scholarly journals Immature granulocytes can help the diagnosis of pulmonary bacterial infections in patients with severe COVID-19 pneumonia

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Thomas Daix ◽  
Robin Jeannet ◽  
Ana Catalina Hernandez Padilla ◽  
Philippe Vignon ◽  
Jean Feuillard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Bacterial Infections ◽  
Distress Syndrome ◽  
Ventilator Associated Pneumonia ◽  
Bacterial Sepsis ◽  
Icu Patients ◽  
Immature Granulocyte ◽  
The Relationship

AbstractDuring COVID-19, immature granulocyte (IG) concentration is heterogeneous with higher concentrations than those found in bacterial sepsis. We investigated the relationship between IG levels at ICU admission and on days 7 (± 2) and 15 (± 2) and associated pulmonary bacterial infections in intensive care unit (ICU) patients hospitalized for an acute respiratory distress syndrome (ARDS) related to SARS-CoV-2. Patients with associated pulmonary bacterial infection had a peak of IGs. IG thresholds of 18% or 2 G/L allowed discriminating patients with ventilator associated pneumonia with 100% sensitivity and specificity. Our study supports that IGs could help identifying pulmonary bacterial infections in this population.

scholarly journals Renal dysfunction decreases specificity and overturns cutoff value of serum CC16 while prohibiting 7-day mortality prediction in diagnosing acute respiratory distress syndrome in intensive care unit.

2020 ◽  
Author(s):  
Jinle Lin ◽  
Wuyuan Tao ◽  
Jian Wei ◽  
Wu Jian ◽  
Wenwu Zhang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Renal Dysfunction ◽  
Predictive Value ◽  
Distress Syndrome ◽  
Icu Patients ◽  
Cutoff Value

Abstract Background: A contradictory tendency between occurrence of acute respiratory distress syndrome (ARDS) and serum club cell protein 16 (CC16) level, However, renal dysfunction (RD) separately raised serum CC16 in our current observation. The purpose of this study was to find the limitation caused by renal dysfunction in the diagnostic performance of CC16 on ARDS in intensive care unit (ICU) patients. Method: We measured serum CC16 in 479 ICU patients. Patients were divided into six subgroups: control, acute kidney injury (AKI), chronic kidney dysfunction (CKD), ARDS, ARDS+AKI, and ARDS+CKD. The cutoff value, sensitivity and specificity of serum CC16 were assessed by receiver operating characteristic curves. Result: Serum CC16 increased among the ARDS group when compared to the control group, which helps identify ARDS and predicts the outcome in patients with normal renal function. However, level of serum CC16 was similar among ARDS+AKI, ARDS+CKD, AIK and CKD groups. Consequently, when compare to AKI and CKD, specificity for diagnosing whether ARDS or ARDS with renal failure decreased from 86.62% to 2.82% or 81.70% to 2.12%. Consistently, a cutoff value of 11.57 ng/mL was overturned from previously at 32.77 ng/mL or 33.72 ng/mL. Moreover, its predictive value for mortality is prohibited before 7 day but works after 28 day. Conclusion: Renal dysfunction limits the specificity, cutoff point, and predictive value at 7-day mortality of CC16 in diagnosing ARDS among ICU patients.

scholarly journals Early Improvement of Acute Respiratory Distress Syndrome in Patients With COVID-19 in the Intensive Care Unit: Retrospective Analysis

10.2196/24843 ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e24843
Author(s):  
Zhu Zhan ◽  
Xin Yang ◽  
Hu Du ◽  
Chuanlai Zhang ◽  
Yuyan Song ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Icu Patients ◽  
Early Improvement ◽  
Icu Stay ◽  
Arterial Blood

Background Since the start of the COVID-19 pandemic, there have been over 2 million deaths globally. Acute respiratory distress syndrome (ARDS) may be the main cause of death. Objective This study aimed to describe the clinical features, outcomes, and ARDS characteristics of patients with COVID-19 admitted to the intensive care unit (ICU) in Chongqing, China. Methods The epidemiology of COVID-19 from January 21, 2020, to March 15, 2020, in Chongqing, China, was analyzed retrospectively, and 75 ICU patients from two hospitals were included in this study. On day 1, 56 patients with ARDS were selected for subgroup analysis, and a modified Poisson regression was performed to identify predictors for the early improvement of ARDS (eiARDS). Results Chongqing reported a 5.3% case fatality rate for the 75 ICU patients. The median age of these patients was 57 (IQR 25-75) years, and no bias was present in the sex ratio. A total of 93% (n=70) of patients developed ARDS during ICU stay, and more than half had moderate ARDS. However, most patients (n=41, 55%) underwent high-flow nasal cannula oxygen therapy, but not mechanical ventilation. Nearly one-third of patients with ARDS improved (arterial blood oxygen partial pressure/oxygen concentration >300 mm Hg) in 1 week, which was defined as eiARDS. Patients with eiARDS had a higher survival rate and a shorter length of ICU stay than those without eiARDS. Age (<55 years) was the only variable independently associated with eiARDS, with a risk ratio of 2.67 (95% CI 1.17-6.08). Conclusions A new subphenotype of ARDS—eiARDS—in patients with COVID-19 was identified. As clinical outcomes differ, the stratified management of patients based on eiARDS or age is highly recommended.

scholarly journals Collective aeromedical evacuations of SARS-CoV-2-related ARDS patients in a military tactical plane: a retrospective descriptive study

2021 ◽  
pp. bmjmilitary-2021-001876
Author(s):  
Thibault Martinez ◽  
K Simon ◽  
L Lely ◽  
C Nguyen Dac ◽  
M Lefevre ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Selection Criteria ◽  
Distress Syndrome ◽  
Descriptive Study ◽  
Military Aircraft ◽  
Life Threatening ◽  
The Military

After the appearance of the COVID-19 pandemic in France, MEROPE system was created to transform the military tactical ATLAS A400M aircraft into a flying intensive care unit. Collective aeromedical evacuations (aero-MEDEVAC) of patients suffering from SARS-CoV-2-related acute respiratory distress syndrome was performed from June to December 2020. A total of 22 patients were transported during seven missions. All aero-MEDEVAC was performed in safe conditions for patients and crew. No life-threatening conditions occurred during flight. Biohazard controls were applied according to French guidelines and prevented crew contamination. Thanks to rigorous selection criteria and continuous in-flight medical care, the safe transportation of these patients was possible. To the best of our knowledge, this is the first description of collective aero-MEDEVAC of these kinds of patients using a tactical military aircraft. We here describe the patient’s characteristics and the flight’s challenges.

Nursing Management of Prone Positioning in Patients With COVID-19

2020 ◽  
pp. e1-e9
Author(s):  
Filippo Binda ◽  
Federica Marelli ◽  
Alessandro Galazzi ◽  
Riccardo Pascuzzo ◽  
Ileana Adamini ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Older Patients ◽  
Distress Syndrome ◽  
Rescue Therapy ◽  
Prone Positioning ◽  
Improvement Project

Background At the height of the coronavirus disease 2019 (COVID-19) pandemic, Italy had the highest number of deaths in Europe; most occurred in the Lombardy region. Up to 4% of patients with COVID-19 required admission to an intensive care unit because they developed a critical illness (eg, acute respiratory distress syndrome). Numerous patients with acute respiratory distress syndrome who had been admitted to the intensive care unit required rescue therapy like prone positioning. Objectives To describe the respiratory management of and the extensive use of prone positioning in patients with COVID-19 at the intensive care unit hub in Lombardy, Italy. Methods A total of 89 patients (67% male; median age, 59 years [range, 23-80 years]) with confirmed COVID-19 who were admitted between February 23 and March 31, 2020, were enrolled in this quality improvement project. Results Endotracheal intubation was required in 86 patients (97%). Prone positioning was used as rescue therapy in 43 (48%) patients. Significantly more younger patients (age ≤ 59 years) were discharged alive (43 of 48 [90%]) than were older patients (age ≥ 60 years; 26 of 41 [63%]; P &lt; .005). Among the 43 patients treated with prone ventilation, 15 (35% [95% CI, 21%-51%]) died in the intensive care unit, of which 10 (67%; P &lt; .001) were older patients. Conclusions Prone positioning is one strategy available for treating acute respiratory distress syndrome in patients with COVID-19. During this pandemic, prone positioning can be used extensively as rescue therapy, per a specific protocol, in intensive care units.

scholarly journals Rhabdomyolysis and acute kidney injury in severe COVID-19 infection

2020 ◽  
Vol 13 (9) ◽  
pp. e237616 ◽  
Author(s):  
Knut Taxbro ◽  
Hannes Kahlow ◽  
Hannes Wulcan ◽  
Anna Fornarve
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Abdominal Pain ◽  
Distress Syndrome ◽  
Kidney Injury ◽  
Forced Diuresis

We report the case of a 38-year-old man who presented to the emergency department with fever, myalgia, nausea, vomiting, dry cough, breathlessness and abdominal pain. He was admitted due to hypoxaemia and was diagnosed with SARS-CoV-2 and was subsequently referred to the intensive care unit for intubation and mechanical ventilation. Severe rhabdomyolysis and acute kidney injury developed 4 days later and were suspected after noticing discolouration of the urine and a marked increase in plasma myoglobin levels. Treatment included hydration, forced diuresis and continuous renal replacement therapy. In addition to the coronavirus disease acute respiratory distress syndrome, he was diagnosed with possible SARS-CoV-2-induced myositis with severe rhabdomyolysis and kidney failure. The patient survived and was discharged from intensive care after 12 days, returning home 23 days after hospitalisation, fully mobilised with a partially restored kidney function.

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