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A low dose heparinized saline protocol is associated with improved duration of arterial line patency in critically ill COVID-19 patients.
Maurer, Lydia R; Luckhurst, Casey M; Hamidi, Arzo; Newman, Kelly A; Barra, Megan E; El Hechi, Majed; Mokhtari, Ava; Breen, Kerry; Lux, Laura; Prout, Laura; Lee, Jarone; Bittner, Edward A; Chang, David; Kaafarani, Haytham M A; Rosovsky, Rachel P; Roberts, Russel J.
  • Maurer LR; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States of America.
  • Luckhurst CM; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States of America.
  • Hamidi A; Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America.
  • Newman KA; Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America.
  • Barra ME; Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America.
  • El Hechi M; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America.
  • Mokhtari A; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America.
  • Breen K; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America.
  • Lux L; Department of Nursing, Massachusetts General Hospital, Boston, MA, United States of America.
  • Prout L; Department of Nursing, Massachusetts General Hospital, Boston, MA, United States of America.
  • Lee J; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America.
  • Bittner EA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America.
  • Chang D; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States of America; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, United States of America.
  • Kaafarani HMA; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America.
  • Rosovsky RP; Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America.
  • Roberts RJ; Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America. Electronic address: rjroberts@mgh.harvard.edu.
J Crit Care ; 60: 253-259, 2020 12.
Article in English | MEDLINE | ID: covidwho-739900
Semantic information from SemMedBD (by NLM)
1. Duration TREATS COVID-19
Subject
Duration
Predicate
TREATS
Object
COVID-19
2. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
3. Duration TREATS Patients
Subject
Duration
Predicate
TREATS
Object
Patients
4. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
5. Health care facility LOCATION_OF Observational Study
Subject
Health care facility
Predicate
LOCATION_OF
Object
Observational Study
6. Arterial thrombosis PROCESS_OF Patients
Subject
Arterial thrombosis
Predicate
PROCESS_OF
Object
Patients
7. Duration TREATS COVID-19
Subject
Duration
Predicate
TREATS
Object
COVID-19
8. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
9. Duration TREATS Patients
Subject
Duration
Predicate
TREATS
Object
Patients
10. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
11. Health care facility LOCATION_OF Observational Study
Subject
Health care facility
Predicate
LOCATION_OF
Object
Observational Study
12. Arterial thrombosis PROCESS_OF Patients
Subject
Arterial thrombosis
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

PURPOSE:

Critically ill patients with Coronavirus Disease 2019 (COVID-19) have high rates of line thrombosis. Our objective was to examine the safety and efficacy of a low dose heparinized saline (LDHS) arterial line (a-line) patency protocol in this population. MATERIALS AND

METHODS:

In this observational cohort study, patients ≥18 years with COVID-19 admitted to an ICU at one institution from March 20-May 25, 2020 were divided into two cohorts. Pre-LDHS patients had an episode of a-line thrombosis between March 20-April 19. Post-LDHS patients had an episode of a-line thrombosis between April 20-May 25 and received an LDHS solution (10 units/h) through their a-line pressure bag.

RESULTS:

Forty-one patients (pre-LDHS) and 30 patients (post-LDHS) were identified. Baseline characteristics were similar between groups, including age (61 versus 54 years; p = 0.24), median Sequential Organ Failure Assessment score (6 versus 7; p = 0.67) and systemic anticoagulation (47% versus 32%; p = 0.32). Median duration of a-line patency was significantly longer in post-LDHS versus pre-LDHS patients (8.5 versus 2.9 days; p < 0.001). The incidence of bleeding complications was similar between cohorts (13% vs. 10%; p = 0.71).

CONCLUSIONS:

A LDHS protocol was associated with a clinically significant improvement in a-line patency duration in COVID-19 patients, without increased bleeding risk.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Catheterization / Heparin / Vascular Access Devices / Saline Solution / COVID-19 Type of study: Etiology study / Clinical Practice Guide / Incidence study / Observational study / Prognostic study / Randomized controlled trials / Risk factors Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: J Crit Care Journal subject: Critical Care Year: 2020 Document Type: Article Affiliation country: J.jcrc.2020.08.025

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Catheterization / Heparin / Vascular Access Devices / Saline Solution / COVID-19 Type of study: Etiology study / Clinical Practice Guide / Incidence study / Observational study / Prognostic study / Randomized controlled trials / Risk factors Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: J Crit Care Journal subject: Critical Care Year: 2020 Document Type: Article Affiliation country: J.jcrc.2020.08.025