scholarly journals Extracorporeal Cytokine Removal in Critically Ill COVID-19 Patients: A Case Series

2021 ◽  
Vol 8 ◽  
Author(s):  
Marcell Virág ◽  
Máté Rottler ◽  
Klementina Ocskay ◽  
Tamás Leiner ◽  
Balázs Horváth ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Randomized Trials ◽  
Statistical Significance ◽  
Laboratory Data ◽  
Case Series ◽  
Report Data ◽  
Hospital Acquired ◽  
Second Wave ◽  
Bacterial Superinfection

Introduction: Extracorporeal hemoadsorption (HA) is a potential adjunctive therapy in severe cases of COVID-19 associated pneumonia. In this retrospective study we report data from critically ill patients treated with HA during the first and second wave of the pandemic.Patients and Methods: All patients, who received HA therapy with CytoSorb within the first 96 h of intensive care unit (ICU) admission without hospital-acquired bacterial superinfection, were included. Clinical and laboratory data were collected: on admission, before (TB) and after (TA) HA therapy.Results: Out of the 367 COVID-19 cases, 13 patients were treated with CytoSorb, also requiring mechanical ventilation and renal replacement therapy. All patients were alive at the end of HA, but only 3 survived hospital stay. From TB-TA there was a tendency of decreasing norepinephrine requirement: 193.7 [IQR: 34.8–270.4] to 50.2 [6.5–243.5] ug/kg/day and increasing PaO2/FiO2 ratio 127.8 (95% CI: 96.0–159.6) to 155.0 (115.3–194.6) mmHg but they did not reach statistical significance (p = 0.14 and 0.58, respectively). Treatment related adverse events were not reported.Conclusion: The treatment was well-tolerated, and there was a tendency toward an improvement in vasopressor need and oxygenation during the course of HA. These observations render the need for prospective randomized trials.

scholarly journals Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e134-e138
Author(s):  
Anke Pape ◽  
Jan T. Kielstein ◽  
Tillman Krüger ◽  
Thomas Fühner ◽  
Reinhard Brunkhorst
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Trials ◽  
Clinical Course ◽  
Pharmacological Therapy ◽  
The European Union ◽  
Positive Effects ◽  
Special Patient

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has a serious impact on health and economics worldwide. Even though the majority of patients present with moderate and mild symptoms, yet a considerable portion of patients need to be treated in the intensive care unit. Aside from dexamethasone, there is no established pharmacological therapy. Moreover, some of the currently tested drugs are contraindicated for special patient populations like remdesivir for patients with severely impaired renal function. On this background, several extracorporeal treatments are currently explored concerning their potential to improve the clinical course and outcome of critically ill patients with COVID-19. Here, we report the use of the Seraph 100 Microbind Affinity filter, which is licensed in the European Union for the removal of pathogens. Authorization for emergency use in patients with COVID-19 admitted to the intensive care unit with confirmed or imminent respiratory failure was granted by the U.S. Food and Drug Administration on April 17, 2020.A 53-year-old Caucasian male with a severe COVID-19 infection was treated with a Seraph Microbind Affinity filter hemoperfusion after clinical deterioration and commencement of mechanical ventilation. The 70-minute treatment at a blood flow of 200 mL/minute was well tolerated, and the patient was hemodynamically stable. The hemoperfusion reduced D-dimers dramatically.This case report suggests that the use of Seraph 100 Microbind Affinity filter hemoperfusion might have positive effects on the clinical course of critically ill patients with COVID-19. However, future prospective collection of data ideally in randomized trials will have to confirm whether the use of Seraph 100 Microbind Affinity filter hemoperfusion is an option of the treatment for COVID-19.

scholarly journals SARS-CoV-2 and Cytomegalovirus Co-Infections—A Case Series of Critically Ill Patients

2021 ◽  
Vol 10 (13) ◽  
pp. 2792
Author(s):  
Patrícia Moniz ◽  
Sérgio Brito ◽  
Pedro Póvoa
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Immune Suppression ◽  
Clinical Course ◽  
Health Care Systems ◽  
Case Series ◽  
Confounding Factors ◽  
Care Systems ◽  
The Impact ◽  
Cmv Reactivation

The SARS-CoV-2 pandemic has placed great strain on the most developed of health care systems, especially in the context of critical care. Although co-infections with cytomegalovirus (CMV) are frequent in the critically ill due to underlying immune suppression of multiple causes, the impact on COVID-19 patients remains unclear. Furthermore, severe COVID-19 has recently been associated with significant immune suppression, and this may in turn impact CMV reactivation, possibly contributing to clinical course. Nevertheless, multiple confounding factors in these patients will certainly challenge upcoming research. The authors present a case series of five patients admitted to the intensive care unit (ICU) in the context of respiratory failure due to severe COVID-19. All patients evolved with CMV reactivation during ICU stay.

scholarly journals Impact of the Gamma Variant on the ICU Admission in a Hospital of the Autonomous City of Buenos Aires (CABA), Argentina

2021 ◽  
Author(s):  
Veronica Mandich ◽  
Daniel Chiacchiara ◽  
Marcelo Bravo ◽  
Antonio Pilipec ◽  
Santiago Grimaldi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Buenos Aires ◽  
Multiorgan Failure ◽  
Laboratory Data ◽  
Ventilatory Support ◽  
Tertiary Hospital ◽  
Observational Prospective Cohort Study ◽  
Data History ◽  
The City ◽  
Second Wave

Abstract Purpose: Comparison between patients admitted to the Intensive Care Unit (ICU) with ventilatory support during the first and second wave (Gamma variant) of COVID 19 in a tertiary hospital in the City of Buenos Aires.Method: Descriptive, observational, prospective cohort study in ICU of an acute general hospital in Argentina, with patients adult patients COVID-19 admitted consecutively to the ICU. The ICU the main variables of interest: Demographic and laboratory data, history, duration of MV, mortality.Results: 44 patients were recruited during the first wave, and 80 in the second. Significant differences were observed in the second wave for age (60, [SD 11]; vs 68 [SD 11]; p <0.01), days with symptoms (9 [SD 5]; vs 4.5 [SD 3]; p <0.01), duration of MV (10 days [SD 7]; vs 16 [SD 13]; p <0.01), Ferritin (1450 mcg / l [SD 547]; vs 941 mcg / l [ SD 593]; p 0.04) and use of antibiotics (97% vs 45% p <0.01). There was no difference in mortality (66% vs 78% p 0.14) but there was in its primary causes; being more frequent hypoxemia associated with sepsis in the second wave (40% vs 3.4% p <0.01) and hypoxemia and multiorgan failure in the first (28% vs 4% p <0.01).Conclusions: During the second wave of the pandemic, due to Gamma variant, more patients were admitted to our unit, younger, with a longer evolution time, a shorter time on MV and a greater inflammatory response, with no difference in mortality, although there was a difference in its causes.

scholarly journals Impact of the Gamma Variant on the ICU Admission in a Hospital of the Autonomous City of Buenos Aires (CABA), Argentina

2021 ◽  
Author(s):  
Veronica Mandich ◽  
Daniel Chiacchiara ◽  
Marcelo Bravo ◽  
Antonio Pilipec ◽  
Santiago Grimaldi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Buenos Aires ◽  
Multiorgan Failure ◽  
Laboratory Data ◽  
Ventilatory Support ◽  
Tertiary Hospital ◽  
Observational Prospective Cohort Study ◽  
Data History ◽  
The City ◽  
Second Wave

Abstract Purpose: Comparison between patients admitted to the Intensive Care Unit (ICU) with ventilatory support during the first and second wave (Gamma variant) of COVID 19 in a tertiary hospital in the City of Buenos Aires.Method: Descriptive, observational, prospective cohort study in ICU of an acute general hospital in Argentina, with patients adult patients COVID-19 admitted consecutively to the ICU. The ICU the main variables of interest: Demographic and laboratory data, history, duration of MV, mortality.Results: 44 patients were recruited during the first wave, and 80 in the second. Significant differences were observed in the second wave for age (60, [SD 11]; vs 68 [SD 11]; p <0.01), days with symptoms (9 [SD 5]; vs 4.5 [SD 3]; p <0.01), duration of MV (10 days [SD 7]; vs 16 [SD 13]; p <0.01), Ferritin (1450 mcg / l [SD 547]; vs 941 mcg / l [ SD 593]; p 0.04) and use of antibiotics (97% vs 45% p <0.01). There was no difference in mortality (66% vs 78% p 0.14) but there was in its primary causes; being more frequent hypoxemia associated with sepsis in the second wave (40% vs 3.4% p <0.01) and hypoxemia and multiorgan failure in the first (28% vs 4% p <0.01).Conclusions: During the second wave of the pandemic, due to Gamma variant, more patients were admitted to our unit, younger, with a longer evolution time, a shorter time on MV and a greater inflammatory response, with no difference in mortality, although there was a difference in its causes.

DOES CHLORHEXIDINE WIPE HELP IN REDUCING HOSPITAL ACQUIRED INFECTIONS (HAIS) AMONG CRITICALLY ILL CHILDREN ADMITTED TO A PAEDIATRIC INTENSIVE CARE UNIT?

2021 ◽  
pp. 35-37
Author(s):  
Madhan Kumar ◽  
Jolly Chandran ◽  
Pragathesh Pragathesh ◽  
Ebor Jacob Gnananayagam ◽  
Hema Paul ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Paediatric Intensive Care Unit ◽  
Paediatric Intensive Care ◽  
Critically Ill Children ◽  
Intervention Period ◽  
Hospital Acquired Infections ◽  
Hospital Acquired ◽  
Historical Controls

OBJECTIVE: To determine the effect of chlorhexidine wipes in reducing the incidence of hospital acquired infections (HAIs) among critically ill children admitted in Paediatric Intensive Care Unit (PICU). METHODS: An interventional study, wherein enrolled children were wiped with chlorhexidine after routine bath. The incidence of HAIs were noted and compared with data from historical controls of previous year during the same period (pre-intervention). RESULTS: One hundred and ninety nine children in the intervention period were compared with 271 children from pre-intervention period. The numbers of ventilator-days were 777 and 696 respectively for the intervention period and pre-intervention periods. Incidence of ventilator associated pneumonia (VAP) reduced from 12.9/1000 ventilator-days in the pre-intervention period to 6.4/1000 ventilator-days in the intervention period (p=0.1). VAP prevalence was 3.3% in the pre-intervention period as compared to 2.5% in the intervention period (p=0.6). The incidence of CLABSI was 3.6/1000 catheter-days (catheter days: 1377) with prevalence of 2.5% in the intervention period, whereas among the historic controls of the previous year it was 4.2/1000 days (catheter days 1432) with a prevalence of 2.2% (p= 0.8). No untoward effect was reported. CONCLUSION: The use of chlorhexidine wipes in ICU was feasible but did not signicantly decrease HAIs.

scholarly journals Hospital-Acquired Blood Stream Infection in an Adult Intensive Care Unit

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Jeffrey Harte ◽  
Germander Soothill ◽  
John Glynn David Samuel ◽  
Laurence Sharifi ◽  
Mary White
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Blood Stream Infection ◽  
Case Series ◽  
Blood Stream ◽  
Apache Ii Score ◽  
Invasive Procedures ◽  
Adult Intensive Care Unit ◽  
Hospital Acquired

Background. Hospital-acquired blood stream infections are a common and serious complication in critically ill patients. Methods. A retrospective case series was undertaken investigating the incidence and causes of bacteraemia in an adult intensive care unit with a high proportion of postoperative cardiothoracic surgical and oncology patients. Results. 405 eligible patients were admitted to the intensive care unit over the course of nine months. 12 of these patients developed a unit-acquired blood stream infection. The average Acute Physiology And Chronic Health Evaluation II (APACHE II) score of patients who developed bacteraemia was greater than that of those who did not (19.8 versus 16.8, respectively). The risk of developing bacteraemia was associated with intubation and higher rates of invasive procedures. The mortality rate amongst the group of patients that developed bacteraemia was 33%; this is in contrast to the mortality rate in our unit as 27.2%. There was a higher proportion of Gram-negative bacteria isolated on blood cultures (9 out of 13 isolates) than in intensive care units reported in other studies. Conclusion. Critical-care patients are at risk of secondary bloodstream infection. This study highlights the importance of measures to reduce the risk of infection in the intensive-care setting, particularly in patients who have undergone invasive procedures.

scholarly journals Delirium and Post-Discharge Neuropsychological Outcomes in Critically Ill Patients with COVID-19: an Institutional Case Series

2020 ◽  
Author(s):  
Jacqueline Ragheb ◽  
Amy McKinney ◽  
Mackenzie Zierau ◽  
Joseph Brooks ◽  
Maria Hill-Caruthers ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cognitive Impairment ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Case Series ◽  
Care Facility ◽  
Study Cohort ◽  
Contributing Factors ◽  
Post Discharge

AbstractDelirium is a serious and common complication among critically ill patients with COVID-19. The objective of this study was to characterize the clinical course of delirium for COVID-19 patients in the intensive care unit, including post-discharge cognitive outcomes. A retrospective chart review was conducted for patients diagnosed with COVID-19 (n=148) admitted to an intensive care unit at Michigan Medicine between 3/1/2020 and 5/31/2020. Delirium was identified in 107/148 (72%) patients in the study cohort, with median (interquartile range) duration lasting 10 (4 – 17) days. Sedative regimens, inflammation, deviation from delirium prevention protocols, and hypoxic-ischemic injury were likely contributing factors, and the most common disposition for delirious patients was a skilled care facility (41/148, 38%). Among patients who were delirious during hospitalization, 4/17 (24%) later tested positive for delirium at home based on caretaker assessment, 5/22 (23%) demonstrated signs of questionable cognitive impairment or cognitive impairment consistent with dementia, and 3/25 (12%) screened positive for depression within two months after discharge. Overall, patients with COVID-19 commonly experience a prolonged course of delirium in the intensive care unit, likely with multiple contributing factors. Furthermore, neuropsychological impairment may persist after discharge.

scholarly journals Impact of the Gamma Variant on the ICU Admission in a Hospital of the Autonomous City of Buenos Aires (CABA), Argentina

2021 ◽  
Author(s):  
Veronica Mandich ◽  
Daniel Chiacchiara ◽  
Marcelo Bravo ◽  
Antonio Pilipec ◽  
Santiago Grimaldi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Buenos Aires ◽  
Multiorgan Failure ◽  
Laboratory Data ◽  
Ventilatory Support ◽  
Tertiary Hospital ◽  
Observational Prospective Cohort Study ◽  
Data History ◽  
The City ◽  
Second Wave

Abstract Purpose: Comparison between patients admitted to the Intensive Care Unit (ICU) with ventilatory support during the first and second wave (Gamma variant) of COVID 19 in a tertiary hospital in the City of Buenos Aires.Method: Descriptive, observational, prospective cohort study in ICU of an acute general hospital in Argentina, with patients adult patients COVID-19 admitted consecutively to the ICU. The ICU the main variables of interest: Demographic and laboratory data, history, duration of MV, mortality.Results: 44 patients were recruited during the first wave, and 80 in the second. Significant differences were observed in the second wave for age (60, [SD 11]; vs 68 [SD 11]; p <0.01), days with symptoms (9 [SD 5]; vs 4.5 [SD 3]; p <0.01), duration of MV (10 days [SD 7]; vs 16 [SD 13]; p <0.01), Ferritin (1450 mcg / l [SD 547]; vs 941 mcg / l [ SD 593]; p 0.04) and use of antibiotics (97% vs 45% p <0.01). There was no difference in mortality (66% vs 78% p 0.14) but there was in its primary causes; being more frequent hypoxemia associated with sepsis in the second wave (40% vs 3.4% p <0.01) and hypoxemia and multiorgan failure in the first (28% vs 4% p <0.01).Conclusions: During the second wave of the pandemic, due to Gamma variant, more patients were admitted to our unit, younger, with a longer evolution time, a shorter time on MV and a greater inflammatory response, with no difference in mortality, although there was a difference in its causes.

scholarly journals Mucormycosis: A Case Series of Patients admitted in Non-COVID-19 Intensive Care Unit of a Tertiary Care Center during the Second Wave

2021 ◽  
Vol 25 (10) ◽  
pp. 1191-1194
Author(s):  
Nikhil Kothari ◽  
Amit Goyal ◽  
Ankur Sharma ◽  
Shilpa Goyal ◽  
Pradeep K Bhatia ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Tertiary Care Center ◽  
Second Wave

scholarly journals What do we know about covid-19 critically ill patients receiving enteral nutrition? a crosssectional study

2020 ◽  
Vol 5 ◽  
Keyword(s):  
Enteral Nutrition ◽  
Critically Ill ◽  
Medical Records ◽  
Statistical Significance ◽  
Invasive Mechanical Ventilation ◽  
Laboratory Data ◽  
Prevalence Ratio ◽  
Simplified Acute Physiology Score ◽  
Cross Sectional Study ◽  
Cross Sectional

Background and Aims: Given the need to nourish critically ill COVID-19 patients, whose specific issues may hinder their nutritional supply, this research aimed to evaluate individuals who fed enteral nutrition (EN) and compare them with patients fed orally (ON), in order to assess their profile and find significant differences between both groups. Methods: This is a cross-sectional study in which demographic, medical and laboratory data of EN and ON severe patients with COVID-19 were collected from electronic medical records. Univariate and multivariate analysis inferred and confirmed Prevalence Ratio (PR) of these variables, respectively. Results: A total of 211 medical records were assessed (EN=123). EN patients were mostly male, over 50 years old, overweight or obese, using invasive mechanical ventilation (IMV) and vasopressor drugs (VD). They presented high levels of SAP3 (Simplified Acute Physiology Score 3), d-dimer and brain natriuretic peptide (BNP), as well as low lymphocyte counts. Death rate was 44,71%. In significant comparisons between EN and ON groups, IMV (PR=7.06, p<0.001), hemodialysis (PR=1.57, p<0.001), VD (PR=2. 16, p<0.001), CT lung injury>50% (PR=1. 31, p=0.039), high BNP (p=0.001) and SAPS3 (p<0.001), lymphopenia (p<0.001) and death (PR=2. 19, p<0.001) prevailed in the former. Logistic regression supported statistical significance for IMV (z=7.027, p<0.001), VD (z=3.473, p=0.001), low lymphocytes count (z=-3.785, p=0.001), and death (z=2.692 and p=0.007). Conclusion: 1) EN patients were more severely ill than those ON. 2) When correlated with ON, EN group had higher rates of IMV, VD, lymphopenia and death.

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