COVID-19 Hastasında Platipne-Ortodeoksi Sendromu

Amaç: COVID-19 pnömonisi hafif solunumsal semptomlardan akut solunum yetersizliğine kadar ilerleyen hayatı tehdit eden bir hastalıktır. Yoğun bakımlarda sıkça karşılaştığımız bu hastalık grubunda nadir görülen platipne-ortopne sendromu olan bir olgu sunumunu paylaşmak istedik. Olgu: Bilinen kronik hastalığı olmayan 64 yaş erkek hasta COVID-19 pnömonisi nedeniyle pandemi servisinde yatarken oksijen ihtiyacında artış nedeniyle yoğun bakıma alındı. Hastanın yatışında 12 litre/dk rezervuarlı maske ile oksijen satürasyonu %88 idi. Pandemi rehberlerine uygun olarak başlanmış olan COVID tedavisine ve akut faz yüksekliği nedeniyle başlanan antibiyotiklerine devam edildi. Almakta olduğu metil prednizalon dozu artırıldı ve aralıklı prone pozisyon uygulandı. Takiplerinde hipoksemisi devam eden hastaya çekilen pa akciğer grafisinde trakea yanında hava izlenmesi nedeniyle çekilen kontrol toraks tomografisinde pnömomediastinum üst loblarda buzlu cam alanları alt loblarda fibrotik çekintiler ve konsolide alanlar izlendi. Takiplerinde 4 litre oksijen ile satürasyon %99 idi. Oturur pozisyonda satürasyonu %80’e düştüğü gözlendi. EKG sinus ritminde idi. Ekokardiyografisi yapılan hasta da pulmoner emboli kapak anormalliği izlenmedi. Sistolik fonksiyonları normal idi. Çekilen kontrol pa akciğer grafilerinde hava kaçağı gözlenmedi. Batın ultrasonunda karaciğer boyutları normal ek patoloji yoktu. CRP prokalsitonin lökosit değerleri normal idi. LDH ferritin hafif yüksek saptandı. Oksijen satürasyonu ihtiyacı 2 litre/dk ile %97 olan hastanın oturur pozisyonda satürasyonu %5’den fazla düştüğü için ön planda platipne-ortopne sendromu düşünüldü. Solunum fizyoterapisi ve oksijen tedavisinin devamı planlandı. Sonuç: Platipne-ortopne sendromu sırtüstü postürde hafifleyen dik pozisyonda arteriyel oksijen desatürasyonu ile karakterize nadir bir antitedir. Sırt üstü pozisyondan dik otutur pozisyona geçerken oksijen satürasyonunda %5’den fazla düşme veya parsiyel oksijen basıncında 4 birimlik düşme tanı için gereklidir. Arteriyel oksijen desatürasyonunun temel patofizyolojisi oluşan arteriovenöz şanttır. Amfizem intertisyel akciğer hastalıkları tercihen akciğer bazallerini içeren konsolidasyon gibi parankimal hastalıklarda da gözlenebilir. Literatürde 6 olguda bu sendrom COVID pnömonisi ile gözlenmiştir. Özellikle entübe hastalarda gözden kaçabilecek bu nadir durum bir olgu sunumu olarak sunulmuştur. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Effects of adjunct treatment with intravenous immunoglobulins on the course of severe COVID-19: results from a retrospective cohort study.

OBJECTIVES: To evaluate the effect of adjunct treatment with Octagam, an intravenous immunoglobulin (IVIG) product, on clinical outcomes and biomarkers in critically ill COVID-19 patients. METHODS: Data from a single center was analyzed retrospectively. Patients had received preliminary standard intensive care (SIC) according to a local treatment algorithm, either alone or along with IVIG 5% at 30 g/day for 5 days. The two groups were compared regarding baseline characteristics, survival and changes in inflammation markers. Imbalance in baseline APACHE II scores was addressed by propensity score matching. Otherwise, Kaplan-Meier and multiple logistic regression models were used. RESULTS: Out of 93 patients, 51 had received IVIG and 42 had not. About 75% of patients were male and both groups had comparable body mass index and AB0 blood type distribution. IVIG-treated patients were younger (mean 65 ± 15 versus 71 ± 15 years, p = .066) and had slightly lower baseline disease scores (APACHE II: 20.6 versus 22.4, p = .281; SOFA: 5.0 versus 7.0, p = .006). Overall survival was 61% in the SIC + IVIG and 38% in the SIC only group (odds ratio: 2.2, 95% confidence interval: 0.9-5.4, p = .091 after controlling for baseline imbalances). IVIG significantly prolonged median survival time (68 versus 18 days, p = .014) and significantly reduced plasma levels of C-reactive protein (median change from baseline -71.5 versus -0.3 mg/L, p = .049). CONCLUSION: Clinically relevant benefits through adjunct IVIG treatment in COVID-19 need to be confirmed in a randomized, controlled trial.

Prognostic Value of Antithrombin Levels in COVID-19 Patients and Impact of Fresh Frozen Plasma Treatment: A Retrospective Study

Objective: The defective interplay between coagulation and inflammation may be the leading cause of intravascular coagulation and organ dysfunction in coronavirus disease-19 (COVID-19) patients. Abnormal coagulation profiles were reported to be associated with poor outcomes. In this study, we assessed the prognostic values of antithrombin (AT) activity levels and the impact of fresh frozen plasma (FFP) treatment on outcome. Materials and Methods: Conventional coagulation parameters as well as AT activity levels and outcomes of 104 consecutive critically ill acute respiratory distress syndrome (ARDS) patients with laboratory-confirmed COVID-19 disease were retrospectively analyzed. Patients with AT activity below 75% were treated with FFP. Maximum AT activity levels achieved in those patients were recorded. Results: AT activity levels at admission were significantly lower in nonsurvivors than survivors (73% vs. 81%). The cutoff level for admission AT activity was 79% and 58% was the lowest AT for survival. The outcome in those patients who had AT activity levels above 75% after FFP treatment was better than that of the nonresponding group. As well as AT, admission values of D-dimer, C-reactive protein, and procalcitonin were coagulation and inflammatory parameters among the mortality risk factors. Conclusion: AT activity could be used as a prognostic marker for survival and organ failure in COVID-19-associated ARDS patients. AT supplementation therapy with FFP in patients with COVID-19-induced hypercoagulopathy may improve thrombosis prophylaxis and thus have an impact on survival.