Adjuvant hemoadsorption therapy in patients with severe COVID-19 and related organ failure requiring CRRT or ECMO therapy: A case series

Introduction: Severe cases of the COVID-19 are often associated with the development of a fulminant sepsis-like state with a concomitant cytokine release syndrome. Recently, immunomodulating approaches to treat such a hyperinflammation have come into focus, including the use of new extracorporeal organ support therapies such as CytoSorb hemoadsorption designed to remove cytokines and other circulating mediators from blood. Patients and methods: Thirteen critically ill COVID-19 patients with ARDS who received either ECMO therapy and/or CRRT with concomitant multiple organ failure were included. Hemoadsorption therapy was initiated once the patient had established—or was at high risk of developing—a hyperinflammatory state with marked hemodynamic instability or progressive lung failure. Levels of inflammatory markers, vasopressor requirements, oxygenation, and ventilation parameters were measured, as well as clinically relevant outcome measures. Results: Combined therapy was associated with a significant reduction in inflammatory mediators, hemodynamic stabilization with a concomitant decrease in requirements for vasoactive substances, and a pronounced improvement in lung function and the need for ventilatory support. Treatment appeared safe and well-tolerated. Conclusions: In this case series of SARS-CoV-2 infected patients admitted to the intensive care unit with ARDS, we report effective interleukin (IL)-6 removal, reduced norepinephrine requirement, and improved lung function while receiving adjuvant, extracorporeal hemoadsorption therapy in the context of a multimodal treatment approach. The presented protocol for CytoSorb initiation may be a good foundation for the development of further prospective studies in the field and may eventually also be applied to other forms of hyperinflammatory ARDS.

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COVID-19 and Multiorgan Dysfunction Syndrome

10.5772/intechopen.99676 ◽

2021 ◽

Author(s):

Jitendra D. Lakhani ◽

Sajni Kapadia ◽

Rohit Choradiya ◽

Roop Preet Gill ◽

Som J. Lakhani

Keyword(s):

Organ Failure ◽

Kidney Injury ◽

Glycemic Variability ◽

Multiple Organ ◽

Organ Support ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Treatment Support ◽

Laboratory Investigations ◽

Hospital Acquired

Severe acute respiratory syndrome (SARS) is the leading cause of death in COVID-19 infection, however, multi-organ dysfunction due to COVID-19 and/or because of co-morbidities is a usual accompaniment causing unfavorable outcome. Early detection of organ failure and giving appropriate organ support may improve the chances of survival. Arterial Blood Gas (ABG) analysis; electrolytes coupled with clinical picture and with organ related laboratory investigations may help in diagnosis of MODS and sepsis in COVID-19 SEVERE SYNDROME. Acute kidney injury (AKI), myocarditis, thromboembolism, acute liver de-compensation, hospital acquired infections, cardiac arrest, glycemic variability, thyroid dysfunction and other organ failure may lead to MODS.As patients having multiple organ syndrome requires ICU admission and interventions like intubation, hemodialysis and other extracorporeal treatment support knowing holistically about “COVID-19 MODS” is important for treating physicians.

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Accidental tramadol ingestion in children admitted in tertiary care centre

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20195200 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2661

Author(s):

Vadlakonda Sruthi ◽

Annaladasu Narendra

Keyword(s):

Pediatric Population ◽

Care Center ◽

Tertiary Care ◽

Ventilatory Support ◽

Case Series ◽

Pediatric Intensive Care ◽

Hemodynamic Instability ◽

Tertiary Care Centre ◽

Medical College ◽

History Of

Background: Tramadol use has been increasing in the adult and pediatric population. Practitioners must be alert because Tramadol misuse can lead to severe intoxication in which respiratory failure and seizures are frequent. Overdoses can lead to death. We report 47 pediatric cases with history of accidental tramadol exposure in children.Methods: An observational, retrospective, single center case -series of children with a history of accidental tramadol exposure in children admitted in pediatric intensive care unit of tertiary care center, Niloufer Hospital (Osmania Medical College) Hyderabad, Telangana India.Results: Of 47 children, 22 (47%) are male and 25 (53%) were female. At presentation 11 (23%) had loss of consciousness, 14 (29%) seizures, 17 (36%) hypotonia was noted. Pupils were miotic in 22 (47%) mydriatic in 2 (4.2%) normal in rest of children. Hemodynamic instability noted in 13 (27.6%). Serotonin syndrome (tachycardia, hyperthermia, hypertension, hyper reflex, clonus) was noted on 5 (10.6%) children. Respiratory depression was seen in 4 (8%) children who needed ventilatory support. Antidote Naloxone was given in 7 children. No adverse reaction was noted with Naloxone. All 47 children were successfully discharged.Conclusions: Overdoses can lead to death and practitioners must be alert because of the increasing use of tramadol in the adult and pediatric population. The handling of the tramadol should be explained to parents and general population and naloxone could be efficient when opioid toxicity signs are present.

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Synthetic Cannabinoid‐Associated Multiple Organ Failure: Case Series and Literature Review

Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy ◽

10.1002/phar.2241 ◽

2019 ◽

Vol 39 (4) ◽

pp. 508-513 ◽

Cited By ~ 6

Author(s):

Faith Armstrong ◽

Michael T. McCurdy ◽

Mojdeh S. Heavner

Keyword(s):

Literature Review ◽

Multiple Organ Failure ◽

Organ Failure ◽

Case Series ◽

Multiple Organ ◽

Synthetic Cannabinoid

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The Effect of Plasma Triglyceride-Lowering Therapy on the Evolution of Organ Function in Early Hypertriglyceridemia-Induced Acute Pancreatitis Patients With Worrisome Features (PERFORM Study): Rationale and Design of a Multicenter, Prospective, Observational, Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.756337 ◽

2021 ◽

Vol 8 ◽

Author(s):

Longxiang Cao ◽

Jing Zhou ◽

Mingzhi Chen ◽

Tao Chen ◽

Man Liu ◽

...

Keyword(s):

Acute Pancreatitis ◽

Cohort Study ◽

Organ Failure ◽

Clinical Outcomes ◽

Multiple Organ ◽

Primary Objective ◽

Organ Support ◽

Lowering Therapy ◽

Observational Prospective Cohort Study ◽

New Onset

Background: Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease with multiple etiologies. The prevalence of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) has been increasing in recent years. It is reported that early triglyceride (TG) levels were associated with the severity of the disease, and TG- lowering therapies, including medical treatment and blood purification, may impact the clinical outcomes. However, there is no consensus regarding the optimal TG-lowering therapy, and clinical practice varies greatly among different centers. Our objective is to evaluate the TG-lowering effects of different therapies and their impact on clinical outcomes in HTG-AP patients with worrisome features.Methods: This is a multicenter, observational, prospective cohort study. A total of approximately 300 patients with HTG-AP with worrisome features are planned to be enrolled. The primary objective of the study is to evaluate the relationship between TG decline and the evolution of organ failure, and patients will be dichotomized depending on the rate of TG decline. The primary outcome is organ failure (OF) free days to 14 days after enrollment. Secondary outcomes include new-onset organ failure, new-onset multiple-organ failure (MOF), new-onset persistent organ failure (POF), new receipt of organ support, requirement of ICU admission, ICU free days to day 14, hospital free days to day 14, 60-day mortality, AP severity grade (Based on the Revised Atlanta Classification), and incidence of systemic and local complications. Generalized linear model (GLM), Fine and Gray competing risk regression, and propensity score matching will be used for statistical analysis.Discussion: Results of this study will reveal the current practice of TG-lowering therapy in HTG-AP and provide necessary data for future trials.

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A Case of Thyroid Storm With Takotsubo Cardiomyopathy and Multi-Organ Failure: What Is the Primary Cause of Hemodynamic Instability and How Do We Treat it?

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1859 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A910-A911

Author(s):

Tiffany Purewal ◽

Christopher Lesniak ◽

Andrew Ravin ◽

Khin Zin ◽

Soemiwati W Holland

Keyword(s):

Organ Failure ◽

Takotsubo Cardiomyopathy ◽

Treatment Plan ◽

Ventilatory Support ◽

Hemodynamic Instability ◽

Thyroid Storm ◽

Shortness Of Breath ◽

Free T4 ◽

Multi Organ Failure ◽

New Onset

Abstract Introduction: Thyroid storm is a rare but life-threatening emergency. Multi-organ failure has been recognized as the most common cause of death, but conventional therapies can be limited depending on the clinical presentation. We present a case of a patient in thyroid storm who rapidly developed multi-organ failure, preventing her from obtaining potentially life-saving treatment. Case Presentation: A 68-year-old female with a past medical history of hypertension, hyperlipidemia, and Grave’s disease, who was non-compliant with medications, presented to a facility for shortness of breath after the unexpected death of her husband. She was diagnosed with a non-ST elevation myocardial infarction and new onset heart failure. At that time, her TSH level was <0.010 uIU/mL and Free T4 was 1.80 ng/dL. Imaging revealed a significantly enlarged thyroid gland measuring 8cm by 6.6cm. She was started on methimazole and discharged home. A few days after discharge, she underwent a cardiac catheterization and was found to have Takotsubo cardiomyopathy. On presentation to our facility 2 weeks later, the patient was experiencing worsening shortness of breath and anxiety. She was found to have new-onset uncontrolled atrial fibrillation with rapid ventricular response and a blood pressure of 77/38 mmHg. The Burch-Wartofsky Point Scale was calculated to be 55 points, highly suggestive of thyroid storm. TSH was < 0.010 uIU/mL, total T4 was 16.63 ug/dL, and free T4 was 3.28 ng/dL. She was initiated on propylthiouracil, cholestyramine, hydrocortisone, and esmolol. Within 12 hours, she developed fulminant multi-organ failure requiring ventilatory support and vasopressors. She also developed ischemic hepatitis and propylthiouracil was discontinued. Urgent therapeutic plasma exchange (TPE) and continuous renal replacement therapy (CRRT) were later attempted but both therapies were not initiated due to severe hemodynamic instability. A bedside echocardiogram revealed an estimated ejection fraction of 20-25%. Due to worsening cardiogenic shock, she was evaluated for extracorporeal membrane oxygenation (ECMO) but was not a candidate. She instead underwent an emergent Impella device implantation. Despite this intervention, the patient’s clinical condition did not improve after multiple vasopressors, and the patient’s family opted for comfort-focused measures. The patient died after 1 day of hospitalization. Conclusion: A multimodality approach to treatment is recommended for patients with thyroid storm but underlying conditions such as Takotsubo cardiomyopathy and fulminant multi-organ failure may complicate the treatment plan. The complexity of this case highlights the need to understand relative contraindications to salvage therapies, such as TPE, and the role for other treatment options when patients present with co-existing multi-organ failure.

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Surgical Stabilization of Clavicle Fractures Reduces Organ Failure Rates in Multiply-injured Patients with Thoracic Trauma: An Analysis Based on the TraumaRegister DGU®.

10.21203/rs.3.rs-76223/v1 ◽

2020 ◽

Author(s):

Helge Eberbach ◽

Rolf Lefering ◽

Sven Hager ◽

Klaus Schumm ◽

Lisa Bode ◽

...

Keyword(s):

Multiple Organ Failure ◽

Organ Failure ◽

Thoracic Trauma ◽

Clavicle Fracture ◽

Length Of Hospital Stay ◽

Multiple Organ ◽

Multiply Injured Patients ◽

Lung Failure ◽

Clavicle Fractures ◽

Injured Patients

Abstract Introduction: Thoracic trauma has decisive influence on the outcome of multiply-injured patients and is often associated with clavicle fractures. The affected patients are prone to lung dysfunction and multiple organ failure. The aim of this study is to investigate the influence of surgical stabilization of clavicle fractures in patients with thoracic trauma on specific outcome parameters.Methods: A multi-center, retrospective analysis of patient records documented in the TraumaRegister DGU® between 2009 and 2015 was performed. The inclusion criteria were multiply-injured patients with thoracic trauma and associated clavicle fracture, maximum AIS severity ≥ 3 and admission to the intensive care unit. The influence of operative vs. non-operative clavicular fracture treatment and timing of surgery on lung failure, multiple organ failure, sepsis, length of ICU stay, intubation time and length of hospital stay was assessed by regression analysis.Results: A total of 3,209 patients were included in the analysis. In 1,362 patients (42%) the clavicle fracture was treated operatively after 7.1 ± 5.3 days. Surgically treated patients had a significant reduction in lung failure (p = 0.013, OR = 0.74), multiple organ failure (p = 0.001, OR = 0.64), intubation time (p = 0.004; -1.81 days) and length of hospital stay (p = 0.014; -1.51 days) compared to non-operative treatment. Moreover, surgical fixation of the clavicle within five days following hospital admission significantly reduced the rates of lung failure (p = 0.01, OR = 0.62), multiple organ failure (p = 0.01, OR = 0.59) and length of hospital stay (p = 0.01; -2.1 days).Conclusions: Based on our results, multiply-injured patients with thoracic trauma and concomitant clavicle fracture seem to benefit significantly from surgical stabilization of a clavicle fracture, especially when surgery is performed within the first five days after hospital admission.

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Malignant Boutonneuse fever with multiple organ failure: a three-case series

Critical Care ◽

10.1186/cc7478 ◽

2009 ◽

Vol 13 (Suppl 1) ◽

pp. P314

Author(s):

B Oliveira ◽

AP Lacerda ◽

Z Costa e Silva ◽

C França

Keyword(s):

Multiple Organ Failure ◽

Organ Failure ◽

Case Series ◽

Multiple Organ ◽

Boutonneuse Fever

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Pre Eclampsia: Its contribution to Pregnancy Related Acute Kidney Injury. A tertiary care nephrology unit experience

Pakistan Journal of Kidney Diseases ◽

10.53778/pjkd50279 ◽

2021 ◽

Vol 5 (02) ◽

Author(s):

Rubina Naqvi

Keyword(s):

Organ Failure ◽

Liver Enzymes ◽

Post Partum ◽

Tertiary Care ◽

Ventilatory Support ◽

Case Series ◽

P Value ◽

Partial Recovery ◽

Multi Organ Failure ◽

Elevated Liver Enzymes

Preeclampsia, eclampsia and hemolysis, elevated liver enzymes and thrombocytopenia (HELLP) are among many other conditions of pregnancy related AKI (PR-AKI). Present study aims to report case series of patients with PR-AKI developing in association with preeclampsia, their course of illness and outcome. Patients and Methods: Subjects for the study reported here comprise a cohort of 227 women coming to this institution with diagnosis of preeclampsia and AKI. Results: From January 1990 to December 2014, there were 1,441 women with PR-AKI brought to this institution among these 227 (15.75%) fulfilled the criteria of preeclampsia. On presentation 93.4% were oligo-anuric, thrombocytopenia was found in 48%, deranged INR in 18.9% and raised liver enzymes in 33.5%. On arrival 22% were in sepsis, mechanical ventilator support required in 11%. Impaired Glasgow coma scale noticed in 22%. Intra uterine death of fetus was reported in 75%. Antepartum hemorrhage in 38% and post partum hemorrhage in 32%. Renal replacement therapy in form of hemodialysis was conducted in 94.7%. Complete recovery seen in 25%, partial recovery in 31%, CKD developed in 4.4%, ESRF in 27.3% and 12 % died during acute phase of illness. Sepsis, multi-organ failure and requirement of mechanical ventilatory support on arrival were significant predictors of mortality with p value <0.001. Conclusion: Preeclampsia and its progress to eclampsia can be a severe life-threatening condition especially when patients present with sepsis and multi organ failure. A significant number of women developed irreversible AKI and progessed to CKD.

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