Emergency cardiac imaging for coronavirus disease 2019 (COVID-19) in practice: a case of takotsubo stress cardiomyopathy

Abstract Background Cardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of ‘takotsubo’ stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit. Case summary An intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing. Conclusion This case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.

Download Full-text

Preoperative indocyanine green clearance (LiMON®) is predictive for prolonged intensive care unit stay after cardiac surgery in patients with reduced ejection fraction

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269138 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

A Beiras-Fernandez ◽

E Kilger ◽

A Lahib ◽

P Möhnle ◽

K Nassau ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Ejection Fraction ◽

Indocyanine Green ◽

Intensive Care Unit Stay ◽

Indocyanine Green Clearance ◽

Reduced Ejection Fraction

Download Full-text

375. COVID 19 infection in a Massachusetts community hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.570 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S257-S258

Author(s):

Raul Davaro ◽

alwyn rapose

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Essential Hypertension ◽

Severe Acute Respiratory Syndrome ◽

High Mortality ◽

Case Series ◽

World Health ◽

Minimal Risk ◽

The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

Download Full-text

Prevalence of multidrug-resistant Acinetobacter baumannii in a critical care setting: A tertiary teaching hospital experience

SAGE Open Medicine ◽

10.1177/20503121211001144 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110011

Author(s):

Thabit Alotaibi ◽

Abdulrhman Abuhaimed ◽

Mohammed Alshahrani ◽

Ahmed Albdelhady ◽

Yousef Almubarak ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Acinetobacter Baumannii ◽

Care Setting ◽

Multidrug Resistant ◽

University Hospital ◽

Published Data ◽

Tertiary Teaching ◽

The Mean

Background: The management of Acinetobacter baumannii infection is considered a challenge especially in an intensive care setting. The resistance rate makes it difficult to manage and is believed to lead to higher mortality. We aim to investigate the prevalence of Acinetobacter baumannii and explore how different antibiotic regimens could impact patient outcomes as there are no available published data to reflect our population in our region. Methods: We conducted a retrospective review of all infected adult patients admitted to the intensive care unit at King Fahad University Hospital with a confirmed laboratory diagnosis of Acinetobacter baumannii from 1 January 2013 until 31 December 2017. Positive cultures were obtained from the microbiology department and those meeting the inclusive criteria were selected. Variables were analyzed using descriptive analysis and cross-tabulation. Results were further reviewed and audited by blinded co-authors. Results: A comprehensive review of data identified 198 patients with Acinetobacter baumannii. The prevalence of Acinetobacter baumannii is 3.37%, and the overall mortality rate is 40.81%. Our sample consisted mainly of male patients, that is, 68.7%, with a mean age of 49 years, and the mean age of female patients was 56 years. The mean age of survivors was less than that of non-survivors, that is, 44.95 years of age. We observed that prior antibiotic use was higher in non-survivors compared to survivors. From the review of treatment provided for patients infected with Acinetobacter baumannii, 65 were treated with colistin alone, 18 were treated with carbapenems, and 22 were treated with a combination of both carbapenems and colistin. The mean length of stay of Acinetobacter baumannii–infected patients was 20.25 days. We found that the survival rates among patients who received carbapenems were higher compared to those who received colistin. Conclusion: We believe that multidrug-resistant Acinetobacter baumannii is prevalent and associated with a higher mortality rate and represents a challenging case for every intensive care unit physician. Further prospective studies are needed.

Download Full-text

Electroconvulsive therapy in the intensive care unit for the treatment of catatonia: a case series and review of the literature

General Hospital Psychiatry ◽

10.1016/j.genhosppsych.2015.09.008 ◽

2016 ◽

Vol 38 ◽

pp. 37-41 ◽

Cited By ~ 16

Author(s):

Femke M. Dessens ◽

Judith van Paassen ◽

David J. van Westerloo ◽

Nic J. van der Wee ◽

Irene M. van Vliet ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Electroconvulsive Therapy ◽

Case Series ◽

Review Of The Literature

Download Full-text

Management and outcomes of congenital chylothorax in the neonatal intensive care unit: A case series

Pediatric Investigation ◽

10.1002/ped4.12007 ◽

2017 ◽

Vol 1 (1) ◽

pp. 21-25 ◽

Cited By ~ 3

Author(s):

Helen Healy ◽

Kevin Gipson ◽

Susanne Hay ◽

Sara Bates ◽

Thomas Bernard Kinane

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Case Series ◽

Congenital Chylothorax

Download Full-text

Lower Cranial Nerve Palsies in the COVID-19 Pandemic: A 10-Case Series of Intensive Care Unit Patients

European Neurology ◽

10.1159/000519226 ◽

2021 ◽

pp. 1-4

Author(s):

Pierre Decavel ◽

Olympe Nahmias ◽

Carine Petit ◽

Laurent Tatu

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prone Position ◽

Cranial Nerve ◽

Nerve Palsy ◽

Case Series ◽

University Hospital ◽

Cranial Neuropathy ◽

Lower Cranial Nerve ◽

Cranial Nerve Palsies

Introduction: A number of neurological complications of COVID-19 have been identified, including cranial nerve paralyses. We present a series of 10 patients with lower cranial nerve involvement after severe COVID-19 infection requiring hospitalization in an intensive care unit. Methods: We conducted a retrospective, observational study of patients admitted to the post-intensive care unit (p-ICU) of Besançon University Hospital (France) between March 16 and May 22, 2020. We included patients with confirmed COVID-19 and cranial neuropathy at admission to the p-ICU. All these patients were treated by orotracheal intubation, and all but one underwent prone-position ventilation therapy. Results: Of the 88 patients admitted to the p-ICU, 10 patients (11%) presented at least 1 cranial nerve palsy. Of these 10 patients, 9 had a hypoglossal nerve palsy and 8 of these also had a deficit in another cranial nerve. The most frequent association was between hypoglossal and vagal palsies (5 patients). None of the patients developed neurological signs related to a global neuropathy. We found no correlation between the intensity of the motor limb weakness and the occurrence of lower cranial nerve palsies. All but 2 of the patients recovered within less than a month. Conclusion: The mechanical compressive hypothesis, linked to the prone-position ventilation therapy, appears to be the major factor. The direct toxicity of SARS-CoV-2 and the context of immune dysfunction induced by the virus may be involved in a multifactorial etiology.

Download Full-text

Heart failure with reduced ejection fraction: Should we submit patients without angina to coronary angiography?

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.04.115 ◽

2015 ◽

Vol 190 ◽

pp. 131-132 ◽

Cited By ~ 5

Author(s):

Filipa Silva ◽

Tiago Borges ◽

Ana Ribeiro ◽

Raquel Mesquita ◽

Olga Laszczynska ◽

...

Keyword(s):

Heart Failure ◽

Coronary Angiography ◽

Ejection Fraction ◽

Reduced Ejection Fraction

Download Full-text

ASSOCIATION OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION WITH ELEVATED NT-pro-BNP IN GENERAL INTENSIVE CARE UNIT PATIENTS WITH PRESERVED EJECTION FRACTION

Shock ◽

10.1097/shk.0b013e3181ad31f8 ◽

2010 ◽

Vol 33 (2) ◽

pp. 141-148 ◽

Cited By ~ 29

Author(s):

Ignatios Ikonomidis ◽

Maria Nikolaou ◽

Ioanna Dimopoulou ◽

Ioannis Paraskevaidis ◽

John Lekakis ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Ejection Fraction ◽

Diastolic Dysfunction ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

General Intensive Care Unit ◽

Preserved Ejection Fraction ◽

Ventricular Diastolic Dysfunction

Download Full-text

Ethical Implications of Risk Stratification in the Acute Care Setting

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180100000906 ◽

1993 ◽

Vol 2 (2) ◽

pp. 193-196 ◽

Cited By ~ 10

Author(s):

William Knaus

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Care ◽

Care Setting ◽

Reference Points ◽

Health Evaluation ◽

Acute Care Setting ◽

Ethical Implications ◽

Modern Hospital ◽

Source Of Information

The increasing complexity of modern hospital care and the decisions that must be made were the reasons we began our research on the Acute Physiology, Age and Chronic Health Evaluation (APACHE) project. As a clinician in an intensive care unit (ICU), I felt very uncomfortable making the sorts of decisions that are common today without any source of information or any reference points. These decisions are not avoidable, they are not discretionary, and they are going to become more frequent in the future because we are treating people at later stages of disease.

Download Full-text