent haemorrhagic event. Both patients died of multi-organ failure in the hospital. Discussion Concurrent aortic and venous thromboses are rare. This finding in COVID-19 cases, who were both critically ill patients, likely reflects the strongly thrombogenic nature of this illness which ultimately contributed to poor outcomes. The absence of deep vein thrombosis or a potential systemic source of embolism suggests in situ thrombosis. Further, the management of anticoagulation and thrombolysis is challenging in patients where an attendant bleeding risk exists.

scholarly journals The clinical data from 19 critically ill patients with Corona Virus Disease 2019: a single-centered, retrospective, observational study

2020 ◽  
Author(s):  
Jinping Zhang
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Virus Disease ◽  
Ground Glass ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Corona Virus ◽  
Index Changes ◽  
Hs Crp ◽  
D Dimer

Abstract Background To analyze the clinical features of Corona Virus Disease 2019 (COVID-19) and evaluate the diagnosis and treatment.Methods Making retrospective analysis of the clinical manifestation and auxiliary examination of the 19 patients of COVID-19 which from the Liyuan Hospital ICU between January 16, 2020 and February 20, 2020.Results There were 11 male and 8 female cases among the patients. The median (range) age was 73 (38-91) years. There are 8（42.1%）patients had died , and the median duration from ICU to death was 2 (IQR: 1–10.75) days in non-survivors. Seven patients have the basic diseases which in the dead patients. Auxiliary examination: fever (68.4%), dry cough (15.8%), dyspnea (10.5%), diarrhea (5.3%). 19 cases (100%) showed ground-glass changes on Chest computed tomography. Serum Hypersensitive C-Reactive Protein (hs-CRP) and Serum Amylase A (SAA) were increased obviously of 19 cases (100%); there are 16（84.2%）cases which the total number of lymphocytes decreased; 12 cases (63%) liver function; 11 cases (58%) were deviant in fibrinogen (FIB) and D-dimer, in particular, the D-dimer was significantly higher compared with the non-survivors and survivors.Conclusion More men than women in critically ill patients. All the cases showed ground-glass changes on chest CT, and the vast majority of patients will appear fever and dry cough. Clinical lab index changes obviously, especially the D-dimer in Non-survivors.

scholarly journals Clinical features of critically ill patients with COVID-19 infection in China

2020 ◽  
Author(s):  
Bo Hu ◽  
Dawei Wang ◽  
Chang Hu ◽  
Ming Hu ◽  
Fangfang Zhu ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Laboratory ◽  
Virus Disease ◽  
Prolonged Mechanical Ventilation ◽  
Univariate Analysis ◽  
Management Strategies ◽  
Case Series ◽  
Hypoxemic Respiratory Failure ◽  
Icu Admission

Abstract Importance: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections outbreak in China is now a global issue. There is only a limited understanding of the clinical characteristics of patients with SARS-CoV-2 infections is available.Objective:To describe the characteristics, management strategies, and outcomes of critically ill patients with SARS-CoV-2 infection.Design, Setting, and Patients: This is aretrospective, multi-center case series of 50 critically ill patients with confirmed SARS-CoV-2 infection who were admitted at Zhongnan Hospital of Wuhan University and Wuhan Pulmonary Hospital in Wuhan, China, from January 8 to February 9, 2020.Exposures:Documented Corona Virus Disease, 2019 (COVID-19).Main Outcome Measures: Demographic, clinical, laboratory, imaging data were collected along with management strategies, complications and outcomes of enrolled individuals. Results Fifty critically ill patients with SARS-CoV-2 infections were enrolled. Their median age was 62 (range, 29-92) [IQR,49.5-69.0] years, 68% were male, and 28 (56%) patients had comorbidities, the most common being hypertension. In this cohort, 20(40%) patients survived ,16(32%) patients died, and the rest remained hospitalized. The invasive mechanical ventilator was used in 36(72%) patients with 15(30%) of them requiring prone positioning, and 17(34%) switched to ECMO. The compliance scores of lungs (Cstat)on the day of ICU admission among survivors were higher than those in non-survivors [42.0(18.0-47.0), vs. 19.5(14.0-24.2), p=0.038].The blood IL-6 levels and neutrophils counts at the first day of ICU admission were significantly higher in non-survivors compared to survivors [123.7(85.3-228.8), vs. 20.2(6.8-67.2) ng/ml, p=0.025 for IL-6, and 20.2(6.8-67.2) vs. 4.01(1.99-7.05) × 10⁹/L, p=0.02 for neutrophils counts].The heart rates, PaCO2, lung injury scale (LIS), and positive end-expiratory pressure levels were constantly higher for 10 days in non-survivors than those who survived (p<0.05). The frequency of vasopressor uses and neuromuscular blockers was higher in non-survivors from day 1 to day 10 compared to survivors (p<0.05). In the whole cohort, the most common complications were ARDS (97%), shock (44%), arrhythmia (38%), acute cardiac injury (26%), and acute kidney injury (22%). A secondary bacterial infection was noted in 17(34%) patients. Univariate analysis indicated that lower lung complianceand higher neutrophil counts at the day of ICU admission were related to higher mortality (p-0.03, and 0.04, respectively)ConclusionWe demonstrated that SARS-CoV-2 infection-related critical illness predominantly affected old individuals with comorbidities and characterized by severe hypoxemic respiratory failure, often requiring prolonged mechanical ventilation and rescue therapies. Low lung compliance and persistently elevated PaCO2 indicated poor outcomes.

scholarly journals Improved night shift schedule related to the mortality of critically ill patients with Corona Virus Disease 2019

2020 ◽  
Vol 75 ◽  
pp. 354-360
Author(s):  
Sun Zhang ◽  
Yuanda Xu ◽  
Kang Wu ◽  
Tao Wang ◽  
Xiaofen Su ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Virus Disease ◽  
Night Shift ◽  
Shift Schedule ◽  
Corona Virus

scholarly journals Clinical course and progression of severe and critically ill patients with corona virus disease 2019

2020 ◽  
Author(s):  
Dan Ding ◽  
Xueying Chen ◽  
Lei Zhang ◽  
Min Zhou ◽  
Yongjian Xu ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Virus Disease ◽  
Public Health Issue ◽  
Major Public Health Issue ◽  
Reactive Protein ◽  
Corona Virus ◽  
Neutrophil Percentage ◽  
The Mean ◽  
Hs Crp

Abstract Background：The emergence of Corona Virus Disease 2019 (COVID-19) in Wuhan, China at the end of 2019 is a major public health issue, causing to a large global outbreak. However, the information regarding the clinical characteristic and progression of severe and critically ill patients with COVID-19 is scarce.Methods: We conducted a single-center, retrospective, observational study and enrolled 126 severe and critically ill adult patients who were admitted to the intensive care unit (ICU) of Tongji hospital, between Feb 1 and Feb 20, 2020.Results: Of 126 patients, 85 patients with the positive of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included. The mean age of 85 patients was 68.3 (SD 10.5) years. More than half were men, 55 (62.4%) had chronic illness. 57 (66.3%) patients had died before Feb 28, 2020. the median duration from onset of illness to death, hospitalization to death and ICU admission to death were 22 (17.0-26.0) days, 9.0 (6.0-13.0) days and 5.0 (2.0-6.0) days, respectively. Compared with survivors, non-survivors were more likely old (69.6 [SD 10.22] vs 65.6 [10.9]). Furthermore, the non-survivors had higher white blood cell (WBC) and neutrophil count, neutrophil percentage, high-sensitive C-reactive protein (hs-CRP) and lower lymphocyte and platelet count, lymphocyte percentage and albumin. Notably, arbidol may improve the survival of severe and critically ill patients.Conclusions: Our study reveals the non-survivors had worse blood routine and other clinical monitors. Additionally, arbidol may play useful role in the survival of severe and critically ill patients, which needs further validation.

scholarly journals Effect of routine vs on-demand nebulization of acetylcysteine with salbutamol on accumulation of airway secretions in endotracheal tubes: substudy of a randomized clinical trial

2020 ◽  
Vol 8 (S1) ◽  
Author(s):  
Sophia van der Hoeven ◽  
◽  
Lorenzo Ball ◽  
Federico Constantino ◽  
David M. van Meenen ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Work Of Breathing ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Invasive Ventilation ◽  
Cross Sectional ◽  
Endotracheal Tubes ◽  
On Demand

Abstract Background Accumulated airway secretions in the endotracheal tube increase work of breathing and may favor airway colonization eventually leading to pneumonia. The aim of this preplanned substudy of the ‘Preventive Nebulization of Mucolytic Agents and Bronchodilating Drugs in Intubated and Ventilated Intensive Care Unit Patients trial’ (NEBULAE) was to compare the effect of routine vs on-demand nebulization of acetylcysteine with salbutamol on accumulation of secretions in endotracheal tubes in critically ill patients. Results In this single-center substudy of a national multicenter trial, patients were randomized to a strategy of routine nebulizations of acetylcysteine with salbutamol every 6 h until end of invasive ventilation, or to a strategy with on-demand nebulizations of acetylcysteine or salbutamol applied on strict clinical indications only. The primary endpoint, the maximum reduction in cross-sectional area (CSA) of the endotracheal tube was assessed with high-resolution computed tomography. Endotracheal tubes were collected from 72 patients, 36 from patients randomized to the routine nebulization strategy and 36 of patients randomized to the on-demand nebulization strategy. The maximum cross-sectional area (CSA) of the endotracheal tube was median 12 [6 to 15]% in tubes obtained from patients in the routine nebulization group, not different from median 9 [6 to 14]% in tubes obtained from patients in the on-demand nebulization group (P = 0.33). Conclusion In adult critically ill patients under invasive ventilation, routine nebulization of mucolytics and bronchodilators did not affect accumulation of airway secretions in the endotracheal tube. Trial registration Clinicaltrials.gov Identifier: NCT02159196

CASE SERIES: A SPECTRUM OF FUNGAL INFECTIONS IN COVID-19

2021 ◽  
pp. 29-30
Author(s):  
Venkatesh B. C. ◽  
Rajendra Rao K. M. ◽  
K. N. Mohan Rao
Keyword(s):  
Diabetes Mellitus ◽  
Fungal Infections ◽  
Virus Disease ◽  
Case Series ◽  
Health Crisis ◽  
Major Health ◽  
Corona Virus ◽  
Patients With Diabetes ◽  
Causative Agents

Corona virus Disease 2019 (COVID-19) pandemic is causing a major health crisis across the globe. With the increasing number of fungal infections associated with COVID-19 being reported, it is imperative to understand the spectrum of such infections. Most documented cases have been reported in patients with diabetes mellitus or treatment with immunomodulators. The most common causative agents are Aspergillus, Candida or Mucorales. This series aims to portray the spectrum of fungal infections associated with COVID-19.

scholarly journals Do Aspirin and Other Antiplatelet Drugs Reduce the Mortality in Critically Ill Patients?

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Wolfgang Lösche ◽  
Janina Boettel ◽  
Björn Kabisch ◽  
Johannes Winning ◽  
Ralf A. Claus ◽  
...  
Keyword(s):  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Option ◽  
Bleeding Risk ◽  
Antiplatelet Drugs ◽  
Beneficial Effects ◽  
Prospective Trials ◽  
High Bleeding Risk

Platelet activation has been implicated in microvascular thrombosis and organ failure in critically ill patients. In the first part the present paper summarises important data on the role of platelets in systemic inflammation and sepsis as well as on the beneficial effects of antiplatelet drugs in animal models of sepsis. In the second part the data of retrospective and prospective observational clinical studies on the effect of aspirin and other antiplatelet drugs in critically ill patients are reviewed. All of these studies have shown that aspirin and other antiplatelet drugs may reduce organ failure and mortality in these patients, even in case of high bleeding risk. From the data reviewed here interventional prospective trials are needed to test whether aspirin and other antiplatelet drugs might offer a novel therapeutic option to prevent organ failure in critically ill patients.

scholarly journals Covid-19 in Critically Ill Patients in the Seattle Region — Case Series

2020 ◽  
Vol 382 (21) ◽  
pp. 2012-2022 ◽  
Author(s):  
Pavan K. Bhatraju ◽  
Bijan J. Ghassemieh ◽  
Michelle Nichols ◽  
Richard Kim ◽  
Keith R. Jerome ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Case Series

scholarly journals Chloroquine-induced Prolonged QT Interval in COVID-19 Patients in Indonesia: Case Series

2021 ◽  
Vol 14 (1) ◽  
pp. 01-05
Author(s):  
Putu Dyah Widyaningsih ◽  
Putu Gita Pranata Putra ◽  
DG Wedha Asmara ◽  
Erna Bagiari ◽  
Agus Santosa ◽  
...  
Keyword(s):  
Qt Interval ◽  
Virus Disease ◽  
Case Series ◽  
Corona Virus ◽  
Prolonged Qt Interval ◽  
Prolonged Qt ◽  
Anti Inflammation

The treatment of corona virus disease 2019 (COVID-19)remains in debate, and the use of chloroquine has not been validated by accurate clinical trials.The aim of this study was to provide the possible cardiotoxicity effect of chloroquine in patients with COVID-19. This study was a case-series of prolonged QT interval of COVID-19 patients treated with chloroquine in a hospital in Bali, Indonesia. There were two cases of COVID-19 with exhibited a prolonged QT interval after being administrated of chloroquine. The prolonged QT interval returned to normal after chloroquine was stopped.These cases alert us the cardiotoxicity effect of chloroquine and the need for serial electro-cardiography monitoring before and during therapy. In conclusion, although antiviral and anti-inflammation properties of chloroquine on COVID-19 are promising, its cardiotoxicity effects should be monitored closely for less harm to the patients.

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