Adaptive Phage Therapy in the Treatment of Patients with Recurrent Pneumonia (Pilot Study)

Aim. To evaluate the safety and efficacy of the adaptive phage therapy technique in patients with recurrent pneumonia in neurological critical care.Material and methods. The clinical study included 83 chronically critically ill patients with severe brain damage. The bacteriophage cocktail selected against specific hospital strains was administered by inhalation to 43 patients. The control group included 40 patients who received conventional antimicrobial therapy. The changes in clinical, laboratory and instrumental parameters, levels of biomarkers, microbiological and PCR tests of bronchoalveolar lavage fluid were assessed, including those in the «phage therapy with antibiotics» (n=29) and «phage therapy without antibiotics» (n=14) subgroups.Results. The groups were comparable in terms of basic parameters (age, sex, diagnosis, organ dysfunction according to APACHE II, use of vasoactive drugs) and the level of airway colonization with antibioticresistant bacterial strains. Good tolerability and absence of clinically significant side effects were observed during inhaled administration of the bacteriophage cocktail. Computed tomography on day 21 showed a significant reduction in lung damage in patients who received bacteriophages. Patients treated with bacteriophages without antibiotics had significantly lower need for mechanical ventilation. The mortality rate on day 28 did not differ significantly and was 4.7% (2/43) in the bacteriophage-treated group vs 5% (2/40) in the control group.Conclusion. The first experience of using the adaptive phage therapy technique in chronically critically ill patients in neurological intensive care demonstrated the safety of inhalational administration of the bacteriophage cocktail. The efficacy of the technique was confirmed by the treatment results obtained in the phage therapy group, which were not inferior to those in the group with conventional antibiotic therapy, while several clinical and laboratory parameters tended to improve even in patients who received bacteriophages and did not receive antibiotics.

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New coronavirus disease (COVID-19): symptoms, laboratory blood indicators in the critically ill and dead patients

EMERGENCY MEDICINE ◽

10.22141/2224-0586.17.4.2021.237722 ◽

2021 ◽

Vol 17 (4) ◽

pp. 13-22

Author(s):

V.I. Trykhlib ◽

A.P. Kazmirchuk ◽

V.V. Grushkevych ◽

T.V. Burakova

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Clinical Laboratory ◽

Clinical Manifestations ◽

High Sensitivity ◽

Lung Damage ◽

Shortness Of Breath ◽

Chronic Respiratory Diseases ◽

Reactive Protein ◽

Seriously Ill Patients

The article states that the new coronavirus disease (COVID-19) is characterized by a range of clinical manifestations, the development of various complications, inconsistency of clinical, laboratory and instrumental data of the patient’s state, which the authors have observed so far according to the results of our previous studies. A review of the literature is presented on the symptoms, laboratory blood tests of critically ill patients who recovered and those who died of a new COVID-19. Among the hospitalized seriously ill patients, there were mostly men, a significant number had comorbidities. According to the literature, hospitalized critically ill patients with confirmed new COVID-19 in most cases had cough, fever, chills, shortness of breath, lymphopenia. Other symptoms include sputum, headache, dizziness, rhinorrhea, anosmia, dysgeusia, sore throat, abdominal pain, anorexia and vomiting, diarrhea, nausea, and muscle pain. The study concluded that doctors, especially after 3 days of illness, when assessing the state of the patient, should pay attention to the following data or their severity, a combination of several symptoms that may suggest the need for hospitalization, particularly in the intensive care unit: the age of the patient; the presence of concomitant pathology (cardiovascular, cerebral, chronic respiratory diseases, diabetes, obesity), especially in the stage of decompensation; the presence and extent of impaired consciousness (Glasgow Coma Scale); cyanosis, pallor of the skin, mucous membranes; acrocyanosis or central cyanosis; duration of fever (> 38 °C) more than 3 days, especially > 39 °C; manifestations of dyspnea (chest tightness, shortness of breath or tachypnea, shortness of breath during exercises), respiratory rate > 24 beats per minute or < 10; heart rate ≥ 125 beats per minute (measured when the patient is sitting); systolic blood pressure < 100 mmHg; SOFA score > 2; CURB-65 score > 2; the presence of signs of emergencies (acute respiratory distress syndrome, acute renal failure, bleedings and others); SpO2 < 93 %; leukocytosis > 10 • 109/l, lymphopenia, thrombocytopenia, serum C-reactive protein > 10 mg/l; an increase in prothrombin time (> 16), in the levels of D-dimer (> 1.5 ng/ml), ferritin (> 300), lactate dehydrogenase (above 360 U/l), procalcitonin (≥ 0.5 ng/ml), lactate (> 2 mmol/L), NT-proBNP (≥ 400 pg/ml), high-sensitivity cardiac troponin (> 5 pg/ml), changes on the electrocardiogram; lung damage more than 25 % according to computed tomography.

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Insulin therapy for hyperglycemia in critically ill patients

Paediatrica Indonesiana ◽

10.14238/pi53.5.2013.250-3 ◽

2016 ◽

Vol 53 (5) ◽

pp. 250

Author(s):

Julianti Julianti ◽

Silvia Triratna ◽

Aditiawati Aditiawati ◽

Irfanuddin Irfanuddin

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Mortality Rate ◽

Insulin Therapy ◽

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Therapy Group ◽

Control Group

Background Hyperglycemia in critically ill patients is associated with higher mortality. Insulin therapy may improve outcomes, not only by preventing deleterious effects of hyperglycemia, but by improving the molecular dynamics in organ dysfunction.Objectives To assess the effects of insulin therapy on critically ill patients in an intensive care unit (ICU) setting and the risk of hypoglycemia.Methods An open-label, clinical trial was conducted in the Pediatric Intensive Care Unit (PICU) of Dr. Moh. Hoesin Hospital, Palembang, from November 2011 to March 2012. Subjects were consecutively assigned to receive either regular insulin at a dose of 0.05 U/kg/h if the blood glucose level reached >200 mg%, or standard therapy (control group). Blood glucose levels were measured hourly until they reached 80-110 mg%. Dose adjustments were made when the blood glucose level reached 145 mg%, by reducing the insulin dose to 0.025 U/kg/h. Outcomes of therapy were measured by Pediatric Logistic Organ Dysfunction (PELOD) score improvement, mortality rate and the occurrence of hypoglycemia.Results Forty subjects were enrolled in this study, with 20 subjects assigned to the insulin therapy group and 20 subjects to the standard therapy group. Two subjects, one from each group, were not included in the final analysis due to their deaths within 24 hours. There was no significant difference in distribution of PELOD scores before intervention between the groups (OR=0.5; 95%CI 0.1 to 1.9, P=0.32). However, after intervention, the PELOD scores was significantly lower in insulin therapy group compared to control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). In the insulin group after intervention, fewer subjects had scores >20.5 and more subjects had scores ≤20.5, indicated a lower risk of organ dysfunction. There was also a significantly lower mortality rate in the insulin group compared to the control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). None of the subjects suffered hypoglycemia.Conclusion Insulin is beneficial in improving organ dysfunction and decreasing mortality for critically ill patients.

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Effect Of Kinetic Therapy on Pulmonary Complications

American Journal of Critical Care ◽

10.4037/ajcc2004.13.5.376 ◽

2004 ◽

Vol 13 (5) ◽

pp. 376-382 ◽

Cited By ~ 52

Author(s):

Thomas Ahrens ◽

Marin Kollef ◽

Jena Stewart ◽

William Shannon

Keyword(s):

Intensive Care ◽

Pulmonary Function ◽

Critically Ill ◽

Critically Ill Patients ◽

Therapy Group ◽

Control Group ◽

Trauma Patients ◽

Ventilator Associated Pneumonia ◽

Potential Cost ◽

Kinetic Therapy

• Background Optimal turning of critically ill patients is not well established. Kinetic therapy (systematic mechanical rotation of patients with 40° turns) may improve pulmonary function more than the improvement in function achieved via the standard of care (turning patients every 2 hours).• Objective To determine (1) if patients receiving mechanical ventilation who tolerate kinetic therapy have better pulmonary function than do patients treated with standard turning and (2) the cost-effectiveness of kinetic therapy.• Methods A prospective, randomized, multicenter study including 234 medical, surgical, and trauma patients (137 control patients, 97 patients receiving kinetic therapy).• Results Kinetic therapy significantly decreased the occurrence of ventilator-associated pneumonia and lobar atelectasis. The risk of pneumonia developing was lower (P = .002) in patients receiving kinetic therapy than in the control patients. The risk of lobar atelectasis developing was decreased (P = .02) for the patients receiving kinetic therapy. Lengths of stay in the intensive care unit and in the hospital did not differ between the groups. Charges for intensive care were less in the kinetic therapy group ($81 700) than in the control group ($84 958), but not significantly less. Twenty-one patients did not tolerate kinetic therapy and were not included in the analysis.• Conclusion Kinetic therapy helps prevent ventilator-associated pneumonia and lobar atelectasis in critically ill patients. Costs to rent the bed may be offset by the potential cost reduction associated with kinetic therapy.

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Effect of applying nurses driven electrolyte repletion protocol on electrolyte disturbances control among critically ill patients

Journal of Nursing Education and Practice ◽

10.5430/jnep.v10n4p72 ◽

2020 ◽

Vol 10 (4) ◽

pp. 72

Author(s):

Mohamed E. Abdelgawad ◽

Nadia T. Ahmed ◽

Ahmed M. Elmenshawy

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Critically Ill Patients ◽

Improve Patient Care ◽

University Hospital ◽

Treatment Modalities ◽

Control Group ◽

Electrolyte Disturbances ◽

Electrolyte Loss

Background and objective: Electrolyte disturbances remain a common lifesaving issue in the intensive care units. They are associated with increased morbidity and mortality. They are mostly resulted secondary to critical illness itself or associated treatment modalities. Therefore, electrolytes repletion should be done effectively and timely. This could be ensured using nurse driven protocols rather than traditional methods of repletion. These protocols are nurse initiated and collaboratively developed. They have been shown to improve patient care outcomes through the provision of high quality care. They are increasingly being used in the critical care setting. Objective: Determine the effect of applying nurses driven electrolytes repletion protocol on electrolytes disturbance control among critically ill patients.Methods: Quasi experimental research design was used. Sixty two critically ill patients with electrolytes loss were enrolled in the study at Alexandria Main University Hospital intensive care units, Egypt. All episodes of electrolyte loss were evaluated. Repletion of electrolyte loss was done according to unit routine for the control group and nurses driven electrolytes repletion protocol for the study group. Episodes of electrolyte disturbances, adverse events and timing of repletion were evaluated.Results: Neurological disorders represent the most encountered diagnosis. The most common cause of electrolyte loss in was the use of diuretics. Furthermore, there was a highly statistical difference between the two groups as regard electrolytes levels, effectiveness and timing of replacement.Conclusions: Application of nurses driven electrolyte repletion protocol resulted in improvements in the effectiveness and timeliness of electrolyte replacement.

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

Critical Care Medicine ◽

10.1097/ccm.0000000000001642 ◽

2016 ◽

Vol 44 (6) ◽

pp. 1138-1144 ◽

Cited By ~ 2

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

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Brain Death-Induced Inflammatory Activity is Similar to Sepsis-Induced Cytokine Release

Cell Transplantation ◽

10.1177/0963689718785629 ◽

2018 ◽

Vol 27 (10) ◽

pp. 1417-1424 ◽

Cited By ~ 2

Author(s):

Patrícia Schwarz ◽

Geisiane Custódio ◽

Jakeline Rheinheimer ◽

Daisy Crispim ◽

Cristiane B. Leitão ◽

...

Keyword(s):

Brain Death ◽

Critically Ill ◽

Critically Ill Patients ◽

Release Kinetics ◽

Magnetic Bead ◽

Control Group ◽

Cytokine Release ◽

Plasma Cytokine ◽

Ifn Γ ◽

Brain Dead

Brain death (BD) is associated with a systemic inflammation leading to worse graft outcomes. This study aimed to compare plasma cytokine values between brain-dead and critically ill patients, including septic and non-septic controls, and evaluate cytokine release kinetics in BD. Sixteen brain-dead and 32 control patients (16 with and 16 without sepsis) were included. Plasma cytokines were measured by magnetic bead assay after the first clinical exam consistent with BD and every 6 hours thereafter, and at the time of study entry in the control group. The values for IL-8 and IFN-γ were higher in brain-dead and septic patients than in non-septic patients [IL-8: 80.3 (18.7–169.6) vs. 68.2 (22.4–359.4) vs. 16.4 (9.2–42.7) pg/mL; P = 0.006; IFN-γ: 2.8 (1.6-6.1) vs. 3.4 (1.2–9.0) vs. 0.5 (0.5–1.8) pg/mL; P = 0.012]. TNF showed a clear tendency to increase in brain-dead patients [2.7 (1.0–4.8) vs. 1.0 (1.0–5.6) vs. 1.0 (1.0–1.0) pg/mL; P = 0.051], and IL-6 values were higher in brain-dead patients than in non-septic controls [174.5 (104.9–692.5) vs. 13.2 (7.3–38.6) pg/mL; P = 0.002]. These differences remained even after excluding brain-dead patients who also had sepsis ( n = 3). IL-1β and IL-10 values increased from baseline to time point 2 (∼6 hours later) [IL-1β: 5.39 (1.93–16.89) vs. 7.11 (1.93–29.13) pg/mL; P = 0.012; IL-10: 8.78 (3.62–16.49) vs. 15.73 (5.49–23.98) pg/mL; P = 0.009]. BD-induced and sepsis-induced plasma cytokine values were similarly high, and both were higher than the observed in non-septic critically ill patients.

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The effects of gastrointestinal function on the incidence of ventilator-associated pneumonia in critically ill patients

Open Medicine ◽

10.1515/med-2018-0082 ◽

2018 ◽

Vol 13 (1) ◽

pp. 556-561

Author(s):

Yuanqiang Lin ◽

Zhixia Sun ◽

Hui Wang ◽

Meihan Liu

Keyword(s):

Gastric Juice ◽

Critically Ill ◽

Critically Ill Patients ◽

Ph Value ◽

Serum Levels ◽

Control Group ◽

Gastrointestinal Function ◽

Ventilator Associated Pneumonia ◽

Observation Group ◽

Gastric Feeding

AbstractObjectiveTo investigate the effect of gastrointestinal function on the incidence of ventilator-associated pneumonia (VAP) in critically ill patients.MethodsFrom August 2012 to June 2016, 160 critically ill patients in the ICU (Intensive Care Unit) of our hospital were selected as the research group; patients were divided equally into an observation group and a control group, 80 patients in each group, based on the random draw envelope principle. The control group was given a nasogastric tube for gastric feeding, the observation group was given a dual lumen gastrointestinal enteral device for gastric feeding; the two groups’ enteral nutrition observation time was 7d; any changes in patient condition and prognosis were recorded.ResultsThe pH value of gastric juice in the control group and the observation group was 6.13±1.38 and 4.01±1.83, respectively: the pH for the observation group was significantly lower than that of the control group (t=4.982, P<0.05). The incidence of VAP in the observation group and the control group was 2.5% and 12.5%, respectively: the VAP for the observation group was significantly lower than that of the control group (P<0.05). The serum levels of pre-albumin and albumin after feeding in the two groups were significantly higher than before feeding (P<0.05); the serum levels of pre-albumin and albumin in the observation group after feeding were significantly higher than those in the control group (P<0.05). The mechanical ventilation time and ICU length of stay in the observation group were 9.12±2.13 days and 12.76±1.98 days, respectively, significantly lower than those of the control group of 10.56±2.89 days and 16.33±2.11 days (P<0.05).ConclusionObstacles to gastrointestinal function in critically ill ICU patients are common; enteral gastric feeding by dual lumen gastrointestinal for can improve the patient’s nutritional status, promote and maintain the normal pH value of gastric juice, thereby reducing the incidence of VAP through rehabilitation of patients.

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Impact of ascorbic acid in reducing the incidence of vancomycin associated nephrotoxicity in critically ill patients: A preliminary randomized controlled trial

F1000Research ◽

10.12688/f1000research.55619.1 ◽

2021 ◽

Vol 10 ◽

pp. 929

Author(s):

Nouran Hesham El-Sherazy ◽

Naglaa Samir Bazan ◽

Sara Mahmoud Shaheen ◽

Nagwa A. Sabri

Keyword(s):

Ascorbic Acid ◽

Critically Ill ◽

Critically Ill Patients ◽

Statistical Significance ◽

Intervention Group ◽

Secondary Outcome ◽

Control Group ◽

Control Groups ◽

The Absolute ◽

And Control

Background Antioxidants show nephroprotective effect against vancomycin associated nephrotoxicity (VAN) in animals. This study aimed to assess the ascorbic acid nephro-protective role against VAN clinically. Methods Forty-one critically ill patients were randomly assigned to one of two groups: intervention group (vancomycin IV plus ascorbic acid, n=21) or control group (vancomycin IV only, n=20). Primary outcomes were the incidence of VAN and the absolute change in creatinine parameters, while mortality rate was the secondary outcome. Nephrotoxicity was defined as an increase in serum creatinine (S.cr) by at least 0.5 mg/dL or 50% of baseline for at least two successive measurements. This study is registered at Clinicaltrials.gov (NCT03921099), April 2019. Results Mean absolute S.cr increase was significant when compared between both groups, P-value = 0.036, where S.cr increased by 0.05(0.12) and 0.34(0.55) mg/dL in the intervention and control groups, respectively. Mean absolute Cr.cl decline was significant when compared between both groups, P-value = 0.04, where Cr.cl was decreased by 5.9(17.8) and 22.3(30.4) ml/min in the intervention and control groups, respectively. Incidence of VAN was 1/21(4.7%) versus 5/20(25%) in the intervention and control groups, respectively (RR: 0.19; CI: 0.024–1.49; P-value = 0.093). Mortality was higher in the control group; however, it was not statistically significant, P-value = 0.141. Conclusion Co-administration of ascorbic acid with vancomycin preserved renal function and reduced the absolute risk of VAN by 20.3%, however, the reduction in VAN incidence didn’t reach statistical significance level. Further large multicenter prospective trials are recommended.

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Observations on the Application of Nursing Risk Management in the Care of Critically Ill Patients in the Respiratory Unit

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v4i4.1352 ◽

2020 ◽

Vol 4 (4) ◽

Author(s):

Yannan Sun

Keyword(s):

Risk Management ◽

Critically Ill ◽

Critically Ill Patients ◽

Treatment Satisfaction ◽

Clinical Symptoms ◽

Statistical Significance ◽

Management Model ◽

Control Group ◽

Observation Group ◽

Significant Difference

Objective: Investigate the effectiveness of nursing risk management in the care of critically ill patients in the respiratory unit. Methods: Among the critically ill respiratory patients admitted to our hospital between May 2019 and April 2020, 78 patients were randomly selected and divided into an observation group and a control group, each consisting of 39 patients. In the observation group, a nursing risk management model was implemented, i.e., patients' clinical symptoms were observed at any time to monitor their treatment satisfaction and the effectiveness of their care and routine care was implemented for the control group. Results: The heart rate, respiratory rate, and pH of patients in the observation group were more stable than those in the control group, and their respiratory status was better, with differences in data. There was also significant statistical significance (P<0.05). The incidence of patient-provider disputes, unplanned extubation, and unplanned events were lower in the observation group compared to the control group, and their data difference was statistically significant (P<0.05). The treatment satisfaction as well as the total effective rate of patients in the observation group was also much higher than that of the control group, and there was also a statistically significant difference in the data (P<0.05). Conclusion: The nursing risk management model has a significant therapeutic effect in the care of critically ill respiratory patients. Therefore, it is worth popularizing to use in the clinical nursing of respiratory critical patients.

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Convalescent Plasma Therapy in Severe and Critically Ill COVID-19 Patients: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-876454/v1 ◽

2021 ◽

Author(s):

Penglei Yang ◽

Jing Wang ◽

Ruiqiang Zheng ◽

Rui Tan ◽

Xianghui Li ◽

...

Keyword(s):

Systematic Review ◽

Critically Ill ◽

Virus Disease ◽

Therapy Group ◽

Meta Analysis ◽

Control Group ◽

Plasma Therapy ◽

Risk Of Death ◽

Randomized Controlled ◽

Randomized Controlled Studies

Abstract Background: Convalescent plasma treatment of severe and critically ill Corona Virus Disease 2019(COVID-19) patients is still controversial.Objective: To evaluate the efficacy and safety of convalescent plasma in patients with severe COVID-19 infection and critically ill patients, We performed a meta-analysis and systematic review of convalescent plasma therapy in severe and critically ill COVID-19 patients.Methods: We conducted a literature search in electronic data and citations of previously published systematic reviews. We included only randomized controlled studies on convalescent plasma for the treatment of severe and critically ill COVID-19 patients. Results: A total of 7 randomized controlled trials and 1363 patients were included in the meta-analysis. Compared to patients of the control group, there was no difference in clinical improvement (Four studies, RR 1.06, 95% CI 0.96 to 1.17, p = 0.22, moderate certainty) and mortality (seven studies, RR 0.86, 95% CI 0.66 to 1.11, p = 0.48, moderate certainty) for patients of convalescent plasma therapy group.Conclusion: Convalescent plasma does not reduce the improvement of symptoms and the risk of death in severely infected and critically ill COVID-19 patients

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