scholarly journals Management of Agitation, Delirium, and Catatonia in Intubated COVID-19 Patients: A Case Series & Rationale for Valproate Sodium Use During Extubation

2021 ◽  
Vol 05 (02) ◽  
pp. 1-1
Author(s):  
Ashley Schumaker ◽  
◽  
Richard Gomez ◽  
Sofia Rojasova ◽  
Cassidy Muir ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Distress Syndrome ◽  
Case Series ◽  
Sedation Scale ◽  
Successful Management ◽  
Neuroprotective Effects ◽  
Valproate Sodium ◽  
Scale Scores ◽  
Hypoxic Respiratory Failure ◽  
Psychotic Features

The complete spectrum of neuropsychiatric effects of SARS-CoV-2 acute respiratory distress syndrome has yet to be fully appreciated, particularly in intubated patients. Manifestations including delirium and catatonia need to be considered in intubated COVID-19 patients. Medications known to exhibit neuroprotective effects, like valproate, can assist in agitation related to sedative withdrawal during extubation. This case series reports on the management of agitation, delirium, and catatonia in COVID-19 patients during and after extubation efforts. We present three cases in which Psychiatry was consulted for agitation in intubated COVID-19 patients. These patients were managed for severe agitation during weaning from extubation as well as for subsequent psychiatric challenges, including catatonia. Patient 1: 26-year-old female with bipolar I with psychotic features who was admitted for acute hypoxic respiratory failure from COVID-19 pneumonia. After an emergency C-section at 31 weeks’ gestation, she was intubated for 9 days and started on valproate 250 mg BID for agitation. She was extubated successfully and discharged home. Patient 2: 42-year-old female with bipolar I and PTSD who was intubated following COVID-19-related acute hypoxic respiratory failure. She received valproate 250mg BID and was extubated successfully. She became catatonic when home quetiapine was resumed and recovered following quetiapine discontinuation and lorazepam. She was discharged on valproic acid and alprazolam. Patient 3: 23-year-old female with bipolar I with psychotic features who was admitted for COVID-19 acute hypoxic respiratory failure and intubated. She received valproate 250 mg BID and was extubated successfully. She became catatonic when risperidone was re-initiated, but recovered following risperidone discontinuation and addition of lorazepam, gabapentin, and duloxetine. Quetiapine was added before discharge. Valproate was effective for managing delirium and agitation during extubation, as evidenced by normalizing Richmond Agitation and Sedation Scale scores. Additionally, valproate aided in managing catatonia post-extubation. This case series reports on the management of agitation in COVID-19 patients during extubation efforts with valproate sodium, due to its ability to manage delirium and catatonia. Valproate is known to exhibit neuroprotective effects, which possibly explains successful management of agitation during the extubation process.

scholarly journals Insights into the use of mesenchymal stem cells in COVID-19 mediated acute respiratory failure

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Nisha Durand ◽  
Jorge Mallea ◽  
Abba C. Zubair
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Stromal Cells ◽  
Distress Syndrome ◽  
Respiratory Illness ◽  
Shortness Of Breath ◽  
Global Pandemic ◽  
Hypoxic Respiratory Failure

Abstract The emergence of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) at the end of 2019 in Hubei province China, is now the cause of a global pandemic present in over 150 countries. COVID-19 is a respiratory illness with most subjects presenting with fever, cough and shortness of breath. In a subset of patients, COVID-19 progresses to hypoxic respiratory failure and acute respiratory distress syndrome (ARDS), both of which are mediated by widespread inflammation and a dysregulated immune response. Mesenchymal stem cells (MSCs), multipotent stromal cells that mediate immunomodulation and regeneration, could be of potential benefit to a subset of COVID-19 subjects with acute respiratory failure. In this review, we discuss key features of the current COVID-19 outbreak, and the rationale for MSC-based therapy in this setting, as well as the limitations associated with this therapeutic approach.

Hiệu quả của phương pháp oxy hóa qua màng ngoài cơ thể (ECMO) trong hỗ trợ điều trị hội chứng suy hô hấp cấp nguy kịch trên bệnh nhân Covid

2022 ◽  
Author(s):  
Tuan Anh Truong
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Case Series ◽  
Patient Reports ◽  
Initial Application ◽  
October 17

TÓM TẮT Sự bùng phát của hội chứng viêm đường hô hấp cấp do coronavirus 2 (SARS-CoV-2) nhanh chóng trở thành đại dịch trên toàn thế giới với hơn 40 triệu người mắc và hơn 1 triệu người chết tính đến ngày 17 tháng 10 năm 2020. Nhiều bệnh nhân COVID-19 được báo cáo cho thấy rằng có thể dẫn đến suy hô hấp cấp cần chăm sóc đặc biệt (ICU) và thiết bị hỗ trợ thở và bệnh cảnh có thể nhanh chóng tiến triển thành chứng suy hô hấp cấp (ARDS) với thiếu oxy ở mức độ nặng và gây ra tử vong dù đã có sự hỗ trợ của thiết bị hỗ trợ thở, cả 2 khả năng này thậm chí có thể cùng xảy ra. Các tổ chức quốc tế và các chuyên gia trong lĩnh vực này khuyến nghị sử dụng ECMO cho những bệnh nhân ARDS bị bệnh nặng có COVID-19. Tuy nhiên, tỷ lệ sống sót là rất thấp trong những trường hợp được sử dụng ECMO với COVID-19 trong đợt đầu tiên. Nghiên cứu của chúng tôi nhằm đánh giá kết quả bước đầu ứng dụng kỹ thuật ECMO trong hỗ trợ điều trị hội chứng suy hô hấp cấp nguy kịch trên bệnh nhân COVID-19 tại trung tâm hồi sức bệnh viện Trung ương Huế. ABSTRACT EFFECTIVENESS OF EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) IN THE TREATMENT OF ACUTE RESPIRATORY DISTRESS SYNDROME IN PATIENTS WITH COVID-19 The outbreak of acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2) quickly developed into a worldwide pandemic with more than 40 million people infected and more than 1 million dead as of October 17, 2020. Numerous patient reports COVID-19 can lead to acute respiratory failure requiring intensive care (ICU) and ventilators, and it can rapidly evolve into a certificate of acute respiratory failure (ARDS) with red oxygen in the heavy and death, despite the protective ventilator, even both. International organizations and experts in the field recommend ECMO for critically ill ARDS patients with COVID-19. However, survival is very low in the ECMO - corrected case series with COVID-19 during the first COVID-19 wave. Our study aimed to evaluate the results of the initial application of transmembrane oxygenation (ECMO) technique in the support of critical acute respiratory distress syndrome on COVID-19 patients at the hospital resuscitation center of Hue central hospital. Keywords: ECMO, ARDS, COVID-19.

scholarly journals Complete Heart Block as a Clinical Feature in Critically Ill Coronavirus Disease 2019 (COVID-19) Patients: A Case Series of Three Cases

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Farook Ahmad ◽  
Priti Gandre ◽  
Julien Nguekam ◽  
Alanna Wall ◽  
ShiYu Ong ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Medical History ◽  
Critically Ill ◽  
Heart Block ◽  
Complete Heart Block ◽  
Case Series ◽  
Coronary Syndrome ◽  
Cardiovascular Morbidity And Mortality ◽  
Hypoxic Respiratory Failure ◽  
New Onset

Background. Novel coronavirus-19 disease (COVID-19) is associated with significant cardiovascular morbidity and mortality. However, there have been very few reports on complete heart block (CHB) associated with COVID-19. This case series describes clinical characteristics, potential mechanisms, and short-term outcomes of critically ill COVID-19 patients complicated by CHB. Case Summary. We present three cases of new-onset CHB in critically ill COVID-19 patients. Patient 1 is a 41-year-old male with well-documented history of Familial Mediterranean Fever (FMF) who required mechanical ventilator support for acute hypoxic respiratory failure from severe COVID-19 pneumonia. He developed new-onset CHB without a hemodynamic derangement but subsequently had acute coronary syndrome complicated by cardiogenic shock. Patient 2 is a 77-year-old male with no past medical history who required intubation for severe COVID-19 pneumonia acute hypoxic respiratory failure. He developed CHB with sinus pause requiring temporary pacing but subsequently developed multiorgan failure. Patient 3 is 36-year-old lady 38 + 2 weeks pregnant, gravida 2 para 1 with no other medical history, who had an emergency Lower Section Caesarean Section (LSCS) as she required intubation for acute hypoxic respiratory failure. She exhibited new-onset CHB without hemodynamic compromise. The CHB resolved spontaneously after 24 hours. Discussion. COVID-19-associated CHB is a very rare clinical manifestation. The potential mechanisms for CHB in patients with COVID-19 include myocardial inflammation or direct viral infiltration as well as other causes such as metabolic derangements or use of sedatives. Patients diagnosed with COVID-19 should be monitored closely for the development of bradyarrhythmia and hemodynamic instability.

scholarly journals Standard care vs. awake prone position in adult non-intubated patients with acute hypoxaemic respiratory failure secondary to COVID-19 infection – A multi-centre feasibility randomized controlled trial

2021 ◽  
Author(s):  
Devachandran Jayakumar ◽  
Pratheema Ramachandran ◽  
Ebenezer Rabindrarajan ◽  
Bharath Kumar Tirupakuzhi Vijayaraghavan ◽  
Nagarajan Ramakrishnan ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Prone Position ◽  
Standard Care ◽  
Distress Syndrome ◽  
Prone Positioning ◽  
Hypoxic Respiratory Failure ◽  
Secondary Outcomes

AbstractBackgroundThe primary manifestation of Corona Virus Disease −2019 (COVID-19) is acute hypoxic respiratory failure secondary to pneumonia and/or acute respiratory distress syndrome. Prone position has been shown to improve outcomes in ventilated patients with moderate to severe acute respiratory distress syndrome. The feasibility and safety of awake prone positioning and its impact on outcomes if any, in non-intubated patients with mild to moderate acute respiratory distress syndrome secondary to COVID-19 is unknown. Results of the observational studies published thus far in this pandemic have been conflicting. In this context, we conducted a multi-centre, parallel group, randomised controlled feasibility study on awake prone positioning in non-intubated patients with COVID-19 pneumonia requiring supplemental oxygen.Methods60 patients diagnosed with acute hypoxic respiratory failure secondary to COVID −19 pneumonia requiring 4 or more litres of oxygen to maintain a saturation of ≥ 92% were recruited in this study. Thirty patients each were randomised to either standard care or awake prone group. Patients randomised to the standard care were allowed to change their position as per comfort and patients randomized to the prone group were encouraged to self-prone for at least 6 hours a day. The primary outcome was the proportion of patients adhering to the protocol in each group. Secondary outcomes include failure of therapy leading to escalation of respiratory support, number of hours prone, maximum hours of continuous prone positioning in a day, length of stay in ICU, ICU mortality, total number of patients needing intubation and adverse events.ResultsIn the prone group, 43% (13 out of 30) of patients were able to self-prone for 6 or more hours a day. The median maximum prone duration per session was 2 hours. In the supine group, 47% (14 out of 30) were completely supine and 53% spent some hours in the prone position, but none exceeded 6 hours. There was no significant difference in any of the secondary outcomes between the two groups and there were no adverse events.InterpretationAwake proning in non-intubated patients with acute hypoxic respiratory failure is feasible and safe under clinical trial conditions. The results of our feasibility study will potentially help in the design of larger definitive trials to address this key knowledge gap.

scholarly journals Acute respiratory failure as primary manifestation of antineutrophil cytoplasmic antibodies-associated vasculitis

2014 ◽  
Vol 4 (2) ◽  
Author(s):  
Evdokia Sourla ◽  
Vasilis Bagalas ◽  
Helias Tsioulis ◽  
Asimina Paspala ◽  
Sofia Akritidou ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Distress Syndrome ◽  
Clinical Presentation ◽  
Ventilatory Support ◽  
Multiple Organ ◽  
Alveolar Hemorrhage ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Organ Systems ◽  
Hypoxic Respiratory Failure

The systemic vasculitides are multifocal diseases characterized by the presence of blood vessel inflammation in multiple organ systems. Their clinical presentation is variable extending from self-limited illness to critical complications including diffuse alveolar hemorrhage and glomerulonephritis. Alveolar hemorrhage is a lifethreatening manifestation of pulmonary vasculitis that can rapidly progress into acute respiratory failure requiring ventilatory support. We present the case of a 74-year-old patient admitted to the Intensive Care Unit with severe hypoxic respiratory failure and diffuse alveolar infiltrates in chest imaging that was later diagnosed as antineutrophil cytoplasmic antibodies-associated vasculitis. The report highlights the importance of differentiate between alveolar hemorrhage and acute respiratory distress syndrome of other etiology because alveolar hemorrhage is reversible with prompt initiation of treatment.

scholarly journals Novel coronavirus 19 (COVID-19) associated sinus node dysfunction: a case series

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6 ◽  
Author(s):  
Graham Peigh ◽  
Marysa V Leya ◽  
Jayson R Baman ◽  
Eric P Cantey ◽  
Bradley P Knight ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Medical History ◽  
Sinus Bradycardia ◽  
Sinus Node ◽  
Case Series ◽  
Sinus Node Dysfunction ◽  
Past Medical History ◽  
Hypoxic Respiratory Failure ◽  
Novel Coronavirus ◽  
New Onset

Abstract Background Novel coronavirus-19 disease (COVID-19) is associated with significant cardiovascular morbidity and mortality. To date, there have not been reports of sinus node dysfunction (SND) associated with COVID-19. This case series describes clinical characteristics, potential mechanisms, and short-term outcomes of COVID-19 patients who experience de novo SND. Case summary We present two cases of new-onset SND in patients recently diagnosed with COVID-19. Patient 1 is a 70-year-old female with no major past medical history who was intubated for acute hypoxic respiratory failure secondary to COVID-19 pneumonia and developed new-onset sinus bradycardia without a compensatory increase in heart rate in response to relative hypotension. Patient 2 is an 81-year-old male with a past medical history of an ascending aortic aneurysm, hypertension, and obstructive sleep apnoea who required intubation for COVID-19-induced acute hypoxic respiratory failure and exhibited new-onset sinus bradycardia followed by numerous episodes of haemodynamically significant accelerated idioventricular rhythm. Two weeks following the onset of SND, both patients remain in sinus bradycardia. Discussion COVID-19-associated SND has not previously been described. The potential mechanisms for SND in patients with COVID-19 include myocardial inflammation or direct viral infiltration. Patients diagnosed with COVID-19 should be monitored closely for the development of bradyarrhythmia and haemodynamic instability.

scholarly journals Sedation Usage in COVID-19 Acute Respiratory Distress Syndrome: A Multicenter Study

2021 ◽  
pp. 106002802110219
Author(s):  
Natalie Tapaskar ◽  
Daniel Colon Hidalgo ◽  
Grace Koo ◽  
Krupa Shingada ◽  
Swathi Rao ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Primary Outcome ◽  
Distress Syndrome ◽  
Sedation Scale ◽  
Scale Scores ◽  
Median Cumulative Dose ◽  
Higher Doses ◽  
Historical Controls

Background Patients with COVID-19 acute respiratory distress syndrome (ARDS) have been shown to have high sedation requirements. Objective The purpose of this study was to compare sedative use between patients with COVID-19 ARDS and non-COVID-19 ARDS. Methods This was a retrospective study of patients with COVID-19 ARDS compared with historical controls of non-COVID-19 ARDS who were admitted to 2 hospitals from March 1, 2020, to April 30, 2020, and April 1, 2018, to December 31, 2019, respectively. The primary outcome was median cumulative dose of propofol (µg/kg) at 24 hours after intubation. Results There were 92 patients with COVID-19 ARDS and 37 patients with non-COVID-19 ARDS included. Within the first 24 hours of intubation, patients with COVID-19 ARDS required higher total median doses of propofol: 51 045 µg/kg (interquartile range, 26 150-62 365 µg/kg) versus 33 350 µg/kg (9632-51 455 µg/kg; P = 0.004). COVID-19 patients were more likely receive intravenous lorazepam (37% vs 14%; P = 0.02) and higher cumulative median doses of midazolam by days 5 (14 vs 4 mg; P = 0.04) and 7 of intubation (89 vs 4 mg; P = 0.03) to achieve the same median Richmond Analgesia-Sedation Scale scores. COVID-19 ARDS patients required more ventilator days (10 vs 6 days; P = 0.02). There was no difference in 30-day mortality. Conclusion and Relevance Patients with COVID-19 ARDS required higher doses of propofol and benzodiazepines than patients with non-COVID-19 ARDS to achieve the same median levels of sedation.

scholarly journals Use of extracorporeal membranous oxygenation in the management of refractory trauma-related severe acute respiratory distress syndrome: a national survey of the Eastern Association for the Surgery of Trauma

2019 ◽  
Vol 4 (1) ◽  
pp. e000341
Author(s):  
Lauren Raff ◽  
Jeffrey David Kerby ◽  
Donald Reiff ◽  
Jan Jansen ◽  
Eric Schinnerer ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
National Survey ◽  
Distress Syndrome ◽  
Trauma Patients ◽  
Provider Attitudes ◽  
Level Of Evidence ◽  
Hypoxic Respiratory Failure

ObjectiveTo report results of a national survey of provider attitudes, observations, and opinions regarding the use of extracorporeal membranous oxygenation (ECMO) to manage severe acute respiratory distress syndrome (ARDS) in trauma patients.DesignA survey was created to query providers on the use of ECMO in trauma, as well as general management principals related to care of the patient with refractory hypoxic respiratory failure. The survey was sent to all members of Eastern Association for the Surgery of Trauma (EAST). Once completed, the survey was returned to the University of Alabama at Birmingham and results were analyzed.Setting/patientsTrauma patients with refractory ARDS.InterventionsNone.Measurements and main resultsRespondents were from 37 states, the District of Columbia, and Puerto Rico. 56.9% reported institutional ECMO capabilities, but only 45.2% reported using ECMO for trauma patients. Most respondents (90.2%) reported ECMO use in less than or equal to five trauma patients per year. 20.9% think there is not enough data to support its use in trauma but only 4.7% would absolutely not consider ECMO use for trauma patients. Ranking the preferred modality of treatments for refractory ARDS from most to least preferable is as follows: airway pressure release ventilation, bilevel ventilation, paralysis, prone positioning, inhaled nitric oxide, epoprostenol, high-frequency oscillatory ventilation, corticosteroids, surfactant.ConclusionsARDS has a high mortality among trauma patients. Despite its utility in treating severe ARDS and other pulmonary disease processes, ECMO has not been universally embraced by the trauma community. There are an increasing number of studies that suggest that ECMO is a safe and viable treatment option for trauma patients with ARDS. Based on the results of this survey, ECMO use remains limited by trauma providers that care for patients with refractory hypoxic respiratory failure and ARDS, likely due to a combination of knowledge gaps and lack of access to ECMO.Level of evidenceLevel V.

scholarly journals Short-Term Corticosteroids in SARS-CoV2 Patients: Hospitalists’ Perspective

2020 ◽  
Author(s):  
Vijairam Selvaraj ◽  
Kwame Dapaah-Afriyie ◽  
Arkadiy Finn ◽  
Timothy Flanigan
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Case Series ◽  
Inpatient Mortality ◽  
Short Term ◽  
Systemic Corticosteroids ◽  
Short Course ◽  
Improved Outcomes ◽  
Hypoxic Respiratory Failure

AbstractBackgroundDexamethasone, a synthetic glucocorticoid, has anti-inflammatory and immunosuppressive properties. There is a hyperinflammatory response involved in the clinical course of patients with pneumonia due to SARS-CoV2. To date, there has been no definite therapy for COVID-19. We reviewed the charts of SARS-CoV2 patients with pneumonia and moderate to severely elevated CRP and worsening hypoxemia who were treated with early, short-term dexamethasone.MethodsWe describe a series of 21 patients who tested positive for SARS-CoV2 and were admitted to The Miriam Hospital in Providence and were treated with a short course of dexamethasone, either alone or in addition to current investigative therapies.ResultsCRP levels decreased significantly following the start of dexamethasone from mean initial levels of 129.52 to 40.73 mg/L at time of discharge. 71% percent of the patients were discharged home with a mean length of stay of 7.8 days. None of the patients had escalation of care, leading to mechanical ventilation. Two patients were transferred to inpatient hospice facilities on account of persistent hypoxemia, in line with their documented goals of care.ConclusionsA short course of systemic corticosteroids among inpatients with SARS-CoV2 with hypoxic respiratory failure was well tolerated, and most patients had improved outcomes. This limited case series may not offer concrete evidence towards the benefit of corticosteroids in COVID-19. However, patients’ positive response to short-term corticosteroids demonstrates that they may help blunt the severity of inflammation and prevent a severe hyperinflammatory phase, in turn reducing the length of stay, ICU admissions, and healthcare costs.SummaryIn this series, we demonstrate that timely, short-term use of systemic corticosteroids among hospitalized patients with hypoxic respiratory failure due to SARS-CoV2 was well tolerated with good outcomes. The outcomes were reflected by reductions in inpatient mortality, CRP levels, requirement for mechanical ventilation and escalation of care.

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