Clinical Significance of Micronutrient Supplementation in Critically Ill COVID-19 Patients with Severe ARDS

The interplay between inflammation and oxidative stress is a vicious circle, potentially resulting in organ damage. Essential micronutrients such as selenium (Se) and zinc (Zn) support anti-oxidative defense systems and are commonly depleted in severe disease. This single-center retrospective study investigated micronutrient levels under Se and Zn supplementation in critically ill patients with COVID-19 induced acute respiratory distress syndrome (ARDS) and explored potential relationships with immunological and clinical parameters. According to intensive care unit (ICU) standard operating procedures, patients received 1.0 mg of intravenous Se daily on top of artificial nutrition, which contained various amounts of Se and Zn. Micronutrients, inflammatory cytokines, lymphocyte subsets and clinical data were extracted from the patient data management system on admission and after 10 to 14 days of treatment. Forty-six patients were screened for eligibility and 22 patients were included in the study. Twenty-one patients (95%) suffered from severe ARDS and 14 patients (64%) survived to ICU discharge. On admission, the majority of patients had low Se status biomarkers and Zn levels, along with elevated inflammatory parameters. Se supplementation significantly elevated Se (p = 0.027) and selenoprotein P levels (SELENOP; p = 0.016) to normal range. Accordingly, glutathione peroxidase 3 (GPx3) activity increased over time (p = 0.021). Se biomarkers, most notably SELENOP, were inversely correlated with CRP (rs = −0.495), PCT (rs = −0.413), IL-6 (rs = −0.429), IL-1β (rs = −0.440) and IL-10 (rs = −0.461). Positive associations were found for CD8+ T cells (rs = 0.636), NK cells (rs = 0.772), total IgG (rs = 0.493) and PaO2/FiO2 ratios (rs = 0.504). In addition, survivors tended to have higher Se levels after 10 to 14 days compared to non-survivors (p = 0.075). Sufficient Se and Zn levels may potentially be of clinical significance for an adequate immune response in critically ill patients with severe COVID-19 ARDS.

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Clinical Significance of Herpes Simplex Virus in the Lower Respiratory Tract of Critically Ill Patients

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-002-0809-y ◽

2002 ◽

Vol 21 (10) ◽

pp. 758-759 ◽

Cited By ~ 20

Author(s):

Camps K. ◽

Jorens P. ◽

Demey H. ◽

Pattyn S. ◽

Ieven M.

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Respiratory Tract ◽

Critically Ill ◽

Clinical Significance ◽

Critically Ill Patients ◽

Lower Respiratory Tract ◽

Simplex Virus

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Early Fever Is Associated With Clinical Outcomes in Patients With Coronavirus Disease

Frontiers in Public Health ◽

10.3389/fpubh.2021.712190 ◽

2021 ◽

Vol 9 ◽

Author(s):

Feng-ming Ding ◽

Yun Feng ◽

Lei Han ◽

Yan Zhou ◽

Yong Ji ◽

...

Keyword(s):

Clinical Outcomes ◽

Critically Ill ◽

Symptom Onset ◽

Critically Ill Patients ◽

Severe Disease ◽

Multivariable Analysis ◽

Reactive Protein ◽

Increased Temperature ◽

Kaplan Meier ◽

Image Improvement

Fever is one of the typical symptoms of coronavirus disease (COVID-19). We aimed to investigate the association between early fever (EF) and clinical outcomes in COVID-19 patients. A total of 1,014 COVID-19 patients at the Leishenshan Hospital were enrolled and classified into the EF and non-EF groups based on whether they had fever within 5 days of symptom onset. Risk factors for clinical outcomes in patients with different levels of disease severity were analyzed using multivariable analyses. Time from symptom onset to symptom alleviation, CT image improvement, and discharge were longer for patients with moderate and severe disease in the EF group than in the non-EF group. Multivariable analysis showed that sex, EF, eosinophil number, C-reactive protein, and IL-6 levels were positively correlated with the time from symptom onset to hospital discharge in moderate cases. The EF patients showed no significant differences in the development of acute respiratory distress syndrome, compared with the non-EF patients. The Kaplan–Meier curve showed no obvious differences in survival between the EF and non-EF patients. However, EF patients with increased temperature showed markedly lower survival than the non-EF patients with increased temperature. EF had no significant impact on the survival of critically ill patients, while an increase in temperature was identified as an independent risk factor. EF appears to be a predictor of longer recovery time in moderate/severe COVID-19 infections. However, its value in predicting mortality needs to be considered for critically ill patients with EF showing increasing temperature.

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Relaxation for Critically ill Patient Outcomes andStress-coping Enhancement (REPOSE): a protocol for a pilot randomised trial of an integrative intervention to improve critically ill patients’ delirium and related outcomes

BMJ Open ◽

10.1136/bmjopen-2018-023961 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023961

Author(s):

Elizabeth D E Papathanassoglou ◽

Yoanna Skrobik ◽

Kathleen Hegadoren ◽

Patrica Thompson ◽

Henry Thomas Stelfox ◽

...

Keyword(s):

Intensive Care ◽

Critical Illness ◽

Critically Ill ◽

Patient Outcomes ◽

Critically Ill Patients ◽

Standard Care ◽

Control Group ◽

Moderate Pressure ◽

Icu Discharge ◽

Integrative Intervention

IntroductionDelirium is a common complication of critical illness, associated with negative patient outcomes. Preventive or therapeutic interventions are mostly ineffective. Although relaxation-inducing approaches may benefit critically ill patients, no well-designed studies target delirium prevention as a primary outcome. The objective of this study is to assess feasibility and treatment effect estimates of a multimodal integrative intervention incorporating relaxation, guided imagery and moderate pressure touch massage for prevention of critical illness delirium and for related outcomes.Methods and analysisRandomised, controlled, single-blinded trial with two parallel groups (1:1 allocation: intervention and standard care) and stratified randomisation (age (18–64 years and ≥65 years) and presence of trauma) with blocking, involving 104 patients with Intensive Care Delirium Screening Checklist (ICDSC): 0–3 recruited from two academic intensive care units (ICUs). Intervention group participants receive the intervention in addition to standard care for up to five consecutive days (or until transfer/discharge); control group participants receive standard care and a sham intervention. We will assess predefined feasibility outcomes, that is, recruitment rates and protocol adherence. The primary clinical outcome is incidence of delirium (ICDSC ≥4). Secondary outcomes include pain scores, inflammatory biomarkers, heart rate variability, stress and quality of life (6 weeks and 4 months) post-ICU discharge. Feasibility measures will be analysed descriptively, and outcomes will be analysed longitudinally. Estimates of effects will be calculated.Ethics and disseminationThe study has received approval from the Human Research Ethics Board, University of Alberta. Results will inform the design of a future multicentre trial.Trial registration numberNCT02905812; Pre-results.

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Parenteral nutrition in the ICU

10.1093/med/9780199600830.003.0207 ◽

2016 ◽

Author(s):

Jonathan Cohen ◽

Shaul Lev

Keyword(s):

Animal Models ◽

Enteral Nutrition ◽

Parenteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Nutrition Support ◽

Glutamine Supplementation ◽

Artificial Nutrition ◽

Omega 3 ◽

Aspen Guidelines

Parenteral nutrition (PN) is a technique of artificial nutrition support, which consists of the intravenous administration of macronutrients, micronutrients, and water. PN has become integrated into intensive care unit (ICU) patient management with the aim of preventing energy deficits and preserving lean body mass. The addition of PN to enteral nutrition is known as supplemental PN. Parenteral feeding should be considered whenever enteral nutritional support is contraindicated, or when enteral nutrition alone is unable to meet energy and nutrient requirements. International guidelines differ considerably regarding the indications for PN. Thus, the ESPEN guidelines recommend initiating PN in critically-ill patients who do not meet caloric goals within 2–3 days of commencing EN, while the Canadian guidelines recommend PN only after extensive attempts to feed with EN have failed. The ASPEN guidelines advocate administering PN after 8 days of attempting EN unsuccessfully. Several studies have demonstrated that parenteral glutamine supplementation may improve outcome, and the ESPEN guidelines give a grade A recommendation to the use of glutamine in critically-ill patients who receive PN. Studies on IV omega-3 fatty acids have yielded promising results in animal models of acute respiratory distress syndrome and proved superior to solutions with omega -6 compositions. The discrepancy between animal models and clinical practice could be related to different time frames.

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Efficacy of Low-Dose Prophylactic Quetiapine on Delirium Prevention in Critically Ill Patients: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

Journal of Clinical Medicine ◽

10.3390/jcm9010069 ◽

2019 ◽

Vol 9 (1) ◽

pp. 69

Author(s):

Youlim Kim ◽

Hyung-Sook Kim ◽

Jong Sun Park ◽

Young-Jae Cho ◽

Ho Il Yoon ◽

...

Keyword(s):

Placebo Group ◽

Critically Ill ◽

Critically Ill Patients ◽

Low Dose ◽

Controlled Study ◽

Double Blind ◽

Double Blind Placebo ◽

Icu Discharge ◽

Tertiary Teaching ◽

Delirium Prevention

Purpose: To evaluate the efficacy of short-term low-dose quetiapine for delirium prevention in critically ill patients. Methods: In this prospective, a single-center, randomized, double-blind, placebo-controlled trial, adult patients who were admitted from July 2015 to July 2017 to a medical intensive care unit (ICU) of a tertiary teaching hospital affiliated to Seoul National University were included. Quetiapine (12.5 mg or 25 mg oral at night; N = 16) or placebo (N = 21) was administered according to randomization until ICU discharge or the 10th ICU day. The primary endpoint was the incidence of delirium within the first 10 ICU days. Secondary endpoints included the rate of positive Confusion Assessment Method for the ICU (CAM-ICU) (the number of positive CAM-ICU counts/the number of total CAM-ICU counts), delirium duration, successful extubation, and overall mortality. Result: The incidence of delirium during the 10 days after ICU admission was 46.7% (7/15) in the quetiapine group and 55.0% (11/20) in the placebo group (p = 0.442). In the quetiapine group, the rate of positive CAM-ICU was significantly lower than in the placebo group (14.4% vs. 37.4%, p = 0.048), delirium duration during the study period was significantly shorter (0.28 day vs. 1.83 days, p = 0.018), and more patients in the quetiapine than in the placebo group were weaned from mechanical ventilation successfully (84.6% vs. 47.1%, p = 0.040). Conclusions: Our study suggests that prophylactic use of low-dose quetiapine could be helpful for preventing delirium in critically ill patients. A further large-scale prospective study is needed.

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Letter To The EditorCharacterization and management of cognitive and emotional alterations in COVID-19 critically ill patients after ICU discharge

Medicina Intensiva ◽

10.1016/j.medin.2020.11.004 ◽

2020 ◽

Author(s):

Guillem Navarra-Ventura ◽

Josefina López-Aguilar ◽

Lluís Blanch ◽

Sol Fernández-Gonzalo

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Icu Discharge

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Nutritional status plays a crucial role in the mortality of critically ill patients with acute renal failure

Journal of Investigative Medicine ◽

10.1136/jim-2017-000518 ◽

2017 ◽

Vol 66 (2) ◽

pp. 309-318 ◽

Cited By ~ 2

Author(s):

Haiyan Zhang ◽

Xiaodong Zhang ◽

Lei Dong

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Nutritional Status ◽

Critically Ill ◽

Critically Ill Patients ◽

Medical Information ◽

Statistical Significance ◽

Nutrition Intervention ◽

Icu Discharge

We aimed to clarify associations between nutritional status and mortality in patients with acute renal failure. De-identified data were obtained from the Medical Information Mart for Intensive Care III database comprising more than 40,000 critical care patients treated at Beth Israel Deaconess Medical Centerbetween 2001 and 2012. Weight loss and body mass index criteria were used to define malnutrition. Data of 193 critically ill patients with acute renal failure were analyzed, including demographics, nutrition intervention, laboratory results, and disease severity. Main outcomes were in-hospital and 1-year mortality. The 1-year mortality was significantly higher in those with malnutrition than in those without malnutrition (50.0% vs 29.3%, p=0.010), but differences in in-hospital survival were not significant (p=0.255). Significant differences in mortality were found between those with malnutrition and without starting at the 52nd day after intensive care unit (ICU) discharge (p=0.036). No significant differences were found between men and women with malnutrition in in-hospital mortality (p=0.949) and 1-year mortality (p=0.051). Male patients requiring intervention with blood products/colloid supplements had greater risk of 1-year mortality, but without statistical significance. Nutritional status is a predictive factor for mortality among critically ill patients with acute renal failure, particularly 1-year mortality after ICU discharge.

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Hypertriglyceridemia in Critically Ill Patients With SARS-CoV-2 Infection

Annals of Pharmacotherapy ◽

10.1177/10600280211038302 ◽

2021 ◽

pp. 106002802110383

Author(s):

Wasim S. El Nekidy ◽

Abdullah Shatnawei ◽

Manal M. Abdelsalam ◽

Mariam Hassan ◽

Ruba Z. Dajani ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Case Reports ◽

Severe Disease ◽

Critical Care Admission ◽

Full Picture ◽

Inflammatory State ◽

Clinically Significant ◽

The Relationship ◽

Over Time

Background Patients with SARS-CoV-2 infection could develop severe disease requiring critical care admission. Case reports indicated high incidence of hypertriglyceridemia (HTG) in critically ill patients infected with SARS-CoV-2, which might be related to the drugs. Objective We sought to determine the risk factors associated with HTG in this population and to investigate the relationship between HTG and lipase. Methods A retrospective observational study was conducted at our hospital between March 1 and June 30, 2020. Patients were included if they were ≥18 years old, admitted to the intensive care unit (ICU), tested positive for SARS-CoV-2, and had triglycerides (TG) checked during their hospital stay. Results Of the 111 critically ill patients, 103 patients were included. Males comprised 88.3% of the sample. The median TG at baseline was 197.4 (IQR: 139.8-283) mg/dL. The lipase median level at baseline was 23.00 (IQR: 0.00-69.50) IU/L. The results of the mixed-effects logistic regression analysis indicated that patient-level variables, favipiravir use, blood glucose level, and propofol use were significantly associated with HTG. There was no relationship between lipase and TG levels over time. Furthermore, TG concentrations over time showed a similar trend to inflammatory markers. Conclusion and Relevance The incidence of clinically significant HTG was high and was associated with propofol and favipiravir use. HTG might reflect the high inflammatory state in these patients. Clinicians should look at the full picture before changing therapies based only on HTG. Our findings need to be replicated in a larger prospective study.

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