scholarly journals Comparison of hydroxychloroquine, lopinavir/ritonavir, and standard of care in critically ill patients with SARS-CoV-2 pneumonia: an opportunistic retrospective analysis

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Marie Lecronier ◽  
Alexandra Beurton ◽  
Sonia Burrel ◽  
Luc Haudebourg ◽  
Robin Deleris ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Standard Of Care

How Long Does (S)He Have? Retrospective Analysis of Outcomes After Palliative Extubation in Elderly, Chronically Critically Ill Patients

2016 ◽  
Vol 44 (6) ◽  
pp. 1138-1144 ◽  
Author(s):  
Cynthia X. Pan ◽  
Dimitris Platis ◽  
Min Min Maw ◽  
Jane Morris ◽  
Simcha Pollack ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Chronically Critically Ill

scholarly journals Prone positioning of patients with moderate hypoxia due to COVID-19: A multicenter pragmatic randomized trial [COVID-PRONE]

2021 ◽  
Author(s):  
Mike Fralick ◽  
Michael Colacci ◽  
Laveena Munshi ◽  
Kevin Venus ◽  
Lee Fidler ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Critically Ill ◽  
Median Time ◽  
Critically Ill Patients ◽  
Primary Outcome ◽  
Standard Of Care ◽  
High Flow ◽  
Hospital Death ◽  
Prone Positioning ◽  
High Flow Oxygen

What is already known on this topic: Prone positioning is considered standard of care for mechanically ventilated patients who have severe acute respiratory distress syndrome. Recent data suggest prone positioning is beneficial for patients with COVID-19 who are requiring high flow oxygen. It is unknown of prone positioning is beneficial for patients not on high flow oxygen. What this study adds: Prone positioning is generally not well tolerated and innovative approaches are needed to improve adherence. Clinical and physiologic outcomes were not improved with prone positioning among hypoxic but not critically ill patients hospitalized with COVID-19. Objectives: To assess the effectiveness of prone positioning to reduce the risk of death or respiratory failure in non-critically ill patients hospitalized with COVID-19 Design: Pragmatic randomized clinical trial of prone positioning of patients hospitalized with COVID-19 across 15 hospitals in Canada and the United States from May 2020 until May 2021. Settings: Patients were eligible is they had a laboratory-confirmed or a clinically highly suspected diagnosis of COVID-19, required supplemental oxygen (up to 50% fraction of inspired oxygen [FiO2]), and were able to independently prone with verbal instruction. (NCT04383613). Main Outcome Measures: The primary outcome was a composite of in-hospital death, mechanical ventilation, or worsening respiratory failure defined as requiring at least 60% FiO2 for at least 24 hours. Secondary outcomes included the change in the ratio of oxygen saturation to FiO2 (S/F ratio). Results: A total of 248 patients were included. The trial was stopped early on the basis of futility for the pre-specified primary outcome. The median time from hospital admission until randomization was 1 day, the median age of patients was 56 years (interquartile range [IQR] 45,65), 36% were female, and 90% of patients were receiving oxygen via nasal prongs at the time of randomization. The median time spent prone in the first 72 hours was 6 hours total (IQR 1.5,12.8) for the prone arm compared to 0 hours (0,2) in the control arm. The risk of the primary outcome was similar between the prone group (18 [14.3%] events) and the standard care group (17 [13.9%] events), odds ratio 0.92 (95% CI 0.44 to 1.92). The change in the S/F ratio after 72 hours was similar for patients randomized to prone compared to standard of care. Conclusion: Among hypoxic but not critically patients with COVID-19 in hospital, a multifaceted intervention to increase prone positioning did not improve outcomes. Adherence to prone positioning was poor, despite multiple efforts. Subsequent trials of prone positioning should aim to develop strategies to improve adherence to awake prone positioning.

scholarly journals Evidence to Support Tooth Brushing in Critically Ill Patients

2011 ◽  
Vol 20 (3) ◽  
pp. 242-250 ◽  
Author(s):  
Nancy J. Ames
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Oral Care ◽  
Standard Of Care ◽  
Tooth Brushing ◽  
Oral Microbiome ◽  
Respiratory Pathogens ◽  
Adults And Children ◽  
Critically Ill Adults ◽  
Powered Toothbrush

Tooth brushing in critically ill patients has been advocated by many as a standard of care despite the limited evidence to support this practice. Attention has been focused on oral care as the evidence accumulates to support an association between the bacteria in the oral microbiome and those respiratory pathogens that cause pneumonia. It is plausible to assume that respiratory pathogens originating in the oral cavity are aspirated into the lungs, causing infection. A recent study of the effects of a powered toothbrush on the incidence of ventilator-associated pneumonia was stopped early because of a lack of effect in the treatment group. This review summarizes the evidence that supports the effectiveness of tooth brushing in critically ill adults and children receiving mechanical ventilation. Possible reasons for the lack of benefit of tooth brushing demonstrated in clinical trials are discussed. Recommendations for future trials in critically ill patients are suggested. With increased emphasis being placed on oral care, the evidence that supports this intervention must be evaluated carefully.

scholarly journals Glucose Management Technologies for the Critically Ill

2019 ◽  
Vol 13 (4) ◽  
pp. 682-690 ◽  
Author(s):  
Pedro D. Salinas ◽  
Carlos E. Mendez
Keyword(s):  
Insulin Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
New Technologies ◽  
Point Of Care ◽  
Glucose Monitoring ◽  
Standard Of Care ◽  
Optimal Method ◽  
Intravenous Insulin ◽  
Glucose Management

Hyperglycemia is common in the intensive care unit (ICU) both in patients with and without a previous diagnosis of diabetes. The optimal glucose range in the ICU population is still a matter of debate. Given the risk of hypoglycemia associated with intensive insulin therapy, current recommendations include treating hyperglycemia after two consecutive glucose >180 mg/dL with target levels of 140-180 mg/dL for most patients. The optimal method of sampling glucose and delivery of insulin in critically ill patients remains elusive. While point of care glucose meters are not consistently accurate and have to be used with caution, continuous glucose monitoring (CGM) is not standard of care, nor is it generally recommended for inpatient use. Intravenous insulin therapy using paper or electronic protocols remains the preferred approach for critically ill patients. The advent of new technologies, such as electronic glucose management, CGM, and closed-loop systems, promises to improve inpatient glycemic control in the critically ill with lower rates of hypoglycemia.

Being overweight or obese is associated with decreased mortality in critically ill patients: A retrospective analysis of a large regional Italian multicenter cohort

2012 ◽  
Vol 27 (6) ◽  
pp. 714-721 ◽  
Author(s):  
Yasser Sakr ◽  
Cristina Elia ◽  
Luciana Mascia ◽  
Bruno Barberis ◽  
Silvano Cardellino ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multicenter Cohort

scholarly journals Early Tocilizumab Dosing is Associated with Improved Survival In Critically Ill Patients Infected With Sars-CoV-2

2020 ◽  
Author(s):  
Russell M. Petrak ◽  
Nicholas W. Van Hise ◽  
Nathan C. Skorodin ◽  
Robert M. Fliegelman ◽  
Vishnu Chundi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Inflammatory Markers ◽  
Standard Of Care ◽  
Control Group ◽  
Cytokine Storm ◽  
Novel Coronavirus ◽  
Multi Center Study ◽  
Center Study

AbstractBackgroundSARS-CoV-2 is a novel coronavirus that has rapidly expanded to become a pandemic, resulting in millions of deaths worldwide. The cytokine storm is caused by the release of inflammatory agents and results in a physiologic disruption. Tocilizumab is an IL-6 receptor antagonist with the ability to suppress the cytokine storm in critically ill patients infected with SARS-CoV-2.MethodsThis was a multi-center study of patients infected with SARS-CoV-2, admitted between 3/13/20 and 4/16/20, requiring mechanical ventilation. Parameters that were evaluated included age, sex, race, usage of steroids, inflammatory markers, and comorbidities. Early dosing was defined as a tocilizumab dose administered prior to or within one (1) day of intubation. Late dosing was defined as a dose administered greater than one (1) day after intubation. A control group that was treated only with standard of care, and without tocilizumab, was utilized for comparison (untreated).FindingsWe studied 118 patients who required mechanical ventilation. Eighty-one (81) received tocilizumab, compared to 37 who were untreated. Early tocilizumab therapy was associated with a statistically significant decrease in mortality as compared to patients who were untreated (p=0.003). Dosing tocilizumab late was associated with an increased mortality compared to the untreated group (p=0.006).InterpretationEarly tocilizumab administration was associated with decreased mortality in critically ill SARS-Co-V-2 patients, but a potential detriment was suggested by dosing later in a patient’s course.FundingThis work did not receive outside funding or sponsorship.

scholarly journals Accuracy of zero-heat-flux thermometry and bladder temperature measurement in critically ill patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Anselm Bräuer ◽  
Albulena Fazliu ◽  
Thorsten Perl ◽  
Daniel Heise ◽  
Konrad Meissner ◽  
...  
Keyword(s):  
Heat Flux ◽  
Critically Ill ◽  
Core Temperature ◽  
Critically Ill Patients ◽  
Gold Standard ◽  
Prospective Observational Study ◽  
Standard Of Care ◽  
Limits Of Agreement ◽  
Blood Temperature ◽  
Bladder Temperature

AbstractCore temperature (TCore) monitoring is essential in intensive care medicine. Bladder temperature is the standard of care in many institutions, but not possible in all patients. We therefore compared core temperature measured with a zero-heat flux thermometer (TZHF) and with a bladder catheter (TBladder) against blood temperature (TBlood) as a gold standard in 50 critically ill patients in a prospective, observational study. Every 30 min TBlood, TBladder and TZHF were documented simultaneously. Bland–Altman statistics were used for interpretation. 7018 pairs of measurements for the comparison of TBlood with TZHF and 7265 pairs of measurements for the comparison of TBlood with TBladder could be used. TBladder represented TBlood more accurate than TZHF. In the Bland Altman analyses the bias was smaller (0.05 °C vs. − 0.12 °C) and limits of agreement were narrower (0.64 °C to − 0.54 °C vs. 0.51 °C to – 0.76 °C), but not in clinically meaningful amounts. In conclusion the results for zero-heat-flux and bladder temperatures were virtually identical within about a tenth of a degree, although TZHF tended to underestimate TBlood. Therefore, either is suitable for clinical use.German Clinical Trials Register, DRKS00015482, Registered on 20th September 2018, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00015482.

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