scholarly journals A Multicenter Evaluation of Blood Purification with Seraph 100 Microbind Affinity Blood Filter for the Treatment of Severe COVID-19: A Preliminary Report

2021 ◽  
Author(s):  
Stephen A. Chitty ◽  
Sarah Mobbs ◽  
Brian S. Rifkin ◽  
Steven W. Stogner ◽  
Michael S. Lewis ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Data Extraction ◽  
Treated Group ◽  
Blood Purification ◽  
Apache Ii Score ◽  
Multivariable Logistic Regression Analysis ◽  
Extracorporeal Blood Purification ◽  
Blood Filter ◽  
Observational Cohort ◽  
Comorbidity Index

ObjectiveThe Seraph®100 Microbind Affinity Blood Filter® (Seraph 100) is an extracorporeal medical countermeasure that can remove many pathogens from blood, including the SARS-CoV-2 virus. The aim of this study was to evaluate safety and efficacy of Seraph 100 treatment for severe coronavirus disease 2019 (COVID-19).DesignMulticenter retrospective observational cohort study.SettingIntensive care units across four of thirteen participating sites who have completed data extraction.PatientsCritically ill COVID-19 patients treated with Seraph 100 under an Emergency Use Authorization (n=53) and historical control patients who met criteria for treatment (n=46).InterventionExtracorporeal treatment with the Seraph 100 filter.Measurements and Main ResultsAt baseline, the median age was 61 years, 72.7% were male, and 59.6% required mechanical ventilation. The groups were matched in terms of sex, race/ethnicity, body mass index, APACHE II score, need for mechanical ventilation, and other COVID-19 treatments. However, patients in the Seraph 100 group were younger with a median age of 61 years (IQR 42-65) compared to controls who had a median age of 64 (IQR 56-68, p=0.036). The Seraph 100 group also had a lower median Charlson comorbidity index (2, IQR 0-3) compared to control patients (3, IQR 2-4, p=0.006). Mortality was lower in the Seraph 100 treated group compared to the historical controls (37.7% vs 67.4%, respectively, p=0.003). Multivariable logistic regression analysis yielded an odds ratio of 0.27 (95% confidence interval 0.09-0.79, p=0.016). Of the 53 patients treated with Seraph 100, only 1 patient experienced a serious adverse event (transient hypotension at the start of the treatment which required a brief period of vasopressor support).ConclusionsThese data suggest that broad spectrum, pathogen agnostic, extracorporeal blood purification technologies can be safely and effectively deployed to meet new pathogen threats as an adjunct to standard treatments while awaiting the development of directed pharmacologic therapies and/or vaccines.

scholarly journals EXTRACORPOREAL BLOOD PURIFICATION IN COVID-19 WITH SERAPH 100 MICROAFFINITY BLOOD FILTER: A SINGLE-CENTER CASE SERIES

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A626-A627
Author(s):  
Melissa Rosas ◽  
Nicholas Niazi ◽  
Arjun Kalra ◽  
Lauren Sattler ◽  
Rohini Chatterjee ◽  
...  
Keyword(s):  
Case Series ◽  
Blood Purification ◽  
Single Center ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Blood Filter

scholarly journals Clinical features and predictors of severity in COVID-19 patients with critical illness in Singapore

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ser Hon Puah ◽  
◽  
Barnaby Edward Young ◽  
Po Ying Chia ◽  
Vui Kian Ho ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Features ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Case Series ◽  
Plateau Pressure ◽  
Apache Ii Score ◽  
Multivariable Logistic Regression Model ◽  
Reactive Protein ◽  
Ventilatory Management

AbstractWe aim to describe a case series of critically and non-critically ill COVID-19 patients in Singapore. This was a multicentered prospective study with clinical and laboratory details. Details for fifty uncomplicated COVID-19 patients and ten who required mechanical ventilation were collected. We compared clinical features between the groups, assessed predictors of intubation, and described ventilatory management in ICU patients. Ventilated patients were significantly older, reported more dyspnea, had elevated C-reactive protein and lactate dehydrogenase. A multivariable logistic regression model identified respiratory rate (aOR 2.83, 95% CI 1.24–6.47) and neutrophil count (aOR 2.39, 95% CI 1.34–4.26) on admission as independent predictors of intubation with area under receiver operating characteristic curve of 0.928 (95% CI 0.828–0.979). Median APACHE II score was 19 (IQR 17–22) and PaO2/FiO2 ratio before intubation was 104 (IQR 89–129). Median peak FiO2 was 0.75 (IQR 0.6–1.0), positive end-expiratory pressure 12 (IQR 10–14) and plateau pressure 22 (IQR 18–26) in the first 24 h of ventilation. Median duration of ventilation was 6.5 days (IQR 5.5–13). There were no fatalities. Most COVID-19 patients in Singapore who required mechanical ventilation because of ARDS were extubated with no mortality.

scholarly journals 556. Evaluation of Hydroxychloroquine-based Combination Therapies for the Treatment of COVID-19

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S343-S343
Author(s):  
Andrew David Berti ◽  
Pramodini Kale-Pradhan ◽  
Christopher Giuliano ◽  
Bianca Aprilliano ◽  
Christopher R Miller ◽  
...  
Keyword(s):  
Vitamin D ◽  
Sofa Score ◽  
Laboratory Data ◽  
Organ Damage ◽  
Secondary Outcome ◽  
Mortality Data ◽  
Observational Cohort ◽  
Comorbidity Index ◽  
Significant Change ◽  
Investigational Agents

Abstract Background During the early COVID-19 pandemic a large number of investigational agents were utilized due to lack of therapeutic options. We evaluate the utility of commonly-used investigational agents combined with hydroxychloroquine (HCQ). Methods This multicenter observational cohort study included patients admitted with COVID-19 between March - May 2020 in Detroit, Michigan who received at least 2 doses of HCQ. Our primary outcome was the change in Sequential Organ Failure Assessment (SOFA) score from presentation to day 5 of HCQ therapy with a secondary outcome of in-hospital mortality. Data collected included demographics, Charlson Comorbidity index (CCI), daily SOFA score, laboratory data and COVID-directed therapies. Multiple linear regressions were performed to control for potential confounders between different therapies and change in SOFA score. Results Three hundred thirty-five patients receiving HCQ were included. Patients were 62 ± 14.8 years of age, male (54%) and African-American (82%) with a mean CCI of 1.7 ± 1.9. In our cohort, 32% were admitted to the intensive care unit and 35% expired. Therapies received by more than 20% of patients in addition to HCQ included azithromycin (80%), zinc (76%) and vitamin D (29%). In our unadjusted analysis, a significant improvement in SOFA score was observed with zinc (0.76) while no significant change was observed with azithromycin (-0.46) or vitamin D (0.05). However, there was no significant change in SOFA score after adjusting for confounders for azithromycin, zinc and vitamin D. No difference in mortality was observed between the groups. Conclusion Overall, no benefit in end-organ damage or mortality was observed with the addition of azithromycin, zinc or vitamin D to HCQ. Further studies are needed to confirm this observation. Disclosures All Authors: No reported disclosures

Peripheral muscular ultrasound as outcome assessment tool in critically ill patients on mechanical ventilation: An observational cohort study

2021 ◽  
Author(s):  
Diogo Oliveira Toledo ◽  
Branca Jardini de Freitas ◽  
Rogério Dib ◽  
Flavia Julie do Amaral Pfeilsticker ◽  
Dyaiane Marques dos Santos ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Outcome Assessment ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Assessment Tool ◽  
Observational Cohort Study ◽  
Observational Cohort

Rest ventilator management in children on veno-venous extracorporeal membrane oxygenation

2021 ◽  
pp. 039139882199938
Author(s):  
Matthew L Friedman ◽  
Samer Abu-Sultaneh ◽  
James E Slaven ◽  
Christopher W Mastropietro
Keyword(s):  
Mechanical Ventilation ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Arterial Oxygen Saturation ◽  
Peak Inspiratory Pressure ◽  
Conventional Mechanical Ventilation ◽  
Arterial Oxygen ◽  
Multivariable Logistic Regression Analysis ◽  
Membrane Oxygenation ◽  
Ventilator Management

Background: We aimed to use the Extracorporeal Life Support Organization registry to describe the current practice of rest mechanical ventilation setting in children receiving veno-venous extracorporeal membrane oxygenation (V-V ECMO) and to determine if relationships exist between ventilator settings and mortality. Methods: Data for patients 14 days to 18 years old who received V-V ECMO from 2012-2016 were reviewed. Mechanical ventilation data available includes mode and settings at 24 h after ECMO cannulation. Multivariable logistic regression analysis was performed to determine if rest settings were associated with mortality. Results: We reviewed 1161 subjects, of which 1022 (88%) received conventional mechanical ventilation on ECMO. Rest settings, expressed as medians (25th%, 75th%), are as follows: rate 12 breaths/minute (10, 17); peak inspiratory pressure (PIP) 22 cmH2O (20,27); positive end expiratory pressure (PEEP) 10 cmH2O (8, 10); and fraction of inspired oxygen (FiO2) 0.4 (0.37, 0.60). Survival to discharge was 68%. Higher ventilator FiO2 (odds ratio:1.13 per 0.1 increase, 95% confidence interval:1.04, 1.23), independent of arterial oxygen saturation, was associated with mortality. Conclusions: Current rest ventilator management for children receiving V-V ECMO primarily relies on conventional mechanical ventilation with moderate amounts of PIP, PEEP, and FiO2. Further study on the relationship between FiO2 and mortality should be pursued.

Effect Of Cluster Intervention Strategy Combined with Targeted Nursing on Prevention of Ventilator-Associated Pneumonia in Icu Patients

2021 ◽  
Vol 7 (6) ◽  
pp. 6395-6401
Author(s):  
XueQin Li ◽  
XiuYing Chen
Keyword(s):  
Mechanical Ventilation ◽  
Detection Rate ◽  
Pathogenic Bacteria ◽  
Nursing Intervention ◽  
Apache Ii Score ◽  
Control Group ◽  
Study Group ◽  
Ventilator Associated Pneumonia ◽  
Icu Patients ◽  
Mechanical Ventilation Time

Background VAP is a common complication of ventilator maintenance therapy. The occurrence of VAP is related to many factors such as long duration of breathing, invasive operation, pollution of respiratory tubes and instruments, and low immunity of patients. The prevention of VAP in critically ill patients I the primary problem for clinical medical staff. Avoiding exogenous bacteria invading the respiratory tract and endogenous bacterial infection is the main method. Objective To investigate the value of optimized cluster nursing intervention combined with targeted nursing measures in reducing the incidence of ventilator-associated pneumonia (VAP) in patients with mechanical ventilation in intensive care unit (ICU). Methods 200 patients with mechanical ventilation in ICU of our institute from January 2017 to June 2020 were selected and randomly divided into study group and control group, with 100 cases in each group. The study group was treated with cluster nursing intervention combined with targeted nursing measures optimized by muItL criteria decision analysis method, and the control group was treated with targeted nursing measures. The incidence of VAP, the detection rate of pathogenic bacteria in sputum specimens and the effect of nursing execution were compared between the two groups. 200 patients were divided into VAP group and non-VAP group according to whether VAP occurred. Multivariate Logistic regression model analysis was used to explore the risk factors of VAP in AECOPD patients. Results A total of 4 strains were detected in the study group and 18 strains were detected in the control group. The detection rate of pathogenic bacteria in the study group was higher than that in the control group (y2=10.010, P=0.002<0.05). The incidence of VAP in the study group was 4.00% lower than 17.00% in the control group, and the difference was statistically significant (P<0.05). Compared with VAP group and non-VAP group, the proportion of patients with serum albumin<30g/L, diabetes mellitus rate, APACHE II score>15 points, tracheotomy rate and mechanical ventilation time≥5 days in VAP group were significantly higher than those in non-VAP group, which had statistical significance (P<0.05). The results of logistic regression model snowed that serum albumin ≥30g/L and optimized cluster nursing could effectively reduce the risk of VAP in ICU patients with mechanical ventilation (P<0.05). The risk of VAP in ICU patients with mechanical ventilation was increased by the combination of diabetes rate. APACHE II score≥15 points, tracheotomy and mechanical ventilation time ≥ 5 days (P<0.05). Conclusion The risk of VAP in ICU patients with mechanical ventilation is high, and the optimized cluster nursing intervention combined with targeted nursing measures can effectively reduce the incidence of VAP.

scholarly journals APHACHE Score as a Predictive Indices for Weanability from Mechanical Ventilation

2013 ◽  
Vol 1 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Md Sayedul Islam
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Private Hospital ◽  
Total Duration ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Apache Score ◽  
Number Of Patients ◽  
Weaning Outcome

Objective: To determine the significance of acute physiology and chronic health evaluation (APACHE) score as an important parameter of weaning outcome for mechanical ventilation. Design: prospective, observational. Setting: The medical ICU of a modernized private hospital, Dhaka. Method: The study was carried out during the period of 2008 to 2009 in a specialized private hospital Dhaka. Critical care physicians were asked to filled up the data sheets having detail problem of the patients including the APACHE II score. The APACHE II score is divided into three steps High score>25, Medium score 20-24 and Low score < 20. The clinicians were suggested to predict whether it would take < 3 days or 4to 7days or >8days to wean each patients from mechanical ventilation. The cause of respiratory failure and total duration of weaning were recorded. The significance was set at p<.05. Result: Total number of patients included in this study were 40. Male were 22 (55%) and female were 18 (45%), the mean age of the patients were 51.1±13.9. The most common cause of respiratory failure were COPD 11(24.5%) and next common were pneumonia and ARDS due to sepsis 8 (20%) each. Among the studied population 20 (50%) having low APACHE score (<20), 12 (30%) were medium score (20-24) and 8 (20%) patients were high score (>25). Total 25 (62.5%) of the patients were successfully weaned from mechanical ventilation, 10 (25%) of the patient died and 5 (12.5%) of the patent were shifted to other low cost hospital. The successfully weaned groups 17 (68%) had lower APACHE II score than the unsuccessfully (failure) group which were statistically significant ÷2 =.8546, df =2, p-value >.005. Conclusions: The overall severity of illness as assessed by APACHE II score correlates better with weaning outcome. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14360 Bangladesh Crit Care J March 2013; 1: 18-22

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