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1.
N Engl J Med ; 386(9): 815-826, 2022 03 03.
Article in English | MEDLINE | ID: covidwho-1721751

ABSTRACT

BACKGROUND: Whether the use of balanced multielectrolyte solution (BMES) in preference to 0.9% sodium chloride solution (saline) in critically ill patients reduces the risk of acute kidney injury or death is uncertain. METHODS: In a double-blind, randomized, controlled trial, we assigned critically ill patients to receive BMES (Plasma-Lyte 148) or saline as fluid therapy in the intensive care unit (ICU) for 90 days. The primary outcome was death from any cause within 90 days after randomization. Secondary outcomes were receipt of new renal-replacement therapy and the maximum increase in the creatinine level during ICU stay. RESULTS: A total of 5037 patients were recruited from 53 ICUs in Australia and New Zealand - 2515 patients were assigned to the BMES group and 2522 to the saline group. Death within 90 days after randomization occurred in 530 of 2433 patients (21.8%) in the BMES group and in 530 of 2413 patients (22.0%) in the saline group, for a difference of -0.15 percentage points (95% confidence interval [CI], -3.60 to 3.30; P = 0.90). New renal-replacement therapy was initiated in 306 of 2403 patients (12.7%) in the BMES group and in 310 of 2394 patients (12.9%) in the saline group, for a difference of -0.20 percentage points (95% CI, -2.96 to 2.56). The mean (±SD) maximum increase in serum creatinine level was 0.41±1.06 mg per deciliter (36.6±94.0 µmol per liter) in the BMES group and 0.41±1.02 mg per deciliter (36.1±90.0 µmol per liter) in the saline group, for a difference of 0.01 mg per deciliter (95% CI, -0.05 to 0.06) (0.5 µmol per liter [95% CI, -4.7 to 5.7]). The number of adverse and serious adverse events did not differ meaningfully between the groups. CONCLUSIONS: We found no evidence that the risk of death or acute kidney injury among critically ill adults in the ICU was lower with the use of BMES than with saline. (Funded by the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand; PLUS ClinicalTrials.gov number, NCT02721654.).


Subject(s)
Acute Kidney Injury/prevention & control , Critical Illness/therapy , Saline Solution/therapeutic use , Acute Kidney Injury/etiology , Adult , Aged , Critical Care/methods , Critical Illness/mortality , Double-Blind Method , Female , Fluid Therapy , Gluconates/adverse effects , Gluconates/therapeutic use , Humans , Intensive Care Units , Magnesium Chloride/adverse effects , Magnesium Chloride/therapeutic use , Male , Middle Aged , Potassium Chloride/adverse effects , Potassium Chloride/therapeutic use , Saline Solution/adverse effects , Sodium Acetate/adverse effects , Sodium Acetate/therapeutic use , Sodium Chloride/adverse effects , Sodium Chloride/therapeutic use , Treatment Outcome
2.
Explore (NY) ; 17(2): 127-129, 2021.
Article in English | MEDLINE | ID: covidwho-807700

ABSTRACT

This report provides a perspective on the relevance of saline water gargling and nasal irrigation to the COVID-19 crisis. While there is limited evidence concerning their curative or preventive role against SARS-CoV-2 infection, previous work on their utility against influenza and recent post-hoc analysis of the Edinburgh and Lothians Viral Intervention Study (ELVIS) provide compelling support to their applicability in the current crisis. Saline water gargling and nasal irrigation represent simple, economical, practically feasible, and globally implementable strategies with therapeutic and prophylactic value. These methods, rooted in the traditional Indian healthcare system, are suitable and reliable in terms of infection control and are relevant examples of harmless interventions. We attempt to derive novel insights into their usefulness, both from theoretical and practical standpoints.


Subject(s)
COVID-19/prevention & control , Nasal Lavage/methods , Pharynx , Saline Solution, Hypertonic/therapeutic use , Saline Solution/therapeutic use , COVID-19/therapy , Humans , SARS-CoV-2 , Therapeutic Irrigation/methods
4.
BMJ Case Rep ; 13(7)2020 Jul 16.
Article in English | MEDLINE | ID: covidwho-650048

ABSTRACT

We describe a 40-year-old woman with severe, persistent macroglossia following prone positioning as part of treatment for COVID-19. We used the treatment method of lingual compression with satisfactory results.


Subject(s)
Betacoronavirus , Compression Bandages , Coronavirus Infections/complications , Macroglossia/complications , Macroglossia/therapy , Patient Positioning/methods , Pneumonia, Viral/complications , Acute Disease , Adult , COVID-19 , Female , Humans , Macroglossia/etiology , Pandemics , Patient Positioning/adverse effects , SARS-CoV-2 , Saline Solution/therapeutic use , Tongue
5.
Eur J Endocrinol ; 183(1): G9-G15, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-647341

ABSTRACT

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.


Subject(s)
Antidiuretic Agents/administration & dosage , Coronavirus Infections/therapy , Deamino Arginine Vasopressin/administration & dosage , Diabetes Insipidus, Neurogenic/therapy , Fluid Therapy/methods , Hypernatremia/therapy , Hyponatremia/therapy , Inappropriate ADH Syndrome/therapy , Pneumonia, Viral/therapy , Brain Injuries/complications , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Dehydration/therapy , Diabetes Insipidus/complications , Diabetes Insipidus/therapy , Diabetes Insipidus, Neurogenic/complications , Disease Management , Humans , Hyponatremia/etiology , Hyponatremia/prevention & control , Hypotonic Solutions/therapeutic use , Neurosurgical Procedures , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Postoperative Complications/therapy , Practice Guidelines as Topic , Saline Solution/therapeutic use , Shock/etiology , Shock/therapy
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