scholarly journals Venous Thromboembolism Complicated with COVID-19: What Do We Know So Far?

2020 ◽  
Vol 143 (5) ◽  
pp. 417-424 ◽  
Author(s):  
Shir Tal ◽  
Galia Spectre ◽  
Ran Kornowski ◽  
Leor Perl
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Present Knowledge ◽  
The Novel ◽  
Proper Treatment ◽  
Anticoagulant Treatment ◽  
Susceptible Population ◽  
Increased Risk ◽  
High Incidence

Coronavirus disease (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is responsible for the ongoing 2019–2020 pandemic. Venous thromboembolism (VTE), a frequent cardiovascular and/or respiratory complication among hospitalized patients, is one of the known sequelae of the illness. Hospitalized COVID-19 patients are often elderly, immobile, and show signs of coagulopathy. Therefore, it is reasonable to assume a high incidence of VTE among these patients. Presently, the incidence of VTE is estimated at around 25% of patients hospitalized in the intensive care unit for COVID-19 even under anticoagulant treatment at prophylactic doses. In this review, we discuss present knowledge of the topic, the unique challenges of diagnosis and treatment of VTE, as well as some of the potential mechanisms of increased risk for VTE during the illness. Understanding the true impact of VTE on patients with COVID-19 will potentially improve our ability to reach a timely diagnosis and initiate proper treatment, mitigating the risk for this susceptible population during a complicated disease.

scholarly journals Does Obesity Predispose Medical Intensive Care Unit Patients to Venous Thromboembolism despite Prophylaxis? A Retrospective Chart Review

2016 ◽  
Vol 2016 ◽  
pp. 1-8
Author(s):  
Bradley J. Peters ◽  
Ross A. Dierkhising ◽  
Kristin C. Mara
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Risk Model ◽  
Medical Intensive Care Unit ◽  
Statistical Significance ◽  
The Body ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Medical Intensive Care

Background. Obesity is a significant issue in the critically ill population. There is little evidence directing the dosing of venous thromboembolism (VTE) prophylaxis within this population. We aimed to determine whether obesity predisposes medical intensive care unit patients to venous thromboembolism despite standard chemoprophylaxis with 5000 international units of subcutaneous heparin three times daily. Results. We found a 60% increased risk of venous thromboembolism in the body mass index (BMI) ≥ 30 kg/m2 group compared to the BMI < 30 kg/m2 group; however, this difference did not reach statistical significance. After further utilizing our risk model, neither obesity nor mechanical ventilation reached statistical significance; however, vasopressor administration was associated with a threefold risk. Conclusions. We can conclude that obesity did increase the rate of VTE, but not to a statistically significant level in this single center medical intensive care unit population.

scholarly journals Considerations in the provision of teleconsultations for outpatient obstetric anaesthesia care during the Covid-19 pandemic

2021 ◽  
pp. 201010582199117
Author(s):  
Leonard Wei Wen Loh ◽  
Yingke He ◽  
Hairil Rizal Abdullah ◽  
Kai Lee Ng ◽  
Un Sam Mok
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Severe Illness ◽  
Continuing Care ◽  
Short Report ◽  
Obstetric Anaesthesia ◽  
Increased Risk ◽  
Process And Outcome ◽  
Risk Of Exposure ◽  
Anaesthesia Care

Evidence has emerged that pregnant women who contract coronavirus disease 2019 (Covid-19) are at increased risk of certain forms of severe illness as well as complications requiring intensive care unit admission and resultant mortality. Teleconsultations can facilitate continuing care for obstetric patients during the Covid-19 pandemic while reducing their risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this short report, we share our experience in the provision of teleconsultations for ambulatory obstetric anaesthesia patients in our high-risk obstetric anaesthesia clinic during the Covid-19 pandemic. Appropriate labour analgesia or anaesthesia plans were able to be formulated and communicated to the patients by teleconsultation, resulting in no delay or compromise in their peripartum care. Both patients and clinicians reported satisfaction with the teleconsultation process and outcome. The considerations and challenges in setting up a teleconsultation service as well as the factors in favour of teleconsultation are also explored.

scholarly journals Increased Risk of Death, in the Hospital and Outside the Intensive Care Unit, for Patients With Cirrhosis After Cardiac Arrest

2017 ◽  
Vol 15 (11) ◽  
pp. 1808-1810 ◽  
Author(s):  
Megan E. Reinders ◽  
Gabriel Wardi ◽  
Ricki Bettencourt ◽  
Daniel Bouland ◽  
Jessica Bazick ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Risk Of Death ◽  
Increased Risk

Purulent Otitis Media—A “Silent” Source of Sepsis in the Pediatric Intensive Care Unit

1985 ◽  
Vol 93 (3) ◽  
pp. 330-334 ◽  
Author(s):  
Michael Persico ◽  
Geoffrey A. Barker ◽  
David P. Mitchell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Middle Ear ◽  
Nasotracheal Intubation ◽  
Pediatric Intensive Care ◽  
Nasogastric Tubes ◽  
High Incidence ◽  
Risk Patients ◽  
Pediatric Icu

Septicemia is common in patients in the pediatric intensive care unit (ICU) who have nasotracheal tubes. Although it is frequently caused by middle ear effusion (MEE), pneumatic otoscopy is not routinely performed in these patients. To demonstrate the value of this procedure, 46 pediatric ICU patients with nasotracheal tubes were followed daily with pneumatic otoscopy for 11 to 98 days and compared with 25 controls without nasotracheal tubes, 12 of whom had nasogastric tubes. Myringotomy was performed whenever blood culture became positive. MEE was significantly more frequent in patients with nasotracheal tubes (87%) than in patients with controls (23%) and occurred first on the side of intubation. Blood bacteria were identical to middle ear pathogens in 80% of patients. Nasogastric tubes were not significant in causing MEE. The high incidence of MEE resulting from nasotracheal intubation indicates the importance of including pneumatic otoscopy in the daily examination of these high-risk patients.

scholarly journals The effectiveness and safety of the use of antithrombotic therapy in COVID-19

2021 ◽  
Vol 18 (2) ◽  
pp. 17-30
Author(s):  
K. V. Lobastov ◽  
O. Ya. Porembskay ◽  
I. V. Schastlivtsev
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Increased Risk ◽  
Severe Infections ◽  
Thrombotic Complications ◽  
Risk Of Disease ◽  
Anticoagulant Prophylaxis ◽  
Discharge From Hospital ◽  
Outpatient Settings

The article is a non-systematic review of the literature, addressing the effectiveness, safety and appropriateness of antithrombotic drugs for COVID-19 in patients undergoing treatment in different settings: in the hospital phase, including the intensive care unit, in the outpatient phase after discharge from hospital, in primary outpatient treatment. The issues of thrombotic complications during vaccination and the necessity of their prevention are discussed. The studies confirm the importance of prophylactic doses of anticoagulants in all hospitalized patients. The use of increased doses has proven ineffective in patients with a severe course of the disease who are being treated in the intensive care unit. In moderately severe infections, there is a clear benefit of increased doses of anticoagulants in reducing the risk of organ failure, but definitive conclusions can only be drawn after the final results of the studies have been published. Prolonged pharmacological prophylaxis after hospital discharge may be useful in individual patients, but the overall risk of thrombotic complications in the long-term period does not appear to be high. The available data do not support the use of anticoagulants in the treatment of coronavirus disease in the outpatient settings, since the risk of thrombotic complications is not increased in such patients, and the safety of anticoagulant use has not been evaluated. Sulodexide may be useful in selected outpatients at increased risk of disease progression. Vaccination may provoke the development of atypical localized thrombosis by immune mechanisms, but the risk of such complications is lower in the coronavirus disease itself. Anticoagulant prophylaxis during vaccine administration is not indicated.

An Outbreak of Multidrug-ResistantPseudomonas AeruginosaAssociated with Increased Risk of Patient Death in an Intensive Care Unit

2002 ◽  
Vol 23 (8) ◽  
pp. 441-446 ◽  
Author(s):  
Geir Bukholm ◽  
Tone Tannæs ◽  
Anne Britt Bye Kjelsberg ◽  
Nils Smith-Erichsen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Bacterial Isolates ◽  
Patient Death ◽  
Antibiotic Policy ◽  
Outbreak Period ◽  
Increased Risk ◽  
Gastric Tubes

Objective:To investigate an outbreak of multidrug-resistantPseudomonas aeruginosain an intensive care unit (ICU).Design:Epidemiologic investigation, environmental assessment, and ambidirectional cohort study.Setting:A secondary-care university hospital with a 10-bed ICU.Patients:All patients admitted to the ICU receiving ventilator treatment from December 1,1999, to September 1, 2000.Results:An outbreak in an ICU with multidrug-resistant isolates ofP. aeruginosabelonging to one amplified fragment-length polymorphism (AFLP)–defined genetic cluster was identified, characterized, and cleared. Molecular typing of bacterial isolates with AFLP made it possible to identify the outbreak and make rational decisions during the outbreak period. The outbreak included 19 patients during the study period. Infection with bacterial isolates belonging to the AFLP cluster was associated with reduced survival (odds ratio, 5.26; 95% confidence interval, 1.14 to 24.26). Enhanced barrier and hygiene precautions, cohorting of patients, and altered antibiotic policy were not sufficient to eliminate the outbreak. At the end of the study period (in July), there was a change in the outbreak pattern from long (December to June) to short Quly) incubation times before colonization and from primarily tracheal colonization (December to June) to primarily gastric or enteral Quly) colonization. In this period, the bacterium was also isolated from water taps.Conclusion:Complete elimination of the outbreak was achieved after weekly pasteurization of the water taps of the ICU and use of sterile water as a solvent in the gastric tubes.

Neonatal Outcomes Associated with Noncephalic Presentation at Delivery in Preterm Birth

2018 ◽  
Vol 35 (12) ◽  
pp. 1131-1137
Author(s):  
Annalisa Post ◽  
Geeta Swamy ◽  
Chad Grotegut ◽  
Amber Wood
Keyword(s):  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Mode Of Delivery ◽  
Secondary Analysis ◽  
Neonatal Outcomes ◽  
Risk Of Death ◽  
Increased Risk ◽  
Stratified Analysis

Objective The objective of this study is to evaluate the effect of noncephalic presentation on neonatal outcomes in preterm delivery. Study Design In this study a secondary analysis of the BEAM trial was performed. It included women with singleton, liveborn, and nonanomalous fetuses. Neonatal outcomes were compared in noncephalic versus cephalic presentation. Adjusted odds ratios and 95% confidence intervals were calculated for each outcome with logistic regression while controlling for possible confounders. A stratified analysis by mode of delivery was also performed in this study. Results A total of 458 noncephalic deliveries were compared with 1,485 cephalic deliveries. In multivariate analysis, noncephalic presentation was associated with increased risk of death in the neonatal intensive care unit (NICU) or death at <15 months corrected gestational age (cGA), and a decreased risk of IVH. The risk of death persisted in stratified analysis, with increased risk of death at <15 months cGA in noncephalic neonates born via cesarean delivery. In the vaginal delivery group, there was an increased risk of death at <15 months cGA and NICU death. Conclusion After controlling for possible confounders, neonates who are noncephalic at delivery have higher risk for death <15 months cGA and death in the NICU while their risk of IVH is reduced. The risk of death persisted in stratified analyses by mode of delivery.

Eosinopenie als Biomarker des Schweregrads einer COVID-19-Infektion

2021 ◽  
pp. 1-2
Author(s):  
Panagiota Xanthouli
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Disease Severity ◽  
Respiratory Diseases ◽  
Severe Disease ◽  
Public Hospitals ◽  
Chronic Respiratory Diseases ◽  
Lack Of Information ◽  
Obstructive Sleep ◽  
Increased Risk

<b>Background:</b> Studies on the role of eosinophils in coronavirus disease 2019 (COVID-19) are scarce, though available findings suggest a possible association with disease severity. Our study analyzes the relationship between eosinophils and COVID-19, with a focus on disease severity and patients with underlying chronic respiratory diseases. <b>Methods:</b> We performed a retrospective analysis of 3,018 subjects attended at two public hospitals in Madrid (Spain) with PCR-confirmed SARS-CoV-2 infection from January 31 to April 17, 2020. Patients with eosinophil counts less than 0.02 × 10<sup>9</sup>/L were considered to have eosinopenia. Individuals with chronic respiratory diseases (<i>n</i> = 384) were classified according to their particular underlying condition, i.e., asthma, chronic pulmonary obstructive disease, or obstructive sleep apnea. <b>Results:</b> Of the 3018 patients enrolled, 479 were excluded because of lack of information at the time of admission. Of 2539 subjects assessed, 1,396 patients presented an eosinophil count performed on admission, revealing eosinopenia in 376 cases (26.93%). Eosinopenia on admission was associated with a higher risk of intensive care unit (ICU) or respiratory intensive care unit (RICU) admission (OR:2.21; 95% CI:1.42–3.45; <i>p</i> &#x3c; 0.001) but no increased risk of mortality (<i>p</i> &#x3e; 0.05). <b>Conclusion:</b> Eosinopenia on admission conferred a higher risk of severe disease (requiring ICU/RICU care), but was not associated with increased mortality. In patients with chronic respiratory diseases who develop COVID-19, age seems to be the main risk factor for progression to severe disease or death.

Venous Thrombosis and SARS-CoV-2

2021 ◽  
Author(s):  
Monika Zdanyte ◽  
Dominik Rath ◽  
Meinrad Gawaz ◽  
Tobias Geisler
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Vascular Endothelium ◽  
Arterial Thrombosis ◽  
Review Article ◽  
Prevention And Treatment ◽  
All Cause Mortality ◽  
Thrombotic Complications

AbstractSARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection is associated with high risk of venous and arterial thrombosis. Thrombotic complications, especially pulmonary embolism, lead to increased all-cause mortality in both intensive care unit and noncritically ill patients. Damage and activation of vascular endothelium, platelet activation, followed by thrombotic and fibrinolytic imbalance as well as hypercoagulability are the key pathomechanisms in immunothrombosis leading to a significant increase in thromboembolism in coronavirus disease 2019 (COVID-19) compared with other acute illnesses. In this review article, we discuss the incidence and prognosis, diagnosis, prevention, and treatment of venous thromboembolism in patients with COVID-19 disease, based on clinical experience and research available to date.

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