COVID-19 and Multiorgan Dysfunction Syndrome

Severe acute respiratory syndrome (SARS) is the leading cause of death in COVID-19 infection, however, multi-organ dysfunction due to COVID-19 and/or because of co-morbidities is a usual accompaniment causing unfavorable outcome. Early detection of organ failure and giving appropriate organ support may improve the chances of survival. Arterial Blood Gas (ABG) analysis; electrolytes coupled with clinical picture and with organ related laboratory investigations may help in diagnosis of MODS and sepsis in COVID-19 SEVERE SYNDROME. Acute kidney injury (AKI), myocarditis, thromboembolism, acute liver de-compensation, hospital acquired infections, cardiac arrest, glycemic variability, thyroid dysfunction and other organ failure may lead to MODS.As patients having multiple organ syndrome requires ICU admission and interventions like intubation, hemodialysis and other extracorporeal treatment support knowing holistically about “COVID-19 MODS” is important for treating physicians.

Download Full-text

Severe Decompression Illness: Case Report, Prehospital Recognition, and Regional Transport Considerations

Case Reports in Emergency Medicine ◽

10.1155/2017/7203085 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Julie Estrada ◽

David Meurer ◽

Kevin De Boer ◽

Karl Huesgen

Keyword(s):

Early Recognition ◽

Multiorgan Failure ◽

Tertiary Care ◽

Pulmonary Arteries ◽

Kidney Injury ◽

Decompression Illness ◽

Arterial Blood Gas ◽

Head Ct ◽

Arterial Blood ◽

Prehospital Emergency

A 46-year-old male presented to our tertiary care emergency department (ED) with shortness of breath and chest pain following an uneventful four-hour SCUBA dive at 100 feet. His prehospital emergency medical services (EMS) assessment revealed transient hypotension and hypoxia. He later developed progressive skin mottling. Serology was significant for acute kidney injury, transaminitis, hemoconcentration, and hypoxia on an arterial blood gas. Computed tomography (CT) angiography demonstrated intravascular gas throughout the mesenteric and pulmonary arteries as well as the portal venous system. No abnormality was seen on head CT and the patient had normal mental status. Prehospital nonrebreather oxygen therapy was changed to continuous positive airway pressure (CPAP) upon ED arrival, and the patient was intubated prior to transfer to a hyperbaric facility. However, within 24 hours the patient was found to have multiorgan failure, diffuse cerebral edema, and brain death despite no further episodes of hypotension or hypoxia. No intracranial gas was seen on repeat head CT. Our case demonstrates the importance of early recognition of decompression illness by EMS personnel, consideration of ground versus flight transportation of these patients to the nearest hyperbaric center, and the possible use of prehospital CPAP as an alternative to enhance oxygenation.

Download Full-text

P18 Plasma-lyte 148 vs 0.9% saline for fluid resuscition in children: electrolytic and clinical outcomes

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314584.29 ◽

2018 ◽

Vol 103 (2) ◽

pp. e1.22-e1 ◽

Cited By ~ 1

Author(s):

Wignell Andrew ◽

Davies Patrick

Keyword(s):

Clinical Outcomes ◽

Kidney Injury ◽

Fluid Volume ◽

Lower Percentage ◽

Clinical Effects ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Significant Difference ◽

Resuscitation Fluid ◽

Plasma Chloride

AimsCrystalloid fluid boluses are a mainstay of treatment in unwell children, with the traditional fluid of choice being 0.9% saline (NS). However, the use of NS has been associated with an increase in plasma chloride levels and acidosis, leading to kidney injury and other detrimental clinical effects. Plasma-Lyte 148 (PLA) is a balanced, physiological, crystalloid intravenous fluid, which is both calcium-free and isotonic. Its use in place of NS for fluid resuscitation may circumvent hyperchloraemic metabolic acidosis. In May 2015 our hospital altered its standard resuscitation fluid from NS to PLA. We aimed to compare the effect of fluid boluses of NS to those of PLA in children.MethodsAll patients admitted in the 18 month periods before and after the change from NS to PLA, and receiving a fluid bolus in the first 24 hours of admission, were included. Post-surgical patients and those who had undergone haemofiltration were excluded. Arterial blood gas and creatinine values for up to 5 days after bolus fluid administration were examined. Patients were stratified according to the total resuscitation volume (ml/kg), then split into categories determined by the balance of PLA vs. NS.The primary outcome was plasma chloride. Secondary outcomes included blood pH and percentage change in creatinine. Clinical outcomes were length of ventilation and length of PICU stay.Results126 patients were included in the analysis. Patients receiving NS boluses tended to have a higher maximum chloride, higher average chloride, lower pH and higher percentage creatinine increase than those given PLA. Subgroup analysis showed a statistically significant difference in average serum chloride for the 61–90 ml/kg group {PLA 105.59±1.29 vs NS 111.29±2.1 mmol/L; difference: −6.21 [95% confidence interval (CI)−9.55,–2.87]}. Patients who received PLA tended to have a higher pH than those receiving NS. A statistically significant difference was seen in the 10–30 ml/kg group [PLA 7.42±0.49 vs NS 7.33±0.65; difference: 0.0913 (95% CI: −0.18 to −0.02)].Significant differences were not seen in the clinical outcomes of length of stay or ventilationConclusionPLA as a resuscitation fluid is significantly associated with a more physiological plasma chloride and pH across several resuscitation fluid volume categories, when compared to NS. The trends in the other fluid volume categories are in line with these findings, but are not statistically significant. There was also a trend towards patients receiving PLA having a lower percentage rise in creatinine than those who received saline. These results were consistent over all weight and age categories.

Download Full-text

Electrocardiographic features of hyperkalemia during acute kidney injury in a patient with pacemaker

Italian Journal of Medicine ◽

10.4081/itjm.2018.986 ◽

2018 ◽

Vol 12 (2) ◽

pp. 145

Author(s):

Alfonso Sforza ◽

Federica De Pisapia ◽

Giuliano De Stefano ◽

Antonio Gaspardini ◽

Maria Immacolata Arnone ◽

...

Keyword(s):

Cardiac Activity ◽

Kidney Injury ◽

Blood Gas Analysis ◽

Sine Wave ◽

Gas Analysis ◽

Acute Confusional State ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Arterial Blood Gas Analysis ◽

History Of

We describe a case of a 79-year-old man with pacemaker who presented to the Emergency Department due to asthenia and acute confusional state. He had a history of atrial fibrillation, anemia and colostomy and he was on treatment with diuretics. The electrocardiogram (ECG) showed pacemaker-induced ventricular activity, QRS complexes excessively wide with sine-wave appearance, tall and peaked T waves, without electrically evident atrial activity. Potassium concentration on arterial blood gas analysis was 8.8 mmol/L. ECG abnormalities disappeared after therapy with calcium chloride and spontaneous cardiac activity reappeared.

Download Full-text

Renal replacement therapy for acute kidney injury and multiple organ failure after surgery under cardiopulmonary bypass

Kardiologiya i serdechno-sosudistaya khirurgiya ◽

10.17116/kardio20181105176 ◽

2018 ◽

Vol 11 (5) ◽

pp. 76 ◽

Cited By ~ 1

Author(s):

E. A. Tabakyan ◽

K. V. Mershin ◽

A. A. Margolina ◽

I. V. Burmistrova ◽

N. A. Buldakova ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiopulmonary Bypass ◽

Renal Replacement Therapy ◽

Multiple Organ Failure ◽

Replacement Therapy ◽

Organ Failure ◽

Kidney Injury ◽

Multiple Organ

Download Full-text

The Effect of Plasma Triglyceride-Lowering Therapy on the Evolution of Organ Function in Early Hypertriglyceridemia-Induced Acute Pancreatitis Patients With Worrisome Features (PERFORM Study): Rationale and Design of a Multicenter, Prospective, Observational, Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.756337 ◽

2021 ◽

Vol 8 ◽

Author(s):

Longxiang Cao ◽

Jing Zhou ◽

Mingzhi Chen ◽

Tao Chen ◽

Man Liu ◽

...

Keyword(s):

Acute Pancreatitis ◽

Cohort Study ◽

Organ Failure ◽

Clinical Outcomes ◽

Multiple Organ ◽

Primary Objective ◽

Organ Support ◽

Lowering Therapy ◽

Observational Prospective Cohort Study ◽

New Onset

Background: Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease with multiple etiologies. The prevalence of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) has been increasing in recent years. It is reported that early triglyceride (TG) levels were associated with the severity of the disease, and TG- lowering therapies, including medical treatment and blood purification, may impact the clinical outcomes. However, there is no consensus regarding the optimal TG-lowering therapy, and clinical practice varies greatly among different centers. Our objective is to evaluate the TG-lowering effects of different therapies and their impact on clinical outcomes in HTG-AP patients with worrisome features.Methods: This is a multicenter, observational, prospective cohort study. A total of approximately 300 patients with HTG-AP with worrisome features are planned to be enrolled. The primary objective of the study is to evaluate the relationship between TG decline and the evolution of organ failure, and patients will be dichotomized depending on the rate of TG decline. The primary outcome is organ failure (OF) free days to 14 days after enrollment. Secondary outcomes include new-onset organ failure, new-onset multiple-organ failure (MOF), new-onset persistent organ failure (POF), new receipt of organ support, requirement of ICU admission, ICU free days to day 14, hospital free days to day 14, 60-day mortality, AP severity grade (Based on the Revised Atlanta Classification), and incidence of systemic and local complications. Generalized linear model (GLM), Fine and Gray competing risk regression, and propensity score matching will be used for statistical analysis.Discussion: Results of this study will reveal the current practice of TG-lowering therapy in HTG-AP and provide necessary data for future trials.

Download Full-text

Severe Tuberculosis Requiring Intensive Care: A Descriptive Analysis

Critical Care Research and Practice ◽

10.1155/2017/9535463 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Raquel Pacheco Duro ◽

Paulo Figueiredo Dias ◽

Alcina Azevedo Ferreira ◽

Sandra Margarida Xerinda ◽

Carlos Lima Alves ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Descriptive Analysis ◽

Univariate Analysis ◽

Multiple Organ ◽

Multiple Organ Dysfunction ◽

Hospital Acquired Infection ◽

Positive Smear ◽

Laboratory Investigations ◽

Hospital Acquired

Background. This study aims to describe the characteristics of tuberculosis (TB) patients requiring intensive care and to determine the in-hospital mortality and the associated predictive factors.Methods. Retrospective cohort study of all TB patients admitted to the ICU of the Infectious Diseases Department of Centro Hospitalar de São João (Porto, Portugal) between January 2007 and July 2014. Comorbid diagnoses, clinical features, radiological and laboratory investigations, and outcomes were reviewed. Univariate analysis was performed to identify risk factors for death.Results. We included 39 patients: median age was 52.0 years and 74.4% were male. Twenty-one patients (53.8%) died during hospital stay (15 in the ICU). The diagnosis of isolated pulmonary TB, a positive smear for acid-fast-bacilli and a positive PCR forMycobacterium tuberculosisin patients of pulmonary disease, severe sepsis/septic shock, acute renal failure and Multiple Organ Dysfunction Syndrome on admission, the need for mechanical ventilation or vasopressor support, hospital acquired infection, use of adjunctive corticotherapy, smoking, and alcohol abuse were significantly associated with mortality (p<0.05).Conclusion. This cohort of TB patients requiring intensive care presented a high mortality rate. Most risk factors for mortality were related to organ failure, but others could be attributed to delay in the diagnostic and therapeutic approach, important targets for intervention.

Download Full-text

The Changing Pattern of Acute Kidney Injury: From One to Multiple Organ Failure

Contributions to Nephrology - Cardiorenal Syndromes in Critical Care ◽

10.1159/000313754 ◽

2010 ◽

pp. 153-158 ◽

Cited By ~ 20

Author(s):

Mark D. Okusa

Keyword(s):

Acute Kidney Injury ◽

Multiple Organ Failure ◽

Organ Failure ◽

Kidney Injury ◽

Multiple Organ

Download Full-text

Adjuvant hemoadsorption therapy in patients with severe COVID-19 and related organ failure requiring CRRT or ECMO therapy: A case series

The International Journal of Artificial Organs ◽

10.1177/03913988211030517 ◽

2021 ◽

pp. 039139882110305

Author(s):

Florian Wunderlich-Sperl ◽

Sebastian Kautzky ◽

Christian Pickem ◽

Christoph Hörmann

Keyword(s):

Lung Function ◽

Organ Failure ◽

Combined Therapy ◽

Ventilatory Support ◽

Case Series ◽

Hemodynamic Instability ◽

Multiple Organ ◽

Organ Support ◽

Lung Failure ◽

Ecmo Therapy

Introduction: Severe cases of the COVID-19 are often associated with the development of a fulminant sepsis-like state with a concomitant cytokine release syndrome. Recently, immunomodulating approaches to treat such a hyperinflammation have come into focus, including the use of new extracorporeal organ support therapies such as CytoSorb hemoadsorption designed to remove cytokines and other circulating mediators from blood. Patients and methods: Thirteen critically ill COVID-19 patients with ARDS who received either ECMO therapy and/or CRRT with concomitant multiple organ failure were included. Hemoadsorption therapy was initiated once the patient had established—or was at high risk of developing—a hyperinflammatory state with marked hemodynamic instability or progressive lung failure. Levels of inflammatory markers, vasopressor requirements, oxygenation, and ventilation parameters were measured, as well as clinically relevant outcome measures. Results: Combined therapy was associated with a significant reduction in inflammatory mediators, hemodynamic stabilization with a concomitant decrease in requirements for vasoactive substances, and a pronounced improvement in lung function and the need for ventilatory support. Treatment appeared safe and well-tolerated. Conclusions: In this case series of SARS-CoV-2 infected patients admitted to the intensive care unit with ARDS, we report effective interleukin (IL)-6 removal, reduced norepinephrine requirement, and improved lung function while receiving adjuvant, extracorporeal hemoadsorption therapy in the context of a multimodal treatment approach. The presented protocol for CytoSorb initiation may be a good foundation for the development of further prospective studies in the field and may eventually also be applied to other forms of hyperinflammatory ARDS.

Download Full-text

Critical Care Nursing

10.1093/med/9780199696260.001.0001 ◽

2017 ◽

Cited By ~ 4

Keyword(s):

Critical Care ◽

Kidney Injury ◽

Multiple Organ ◽

Major Incident ◽

Organ Support ◽

Evidence Based ◽

Care Environment ◽

Organ Systems ◽

General Aspects ◽

The Impact

This textbook encompasses the knowledge, skills, and expertise needed to deliver excellent nursing care to critically ill patients. Emphasis is placed on a holistic and compassionate approach towards humanizing the impact of the environment, organ support, and monitoring, as well as critical illness itself. Chapters cover the general aspects of critical care such as the critical care environment or critical care continuum and specific organ systems and diseases. The structure of the systems chapters reminds the reader of the underlying anatomy and physiology as well as highlighting areas of particular relevance to critical care. The focus on priorities for management builds on the ABCDE assessment and offers insight into key interventions in urgent situations as well as outlining evidence-based practice. The book is ideal for those new to the critical care environment, but will also act as a reminder for more experienced nurses when faced with a new situation or when teaching/mentoring students. The patient and their family remain the centre of all This new edition brings the definitions, pathophysiology, and management of fast-changing and challenging areas such as ARDS, sepsis and multiple organ dysfunction, resuscitation, and acute kidney injury up to date as well as including any evidence-based changes associated with nursing practice in critical care. A new chapter covers major incident planning and management and the role of critical care in pandemic situations.

Download Full-text