The effect of therapeutic plasma exchange therapy on veno-venous ECMO weaning success in severe COVID-19 ARDS patients.

INTRODUCTION: Primarily, this study aimed to investigate the effect of TPE (therapeutic plasma exchange) treatment on successful ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO. METHODS: The study was applied retrospectively on patients over the age of 18 who were hospitalized in the ICU between January 1, 2020 and March 1, 2022. RESULTS: The study was performed on 33 patients, 36.3% (n: 12) of whom received TPE treatment. The rate of successful ECMO weaning was statistically higher in the TPE treatment group (without TPE: 14.3% [n: 3], with TPE: 50% [n: 6], p = 0.044). The 1-month mortality was also statistically lower in the TPE treatment group (p = 0.044). In the logistic analysis, It was found that the risk of unsuccessful ECMO weaning increased 6 times in those who did not receive TPE treatment (OR; 6.0, 95% CI; 1.134-31.735, p = 0.035). CONCLUSION: TPE treatment may increase the success rate of V-V ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO.

V-V ECMO Vascular Cannula Problems: 3 Case Report

The vascular cannulation step is of great importance for the effective and safe implementation of extracorporeal membrane oxygenation (ECMO) support. We experienced various problems associated with ECMO vascular cannulation (malposition, thrombosis, recannulation, collapse) in 3 patients who developed coronavirus disease-2019 acute respiratory distress syndrome and received veno-venous ECMO support, and here we share our experience in their management. Appropriate vascular cannula size, vascular cannula structure, selection of the vascular cannulation site, and precise vascular cannulation can make ECMO support more effective and reliable. (English) [ FROM AUTHOR]

The Effect of Host miRNAs on Prognosis in COVID-19: miRNA-155 May Promote Severity via Targeting Suppressor of Cytokine Signaling 1 (SOCS1) Gene.

The epigenetic features contribute to variations in host susceptibility to SARS-CoV-2 infection and severity of symptoms. This study aimed to evaluate the relationship between the relative expression of microRNAs (miRNAs) and the severity of the disease in COVID-19 patients. The miRNA profiles were monitored during the different stages of the disease course using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The expression levels of the selected 11 miRNAs were measured in the blood samples collected from 73 patients (moderate, n = 37; severe, n = 25; critically ill, n = 11, a total of 219 longitudinal samples) on hospitalization day and days 7 and 21. Expression changes were expressed as "fold change" compared to healthy controls (n = 10). Our study found that several miRNAs differed according to disease severity, with the miR-155-5p the most strongly upregulated (p = 0.0001). A statistically significant negative correlation was observed between the expression of miR-155-5p and its target gene, the suppressor of cytokine signaling 1 (SOCS1). The relative expression of miR-155-5p was significantly increased and SOCS1 was significantly decreased with the disease progression (r = -0.805 p = 0.0001, r = -0.940 p = 0.0001, r = -0.933 p = 0.0001 for admission, day 7, and day 21, respectively). The overexpression of miR-155-5p has significantly increased inflammatory cytokine production and promoted COVID-19 progression. We speculated that microRNA-155 facilitates immune inflammation via targeting SOCS1, thus establishing its association with disease prognosis.

Simplified calculation of mechanical power for pressure controlled ventilation in Covid-19 ARDS patients.

BACKGROUND: Mechanical power (MP) is a promising tool for guidance of lung protective ventilation. Different equations have been proposed to calculate MP in pressure control ventilation (PCV). The aim of this study is to introduce an easy to use MP equation MPpcv(m-simpl) and compare it to an equation proposed by Van der Meijden et al. (MPpcv) which considered as the reference equation in PCV. METHODS: Ventilatory parameters of 206 Covid-19 ARDS patients recorded between 24-72 hours after admission to intensive care unit. The PCV data from these patients were retrospectively investigated. MP in PCV was calculated with a modified equation (MPpcv(m-simpl)) derived from the equation (MPpcv) of Van der Meijden et al.: 0.098xRRx∆Vx(PEEP+∆Pinsp - 1). The results from MPpcv(slope), MPpcv(simpl), and MPpcv(m-simpl) were compared to MPpcv at 15 cmH2O ∙ s/L inspiratory resistance levels by univariable regression and Bland-Altman analysis. RESULTS: Inspiratory resistance levels at 15 cmH2O s/L was found to be correlated between the power values calculated by MPpcv(simpl)/MPpcv(m-simpl) and the MPpcv(slope)/MPpcv based on univariable logistic regression (R2≥98) analyses. In the comparison of all patients average MP values computed by the MPpcv(m-simpl) equation and the MPpcv reference equation. Bland-Altman analysis mean difference and p values at 15 cmH2O s/L inspiratory resistance values (J/min) were found to be MPpcv(m-simpl) vs MPpcv=-0,04 (P=0.014); MPpcv(slope) vs. MPpcv=0.63 (P<0.0001); MPpcv(simpl) vs. MPpcv=0.64 J/min (P<0.0001), respectively. CONCLUSIONS: The results of this study confirmed that the MPpcv(m-simpl) equation can be used easily to calculate MP at bedside in pressure control ventilated COVID-19 ARDS patients.

Comparison of Respiratory and Hemodynamic Parameters of COVID-19 and Non-COVID-19 ARDS Patients.

BACKGROUND: COVID-19 can cause a clinical spectrum from asymptomatic disease to life-threatening respiratory failure and acute respiratory distress syndrome (ARDS). There is an ongoing discussion whether the clinical presentation and ventilatory parameters are the same as typical ARDS or not. There is no clear understanding of how the hemodynamic parameters have been affected in COVID-19 ARDS patients. We aimed to compare hemodynamic and respiratory parameters of moderate and severe COVID-19 and non-COVID-19 ARDS patients. These patients were monitored with an advanced hemodynamic measurement system by the transpulmonary thermodilution method in prone and supine positions. PATIENTS AND METHODS: Data of 17 patients diagnosed with COVID-19 and 16 patients diagnosed with other types of diseases with moderate and severe ARDS, mechanically ventilated, placed in a prone position, had advanced hemodynamic measurements with PiCCO, and stayed in the intensive care unit for more than a week were analyzed retrospectively. Patient characteristics and arterial blood gases analysis recorded at admission and respiratory and advanced hemodynamic parameters during the first week were compared in prone and supine positions. RESULTS: No difference was observed in the respiratory parameters including respiratory system compliance between COVID-19 and non-COVD-19 patients in prone and supine positions. In comparison of advanced hemodynamic parameters in the first week of intensive care, the extravascular lung water and pulmonary vascular permeability indexes measured in supine position of COVID-19 ARDS patients were found to be significantly higher than non-COVID-19 patients. Duration of prone position was significantly longer in patients diagnosed with COVID-19 ARDS. CONCLUSIONS: The results of this study suggested that COVID-19 ARDS is a variant of typical ARDS with a different pathophysiology. HOW TO CITE THIS ARTICLE: Asar S, Acicbe Ö, Sabaz MS, Tontu F, Canan E, Cukurova Z, et al. Comparison of Respiratory and Hemodynamic Parameters of COVID-19 and Non-COVID-19 ARDS Patients. Indian J Crit Care Med 2021;25(6):704-708.