[Prise en charge des formes graves de Covid-19 en reanimation]

MANAGEMENT OF CRITICAL COVID-19 IN THE INTENSIVE CARE UNIT The management of patients with severe to critical forms of Covid-19 in the intensive care unit includes oxygen therapy to treat the deep hypoxaemia induced by the disease, either delivered non-invasively (high concentration mask, high flow oxygen therapy, NIV) or invasively after oro-tracheal intubation in the most severe forms. The symptomatic management becomes then similar to that of an acute respiratory distress syndrome (ARDS) of other origin with the introduction of protective mechanical ventilation, sedation or even curarisation, and prone positioning in the most hypoxemic patients. Other organ failures, including haemodynamic and renal failures, should also be diagnosed and treated. Thrombo-prophylaxis at a higher than usual dose (intermediate or even curative dose) should also be initiated in the acute phase of the disease. Finally, specific treatment is mainly based on systemic corticosteroid therapy with dexamethasone 6 mg/d, possibly combined with tocilizumab. Other Covid-19-specific treatments have not yet been proven to be effective in critical care patients.

Interleukine 6 is associated with severity and poor outcome in ICU-patients with SARS-CoV-2 infection

Background-aim: SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in Covid-19 patients admitted in ICU Methods: We performed a retrospective multicenter study including all patients with SARS-Cov-2 infection admitted in 3 ICUs between March 1st and April 15th 2020, with at least 2 measurements of Interleukin 6 (IL6) in 4 days (baseline and day 3-4). Patients who received immunomodulatory treatment were excluded. IL6 was measured on serum by ELISA (Quantikine R&D Systems) and results were expressed at median [25th – 75th percentile]. The relationship between IL6 and CRP, organ failure severity (SOFA score) or in-ICU mortality was analyzed. Results: From the 140 patients admitted in the 3 ICU for SARS-Cov2 infection (PCR diagnosis), 101 patients were included, the mean age was 59 ± 11 years with a high proportion of men (82%). Patients had severe respiratory disease with media SOFA score of 4 [3-7] and 83 required endotracheal intubation/mechanical ventilation at baseline. An increase of SOFA score between baseline and day3-4 was observed in 32 patients (worsening group). Baseline measurements were done 14 days [11-20] after onset of symptoms. At the end of the study, on April 15th 2020, 47 patients had been discharged from ICU, 35 were still in ICU, and 19 had died in ICU. Baseline IL6 concentrations were positively associated with SOFA score. Moreover, baseline IL-6 and CRP concentrations were significantly higher in the worsening group vs the non-worsening: 278 [70-622] vs 71 [29-153] pg/mL (P<0.01) for IL6 and 178 [100-295] vs 100 [37-213] mg/L (P<0.05) for CRP. However, IL6 concentrations were not correlated with CRP. Il6 and CRP concentrations were higher in non-survivors at baseline and at day 3-4. CRP significantly decreased in survivors (190 [80-248] to 108 [45-185], P<0.05) whereas IL6 decreased in both groups. Conclusions: In this multicenter cohort of ICU patients with SARS-CoV-2 infection, we found that Il6 was associated with organ failure severity, worsening and poor outcome.

I Stink, Therefore I Mink: A Manifesto

The recent mass culling of mink in Denmark and elsewhere, following the animals' contamination by a COVID-19 variant, is taken as a re-entry point into Derrida and Lacan's mink-mediated conversation in The Beast and the Sovereign. Out of the etymological 'stink' attached to the mink emerges an animot gifted with (unlimited) ink, with a potential to disturb philosophies of language, to write back or strike back, as it has recently done in the form of alignments of dead yet resurfacing animals. In the wake of Derrida's verbal disseminations around the vison, and of Lacan's attribution of a 'sort of language' to the animal in The Formations of the Unconscious, this essay follows an animal pack with includes the 17 million mink programmed for (double) extinction by inhumation and cremation. A hauntology follows, adumbrated by Lacan's interest in the 'secretion' of fur, mink oil and (psychoanalytic) sense, and by Derrida's encounter with the neoliberal, crypto-vison Alain Minc in 1994.

Tocilizumab and COVID-19: Timing of administration assessment.

Recent evidence showed greater efficacy of tocilizumab (TCZ) in the subgroups of COVID-19 patients who presented with symptoms for less than 7 days and in those only receiving oxygen. We retrospectively analyzed a compassionate use cohort to determine the best timing for TCZ injection. We showed no association between the timing of injection after symptom onset and the efficacy of TCZ on mortality. We then investigated whether the oxygen level at the time of TCZ injection impacted the mortality rate. Our study finally suggested that TCZ could be less effective when oxygen requirement is >11L/min and we hypothesized that earlier administration could be associated with better outcome. However, randomized clinical trials are required to confirm this hypothesis.