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1.
Trends in Anaesthesia and Critical Care ; : 101208, 2022.
Article in English | ScienceDirect | ID: covidwho-2165884

ABSTRACT

Introduction COVID-19 can lead to acute respiratory failure (ARF) requiring admission to intensive care unit (ICU). This study analyzes COVID-19 patients admitted to the ICU, according to the initial respiratory support. Its main aim is to determine if the use of combination therapy: high-flow oxygen system with nasal cannula (HFNC) and non-invasive ventilation (NIV), is effective and safe in the treatment of these patients. Methods Retrospective observational study with a prospective database. All COVID-19 patients, admitted to the ICU, between March 11, 2020, and February 12, 2022, and who required HFNC, NIV, or endotracheal intubation with invasive mechanical ventilation (ETI-IMV) were analyzed. HFNC failure was defined as therapeutic escalation to NIV, and NIV failure as the need for ETI-IMV or death in the ICU. The management of patients with non-invasive respiratory support included the use of combined therapy with different devices. The study period included the first six waves of the pandemic in Spain. Results 424 patients were analyzed, of whom 12 (2.8%) received HFNC, 397 (93.7%) NIV and 15 (3.5%) ETI-IMV as first respiratory support. PaO2/FiO2 was 145 ± 30, 119 ± 26 and 117 ± 29 mmHg, respectively (p = 0.003). HFNC failed in 11 patients (91.7%), who then received NIV. Of the 408 patients treated with NIV, 353 (86.5%) received combination therapy with HFNC. In patients treated with NIV, there were 114 failures (27.9%). Only the value of SAPS II index (p = 0.001) and PaO2/FiO2 (p < 0.001) differed between the six analyzed waves, being the most altered values in the 3rd and 6th waves. Hospital mortality was 18.7%, not differing between the different waves (p = 0.713). Conclusions Severe COVID-19 ARF can be effectively and safely treated with NIV combined with HFNC. The clinical characteristics of the patients did not change between the different waves, only showing a slight increase in severity in the 3rd and 6th waves, with no difference in the outcome.

2.
Frontiers in Medicine ; 9, 2022.
Article in English | Web of Science | ID: covidwho-2163045

ABSTRACT

IntroductionAfter the rapid surge of a novel coronavirus (SARS-CoV-2) in 2020 anti-SARS-CoV-2 vaccines have been developed to prevent the development of critical forms of COVID-19 leading to Intensive Care Unit (ICU) admission. The possibility of ICU admission after the first-cycle vaccination has been already reported;however, no data have been published regarding vaccinated patients with a "booster" dose. This retrospective study describes the characteristics of critically ill patients after the implementation of the regional "booster" dose vaccination program in a southern region of Italy. Materials and methodsWe screened all medical records of critically ill COVID-19 patients in the period between January to April 2022. We collected the demographic characteristics, the presence of comorbidities, the vaccination status, the clinical course (arterial blood gases and type of respiratory support) and outcomes (rate of tracheostomy, ICU length of stay and mortality). ResultsA total of 272 patients were admitted to ICUs during the study period. 161 patients were unvaccinated, whereas 111 were vaccinated with the complete first-cycle or "booster" dose. The type of respiratory support was similar between groups. Vaccinated patients were characterized by a better oxygenation throughout the whole ICU length of stay. Fourteen unvaccinated and 3 vaccinated patients required tracheostomy (p = 0.045). ICU length of stay was 12.2 (+/- 7.3) days in unvaccinated patients and 10.4 (+/- 6.7) days in vaccinated patients (p = 0.036). ICU mortalities were 38.5 and 24.3% in unvaccinated and vaccinated patients, respectively (p = 0.014). ConclusionVaccinated patients have better clinical course and outcomes as compared to the unvaccinated population.

3.
Journal for ImmunoTherapy of Cancer ; 10(Supplement 2):A957, 2022.
Article in English | EMBASE | ID: covidwho-2161948

ABSTRACT

Background Immune checkpoint inhibitors are a newer modality of systemic cancer-directed therapy that is often more tolerable and has broader eligibility criteria than traditional cytotoxic chemotherapy. Unfortunately, pneumonitis is a feared complication of these drugs in around 5% of all patients, including a rare risk of death. Per professional guidelines, there are no pathognomonic features in radiology, clinical history, or laboratory testing to confirm pneumonitis. The global COVID-19 pandemic and the widespread utilization of these drugs have complicated this diagnostic challenge. We sought to develop a systematic method to measure the incidence of different etiologies of acute respiratory failure in the current landscape. Methods We developed a novel patient registry from a retrospective cohort of patients treated with an immune checkpoint inhibitor for cancer and then presented to the hospital after the onset of the COVID19 pandemic in this region. We created a novel case report template in REDCap that collected all relevant data from clinical documentation, imaging reports, and laboratory values during the hospitalization and follow-up. The template prompted the physician reviewer to attribute the respiratory failure based on diagnostic criteria from professional guidelines. Results Our retrospective cohort was made up of 110 patients who had 304 separate hospitalizations between March 2020 and June 2022. Nearly half of these encounters (n = 138, 45%) had a respiratory complaint noted on admission, and an additional 36 encounters (11%) had respiratory testing at any point during their hospitalization. Respiratory complaints were most commonly due to bacterial pneumonia (n = 52, 30.2%), COPD exacerbations (n = 20, 11.6%), pleural effusions (n = 18, 10.5%), malignant obstruction (n = 18, 10.5%), multiple etiologies (n = 16, 9.3%), other etiologies (n = 16, 9.3%), checkpoint inhibitor pneumonitis (n = 3, 2%) and COVID19 pneumonia (n = 2, 1%). Conclusions Our analysis found that respiratory evaluations occurred in most hospitalizations among patients receiving an immune checkpoint inhibitor for cancer. Although the current widespread use of these drugs and the COVID19 pandemic have altered the diagnosis and management of respiratory failure patients with cancer, most cases were still due to bacterial infections or malignant progression. Our study also provides proof-of-concept for a novel case report template form that can systematically collect and categorize data from these complicated hospitalizations.

4.
Medicina Intensiva (English Edition) ; 2022.
Article in English | ScienceDirect | ID: covidwho-2159547

ABSTRACT

Objective To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design Cohort, prospective and observational study. Setting Post-intensive care multidisciplinary program. Patients or participants Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. Interventions Inclusion in the post-ICU multidisciplinary program. Main variables of interest Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF);brachial plexopathy (10.7% IMV vs 0% ONAF);decrease in grip strength: right hand 20.67 kg (+/- 8.27) in VMI vs 31.8 kg (+/- 11.59) in ONAF and left hand 19.39 kg (+/- 8.45) in VMI vs 30.26 kg (+/- 12.74) in ONAF;and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions. Resumen Objetivo Describir las secuelas al mes del alta hospitalaria en pacientes que precisaron ingreso en Cuidados Intensivos por neumonía grave COVID-19 y analizar las diferencias entre los que recibieron terapia exclusivamente con oxigenoterapia con alto flujo con respecto a los que precisaron ventilación mecánica invasiva (VMI). Diseño Estudio de cohorte, prospectivo y observacional. Ámbito Consulta multidisciplinar post cuidados intensivos. Pacientes o participantes Pacientes que superaron el ingreso en la unidad de cuidados intensivos (UCI) por neumonía grave COVID 19 desde abril 2020 hasta octubre 2021. Intervenciones Inclusión en el programa multidisciplinar post UCI. Variables de interés principals Secuelas motoras, sensitivas, psicológicas/psiquiátricas, respiratorias y nutricionales tras el ingreso hospitalario. Resultados Se incluyeron 104 pacientes. 48 pacientes recibieron oxigenoterapia nasal de alto flujo (ONAF) y 56 ventilación mecánica invasiva (VMI). Las principales secuelas encontradas fueron la neuropatía distal (33,9% VMI vs 10,4% ONAF);plexopatía braquial (10,7% VMI vs 0% ONAF);disminución de fuerza de agarre: mano derecha 20,67 kg (+/- 8,27) en VMI vs 31,8 kg (+/- 11,59) en ONAF y mano izquierda 19,39 kg (+/- 8,45) en VMI vs 30,26 kg (+/- 12,74) en ONAF;y balance muscular limitado en miembros inferiores (28,6% VMI vs 8,6% ONAF). Las diferencias observadas entre ambos grupos no alcanzaron significación estadística en el estudio multivariable. Conclusiones Los resultados obtenidos tras el estudio multivariable sugieren no existir diferencias en cuanto a las secuelas físicas percibidas al mes del alta hospitalaria en función de la terapia respiratoria empleada, ya fuera oxigenoterapia nasal de alto flujo o ventilación mecánica prolongada, si bien son precisos más estudios para poder obtener conclusiones al respecto.

5.
International Journal of Nursing Studies Advances ; 4, 2022.
Article in English | Scopus | ID: covidwho-2158993

ABSTRACT

Background: Although people receiving invasive home mechanical ventilation through a tracheostomy are facing both physical and mental health challenges, healthcare services often focus mainly on physical symptoms. To ensure well-functioning treatment and care for people receiving tracheostomy ventilation in a home setting, their mental health needs to be promoted and seen as an integral part of their health in general. Objective: This scoping review aimed to provide a summary of the current knowledge on the mental health of people receiving invasive home mechanical ventilation through a tracheostomy. Design: A scoping review of published and gray literature based on the framework developed by Arksey and O'Malley and refined by the JBI was performed. The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist was used for reporting the findings. Methods: A literature search was conducted by two researchers independently in the PubMed, CINAHL and PsycINFO databases. Additional searches for gray literature were conducted in Google, Google Scholar, websites of selected organisations, and the reference lists of included studies. The software system Covidence was used in the study selection process. For critical appraisal, the Mixed Methods Appraisal Tool was used. Results: Thirteen studies were included in this review, of which six used qualitative, six quantitative, and one mixed methods. The majority of studies were authored in Europe (n = 10), followed by the Americas (n = 2) and the Western Pacific (n = 1). Mental health was investigated both directly and indirectly (61.5% vs. 38.5%). Categorizing the reported mental health outcomes, we found that emotional well-being was reported widely across the studies (n = 13), while psychological well-being (n = 5) and social well-being (n = 4) were less widely reported. Conclusions: The mental health of people receiving home tracheostomy ventilation has received some scholarly attention. A heterogeneity of mental health outcomes was reported in the literature with emotional well-being being an important mental health area both in relation to the sub-components positive affect and quality of life appraisal. Mental health outcomes in relation to psychological well-being and social well-being were fragmented and only sparsely investigated. © 2022 The Author(s)

6.
Cytokine ; 162:156111, 2023.
Article in English | ScienceDirect | ID: covidwho-2158716

ABSTRACT

Objectives Elevated concentrations of soluble urokinase plasminogen activator receptor (suPAR) predict progression to severe respiratory failure (SRF) or death among patients with COVID-19 pneumonia and guide early anakinra treatment. As suPAR testing may not be routinely available in every health-care setting, alternative biomarkers are needed. We investigated the performance of C-reactive protein (CRP), interferon gamma-induced protein-10 (IP-10) and TNF-related apoptosis-inducing ligand (TRAIL) for predicting SRF or death in COVID-19. Methods Two cohorts were studied;one discovery cohort with 534 patients from the SAVE-MORE clinical trial;and one validation cohort with 364 patients from the SAVE trial including also 145 comparators. CRP, IP-10 and TRAIL were measured by the MeMed Key® platform in order to select the biomarker with the best prognostic performance for the early prediction of progression into SRF or death. Results

7.
Hepatology ; 76(Supplement 1):S225-S226, 2022.
Article in English | EMBASE | ID: covidwho-2157782

ABSTRACT

Background: T-cell chronic active Epstein-Barr virus infection (CAEBV) is a rare disease in which patients have the Epstein-Barr virus (EBV) present mainly in the T-cells, which infiltrate tissues like the liver, and bone marrow. Patients eventually develop liver failure, hemophagocytic lymph histiocytosis (HLH), coronary artery aneurysms, EBV infiltrating T-cells impairing organ function, or T-cell lymphomas. Prognosis is poor. The current treatment of choice is an allogeneic hematopoietic stem cell transplant. A study by the NIH and Baylor College of Medicine, which reviewed 28 years of data, only found 19 cases of CAEBV. We aim to report a rare case of T-cell chronic active Ebstein-Barr Virus (CAEBV) complicated by the development of HLH and T-Cell LPD. Method(s): A chart review of the CAEBV patient was performed, focusing on disease progression, treatment plans, and complications. Result(s): A 45-year- old Latin American woman from Mexico initially presented with abnormal liver enzymes after taking herbal medications. The patient underwent a liver biopsy and was initiated on prednisone for possible autoimmune hepatitis pending the biopsy report. The liver biopsy showed EBV hepatitis with EBV positive atypical T-cell infiltrate with steatohepatitis and marked steatosis. Prednisone was stopped, and the patient was referred to Hematology. Plasma EBV level was elevated to 3300 IU/mL. The patient was readmitted for sepsis and pancytopenia prior to being seen by Hematology. Bone marrow biopsy showed EBV+T-cell LPD and HLH, and the patient was started on dexamethasone and rituximab. The patient improved, and dexamethasone was weaned off. Subsequently the patient has had numerous hospital admissions for ESBL UTI, CoNS bacteremia, aspiration pneumonia, vocal cord dysfunction, EBV pneumonia, PCP pneumonia, chemotherapy-induced neuropathy, neutropenic fever, chronic respiratory failure and EBV reactivation. The patient underwent multiple rounds of chemotherapy with rituximab and R-CHOP regimen for persistent HLH. In spite of the treatment, the patient developed EBV encephalitis, further complicated by COVID -19 infection. Her family opted for comfort care, and the patient passed away in the hospital. Conclusion(s): Approximately 95% of adults are infected with EBV at some point in their lives and are asymptomatic in most cases. Very rarely do patients develop CAEBV -a life-threatening disease. Allogeneic stem cell transplant should be considered early on in the disease. Unfortunately, our patient had social factors such as lack of insurance and social support that prevented her from getting a timely stem cell transplant. (Figure Presented).

8.
Rassegna di Patologia dell'Apparato Respiratorio ; 37(3):153-155, 2022.
Article in Italian | EMBASE | ID: covidwho-2156218
9.
Cureus ; 14(11):e32087, 2022.
Article in English | EuropePMC | ID: covidwho-2155779

ABSTRACT

Background High-flow oxygen therapy (HFOT) has been widely used as an effective alternative to invasive mechanical ventilation (IMV) in some critically ill patients with COVID-19 pneumonia. This study aimed to compare different tools, including the respiratory rate and oxygenation (ROX) index, to predict HFOT failure in this setting. Methodology This single-center retrospective observational study was conducted from September to December 2020 and assessed COVID-19 patients who required HFOT as the first treatment at admission;HFOT failure was defined as IMV use. Prognostic scoring tools were as follows: the Sequential Organ Failure Assessment (SOFA), Acute Physiology And Chronic Health Evaluation (APACHE) II, and Simplified Acute Physiology Score (SAPS) III scores;C-reactive protein;lung consolidation percentage on chest CT;mean partial pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FiO2) ratio;and ROX index and modified ROX index, calculated using PaO2 instead of blood oxygen saturation, within the first 24 hours after admission to the intensive care unit (ICU). These scores were analyzed using a multivariate Cox proportional hazard model;optimal cutoffs were computed using the R system for statistical computing. Results The study enrolled 52 patients, 31 (60%) of whom experienced HFOT failure. The best predictors of HFOT failure measured 24 hours after HFOT initiation were as follows: PaO2/FiO2 (threshold 123.6, sensitivity 87%, specificity 81%, hazard ratio [HR] 7.76, and 95% confidence interval [CI] 2.39-17.1);ROX index (threshold 5.63, sensitivity 68%, specificity 95%, HR 6.18, and 95% CI 2.54-13.4);and modified ROX index (threshold 4.94, sensitivity 81%, specificity 90%, HR 8.16, and 95% CI 3.16-21.5) (P < 0.001 for all). Conclusions Early assessment of the ROX index, modified ROX index, and PaO2/FiO2 ratio can adequately predict, with high accuracy, HFOT failure in COVID-19 patients. Because thresholds remain debated and are still not sufficiently validated, we advocate using them with caution for clinical decision-making in this context.

10.
Cureus ; 14(11):e31086, 2022.
Article in English | EuropePMC | ID: covidwho-2155776

ABSTRACT

Introduction Treatment with dexamethasone reduces mortality in patients with coronavirus disease 2019 (COVID-19) pneumonia requiring supplemental oxygen, but the optimal dose has not been determined. Objective To determine whether weight-based dexamethasone of 0.2 mg/kg is superior to 6 mg daily in reducing 28-day mortality in patients with COVID-19 and hypoxemia. Materials and methods A multicenter, open-label, randomized clinical trial was conducted between March 2021 and December 2021 at seven hospitals within Northwell Health. A total of 142 patients with confirmed COVID-19 and hypoxemia were included. Participants were randomized in a 1:1 ratio to dexamethasone 0.2 mg/kg intravenously daily (n = 70) or 6 mg daily (n = 72) for up to 10 days. Results There was no statistically significant difference in the primary outcome of 28-day all-cause mortality with deaths in 12 of 70 patients (17.14%) in the intervention group and 15 of 72 patients (20.83%) in the control group (p = 0.58). There were no statistically significant differences among the secondary outcomes. Conclusion In patients with COVID-19 and hypoxemia, the use of weight-based dexamethasone dosing was not superior to dexamethasone 6 mg in reducing all-cause mortality at 28 days. Clinical trial registration This study was registered under ClinicalTrials.gov (identifier: NCT04834375).

11.
Eur J Med Res ; 27(1):269, 2022.
Article in English | PubMed | ID: covidwho-2153677

ABSTRACT

BACKGROUND: The management of acute respiratory failure during pregnancy is a poorly defined issue in the literature, especially regarding the use of the prone position and the appropriate time for delivery. This study describes our experience in treating pregnant and postpartum women with severe or critical coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: This descriptive retrospective study included 25 pregnant and 4 postpartum women admitted to an ICU due to respiratory complications from COVID-19 from June 2020 to August 2021. RESULTS: The mean maternal age was 33.6 years, and the median gestational age (GA) at admission was 33 weeks. Obesity was the most common comorbidity. The median time between symptom onset and ICU admission was 10 days, while the median length of ICU stay was 14 days. Invasive mechanical ventilation (IMV) was required in 16 (55.2%) patients for a median time of 16.5 days. Prone positioning (PP) was performed in 68.7% of the patients on IMV, and resulted in an expressive increase in arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2 ratio). Eleven (44%) pregnant women delivered during their ICU stay for obstetric or fetal reasons: of these, 2 (18%) developed postpartum hemorrhagic shock and 1 (9%) developed abdominal wall infection. None of the 25 pregnant women underwent delivery due to acute respiratory failure or in an attempt to avoid intubation. There were 2 fetal deaths, but no maternal or neonatal deaths. CONCLUSION: We observed favorable outcomes in pregnant and postpartum women with severe and critical COVID-19 admitted to our institution. This finding reinforces the effectiveness of PP in the treatment of hypoxemic respiratory failure secondary to COVID-19 in pregnant women undergoing IMV, and suggests that gestation should only be interrupted in cases of obstetric and fetal complications, provided the patient is stable, or when hypoxemia is refractory to PP.

12.
Obstetric Medicine ; 15(4):220-224, 2022.
Article in English | ProQuest Central | ID: covidwho-2153262

ABSTRACT

Although the pregnant population was affected by early waves of the COVID-19 pandemic, increasing transmission and severity due to new viral variants has resulted in an increased incidence of severe illness during pregnancy in many regions. Critical illness and respiratory failure are relatively uncommon occurrences during pregnancy, and there are limited high-quality data to direct management. This paper reviews the current literature on COVID-19 management as it relates to pregnancy, and provides an overview of critical care support in these patients. COVID-19 drug therapy is similar to that used in the non-pregnant patient, including anti-inflammatory therapy with steroids and IL-6 inhibitors, although safety data are limited for antiviral drugs such as remdesivir and monoclonal antibodies. As both pregnancy and COVID-19 are thrombogenic, thromboprophylaxis is essential. Endotracheal intubation is a higher risk during pregnancy, but mechanical ventilation should follow usual principles. ICU management should be directed at optimizing maternal well-being, which in turn will benefit the fetus.

14.
Anaesthesia and Intensive Care Medicine ; 23(10):642-646, 2022.
Article in English | Web of Science | ID: covidwho-2147623

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) support of the respiratory system has undergone significant evolution over the past decade. Historically used as rescue therapy, the treatment is now being utilized earlier in the disease course, and its indications for use expanded. The coronavirus disease (COVID-19) pandemic has further increased the experience of ECMO centres and expanded the body of evidence. This article will review the physiology of veno-venous (V-V) ECMO, con-trol of oxygenation and carbon dioxide, principal equipment, patient se-lection and timing, complications and weaning from V-V ECMO.

15.
BMC Pulm Med ; 22(1): 227, 2022 Jun 13.
Article in English | MEDLINE | ID: covidwho-1885300

ABSTRACT

BACKGROUND: This study was designed to explore the early predictive value of the respiratory rate oxygenation (ROX) index modified by PaO2 (mROX) in high-flow nasal cannula (HFNC) therapy in patients with acute hypoxemia respiratory failure (AHRF). METHOD: Seventy-five patients with AHRF treated with HFNC were retrospectively reviewed. Respiratory parameters at baseline and 2 h after HFNC initiation were analyzed. The predictive value of the ROX (ratio of pulse oximetry/FIO2 to respiratory rate) and mROX (ratio of arterial oxygen /FIO2 to respiratory rate) indices with two variations by adding heart rate to each index (ROX-HR and mROX-HR) was evaluated. RESULTS: HFNC therapy failed in 24 patients, who had significantly higher intensive care unit (ICU) mortality and longer ICU stay. Both the ROX and mROX indices at 2 h after HFNC initiation can predict the risk of intubation after HFNC. Two hours after HFNC initiation, the mROX index had a higher area under the receiver operating characteristic curve (AUROC) for predicting HFNC success than the ROX index. Besides, baseline mROX index of greater than 7.1 showed a specificity of 100% for HFNC success. CONCLUSION: The mROX index may be a suitable predictor of HFNC therapy outcomes at the early phase in patients with AHRF.


Subject(s)
Noninvasive Ventilation , Respiratory Insufficiency , Blood Gas Analysis , Cannula , Humans , Oxygen Inhalation Therapy , Respiratory Insufficiency/therapy , Respiratory Rate , Retrospective Studies
16.
Journal of the American Society of Nephrology ; 33:842, 2022.
Article in English | EMBASE | ID: covidwho-2125089

ABSTRACT

Introduction: Thrombotic Microangiopathy (TMA) after non renal solid organ transplantation is very rare. While few cases of TMA following liver and lung transplants have been published, it has been very rarely reported following orthotopic heart transplant (OHT). We report the first case of kidney biopsy proven De Novo TMA after OHT. Case Description: 58-year-old male with non ischemic cardiomyopathy undergoes OHT in Jan 2021. He had normal renal function pre transplantation. Post-operatively he had pericardial effusion and in that setting developed oliguric AKI from ATN requiring dialysis. His renal function recovered and was discharged without dialysis. He was on tacrolimus, MMF and steroid regimen. Frequent heart biopsies were negative for rejection. In March 2021 the patient was admitted for GI bleed and again noted to have AKI. However, during this episode he developed proteinuria of over 2gm, new compared to previous urine studies. He was discharged with a serum creatinine of 2.6mg/dL. By July 2021 renal function worsened and he underwent a renal biopsy on 7/30/21 which showed acute and chronic TMA, related to calcineurin inhibitor use. Viral causes and other medications were ruled out (CMV, BK, adenovirus, SARs-COV2). Tacrolimus was held and he was initiated on Everolimus. Genetic and complement testing revealed normal complement levels, an elevated SC5b-9 complex, heterozygous for the APOL1 gene mutation (c.[1024A>G;1152T>G] p.[Ser342Gly;Ile384Met] (G1 allele)), and heterozygous for the CFHR5 gene mutation, suggestive for complement mediated TMA. He was initiated on Eculizumab. After two doses of Eculizumab he was again admitted with acute respiratory failure requiring intubation secondary to mTOR induced pneumonitis. His renal function worsened and he was reinitiated on dialysis. After a multidisciplinary discussion, he was transitioned to cyclosporine for immunosuppression. He continues to be on dialysis and cyclosporine with eculizumab without other non-renal findings of TMA. He is currently being evaluated for kidney transplantation. He has no signs of OHT rejection on heart biopsies. Discussion(s): The early identification and treatment of TMA in OHT is important in preventing further complications associated with it. Although rare as compared to other solid organ transplants, it is essential to maintain TMA as a differential diagnosis for AKI following OHT.

17.
Journal of the American Society of Nephrology ; 33:328, 2022.
Article in English | EMBASE | ID: covidwho-2124928

ABSTRACT

Background: AKI is common in critically ill patients with COVID-19. The aim of this study was to evaluate the 30-and 60-day survival of patients with COVID-19 and AKI, treated in the ICU. We analysed two groups of patients: patients in the first group were treated with CRRT only, and patients in the second group were treated with CRRT plus hemoadsorption with Cytosorb cartridge. Method(s): This is a retrospective study of patients admitted with COVID-19 between March, 2020 and April, 2022 in all COVID ICUs of our hospital. Inflammatory and biochemical biomarkers at admission, length of ICU stay, and mortality at day 30 and day 60 after ICU admission were analysed. Result(s): One hundred two patients (mean age 68.1+/-8.1 years, 74.5% male) had AKI requiring CRRT, and 44 (43.1%) out of these patients were treated concomitantly with CRRT and Cytosorb. Of the prior concomitant diseases, 39 (38.2%) patients had diabetes, 75 (73.5%) had hypertension, 22 (21.6%) had heart failure, and 26 (25.5%) had chronic kidney disease. Patients treated with CRRT and Cytosorb were younger (64.7 vs. 70.6 years;p<0.001), had lower serum creatinine levels (294 vs. 405 mumol/L;p<0.001), urea levels (29 vs. 48 mmol/L;p < 0.001), higher levels of IL-6 (1754 vs. 385 pg/mL;p<0.001) and lactate dehydrogenase (8.8 vs.7.1;p=0.038). We found no statistically significant difference between the two groups for serum lactate, ferritin, D-dimer, C-reactive protein, and procalcitonin. Onset of treatment was earlier in patients treated with CRRT and Cytosorb than in patients treated with CRRT alone (11.4 vs. 18.2 days;p=0.005). Mean length of stay in ICU was 27.4+/-20.2 days, with no differences between the two groups. Mortality 30 and 60 days after ICU admission was in all patients 58.8% and 76.5%. In patients treated with CRRT alone, mortality at 30 and 60 days was 65.5% and 84.5%, and in patients treated with CRRT and Cytosorb, 50% and 65.9%. The number of patients who died 60 days after ICU admission was statistically significantly higher in the group of patients treated with CRRT alone (x2, p=0.029). The most common causes of death were sepsis and multiple organ failure (55.1%), acute respiratory failure (24.4%), and cardiac arrest (19.2%). Conclusion(s): CRRT and CytoSorb cartridge treatment results in improved 60-day survival in COVID-19 ICU patients with AKI.

18.
Journal of Experimental and Clinical Medicine (Turkey) ; 39(4):1194-1201, 2022.
Article in English | EMBASE | ID: covidwho-2146842

ABSTRACT

COVID-19 affects pregnant women more severely than nonpregnant women of reproductive age. However, the rate of critical illness and fatality reported in other studies varied in a wide range in both groups. The study aims to investigate the clinical outcomes of COVID-19 in the pregnant and nonpregnant matched control patients admitted to the hospital. Pregnant and nonpregnant patients of reproductive age (18-45 years) infected with COVID-19 who were admitted to Ondokuz Mayis University Hospital, Samsun, Turkey, from March 11 to December 11, 2020, were enrolled in the study. The clinical, radiological, and laboratory data of the patients were analyzed retrospectively. A total of 153 patients were investigated;123 were nonpregnant, and 30 were pregnant. Emergency delivery occurred in 5 (17%) pregnant women due to acute respiratory failure associated with COVID-19 and 1 (3%) pregnant woman due to obstetric reasons. Four premature births, one perinatal death, and no stillbirth or miscarriage were reported. The rate of admission to the intensive care unit (ICU) [7/30 (23.3%) vs 3/123 (2.4%), p<0.001] and the need for invasive mechanical ventilation (IMV) [5/30 (17.0%) vs 2/123 (1.6%), p=0.003] were significantly higher in pregnant than in non-pregnant patients. However, hospital length of stay (HLOS) and mortality did not differ between groups: HLOS was median 4 vs 5 days, p=0.68, and the mortality rate was 1/123 (0.8%) vs 0/30 (0%), p=0.62 in nonpregnant and pregnant patients respectively. We observed that COVID-19 has a more severe course in pregnant women versus the nonpregnant control group, but no difference was noted in terms of hospital length of stay and mortality. The overall case fatality rate of COVID-19 in hospitalized pregnant or nonpregnant women of reproductive age was found to be much lower than the general hospitalized population worldwide. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.

19.
6th International Conference on Automation, Control and Robots, ICACR 2022 ; : 88-92, 2022.
Article in English | Scopus | ID: covidwho-2136189

ABSTRACT

In this paper, a slider type mechanical ventilator system using Ambu bag for emergency breathing assistance device was proposed and evaluated. A new type coronavirus infection occurred in early December 2019, and the infection has spread worldwide. When it became severe, respiratory failure often occurs, and there is concern about a shortage of ventilators. Meanwhile, MIT has released a blueprint for a mechanical type ventilator using an Ambu bag. In this study, we started the development based on the MIT ventilator. In our method, we proposed to reduce the load on the motor compared to the MIT type by using a horizontally moving slider to push in the pads. Using a test lung connected to Ambu bag device, we confirmed the mechanical stability between the MIT type and our proposed device. Next, we confirmed the three pads device manufacturing methods for device failure characteristics when driven for a long time (max two weeks). At last, we introduced the simple proportional type controller, and confirmed the pressure stability. The proposed a slider type mechanical Ambu bag ventilator system could realize that the Ambu bag did not move for at least one week and showed stable driving characteristics. Comparing the three types of pads manufacturing methods, the highest-performance pads used duralumin for the columns, and surface of the pad used ABS resin. Simple P controller real time pressure control experiment shows that it was necessary to device a pressure control method after carefully considering the characteristics of the check valve that responds to non-linear pressure inside the Ambu bag. © 2022 IEEE.

20.
Chest ; 162(6):e311-e316, 2022.
Article in English | EMBASE | ID: covidwho-2130346

ABSTRACT

Case Presentation: An acute exacerbation of interstitial lung disease (ILD) is an acute deterioration that can occur at any time and is associated with significant morbidity and mortality rates. We herein report three patients with ILD who experienced acute respiratory failure after SARS-CoV-2 messenger RNA vaccination. All the patients were male;the mean age was 77 years. They had a smoking history that ranged from 10 to 30 pack-years. Duration from the vaccination to the onset of respiratory failure was 1 day in two patients and 9 days in one patient. In an autopsied case, lung pathologic evidence indicated diffuse alveolar damage superimposed on usual interstitial pneumonia. In the other two cases, CT scans showed diffuse ground-glass opacities and subpleural reticulation, which suggests acute exacerbation of ILD. Two patients were treated successfully with high-dose methylprednisolone. Although benefits of vaccination outweigh the risks associated with uncommon adverse events, patients with chronic lung diseases should be observed carefully after SARS-CoV-2 vaccination. Copyright © 2022 American College of Chest Physicians

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