scholarly journals Efficacy of Tocilizumab in COVID-19: Single-Center Experience

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Safak Kaya ◽  
Seyhmus Kavak
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Period ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Survival Group ◽  
Survivor Group ◽  
Group 2 ◽  
D Dimer ◽  
Group 1

Background. Cytokine release syndrome can be observed during the course of COVID-19. Tocilizumab is used for treating this highly fatal syndrome. We think that the starting time of tocilizumab is important. In this article, we aimed to discuss the efficacy of tocilizumab and to review the necessity of starting it in the early period and the laboratory values that guide us in determining the time of this early period. Methods. This retrospective study includes a total of 308 patients with a diagnosis of COVID-19 who were treated with tocilizumab, who were hospitalized in the University of Health Sciences, Gazi Yaşargil Training and Research Hospital between July 2020 and December 2020. The data of the patients were recorded on the day of hospitalization, the day of taking tocilizumab (day 0), and the 1st day, 3rd day, 7th day, and 14th day after taking tocilizumab. Data included age, gender, underlying diseases, where the patient was followed, duration of symptoms before admission to the hospital, duration of oxygen demand before tocilizumab, fever, saturation, and laboratory values. Patients were divided into the mortality group (group 1) and the survival group (group 2), and all data were compared. Results. The study consisted of 308 COVID-19 patients divided into two groups: the mortality group (group 1, n = 135 ) and the survival group (group 2, n = 173 ). The median age of the patients was 60 (min–max: 50-70) years, 75.3% ( n = 232 ) were male, and 56.8% had at least one comorbidity. While 88.9% of group 1 was in the intensive care unit, 26.6% of group 2 received tocilizumab while in the intensive care unit, and there was a statistically significant difference. Median SpO2 values and lymphocyte counts were significantly lower in group 1 than in group 2, both on the day of hospitalization and on the day of the first dose of tocilizumab treatment ( p < 0.001 for both). C-reactive protein, d-dimer, and alanine aminotransferase values were higher in the mortal group on the first day of hospitalization, and this was significant ( p = 0.021 , p = 0.001 , and p = 0.036 , respectively). In our study, d-dimer was 766.5 ng/mL in the survivor group and 988.5 ng/mL in the mortal group. In our patient group, the mean lymphocyte count was 700 × 10 3 / m m 3 in the group that survived the first day of TCZ and 500 × 10 3 / m m 3 in the mortal group. In addition, the CRP value was 135.5 mg/L in the survivor group and 169 mg/L in the mortal group. There was no difference between ferritin values. Conclusions. Tocilizumab is still among the COVID-19 treatment options and appears to be effective. But the start time is important. In order to increase its effectiveness, it may be important to know a cut-off value of the laboratory findings required for the diagnosis of cytokine release syndrome. Further studies are needed for this.

The role of IL-6 receptor inhibitor treatment in critical patient monitoring with COVID-19

2021 ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactate Dehydrogenase ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Group 2 ◽  
D Dimer

Objectives: The COVID-19 disease can manifest itself with acute respiratory distress syndrome, renal failure, and septic shock in critically ill patients. There are opinions that there is a correlation between high IL-6 levels and disease severity. In our intensive care unit, we evaluated the changes in the laboratory data and radiological involvement severity of our patients who underwent tocilizumab treatment and examined the appropriate laboratory parameter in the treatment follow-up and its effect on survival. Methods: In the critical patient follow-up of COVID-19, 17 of the 23 patients treated with tocilizumab had a mortal course (Group 1) and the remaining 6 (Group 2) were. The C-reactive protein, lactate dehydrogenase, IL-6, D-dimer, procalcitonin, albumin, and ferritin values, which were routinely screened in our clinic on the day of tocilizumab treatment and the 5th day after, were recorded. Both the change between the two groups and the change between days 1 and 5 were analyzed. Results: A total of 23 patients (55.35 ± 13.31 years) were included in the study. The computed tomography severity score assessed at the intensive care unit admission was statistically significantly higher in Group 2. The procalcitonin and lactate dehydrogenase values measured on day 5 after tocilizumab were significantly lower in Group 2. On the 5th day after treatment, the levels of C-reactive protein, ferritin, chest X-rays, IL-6 and D-dimer statistically significantly changed compared to the first day of the treatment. In correlation with the decrease in PCT as of the 5th day after tocilizumab administration, an increasing tendency was observed in 28-day survival. Conclusion: This study demonstrated that tocilizumab treatment may positively contribute to the treatment by decreasing cytokine levels. PCT and LDH follow-up before and after treatment in critically ill patients who are receiving tocilizumab treatment can give an idea about survival.

scholarly journals Comparison of ICU Outcomes between Intravenous Immunoglobulin and Plasma Exchange in Treatment of Mechanically Ventilated Patients with GuillainBarré Syndrome in a Neuro-Intensive Care Unit in a Govt. Hospital of Bangladesh: A Observational Cohort Study

2019 ◽  
Vol 5 (2) ◽  
pp. 118-122
Author(s):  
Uzzwal Kumar Mallick ◽  
Mohammad Shah Jahirul Hoque Chowdhury ◽  
Mohammad Enayet Hussain ◽  
Mohammad Asaduzzaman ◽  
Md Sirajul Islam ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intravenous Immunoglobulin ◽  
Statistical Significance ◽  
Axonal Neuropathy ◽  
Male Predominance ◽  
Icu Stay ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background: The management of Guillain-Barré Syndrome is very crucial for the outcome of the patient. Objective: The aim of the study was to compare efficacy of IvIg(Intravenous Immunoglobulin) versus PE(Plasmaexchange) in treatment of mechanically ventilation adults with GBS in neuro-intensive care unit of Bangladesh. Methodology: Thiswas a prospective, observationalcohort study, in a Neuro-ICU from 2017 to 2018. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 5 PE during 10days, every alternate day). We collectedclinical and therapeutic aspects and outcome. Results: A total number of 49 patients (34 in group 1 and 15 in group 2) were enrolled. The mean age was 37.4±9.2 years, with a male predominance (65.3%). on electrophysiological findings, in 4(32.7%) patients had acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) in 26 (53.1%) patients and acute motor-sensory axonal neuropathy (AMSAN) was 3(6.1%)and NCS was not done in 4(8.2%) cases. The mean length of ICU stay was 20±19.10 days and 46.60±30.02 days in IVIG and PE group respectively. The ICU stay was significantly shorter (p = 0.001) in the IvIg group than PE group. Patients receiving IvIg were early weaned of MV (p = 0.002) compared to those receiving PE with a statistical significance. Also, duration of M/V (P=.002), Need of tracheostomy (p=.005) and over all surval rate (p=.007) was significantly in favoue of IvIg group than PE group. Out of 49 patients, total 3 patients were died and they all were AMAN variety. Conclusion: Our work reveals a meaningful difference for the MV duration, ICU stay, weaning and excellent recovery in IvIg group compared to PE group in terms of less complcations. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 118-122

Carbapenem-Resistant Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit: Risk Factors for Mortality

2020 ◽  
Author(s):  
Meltem Bor ◽  
Ozkan Ilhan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Congenital Anomalies ◽  
Neonatal Intensive Care ◽  
Carbapenem Resistant ◽  
Group 2 ◽  
Antifungal Use ◽  
Group 1

Abstract Aim The aim of our study was to determine the factors associated with mortality in neonates with carbapenem-resistant Klebsiella pneumoniae (CRKP). Material and methods This retrospective, single-center study was conducted in the Neonatal Intensive Care Unit of Harran University Faculty of Medicine between January 2017 and July 2018 who had CRKP growth in their blood, urine or cerebrospinal fluid cultures. The discharged group was designated as the control group (Group 1), whereas the group that faced mortality was classified as the case group (Group 2). The demographic data, clinical findings and laboratory and microbiological results of the two groups were compared to identify risk factors. Results A total of 58 patients (36 in Group 1 and 22 in Group 2) exhibited CRKP growth during the study period. Low birth weight (p = 0.039), previous antifungal (p = 0.002) or amikacin use (p = 0.040), congenital anomalies (p = 0.002), total parenteral nutrition (TPN) administration (p = 0.002), surgery (p = 0.035), thrombocytopenia (p = 0.007), low platelet mass index (p = 0.011), elevated C-reactive protein (p = 0.004), high carbapenem minimum inhibitory concentration (MIC) (p = 0.029) and high amikacin MIC (p = 0.019) were associated with mortality. In a multivariate regression analysis, previous antifungal use (p = 0.028), congenital anomalies (p = 0.032) and TPN use (p = 0.013) were independent factors in predicting mortality. Conclusion Previous antifungal use, congenital anomalies and TPN use were found to be independent risk factors for mortality in neonates with CRKP infection.

scholarly journals Peculiarities of the morphology of liver biopsy samples of donors above 60 years of age

2020 ◽  
Vol 21 (4) ◽  
pp. 36-40
Author(s):  
I. M. Iljinsky ◽  
N. P. Mozheyko ◽  
D. V. Voronov ◽  
M. G. Minina ◽  
O. M. Tsirulnikova
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Biopsy ◽  
Optimal Level ◽  
Morphological Parameters ◽  
Careful Monitoring ◽  
Donor Pool ◽  
Total Pool ◽  
Group 2 ◽  
Group 1

Objective: to study the differences in the frequency of pathological processes in liver biopsy samples of donors older than 60 years (group 1) and donors currently recognized as “standard” by age – 60 years and younger (group 2). Material and methods. Of the total pool of 300 consecutive donors with brain death, there were 28 (9.3%) donors over 60 years old (61 to 73 years old; 19 men and 9 women). Results. The frequency of pathology is independent of gender in both groups (p > 0.05). In elderly donors, compared with “standard” donors, mild (p < 0.05) and significantly more often severe (p < 0.05) albuminous degeneration are significantly less frequent, and there is only a tendency (p > 0.05) to more frequent mild hepatic steatosis. Dystrophic processes are the result of more severe ischemic injury to the liver of elderly donors. Ischemic liver injury determines the risk of more frequent biliary complications, which require careful monitoring and maintenance at an optimal level of hemodynamics for donors in the intensive care unit. Based on other morphological parameters, the liver of donors above 60 years of age does not significantly differ (p > 0.05) from the liver of donors 60 years and younger. Conclusion. To expand the donor pool, age restrictions should be removed when selecting a liver for transplantation, thereby maximizing the use of donor potential.

scholarly journals Comparison of use and non-use of prophylactic antibiotics for severe acute pancreatitis

2021 ◽  
Vol 8 (8) ◽  
pp. 2281
Author(s):  
Hector Losada M. ◽  
Sonia Curitol ◽  
Andres Troncoso T. ◽  
Norberto Portillo L.
Keyword(s):  
Intensive Care Unit ◽  
Acute Pancreatitis ◽  
Intensive Care ◽  
Severe Acute Pancreatitis ◽  
Preliminary Report ◽  
Prophylactic Antibiotics ◽  
Average Hospital ◽  
Antibiotics Use ◽  
Group 2 ◽  
Group 1

Background: Acute pancreatitis is a frequent disease in Chile, with mortality rate of 10-30%. Prophylactic antibiotics administration has been part of severe acute pancreatitis treatment for theoretical prevention of infectious complications and mortality reduction. Yet the available evidence is controversial. The aim of the study was to demonstrate that prophylactic antibiotics do not reduce complications, need for intensive care unit bed or mortality in severe acute pancreatitis.Methods: Randomized clinical trial with simple randomization using a computational table (use or non-use of prophylactic antibiotics) of patients with severe acute pancreatitis. We define severe acute pancreatitis as APACHE II ≥8, C-reactive protein ≥150. In prophylactic antibiotics use group, ciprofloxacin and metronidazole were administered for 7 days. This preliminary report is presented with 50% of the calculated sample.Results: N=150, two randomized groups; group 1 (n=73), without prophylactic antibiotics use, and group 2 (n=77) with antibiotic prophylaxis use. Twenty-four patients (16%) required intensive care unit bed; twelve in group 1, and twelve in group 2 (p=0.53). Ten patients (6.66%) had some type of complication, one in group 1 and nine in group 2 (p=0.01). The average hospital stay was 15.7±9.0 days in group 1, and 16.8±17.9 days in group 2 (p=0.57). Mortality was four patients (2.66%), one in group 1 and three in group 2 (p=0.33).Conclusions: In this preliminary report, the prophylactic antibiotics use for severe acute pancreatitis was not shown to reduce complications, need for an intensive care unit bed or mortality.

Cytokine release syndrome. Reviewing a new entity in the intensive care unit

2019 ◽  
Vol 43 (8) ◽  
pp. 480-488 ◽  
Author(s):  
Alejandra García Roche ◽  
Cándido Díaz Lagares ◽  
Elena Élez ◽  
Ricard Ferrer Roca
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cytokine Release ◽  
Cytokine Release Syndrome

A Central Venous Line Protocol Decreases Bloodstream Infections and Length of Stay in a Trauma Intensive Care Unit Population

2009 ◽  
Vol 75 (12) ◽  
pp. 1166-1170 ◽  
Author(s):  
TherÈSe M. Duane ◽  
Holly Brown ◽  
C. Todd Borchers ◽  
Luke G. Wolfe ◽  
Ajai K. Malhotra ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Bloodstream Infections ◽  
Central Venous Line ◽  
Trauma Patients ◽  
Central Venous ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

We evaluated the benefit of a central venous line (CVL) protocol on bloodstream infections (BSIs) and outcome in a trauma intensive care unit (ICU) population. We prospectively compared three groups: Group 1 (January 2003 to June 2004) preprotocol; Group 2 (July 2004 to June 2005) after the start of the protocol that included minimizing CVL use and strict universal precautions; and Group 3 (July 2005 to December 2006) after the addition of a line supply cart and nursing checklist. There were 1622 trauma patients admitted to the trauma ICU during the study period of whom 542 had a CVL. Group 3 had a higher Injury Severity Score (ISS) compared with both Groups 2 and 1 (28.3 ± 13.0 vs 23.5 ± 11.7 vs 22.8 ± 12.0, P = 0.0002) but had a lower BSI rate/1000 line days (Group 1:16.5; Group 2:15.0; Group 3: 7.7). Adjusting for ISS group, three had shorter ICU length of stay (LOS) compared with Group 1 (12.11 ± 1.46 vs 18.16 ± 1.51, P = 0.01). Logistic regression showed ISS ( P = 0.04; OR, 1.025; CI, 1.001-1.050) and a lack of CVL protocol ( P = 0.01; OR, 0.31; CI, 0.13-0.76) to be independent predictors of BSI. CVL protocols decrease both BSI and LOS in trauma patients. Strict enforcement by a nurse preserves the integrity of the protocol.

scholarly journals Comparison of nursing workload in a Pediatric Intensive Care Unit estimated by three instruments

2021 ◽  
Vol 55 ◽  
Author(s):  
Kelly Dayane Stochero Velozo ◽  
Caroline Abud Drumond Costa ◽  
Cristian Tedesco Tonial ◽  
Francielly Crestani ◽  
Gabriela Rupp Hanzen Andrades ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Working Hours ◽  
University Hospital ◽  
Nursing Workload ◽  
Strong Correlations ◽  
Group 2 ◽  
Group 1

ABSTRACT Objective: To compare the nursing workload using the Nursing Activities Score (NAS), Therapeutic Intervention Scoring System-28 (TISS-28) and Nine Equivalents of Nursing Manpower Use Score (NEMS) instruments in children admitted to a Pediatric Intensive Care Unit in a university hospital. Method: A prospective cohort study performed in a Pediatric Intensive Care Unit, with a sample formed of all children hospitalized during the study period. Nursing workload was evaluated using the TISS-28, NEMS and NAS instruments, and further divided into two groups: Group 1 forming a category of basic activities items and Group 2 forming a category of other support and intervention activities. Results: The sample consisted of 490 Pediatric Intensive Care Unit admissions, totaling 4617 observations. NAS presented the best estimate of total working hours. TISS-28 and NEMS showed better agreement and the results showed strong correlations between NAS and TISS-28 and between NEMS and TISS-28. In Group 1 (basic activities), NAS(1) and TISS-28(1) showed moderate correlation, in Group 2 (specialized activities) the three instruments showed strong correlations. Conclusion: NAS stood out in the evaluation of nursing workload and showed good correlation and agreement with the TISS-28.

scholarly journals Psoriasis and Pregnancy: Retrospective Evaluation of 47 Pregnancies in a Tertiary Center

2018 ◽  
pp. 1 ◽  
Author(s):  
Efsun Tanacan ◽  
Atakan Tanacan ◽  
Erdem Fadiloglu ◽  
Canan Unal ◽  
Mehmet Sinan Beksac
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Maternal Age ◽  
Neonatal Intensive Care ◽  
Chronic Plaque Psoriasis ◽  
Gestational Week ◽  
Group 2 ◽  
Minute Apgar Score ◽  
Group 1

<p><strong>Objective:</strong> To evaluate the impact of psoriasis on pregnancy outcomes.</p><p><strong>Study Design:</strong> Data of pregnant women with chronic plaque psoriasis who were followed up at Ha­cet­­tepe University Hospital between January 1, 2010 and December 31, 2017 were evaluated. Pregnant women with singleton pregnancies who had chronic plaque psoriasis were included in the study. Patients were divided into two groups based on the clinical course of psoriasis: group 1 (improvement/disease-stable), and group 2 (deterioration). Median maternal age, gravida, parity, gestational week at birth, birthweight, 5th minute APGAR score together with the rates of cesarean section, neonatal intensive care unit admission and pregnancy complications (spontaneous abortion, preterm delivery, fetal growth restriction and preeclampsia) were compared between the groups.</p><p><strong>Results:</strong> There were 29 (61.7%) patients in group 1 and 18 (38.3%) patients in group 2. Mean values for maternal age, gravida and parity were comparable between the groups (p values were 0.32, 0.09 and 0.17, respectively). Median values for gestational week at birth (39.2 vs 36.1, p =0.002), birthweight (3200 vs 2310, p =0.002) and 5th minute APGAR score (9 vs 7, p &lt;0.001) were statistically significantly lower in group 2. Cesarean section (33.3% vs 71.4%, p =0.02), neonatal intensive care unit admission (11.1% vs 64.3%, p &lt;0.001) and pregnancy complication rates (p =0.003) were statistically significantly higher in group 2. Frequencies of spontaneous abortion, preterm delivery, fetal growth restriction and preeclampsia were 6.9%, 10.3%, 3.4% and 3.4% in group 1, and 22.2%, 27.8%, 16.7% and 16.7% in group 2, respectively.</p><p><strong>Conclusion:</strong> Deterioration of psoriasis in pregnancy was associated with adverse obstetric outcome.</p>

scholarly journals Experience of using surfactant therapy for pneumonia associated with COVID-19 of obstetric patients

2020 ◽  
pp. 42-47
Author(s):  
M.V. Shvechkova ◽  
◽  
I.I. Kukarskaya ◽  
R.N. Marchenko ◽  
I.I. Kuratcenko ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pregnant Women ◽  
Integrated Treatment ◽  
Surfactant Therapy ◽  
Postpartum Women ◽  
Complex Therapy ◽  
Group 2 ◽  
Group 1

Introduction. Pregnant women may be at increased risk for severe COVID-19 illness. Pregnant women are more likely to be hospitalized at ICU, needed the mechanical ventilation compared to nonpregnant women. The pregnant women are currently excluded from the most of the clinical trials of COVID-19 drug therapy. This limits the formulation of appropriate recommendations for the treatment of pregnant women with SARS-CoV-2 infection. Building on the experience of the effective use of surfactant therapy for influenza A/H1N1 treatment of pregnant women with COVID-19, the domestic/local drug Surfactant BL was included in the complex therapy. The objective. To evaluate the effectiveness of surfactant therapy in the integrated treatment of severe COVID-19 pneumonia of pregnant women and postpartum women. Materials and methods. The study included 69 pregnant and postpartum women with severe COVID-19 pneumonia. All ofthem received antiviral, anticoagulant and anti-inflammatory therapy. 47 patients (group 1) with an initially more severe course of the disease received inhalations with Surfactant BL in 1–2 days after admission to the intensive care unit, 22 patients (group 2) were prescribed surfactant therapy for 4–5 days, due to the progression of respiratory failure. Surfactant BL was administered at a dose of 75 mg 2 times a day through a nebulizer for 2–5 days. Result. In group 1 patients, SpO2 recovered faster and dyspnea decreased. All patients of group 1 did not require mechanical ventilation; in group 2, 3 patients (14.3%) required mechanical ventilation. In the group of early use of surfactant therapy with CT control, in most cases, there was a positive trend (67.6%), in contrast to group 2 (37.5%). Stay in ICU conditions in group 1 was 8.6 days, in group 2 – 13.2 days. No lethal outcomes were observed with surfactant therapy in both groups. Conclusion. Early surfactant therapy against the background of complex therapy allows to avoid mechanical ventilation, reducing the length of stay of patients in the intensive care unit and preventing mortality from COVID-19 pneumonia.

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