Association between Biomarkers of Inflammation and Delirium in Critically Ill Patients with COVID-19.

Background: Critical illness with COVID-19 is associated with increased delirium duration and severity, and delirium is associated with poor health outcomes. The pathophysiology of delirium in this population is not well understood but neuroinflammation is hypothesized to play a key role. Objective: To evaluate the relationship between biomarkers of systemic inflammation and delirium in critically ill patients with COVID-19. Design: Observational retrospective data extraction study from March 1, 2020 – June 7, 2020. Biomarker levels and delirium occurrence were assessed up to the first 14 days in the intensive care unit (ICU). Setting: Two large, urban, academic referral hospitals in Indianapolis, IN Patients: Two hundred thirty-five patients admitted to the ICU with a positive SARS-Co-V2 PCR test Methods and Main Results: A total of 235 consecutive patients admitted to the ICU were included in the analysis. The cohort had a mean age of 58.6 years (SD: 15.4), 43.4% were female, 45.9% were African American, with median Acute Physiology and Chronic Evaluation-II score of 18.0 (IQR: 13.0 -15.0). Delirium occurred in 176 (79.1%). Increased levels of C-Reactive Protein (CRP) were associated with increased odds of delirium and coma (OR: 1.27, 95% CI: 1.08, 1.49, p=0.004). Increased levels of D-dimer were not associated with increased odds of delirium/coma (OR: 0.94, 95% CI 0.76, 1.16, p=0.574). Increased levels of ferritin (OR: 1.04, 95% CI 0.84, 1.29, p=0.717) and lactate dehydrogenase (LDH) were also not associated with increased odds of delirium/coma (OR: 0.86, 95% CI 0.70, 1.06, p=0.149). Elevated levels of creatine kinase (CK) levels were associated with lower odds of delirium/coma (OR: 0.71 95% CI 0.52, 0.97, p=0.033). Conclusion: Increased levels of biomarkers of inflammation and thrombosis were associated with greater odds of delirium and coma. Further studies are needed to validate these results in a larger population. “This project was funded, in part, with support from the NIH NHLBI Short-Term Training Program in Biomedical Sciences Grantfunded, in part by T35HL110854 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.”

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Faculty Opinions recommendation of Population pharmacokinetics and pharmacodynamics of continuous versus short-term infusion of imipenem-cilastatin in critically ill patients in a randomized, controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1099302.555530 ◽

2008 ◽

Author(s):

Mathias Pletz

Keyword(s):

Randomized Controlled Trial ◽

Population Pharmacokinetics ◽

Critically Ill ◽

Critically Ill Patients ◽

Controlled Trial ◽

Pharmacokinetics And Pharmacodynamics ◽

Short Term ◽

Population Pharmacokinetics And Pharmacodynamics ◽

Randomized Controlled

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Faculty Opinions recommendation of Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718011916.793479251 ◽

2013 ◽

Author(s):

Bruce Bistrian

Keyword(s):

Randomized Controlled Trial ◽

Enteral Nutrition ◽

Parenteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Controlled Trial ◽

Early Enteral Nutrition ◽

Short Term ◽

Randomized Controlled ◽

Early Parenteral Nutrition

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Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Scientific Reports ◽

10.1038/s41598-021-90013-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yongfang Zhou ◽

Steven R. Holets ◽

Man Li ◽

Gustavo A. Cortes-Puentes ◽

Todd J. Meyer ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

History Of ◽

Training Background ◽

The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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The Efficacy of Convalescent Plasma Use in Critically Ill COVID-19 Patients

Medicina ◽

10.3390/medicina57030257 ◽

2021 ◽

Vol 57 (3) ◽

pp. 257

Author(s):

Livius Tirnea ◽

Felix Bratosin ◽

Iulia Vidican ◽

Bianca Cerbu ◽

Mirela Turaiche ◽

...

Keyword(s):

Pilot Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Therapeutic Option ◽

White Blood Cells ◽

The United States ◽

Plasma Therapy ◽

Reactive Protein ◽

United States Food ◽

States Food

Background and Objectives: On 24 March 2020, the United States Food and Drug Administration (FDA) announced the approval of convalescent plasma therapy for critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an emergency investigational new drug. This pilot study from Romania aimed to determine if convalescent plasma transfusion can be beneficial in the treatment of selected critically ill patients diagnosed with a SARS-CoV-2 infection. Materials and Methods: Donor and receiver eligibility for critically ill coronavirus disease 2019 (COVID-19) patients was based on Romanian guidelines issued at the time of the study. Here, we describe the evolution of a total of five eligible patients diagnosed with COVID-19 who received convalescent plasma (CP) in Romania. Results: In spite of our efforts and convalescent plasma administration, three of the five patients did not survive, while the other two recovered completely. Over the course of our five-day laboratory record, the surviving patients had significantly lower values for C-reactive protein, interleukin-6, and white blood cells. Conclusions: This pilot study provides insufficient evidence to determine the efficacy of convalescent plasma use as a therapeutic option for critically ill COVID-19 patients.

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The relationship between sedative drug utilization and outcomes in critically ill patients undergoing mechanical ventilation

Journal of Anesthesia ◽

10.1007/s00540-016-2196-z ◽

2016 ◽

Vol 30 (5) ◽

pp. 763-769 ◽

Cited By ~ 5

Author(s):

Kenshi Hayashida ◽

Takeshi Umegaki ◽

Hiroshi Ikai ◽

Genki Murakami ◽

Masaji Nishimura ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Drug Utilization ◽

Critically Ill Patients ◽

Sedative Drug ◽

The Relationship

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Patterns of c-reactive protein predicts response to therapy in healthcare-associated pneumonia in critically ill patients with cancer

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a254 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

L Sarmet Cunha Farah Rabello ◽

T Lisboo ◽

L Azevedo ◽

JR Lapa e Silva ◽

M Soares ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Response To Therapy ◽

C Reactive Protein ◽

Patients With Cancer ◽

Reactive Protein ◽

Healthcare Associated

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Pharmacological Management of Seizures and Status Epilepticus in Critically Ill Patients

Journal of Pharmacy Practice ◽

10.1177/0897190010372321 ◽

2010 ◽

Vol 23 (5) ◽

pp. 441-454 ◽

Cited By ~ 12

Author(s):

Eljim P. Tesoro ◽

Gretchen M. Brophy

Keyword(s):

Status Epilepticus ◽

Critically Ill ◽

Critically Ill Patients ◽

Neurological Disease ◽

Medical Emergency ◽

Significant Morbidity ◽

First Line ◽

Short Term ◽

Pharmacological Management ◽

First Line Treatment

Seizures are serious complications seen in critically ill patients and can lead to significant morbidity and mortality if the cause is not identified and treated quickly. Uncontrolled seizures can lead to status epilepticus (SE), which is considered a medical emergency. The first-line treatment of seizures is an intravenous (IV) benzodiazepine followed by anticonvulsant therapy. Refractory SE can evolve into a nonconvulsive state requiring IV anesthetics or induction of pharmacological coma. To prevent seizures and further complications in critically ill patients with acute neurological disease or injury, short-term seizure prophylaxis should be considered in certain patients.

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