Miositis viral aguda en un paciente pediátrico con Covid-19: a propósito de un caso / Acute viral myositis in a pediatric patient with Covid-19: about a case

Se presenta el reporte de un caso de miositis aguda en un niño de 4 años de edad con COVID-19. El paciente manifestó fiebre y dolor en ambas pantorrillas. Con sospecha de miositis se realizó análisis de CPK, encontrando valores de 4460 UI/L. Asimismo se realizó hisopado nasofaríngeo para SARS-CoV 2, confirmando la infección. El paciente recibió hiperhidratación, presentando resolución de su cuadro clínico en menos de 5 días

This case report describes a 4 year old child with COVID-19. He presented with fever and pain in both calves. Under the suspicion of myositis a CPK analysis was performed, which showed CPK: 4460 UI/L. Nasopharyngeal RT - PCR was also performed, which was positive. As a treatment, the patient received hyperhydration, achieving full recovery after five days

Tocilizumab therapy reduced intensive care unit admissions and/or mortality in COVID-19 patients.

INTRODUCTION: No therapy has yet proven effective in COVID-19. Tocilizumab (TCZ) in patients with severe COVID-19 could be an effective treatment. METHOD: We conducted a retrospective case-control study in the Nord Franche-Comté Hospital, France. We compared the outcome of patients treated with TCZ and patients without TCZ considering a combined primary endpoint: death and/or ICU admissions. RESULTS: Patients with TCZ (n=20) had a higher Charlson comorbidity index (5.3 [±2.4] vs 3.4 [±2.6], P=0.014), presented with more severe forms (higher level of oxygen therapy at 13L/min vs 6L/min, P<0.001), and had poorer biological findings (severe lymphopenia: 676/mm3 vs 914/mm3, P=0.037 and higher CRP level: 158mg/L vs 105mg/L, P=0.017) than patients without TCZ (n=25). However, death and/or ICU admissions were higher in patients without TCZ than in the TCZ group (72% vs 25%, P=0.002). CONCLUSION: Despite the small sample size and retrospective nature of the work, this result strongly suggests that TCZ may reduce the number of ICU admissions and/or mortality in patients with severe SARS-CoV-2 pneumonia.

Effects of hemorrhage on gastrointestinal oxygenation.

OBJECTIVES: (1) To demonstrate that metabolic parameters are better indicators of tissue hypoxia than regional and whole oxygen consumption (VO(2)). (2) To compare intramucosal pH (pHi) in different gastrointestinal segments. DESIGN: Prospective, interventional study. SETTING: Research laboratory at a university center. SUBJECTS: Fourteen anesthetized, mechanically ventilated dogs. INTERVENTIONS: Twenty milliliters per kilogram bleeding. MEASUREMENTS AND MAIN RESULTS: We placed pulmonary, aortic and mesenteric venous catheters, and an electromagnetic flow probe in the superior mesenteric artery, and gastric, jejunal and ileal tonometers to measure flows, arterial and venous blood gases and lactate, and intramucosal PCO(2). We calculated systemic and intestinal oxygen transport (DO(2)) and consumption (VO(2)), pHi and arterial minus intramucosal PCO(2) (DeltaPCO(2)). Then, we bled the dogs and repeated the measurements after 30 min. Systemic and intestinal DO(2) fell (26.0+/-7.3 versus 8.9+/-2.6 and 71.9+/-17.3 versus 24.6+/-9.6 ml/min per kg, respectively, p<0.0001). Systemic and intestinal VO(2) remained unchanged (5.5+/-1.3 versus 5.4+/-1.3 and 15.7+/-5.0 versus 14.9+/-5.3 ml/min per kg, respectively). Gastric, jejunal and ileal pHi (7.13+/-0.11 versus 6.96+/-0.17, 7.18+/-0.06 versus 6.97+/-0.15, 7.12+/-0.11 versus 6.94+/-0.14, p<0.05) and DeltaPCO(2) (21+/-13 versus 35+/-23, 15+/-5 versus 33+/-16, 23+/-17 versus 38+/-20, p<0.05) changed accordingly. Arterial and mesenteric venous lactate and their difference, rose significantly (1.7+/-0.9 versus 3.7+/-1.4 and 1.8+/-0.8 versus 4.3+/-1.5 mmol/l, 0.1+/-0.6 versus 0.6+/-0.7 mmol/l, p<0.05). CONCLUSIONS: During hemorrhage, systemic and intestinal VO(2) remained stable. However, hyperlactatemia and intramucosal acidosis evidenced anaerobic metabolism. pHi changes paralleled in the three intestinal segments.

Lack of agreement between tonometric and gastric juice partial carbon dioxide tension.

STATEMENT OF FINDINGS: Our goal was to compare measurement of tonometered saline and gastric juice partial carbon dioxide tension (PCO2). In this prospective observational study, 112 pairs of measurements were simultaneously obtained under various hemodynamic conditions, in 15 critical care patients. Linear regression analysis showed a significant correlation between the two methods of measuring PCO2 (r(2) = 0.43; P < 0.0001). However, gastric juice PCO2 was systematically higher (mean difference 51 mmHg). The 95% limits of agreement were 315 mmHg and the dispersion increased as the values of PCO2 increased. Tonometric and gastric juice PCO2 cannot be used interchangeably. Gastric juice PCO2 measurement should be interpreted with caution.

End-tidal CO2 pressure determinants during hemorrhagic shock.

OBJECTIVES: To examine the relationship between end-tidal CO2 (PETCO2) and its physiological determinants, pulmonary blood flow (cardiac output, CO) and CO2 production (VCO2), in a model of hemorrhagic shock during fixed minute ventilation. DESIGN AND SETTING: Prospective, observational study in a research laboratory at a university center. SUBJECTS AND INTERVENTIONS: Six anesthetized, intubated, and mechanically ventilated mongrel dogs. Progressive stepwise bleeding. MEASUREMENTS AND RESULTS: We continuously measured PETCO2 with a capnograph, pulmonary artery blood flow with an electromagnetic flow probe, arterial oxygen saturation (SaO2) with a fiberoptic catheter, and oxygen consumption (VO2) and VCO2 by expired gases analysis. Oxygen delivery (DO2) was continuously calculated from pulmonary blood flow and SaO2. We studied the correlation of PETCO2 with CO and VCO2 in each individual experiment. We also calculated the critical point in the relationships PETCO2/ DO2 and VO2/DO2 by the polynomial method. As expected, PETCO2 was correlated with CO. The best fit was logarithmic in all experiments (median r2 = 0.90), showing that PETCO2 decrease is greater in lowest flow states. PETCO2 was correlated with VCO2, but the best fit was linear (median r2 = 0.77). Critical DO2 for PETCO2 and VO2 was 8.0 +/- 3.3 and 6.3 +/- 2.5 ml x min(-1) kg(-1), respectively (NS). CONCLUSIONS: Our data reconfirm the relationship between PETCO2 and CO during hemorrhagic shock. The relatively greater decrease in PETCO2 at lowest CO levels could represent diminished CO2 production during the period of VO2 supply dependency.

Distintos comportamientos de la oxigenación sistémica e intestinal en el síndrome de distress respiratorio del adulto (ARDS) tratado con presión espiratoria positiva final (PEEP) / Different behaviors of the systemic and intestinal oxygenation in the adult respiratory distress syndrome treated with positive end-expiratory pressure

La relación entre disponibilidad y consumo de O2 (DO2 y VO2, respectivamente) ha sido extensamente estudiada en pacientes críticos. Sin embargo, existen pocos intentos de vincular éstas mediciones a la oxigenación tisular. Nosotros realizamos éste estudio en pacientes con ARDS tratados con PEEP con el propósito de demostrar que el pH intramucoso gástrico (pHi) podría contribuir al monitoreo de la oxigenación tisular y aportar información adicional sobre el significado de la relación VO2/DO2. Con éste objetivo, 11 pacientes con ARDS, sedados con diazepam, relajados con pancuronio y ventilados mecánicamente con una FiO2 de 1, fueron sometidos a incrementos secuenciales de PEEP a O, 10 y 15 cmH2O, con intervalos de 209 minutos. En cada caso se midieron pHi por tonometría, volumen minuto cardíaco por termodilución y contenidos arteriales y venosos mixtos de O2 (gases, Hb y saturación), calculándose DO2 y VO2. Se realizaron correlaciones entre DO2 y VO2 y DO2 y pHi por cuadrados mínimos. A través de un método de agrupamiento se distinguieron diferentes comportamientos. Adicionalmente, se incluyeron otros 2 pacientes para corroborar la metodología estadística. De ésta forma quedaron definidos 3 grupos. En el grupo I (6 pacientes), con las dismuinuciones de la DO2, el VO2 fue constante (r media 0,49 ñ 0,34), aunque el pHi se redujo (r media 0,90 ñ 0,09)...

Distintos comportamientos de la oxigenación sistémica e intestinal en el síndrome de distress respiratorio del adulto (ARDS) tratado con presión espiratoria positiva final (PEEP) / Different behaviors of the systemic and intestinal oxygenation in the adult respiratory distress syndrome treated with positive end-expiratory pressure

La relación entre disponibilidad y consumo de O2 (DO2 y VO2, respectivamente) ha sido extensamente estudiada en pacientes críticos. Sin embargo, existen pocos intentos de vincular éstas mediciones a la oxigenación tisular. Nosotros realizamos éste estudio en pacientes con ARDS tratados con PEEP con el propósito de demostrar que el pH intramucoso gástrico (pHi) podría contribuir al monitoreo de la oxigenación tisular y aportar información adicional sobre el significado de la relación VO2/DO2. Con éste objetivo, 11 pacientes con ARDS, sedados con diazepam, relajados con pancuronio y ventilados mecánicamente con una FiO2 de 1, fueron sometidos a incrementos secuenciales de PEEP a O, 10 y 15 cmH2O, con intervalos de 209 minutos. En cada caso se midieron pHi por tonometría, volumen minuto cardíaco por termodilución y contenidos arteriales y venosos mixtos de O2 (gases, Hb y saturación), calculándose DO2 y VO2. Se realizaron correlaciones entre DO2 y VO2 y DO2 y pHi por cuadrados mínimos. A través de un método de agrupamiento se distinguieron diferentes comportamientos. Adicionalmente, se incluyeron otros 2 pacientes para corroborar la metodología estadística. De ésta forma quedaron definidos 3 grupos. En el grupo I (6 pacientes), con las dismuinuciones de la DO2, el VO2 fue constante (r media 0,49 ñ 0,34), aunque el pHi se redujo (r media 0,90 ñ 0,09)...(AU)