scholarly journals Decreased CRRT Filter Lifespan in COVID-19 ICU Patients

2021 ◽  
Vol 10 (9) ◽  
pp. 1873
Author(s):  
David Legouis ◽  
Maria F. Montalbano ◽  
Nils Siegenthaler ◽  
Camille Thieffry ◽  
Benjamin Assouline ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Historical Data ◽  
Activated Partial Thromboplastin Time ◽  
Control Group ◽  
Confounding Factors ◽  
Thromboembolic Events ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Icu Patients ◽  
Heparin Resistance

(1) Background: Increased thromboembolic events and an increased need for continuous renal replacement therapy (CRRT) have been frequently reported in COVID-19 patients. Our aim was to investigate CRRT filter lifespan in intensive care unit (ICU) COVID-19 patients. (2) Methods: We compared CRRT adjusted circuit lifespan in COVID-19 patients admitted for SARS-CoV-2 infection to a control group of patients admitted for septic shock of pulmonary origin other than COVID-19. Both groups underwent at least one session of CRRT for AKI. (3) Results: Twenty-six patients (13 in each group) were included. We analysed 117 CRRT circuits (80 in the COVID-19 group and 37 in the control group). The adjusted filter lifespan was shorter in the COVID-19 group (17 vs. 39 h, p < 0.001). This trend persisted after adjustment for confounding factors (−14 h, p = 0.037). Before CRRT circuit clotting, the COVID-19 group had a more procoagulant profile despite higher heparin infusion rates. Furthermore, we reported a decreased relation between activated partial thromboplastin time (aPTT) and cumulative heparin dose in COVID-19 patients when compared to historical data of 23,058 patients, suggesting a heparin resistance. (4) Conclusion: COVID-19 patients displayed a shorter CRRT filter lifespan that could be related to a procoagulant profile and heparin resistance.

scholarly journals The Effect of the Dreamer Spiritual Therapies on Saliva Cortisol Hormone and Pain Score Patients in the Intensive Care Unit: A True-experimental Study

2021 ◽  
Vol 9 (G) ◽  
pp. 281-287
Author(s):  
Iwan Purnawan ◽  
Sri Setiyarini ◽  
Probosuseno Probosuseno ◽  
Yunita Widyastuti
Keyword(s):  
Intensive Care Unit ◽  
Experimental Study ◽  
Intensive Care ◽  
Pain Score ◽  
Wilcoxon Test ◽  
Control Group ◽  
Icu Patients ◽  
Pain Scores ◽  
Spiritual Therapy ◽  
Paired T Test

BACKGROUND: Patients’ conditions can worsen if stress and pain are not appropriately managed. Conventional therapy ignores psychological and spiritual aspects. Both influence the body’s response to various stimuli. AIM: This study aimed to assess how Dreamer’s spiritual therapy can affect the cortisol and pain in the intensive care unit (ICU) patients. METHODS: It involved 86 ICU patients in a true-experimental study. Respondents were divided into the intervention and the control group randomly. The intervention group received Dreamer spiritual therapy (DST) for 30 min but not for the control group. Saliva samples and pain scores were taken from both groups before and after treatment. The comparison of two groups cortisol decreases using Wilcoxon test. Differences in pre- and post-pain scores in each group were analyzed using paired t-test. RESULTS: According to Levene’s test, the two groups were homogeneous (p > 0.05). The Wilcoxon test revealed a statistically significant difference in cortisol level reduction between the intervention (3.88 ng/mL) and control (3.82 ng/ml) groups (p = 0.024), with a large effect size (Cohen’s d value = 59.5). The paired t-test revealed a statistically significant decrease in the intervention group’s pain score from 2.6 to 1.95 (p = 0.001), with a moderate effect size (Cohen’s d value = 0.49). The control group’s pain score did not significantly decrease (p = 0.75). CONCLUSIONS: A DST is effective in reducing salivary cortisol levels and pain scores of ICU patients.

Continuous Subcutaneous Heparin Infusion During Pregnancy In A Patient With A Prosthetic Mitral Valve. Clinical And Laboratory Consideration

1981 ◽  
Author(s):  
Harry L Messmore ◽  
Jawed Fareed ◽  
Barbara Hixon ◽  
Judith Kniffin ◽  
Grace Squillaci
Keyword(s):  
Infusion Pump ◽  
Pregnant Patient ◽  
Activated Partial Thromboplastin Time ◽  
Poor Correlation ◽  
Intravenous Route ◽  
Subcutaneous Route ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Prosthetic Mitral Valve ◽  
Clinical Conditions

Administration of heparin for prolonged periods during pregnancy has usually been by the intravenous route when full anticoagulant dosages are required. Bolus subcutaneous injection of heparin has also been used, however this requires medical supervision and proper laboratory control. We have administered heparin (Elkins - Sinn) to a pregnant patient by the subcutaneous route utilizing an infusion pump (Auto-Syringe RModel AS3A) for 15 weeks, maintaining an activated partial thromboplastin time (APTT) of approximately 50 sec (N=22-35) using “ACTIN” (Dade) brand ellagic acid cephaloplastin reagent. The average heparin dose has been 26,000 units/24 hours during the 4th to 19th week of her pregnancy. In order to establish the presence of circulating heparin we also performed Xa and thrombin-based amidolytic assays for the absolute levels of heparin in patient’s plasma. A poor correlation was seen between the heparin levels and the APTT values. These data indicate that absolute levels of heparin may not be taken as an index of heparinization in certain clinical conditions. Lack of serious complications and ease of administration has prompted us to continue heparin by this route during the remainder of her pregnancy.

scholarly journals Using anti-Xa level for adjusting intravenous unfractionated heparin infusion in peripartum thromboembolic disease

2018 ◽  
Vol 12 (3) ◽  
pp. 146-150
Author(s):  
Enrica Tse ◽  
Rshmi Khurana ◽  
Gwen Clarke ◽  
Winnie Sia
Keyword(s):  
Venous Thrombosis ◽  
Unfractionated Heparin ◽  
Partial Thromboplastin Time ◽  
Thromboembolic Disease ◽  
Activated Partial Thromboplastin Time ◽  
Term Pregnancy ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Thrombotic Risk ◽  
In Pregnancy

Background Intravenous unfractionated heparin infusion is often used to minimize the duration of time without anticoagulation around delivery in pregnant patients with high thrombotic risk. Activated partial thromboplastin time is commonly used to monitor and adjust heparin dose. However, using activated partial thromboplastin time is problematic in pregnancy because activated partial thromboplastin time response to unfractionated heparin is attenuated due to elevated Factor VIII levels and may lead to incorrect dosing. Case We report a case of deep venous thrombosis occurring in a term pregnancy managed by intravenous unfractionated heparin adjusted using anti-Xa level around the time of delivery. We modified the intravenous unfractionated heparin nomogram by using anti-Xa levels instead of activated partial thromboplastin time and observed lower dosing of unfractionated heparin than otherwise required to achieve and maintain target levels. Conclusion This report demonstrates the feasibility and effectiveness of using anti-Xa level to monitor and adjust intravenous unfractionated heparin infusion in pregnancy.

scholarly journals Thromboembolic Rates Are Similar Between Intensive Care Unit and Nonintensive Care Unit Hospitalized Patients With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Retrospective Cohort Study

2021 ◽  
Vol 27 ◽  
pp. 107602962110533
Author(s):  
Heidi Worth ◽  
Kasey Helmlinger ◽  
Renju Raj ◽  
Eric Heidel ◽  
Ronald Lands
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Thromboembolic Event ◽  
Hospitalized Patients ◽  
Thromboembolic Events ◽  
Icu Patients ◽  
Increased Risk

High rates of thromboembolic events have been described in intensive care unit (ICU) patients. Data regarding thromboembolic events in all hospitalized patients has been less frequently reported, raising concerns that thromboembolic events in non-ICU may be underrecognized. In addition, optimal anticoagulation type and dose is still unsettled at this time. This is a retrospective cohort study of 159 hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia during a 9-month period to determine an association between the frequency of thromboembolic rates and hospitalized patients with COVID-19. Secondary outcomes sought to investigate association of thromboembolic events with relation to place of admission, risk factors, anticoagulation, mortality, hospital length of stay, and discharge disposition. Among the cohort of 159 hospitalized patients who met criteria, 16 (10%) were diagnosed with a thromboembolic event. There were a total of 18 thromboembolic events with 12 venous and 6 arterial. Admission to the ICU was not associated with a higher frequency of thromboembolic events compared with non-ICU patients (37.5% vs 62.5%), p = .71. Patients with a thromboembolic event had a significantly higher mortality compared with those with no thromboembolic event (37.5% vs 13.3%), p = .012. Patients hospitalized with COVID-19 have increased rates of thromboembolic events, both venous and arterial, which contribute to a significant increase in mortality. However, the frequency of thromboembolism in patients admitted to the ICU was similar to events in non-ICU patients. We hope to increase awareness of the increased risk of hypercoagulability in all hospitalized patients with COVID-19 including non-ICU patients.

scholarly journals Immunological Effects of Glutamine Supplementation in Polytrauma Patients in Intensive Care Unit.

2021 ◽  
Author(s):  
Antonella Cotoia ◽  
Leonarda Pia Cantatore ◽  
Renata Beck ◽  
Alessandra De Gregorio ◽  
Flavia Marchese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
B Lymphocytes ◽  
Glutamine Supplementation ◽  
Control Group ◽  
Cell Mediated Immunity ◽  
T Helper ◽  
Icu Patients ◽  
T Helper Lymphocytes ◽  
Suppressor Lymphocytes

Abstract Background In polytrauma intensive care unit (ICU) patients, glutamine (GLN) become a "conditionally essential" amino acid; its role has been extensively studied in numerous clinical trials but their results are inconclusive. We evaluated the IgA–mediated humoral immunity after GLN supplementation in polytrauma ICU patients. Results All consecutive patients with polytrauma who required mechanical ventilation and enteral nutrition (EN) provided within 24 hours since the admission in ICU at the University Hospital of Foggia from September 2016 to February 2017 were included. Thereafter, two groups were identified: patients treated by conventional EN (25 kcal/kg/die) and patients who have received conventional EN enriched with 50 mg/kg/ideal body weight of alanyl-GLN 20% intravenously. We analyzed plasmatic concentration of IgA, CD3+/CD4+ T Helper Lymphocytes, CD3+/CD8+ T suppressor Lymphocytes, CD3+/CD19+ B Lymphocytes, IL-4 and IL-2 at admission, at 4, 8 days. We identified 30 patients, with 15 subjects per group. IgA levels increased significantly in GLN vs control group at T0, T4 and T8.CD3+/CD4+ T helper lymphocytes and CD3+/CD8+ T suppressor lymphocytes levels significantly increased in GLN vs control group at T4 and T8. CD3+/CD19+ B lymphocytes levels increased significantly in GLN vs control group only at T8.IL-2 and IL-4 levels showed no significant differences when comparing GLN with control group. Conclusions Our study showed that there was an improvement in humoral and cell-mediated immunity with GLN supplementation in polytrauma ICU patients using recommended doses.

scholarly journals Might Confounding Factors Have an Effect on Suboptimal Dosing of Fluconazole in Critically Ill Patients?

2020 ◽  
Author(s):  
Emre Kara ◽  
Aygin Bayraktar Ekincioglu ◽  
Gokhan Metan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Antimicrobial Agents ◽  
Confounding Factors ◽  
Recent Issue ◽  
Icu Patients ◽  
Wide Variability

In a recent issue of Antimicrobial Agents and Chemotherapy, Muilwijk et al. evaluated the fluconazole pharmacokinetics (PK) and dosing in critically ill patients and concluded that there is wide variability in pharmacokinetic characteristics among intensive care unit (ICU) patients (1).…

scholarly journals Use of Thromboelastogram in Venovenous Extracorporeal Membrane Oxygenation for a Patient with Pulmonary Hemorrhage due to Microscopic Polyangiitis

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Chak-Kwan Tong ◽  
Jun Jin ◽  
Qian Du
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Microscopic Polyangiitis ◽  
Pulmonary Hemorrhage ◽  
Activated Partial Thromboplastin Time ◽  
Clotting Time ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Membrane Oxygenation ◽  
Activated Clotting Time ◽  
Venovenous Extracorporeal Membrane Oxygenation

Systemic heparinisation is required for extracorporeal membrane oxygenation therapy, to prevent clotting of circuit and formation of thrombus in patient. Activated clotting time (ACT) or activated partial thromboplastin time (aPTT) has been the mainstay of monitoring of heparin dose. Thromboelastogram (TEG) is increasingly being used again in recent years with the advancement in technology. Its clinical usefulness in the monitoring of anticoagulation of ECMO therapy is demonstrated in the case presented. Our patient suffered from severe hemoptysis due to active microscopic polyangiitis and respiratory failure. Heparin infusion was given at the initiation of ECMO support without further aggravation of hemoptysis. Dose of heparin was adjusted successfully with the integration of the clotting profile and TEG results.

scholarly journals Comparison of Intravenous Enoxaparin with Subcutaneous Enoxaparin in Preventing Venous Thromboembolism in Patients Admitted to Intensive Care Unit

2020 ◽  
Author(s):  
Masoum Khoshfetrat ◽  
Majid Khorram ◽  
Aliakbar Keykha ◽  
Hossein Ansari
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Intervention Group ◽  
Factor Xa ◽  
Control Group ◽  
Icu Patients ◽  
Active Factor ◽  
Significant Difference ◽  
Subcutaneous Enoxaparin

Background: The use of subcutaneous enoxaparin is a usual method for preventing venous thromboembolism (VTE) in the intensive care unit (ICU) patients, but adequate absorption of the drug is not reliable due to the illness intensity, existing edema and hypoperfusion in these patients. The aim of this study was to compare the effect of intravenous enoxaparin with subcutaneous enoxaparin to prevent VTE in ICU patients. Methods: The current double-blind Randomized clinical trial was performed on 64 patients admitted to the ICU at Khatam- Al- Anbia Hospital in Zahedan, southeast of Iran. The patients were randomly assigned into each of the subcutaneous enoxaparin and the intravenous enoxaparin groups. The blood sampling was performed aseptically and then active factor Xa level was measured. Next, the intervention group received 0.5 mg/kg of intravenous enoxaparin for 10 days and the control group was injected subcutaneously the same dosage of drug. Four hours after the first injection and 12 hours after the last injection on the tenth day, the factor Xa level and the frequency of VTE incidence was measured again. Results: In all three measurement times, the active factor Xa level in the intravenous enoxaparin group was lower than that of the subcutaneous group, but no significant difference was observed between the two groups and different times (P> 0.05). Conclusion: The results of this study showed that the use of intravenous enoxaparin is an effective way to prevent the VTE development in the ICU patients.

Anticoagulation by Constant Subcutaneous Heparin Infusion

1982 ◽  
Vol 47 (01) ◽  
pp. 001-002 ◽  
Author(s):  
Nenita Parrilla ◽  
Jack Ansell
Keyword(s):  
Clinical Trial ◽  
Impedance Plethysmography ◽  
High Dose ◽  
Intravenous Therapy ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Subcutaneous Infusion ◽  
Subcutaneous Heparin ◽  
Therapeutic Anticoagulation ◽  
Continuous Subcutaneous Infusion

SummaryA preliminary clinical trial was conducted to determine the feasibility of achieving and regulating therapeutic anticoagulation with heparin given by continuous subcutaneous infusion. Five patients with deep venous thrombosis confirmed by impedance plethysmography and/or venography were studied. All patients received an initial heparin dose of 5000 units by IV bolus. This was followed by a continuous subcutaneous heparin infusion at a dose of 15 to 25 units per kilogram per hour. Effective levels of anticoagulation were achieved in all five patients. Regulation and maintenance of therapeutic anticoagulation were no more difficult than with intravenous therapy. No major complications were encountered during therapy.Continuous subcutaneous infusion of heparin may have advantages over standard intravenous therapy or high dose intermittent subcutaneous therapy. However, more extensive clinical evaluation is warranted.

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