Molecular markers for early stratification of disease severity and progression in COVID-19

COVID-19 infections have imposed immense pressure on the healthcare system of most countries. While the initial studies have identified better therapeutic and diagnostic approaches, the disease severity is still assessed by close monitoring of symptoms by healthcare professionals due to the lack of biomarkers for disease stratification. In this study, we have probed the immune and molecular profiles of COVID-19 patients at 48-hour intervals after hospitalization to identify early markers, if any, of disease progression and severity. Our study reveals that the molecular profiles of patients likely to enter the host-immune response mediated moderate or severe disease progression are distinct even in the early phase of infection when severe symptoms are not yet apparent. Our data from 37 patients suggest that at hospitalization, IL6 (>300pg/ml) and IL8 levels (>200pg/ml) identify cytokine-dependent disease progression. Monitoring their levels will facilitate timely intervention using available immunomodulators or precision medicines in those likely to progress due to cytokine storm and help improve outcomes. Additionally, it will also help identify cytokine-independent progressive patients, not likely to benefit from immuno-modulators or precision drugs.

Prospective Observational Study on Evaluation of Cardiac Dysfunction Induced during the Weaning Process.

CONTEXT: Weaning induced cardiac dysfunction can occur without underlying heart disease. Changes in intrathoracic pressure, systemic vascular resistance, preload and afterload leading to heart-lung interactions are the possible explanatory mechanisms. AIMS: The aim of the current study was whether the assessment and identification of cardiac dysfunction induced during the weaning process could predict the outcome of extubation. SETTINGS AND DESIGN: A prospective observational study with convenience sampling method was conducted from May 2015 to April 2016 after institutional ethical committee approval (ref 161/2015). MATERIALS AND METHODS: Patients over eighteen and planned for extubation were included. Weaning method used was a spontaneous breathing trial (SBT) by pressure support-positive end-expiratory pressure (PS-PEEP). Baseline characteristics, weaning, and echocardiography parameters were collected pre extubation. Post-extubation echocardiographic parameters were collected within six hours as per the protocol. The primary outcome was extubation failure (reintubation within 48 hours). Secondary outcomes were ICU length of stay and ICU mortality. STATISTICAL ANALYSIS: Statistical method used is STATA™ (Version14, College Station TX). RESULTS: Out of one hundred and sixty-one patients, twenty-one failed extubation (13.04 %). Pre-extubation echocardiographic parameters were similar in two groups except for preexisting LV systolic dysfunction. Post-extubation E/e` (9.30 vs. 7.71 p = 0.018) was higher in the extubation failure group. Extubation failure group had higher intensive care unit (ICU) length of stay and ICU mortality. CONCLUSION: In our study E/e` during a weaning trial did not predict extubation success. Cardiac dysfunction induced during weaning may get masked during weaning and manifests postextubation. This needs to be verified in subsequent studies. KEY MESSAGES: Cardiac dysfunction induced during the weaning process may get masked and manifests post-extubation. Echocardiographic assessment during the weaning process and post-extubation helps to evaluate and identify the patients at risk of reintubation. HOW TO CITE THIS ARTICLE: Amarja H, Bhuvana K, Sriram S. Prospective Observational Study on Evaluation of Cardiac Dysfunction Induced during the Weaning Process. Indian Journal of Critical Care Medicine, January 2019;23(1):15-19.

A low-cost reusable phantom for ultrasound-guided subclavian vein cannulation.

Guidelines support the use of ultrasound (US)-guided central venous cannulation in the intensive care unit. Traditional techniques based on anatomical landmarks are blind procedures and inexpert USG procedures may be hazardous. Commercially available phantoms for simulation and training are expensive. The technique of making a low-cost reusable gelatin phantom which simulates subclavian vein anatomy is described. Techniques to improve eye-hand skills with this phantom are described. This phantom is easy to make, inexpensive and easily renewable.