ABSTRACT
Background: Severe acute respiratory distress syndrome (ARDS) occurs in nearly 25% of all mechanically ventilated patients in the ICU. With the evolving coronavirus pandemic, ARDS has become even more common. Severe ARDS has a mortality rate estimated at 35%-45%, despite rescue therapies such as proning and ECMO. This indicates there is a need for alternative therapies. Therapeutic hypothermia is a non-invasive therapy that has successfully been used in patients with severe ARDS. Therapeutic hypothermia involves cooling the body to target temperatures of less than 36 degreeC. This has been shown to reduce mortality and improve neurologic outcomes for a select group of patients. Mild therapeutic hypothermia is currently being used to prevent anoxic brain injury post-cardiac arrest in adults and is now being trialed for severe ARDS. Objective(s): To discuss the use of therapeutic hypothermia as rescue therapy for patients with severe ARDS. This presentation will also discuss the current barriers to targeted temperature management. Discussion(s): In some cases, once patients have been proned and fail to improve, extracorporeal membrane oxygenation (ECMO) is considered. ECMO is extremely invasive and has had poor outcomes when used in the adult population. Therapeutic hypothermia is much less invasive than ECMO, especially when using the surface cooling method. Therapeutic hypothermia use has been limited due to a lack of protocols for treatment time as well as how to rewarm patients. In a small-sized study, the group of ARDS patients treated with therapeutic hypothermia was shown to have a significant reduction in mortality compared to the control group. Conclusion(s): For therapeutic hypothermia to be used more frequently, there needs to be further research into the amount of time a patient needs to be cooled for, as well as the speed of rewarming. If these protocols can be developed, therapeutic hypothermia could be a promising rescue therapy for ARDS.
ABSTRACT
Background: Patients with COVID-19 have a high incidence of acute kidney injury (AKI), which is associated with mortality. The objetive of our study is to know the factors associated with AKI, to manage the level of care and health resources according to risk. Method(s): We design an observational retrospective cohort study in 2 hospitals in Bogota, Colombia. Adults hospitalized for > 48 hours between March 2020 and March 2021, with confirmed SARS-CoV-2 infection. The main outcome was incidence of AKI during the first 28 days from admission. A descriptive analysis of the sociodemographic and clinical characteristics of the study population was performed. Univariate and bivariate analysis and multivariate logistic regression model was conducted for the outcome AKI. Result(s): We included 1584 patients, 60.4% male, 46.8% older than 65 years. The incidence of AKI was 46.5%, stage 1 in 60.7%, Stage 2 in 15.7%, and stage 3 in 23.6%. Renal replacement therapy was performed in 11.1% of patients with AKI. Table 1 summarizes cohort characteristics and the bivariate analysis. In the multivariate analysis, sex, age, hypertension, CKD, treatment with oral antidiabetics, diuretics, statins, qSOFA, platelet count, CRP, D-dimer, treatment with vancomycin, piperacillin tazobactam, requirement of vasopressor support were realated with AKI. The interactions antihypertensive /diuretics, PAFI /Requirement of invasive mechanical ventilation, Hypertension /antihypertensives, were associated with AKI (P value <0.5). Hospital crude mortality for AKI was 45.5% versus 11.7% without AKI (p<0.0001) Conclusion(s): AKI is frequent in patients hospitalized with COVID 19, conventional risk factors are the rule, we denote other known markers of severity for COVID-19 in association with AKI. These results allowed us to manage the hospital resource.