Practice Guidelines for the Diagnosis of COVID-19-Associated Pulmonary Aspergillosis in an Intensive Care Setting

2021 ◽  
pp. 088506662110471
Author(s):  
Zia Hashim ◽  
Zafar Neyaz ◽  
Rungmei S.K. Marak ◽  
Alok Nath ◽  
Soniya Nityanand ◽  
...  
Keyword(s):  
Intensive Care ◽  
Practice Guidelines ◽  
Clinical Management ◽  
Care Setting ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Third Wave ◽  
Intensive Care Setting ◽  
Pulmonary Aspergillosis

Coronavirus disease-2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a new disease characterized by secondary Aspergillus mold infection in patients with COVID-19. It primarily affects patients with COVID-19 in critical state with acute respiratory distress syndrome, requiring intensive care and mechanical ventilation. CAPA has a higher mortality rate than COVID-19, posing a serious threat to affected individuals. COVID-19 is a potential risk factor for CAPA and has already claimed a massive death toll worldwide since its outbreak in December 2019. Its second wave is currently progressing towards a peak, while the third wave of this devastating pandemic is expected to follow. Therefore, an early and accurate diagnosis of CAPA is of utmost importance for effective clinical management of this highly fatal disease. However, there are no uniform criteria for diagnosing CAPA in an intensive care setting. Therefore, based on a review of existing information and our own experience, we have proposed new criteria in the form of practice guidelines for diagnosing CAPA, focusing on the points relevant for intensivists and pulmonary and critical care physicians. The main highlights of these guidelines include the role of CAPA-appropriate test specimens, clinical risk factors, computed tomography of the thorax, and non-culture-based indirect and direct mycological evidence for diagnosing CAPA in the intensive care unit. These guidelines classify the diagnosis of CAPA into suspected, possible, and probable categories to facilitate clinical decision-making. We hope that these practice guidelines will adequately address the diagnostic challenges of CAPA, providing an easy-to-use and practical algorithm to clinicians for rapid diagnosis and clinical management of the disease.

scholarly journals The Role of C-Reactive Protein and the SOFA Score as Parameter for Clinical Decision Making in Surgical Patients during the Intensive Care Unit Course

PLoS ONE ◽  
2013 ◽  
Vol 8 (2) ◽  
pp. e55964 ◽  
Author(s):  
Zainna C. Meyer ◽  
Jennifer M. J. Schreinemakers ◽  
Paul G. H. Mulder ◽  
Ruud A. L. de Waal ◽  
Antonius A. M. Ermens ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Sofa Score ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surgical Patients ◽  
C Reactive Protein ◽  
Reactive Protein

scholarly journals The role of urea-induced osmotic diuresis and hypernatremia in a critically ill patient: case report and literature review

2020 ◽  
Vol 42 (1) ◽  
pp. 106-112 ◽  
Author(s):  
Jesiree Iglésias Quadros Distenhreft ◽  
Júlia Guasti Pinto Vianna ◽  
Gabriela S. Scopel ◽  
Jayme Mendonça Ramos ◽  
Antonio Carlos Seguro ◽  
...  
Keyword(s):  
Intensive Care ◽  
Care Setting ◽  
Free Water ◽  
Recovery Phase ◽  
Critically Ill Patient ◽  
Clinical Approach ◽  
Intensive Care Setting ◽  
Osmotic Diuresis ◽  
Free Water Clearance

Abstract Hypernatremia is a common electrolyte problem at the intensive care setting, with a prevalence that can reach up to 25%. It is associated with a longer hospital stay and is an independent risk factor for mortality. We report a case of hypernatremia of multifactorial origin in the intensive care setting, emphasizing the role of osmotic diuresis due to excessive urea generation, an underdiagnosed and a not well-known cause of hypernatremia. This scenario may occur in patients using high doses of corticosteroids, with gastrointestinal bleeding, under diets and hyperprotein supplements, and with hypercatabolism, especially during the recovery phase of renal injury. Through the present teaching case, we discuss a clinical approach to the diagnosis of urea-induced osmotic diuresis and hypernatremia, highlighting the utility of the electrolyte-free water clearance concept in understanding the development of hypernatremia.

scholarly journals The impact of focused echocardiography using the Focused Intensive Care Echo protocol on the management of critically ill patients, and comparison with full echocardiographic studies by BSE-accredited sonographers

2017 ◽  
Vol 18 (3) ◽  
pp. 206-211 ◽  
Author(s):  
David P Hall ◽  
Helen Jordan ◽  
Shirjel Alam ◽  
Michael A Gillies
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Management ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Diagnostic Information ◽  
Expert Assessment ◽  
Focused Echocardiography ◽  
The Impact

Introduction Focused echocardiography is widely used to assist clinical decision-making in critically ill patients. In the UK, the Focused Intensive Care Echo protocol is recommended by the Intensive Care Society to ensure consistency of approach and guarantee training standards. Concerns remain about the reliability of information attained by non-expert clinicians in focused echocardiography, particularly when this is used to alter clinical management. Methods A prospective, observational evaluation of 60 consecutive patients undergoing Focused Intensive Care Echo studies in a single ICU. Results A complete Focused Intensive Care Echo study was possible in 43/60 scans (72%) and new diagnostic information obtained following 41/60 scans (68%), which lead to a change of clinical management in 28/60 (47%) of cases. In 24/60 (40%) of cases, a full transthoracic study was subsequently undertaken by a fully accredited sonographer. There were no cases where the results from the full study contradicted those from the limited Focused Intensive Care Echo study; additional diagnostic information was attained following 68% of full studies. Conclusion Focused echocardiography using the Focused Intensive Care Echo protocol is feasible and clinically useful in a high proportion of ICU patients. However, many still require additional expert echocardiographic assessment. Focused echocardiography delivered by non-experts is clinically useful in this setting but its limitations must be understood and access to expert assessment should be available.

scholarly journals Considering Values and Contexts in Clinical Practice Guidelines: Are We Becoming More Person-Centred?

1970 ◽  
Vol 11 (2) ◽  
Author(s):  
Benjamin Chin-Yee BSc MA ◽  
Linda Richardson MD MA FCRPC
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Critical Discourse Analysis ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Critical Discourse ◽  
Patient Values

Clinical practice guidelines (CPGs) have become ubiquitous in medicine, created to promote rational and standardized clinical decision-making. CPGs are often criticized for overlooking patient values and contexts, which many argue deserve a more explicit place in recommendations. This article explores the role of patient values and contexts in CPGs based on a critical discourse analysis of Canadian Diabetes Association (CDA) Guidelines from 1992-2013. We highlight emerging discourses related to person-centred care in CDA guidelines during this period, which support an increasing emphasis on collaboration and shared decision-making, as well as consideration of patient values and contexts. We discuss possible reasons for this shift and the implications for practitioners. Despite this encouraging trend, our analysis also suggests areas for improvement, particularly concerning the integration of patient preferences in clinical decision making and research.

Sign in / Sign up

Export Citation Format

Share Document