Assessing thrombocytopenia in the intensive care unit: the past, present, and future

Abstract Thrombocytopenia is common among patients admitted to the intensive care unit (ICU). Multiple pathophysiological mechanisms may contribute, including thrombin-mediated platelet activation, dilution, hemophagocytosis, extracellular histones, ADAMTS13 deficiency, and complement activation. From the clinical perspective, the development of thrombocytopenia in the ICU usually indicates serious organ system derangement and physiologic decompensation rather than a primary hematologic disorder. Thrombocytopenia is associated with bleeding, transfusion, and adverse clinical outcomes including death, though few deaths are directly attributable to bleeding. The assessment of thrombocytopenia begins by looking back to the patient’s medical history and presenting illness. This past information, combined with careful observation of the platelet trajectory in the context of the patient’s clinical course, offers clues to the diagnosis and prognosis. Management is primarily directed at the underlying disorder and transfusion of platelets to prevent or treat clinical bleeding. Optimal platelet transfusion strategies are not defined, and a conservative approach is recommended.

Download Full-text

A Timely Call to Arms: COVID-19, the Circadian Clock, and Critical Care

Journal of Biological Rhythms ◽

10.1177/0748730421992587 ◽

2021 ◽

Vol 36 (1) ◽

pp. 55-70

Author(s):

Jeffrey Haspel ◽

Minjee Kim ◽

Phyllis Zee ◽

Tanja Schwarzmeier ◽

Sara Montagnese ◽

...

Keyword(s):

Intensive Care Unit ◽

Human Physiology ◽

Critical Care ◽

Intensive Care ◽

Severe Acute Respiratory Syndrome ◽

Circadian Clock ◽

Clinical Course ◽

Disease Expression ◽

Severe Manifestation ◽

Novel Coronavirus

We currently find ourselves in the midst of a global coronavirus disease 2019 (COVID-19) pandemic, caused by the highly infectious novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we discuss aspects of SARS-CoV-2 biology and pathology and how these might interact with the circadian clock of the host. We further focus on the severe manifestation of the illness, leading to hospitalization in an intensive care unit. The most common severe complications of COVID-19 relate to clock-regulated human physiology. We speculate on how the pandemic might be used to gain insights on the circadian clock but, more importantly, on how knowledge of the circadian clock might be used to mitigate the disease expression and the clinical course of COVID-19.

Download Full-text

Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter

TH Open ◽

10.1055/s-0041-1727121 ◽

2021 ◽

Vol 05 (02) ◽

pp. e134-e138

Author(s):

Anke Pape ◽

Jan T. Kielstein ◽

Tillman Krüger ◽

Thomas Fühner ◽

Reinhard Brunkhorst

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Randomized Trials ◽

Clinical Course ◽

Pharmacological Therapy ◽

The European Union ◽

Positive Effects ◽

Special Patient

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has a serious impact on health and economics worldwide. Even though the majority of patients present with moderate and mild symptoms, yet a considerable portion of patients need to be treated in the intensive care unit. Aside from dexamethasone, there is no established pharmacological therapy. Moreover, some of the currently tested drugs are contraindicated for special patient populations like remdesivir for patients with severely impaired renal function. On this background, several extracorporeal treatments are currently explored concerning their potential to improve the clinical course and outcome of critically ill patients with COVID-19. Here, we report the use of the Seraph 100 Microbind Affinity filter, which is licensed in the European Union for the removal of pathogens. Authorization for emergency use in patients with COVID-19 admitted to the intensive care unit with confirmed or imminent respiratory failure was granted by the U.S. Food and Drug Administration on April 17, 2020.A 53-year-old Caucasian male with a severe COVID-19 infection was treated with a Seraph Microbind Affinity filter hemoperfusion after clinical deterioration and commencement of mechanical ventilation. The 70-minute treatment at a blood flow of 200 mL/minute was well tolerated, and the patient was hemodynamically stable. The hemoperfusion reduced D-dimers dramatically.This case report suggests that the use of Seraph 100 Microbind Affinity filter hemoperfusion might have positive effects on the clinical course of critically ill patients with COVID-19. However, future prospective collection of data ideally in randomized trials will have to confirm whether the use of Seraph 100 Microbind Affinity filter hemoperfusion is an option of the treatment for COVID-19.

Download Full-text

Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis

BMC Anesthesiology ◽

10.1186/s12871-021-01396-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stephanie-Susanne Stecher ◽

Sofia Anton ◽

Alessia Fraccaroli ◽

Jeremias Götschke ◽

Hans Joachim Stemmler ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Lung Ultrasound ◽

Clinical Course ◽

Point Of Care ◽

Clinical Deterioration ◽

Normal Lung ◽

Icu Patients ◽

Standardized Protocol ◽

Ultrasound Score

Abstract Background Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome. Methods We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0–12 points) and a high (13–24 points) lung ultrasound score group. Results The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and paO2 (107 [80–130] vs 80 [66–93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3–25] vs 36.5 [9.8–70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559). Conclusions LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.

Download Full-text

Clinical course of sepsis in children with acute leukemia admitted to the pediatric intensive care unit*

Pediatric Critical Care Medicine ◽

10.1097/pcc.0b013e31821927f1 ◽

2011 ◽

Vol 12 (6) ◽

pp. 649-654 ◽

Cited By ~ 11

Author(s):

Kanakadurga Singer ◽

Perla Subbaiah ◽

Raymond Hutchinson ◽

Folafoluwa Odetola ◽

Thomas P. Shanley

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Acute Leukemia ◽

Pediatric Intensive Care Unit ◽

Clinical Course ◽

Pediatric Intensive Care

Download Full-text

Hypoxic hepatitis in cardiac intensive care unit: a study of cardiovascular risk factors, clinical course, and outcomes

Therapeutics and Clinical Risk Management ◽

10.2147/tcrm.s59312 ◽

2014 ◽

pp. 139 ◽

Cited By ~ 9

Author(s):

Norberto Chavez Tapia ◽

Patricia Meza-Meneses ◽

Brenda Balderas-Garces ◽

Magali Herrera-Gomar ◽

Misael Uribe ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Clinical Course ◽

Cardiac Intensive Care Unit ◽

Hypoxic Hepatitis ◽

Cardiac Intensive Care

Download Full-text

Clinical course of community-acquired respiratory syncytial virus pneumonia in newborns hospitalized in neonatal intensive care unit

Tuberkuloz ve Toraks ◽

10.5578/tt.10895 ◽

2017 ◽

Vol 64 (1) ◽

pp. 64-65 ◽

Cited By ~ 1

Author(s):

Selmin KARADEMİR ◽

Tamer YOLDAŞ

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Syncytial Virus ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Clinical Course ◽

Virus Pneumonia ◽

Syncytial Virus

Download Full-text

Sepsis

10.2310/fm.1147 ◽

2020 ◽

Author(s):

Steven P LaRosa ◽

Steven M. Opal

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Organ Dysfunction ◽

Fluid Resuscitation ◽

Multiorgan Failure ◽

Sepsis Management ◽

The Past ◽

Sepsis And Septic Shock

Sepsis, along with the multiorgan failure that often accompanies this condition, is a leading cause of mortality in the intensive care unit. Although modest improvements in the prognosis have been made over the past two decades and promising new therapies continue to be investigated, innovations in the management of septic shock are still required. This chapter discusses the definitions, epidemiology, and pathogenesis (including microbial factors, host-derived mediators, and organ dysfunction) relating to sepsis. Management of severe sepsis and septic shock is also described. This review contains 5 figures, 11 tables, and 99 references. Keywords:Organ dysfunction, sepsis, septic shock, infection, bacteremia, fluid resuscitation, vasopressor

Download Full-text

Types of Interventions

Preventing Hospital Infections ◽

10.1093/med/9780197509159.003.0004 ◽

2021 ◽

pp. 40-51

Author(s):

Jennifer Meddings ◽

Vineet Chopra ◽

Sanjay Saint

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Bloodstream Infection ◽

Infection Prevention ◽

Central Line ◽

Peripherally Inserted Central Catheters ◽

Trade Off ◽

Central Lines ◽

The Past ◽

Central Catheters

Prevention of central line–associated bloodstream infection (CLABSI), while initially making great strides in 2003, has declined as use of peripherally inserted central catheters (PICCs) has grown tremendously over the past two decades. The convenience of a PICC has led to sicker patients being treated outside the intensive care unit, and there has been little recognition of a trade-off between benefits and risks after PICC placement. For these reasons, CLABSI prevention has become more challenging. This chapter describes the contents of an infection prevention bundle for CLABSI. In the case of CLABSI, the intervention outlines appropriate and inappropriate uses of central lines. Several new tools are discussed, which help doctors and nurses think through which device is most appropriate for any given patient.

Download Full-text

The need to know: experiences of critically ill patients

American Journal of Critical Care ◽

10.4037/ajcc2000.9.3.192 ◽

2000 ◽

Vol 9 (3) ◽

pp. 192-198 ◽

Cited By ~ 40

Author(s):

JE Hupcey ◽

HE Zimmerman

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critical Illness ◽

Critically Ill ◽

Nursing Staff ◽

Critically Ill Patients ◽

Second Phase ◽

The Past ◽

Intensive Care Unit Nurses ◽

Vivid Memories

BACKGROUND: Critically ill patients vary in their memories of their experience in the intensive care unit. Some have little recall and need to learn about their critical illness. Others have more vivid memories of their experiences, some of which were extremely unpleasant. Patients' not knowing what was happening may have exacerbated the unpleasant experiences. OBJECTIVES: To elicit the experience of knowing for critically ill patients and to explore the differences in perceptions between patients who were intubated and those who were not intubated during the illness. METHODS: Grounded theory was used to explore the meaning of knowing and not knowing and the process by which knowing occurs. Unstructured interviews were done with 14 patients. RESULTS: Knowing had 2 phases: the need to know (1) during and (2) after the critical illness. The first phase had 3 facets: needing information, needing to be oriented, and having confusing perceptions. The second phase had 2 facets: needing information about what had happened and piecing together events. Many experiences with knowing during and after a critical illness were similar for both intubated and nonintubated patients. The main difference was the intensity of the experience in some categories. CONCLUSIONS: Critically ill patients have a strong need to know throughout and after their time in the intensive care unit. Nurses must address this need for constant reorientation to the past and present in these patients. In addition, adequate nursing staff must be available for these patients.

Download Full-text