Acute and Critical Care

Original Article

Pulmonary
Increased red cell distribution width predicts mortality in COVID-19 patients admitted to a Dutch intensive care unit: Anthony D. Mompiere, Jos L.M.L. le Noble, Manon Fleuren-Janssen, Kelly Broen, Frits van Osch, Norbert Foudraine; Acute Crit Care. 2024;39(3):359-368. Published online August 22, 2024; DOI: https://doi.org/10.4266/acc.2023.01137

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Abstract PDF: Background
Abnormal red blood cell distribution width (RDW) is associated with poor cardiovascular, respiratory, and coronavirus disease 2019 (COVID-19) outcomes. However, whether RDW provides prognostic insights regarding COVID-19 patients admitted to the intensive care unit (ICU) was unknown. Here, we retrospectively investigated the association of RDW with 30-day and 90- day mortalities, duration of mechanical ventilation, and length of ICU and hospital stay in patients with COVID-19.
Methods
This study included 321 patients with COVID-19 aged >18 years who were admitted to the ICU between March 2020 and July 2022. The outcomes were mortality, duration of mechanical ventilation, and length of stay. RDW >14.5% was assessed in blood samples within 24 hours of admission.
Results
The mortality rate was 30.5%. Multivariable Cox regression analysis showed an association between increased RDW and 30-day mortality (hazard ratio [HR], 3.64; 95% CI, 1.54–8.65), 90-day mortality (HR, 3.66; 95% CI, 1.59–8.40), and shorter duration of invasive ventilation (2.7 ventilator-free days, P=0.033).
Conclusions
Increased RDW in COVID-19 patients at ICU admission was associated with increased 30-day and 90-day mortalities, and shorter duration of invasive ventilation. Thus, RDW can be used as a surrogate biomarker for clinical outcomes in COVID-19 patients admitted to the ICU.

Review Article

Pulmonary
Beyond survival: understanding post-intensive care syndrome: Lovish Gupta, Maazen Naduthra Subair, Jaskaran Munjal, Bhupinder Singh, Vasu Bansal, Vasu Gupta, Rohit Jain; Acute Crit Care. 2024;39(2):226-233. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01158

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Post-intensive care syndrome (PICS) refers to persistent or new onset physical, mental, and neurocognitive complications that can occur following a stay in the intensive care unit. PICS encompasses muscle weakness; neuropathy; cognitive deficits including memory, executive, and attention impairments; post-traumatic stress disorder; and other mood disorders. PICS can last long after hospital admission and can cause significant physical, emotional, and financial stress for patients and their families. Several modifiable risk factors, such as duration of sepsis, delirium, and mechanical ventilation, are associated with PICS. However, due to limited awareness about PICS, these factors are often overlooked. The objective of this paper is to highlight the pathophysiology, clinical features, diagnostic methods, and available preventive and treatment options for PICS.

Citations

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Post-COVID microvascular dysfunction in hospitalized COVID-19 survivors is associated with acute disease severity and persistent cognitive complaints
Noa van der Knaap, Simona Klinkhammer, Alida A. Postma, Johanna M.A. Visser-Meily, Janneke Horn, Caroline M. van Heugten, Paulien H.M. Voorter, Merel M. van der Thiel, Gerhard S. Drenthen, Walter H. Backes, Frank van Rosmalen, Susanne van Santen, Bas C.T.
Journal of the Neurological Sciences.2025; 472: 123464. CrossRef
Comparing virtual reality with traditional methods in cognitive rehabilitation in PICS syndrome
A. Despoti, I. Patsaki, A. Alexandropoulou, E. Magkouti, D. Tzoumi, N. Leventakis, G. Roussou, Α. Papathanasiou, N. Dimitriadi, P. Presvelou, S. Nanas, E. Karatzanos
Applied Neuropsychology: Adult.2025; : 1. CrossRef

Original Articles

Infection
Comparative evaluation of tocilizumab and itolizumab for treatment of severe COVID-19 in India: a retrospective cohort study: Abhyuday Kumar, Neeraj Kumar, Arunima Pattanayak, Ajeet Kumar, Saravanan Palavesam, Pradhan Manigowdanahundi Nagaraju, Rekha Das; Acute Crit Care. 2024;39(2):234-242. Published online April 1, 2024; DOI: https://doi.org/10.4266/acc.2023.00983; Correction in: Acute Crit Care 2024;39(4):652

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Abstract PDF: Background
Itolizumab downregulates the synthesis of proinflammatory cytokines and adhesion molecules by inhibiting CD6 leading to lower levels of interferon-γ, interleukin-6, and tumor necrotic factor-α and reduced T-cell infiltration at inflammatory sites. This study aims to compare the effects of tocilizumab and itolizumab in the management of severe coronavirus disease 2019 (COVID-19).
Methods
The study population was adults (>18 years) with severe COVID-19 pneumonia admitted to the intensive care unit receiving either tocilizumab or itolizumab during their stay. The primary outcome was clinical improvement (CI), defined as a two-point reduction on a seven-point ordinal scale in the status of the patient from initiating the drug or live discharge. The secondary outcomes were time until CI, improvement in PO2 /FiO2 ratio, best PO2 /FiO2 ratio, need for mechanical ventilation after administration of study drugs, time to discharge, and survival days.
Results
Of the 126 patients included in the study, 92 received tocilizumab and 34 received itolizumab. CI was seen in 46.7% and 61.7% of the patients in the tocilizumab and itolizumab groups, respectively and was not statistically significant (P=0.134). The PO2 /FiO2 ratio was significantly better with itolizumab compared to tocilizumab (median [interquartile range]: 315 [200–380] vs. 250 [150–350], P=0.043). The incidence of serious adverse events due to the study drugs was significantly higher with itolizumab compared to tocilizumab (14.7% vs. 3.3%, P=0.032).
Conclusions
The CI with itolizumab is similar to tocilizumab. Better oxygenation can be achieved with itolizumab and it can be a substitute for tocilizumab in managing severe COVID-19.

Pulmonary
Factors related to lung function outcomes in critically ill COVID-19 patients in South Korea: Tae Hun Kim, Myung Jin Song, Sung Yoon Lim, Yeon Joo Lee, Young-Jae Cho; Acute Crit Care. 2024;39(1):100-107. Published online February 20, 2024; DOI: https://doi.org/10.4266/acc.2023.00668

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Abstract PDF Supplementary Material: Background
New variants of the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic continue to emerge. However, little is known about the effect of these variants on clinical outcomes. This study evaluated the risk factors for poor pulmonary lung function test (PFT).
Methods
The study retrospectively analyzed 87 patients in a single hospital and followed up by performing PFTs at an outpatient clinic from January 2020 to December 2021. COVID-19 variants were categorized as either a non-delta variant (November 13, 2020–July 6, 2021) or the delta variant (July 7, 2021–January 29, 2022).
Results
The median age of the patients was 62 years, and 56 patients (64.4%) were male. Mechanical ventilation (MV) was provided for 52 patients, and 36 (41.4%) had restrictive lung defects. Forced vital capacity (FVC) and diffusion capacity of the lung for carbon monoxide (DLCO ) were lower in patients on MV. Male sex (odds ratio [OR], 0.228) and MV (OR, 4.663) were significant factors for decreased DLCO . The duration of MV was associated with decreased FVC and DLCO . However, the type of variant did not affect the decrease in FVC (P=0.750) and DLCO (P=0.639).
Conclusions
Among critically ill COVID-19 patients, 40% had restrictive patterns with decreased DLCO . The reduction of PFT was associated with MV, type of variants.

Review Article

Pulmonary
Prolonged intensive care: muscular functional, and nutritional insights from the COVID-19 pandemic: Miguel Ángel Martínez-Camacho, Robert Alexander Jones-Baro, Alberto Gómez-González, Dalia Sahian Lugo-García, Pía Carolina Gallardo Astorga, Andrea Melo-Villalobos, Bárbara Kassandra Gonzalez-Rodriguez, Ángel Augusto Pérez-Calatayud; Acute Crit Care. 2024;39(1):47-60. Published online February 2, 2024; DOI: https://doi.org/10.4266/acc.2023.01284

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Abstract PDF: During the coronavirus disease 2019 (COVID-19) pandemic, clinical staff learned how to manage patients enduring extended stays in an intensive care unit (ICU). COVID-19 patients requiring critical care in an ICU face a high risk of experiencing prolonged intensive care (PIC). The use of invasive mechanical ventilation in individuals with severe acute respiratory distress syndrome can cause numerous complications that influence both short-term and long-term morbidity and mortality. Those risks underscore the importance of proactively addressing functional complications. Mitigating secondary complications unrelated to the primary pathology of admission is imperative in minimizing the risk of PIC. Therefore, incorporating strategies to do that into daily ICU practice for both COVID-19 patients and those critically ill from other conditions is significantly important.

Original Articles

Epidemiology
Prevalence of extracorporeal blood purification techniques in critically ill patients before and during the COVID-19 pandemic in Egypt: Aya Osama Mohammed, Hanaa I. Rady; Acute Crit Care. 2024;39(1):70-77. Published online February 1, 2024; DOI: https://doi.org/10.4266/acc.2023.00654

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Abstract PDF: Background
Extracorporeal blood-purification techniques are frequently needed in the pediatric intensive care unit (PICU), yet data on their clinical application are lacking. This study aims to review the indications, rate of application, clinical characteristics, complications, and outcomes of patients undergoing extracorporeal blood purification (i.e., by continuous renal replacement therapy [CRRT] or therapeutic plasma exchange [TPE]) in our PICU, including before the coronavirus disease 2019 (COVID-19) pandemic in 2019 and during the pandemic from 2020 to 2022.
Methods
This study included children admitted for extracorporeal blood-purification therapy in the PICU. The indications for TPE were analyzed and compared to the American Society for Apheresis categories.
Results
In 82 children, 380 TPE sessions and 37 CRRT sessions were carried out children, with 65 patients (79%) receiving TPE, 17 (20.7%) receiving CRRT, and four (4.8%) receiving both therapies. The most common indications for TPE were neurological diseases (39/82, 47.5%), followed by hematological diseases (18/82, 21.9%). CRRT was mainly performed for patients suffering from acute kidney injury. Patients with neurological diseases received the greatest number of TPE sessions (295, 77.6%). Also, the year 2022 contained the greatest number of patients receiving extracorporeal blood-purification therapy (either CRRT or TPE).
Conclusions
The use of extracorporeal blood-purification techniques increased from 2019 through 2022 due to mainly autoimmune dysregulation among affected patients. TPE can be safely used in an experienced PICU. No serious adverse events were observed in the patients that received TPE, and overall survival over the 4 years was 86.5%.

Nursing
Effectiveness of massage and range of motion exercises on muscle strength and intensive care unit-acquired weakness in Iranian patients with COVID-19: a randomized parallel-controlled trial: Mohammad Ali Zakeri, Adnan Rashid Aziz, Elham Rahiminezhad, Mahlagha Dehghan; Acute Crit Care. 2024;39(1):78-90. Published online December 13, 2023; DOI: https://doi.org/10.4266/acc.2023.00416

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Abstract PDF Supplementary Material: Background
Muscle weakness is prevalent in intensive care patients. This study focused on comparing the effects of massage and range of motion (ROM) exercises on muscle strength and intensive care unit-acquired weakness (ICU-AW) among patients with coronavirus disease 2019 (COVID-19).
Methods
This study was a randomized clinical trial that recruited patients (n=45) with COVID-19 admitted to the ICU and divided them into three groups (ROM exercises, massage, and control). We evaluated muscle strength and ICU-AW in the arms and legs using a hand dynamometer. The Medical Research Council sum score was determined before and after the intervention.
Results
The study findings were that 0%, 20%, and 100% of the participants in the ROM exercises, massage, and control groups had ICU-AW on the 7th day of ICU admission. The ROM exercise group had greater muscle strength in the hands and legs than the massage and control groups, and the massage group had greater muscle strength than the control group.
Conclusions
Massage and ROM exercises could improve muscle strength and reduce ICU-AW in COVID-19 patients admitted to the ICU.

Infection
Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes: Ahlem Trifi, Selim Sellaouti, Asma Mehdi, Lynda Messaoud, Eya Seghir, Badis Tlili, Sami Abdellatif; Acute Crit Care. 2023;38(4):425-434. Published online November 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00773

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Abstract PDF Supplementary Material

Background
Coronavirus disease 2019 (COVID-19) pandemic disrupted adherences to healthcare-associated infection (HAI) prevention protocols. Herein, we studied the characteristics of all HAIs occurring in critically ill COVID-19 patients.
Methods
A retrospective, single-center cohort of critical COVID-19 patients during 2021. Microbiological samples were collected if HAI was suspected. We analyzed all factors that could potentially induce HAI, using septic shock and mortality as endpoints.
Results
Sixty-four among 161 included patients (39.7%) presented a total of 117 HAIs with an incidence density of 69.2 per 1,000 hospitalization days. Compared to the prior COVID-19 period (2013–2019), the identification of HAI increased in 2021. HAIs were classified into ventilator-associated pneumonia (VAP; n=38), bloodstream infection (n=32), urinary tract infection (n=24), catheter-related infection (n=12), and fungal infection (n=11). All HAIs occurred significantly earlier in the post–COVID-19 period (VAP: 6 vs. 10 days, P=0.045, in 2017 and 2021). Acinetobacter baumannii (39.5%) and Klebsiella pneumoniae (27%) were the most commonly isolated pathogens that exhibited a multidrug-resistant (MDR) profile, observed in 89% and 64.5%, respectively. The HAI factors were laboratory abnormalities (odds ratio [OR], 6.4; 95% confidence interval [CI], 2.3–26.0), cumulative steroid dose (OR, 1.9; 95% CI, 1.3–4.0), and invasive procedures (OR, 20.7; 95% CI, 5.3–64.0). HAI was an independent factor of mortality (OR, 8.5; P=0.004).
Conclusions
During the COVID-19 era, the incidence of HAIs increased and MDR isolates remained frequent. A severe biological inflammatory syndrome, invasive devices, and elevated cumulative steroid dosages were related to HAIs. HAI was a significant death factor.

Citations

Citations to this article as recorded by

Depression during the COVID pandemic in La Manouba Governorate, Tunisia: A community survey
Mauro G Carta, Viviane Kovess, Amina Aissa, Amine Larnaout, Yosra Zgueb, Lubna A Alnasser, Maria Francesca Moro, Federica Sancassiani, Elisa Cantone, Salsabil Rjaibi, Nada Zoghlami, Mejdi Zid, Hajer Aounallah-Skhiri, Uta Ouali
International Journal of Social Psychiatry.2024; 70(6): 1128. CrossRef
Multidrug-Resistant Klebsiella pneumoniae Strains in a Hospital: Phylogenetic Analysis to Investigate Local Epidemiology
Maria Vittoria Ristori, Fabio Scarpa, Daria Sanna, Marco Casu, Nicola Petrosillo, Umile Giuseppe Longo, De Florio Lucia, Silvia Spoto, Rosa Maria Chiantia, Alessandro Caserta, Raffaella Rosy Vescio, Flavio Davini, Lucrezia Bani, Elisabetta Riva, Massimo C
Microorganisms.2024; 12(12): 2541. CrossRef

Pulmonary
Combining reservoir mask oxygenation with high-flow nasal cannula in the treatment of hypoxemic respiratory failure among patients with COVID-19 pneumonia: a retrospective cohort study: Ivan Gur, Ronen Zalts, Yaniv Dotan, Khitam Hussain, Ami Neuberger, Eyal Fuchs; Acute Crit Care. 2023;38(4):435-441. Published online November 23, 2023; DOI: https://doi.org/10.4266/acc.2023.00451

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Abstract PDF Supplementary Material: Background
Concerns regarding positive-pressure-ventilation for the treatment of coronavirus disease 2019 (COVID-19) hypoxemia led the search for alternative oxygenation techniques. This study aimed to assess one such method, dual oxygenation, i.e., the addition of a reservoir mask (RM) on top of a high-flow nasal cannula (HFNC).
Methods
In this retrospective cohort study, the records of all patients hospitalized with COVID-19 during 2020–2022 were reviewed. Patients over the age of 18 years with hypoxemia necessitating HFNC were included. Exclusion criteria were positive-pressure-ventilation for any indication other than hypoxemic respiratory failure, transfer to another facility while still on HFNC and “do-not-intubate/resuscitate” orders. The primary outcome was mortality within 30 days from the first application of HFNC. Secondary outcomes were intubation and admission to the intensive care unit.
Results
Of 659 patients included in the final analysis, 316 were treated with dual oxygenation and 343 with HFNC alone. Propensity for treatment was estimated based on background diagnoses, laboratories and vital signs upon admission, gender and glucocorticoid dose. Inverse probability of treatment weighted regression including age, body mass index, Sequential Organ Failure Assessment (SOFA) score and respiratory rate oxygenation index showed treatment with dual oxygenation to be associated with lower 30-day mortality (adjusted hazard ratio, 0.615; 95% confidence interval, 0.469–0.809). Differences in the secondary outcomes did not reach statistical significance.
Conclusions
Our study suggests that the addition of RM on top of HFNC may be associated with decreased mortality in patients with severe COVID-19 hypoxemia.

Pediatric
Impact of the COVID-19 pandemic on diabetic ketoacidosis management in the pediatric intensive care unit: Fevzi Kahveci, Buse Önen Ocak, Emrah Gün, Anar Gurbanov, Hacer Uçmak, Ayşen Durak Aslan, Ayşegül Ceran, Hasan Özen, Burak Balaban, Edin Botan, Zeynep Şıklar, Merih Berberoğlu, Tanıl Kendirli; Acute Crit Care. 2023;38(3):371-379. Published online August 31, 2023; DOI: https://doi.org/10.4266/acc.2023.00038

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Abstract PDF

Background
Diabetic ketoacidosis (DKA) is a common endocrine emergency in pediatric patients. Early presentation to health facilities, diagnosis, and good management in the pediatric intensive care unit (PICU) are crucial for better outcomes in children with DKA.
Methods
This was a single-center, retrospective cohort study conducted between February 2015 and January 2022. Patients with DKA were divided into two groups according to pandemic status and diabetes diagnosis.
Results
The study enrolled 59 patients, and their mean age was 11±5 years. Forty (68%) had newly diagnosed type 1 diabetes mellitus (T1DM), and 61% received follow-up in the pre-pandemic period. Blood glucose, blood ketone, potassium, phosphorus, and creatinine levels were significantly higher in the new-onset T1DM group compared with the previously diagnosed group (P=0.01, P=0.02, P<0.001, P=0.01, and P=0.08, respectively). In patients with newly diagnosed T1DM, length of PICU stays were longer than in those with previously diagnosed T1DM (28.5±8.9 vs. 17.3±6.7 hours, P<0.001). The pandemic group was compared with pre-pandemic group, there was a statistically significant difference in laboratory parameters of pH, HCO3, and lactate and also Pediatric Risk of Mortality (PRISM) III score. All patients survived, and there were no neurologic sequelae.
Conclusions
Patients admitted during the pandemic period were admitted with more severe DKA and had higher PRISM III scores. During the pandemic period, there was an increase in the incidence of DKA in the participating center compared to that before the pandemic.

Citations

Citations to this article as recorded by

Covid 19 and diabetes in children: advances and strategies
Zhaoyuan Wu, Jinling Wang, Rahim Ullah, Minghao Chen, Ke Huang, Guanping Dong, Junfen Fu
Diabetology & Metabolic Syndrome.2024;[Epub] CrossRef
Impact of the COVID-19 Pandemic on Diabetic Ketoacidosis Patients Treated in a Pediatric Intensive Care Unit: A Single-Center Cross-Sectional Study
Eva Perak, Dina Mrcela, Josko Markic
Medicina.2024; 60(11): 1775. CrossRef

Pulmonary
Outcomes of patients with COVID-19 requiring extracorporeal membrane oxygenation and continuous renal replacement therapy in the United States: Carlos R Franco Palacios, Rudiona Hoxhaj, Catlyn Thigpen, Jeffrey Jacob, Atul Bhatnagar, Asif Saberi; Acute Crit Care. 2023;38(3):308-314. Published online August 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00115

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Abstract PDF

Background
Coronavirus disease 2019 (COVID-19) infection is associated with significant morbidity and mortality. Some patients develop severe acute respiratory distress syndrome and kidney failure requiring the combination of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT).
Methods
Retrospective cohort study of 127 consecutive patients requiring combined ECMO and CRRT support in intensive care units at an ECMO center in Marietta, GA, United States.
Results
Sixty and 67 patients with and without COVID-19, respectively, required ECMO-CRRT support. After adjusting for confounding variables, patients with COVID-19 had increased mortality at 30 days (hazard ratio [HR], 5.19; 95% confidence interval [CI], 2.51–10.7; P<0.001) and 90 days (HR, 6.23; 95% CI, 2.60–14.9; P<0.001).
Conclusions
In this retrospective study, patients with COVID-19 who required ECMO-CRRT had increased mortality when compared to patients without COVID-19.

Citations

Citations to this article as recorded by

Factors associated with post-hospitalization dialysis dependence in ECMO patients who required continuous renal replacement therapy
Carlos Rodrigo Franco Palacios, Rudiona Hoxhaj, Catlyn Thigpen, Jeffrey Jacob
Renal Failure.2024;[Epub] CrossRef

Pulmonary
Mechanically ventilated COVID-19 patients admitted to the intensive care unit in the United States with or without respiratory failure secondary to COVID-19 pneumonia: a retrospective comparison of characteristics and outcomes: Jesse A. Johnson, Kashka F. Mallari, Vincent M. Pepe, Taylor Treacy, Gregory McDonough, Phue Khaing, Christopher McGrath, Brandon J. George, Erika J. Yoo; Acute Crit Care. 2023;38(3):298-307. Published online August 23, 2023; DOI: https://doi.org/10.4266/acc.2022.01123

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Abstract PDF Supplementary Material

Background
There is increasing heterogeneity in the clinical phenotype of patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19,) and reasons for mechanical ventilation are not limited to COVID pneumonia. We aimed to compare the characteristics and outcomes of intubated patients admitted to the ICU with the primary diagnosis of acute hypoxemic respiratory failure (AHRF) from COVID-19 pneumonia to those patients admitted for an alternative diagnosis.
Methods
Retrospective cohort study of adults with confirmed SARS-CoV-2 infection admitted to nine ICUs between March 18, 2020, and April 30, 2021, at an urban university institution. We compared characteristics between the two groups using appropriate statistics. We performed logistic regression to identify risk factors for death in the mechanically ventilated COVID-19 population.
Results
After exclusions, the final sample consisted of 319 patients with respiratory failure secondary to COVID pneumonia and 150 patients intubated for alternative diagnoses. The former group had higher ICU and hospital mortality rates (57.7% vs. 36.7%, P<0.001 and 58.9% vs. 39.3%, P<0.001, respectively). Patients with AHRF secondary to COVID-19 pneumonia also had longer ICU and hospital lengths-of-stay (12 vs. 6 days, P<0.001 and 20 vs. 13.5 days, P=0.001). After risk-adjustment, these patients had 2.25 times higher odds of death (95% confidence interval, 1.42–3.56; P=0.001).
Conclusions
Mechanically ventilated COVID-19 patients admitted to the ICU with COVID-19-associated respiratory failure are at higher risk of hospital death and have worse ICU utilization outcomes than those whose reason for admission is unrelated to COVID pneumonia.

Citations

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Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19—A Prospective Monocentric Cohort Study
Lenka Doubravská, Miroslava Htoutou Sedláková, Kateřina Fišerová, Olga Klementová, Radovan Turek, Kateřina Langová, Milan Kolář
Antibiotics.2024; 13(2): 192. CrossRef

Pulmonary
Awake prone positioning for COVID-19 acute hypoxemic respiratory failure in Tunisia: Khaoula Ben Ismail, Fatma Essafi, Imen Talik, Najla Ben Slimene, Ines Sdiri, Boudour Ben Dhia, Takoua Merhbene; Acute Crit Care. 2023;38(3):271-277. Published online August 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00591

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Abstract PDF: Background
In this study, we explored whether awake prone position (PP) can impact prognosis of severe hypoxemia coronavirus disease 2019 (COVID-19) patients.
Methods
This was a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. Patients were divided into two groups: group G1, patients who benefited from a vigilant and effective PP (>4 hours minimum/24) and group G2, control group. We compared demographic, clinical, paraclinical and evolutionary data.
Results
Three hundred forty-nine patients were hospitalized during the study period, 273 met the inclusion criteria. PP was performed in 192 patients (70.3%). The two groups were comparable in terms of demographic characteristics, clinical severity and modalities of oxygenation at intensive care unit (ICU) admission. The mean PaO2/ FIO2 ratios were 141 and 128 mm Hg, respectively (P=0.07). The computed tomography scan was comparable with a critical >75% in 48.5% (G1) versus 54.2% (G2). The median duration of the daily PP session was 13±7 hours per day. The average duration of spontaneous PP days was 7 days (4–19). Use of invasive ventilation was lower in the G1 group (27% vs. 56%, P=0.002). Healthcare-associated infections were significantly lower in G1 (42.1% vs. 82%, P=0.01). Duration of total mechanical ventilation and length of ICU stay were comparable between the two groups. Mortality was significantly higher in G2 (64% vs. 28%, P=0.02).
Conclusions
Our study confirmed that awake PP can improve prognosis in COVID-19 patients. Randomized controlled trials are needed to confirm this result.

Pulmonary
Relationship between positive end-expiratory pressure levels, central venous pressure, systemic inflammation and acute renal failure in critically ill ventilated COVID-19 patients: a monocenter retrospective study in France: Pierre Basse, Louis Morisson, Romain Barthélémy, Nathan Julian, Manuel Kindermans, Magalie Collet, Benjamin Huot, Etienne Gayat, Alexandre Mebazaa, Benjamin G. Chousterman; Acute Crit Care. 2023;38(2):172-181. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01494

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Abstract PDF Supplementary Material

Background
The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute kidney injury (AKI) have been poorly described in mechanically ventilated patient secondary to coronavirus disease 2019 (COVID-19).
Methods
This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical intensive care unit between March 2020 and July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the 5 days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end-expiratory pressure (PEEP), CVP, and leukocytes count.
Results
Fifty-seven patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median [IQR], 12 mm Hg [11-13] vs. 10 mm Hg [9–12]; P=0.03). Multivariate models with adjustment on leukocytes and Simplified Acute Physiology Score (SAPS) II confirmed the association between CVP value and risk of WRF (odd ratio, 1.97; 95% confidence interval, 1.12–4.33). Leukocytes count was also associated with occurrence of WRF in the WRF group (14 G/L [11–18]) and the no-WRF group (9 G/L [8–11]) (P=0.002).
Conclusions
In mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF.

Citations

Citations to this article as recorded by

Bidirectional pressure: a mini review of ventilator-lung-kidney interactions
Avnee Kumar, Katie Epler, Sean DeWolf, Laura Barnes, Mark Hepokoski
Frontiers in Physiology.2024;[Epub] CrossRef
Renal venous flow in different regions of the kidney are different and reflecting different etiologies of venous reflux disorders in septic acute kidney injury: a prospective cohort study
Rongping Chen, Hui Lian, Hua Zhao, Xiaoting Wang
Intensive Care Medicine Experimental.2024;[Epub] CrossRef

Meta-analysis
Comparison of safety and efficacy between therapeutic or intermediate versus prophylactic anticoagulation for thrombosis in COVID-19 patients: a systematic review and meta-analysis: Hyeon-Jeong Lee, Hye Jin Jang, Won-Il Choi, Joonsung Joh, Junghyun Kim, Jungeun Park, Miyoung Choi; Acute Crit Care. 2023;38(2):160-171. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01424; Correction in: Acute Crit Care 2023;38(4):516

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Abstract PDF Supplementary Material

Background
Patients with coronavirus disease 2019 (COVID-19) infections often have macrovascular or microvascular thrombosis and inflammation, which are known to be associated with a poor prognosis. Heparin has been hypothesized that administration of heparin with treatment dose rather than prophylactic dose for prevention of deep vein thrombosis in COVID-19 patients.
Methods
Studies comparing therapeutic or intermediate anticoagulation with prophylactic anticoagulation in COVID-19 patients were eligible. Mortality, thromboembolic events, and bleeding were the primary outcomes. PubMed, Embase, the Cochrane Library, and KMbase were searched up to July 2021. A meta-analysis was performed using random-effect model. Subgroup analysis was conducted according to disease severity.
Results
Six randomized controlled trials (RCTs) with 4,678 patients and four cohort studies with 1,080 patients were included in this review. In the RCTs, the therapeutic or intermediate anticoagulation was associated with significant reductions in the occurrence of thromboembolic events (5 studies, n=4,664; relative risk [RR], 0.72; P=0.01), and a significant increase in bleeding events (5 studies, n=4,667; RR, 1.88; P=0.004). In the moderate patients, therapeutic or intermediate anticoagulation was more beneficial than prophylactic anticoagulation in terms of thromboembolic events, but showed significantly higher bleeding events. In the severe patients, the incidence of thromboembolic and bleeding events in the therapeutic or intermediate.
Conclusions
The study findings suggest that prophylactic anticoagulant treatment should be used in patients with moderate and severe COVID-19 infection groups. Further studies are needed to determine more individualized anticoagulation guidance for all COVID-19 patients.

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