scholarly journals PROGNOSTIC VALUE OF PRO-ADM BIOMARKER IN PATIENTS WITH COVID-19.

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Nashua Daidone ◽  
Tiziana Callegari ◽  
Elia Ranzato
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prognostic Value ◽  
Early Stage ◽  
Plasma Concentrations ◽  
Risk Of Mortality ◽  
Single Center Study ◽  
Significant Difference ◽  
Short Term Mortality ◽  
Automated Instrument

This study was performed at the analytical laboratory of the Hospital SS. Antonio e Biagio e Cesare Arrigo" Hospital in Alessandria (AL) in the period March-June 2020. This is an observational, prospective, single-center study carried out on a cohort of patients diagnosed with ARDS secondary to SARS-CoV2 infection admitted in the first wave of the pandemic at the Sub-Intensive Care Unit of the Hospital of Alessandria. OBJECTIVE The aim of this study was to assess plasma concentrations of the regional mean proadrenomedullin biomarker (MR-proADM) at the time of patient access to the Emergency Department and subsequently 1, 3 and 5 days after admission, to verify its prognostic value in terms of short-term mortality. The second objective of the study was to compare this biomarker with other commonly used biomarkers such as PCR and Procalcitonin, to evaluate the effectiveness of MR-proADM in risk stratification in these patients. METHODOLOGY Samples used in this study were collected in a tube containing the anticoagulant EDTA, and measurements were performed using a fully automated instrument: the Kryptor Compact Plus. RESULTS Among the various Biomarkers assayed only MR-proADM and LDH concentrations were significantly higher in deceased patients than in surviving patients while no statistically significant difference was observed for PCR PCT concentrations. Increasing levels of MRproADM between the second and fifth day of admission to the intensive care unit represent the key to determining mortality risk. CONCLUSIONS Mr-proADM was found to be a more effective biomarker than other commonly used biomarkers (PCR, WBC, Procalcitonin) in identifying Covid-19 patients with poor prognosis at an early stage. This study allowed clinicians to routinely include the assay of this biomarker, useful in the stratification of these patients and in predicting a higher or lower risk of mortality, in the second wave of the epidemic.

scholarly journals The Use of Eosinophil Count in Predicting the Need of Coronavirus Disease 2019 Patient for Treatment in Intensive Care Unit

2021 ◽  
Vol 9 (B) ◽  
pp. 631-635
Author(s):  
Ngakan Ketut Wira Suastika ◽  
Ketut Suega
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Eosinophil Count ◽  
Early Stage ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Receiver Operating Curve ◽  
Significant Difference ◽  
The Difference ◽  
Eosinophil Counts

BACKGROUND: Identification of coronavirus disease 2019 (COVID-19) patients who have the potential to become critical cases at an early stage and providing aggressive therapy can reduce the mortality rate. AIM: This study aims to determine the diagnostic value and differences of eosinophil counts in patients with COVID-19 who require treatment in intensive care unit (ICU) and non-ICU. METHOD: The prospective study was conducted on 382 patients with confirmed COVID-19 who were hospitalized from May to September 2020. Samples were obtained through consecutive sampling techniques. Mann–Whitney analysis was used to determine the difference of eosinophil counts in COVID-19 patients who require treatment in ICU and non-ICU. Receiver operating curve analysis was used to determine the diagnostic value of eosinophil count to predict the need of COVID-19 patients for treatment in ICU. RESULTS: There is a significant difference in the absolute and percentage eosinophil count in COVID-19 patients who need treatment in ICU and non-ICU. The area under the curve of absolute and percentage eosinophil count to predict the need of COVID-19 patients for treatment in ICU is 0.659 and 0.738, respectively. The best cutoff value, sensitivity and specificity of absolute and percentage eosinophil count is <0.025 × 103 μL and <0.25%; 77.7% and 78.3%; and 50.0% and 57.1%, respectively. CONCLUSIONS: The eosinophil count can be used as a biomarker to predict the need of COVID-19 patients for treatment in ICU.

scholarly journals Early prolonged neutrophil activation in critically ill patients with sepsis

2021 ◽  
Vol 27 (2) ◽  
pp. 192-200
Author(s):  
Sanna Törnblom ◽  
Sara Nisula ◽  
Suvi T Vaara ◽  
Meri Poukkanen ◽  
Sture Andersson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Plasma Concentrations ◽  
Neutrophil Activation ◽  
Early Event ◽  
Heparin Binding ◽  
Activation Markers ◽  
Heparin Binding Protein ◽  
Pro Inflammatory Cytokines

We hypothesised that plasma concentrations of biomarkers of neutrophil activation and pro-inflammatory cytokines differ according to the phase of rapidly evolving sepsis. In an observational study, we measured heparin-binding protein (HBP), myeloperoxidase (MPO), IL-6 and IL-8 in 167 sepsis patients on intensive care unit admission. We prospectively used the emergence of the first sepsis-associated organ dysfunction (OD) as a surrogate for the sepsis phase. Fifty-five patients (of 167, 33%) developed the first OD > 1 h before, 74 (44%) within ± 1 h, and 38 (23%) > 1 h after intensive care unit admission. HBP and MPO were elevated at a median of 12 h before the first OD, remained high up to 24 h, and were not associated with sepsis phase. IL-6 and IL-8 rose and declined rapidly close to OD emergence. Elevation of neutrophil activation markers HBP and MPO was an early event in the evolution of sepsis, lasting beyond the subsidence of the pro-inflammatory cytokine reaction. Thus, as sepsis biomarkers, HBP and MPO were not as prone as IL-6 and IL-8 to the effect of sample timing.

scholarly journals Infections in hematopoietic stem cell transplant patients admitted to Hematology intensive care unit: a single-center study

Hematology ◽  
2021 ◽  
Vol 26 (1) ◽  
pp. 328-339
Author(s):  
Tuğba Barlas ◽  
Kamil İnci ◽  
Gulbin Aygencel ◽  
Melda Türkoğlu ◽  
Özlem Güzel Tunçcan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Single Center ◽  
Hematopoietic Stem ◽  
Transplant Patients ◽  
Single Center Study ◽  
Center Study

scholarly journals Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis

2021 ◽  
Vol 49 (1) ◽  
pp. 23-34
Author(s):  
Katherine P Hooper ◽  
Matthew H Anstey ◽  
Edward Litton
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Diagnostic Testing ◽  
Intervention Group ◽  
Cochrane Central Register ◽  
Safety And Efficacy ◽  
Significant Difference

Reducing unnecessary routine diagnostic testing has been identified as a strategy to curb wasteful healthcare. However, the safety and efficacy of targeted diagnostic testing strategies are uncertain. The aim of this study was to systematically review interventions designed to reduce pathology and chest radiograph testing in patients admitted to the intensive care unit (ICU). A predetermined protocol and search strategy included OVID MEDLINE, OVID EMBASE and the Cochrane Central Register of Controlled Trials from inception until 20 November 2019. Eligible publications included interventional studies of patients admitted to an ICU. There were no language restrictions. The primary outcomes were in-hospital mortality and test reduction. Key secondary outcomes included ICU mortality, length of stay, costs and adverse events. This systematic review analysed 26 studies (with more than 44,00 patients) reporting an intervention to reduce one or more diagnostic tests. No studies were at low risk of bias. In-hospital mortality, reported in seven studies, was not significantly different in the post-implementation group (829 of 9815 patients, 8.4%) compared with the pre-intervention group (1007 of 9848 patients, 10.2%), (relative risk 0.89, 95% confidence intervals 0.79 to 1.01, P = 0.06, I2 39%). Of the 18 studies reporting a difference in testing rates, all reported a decrease associated with targeted testing (range 6%–72%), with 14 (82%) studies reporting >20% reduction in one or more tests. Studies of ICU targeted test interventions are generally of low quality. The majority report substantial decreases in testing without evidence of a significant difference in hospital mortality.

scholarly journals Effect of Aprotinin and Avifavir® Combination Therapy for Moderate COVID-19 Patients

Viruses ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1253
Author(s):  
Andrey A. Ivashchenko ◽  
Valeria N. Azarova ◽  
Alina N. Egorova ◽  
Ruben N. Karapetian ◽  
Dmitry V. Kravchenko ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Body Temperature ◽  
Combination Therapy ◽  
Serine Proteases ◽  
Clinical Status ◽  
Single Center ◽  
Single Center Study ◽  
D Dimer ◽  
Center Study

COVID-19 is a contagious multisystem inflammatory disease caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We studied the efficacy of Aprotinin (nonspecific serine proteases inhibitor) in combination with Avifavir® or Hydroxychloroquine (HCQ) drugs, which are recommended by the Russian Ministry of Health for the treatment therapy of moderate COVID-19 patients. This prospective single-center study included participants with moderate COVID-19-related pneumonia, laboratory-confirmed SARS-CoV-2, and admitted to the hospitals. Patients received combinations of intravenous (IV) Aprotinin (1,000,000 KIU daily, 3 days) and HCQ (cohort 1), inhalation (inh) treatment with Aprotinin (625 KIU four times per day, 5 days) and HCQ (cohort 2) or IV Aprotinin (1,000,000 KIU daily for 5 days) and Avifavir (cohort 3). In cohorts 1–3, the combination therapy showed 100% efficacy in preventing the transfer of patients (n = 30) to the intensive care unit (ICU). The effect of the combination therapy in cohort 3 was the most prominent, and the median time to SARS-CoV-2 elimination was 3.5 days (IQR 3.0–4.0), normalization of the CRP concentration was 3.5 days (IQR 3–5), of the D-dimer concentration was 5 days (IQR 4 to 5); body temperature was 1 day (IQR 1–3), improvement in clinical status or discharge from the hospital was 5 days (IQR 5–5), and improvement in lung lesions of patients on 14 day was 100%.

Sibling Visiting in a Neonatal Intensive Care Unit

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 835-838
Author(s):  
Fred Schwab ◽  
Brenda Tolbert ◽  
Stephen Bagnato ◽  
M. Jeffrey Maisels
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Direct Observation ◽  
Neonatal Intensive Care ◽  
Behavioral Patterns ◽  
Control Intervention ◽  
Significant Difference

The effect of sibling visiting in a neonatal intensive care unit was studied. Sixteen siblings of 13 infants were randomly assigned to a visiting or nonvisiting group. Behavioral patterns were measured by questionnaires administered to the parents and by direct observation and interviews with the children. There were no significant changes in the behavior of the children following the birth of their sibling, and there was no significant difference between the behavior scores of the two groups 1 week after the experimental (or control) intervention. The visiting children did not show signs of fear or anxiety during the visit. These data suggest that sibling visiting to a neonatal intensive care unit is not likely to be harmful and might be beneficial to the siblings and their families.

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

scholarly journals Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000239 ◽  
Author(s):  
Krishna Aparanji ◽  
Shreedhar Kulkarni ◽  
Megan Metzke ◽  
Yvonne Schmudde ◽  
Peter White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Quality Metric ◽  
Risk Of Mortality ◽  
Simulation Based ◽  
Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

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