scholarly journals 340. Outcomes of COVID-19 in Hospitalized SOT Recipients: Experence in Colombia, South America

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S274-S274
Author(s):  
Fernando Rosso ◽  
Eric Tafurt
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Low Dose ◽  
Glucocorticoid Therapy ◽  
Nasopharyngeal Swab ◽  
High Dose ◽  
Icu Mortality ◽  
Secondary Infections ◽  
Hospital Acquired

Abstract Background SOTs (SOT) recipients with COVID-19 are considered to be at high risk of severe clinical outcomes. Several descriptive studies have reported a high frequency of intensive care unit admission and death rates. There is a lack of evidence regarding the best approach for immunosuppressive therapy in SOT recipients with COVID-19. Methods We performed a single-centered, retrospective, observational study of all SOT recipients with SARS-CoV-2 confirmed infection RT-PCR from nasopharyngeal swab specimens who were admitted to the emergency department from March 25 to September 1, 2020. Glucocorticoid therapy was administered according to the criteria of the attending physician. We classified glucocorticoid dose as low dose therapy if the patient received dexamethasone 6 mg/day or methylprednisolone 40 mg/day, and a high dose if the patient received methylprednisolone 80–160 mg/day. Specimens collected within the first 48 hours were defined coinfection, while specimens collected after 48 hours were defined as hospital-acquired superinfection. Results Of a total of 43 SOT recipients with COVID-19, 17 (39%) required intensive care unit admission. 32 (74.4%) required glucocorticoid therapy: 13 received low dose and 19 high dose. 15 (34.8%) had secondary infections. A total of 12 (27.9%) presented hospital-acquired bacterial superinfections, mostly caused by P. aeruginosa, most of isolations were from respiratory tract cultures. The median time from hospital admission to superinfection diagnosis was 9 (7-13) days. Community-acquired co-infection at COVID-19 diagnosis was documented only in 3 (6.9%) patients, mostly caused by K. Pneumoniae, all isolations were from urine culture. Glucocorticoid therapy was indicated in 32 (80%) patients, 19 received high dose and 13 low doses. Overall hospital mortality was 17.5%. ICU mortality was 41%. Overall mortality in the high dose steroids group was 37 % vs . 0% in the low dose group. Conclusion Our results showed a higher frequency of superinfection in SOT recipients with COVID-19 compared to previous reports, and higher ICU mortality. Further studies are needed to establish the best approach for glucocorticoid therapy in SOT recipients with COVID-19. Disclosures All Authors: No reported disclosures

Safety, Efficacy, and Timeliness of Intravenous Potassium Chloride Replacement Protocols in a Pediatric Cardiothoracic Intensive Care Unit

2018 ◽  
Vol 35 (4) ◽  
pp. 371-377
Author(s):  
Rambod Amirnovin ◽  
Phuong Lieu ◽  
Flerida Imperial-Perez ◽  
Carol Taketomo ◽  
Barry P. Markovitz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Potassium Chloride ◽  
Low Dose ◽  
Pediatric Patients ◽  
Univariate Analysis ◽  
Lower Percentage ◽  
High Dose ◽  
Increased Risk

Objective: Hypokalemia in children following cardiac surgery occurs frequently, placing them at risk of life-threatening arrhythmias. However, renal insufficiency after cardiopulmonary bypass warrants careful administration of potassium (K+). Two different nurse-driven protocols (high dose and tiered dosing) were implemented to identify an optimal K+ replacement regimen, compared to an historical low-dose protocol. Our objective was to evaluate the safety, efficacy, and timeliness of these protocols. Design: A retrospective cohort review of pediatric patients placed on intravenous K+ replacement protocols over 1 year was used to determine efficacy and safety of the protocols. A prospective single-blinded review of K+ repletion was used to determine timeliness. Patients: Pediatric patients with congenital or acquired cardiac disease. Setting: Twenty-four-bed cardiothoracic intensive care unit in a tertiary children’s hospital. Interventions: Efficacy was defined as fewer supplemental potassium chloride (KCl) doses, as well as a higher protocol to total doses ratio per patient. Safety was defined as a lower percentage of serum K+ levels ≥4.8 mEq/L after a dose of KCl. Between-group differences were assessed by nonparametric univariate analysis. Results: There were 138 patients with a median age of 3.0 (interquartile range: 0.23-10.0) months. The incidence of K+ levels ≥4.8 mEq/L after a protocol dose was higher in the high-dose protocol versus the tiered-dosing protocol but not different between the low-dose and tiered-dosing protocols (high dose = 2.2% vs tiered dosing = 0.5%, P = .05). The ratio of protocol doses to total doses per patient was lower in the low-dose protocol compared to the tiered-dosing protocol ( P < .05). Protocol doses were administered 45 minutes faster ( P < .001). Conclusion: The tiered-dosed, nurse-driven K+ replacement protocol was associated with decreased supplemental K+ doses without increased risk of hyperkalemia, administering doses faster than individually ordered doses; the protocol was effective, safe, and timely in the treatment of hypokalemia in pediatric patients after cardiac surgery.

scholarly journals Anticoagulation Before Hospitalization Is a Potential Protective Factor for COVID‐19: Insight From a French Multicenter Cohort Study

2021 ◽  
Author(s):  
Richard Chocron ◽  
Vincent Galand ◽  
Joffrey Cellier ◽  
Nicolas Gendron ◽  
Thibaut Pommier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Propensity Score ◽  
Intensive Care Unit Admission ◽  
Protective Factor ◽  
Anticoagulation Therapy ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
High Dose ◽  
Medical Wards

Background Coronavirus disease 2019 (COVID‐19) is a respiratory disease associated with thrombotic outcomes with coagulation and endothelial disorders. Based on that, several anticoagulation guidelines have been proposed. We aimed to determine whether anticoagulation therapy modifies the risk of developing severe COVID‐19. Methods and Results Patients with COVID‐19 initially admitted in medical wards of 24 French hospitals were included prospectively from February 26 to April 20, 2020. We used a Poisson regression model, Cox proportional hazard model, and matched propensity score to assess the effect of anticoagulation on outcomes (intensive care unit admission or in‐hospital mortality). The study enrolled 2878 patients with COVID‐19, among whom 382 (13.2%) were treated with oral anticoagulation therapy before hospitalization. After adjustment, anticoagulation therapy before hospitalization was associated with a better prognosis with an adjusted hazard ratio of 0.70 (95% CI, 0.55–0.88). Analyses performed using propensity score matching confirmed that anticoagulation therapy before hospitalization was associated with a better prognosis, with an adjusted hazard ratio of 0.43 (95% CI, 0.29–0.63) for intensive care unit admission and adjusted hazard ratio of 0.76 (95% CI, 0.61–0.98) for composite criteria intensive care unit admission or death. In contrast, therapeutic or prophylactic low‐ or high‐dose anticoagulation started during hospitalization were not associated with any of the outcomes. Conclusions Anticoagulation therapy used before hospitalization in medical wards was associated with a better prognosis in contrast with anticoagulation initiated during hospitalization. Anticoagulation therapy introduced in early disease could better prevent COVID‐19–associated coagulopathy and endotheliopathy, and lead to a better prognosis.

scholarly journals Hospital-Acquired Infections among Adult Patients Admitted for COVID-19

2021 ◽  
pp. 1-15
Author(s):  
Leigh Smith ◽  
Sara M Karaba ◽  
Joe Amoah ◽  
George Jones ◽  
Robin Avery ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Antibiotic Exposure ◽  
Hospital Acquired Infection ◽  
Hospital Acquired Infections ◽  
Multicenter Cohort ◽  
Hospital Acquired

Abstract In a multicenter cohort of 963 adults hospitalized due to COVID-19, 5% had a proven hospital-acquired infection (HAI) and 21% had a proven/probable or possible HAI. Risk factors for proven/probable HAIs included intensive care unit admission, dexamethasone use, severe COVID-19, heart failure and antibiotic exposure upon admission.

Sign in / Sign up

Export Citation Format

Share Document