Management in the ICU

Patients hospitalised due to infection with SARS-CoV-2 frequently require admission to the ICU for organ support. Most of these admissions are due to acute respiratory failure, often fulfilling the criteria for ARDS. This chapter will review current evidence-based management of this patient population. We discuss how oxygenation can be supported via noninvasive and invasive methods, and describe how invasive ventilation should be set to provide lung protection. We discuss how there is no place for routine antiviral, antibiotic and therapeutic anticoagulation in ICU patients with COVID-19-related ARDS, but there is a place for steroids and immunomodulation via anti-IL-6. Finally, we provide an overview of the complications and long-term consequences of critical illness caused by COVID-19.Copyright © ERS 2021.

DEVELOPMENT AND EVALUATION OF FAVIPIRAVIR AGGLOMERATES FOR DIRECT COMPRESSION BY CRYSTALLO-CO-AGGLOMERATION TECHNIQUE

During the severe worldwide pandemic caused due to SARS COV-2 Corona virus, Favipiravir has been used for the treatment. It is a water insoluble anti-viral drug with poor dissolution and poor flow properties, resulting in poor oral absorption and less bioavailability. For a long time, the phrase "direct compression" was used to describe the compression of a single crystalline component into a compact without the addition of any other materials. Using excipients and solvents, the crystallo-co-agglomeration process aggregates drug crystals in the form of small spherical particles to create an intermediate product with better micromeritic and mechanical characteristics, solubility, and dissolution. Crystallo-co-agglomeration is a unique approach in which the pharmaceuticals or excipients are crystallized and agglomerated concurrently from a good solvent and/or bridging liquid by adding a non-solvent. The present study aims to formulate crystallo-co-agglomerates of Favipiravir to improve its physicochemical and mechanical properties. Results obtained during the evaluation showed that CCA technique could be successfully employed as an alternative to conventional wet agglomeration.

Association of hyperglycaemia with hospital mortality in nondiabetic COVID-19 patients: A cohort study.

OBJECTIVE: Diabetes is a known risk factor for mortality in Coronavirus disease 2019 (COVID-19) patients. Our objective was to identify prevalence of hyperglycaemia in COVID-19 patients with and without prior diabetes and quantify its association with COVID-19 disease course. RESEARCH DESIGN AND METHODS: This observational cohort study included all consecutive COVID-19 patients admitted to John H Stroger Jr. Hospital, Chicago, IL from March 15, 2020 to May 3, 2020 and followed till May 15, 2020. The primary outcome was hospital mortality, and the studied predictor was hyperglycaemia [any blood glucose ≥7.78 mmol/L (140 mg/dL) during hospitalization]. RESULTS: Of the 403 COVID-19 patients studied, 51 (12.7%) died; 335 (83.1%) were discharged while 17 (4%) were still in hospital. Hyperglycaemia occurred in 228 (56.6%) patients; 83 of these hyperglycaemic patients (36.4%) had no prior history of diabetes. Compared to the reference group no-diabetes/no-hyperglycaemia patients the no-diabetes/hyperglycaemia patients showed higher mortality [1.8% versus 20.5%, adjusted odds ratio 21.94 (95% confidence interval 4.04-119.0), P < 0.001]; improved prediction of death (P = 0.01) and faster progression to death (P < 0.01). Hyperglycaemia within the first 24 and 48 h was also significantly associated with mortality (odds ratio 2.15 and 3.31, respectively). CONCLUSIONS: Hyperglycaemia without prior diabetes was common (20.6% of hospitalized COVID-19 patients) and was associated with an increased risk of and faster progression to death. Development of hyperglycaemia in COVID-19 patients who do not have diabetes is an early indicator of progressive disease.

Instability in blood glucose and other effects on allografts following corona virus (COVID-19) infection in simultaneous pancreas-kidney transplant recipient (SPKTR) for type 1 diabetes mellitus

Background: Effects of COVID-19 in SPKTR with its consequences on renal and pancreatic function is reported for the first time. Case Report: 36 years male SPKTR (4/6 mismatch) was admitted with COVID-19 on 7.5 months after an eventful transplantation with serum creatinine 95 μmol/L, no albuminuria and normal pancreatic function-off insulin. Immunosuppression included thymoglobulin induction, Tacrolimus, mycophenolate and prednisolone. Chest X ray showed minimal degree of central pulmonary venous congestion. Low flow nasal oxygen was given for mild tachypnoea for 24 hours. Admission was prolonged for 4 days due to accidental overdose of Tacrolimus (4 times the usual dose) and was discharged home with no concerns. Findings during admission include: (1) Acute renal dysfunction (Day 1) on admission (S Creatinine 119 μmol/L) reverted to baseline in 4 days, despite accidental overdose of Tacrolimus. (2) Metabolic acidosis on admission (S bicarbonate 16) reverted to baseline on day 9. (3) New onset albuminuria (U ACR 56.4 mg/mmol) measured for the first time on day 53 did resolve on day 67. (4) Social isolation lead to weight gain of 6.1 kg on Day 53 was short lived. (5) Asymptomatic transient hypoglycaemia (Blood Glucose 2.0 mmol/L) on day 53 with Serum Insulin 28-31 mU/L (N < 12), C-Peptide 0.83 to 0.99 nmol/L (0.2-0.9) and negative Insulin antibodies reflected transient increase in beta cell dysfunction, in settings of insulin resistance (weight gain, low dose steroids) with beta-cell dysfunction also perturbed by tacrolimus use was considered. Conclusion: SPKTR after COVID-19 infection experienced had short term effects on renal function and metabolic events with no consequences.