Susan A Olender, Katherine K Perez, Alan S Go, Bindu Balani, Eboni G Price-Haywood, Nirav S Shah, Su Wang, Theresa L Walunas, Shobha Swaminathan, Jihad Slim, BumSik Chin, Stéphane De Wit, Shamim M Ali, Alex Soriano Viladomiu, Philip Robinson, Robert L Gottlieb, Tak Yin Owen Tsang, I-Heng Lee, Richard H Haubrich, Anand P Chokkalingam, Lanjia Lin, Lijie Zhong, B Nebiyou Bekele, Robertino Mera-Giler, Joel Gallant, Lindsey E Smith, Anu O Osinusi, Diana M Brainard, Hao Hu, Chloé Phulpin, Holly Edgar, Helena Diaz-Cuervo, Jose I Bernardino
BACKGROUND: We compared the efficacy of the antiviral agent, remdesivir, versus standard-of-care treatment in adults with severe COVID-19 using data from a phase 3 remdesivir trial and a retrospective cohort of patients with severe COVID-19 treated with standard-of-care. METHODS: GS-US-540-5773 is an ongoing phase 3, randomized, open-label trial comparing two courses of remdesivir (remdesivir-cohort). GS-US-540-5807 is an ongoing real-world, retrospective cohort study of clinical outcomes in patients receiving standard-of-care treatment (non-remdesivir-cohort)...
July 24, 2020: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Marlies Ostermann, Nuttha Lumlertgul, Lui G Forni, Eric Hoste
Acute kidney injury (AKI) is a serious complication in critically ill patients with COVID-19 with a reported incidence ranging from <5% to >25%. Proposed aetiologies include hypovolemia, hemodynamic disturbance and inflammation but also specific factors like direct viral invasion, microvascular thrombosis, and altered regulation of the renin-angiotensin-aldosterone system. To date, there are no confirmed specific therapies, and prevention and management of AKI should follow established guidelines. Novel therapies specifically targeting COVID-19 related pathologies are under investigation...
December 2020: Journal of Critical Care
Seena Tabibi, Tara Tabibi, Rosalynn R Z Conic, Nassim Banisaeed, Michael B Streiff
In the 5 months since initial reports of COVID-19 came to light, the death toll due to SARS-CoV-2 has rapidly increased. The morbidity and mortality of the infection varies based upon patient age, comorbid conditions, viral load, and the availability of effective treatments. Findings from limited autopsies, clinical observations, and laboratory data suggest that high cytokine levels and a procoagulant state can precipitate acute respiratory distress syndrome and multi-organ dysfunction syndrome in critically ill patients...
July 15, 2020: Journal of Intensive Care Medicine
Ingrid Egerod, Benjamin Olivares Bøgeskov, Janet F Jensen, Lisa Dahlager, Dorthe Overgaard
BACKGROUND: Life-threatening illness can be devastating for patients as they experience shifting levels of consciousness, recurrent delirium, and repeated setbacks. Narrative Medicine and its sub-discipline Narrative Critical Care increase healthcare professionals' understanding of the patient perspective, and interpretation of their stories is a means to improving practice. PURPOSE: We aimed to investigate book length first-person accounts of critical illness to gain a deeper understanding of universal and individual patient responses and to provide an example of Narrative Critical Care...
October 2020: Journal of Critical Care
Seyed MohammadReza Hashemian, Tayebeh Farhadi, Ali Akbar Velayati
INTRODUCTION: Candidemia is the fourth frequent reason of healthcare-related bloodstream infections in critically ill patients. For initial management of (suspected) invasive candidiasis in critically ill patients, usage of an echinocandin, e.g. caspofungin, has been recommended. AREAS COVERED: In this study, characteristics of caspofungin and its use in intensive care unit (ICU) patients are reviewed based on an electronic search using PubMed and Google scholar...
December 2020: Expert Review of Anti-infective Therapy
Akash Deep, Mehak Bansal, Zaccaria Ricci
Children seem to be less severely affected by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) as compared to adults. Little is known about the prevalence and pathogenesis of acute kidney injury (AKI) in children affected by SARS-CoV-2. Dehydration seems to be the most common trigger factor, and meticulous attention to fluid status is imperative. The principles of initiation, prescription, and complications related to renal replacement therapy are the same for coronavirus disease (COVID) patients as for non-COVID patients...
July 14, 2020: Blood Purification
Yiqi Fu, Qing Yang, Min Xu, Haishen Kong, Hongchao Chen, Yajie Fu, Yake Yao, Hua Zhou, Jianying Zhou
Secondary bacterial infections occurred in 13.9% (5 of 36) of critical ill patients with coronavirus disease 2019. All 5 patients had been admitted to intensive care unit and received mechanical ventilation before developing bacterial infection. Active surveillance of culture should be performed for critically ill patients. Prevention of nosocomial infection should to be taken seriously.
June 2020: Open Forum Infectious Diseases
Tarun D Singh, John C O'Horo, Courtney N Day, Jay Mandrekar, Alejandro A Rabinstein
BACKGROUND: Acute encephalopathy (AE) is a common complication of critical illness and is associated with increased short and long-term mortality. In this study, we evaluated the role of cefepime in causing AE. METHODS: Retrospective case-control study involving consecutive patients enrolled in the intensive care units (ICUs) of Mayo Clinic Rochester, MN between July 1, 2004 and December 31, 2015. AE was defined by the presence of delirium or depressed level of consciousness in the absence of deep sedation...
July 1, 2020: Neurocritical Care
Paul J Secombe, Alex Brown, Michael J Bailey, David Pilcher
No abstract text is available yet for this article.
July 2020: Medical Journal of Australia
Prashant Rao, Daniel Katz, Michinari Hieda, Marwa Sabe
The incidence of cardiogenic shock and the utilization of mechanical circulatory support devices are increasing in the US. In this review we discuss the pathophysiology of cardiogenic shock through basic hemodynamic and myocardial energetic principles. We also explore the commonly used platforms for temporary mechanical circulatory support, their advantages, disadvantages and practical considerations relating to implementation and management. It is through the translation of underlying physiological principles that we can attempt to maximize the clinical utility of circulatory support devices and improve outcomes in cardiogenic shock...
July 2020: Heart Failure Clinics
Christian Sebat, Mary Anne Vandegrift, Sean Oldroyd, Andrew Kramer, Frank Sebat
BACKGROUND: Capillary refill time (CRT) is easy, quick to perform and when prolonged in critical illness, correlates with progression of organ failure and mortality. It is utilized in our hospital's early warning score (EWS) as one of 11 parameters. We sought to define CRT's value in predicting patient outcomes, compared to the remaining EWS elements. METHODS: Five-year prospective observational study of 6480 consecutive Rapid Response Team (RRT) patients. CRT measured at the index finger was considered prolonged if time to previous-color return was >3 s...
August 2020: Resuscitation
Francesco Licciardi, Giulia Pruccoli, Marco Denina, Emilia Parodi, Manuela Taglietto, Sergio Rosati, Davide Montin
We describe 2 children with persistent fever and profuse diarrhea who developed signs of mucocutaneous involvement (conjunctivitis, fissured lips, skin rash, erythema, and edema of the hands and feet). Blood tests revealed elevated markers of inflammation, lymphopenia, thrombocytopenia, and complement consumption. Afterward, diffuse edema with hypoalbuminemia appeared in the context of a capillary leak syndrome. In both patients, repeated nasal swabs were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but each patient had high titers of immunoglobulin G and immunoglobulin M against the SARS-CoV-2 virus...
August 2020: Pediatrics
Mandeep R Mehra, Sapan S Desai, Frank Ruschitzka, Amit N Patel
BACKGROUND: Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19. METHODS: We did a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19...
May 22, 2020: Lancet
Yeming Wang, Dingyu Zhang, Guanhua Du, Ronghui Du, Jianping Zhao, Yang Jin, Shouzhi Fu, Ling Gao, Zhenshun Cheng, Qiaofa Lu, Yi Hu, Guangwei Luo, Ke Wang, Yang Lu, Huadong Li, Shuzhen Wang, Shunan Ruan, Chengqing Yang, Chunlin Mei, Yi Wang, Dan Ding, Feng Wu, Xin Tang, Xianzhi Ye, Yingchun Ye, Bing Liu, Jie Yang, Wen Yin, Aili Wang, Guohui Fan, Fei Zhou, Zhibo Liu, Xiaoying Gu, Jiuyang Xu, Lianhan Shang, Yi Zhang, Lianjun Cao, Tingting Guo, Yan Wan, Hong Qin, Yushen Jiang, Thomas Jaki, Frederick G Hayden, Peter W Horby, Bin Cao, Chen Wang
BACKGROUND: No specific antiviral drug has been proven effective for treatment of patients with severe coronavirus disease 2019 (COVID-19). Remdesivir (GS-5734), a nucleoside analogue prodrug, has inhibitory effects on pathogenic animal and human coronaviruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro, and inhibits Middle East respiratory syndrome coronavirus, SARS-CoV-1, and SARS-CoV-2 replication in animal models. METHODS: We did a randomised, double-blind, placebo-controlled, multicentre trial at ten hospitals in Hubei, China...
May 16, 2020: Lancet
Ana Paula de Carvalho Panzeri Carlotti, Werther Brunow de Carvalho, Cíntia Johnston, Isadora Souza Rodriguez, Artur Figueiredo Delgado
This review aims to verify the main epidemiologic, clinical, laboratory-related, and therapeutic aspects of coronavirus disease 2019 (COVID-19) in critically ill pediatric patients. An extensive review of the medical literature on COVID-19 was performed, mainly focusing on the critical care of pediatric patients, considering expert opinions and recent reports related to this new disease. Experts from a large Brazilian public university analyzed all recently published material to produce a report aiming to standardize the care of critically ill children and adolescents...
2020: Clinics
Ivor S Douglas, Philip M Alapat, Keith A Corl, Matthew C Exline, Lui G Forni, Andre L Holder, David A Kaufman, Akram Khan, Mitchell M Levy, Gregory S Martin, Jennifer A Sahatjian, Eric Seeley, Wesley H Self, Jeremy A Weingarten, Mark Williams, Douglas M Hansell
BACKGROUND: Fluid and vasopressor management in septic shock remains controversial. In this randomized controlled trial, we evaluated the efficacy of dynamic measures (stroke volume change during passive leg raise) to guide resuscitation and improve patient outcome. RESEARCH QUESTION: Will resuscitation that is guided by dynamic assessments of fluid responsiveness in patients with septic shock improve patient outcomes? STUDY DESIGN AND METHODS: We conducted a prospective, multicenter, randomized clinical trial at 13 hospitals in the United States and United Kingdom...
October 2020: Chest
Ning Tang, Huan Bai, Xing Chen, Jiale Gong, Dengju Li, Ziyong Sun
BACKGROUND: A relatively high mortality of severe coronavirus disease 2019 (COVID-19) is worrying, and the application of heparin in COVID-19 has been recommended by some expert consensus because of the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy remains to be validated. METHODS: Coagulation results, medications, and outcomes of consecutive patients being classified as having severe COVID-19 in Tongji hospital were retrospectively analyzed...
May 2020: Journal of Thrombosis and Haemostasis: JTH
Jason Phua, Li Weng, Lowell Ling, Moritoki Egi, Chae-Man Lim, Jigeeshu Vasishtha Divatia, Babu Raja Shrestha, Yaseen M Arabi, Jensen Ng, Charles D Gomersall, Masaji Nishimura, Younsuck Koh, Bin Du
As coronavirus disease 2019 (COVID-19) spreads across the world, the intensive care unit (ICU) community must prepare for the challenges associated with this pandemic. Streamlining of workflows for rapid diagnosis and isolation, clinical management, and infection prevention will matter not only to patients with COVID-19, but also to health-care workers and other patients who are at risk from nosocomial transmission. Management of acute respiratory failure and haemodynamics is key. ICU practitioners, hospital administrators, governments, and policy makers must prepare for a substantial increase in critical care bed capacity, with a focus not just on infrastructure and supplies, but also on staff management...
April 6, 2020: Lancet Respiratory Medicine
Chenguang Shen, Zhaoqin Wang, Fang Zhao, Yang Yang, Jinxiu Li, Jing Yuan, Fuxiang Wang, Delin Li, Minghui Yang, Li Xing, Jinli Wei, Haixia Xiao, Yan Yang, Jiuxin Qu, Ling Qing, Li Chen, Zhixiang Xu, Ling Peng, Yanjie Li, Haixia Zheng, Feng Chen, Kun Huang, Yujing Jiang, Dongjing Liu, Zheng Zhang, Yingxia Liu, Lei Liu
Importance: Coronavirus disease 2019 (COVID-19) is a pandemic with no specific therapeutic agents and substantial mortality. It is critical to find new treatments. Objective: To determine whether convalescent plasma transfusion may be beneficial in the treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design, Setting, and Participants: Case series of 5 critically ill patients with laboratory-confirmed COVID-19 and acute respiratory distress syndrome (ARDS) who met the following criteria: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment; Pao2/Fio2 <300; and mechanical ventilation...
April 28, 2020: JAMA
Jinoos Yazdany, Alfred H J Kim
No abstract text is available yet for this article.
June 2, 2020: Annals of Internal Medicine
2020-04-10 19:27:48
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