COVID-19 critical illness in pregnancy

Although the pregnant population was affected by early waves of the COVID-19 pandemic, increasing transmission and severity due to new viral variants has resulted in an increased incidence of severe illness during pregnancy in many regions. Critical illness and respiratory failure are relatively uncommon occurrences during pregnancy, and there are limited high-quality data to direct management. This paper reviews the current literature on COVID-19 management as it relates to pregnancy, and provides an overview of critical care support in these patients. COVID-19 drug therapy is similar to that used in the non-pregnant patient, including anti-inflammatory therapy with steroids and IL-6 inhibitors, although safety data are limited for antiviral drugs such as remdesivir and monoclonal antibodies. As both pregnancy and COVID-19 are thrombogenic, thromboprophylaxis is essential. Endotracheal intubation is a higher risk during pregnancy, but mechanical ventilation should follow usual principles. ICU management should be directed at optimizing maternal well-being, which in turn will benefit the fetus.

Management and outcomes in critically ill nonagenarian versus octogenarian patients

Background Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80–89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90–1.74; p = 0.19)). Conclusion After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered– together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. Trial registration NCT03134807 and NCT03370692.

First case of concomitant cytomegalovirus (CMV) viremia in non-immunocompromised COVID 19 patient and ICU management strategy in Qatar with literature review.

COVID 19 has created one of the world’s worst pandemics and is associated with various life-threatening complications, such as Cytomegalovirus (CMV) co-infection. We present a life-threatening CMV viremia co-infection in a none-immunocompromised COVID 19 patient to highlight our management approach and a comprehensive literature review.

Clinical Features And Prognostic Factors For Status Epilepticus In The Pediatric Emergency Department: A Retrospective Study

Background: Uncontrolled status epilepticus (SE) causes damage to all organs, especially the brain. Although there are guidelines regarding the management of convulsive SE, the timing for administering first-line rescue medications (RMeds) remains unclear. Therefore, we analyzed patients with persistent SE lasting for >30 min, who visited the pediatric emergency department (pED), to determine clinical features and risk factors and provide directions for management on arrival to the pED. Methods: This study was conducted by retrospectively reviewing medical charts of patients aged 0–19 years diagnosed with SE and accompanying motor seizures, who visited the pED between January 2010 and December 2019. After arrival at the pED, patients were divided into two groups, namely ≥30 min (n = 12) and <30 min (n = 13), according to the additional seizure time and administration of the first dose of RMeds before and after 5 min. Results: Seizures lasting for <30 min were mainly belonged to idiopathic SE in the pED. Among four SE patients who needed intensive care unit (ICU) management, three had delayed administration of RMeds of >5 min, which was statistically significant; hence, more hospitalizations in the ICU were observed when RMed administration was delayed (p = 0.047). In acute symptomatic SE such as encephalitis, more than three doses of RMeds were needed to control seizures. Conclusions: Patients with convulsive SE should arrive at the pED as soon as possible and immediately receive RMeds after arrival at the pED for good outcomes.

Clinical features and prognostic factors for status epilepticus in the pediatric emergency department: A retrospective study

Background: Uncontrolled seizures cause damage to all organs, especially the brain. Although there are guidelines regarding the management of status epilepticus (SE) involving motor seizures, the timing for administering first-line rescue medications (RMeds) remains unclear. Therefore, we analyzed patients with persistent SE lasting for >30 min and who visited the pediatric emergency department (pED) to determine clinical features and risk factors and provide directions for management on arrival to the pED. Methods: This study was conducted by retrospectively reviewing medical charts of patients aged 0–19 years who were diagnosed with SE accompanying motor seizures and who visited the pED between January 2010 and December 2019. After pED arrival, patients were divided into two groups, namely ≥30 min (n = 12) and <30 min (n = 13), according to the additional seizure time and receipt of the first dose of RMeds before and after 5 min.Results: Seizures lasting for <30 min were mainly observed for the etiology of idiopathic SE in the pED. Among four SE patients who needed intensive care unit (ICU) management, three had delayed administration of RMeds of more than 5 min, which was statistically significant because more hospitalizations in the ICU were observed when RMed administration was delayed. (p = 0.047). In acute symptomatic SE such as encephalitis, more than three doses of RMeds were needed to stop seizures.Conclusions: Patients with convulsive status epilepticus should receive RMeds after arrival at the pED.

SARS-CoV-2 testing of 11,884 healthcare workers at an acute NHS hospital trust in England: a retrospective analysis

ABSTRACTHealthcare workers (HCWs) are known to be at increased risk of infection with SARS-CoV-2, although whether these risks are equal across all roles is uncertain. Here we report a retrospective analysis of a large real-world dataset obtained from 10 March to 6 July 2020 in an NHS Foundation Trust in England with 17,126 employees. 3,338 HCWs underwent symptomatic PCR testing (14.4% positive, 2.8% of all staff) and 11,103 HCWs underwent serological testing for SARS-CoV-2 IgG (8.4% positive, 5.5% of all staff). Seropositivity was lower than other hospital settings in England but higher than community estimates. Increased test positivity rates were observed in HCWs from BAME backgrounds and residents in areas of higher social deprivation. A logistic regression model adjusting for these factors showed significant increases in the odds of testing positive in certain occupational groups, most notably domestic services staff, nurses and health-care assistants. PCR testing of symptomatic HCWs appeared to underestimate overall infection levels, probably due to asymptomatic seroconversion. Clinical outcomes were reassuring, with only a small minority of HCWs with COVID-19 requiring hospitalisation (2.3%) or ICU management (0.7%) and with no deaths. Despite a relatively low level of HCW infection compared to other UK cohorts, there were nevertheless important differences in test positivity rates between occupational groups, robust to adjustment for demographic factors such as ethnic background and social deprivation. Quantitative and qualitative studies are needed to better understand the factors contributing to this risk. Robust informatics solutions for HCW exposure data are essential to inform occupational monitoring.