# ent

id: cord-026885-ql57moyi
type: ORG
entity:
  1 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine 81


id: cord-026885-ql57moyi
type: ORG
entity:
  the American College of Cardiology Foundation American Heart Association Task Force on Practice Guidelines ESC Guidelines


id: cord-026885-ql57moyi
type: WORK_OF_ART
entity:
  Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST Segment Elevation of the European Society of Cardiology ESC Standardized


id: cord-311176-dlwph5za
type: DISEASE
entity:
  influenza A H1N1 pandemic preparation for severe respiratory emergency outbreaks Middle East respiratory syndrome coronavirus


id: cord-003219-iryb3v0z
type: PRODUCT
entity:
  APACHE II Acute Physical and Chronic Health Evaluation SOFA Sequential Organ Function Assessment PSI


id: cord-003219-iryb3v0z
type: ORG
entity:
  Thoracic Society European Society of Intensive Care Medicine Society of Critical Care Medicine Clinical Practice Guideline Mechanical Ventilation


id: cord-032831-mupxzffk
type: PROTEIN
entity:
  J L Piquilloud L Vimpere D Aissaoui N Guerot E Augy J L Pierrot M Hourton D Arnoux A Richard C Mancebo J Mercat A title


id: cord-032831-mupxzffk
type: DNA
entity:
  ECCO 2 R 11 7 7 5 15 0 versus 22 6 13 9 34 7 Joules min p 0 0625 and 1 1 0 8 1 4 versus 1 5 0 9 2 8 Joules L p 0 0625


id: cord-316681-b46ycocg
type: ORG
entity:
  the European Organization for Research and Treatment of Cancer Invasive Fungal Infections Cooperative Group


id: cord-328569-1lx3fkv3
type: DISEASE
entity:
  dilated right ventricle end diastolic right ventricle left ventricle area ratio 0 6 pulmonary embolism hyperlactatemia


id: cord-003198-1kw5v6rm
type: CHEMICAL
entity:
  Mathilde Voiriot Guillaume Fartoukh Muriel Coudroy Rémi Dumas Guillaume Maury Eric Terzi Nicolas Tandjaoui


id: cord-316647-jj8anf5g
type: ORG
entity:
  The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team The Epidemiological Characteristics


id: cord-316647-jj8anf5g
type: ORG
entity:
  National Health Commission State Administration of Traditional Chinese Medicine Diagnosis and Treatment Protocol


id: cord-316647-jj8anf5g
type: ORG
entity:
  Guideline of Prevention and Control of Novel Coronavirus Infection Within Medical Facilities Chinese


id: cord-316647-jj8anf5g
type: WORK_OF_ART
entity:
  Treatment of Severe Acute Respiratory Syndrome With Glucosteroids the Guangzhou Experience Hydrocortisone


id: cord-306315-vt2e0crh
type: DNA
entity:
  Open Access Correspondence guillaume voiriot aphp fr 1 Assistance Publique Hôpitaux de Paris Service de médecine intensive réanimation Hôpital Tenon Sorbonne Université Paris France Full list


id: cord-025615-xaehtmjf
type: DNA
entity:
  diaphragm 30 6 parasternal intercostals 41 6 scalene 40 8 sternocleidomastoid 43 6 alae nasi and 30 6 genioglossus


id: cord-014538-6a2pviol
type: PROTEIN
entity:
  Bruno Neuville Mathilde D ortho Marie Pia Bouadma Lila Rouvel Tallec Anny Rudler Marika Weiss Nicolas Perlbarg Vincent Galanaud Damien Thabut Dominique Rachdi Emna


id: cord-014538-6a2pviol
type: DNA
entity:
  Louf Durier Aurore Tapponnier Romain Louis Bruno Forel Jean Marie Bisbal Magali Lehingue Samuel Rambaud Romain


id: cord-014538-6a2pviol
type: DISEASE
entity:
  Deransy Romain Brisson Hélène Monsel Antoine Conti Filomena Scatton Olivier Langeron Olivier Ghezala Hassen Ben Snouda Salah


id: cord-014538-6a2pviol
type: DISEASE
entity:
  neoplasms breast lung ovarian urologic gastrointestinal digestive system abdominal brain carcinoid tumor sarcoma testicular seminoma


id: cord-029136-mbqncen1
type: CELL_LINE
entity:
  mini bronchoalveolar lavage BAL 40 mL sterile 0 9 saline solution was blindly instilled through a telescopic catheter and immediately aspirated in a trap was performed on day 4


id: cord-335975-m6lkrehi
type: GGP
entity:
  envenomations i e 0 098 The median age was 43 years with extremes ranging from 20 to 78 years The sex ratio was 4 Scorpion stings occurred at night in 80 of patients 60 in the first half of the night between 6 pm and 11 59 pm and 20 in the second half of the night 0 to 5 h Venom inoculation points were in the lower limbs in 80 of cases followed by upper limbs 20 The color of the incriminated scorpion was yellow in 80 black in 10 and unspecified in 10 of the cases For admission classes there were 10 Class I 80 Class II


id: cord-355038-o2hr5mox
type: CELL_LINE
entity:
  Kais Regaieg Sabrine Nakaa Arnaud Mailloux Madjid Boukari Johana Cohen Dany Goldgran Toledano Groupe hospitalier intercommunal Le Raincy Montfermeil Montfermeil France Correspondence Kais Regaieg


id: cord-355038-o2hr5mox
type: GGP
entity:
  H2 r 0 37 95 CI 0 10 0 59 p 0 0064 We showed a significant relationship between the variation in plasma concentration of GRP78


id: cord-355038-o2hr5mox
type: GGP
entity:
  IV p 10 3 duration of symptoms before hospitalization p 0 03 APACHE II score p 0 04 pH p 0 004 shock on admission p 0 01 and septic shock as evolutionary complication p 0 01 were predictors of mortality in our study Besides shock on admission p 0 001 and as evolutionary complication p 0 017 were the two independent prognostic factors


id: cord-355038-o2hr5mox
type: GGP
entity:
  Agir À Domicile GALICIER Lionel Consultancy Expert NOVARTIS EUSAPHARMA Trainings Teaching Baxalta PFIZER Invitation to national or international congresses No conflict of interest ICHAÏ Philippe No conflict of interest IMEN Sioud No conflict of interest IOOS Vincent No disclosure ISERIN Franck No disclosure ISSA Nahema No conflict of interest JABER Samir Consultancy Expert drager Fisher Paykel Medtronic Baxter Xenios Fresenius Invitation to national or international congresses Drager No conflict of interest JACQ Gwenaëlle No conflict of interest JACQUET Emmanuelle


id: cord-355038-o2hr5mox
type: ORG
entity:
  Réanimation Médicale CHU RENNES Rennes France 3 Réanimation Chirurgicale CHU NANTES Nantes France 4 Réanimation


id: cord-355038-o2hr5mox
type: ORG
entity:
  Fresenius Medical Care Consultancy Expert Fresenius Medical Care Trainings Teaching Fresenius Medical Care Invitation


id: cord-355038-o2hr5mox
type: DISEASE
entity:
  thoracic abdominal neurosurgery gynecologic urologic otorhinolaryngology or spinal surgery The primary


# bib

id: cord-000812-mu5u5bvj
author: Wiesen, Jonathan
date: 2012-08-28
txt: ./txt/cord-000812-mu5u5bvj.txt
cache: ./cache/cord-000812-mu5u5bvj.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503790/
doi: 10.1186/2110-5820-2-41
summary:
  Based on clinical bedside observations and published reports [4, 5, 8] , we hypothesize that ALI/ARDS secondary to pandemic influenza is associated with similar ICU outcomes but increased resource utilization and higher hospital charges due to the frequent need for rescue interventions and prolonged ventilatory assistance. A Research Electronic Data Capture (REDCap) database was constructed with a complete listing of the patient''s demographic and clinical information, including age, gender, height, weight, body mass index (BMI), presenting symptoms, past medical history, primary reason for admission to the ICU, vital signs, presence of vasopressors, laboratory values, ventilator settings and respiratory parameters, Acute Physiology and Chronic Health Evaluation (APACHE) III and Sequential Organ Failure Assessment (SOFA) scores on admission to the MICU, number of intubated days, duration of ICU and hospital stay, mortality, and rescue therapies (namely inhaled nitric oxide, proning, high-frequency oscillatory ventilation, and extracorporeal membrane oxygenation [ECMO]) [22] .

title:
  Relative cost and outcomes in the intensive care unit of acute lung injury (ALI) due to pandemic influenza compared with other etiologies: a single-center study

abstract:
  BACKGROUND: Critical illness due to 2009 H1N1 influenza has been characterized by respiratory complications, including acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), and associated with high mortality. We studied the severity, outcomes, and hospital charges of patients with ALI/ARDS secondary to pandemic influenza A infection compared with ALI and ARDS from other etiologies. METHODS: A retrospective review was conducted that included patients admitted to the Cleveland Clinic MICU with ALI/ARDS and confirmed influenza A infection, and all patients admitted with ALI/ARDS from any other etiology from September 2009 to March 2010. An itemized list of individual hospital charges was obtained for each patient from the hospital billing office and organized by billing code into a database. Continuous data that were normally distributed are presented as the mean ± SD and were analyzed by the Student’s t test. The chi-square and Fisher exact tests were used to evaluate differences in proportions between patient subgroups. Data that were not normally distributed were compared with the Wilcoxon rank-sum test. RESULTS: Forty-five patients were studied: 23 in the H1N1 group and 22 in the noninfluenza group. Mean ± SD age was similar (44 ± 13 and 51 ± 17 years, respectively, p = 0.15). H1N1 patients had lower APACHE III scores (66 ± 20 vs. 89 ± 32, p = 0.015) and had higher Pplat and PEEP on days 1, 3, and 14. Hospital and ICU length of stay and duration of mechanical ventilation were comparable. SOFA scores over the first 2 weeks in the ICU indicate more severe organ failure in the noninfluenza group (p = 0.017). Hospital mortality was significantly higher in the noninfluenza group (77 vs. 39%, p = 0.016). The noninfluenza group tended to have higher overall charges, including significantly higher cost of blood products in the ICU. CONCLUSIONS: ALI/ARDS secondary to pandemic influenza infection is associated with more severe respiratory compromise but has lower overall acuity and better survival rates than ALI/ARDS due to other causes. Higher absolute charges in the noninfluenza group are likely due to underlying comorbid medical conditions.


id: cord-002011-u6dfp6gf
title: Association of REL polymorphisms and outcome of patients with septic shock
author: Toubiana, Julie
date: 2016-04-08
txt: ./txt/cord-002011-u6dfp6gf.txt
cache: ./cache/cord-002011-u6dfp6gf.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4826362/
doi: 10.1186/s13613-016-0130-z
summary:
  CONCLUSION: In a large ICU population, we report a significant clinical association between a variation in the human REL gene and severity and mortality of septic shock, suggesting for the first time a new insight into the role of cRel in response to infection in humans. Hence, the present study aims to test the hypothesis of an association between clinically significant REL genetic variants and severity of septic shock in a large cohort of well-defined intensive care unit (ICU) patients. In order to study the link between REL SNPs and septic shock severity, we compared acute respiratory distress syndrome (ARDS) and MODS frequencies, and VFD value between patients carrying REL rs842647*G and rs13031237*T minor alleles and in those homozygous for the major alleles. This study was the first to investigate the importance of two polymorphisms within REL gene in a large European population of septic shock patients.

abstract:
  BACKGROUND: cRel, a subunit of NF-κB, is implicated in the inflammatory response observed in autoimmune disease. Hence, knocked-out mice for cRel had a significantly higher mortality, providing new and important functions of cRel in the physiopathology of septic shock. Whether genetic variants in the human REL gene are associated with severity of septic shock is unknown. METHODS: We genotyped a population of 1040 ICU patients with septic shock and 855 ICU controls for two known polymorphisms of REL; REL rs842647 and REL rs13031237. Outcome of patients according to the presence of REL variant alleles was compared. RESULTS: The distribution of REL variant alleles was not significantly different between patients and controls. Among the septic shock group, REL rs13031237*T minor allele was not associated with worse outcome. In contrast, REL rs842647*G minor allele was significantly associated with more multi-organ failure and early death [OR 1.4; 95 % CI (1.02–1.8)]. CONCLUSION: In a large ICU population, we report a significant clinical association between a variation in the human REL gene and severity and mortality of septic shock, suggesting for the first time a new insight into the role of cRel in response to infection in humans.


id: cord-003198-1kw5v6rm
author: Vuillard, Constance
date: 2018-09-11
txt: ./txt/cord-003198-1kw5v6rm.txt
cache: ./cache/cord-003198-1kw5v6rm.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131681/
doi: 10.1186/s13613-018-0433-3
summary:
  The following data were collected on a standardized anonymized case record form: demographic characteristics (age, gender), severity scores upon ICU admission (Sequential Organ Failure Assessment [23] and Simplified Acute Physiology Score II [24] ), main comorbidities, delay between first respiratory sign and ICU admission, clinical examination (respiratory and extra-respiratory manifestations) and laboratory findings at the time of ICU admission (blood leukocytes and platelets counts, serum procalcitonine, C-reactive protein, creatine kinase and creatinine levels, PaO 2 /FiO 2 with FiO 2 calculated according to the following formula [25, 26] : FiO 2 = oxygen flow in liter per minute × 0.04 + 0.21 when standard oxygen was used), radiological findings on chest X-ray and CT scan, cytological and bacteriological analyses of broncho-alveolar lavage (BAL) fluid, type of positive autoantibodies (Jo-1, PL7, PL12, OJ, EJ, KS, Zo, YRS/Tyr/ Ha or aMDA-5), immunosuppressive treatments received (corticosteroids, cyclophosphamide, rituximab, basiliximab, tacrolimus, cyclosporine, methotrexate, intravenous immunoglobulins or plasma exchange), organ supports in the ICU (invasive mechanical ventilation, extra-corporeal membrane oxygenation (ECMO), renal replacement therapy, vasopressors), ICU and hospital length of stay, ICU and hospital mortality.

title:
  Clinical features and outcome of patients with acute respiratory failure revealing anti-synthetase or anti-MDA-5 dermato-pulmonary syndrome: a French multicenter retrospective study

abstract:
  BACKGROUND: Anti-synthetase (AS) and dermato-pulmonary associated with anti-MDA-5 antibodies (aMDA-5) syndromes are near one of the other autoimmune inflammatory myopathies potentially responsible for severe acute interstitial lung disease. We undertook a 13-year retrospective multicenter study in 35 French ICUs in order to describe the clinical presentation and the outcome of patients admitted to the ICU for acute respiratory failure (ARF) revealing AS or aMDA-5 syndromes. RESULTS: From 2005 to 2017, 47 patients (23 males; median age 60 [1st–3rd quartiles 52–69] years, no comorbidity 85%) were admitted to the ICU for ARF revealing AS (n = 28, 60%) or aMDA-5 (n = 19, 40%) syndromes. Muscular, articular and cutaneous manifestations occurred in 11 patients (23%), 14 (30%) and 20 (43%) patients, respectively. Seventeen of them (36%) had no extra-pulmonary manifestations. C-reactive protein was increased (139 [40–208] mg/L), whereas procalcitonine was not (0.30 [0.12–0.56] ng/mL). Proportion of patients with creatine kinase ≥ 2N was 20% (n = 9/47). Forty-two patients (89%) had ARDS, which was severe in 86%, with a rate of 17% (n = 8/47) of extra-corporeal membrane oxygenation requirement. Proportion of patients who received corticosteroids, cyclophosphamide, rituximab, intravenous immunoglobulins and plasma exchange were 100%, 72%, 15%, 21% and 17%, respectively. ICU and hospital mortality rates were 45% (n = 21/47) and 51% (n = 24/47), respectively. Patients with aMDA-5 dermato-pulmonary syndrome had a higher hospital mortality than those with AS syndrome (n = 16/19, 84% vs. n = 8/28, 29%; p = 0.001). CONCLUSIONS: Intensivists should consider inflammatory myopathies as a cause of ARF of unknown origin. Extra-pulmonary manifestations are commonly lacking. Mortality is high, especially in aMDA-5 dermato-pulmonary syndrome.


id: cord-003219-iryb3v0z
author: Kao, Kuo-Chin
date: 2018-09-24
txt: ./txt/cord-003219-iryb3v0z.txt
cache: ./cache/cord-003219-iryb3v0z.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153196/
doi: 10.1186/s13613-018-0440-4
summary:
  title: Predictors of survival in patients with influenza pneumonia-related severe acute respiratory distress syndrome treated with prone positioning CONCLUSIONS: In the present study, in evaluating the effect of prone positioning in patients with influenza pneumonia-related ARDS, pneumonia severity index, renal replacement therapy and increase in dynamic driving pressure were associated with 60-day mortality in patients with influenza pneumonia-related ARDS receiving prone positioning. After multivariate Cox regression analysis, PSI, renal replacement therapy and increased dynamic driving pressure were associated with 60-day mortality in patients with influenza pneumonia-related ARDS receiving prone positioning. The present study in influenza pneumonia-related ARDS patients receiving prone positioning also found that increased dynamic driving pressure (hazard ratio 1.372, 95% confidence interval 1.095-1.718; p = 0.006) was identified as After multivariate Cox regression analysis, it was found that PSI, renal replacement therapy and increased dynamic driving pressure were associated with 60-day mortality in patients with influenza pneumoniarelated ARDS receiving prone positioning.

title:
  Predictors of survival in patients with influenza pneumonia-related severe acute respiratory distress syndrome treated with prone positioning

abstract:
  BACKGROUND: Patients with influenza complicated with pneumonia are at high risk of rapid progression to acute respiratory distress syndrome (ARDS). Prone positioning with longer duration and lung-protective strategies might reduce the mortality level in ARDS. The aim of this study is to investigate the survival predictors of prone positioning in patients with ARDS caused by influenza pneumonia. METHODS: This retrospective study was conducted by eight tertiary referral centers in Taiwan. From January 1 to March 31 in 2016, all of the patients in intensive care units with virology-proven influenza pneumonia were collected, while all of those patients with ARDS and receiving prone positioning were enrolled. Demographic data, laboratory examinations, management records, ventilator settings and clinical outcomes were collected for analysis. RESULTS: During the study period, 336 patients with severe influenza pneumonia were screened and 263 patients met the diagnosis of ARDS. Totally, 65 patients receiving prone positioning were included for analysis. The 60-day survivors had lower Acute Physiology and Chronic Health Evaluation (APACHE) II score, pneumonia severity index (PSI), creatinine level and lower rate of receiving renal replacement therapy than non-survivors (22.4 ± 8.5 vs. 29.2 ± 7.4, p = 0.003; 106.6 ± 40.9 vs. 135.3 ± 48.6, p = 0.019; 1.2 ± 0.9 mg/dL vs. 3.1 ± 3.6 mg/dL, p = 0.040; and 4% vs. 42%, p < 0.005). Multivariate Cox regression analysis identified PSI (hazard ratio 1.020, 95% confidence interval 1.009–1.032; p < 0.001), renal replacement therapy (hazard ratio 6.248, 95% confidence interval 2.245–17.389; p < 0.001), and increase in dynamic driving pressure (hazard ratio 1.372, 95% confidence interval 1.095–1.718; p = 0.006) which were independent predictors associated with 60-day mortality. CONCLUSIONS: In the present study, in evaluating the effect of prone positioning in patients with influenza pneumonia-related ARDS, pneumonia severity index, renal replacement therapy and increase in dynamic driving pressure were associated with 60-day mortality in patients with influenza pneumonia-related ARDS receiving prone positioning. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-018-0440-4) contains supplementary material, which is available to authorized users.


id: cord-003798-nki2sasr
author: Vidaur, Loreto
date: 2019-07-24
txt: ./txt/cord-003798-nki2sasr.txt
cache: ./cache/cord-003798-nki2sasr.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656825/
doi: 10.1186/s13613-019-0559-y
summary:
  BACKGROUND: Information on the clinical, epidemiological and molecular characterization of human metapneumovirus in critically ill adult patients with severe community-acquired pneumonia (CAP) and the role of biomarkers identifying bacterial coinfection is scarce. METHODS: This is a retrospective epidemiological study of adult patients with hMPV severe CAP admitted to ICU during a ten-year period with admission PSI score ≥ 3. The main objective of this study was to describe the clinical and epidemiological characteristics of adults with severe pneumonia caused by hMPV who required intensive care unit (ICU) admission, over a long period of time. Interestingly, three patients (10.7%) were young adult patients without comorbidities and without bacterial coinfection that developed ARDS pointing out a main role of hMPV in the etiology of severe respiratory infections requiring mechanical ventilation. Main characteristics of immunosuppressed adult patients admitted to the Intensive Care Unit due to a severe community-acquired pneumonia associated with human metapneumovirus infection (Guipuzcoa, Basque Country, Spain, 2007-2017).

title:
  Human metapneumovirus as cause of severe community-acquired pneumonia in adults: insights from a ten-year molecular and epidemiological analysis

abstract:
  BACKGROUND: Information on the clinical, epidemiological and molecular characterization of human metapneumovirus in critically ill adult patients with severe community-acquired pneumonia (CAP) and the role of biomarkers identifying bacterial coinfection is scarce. METHODS: This is a retrospective epidemiological study of adult patients with hMPV severe CAP admitted to ICU during a ten-year period with admission PSI score ≥ 3. RESULTS: The 92.8% of the 28 patients with severe CAP due to human metapneumovirus were detected during the first half of the year. Median age was 62 years and 60.7% were male. The genotyping of isolated human metapneumovirus showed group B predominance (60.7%). All patients had acute respiratory failure. Median APACHE II and SOFA score were 13 and 6.55, respectively. The 25% were coinfected with Streptococcus pneumoniae. 60.7% of the patients had shock at admission and 50% underwent mechanical ventilation. Seven patients developed ARDS, three of them younger than 60 years and without comorbidities. Mortality in ICU was 14.3%. Among survivors, ICU and hospital stay were 6.5 and 14 days, respectively. Plasma levels of procalcitonin were higher in patients with bacterial coinfection (18.2 vs 0.54; p < 0.05). The levels of C-reactive protein, however, were similar. CONCLUSION: Human metapneumovirus was associated with severe CAP requiring ICU admission among elderly patients or patients with comorbidities, but also in healthy young subjects. These patients often underwent mechanical ventilation with elevated health resource consumption. While one out of four patients showed pneumococcal coinfection, plasma procalcitonin helped to implement antimicrobial stewardship. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-019-0559-y) contains supplementary material, which is available to authorized users.


id: cord-004002-b35wm2db
author: Gaborit, Benjamin Jean
date: 2019-11-27
txt: ./txt/cord-004002-b35wm2db.txt
cache: ./cache/cord-004002-b35wm2db.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881486/
doi: 10.1186/s13613-019-0604-x
summary:
  BMI, body mass index; ICU, intensive care unit; ARDS, acute respiratory distress syndrome; SAPS2, simplified acute physiology score version 2; SOFA score, sequential organ failure assessment score; HIV, human immunodeficiency virus; PJP, Pneumocystis jirovecii pneumonia; CRP, C-reactive protein; LDH, lactate dehydrogenase; PJ, Pneumocystis jirovecii a The total exceeds 100% because some patients had more than one cause of immunodeficiency b Of these 21 patients, 7 followed their prescribed prophylactic regimen (aerosolised pentamidine, n = 6; and atovaquone, n = 1) and 14 did not (trimethoprim/sulfamethoxazole, n = 11; and aerosolised pentamidine, n = 3) Two factors were independently associated with 90-day mortality by multivariate analysis, a worse SOFA score was associated with higher 90-day mortality (OR, 1.05; 95% CI 1.02-1.09; p < 0.001), whereas BAL fluid alveolitis profile was associated with lower 90-day mortality (OR, 0.79; 95% CI 0.65-0.96; p < 0.05) ( Table 3) .

title:
  Outcome and prognostic factors of Pneumocystis jirovecii pneumonia in immunocompromised adults: a prospective observational study

abstract:
  BACKGROUND: Pneumocystis jirovecii pneumonia (PJP) remains a severe disease associated with high rates of invasive mechanical ventilation (MV) and mortality. The objectives of this study were to assess early risk factors for severe PJP and 90-day mortality, including the broncho-alveolar lavage fluid cytology profiles at diagnosis. METHODS: We prospectively enrolled all patients meeting pre-defined diagnostic criteria for PJP admitted at Nantes university hospital, France, from January 2012 to January 2017. Diagnostic criteria for PJP were typical clinical features with microbiological confirmation of P. jirovecii cysts by direct examination or a positive specific quantitative real-time polymerase chain reaction (PCR) assay. Severe PJP was defined as hypoxemic acute respiratory failure requiring high-flow nasal oxygen with at least 50% FiO(2), non-invasive ventilation, or MV. RESULTS: Of 2446 respiratory samples investigated during the study period, 514 from 430 patients were positive for P. jirovecii. Of these 430 patients, 107 met criteria for PJP and were included in the study, 53 (49.5%) patients had severe PJP, including 30 who required MV. All patients were immunocompromised with haematological malignancy ranking first (n = 37, 35%), followed by solid organ transplantation (n = 27, 25%), HIV-infection (n = 21, 20%), systemic diseases (n = 13, 12%), solid tumors (n = 12, 11%) and primary immunodeficiency (n = 6, 8%). By multivariate analysis, factors independently associated with severity were older age (OR, 3.36; 95% CI 1.4–8.5; p < 0.05), a P. jirovecii microscopy-positive result from bronchoalveolar lavage (BAL) (OR, 1.3; 95% CI 1.54–9.3; p < 0.05); and absence of a BAL fluid alveolitis profile (OR, 3.2; 95% CI 1.27–8.8; p < 0.04). The 90-day mortality rate was 27%, increasing to 50% in the severe PJP group. Factors independently associated with 90-day mortality were worse SOFA score on day 1 (OR, 1.05; 95% CI 1.02–1.09; p < 0.001) whereas alveolitis at BAL was protective (OR, 0.79; 95% CI 0.65–0.96; p < 0.05). In the subgroup of HIV-negative patients, similar findings were obtained, then viral co-infection were independently associated with higher 90-day mortality (OR, 1.25; 95% CI 1.02–1.55; p < 0.05). CONCLUSIONS: Older age and P. jirovecii oocysts at microscopic examination of BAL were independently associated with severe PJP. Both initial PJP severity as evaluated by the SOFA score and viral co-infection predicted 90-day mortality. Alveolitis at BAL examination was associated with less severe PJP. The pathophysiological mechanism underlying this observation deserves further investigation.


id: cord-004059-furt6xcn
author: Hraiech, Sami
date: 2019-12-23
txt: ./txt/cord-004059-furt6xcn.txt
cache: ./cache/cord-004059-furt6xcn.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928167/
doi: 10.1186/s13613-019-0616-6
summary:
  However, little is known about herpes simplex virus (HSV) and Cytomegalovirus (CMV) reactivation occurring in patients with severe ARDS under veno-venous extracorporeal membrane oxygenation (ECMO). The following data were retrospectively recorded from the patients'' medical file: age, sex, Simplified Acute Physiologic Score II (SAPS II) [21] , Sequential Organ Failure Assessment (SOFA) score [22] , presence of co-morbidities, presence of previous immunosuppression, cause of ARDS, date of MV initiation, date of ECMO implementation, other organ failure associated with ARDS during ICU stay (in particular need for catecholamines or renal replacement therapy), blood transfusion, post-aggressive pulmonary fibrosis (defined by an alveolar procollagen III higher than 9 µg/l) [23] , time of HSV/CMV reactivation, delay between MV and HSV/CMV reactivation, delay between ECMO and HSV/CMV reactivation, duration of MV (from the day of intubation to the day of MV weaning), ECMO duration (from the day of ECMO implementation to its removal or death), ECMO-free days at day 28, ventilator-free days (VFD) at day 28, ICU length of stay [from the day of ICU admission (in the first ICU if the patient was referred from another hospital) to discharge], hospital length of stay [from the admission to hospital (in the original hospital if the patient was referred from another hospital) to discharge to home or to rehabilitation ward], ICU and hospital mortality, acyclovir or ganciclovir treatment after reactivation under ECMO.

title:
  Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO

abstract:
  BACKGROUND: Herpesviridae reactivation among non-immunocompromised critically ill patients is associated with impaired prognosis, especially during acute respiratory distress syndrome (ARDS). However, little is known about herpes simplex virus (HSV) and Cytomegalovirus (CMV) reactivation occurring in patients with severe ARDS under veno-venous extracorporeal membrane oxygenation (ECMO). We tried to determine the frequency of Herpesviridae reactivation and its impact on patients’ prognosis during ECMO for severe ARDS. RESULTS: During a 5-year period, 123 non-immunocompromised patients with a severe ARDS requiring a veno-venous ECMO were included. Sixty-seven patients (54%) experienced HSV and/or CMV reactivation during ECMO course (20 viral co-infection, 40 HSV alone, and 7 CMV alone). HSV reactivation occurred earlier than CMV after the beginning of MV [(6–15) vs. 19 (13–29) days; p < 0.01] and after ECMO implementation [(2–8) vs. 14 (10–20) days; p < 0.01]. In univariate analysis, HSV/CMV reactivation was associated with a longer duration of mechanical ventilation [(22–52.5) vs. 17.5 (9–28) days; p < 0.01], a longer duration of ECMO [15 (10–22.5) vs. 9 (5–14) days; p < 0.01], and a prolonged ICU [29 (19.5–47.5) vs. 16 (9–30) days; p < 0.01] and hospital stay [44 (29–63.5) vs. 24 (11–43) days; p < 0.01] as compared to non-reactivated patients. However, in multivariate analysis, viral reactivation remained associated with prolonged MV only. When considered separately, both HSV and CMV reactivation were associated with a longer duration of MV as compared to non-reactivation patients [29 (19.5–41) and 28 (20.5–37), respectively, vs. 17.5 (9–28) days; p < 0.05]. Co-reactivation patients had a longer duration of MV [58.5 (38–72.3); p < 0.05] and ICU stay [51.5 (32.5–69) vs. 27.5 (17.75–35.5) and 29 (20–30.5), respectively] as compared to patients with HSV or CMV reactivation alone. In multivariate analysis, HSV reactivation remained independently associated with a longer duration of MV and hospital length of stay. CONCLUSIONS: Herpesviridae reactivation is frequent among patients with severe ARDS under veno-venous ECMO and is associated with a longer duration of mechanical ventilation. The direct causative link between HSV and CMV reactivation and respiratory function worsening under ECMO remains to be confirmed.


id: cord-004092-wb150n8w
author: Nieman, Gary F.
date: 2020-01-06
txt: ./txt/cord-004092-wb150n8w.txt
cache: ./cache/cord-004092-wb150n8w.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944723/
doi: 10.1186/s13613-019-0619-3
summary:
  Understanding how ARDS alters the dynamic alveolar inflation physiology enables us to adjust the mechanical breath profile (MB P -all airway pressures, volumes, flows, rates and the time at inspiration and expiration at which they are applied) necessary to minimize VILI [12] . The ARDSnet Low Vt (LVt) method is intended to protect the non-dependent normal lung tissue from overdistension (OD) and reduce alveolar recruitment/ derecruitment (R/D) with positive end expiratory pressure (PEEP), while resting severely injured tissue by allowing it to remain collapsed throughout the ventilation cycle [2] . Abbreviations ARDS: acute respiratory distress syndrome; VILI: ventilator-induced lung injury; APRV: airway pressure release ventilation; FRC: functional residual capacity; TCAV: time-controlled adaptive ventilation; CPAP: continuous positive airway pressure; TC-PEEP: time controlled-positive end expiratory pressure; T Low : time at low pressure; T High : time at high pressure; P High : pressure at inspiration; P Low : pressure at expiration; PEEP: positive end expiratory pressure; E FT : expiratory flow termination; E FP : expiratory flow peak; RCT : randomized controlled trial; OLA: open lung approach; MB P : mechanical breath pattern; CT: computerized axial tomography.

title:
  Prevention and treatment of acute lung injury with time-controlled adaptive ventilation: physiologically informed modification of airway pressure release ventilation

abstract:
  Mortality in acute respiratory distress syndrome (ARDS) remains unacceptably high at approximately 39%. One of the only treatments is supportive: mechanical ventilation. However, improperly set mechanical ventilation can further increase the risk of death in patients with ARDS. Recent studies suggest that ventilation-induced lung injury (VILI) is caused by exaggerated regional lung strain, particularly in areas of alveolar instability subject to tidal recruitment/derecruitment and stress-multiplication. Thus, it is reasonable to expect that if a ventilation strategy can maintain stable lung inflation and homogeneity, regional dynamic strain would be reduced and VILI attenuated. A time-controlled adaptive ventilation (TCAV) method was developed to minimize dynamic alveolar strain by adjusting the delivered breath according to the mechanical characteristics of the lung. The goal of this review is to describe how the TCAV method impacts pathophysiology and protects lungs with, or at high risk of, acute lung injury. We present work from our group and others that identifies novel mechanisms of VILI in the alveolar microenvironment and demonstrates that the TCAV method can reduce VILI in translational animal ARDS models and mortality in surgical/trauma patients. Our TCAV method utilizes the airway pressure release ventilation (APRV) mode and is based on opening and collapsing time constants, which reflect the viscoelastic properties of the terminal airspaces. Time-controlled adaptive ventilation uses inspiratory and expiratory time to (1) gradually “nudge” alveoli and alveolar ducts open with an extended inspiratory duration and (2) prevent alveolar collapse using a brief (sub-second) expiratory duration that does not allow time for alveolar collapse. The new paradigm in TCAV is configuring each breath guided by the previous one, which achieves real-time titration of ventilator settings and minimizes instability induced tissue damage. This novel methodology changes the current approach to mechanical ventilation, from arbitrary to personalized and adaptive. The outcome of this approach is an open and stable lung with reduced regional strain and greater lung protection.


id: cord-004138-5nvhtqoh
author: Pouly, Olivier
date: 2020-01-13
txt: ./txt/cord-004138-5nvhtqoh.txt
cache: ./cache/cord-004138-5nvhtqoh.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957592/
doi: 10.1186/s13613-020-0624-6
summary:
  VAE and VA-LRTI were associated with significantly longer duration of mechanical ventilation, ICU and hospital length of stay. VAE episodes were significantly associated with longer duration of mechanical ventilation and length of stay, but not with ICU mortality. Ventilator-associated lower respiratory tract infections (VA-LRTI), including ventilator-associated pneumonia (VAP), and ventilator-associated tracheobronchitis (VAT) are the most common complications in patients receiving mechanical ventilation. However, recent studies and meta-analysis reported poor agreement between VAE, including ventilator-associated conditions (VAC), infection-related ventilator-associated complications (IVAC), or probable VAP (pVAP) [5] [6] [7] . Therefore, we conducted this retrospective analysis of prospectively collected data to determine the agreement between VAE and VA-LRTI, including VAP and VAT. ICU mortality, duration of mechanical ventilation and length of stay were significantly different between patients with VAP, VAT, or no VA-LRTI (Table 4 ). In patients with VAT, as compared with those with no VA-LRTI, duration of mechanical ventilation and length of stay were higher, and ICU mortality was significantly lower.

title:
  Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections

abstract:
  BACKGROUND: The aim of this study was to investigate the concordance between ventilator-associated events (VAE) and ventilator-associated lower respiratory tract infections (VA-LRTI), and their impact on outcome. METHODS: This retrospective study was performed in five 10-bed ICUs of a teaching hospital, during a 2-year period. Ventilator-associated lower respiratory tract infections (VA-LRTI), including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) were prospectively diagnosed. The agreement between VAE, VAT and VAP was assessed by k statistics. RESULTS: A total of 1059 patients (15,029 ventilator-days) were included. 268 VAP (17.8 per 1000 ventilator-days), 127 VAT (8.5 per 1000 ventilator-days) and 262 VAE (17.4 per 1000 ventilator-days) were diagnosed. There was no agreement between VAT and VAE, and the agreement was poor between VAP and VAE (k = 0.12, 95% CI 0.03–0.20). VAE and VA-LRTI were associated with significantly longer duration of mechanical ventilation, ICU and hospital length of stay. VAP, VAT and VAE were not significantly associated with mortality in multivariate analysis. CONCLUSIONS: The agreement was poor between VAE and VAP. No agreement was found between VAE and VAT. VAE episodes were significantly associated with longer duration of mechanical ventilation and length of stay, but not with ICU mortality.


id: cord-004284-2prli5s1
title: Natural versus artificial light exposure on delirium incidence in ARDS patients
author: Vahedian-Azimi, Amir
date: 2020-02-05
txt: ./txt/cord-004284-2prli5s1.txt
cache: ./cache/cord-004284-2prli5s1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002756/
doi: 10.1186/s13613-020-0630-8
abstract: nan
summary:
  title: Natural versus artificial light exposure on delirium incidence in ARDS patients on the impact of natural light (NL) exposure on delirium-associated outcomes in mechanically ventilated (MV) intensive care unit (ICU) patients [1] . In this single-center, prospective, observational study, the authors report an improvement in the secondary outcomes of hallucination incidence and haloperidol administration for agitation. Here, we report the results of a retrospective secondary analysis of 4200 patients from the mixed medical-surgical ICUs of two academic hospitals to assess the impact of NL exposure on delirium incidence. Impact of natural light exposure on delirium burden in adult patients receiving invasive mechanical ventilation in the ICU: a prospective study Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU) Delirium and effect of circadian light in the intensive care unit: a retrospective cohort study


id: cord-004438-jjszkq2n
author: Gavelli, Francesco
date: 2020-03-02
txt: ./txt/cord-004438-jjszkq2n.txt
cache: ./cache/cord-004438-jjszkq2n.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052093/
doi: 10.1186/s13613-020-0644-2
summary:
  title: Transpulmonary thermodilution detects rapid and reversible increases in lung water induced by positive end-expiratory pressure in acute respiratory distress syndrome PURPOSE: It has been suggested that, by recruiting lung regions and enlarging the distribution volume of the cold indicator, increasing the positive end-expiratory pressure (PEEP) may lead to an artefactual overestimation of extravascular lung water (EVLW) by transpulmonary thermodilution (TPTD). Many studies have investigated the changes in EVLW induced by a positive end-expiratory pressure (PEEP), which is the cornerstone of ARDS treatment (Additional file 1: Table S1 ). Thus, the goal of our study, conducted in ARDS patients, was to investigate whether the estimation of EVLW by TPTD is artefactually influenced by the lung derecruitment potentially secondary to the decrease in the PEEP level. In our study, the changes in EVLW were the same among patients with high or low derecruitment, when derecruitment was assessed by the PEEP-induced change in lung volume, the method that is today the best one for estimating recruitment/derecruitment at the bedside [36] .

title:
  Transpulmonary thermodilution detects rapid and reversible increases in lung water induced by positive end-expiratory pressure in acute respiratory distress syndrome

abstract:
  PURPOSE: It has been suggested that, by recruiting lung regions and enlarging the distribution volume of the cold indicator, increasing the positive end-expiratory pressure (PEEP) may lead to an artefactual overestimation of extravascular lung water (EVLW) by transpulmonary thermodilution (TPTD). METHODS: In 60 ARDS patients, we measured EVLW (PiCCO2 device) at a PEEP level set to reach a plateau pressure of 30 cmH(2)O (HighPEEP(start)) and 15 and 45 min after decreasing PEEP to 5 cmH(2)O (LowPEEP(15′) and LowPEEP(45′), respectively). Then, we increased PEEP back to the baseline level (HighPEEP(end)). Between HighPEEP(start) and LowPEEP(15′), we estimated the degree of lung derecruitment either by measuring changes in the compliance of the respiratory system (Crs) in the whole population, or by measuring the lung derecruited volume in 30 patients. We defined patients with a large derecruitment from the other ones as patients in whom the Crs changes and the measured derecruited volume were larger than the median of these variables observed in the whole population. RESULTS: Reducing PEEP from HighPEEP(start) (14 ± 2 cmH(2)O) to LowPEEP(15′) significantly decreased EVLW from 20 ± 4 to 18 ± 4 mL/kg, central venous pressure (CVP) from 15 ± 4 to 12 ± 4 mmHg, the arterial oxygen tension over inspired oxygen fraction (PaO(2)/FiO(2)) ratio from 184 ± 76 to 150 ± 69 mmHg and lung volume by 144 [68–420] mL. The EVLW decrease was similar in “large derecruiters” and the other patients. When PEEP was re-increased to HighPEEP(end), CVP, PaO(2)/FiO(2) and EVLW significantly re-increased. At linear mixed effect model, EVLW changes were significantly determined only by changes in PEEP and CVP (p < 0.001 and p = 0.03, respectively, n = 60). When the same analysis was performed by estimating recruitment according to lung volume changes (n = 30), CVP remained significantly associated to the changes in EVLW (p < 0.001). CONCLUSIONS: In ARDS patients, changing the PEEP level induced parallel, small and reversible changes in EVLW. These changes were not due to an artefact of the TPTD technique and were likely due to the PEEP-induced changes in CVP, which is the backward pressure of the lung lymphatic drainage. Trial registration ID RCB: 2015-A01654-45. Registered 23 October 2015


id: cord-004462-e8fbg6i6
author: Liu, Songqiao
date: 2020-03-06
txt: ./txt/cord-004462-e8fbg6i6.txt
cache: ./cache/cord-004462-e8fbg6i6.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060304/
doi: 10.1186/s13613-020-0647-z
summary:
  title: Optimal mean airway pressure during high-frequency oscillatory ventilation in an experimental model of acute respiratory distress syndrome: EIT-based method Our objective was to evaluate the air distribution, ventilatory and hemodynamic effects of individual mPaw titration during HFOV in ARDS animal based on oxygenation and electrical impedance tomography (EIT). CONCLUSION: Our data suggested personalized optimal mPaw titration by EIT-based indices improves regional ventilation distribution and lung homogeneity during high-frequency oscillatory ventilation. But the ventilation distribution and homogeneity remain unknown toward the methods mentioned above to titrate mPaw. Electrical impedance tomography (EIT) might allow the clinician to better adjust these ventilatory settings. In the present study, our objective was to evaluate the air distribution, ventilatory, and hemodynamic effects of individual mPaw titration in HFOV based on oxygenation and EIT. Our data provide personalized optimal mPaw titration in HFOV with EIT-based indices, which may provide a new insight of regional ventilation distribution and lung homogeneity during high-frequency oscillatory ventilation.

title:
  Optimal mean airway pressure during high-frequency oscillatory ventilation in an experimental model of acute respiratory distress syndrome: EIT-based method

abstract:
  BACKGROUND: High-frequency oscillatory ventilation (HFOV) may theoretically provide lung protective ventilation. The negative clinical results may be due to inadequate mean airway pressure (mPaw) settings in HFOV. Our objective was to evaluate the air distribution, ventilatory and hemodynamic effects of individual mPaw titration during HFOV in ARDS animal based on oxygenation and electrical impedance tomography (EIT). METHODS: ARDS was introduced with repeated bronchoalveolar lavage followed by injurious mechanical ventilation in ten healthy male pigs (51.2 ± 1.9 kg). Settings of HFOV were 9 Hz (respiratory frequency), 33% (inspiratory time) and 70 cmH(2)O (∆pressure). After lung recruitment, the mPaw was reduced in steps of 3 cmH(2)O every 6 min. Hemodynamics and blood gases were obtained in each step. Regional ventilation distribution was determined with EIT. RESULTS: PaO(2)/FiO(2) decreased significantly during the mPaw decremental phase (p < 0.001). Lung overdistended regions decreased, while recruitable regions increased as mPaw decreased. The optimal mPaw with respect to PaO(2)/FiO(2) was 21 (18.0–21.0) cmH(2)O, that is comparable to EIT-based center of ventilation (EIT-CoV) and EIT-collapse/over, 19.5 (15.0–21.0) and 19.5 (18.0–21.8), respectively (p = 0.07). EIT-CoV decreasing along with mPaw decrease revealed redistribution toward non-dependent regions. The individual mPaw titrated by EIT-based indices improved regional ventilation distribution with respect to overdistension and collapse (p = 0.035). CONCLUSION: Our data suggested personalized optimal mPaw titration by EIT-based indices improves regional ventilation distribution and lung homogeneity during high-frequency oscillatory ventilation.


id: cord-005511-h5d2v4ga
author: Ospina-Tascón, Gustavo A.
date: 2020-03-24
txt: ./txt/cord-005511-h5d2v4ga.txt
cache: ./cache/cord-005511-h5d2v4ga.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093634/
doi: 10.1186/s13613-020-00651-1
summary:
  We sought to evaluate the relationships between dynamic variations in V(D)/V(T) and extra-pulmonary microcirculatory blood flow detected at sublingual mucosa hypothesizing that an altered microcirculation, which is a generalized phenomenon during severe inflammatory conditions, could influence ventilation/perfusion mismatching manifested by increases in V(D)/V(T) fraction during early stages of ARDS. Thus, considering microcirculatory dysfunction during inflammatory conditions as a generalized phenomenon, which may involve systemic and pulmonary vascular beds, we hypothesized that alterations in microvascular blood flow distribution evaluated at the sublingual mucosa as representative of an extra-pulmonary territory could be related to variations in dead-space ventilation V D /V T during early phases of moderate and severe ARDS.

title:
  Microcirculatory dysfunction and dead-space ventilation in early ARDS: a hypothesis-generating observational study

abstract:
  BACKGROUND: Ventilation/perfusion inequalities impair gas exchange in acute respiratory distress syndrome (ARDS). Although increased dead-space ventilation (V(D)/V(T)) has been described in ARDS, its mechanism is not clearly understood. We sought to evaluate the relationships between dynamic variations in V(D)/V(T) and extra-pulmonary microcirculatory blood flow detected at sublingual mucosa hypothesizing that an altered microcirculation, which is a generalized phenomenon during severe inflammatory conditions, could influence ventilation/perfusion mismatching manifested by increases in V(D)/V(T) fraction during early stages of ARDS. METHODS: Forty-two consecutive patients with early moderate and severe ARDS were included. PEEP was set targeting the best respiratory-system compliance after a PEEP-decremental recruitment maneuver. After 60 min of stabilization, hemodynamics and respiratory mechanics were recorded and blood gases collected. V(D)/V(T) was calculated from the CO(2) production ([Formula: see text] ) and CO(2) exhaled fraction ([Formula: see text] ) measurements by volumetric capnography. Sublingual microcirculatory images were simultaneously acquired using a sidestream dark-field device for an ulterior blinded semi-quantitative analysis. All measurements were repeated 24 h after. RESULTS: Percentage of small vessels perfused (PPV) and microcirculatory flow index (MFI) were inverse and significantly related to V(D)/V(T) at baseline (Spearman’s rho = − 0.76 and − 0.63, p < 0.001; R(2) = 0.63, and 0.48, p < 0.001, respectively) and 24 h after (Spearman’s rho = − 0.71, and − 0.65; p < 0.001; R(2) = 0.66 and 0.60, p < 0.001, respectively). Other respiratory, macro-hemodynamic and oxygenation parameters did not correlate with V(D)/V(T). Variations in PPV between baseline and 24 h were inverse and significantly related to simultaneous changes in V(D)/V(T) (Spearman’s rho = − 0.66, p < 0.001; R(2) = 0.67, p < 0.001). CONCLUSION: Increased heterogeneity of microcirculatory blood flow evaluated at sublingual mucosa seems to be related to increases in V(D)/V(T), while respiratory mechanics and oxygenation parameters do not. Whether there is a cause–effect relationship between microcirculatory dysfunction and dead-space ventilation in ARDS should be addressed in future research.


id: cord-009600-sb1pgqi8
title: Diastolic shock index and clinical outcomes in patients with septic shock
author: Ospina-Tascón, Gustavo A.
date: 2020-04-16
txt: ./txt/cord-009600-sb1pgqi8.txt
cache: ./cache/cord-009600-sb1pgqi8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160223/
doi: 10.1186/s13613-020-00658-8
summary:
  Thus, we evaluated the relationships between very early HR:DAP ratios (i.e., the diastolic shock index, or DSI, calculated just before or at the start of vasopressor support) and clinical outcomes in patients with septic shock, hypothesizing that very early DSI values could promptly identify patients at high risk of unfavorable outcomes, while persistence of high DSI during the first hours of resuscitation could reflect more severe cardiovascular dysfunction. Our study retrieves four important findings: (a) progressively higher DSI values calculated just before or at the start of vasopressors are associated with a gradual increase in the risk of death in patients with septic shock; (b) isolated low DAP or high HR values do not clearly identify such risk; (c) non-survivors evolve with persistently high DSI values while requiring higher doses of vasopressors and more resuscitation fluids than survivors; (d) Pre-VPs/DSI and VPs/DSI showed similar performance to SOFA score and initial lactate levels to predict mortality, while mean arterial pressure and systolic shock index did not.

abstract:
  BACKGROUND: Loss of vascular tone is a key pathophysiological feature of septic shock. Combination of gradual diastolic hypotension and tachycardia could reflect more serious vasodilatory conditions. We sought to evaluate the relationships between heart rate (HR) to diastolic arterial pressure (DAP) ratios and clinical outcomes during early phases of septic shock. METHODS: Diastolic shock index (DSI) was defined as the ratio between HR and DAP. DSI calculated just before starting vasopressors (Pre-VPs/DSI) in a preliminary cohort of 337 patients with septic shock (January 2015 to February 2017) and at vasopressor start (VPs/DSI) in 424 patients with septic shock included in a recent randomized controlled trial (ANDROMEDA-SHOCK; March 2017 to April 2018) was partitioned into five quantiles to estimate the relative risks (RR) of death with respect to the mean risk of each population (assumed to be 1). Matched HR and DAP subsamples were created to evaluate the effect of the individual components of the DSI on RRs. In addition, time-course of DSI and interaction between DSI and vasopressor dose (DSI*NE.dose) were compared between survivors and non-survivors from both populations, while ROC curves were used to identify variables predicting mortality. Finally, as exploratory observation, effect of early start of vasopressors was evaluated at each Pre-VPs/DSI quintile from the preliminary cohort. RESULTS: Risk of death progressively increased at gradual increments of Pre-VPs/DSI or VPs/DSI (One-way ANOVA, p < 0.001). Progressive DAP decrease or HR increase was associated with higher mortality risks only when DSI concomitantly increased. Areas under the ROC curve for Pre-VPs/DSI, SOFA and initial lactate were similar, while mean arterial pressure and systolic shock index showed poor performances to predict mortality. Time-course of DSI and DSI*NE.dose was significantly higher in non-survivors from both populations (repeated-measures ANOVA, p < 0.001). Very early start of vasopressors exhibited an apparent benefit at higher Pre-VPs/DSI quintile. CONCLUSIONS: DSI at pre-vasopressor and vasopressor start points might represent a very early identifier of patients at high risk of death. Isolated DAP or HR values do not clearly identify such risk. Usefulness of DSI to trigger or to direct therapeutic interventions in early resuscitation of septic shock need to be addressed in future studies.


id: cord-025157-7b3v5yct
author: Darreau, C.
date: 2020-05-24
txt: ./txt/cord-025157-7b3v5yct.txt
cache: ./cache/cord-025157-7b3v5yct.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245631/
doi: 10.1186/s13613-020-00668-6
summary:
  In the multivariate analysis, seven parameters were significantly associated with early intubation and ranked as follows by decreasing weight: Glasgow score, center effect, use of accessory respiratory muscles, lactate level, vasopressor dose, pH and inability to clear tracheal secretions. Several arguments have been put forward in favor of early ventilatory support in septic shock patients, as part of the bundle that should be introduced in the first hours Open Access *Correspondence: nicolas.lerolle@univ-angers.fr 31 Medical Intensive Care Unit, Angers University Hospital, Angers, France Full list of author information is available at the end of the article of care together with antibiotic, fluid, and vasopressor use. To assess use, timing and factors associated with tracheal intubation in septic shock patients, we conducted a multicenter observational prospective study in 30 intensive care units (ICUs) in France and Spain.

title:
  Use, timing and factors associated with tracheal intubation in septic shock: a prospective multicentric observational study

abstract:
  BACKGROUND: No recommendation exists about the timing and setting for tracheal intubation and mechanical ventilation in septic shock. PATIENTS AND METHODS: This prospective multicenter observational study was conducted in 30 ICUs in France and Spain. All consecutive patients presenting with septic shock were eligible. The use of tracheal intubation was described across the participating ICUs. A multivariate analysis was performed to identify parameters associated with early intubation (before H8 following vasopressor onset). RESULTS: Eight hundred and fifty-nine patients were enrolled. Two hundred and nine patients were intubated early (24%, range 4.5–47%), across the 18 centers with at least 20 patients included. The cumulative intubation rate during the ICU stay was 324/859 (38%, range 14–65%). In the multivariate analysis, seven parameters were significantly associated with early intubation and ranked as follows by decreasing weight: Glasgow score, center effect, use of accessory respiratory muscles, lactate level, vasopressor dose, pH and inability to clear tracheal secretions. Global R-square of the model was only 60% indicating that 40% of the variability of the intubation process was related to other parameters than those entered in this analysis. CONCLUSION: Neurological, respiratory and hemodynamic parameters only partially explained the use of tracheal intubation in septic shock patients. Center effect was important. Finally, a vast part of the variability of intubation remained unexplained by patient characteristics. Trial registration Clinical trials NCT02780466, registered on May 23, 2016. https://clinicaltrials.gov/ct2/show/NCT02780466?term=intubatic&draw=2&rank=1.


id: cord-025170-dtbm4ue1
author: Malbrain, Manu L. N. G.
date: 2020-05-24
txt: ./txt/cord-025170-dtbm4ue1.txt
cache: ./cache/cord-025170-dtbm4ue1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245999/
doi: 10.1186/s13613-020-00679-3
summary:
  Resuscitation fluids are used to correct an intravascular volume deficit or acute hypovolemia; replacement solutions are prescribed to correct existing or developing deficits that cannot be compensated by oral intake alone [6] ; maintenance solutions are indicated in hemodynamically stable patients that are not able/allowed to drink water in order to cover their daily requirements of water and electrolytes [10, 11] . Despite the unexpectedly low volume of crystalloids, the authors found a small difference in the primary outcome, i.e., the incidence of major adverse kidney events within 30 days (composite of death, new renal replacement therapy or persistent renal dysfunction) in favor of balance solutions. Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: The SPLIT randomized clinical trial Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial

title:
  Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA)

abstract:
  Intravenous fluid administration should be considered as any other pharmacological prescription. There are three main indications: resuscitation, replacement, and maintenance. Moreover, the impact of fluid administration as drug diluent or to preserve catheter patency, i.e., fluid creep, should also be considered. As for antibiotics, intravenous fluid administration should follow the four Ds: drug, dosing, duration, de-escalation. Among crystalloids, balanced solutions limit acid–base alterations and chloride load and should be preferred, as this likely prevents renal dysfunction. Among colloids, albumin, the only available natural colloid, may have beneficial effects. The last decade has seen growing interest in the potential harms related to fluid overloading. In the perioperative setting, appropriate fluid management that maintains adequate organ perfusion while limiting fluid administration should represent the standard of care. Protocols including a restrictive continuous fluid administration alongside bolus administration to achieve hemodynamic targets have been proposed. A similar approach should be considered also for critically ill patients, in whom increased endothelial permeability makes this strategy more relevant. Active de-escalation protocols may be necessary in a later phase. The R.O.S.E. conceptual model (Resuscitation, Optimization, Stabilization, Evacuation) summarizes accurately a dynamic approach to fluid therapy, maximizing benefits and minimizing harms. Even in specific categories of critically ill patients, i.e., with trauma or burns, fluid therapy should be carefully applied, considering the importance of their specific aims; maintaining peripheral oxygen delivery, while avoiding the consequences of fluid overload.


id: cord-025615-xaehtmjf
author: Roesthuis, L. H.
date: 2020-05-29
txt: ./txt/cord-025615-xaehtmjf.txt
cache: ./cache/cord-025615-xaehtmjf.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256918/
doi: 10.1186/s13613-020-00684-6
summary:
  Diaphragm and extradiaphragmatic inspiratory muscle activity increased in response to lower PS levels (36 ± 6% increase for the diaphragm, 30 ± 6% parasternal intercostals, 41 ± 6% scalene, 40 ± 8% sternocleidomastoid, 43 ± 6% alae nasi and 30 ± 6% genioglossus). In previous studies, surface EMG has been used in ventilated ICU patients to evaluate activity of the extradiaphragmatic inspiratory muscles, including alae nasi, parasternal intercostals [26] , scalene [26, 27] , sternocleidomastoid and genioglossus [26] [27] [28] . Therefore, the aim of the current study is to investigate in invasively ventilated ICU patients the recruitment pattern of extradiaphragmatic inspiratory muscles with respect to the diaphragm in response to different inspiratory support levels and to evaluate agreement between activity of the extradiaphragmatic inspiratory muscles and the diaphragm. Keywords: Ventilated critically ill patients, Respiratory drive, Electrical activity of the diaphragm, Extradiaphragmatic inspiratory muscle activity, Surface electromyography EAdi was obtained using a multi-electrode nasogastric catheter.

title:
  Recruitment pattern of the diaphragm and extradiaphragmatic inspiratory muscles in response to different levels of pressure support

abstract:
  BACKGROUND: Inappropriate ventilator assist plays an important role in the development of diaphragm dysfunction. Ventilator under-assist may lead to muscle injury, while over-assist may result in muscle atrophy. This provides a good rationale to monitor respiratory drive in ventilated patients. Respiratory drive can be monitored by a nasogastric catheter, either with esophageal balloon to determine muscular pressure (gold standard) or with electrodes to measure electrical activity of the diaphragm. A disadvantage is that both techniques are invasive. Therefore, it is interesting to investigate the role of surrogate markers for respiratory dive, such as extradiaphragmatic inspiratory muscle activity. The aim of the current study was to investigate the effect of different inspiratory support levels on the recruitment pattern of extradiaphragmatic inspiratory muscles with respect to the diaphragm and to evaluate agreement between activity of extradiaphragmatic inspiratory muscles and the diaphragm. METHODS: Activity from the alae nasi, genioglossus, scalene, sternocleidomastoid and parasternal intercostals was recorded using surface electrodes. Electrical activity of the diaphragm was measured using a multi-electrode nasogastric catheter. Pressure support (PS) levels were reduced from 15 to 3 cmH(2)O every 5 min with steps of 3 cmH(2)O. The magnitude and timing of respiratory muscle activity were assessed. RESULTS: We included 17 ventilated patients. Diaphragm and extradiaphragmatic inspiratory muscle activity increased in response to lower PS levels (36 ± 6% increase for the diaphragm, 30 ± 6% parasternal intercostals, 41 ± 6% scalene, 40 ± 8% sternocleidomastoid, 43 ± 6% alae nasi and 30 ± 6% genioglossus). Changes in diaphragm activity correlated best with changes in alae nasi activity (r(2) = 0.49; P < 0.001), while there was no correlation between diaphragm and sternocleidomastoid activity. The agreement between diaphragm and extradiaphragmatic inspiratory muscle activity was low due to a high individual variability. Onset of alae nasi activity preceded the onset of all other muscles. CONCLUSIONS: Extradiaphragmatic inspiratory muscle activity increases in response to lower inspiratory support levels. However, there is a poor correlation and agreement with the change in diaphragm activity, limiting the use of surface electromyography (EMG) recordings of extradiaphragmatic inspiratory muscles as a surrogate for electrical activity of the diaphragm.


id: cord-026421-ygocpnht
title: Response to the authors
author: de Jager, Pauline
date: 2020-06-08
txt: ./txt/cord-026421-ygocpnht.txt
cache: ./cache/cord-026421-ygocpnht.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278274/
doi: 10.1186/s13613-020-00694-4
abstract: nan
summary:
  High-frequency oscillatory ventilation (HFOV) is used in our unit for any type of PARDS when the patient meets specific criteria as outlined in our manuscript (in summary, peak inspiratory pressure [PIP] > 28-32 cm H 2 O, PEEP > 8 cm H 2 O, FiO 2 > 0.60, and oxygenation index [OI] increases on three consecutive 1-h measurements despite increasing PEEP) [1] . We understand the author''s perspective that HFOV might be more effective in certain types of PARDS, but we advocate that HFOV should not only be considered in case of refractory hypoxaemia, but also when the bedside team wants to prevent ventilator settings becoming toxic. For simplicity, when we implemented the HFOV clinical algorithm in our unit, the advice was to start with 12 Hz in all patients, irrespective of age or PARDS severity and titrate immediately after the lung volume optimisation manoeuvre using the PCO 2 to give direction (e.g. frequency up or down). Lung volume optimization maneuver responses in pediatric high frequency oscillatory ventilation


id: cord-026659-mhe6q1ce
author: Sanaie, Sarvin
date: 2020-06-12
txt: ./txt/cord-026659-mhe6q1ce.txt
cache: ./cache/cord-026659-mhe6q1ce.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289937/
doi: 10.1186/s13613-020-00696-2
summary:
  title: A comparison of nasogastric tube insertion by SORT maneuver (sniffing position, NGT orientation, contralateral rotation, and twisting movement) versus neck flexion lateral pressure in critically ill patients admitted to ICU: a prospective randomized clinical trial The current study purposed to investigate if SORT maneuver (sniffing position, NGT orientation, contralateral rotation, and twisting movement) increases the success rate of NGT correct placement versus neck flexion lateral pressure (NFLP) method. The present study was carried out to compare NGT insertion by SORT maneuver with neck flexion lateral pressure (NFLP) in critically ill patients admitted to ICU. Another technique Table 2 Comparing the outcomes of interest between the study groups NFLP: neck flexion lateral pressure; SORT: sniffing position, NGT orientation, contralateral rotation, and twisting movement Ease of insertion: I: successful insertion in less than 50 s and in first attempt II: successful insertion in 1st attempt with more than 50 s, or in 2nd attempts with less than 100 s III: successful insertion in 2nd attempts with more than 100 s, or in 3 attempts to overcome the difficulties of blind NGT insertion is considering patients'' anatomical factors.

title:
  A comparison of nasogastric tube insertion by SORT maneuver (sniffing position, NGT orientation, contralateral rotation, and twisting movement) versus neck flexion lateral pressure in critically ill patients admitted to ICU: a prospective randomized clinical trial

abstract:
  BACKGROUND: Although many techniques have been introduced to facilitate nasogastric tube (NGT) insertion using anatomic landmarks and a group of devices, there is a lack of general consensus regarding a standard method. The current study purposed to investigate if SORT maneuver (sniffing position, NGT orientation, contralateral rotation, and twisting movement) increases the success rate of NGT correct placement versus neck flexion lateral pressure (NFLP) method. METHODS: A randomized controlled trial study was conducted in two university affiliated intensive care units (tertiary referral center). Three hundred and ninety-six critically ill patients older than 18 years of age were randomly divided into SORT (n = 200) and NFLP (n = 196) groups. The technique was classified as “failed” after the third unsuccessful attempt. Patient characteristics, success rate for the first attempt, time required for the successful first attempt and overall successful insertion time, various complications including kinking, coiling and bleeding and ease of insertion were noted as main outcomes measured. RESULTS: Ease of insertion was significantly better in the SORT group compared to the NFLP group (P < 0.001). The number of failed attempts was significantly higher in the NFLP group (7.5%) vs the SORT group (3.0%) (P = 0.046). The pattern of complications was not different between two study groups (P = 0.242). The odds of stage II (odds ratio (OR) = 49.9; 95% confidence interval (CI) 25.2 to 98.6), stage III (OR = 67.1; 95% CI 14.9 to 302.8)) and stage IV (OR = 11.8; 95% CI 3.4 to 41.2) ease of insertion were much higher in NFLP compared to SORT group, after adjusting for age and body mass index (BMI). The odds of failure was not significantly different in NFLP group compared to SORT group (OR = 2.3; 95% CI 0.85 to 6.3), after adjusting for age and BMI. CONCLUSIONS: SORT technique may be considered as a promising method for successful NGT insertions in critically ill patients. However, more trials are needed to confirm the results of this study. The decision must account for individual patient and clinical factors and the operator’s experience and preference. Trial registration: The study was registered at government registry of clinical trials in Iran (http://www.IRCT.ir) (number: IRCT20091012002582N18, 13 March 2018)


id: cord-026885-ql57moyi
author: Hong, David
date: 2020-06-16
txt: ./txt/cord-026885-ql57moyi.txt
cache: ./cache/cord-026885-ql57moyi.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296889/
doi: 10.1186/s13613-020-00701-8
summary:
  BACKGROUND: Limited data are available on the impact of a specialized extracorporeal membrane oxygenation (ECMO) team on clinical outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Particularly, in refractory CS not responding to Open Access *Correspondence: jhysmc@gmail.com † David Hong and Ki Hong Choi contributed equally to this work 1 Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea Full list of author information is available at the end of the article conventional medical therapies, in-hospital mortality rate reaches 50% to 60% [3, 4] and mechanical support such as veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) is recommended in both the latest American Heart Association and the European Society of Cardiology guidelines (classes IIA and IIB, respectively) [5, 6] .

title:
  Multidisciplinary team approach in acute myocardial infarction patients undergoing veno-arterial extracorporeal membrane oxygenation

abstract:
  BACKGROUND: Limited data are available on the impact of a specialized extracorporeal membrane oxygenation (ECMO) team on clinical outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). This study evaluated whether specialized ECMO team is associated with improved in-hospital mortality in AMI patients undergoing veno-arterial (VA) ECMO. METHODS: A total of 255 AMI patients who underwent VA-ECMO were included. In January 2014, a multidisciplinary ECMO team was founded at our institution. Eligible patients were classified into a pre-ECMO team group (n = 131) and a post-ECMO team group (n = 124). The primary outcome was in-hospital mortality. RESULTS: In-hospital mortality (pre-ECMO team vs. post-ECMO team, 54.2% vs. 33.9%; p = 0.002) and cardiac intensive care unit mortality (pre-ECMO team vs. post-ECMO team, 51.9% vs. 30.6%; p = 0.001) were significantly lower after the implementation of a multidisciplinary ECMO team. On multivariable logistic regression model, implementation of the multidisciplinary ECMO team was associated with reduction of in-hospital mortality [odds ratio: 0.37, 95% confidence interval (CI) 0.20–0.67; p = 0.001]. Incidence of all-cause mortality [58.3% vs. 35.2%; hazard ratio (HR): 0.49, 95% CI 0.34–0.72; p < 0.001) and readmission due to heart failure (28.2% vs. 6.4%; HR: 0.21, 95% CI 0.08–0.58; p = 0.003) at 6 months of follow-up were also significantly lower in the post-ECMO team group than in the pre-ECMO team group. CONCLUSIONS: Implementation of a multidisciplinary ECMO team was associated with improved clinical outcomes in AMI patients complicated by CS. Our data support that a specialized ECMO team is indispensable for improving outcomes in patients with AMI complicated by CS.


id: cord-029136-mbqncen1
title: Pharmacokinetics of high-dose tigecycline in critically ill patients with severe infections
author: De Pascale, Gennaro
date: 2020-07-13
txt: ./txt/cord-029136-mbqncen1.txt
cache: ./cache/cord-029136-mbqncen1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357259/
doi: 10.1186/s13613-020-00715-2
summary:
  Critically ill adult patients were considered eligible for the study when the attending physician prescribed TGC as empirical treatment (within 12 h from microbiological sampling) of a possible MDR infection, or as targeted therapy based on definitive results, in the absence of any exclusion criteria: known TGC allergy, creatinine clearance less than 40 mL/min (calculated according to the Cocrockft-Gault formula) apart from those ones who were anuric and on continuous renal replacement therapy (CRRT), hyperbilirubinemia (bilirubin level higher than 3 mg/dL), severe hepatic failure (Child-Pugh C), little chance of survival as defined by the Simplified Acute Physiology 2 (SAPS 2) score > 80, concomitant treatment with other drugs that can potentially interfere with TGC (i.e., rifampin and cyclosporine). Our study is the first investigation where not only plasmatic but also pulmonary tigecycline concentrations are investigated during the treatment of severe infections in critically ill patients with high-dose TGC.

abstract:
  BACKGROUND: In critically ill patients, the use of high tigecycline dosages (HD TGC) (200 mg/day) has been recently increasing but few pharmacokinetic/pharmacodynamic (PK/PD) data are available. We designed a prospective observational study to describe the pharmacokinetic/pharmacodynamic (PK/PD) profile of HD TGC in a cohort of critically ill patients with severe infections. RESULTS: This was a single centre, prospective, observational study that was conducted in the 20-bed mixed ICU of a 1500-bed teaching hospital in Rome, Italy. In all patients admitted to the ICU between 2015 and 2018, who received TGC (200 mg loading dose, then 100 mg q12) for the treatment of documented infections, serial blood samples were collected to measure steady-state TGC concentrations. Moreover, epithelial lining fluid (ELF) concentrations were determined in patients with nosocomial pneumonia. Amongst the 32 non-obese patients included, 11 had a treatment failure, whilst the other 21 subjects successfully eradicated the infection. There were no between-group differences in terms of demographic aspects and main comorbidities. In nosocomial pneumonia, for a target AUC(0-24)/MIC of 4.5, 75% of the patients would be successfully treated in presence of 0.5 mcg/mL MIC value and all the patients obtained the PK target with MIC ≤ 0.12 mcg/mL. In intra-abdominal infections (IAI), for a target AUC(0-24)/MIC of 6.96, at least 50% of the patients would be adequately treated against bacteria with MIC ≤ 0.5 mcg/mL. Finally, in skin and soft-tissue infections (SSTI), for a target AUC(0-24)/MIC of 17.9 only 25% of the patients obtained the PK target at MIC values of 0.5 mcg/mL and less than 10% were adequately treated against germs with MIC value ≥ 1 mcg/mL. HD TGC showed a relevant pulmonary penetration with a median and IQR ELF/plasma ratio (%) of 152.9 [73.5–386.8]. CONCLUSIONS: The use of HD TGC is associated with satisfactory plasmatic and pulmonary concentrations for the treatment of severe infections due to fully susceptible bacteria (MIC < 0.5 mcg/mL). Even higher dosages and combination strategies may be suggested in presence of difficult to treat pathogens, especially in case of SSTI and IAI.


id: cord-029984-sjvqjoye
author: Gaudet, Alexandre
date: 2020-08-03
txt: ./txt/cord-029984-sjvqjoye.txt
cache: ./cache/cord-029984-sjvqjoye.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396887/
doi: 10.1186/s13613-020-00721-4
summary:
  CONCLUSIONS: A CPIS value ≥ 7 reproducibly allowed to differentiate VAT from VAP with high specificity and PPV and moderate sensitivity and NPV in our derivation and validation cohorts. Furthermore, such an evaluation should be preferentially performed in 2 independent cohorts to assess its reproducibility, given the heterogeneity in the performances of CPIS for the diagnosis of VAP in ventilated patients [9] , and because this score was not initially developed to distinguish VAT from VAP. Therefore, we aimed in this study to evaluate the accuracy of the CPIS to differentiate VAT from VAP in 2 independent cohorts of patients with microbiologically confirmed VA-LRTI. Data are presented as number (%) or mean (SD) COPD Chronic obstructive pulmonary disease, SAPS Simplified acute physiology score, SOFA Sequential organ failure assessment, VAP Ventilator-associated pneumonia, VAT Ventilator-associated tracheobronchitis p value < 0.05 is indicated in italic characters Clinical outcomes in the derivation and validation cohorts are shown in Table 2 and Additional file 3.

title:
  Accuracy of the clinical pulmonary infection score to differentiate ventilator-associated tracheobronchitis from ventilator-associated pneumonia

abstract:
  BACKGROUND: Differentiating Ventilator-Associated Tracheobronchitis (VAT) from Ventilator-Associated Pneumonia (VAP) may be challenging for clinicians, yet their management currently differs. In this study, we evaluated the accuracy of the Clinical Pulmonary Infection Score (CPIS) to differentiate VAT and VAP. METHODS: We performed a retrospective analysis based on the data from 2 independent prospective cohorts. Patients of the TAVeM database with a diagnosis of VAT (n = 320) or VAP (n = 369) were included in the derivation cohort. Patients admitted to the Intensive Care Centre of Lille University Hospital between January 1, 2016 and December 31, 2017 who had a diagnosis of VAT (n = 70) or VAP (n = 139) were included in the validation cohort. The accuracy of the CPIS to differentiate VAT from VAP was assessed within the 2 cohorts by calculating sensitivity and specificity values, establishing the ROC curves and choosing the best threshold according to the Youden index. RESULTS: The areas under ROC curves of CPIS to differentiate VAT from VAP were calculated at 0.76 (95% CI [0.72–0.79]) in the derivation cohort and 0.67 (95% CI [0.6–0.75]) in the validation cohort. A CPIS value ≥ 7 was associated with the highest Youden index in both cohorts. With this cut-off, sensitivity and specificity were respectively found at 0.51 and 0.88 in the derivation cohort, and at 0.45 and 0.89 in the validation cohort. CONCLUSIONS: A CPIS value ≥ 7 reproducibly allowed to differentiate VAT from VAP with high specificity and PPV and moderate sensitivity and NPV in our derivation and validation cohorts.


id: cord-030130-n1x6gcn2
author: Hurtado, Daniel E.
date: 2020-08-06
txt: ./txt/cord-030130-n1x6gcn2.txt
cache: ./cache/cord-030130-n1x6gcn2.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407426/
doi: 10.1186/s13613-020-00725-0
summary:
  title: Progression of regional lung strain and heterogeneity in lung injury: assessing the evolution under spontaneous breathing and mechanical ventilation BACKGROUND: Protective mechanical ventilation (MV) aims at limiting global lung deformation and has been associated with better clinical outcomes in acute respiratory distress syndrome (ARDS) patients. We hypothesize that regional deformation in lung injury progresses in time in spontaneous-breathing lungs, whereas it remains uniform in subjects under controlled MV. In this work, we studied the lung regional strain distribution, heterogeneity, and deformation progression in subjects spontaneously breathing and subjects on controlled low-V t MV in a murine lung-injury model. We found that a significant progression in regional volumetric strain and heterogeneity was observed after 3 h of spontaneous breathing in injured lungs. We identified a progression of regional deformation and heterogeneity in injured lungs under spontaneous breathing, but not in low V t MV subjects.

title:
  Progression of regional lung strain and heterogeneity in lung injury: assessing the evolution under spontaneous breathing and mechanical ventilation

abstract:
  BACKGROUND: Protective mechanical ventilation (MV) aims at limiting global lung deformation and has been associated with better clinical outcomes in acute respiratory distress syndrome (ARDS) patients. In ARDS lungs without MV support, the mechanisms and evolution of lung tissue deformation remain understudied. In this work, we quantify the progression and heterogeneity of regional strain in injured lungs under spontaneous breathing and under MV. METHODS: Lung injury was induced by lung lavage in murine subjects, followed by 3 h of spontaneous breathing (SB-group) or 3 h of low V(t) mechanical ventilation (MV-group). Micro-CT images were acquired in all subjects at the beginning and at the end of the ventilation stage following induction of lung injury. Regional strain, strain progression and strain heterogeneity were computed from image-based biomechanical analysis. Three-dimensional regional strain maps were constructed, from which a region-of-interest (ROI) analysis was performed for the regional strain, the strain progression, and the strain heterogeneity. RESULTS: After 3 h of ventilation, regional strain levels were significantly higher in 43.7% of the ROIs in the SB-group. Significant increase in regional strain was found in 1.2% of the ROIs in the MV-group. Progression of regional strain was found in 100% of the ROIs in the SB-group, whereas the MV-group displayed strain progression in 1.2% of the ROIs. Progression in regional strain heterogeneity was found in 23.4% of the ROIs in the SB-group, while the MV-group resulted in 4.7% of the ROIs showing significant changes. Deformation progression is concurrent with an increase of non-aerated compartment in SB-group (from 13.3% ± 1.6% to 37.5% ± 3.1%), being higher in ventral regions of the lung. CONCLUSIONS: Spontaneous breathing in lung injury promotes regional strain and strain heterogeneity progression. In contrast, low V(t) MV prevents regional strain and heterogeneity progression in injured lungs.


id: cord-032831-mupxzffk
title: Physiological effects of adding ECCO(2)R to invasive mechanical ventilation for COPD exacerbations
author: Diehl, J.-L.
date: 2020-09-29
txt: ./txt/cord-032831-mupxzffk.txt
cache: ./cache/cord-032831-mupxzffk.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523267/
doi: 10.1186/s13613-020-00743-y
summary:
  We aimed to evaluate in such patients the effects of a low-to-middle extracorporeal blood flow device on both gas exchanges and dynamic hyperinflation, as well as on work of breathing (WOB) during the IMV weaning process. In the present study, we hypothesized that the addition of ECCO 2 R at the early phase of IMV could both improve gas exchanges and could also permit to diminish respiratory rate (RR), therefore, minimizing dynamic hyperinflation in AE-COPD patients. Accordingly, there was a decrease in native lungs'' CO 2 elimination, which, in conjunction with RR adjustment, permitted to improve arterial pH and to obtain a median absolute decrease in PaCO 2 of 19 mmHg. This could be beneficial at the early stage of IMV in AE COPD patients, mainly by minimizing the deleterious effects of acute hypercapnia on ventilator demands, therefore, allowing to shorten deep sedation periods and to rapidly initiate the IMV weaning process.

abstract:
  BACKGROUND: Extracorporeal CO(2) removal (ECCO(2)R) could be a valuable additional modality for invasive mechanical ventilation (IMV) in COPD patients suffering from severe acute exacerbation (AE). We aimed to evaluate in such patients the effects of a low-to-middle extracorporeal blood flow device on both gas exchanges and dynamic hyperinflation, as well as on work of breathing (WOB) during the IMV weaning process. STUDY DESIGN AND METHODS: Open prospective interventional study in 12 deeply sedated IMV AE-COPD patients studied before and after ECCO(2)R initiation. Gas exchange and dynamic hyperinflation were compared after stabilization without and with ECCO(2)R (Hemolung, Alung, Pittsburgh, USA) combined with a specific adjustment algorithm of the respiratory rate (RR) designed to improve arterial pH. When possible, WOB with and without ECCO(2)R was measured at the end of the weaning process. Due to study size, results are expressed as median (IQR) and a non-parametric approach was adopted. RESULTS: An improvement in PaCO(2), from 68 (63; 76) to 49 (46; 55) mmHg, p = 0.0005, and in pH, from 7.25 (7.23; 7.29) to 7.35 (7.32; 7.40), p = 0.0005, was observed after ECCO(2)R initiation and adjustment of respiratory rate, while intrinsic PEEP and Functional Residual Capacity remained unchanged, from 9.0 (7.0; 10.0) to 8.0 (5.0; 9.0) cmH(2)O and from 3604 (2631; 4850) to 3338 (2633; 4848) mL, p = 0.1191 and p = 0.3013, respectively. WOB measurements were possible in 5 patients, indicating near-significant higher values after stopping ECCO(2)R: 11.7 (7.5; 15.0) versus 22.6 (13.9; 34.7) Joules/min., p = 0.0625 and 1.1 (0.8; 1.4) versus 1.5 (0.9; 2.8) Joules/L, p = 0.0625. Three patients died in-ICU. Other patients were successfully hospital-discharged. CONCLUSIONS: Using a formalized protocol of RR adjustment, ECCO(2)R permitted to effectively improve pH and diminish PaCO(2) at the early phase of IMV in 12 AE-COPD patients, but not to diminish dynamic hyperinflation in the whole group. A trend toward a decrease in WOB was also observed during the weaning process. Trial registration ClinicalTrials.gov: Identifier: NCT02586948.


id: cord-269161-6nsvup68
title: Vitamins as adjunctive treatment for coronavirus disease!
author: Kapoor, Indu
date: 2020-09-29
txt: ./txt/cord-269161-6nsvup68.txt
cache: ./cache/cord-269161-6nsvup68.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13613-020-00748-7
doi: 10.1186/s13613-020-00748-7
abstract: nan
summary:
  We read with great interest the article by Li et al., where authors have reviewed many therapeutic strategies for critically ill patients with coronavirus disease (COVID-19) [1] . Though authors have not mentioned, another important supplementary adjunct to treat these critically ill patients in intensive care unit is various vitamins. A large systematic review and meta-analysis including 11,321 patients has also shown that vitamin D supplementation is effective against acute respiratory tract infection [6] . Therefore, these vitamins have shown to protect against the acute viral infections and should be the part of adjunctive therapy in critically ill COVID-19 patients. Therapeutic strategies for critically ill patients with COVID-19 The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data


id: cord-278993-w5aa0elj
author: Tonetti, Tommaso
date: 2020-10-12
txt: ./txt/cord-278993-w5aa0elj.txt
cache: ./cache/cord-278993-w5aa0elj.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33044646/
doi: 10.1186/s13613-020-00750-z
summary:
  We retrospectively studied consecutive critically ill patients with confirmed Covid-19 who were referred to the hospitals of the Lombardy, Veneto and Emilia-Romagna regions during the first 2 weeks of the Italian outbreak (February 24March 8, 2020) . The present study describes how the Italian health-care system of three northern Italian regions responded to the increasing need for clinical resources for critically ill patients during the first 14 days of the Covid-19 outbreak through the 28.7% increase in ICU beds and the increasing use of non-invasive respiratory support outside the ICU. Our data show that, compared to patients admitted to the ICU, patients receiving respiratory support outside the ICU were significantly older, had more comorbidities and had a higher PaO 2 /FiO 2 ratio and a lower PaCO 2 .

title:
  Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy

abstract:
  BACKGROUND: A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. RESULTS: In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24–March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO(2)/FiO(2) ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO(2) and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. CONCLUSIONS: Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.


id: cord-279440-0mn5b0vv
title: Response to Damiani and colleagues
author: Diehl, J-L
date: 2020-10-14
txt: ./txt/cord-279440-0mn5b0vv.txt
cache: ./cache/cord-279440-0mn5b0vv.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13613-020-00757-6
doi: 10.1186/s13613-020-00757-6
abstract: nan
summary:
  have put our results in perspective with their own published observations of an inverse relationship between sublingual perfused vessel density and D-dimers in mechanically ventilated patients with severe SARS-CoV-2 pneumonia. To explore if COVID-19 ARDS patients could exhibit a lung-specific microvascular response to high PEEP levels, as compared to non-COVID-19 ARDS patients, seems to be an important field of investigation. One important point is that the very vast majority of studies in COVID-19 ARDS patients used, by convenience, ventilatory ratio (VR) as a marker of impaired ventilatory efficacy, as mentioned in Damiani''s comment, rather than dead space measurements. Finally, it will be important to further precisely investigate the relationship between dead space measurements, with a special focus on indicators of alveolar dead space, and markers of endothelial dysfunction, such as bio-markers (such as CECs and D-dimers) and innovative methods such as the video-microscopy methods used by Damiani and colleagues.


id: cord-280965-x5ffw843
author: Damiani, Elisa
date: 2020-10-23
txt: ./txt/cord-280965-x5ffw843.txt
cache: ./cache/cord-280965-x5ffw843.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33095905/
doi: 10.1186/s13613-020-00765-6
abstract: nan
summary:
  title: Comment on "Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study" on the evaluation of respiratory mechanics and gas exchanges in patients with acute respiratory distress syndrome (ARDS) due to COVID-19 that was recently published in the Annals of Intensive Care [1] . In 22 patients with moderate-to-severe ARDS, the authors observed high physiological dead space (V D /V T ) and ventilatory ratio (VR). In a recent report, we described the sublingual microcirculation of mechanically ventilated patients with severe SARS-COV-2 pneumonia and showed an inverse correlation between perfused vessel density (PVD) and D-dimers [4] . Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study Microcirculatory dysfunction and dead-space ventilation in early ARDS: a hypothesis-generating observational study All authors read and approved the final manuscript.

title:
  Comment on “Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study”


id: cord-285130-tcnpskpy
author: Wang, Ke
date: 2020-03-30
txt: ./txt/cord-285130-tcnpskpy.txt
cache: ./cache/cord-285130-tcnpskpy.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32232685/
doi: 10.1186/s13613-020-00653-z
summary:
  title: The experience of high-flow nasal cannula in hospitalized patients with 2019 novel coronavirus-infected pneumonia in two hospitals of Chongqing, China Most of the critically ill patients received high-flow nasal cannula (HFNC) oxygen therapy. Among them, 27 (8.4%) patients experienced severe acute respiratory failure including 17 patients (63%) treated with HFNC as first-line therapy, 9 patients (33%) treated with noninvasive ventilation (NIV) and one patient (4%) treated with invasive ventilation. The NCIP patients who required HFNC, NIV or invasive ventilation to improve oxygen were classified as severe acute respiratory failure. In this study, 13% of patients experienced HFNC failure and required NIV as rescue therapy. Abbreviations NCIP: Novel coronavirus (2019-nCoV)-infected pneumonia; HFNC: High-flow nasal cannula; NIV: Noninvasive ventilation; ARDS: Acute respiratory distress syndrome; APACHE II: Acute physiology and chronic health evaluation II; SOFA: Sequential organ failure assessment; RR: Respiratory rate; HR: Heart rate; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; IQR: Interquartile range.

title:
  The experience of high-flow nasal cannula in hospitalized patients with 2019 novel coronavirus-infected pneumonia in two hospitals of Chongqing, China

abstract:
  BACKGROUND: The outbreak of a novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) is currently ongoing in China. Most of the critically ill patients received high-flow nasal cannula (HFNC) oxygen therapy. However, the experience of HFNC in this population is lacking. METHODS: We retrospectively screened 318 confirmed patients with NCIP in two hospitals of Chongqing, China, from January 1st to March 4th, 2020. Among them, 27 (8.4%) patients experienced severe acute respiratory failure including 17 patients (63%) treated with HFNC as first-line therapy, 9 patients (33%) treated with noninvasive ventilation (NIV) and one patient (4%) treated with invasive ventilation. HFNC failure was defined by the need of NIV or intubation as rescue therapy. RESULTS: Of the 17 HFNC patients, 7 (41%) experienced HFNC failure. The HFNC failure rate was 0% (0/6) in patients with PaO(2)/FiO(2) > 200 mm Hg vs. 63% (7/11) in those with PaO(2)/FiO(2) ≤ 200 mm Hg (p = 0.04). Compared with baseline data, the respiratory rate significantly decreased after 1–2 h of HFNC in successful group [median 26 (IQR: 25–29) vs. 23 (22–25), p = 0.03]. However, it did not in the unsuccessful group. After initiation of NIV as rescue therapy among the 7 patients with HFNC failure, PaO(2)/FiO(2) significantly improved after 1–2 h of NIV [median 172 (150–208) mmHg vs. 114 (IQR: 79–130) under HFNC, p = 0.04]. However, two out of seven (29%) patients with NIV as rescue therapy ultimately received intubation. Among the 27 patients with severe acute respiratory failure, four patients were eventually intubated (15%). CONCLUSIONS: Our study indicated that HFNC was the most common ventilation support for patients with NCIP. Patients with lower PaO(2)/FiO(2) were more likely to experience HFNC failure.


id: cord-291459-m56dy8us
author: Hraiech, Sami
date: 2020-05-24
txt: ./txt/cord-291459-m56dy8us.txt
cache: ./cache/cord-291459-m56dy8us.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13613-020-00678-4
doi: 10.1186/s13613-020-00678-4
abstract: nan
summary:
  In order to evaluate these results in intensive care unit (ICU) patients, we retrospectively assessed in moderate-to-severe ARDS the efficacy of hydroxychloroquine-azithromycin combination regarding viral disappearance at both day 6 of the treatment and day 6 of evolution of ARDS as compared with patients treated with lopinavir-ritonavir and a control group without any anti-viral treatment. Negative nasopharyngeal PCR for SARS-CoV-2 at day 6 following the initiation of treatment were observed in 5 (38%) patients from the lopinavir-ritonavir group as compared with 3 (18%) patients from the hydroxychloroquine-azithromycin group and 2 (20%) from the control group (p = 0.39). At day 6 following ARDS onset, PCR was negative in only 9 patients, 5 from the lopinavir-ritonavir group, 2 from the hydroxychloroquine-azithromycin group and 2 from the control group.

title:
  Lack of viral clearance by the combination of hydroxychloroquine and azithromycin or lopinavir and ritonavir in SARS-CoV-2-related acute respiratory distress syndrome


id: cord-305582-3hmsknon
title: Therapeutic strategies for critically ill patients with COVID-19
author: Li, Lei
date: 2020-04-20
txt: ./txt/cord-305582-3hmsknon.txt
cache: ./cache/cord-305582-3hmsknon.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32307593/
doi: 10.1186/s13613-020-00661-z
summary:
  In the present article, we have summarized the promising drugs, adjunctive agents, respiratory supportive strategies, as well as circulation management, multiple organ function monitoring and appropriate nutritional strategies for the treatment of COVID-19 in the ICU based on the previous experience of treating other viral infections and influenza. According to the latest version of diagnosis and treatment guidelines, confirmed cases infected with 2019-nCoV are classified to have severe illness once complying with one of the following symptoms: (1) anhelation, respiratory rate ≥ 30 times/min; (2) oxygen saturation at rest ≤ 93%; (3) PaO2/FiO2 ≤ 300 mmHg; and classified to be the critical/life-threatening illness once complying with one of the following symptoms: (1) respiratory failure, mechanical ventilation needed; (2) shock; (3) other organ dysfunction syndrome and requirement of intensive care unit admission.

abstract:
  Since the 2019 novel coronavirus disease (COVID-19) outbreak originated from Wuhan, Hubei Province, China, at the end of 2019, it has become a clinical threat to the general population worldwide. Among people infected with the novel coronavirus (2019-nCoV), the intensive management of the critically ill patients in intensive care unit (ICU) needs substantial medical resource. In the present article, we have summarized the promising drugs, adjunctive agents, respiratory supportive strategies, as well as circulation management, multiple organ function monitoring and appropriate nutritional strategies for the treatment of COVID-19 in the ICU based on the previous experience of treating other viral infections and influenza. These treatments are referable before the vaccine and specific drugs are available for COVID-19.


id: cord-306315-vt2e0crh
author: Elabbadi, Alexandre
date: 2020-09-14
txt: ./txt/cord-306315-vt2e0crh.txt
cache: ./cache/cord-306315-vt2e0crh.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13613-020-00738-9
doi: 10.1186/s13613-020-00738-9
summary:
  CONCLUSIONS: Viruses are frequently identified in the respiratory tract of HIV-infected patients with acute respiratory failure that requires ICU admission, but with a non-viral copathogen in two-thirds of cases. Indeed, using nucleic acid amplification test such as multiplex polymerase chain reaction (mPCR), these pathogens have been shown highly prevalent (20-56%) in large cohorts of adult patients admitted to the ICU for all-cause ARF [7, 8] , community-acquired pneumonia [9, 10] , hospitalacquired pneumonia [11] , acute exacerbation of COPD [12, 13] , and asthma [14] , compared to asymptomatic adults [15, 16] . We investigated whether a respiratory virus-associated infection Table 2 Causative diagnosis of acute respiratory failure in 123 HIV-infected patients admitted to the ICU Data are presented as number (%). Viruses are frequently identified in the respiratory tract of HIV-infected patients with ARF that required ICU admission, but with a non-viral copathogen in two-thirds of cases.

title:
  Respiratory virus-associated infections in HIV-infected adults admitted to the intensive care unit for acute respiratory failure: a 6-year bicenter retrospective study (HIV-VIR study)

abstract:
  INTRODUCTION: Acute respiratory failure is the main reason for admission to the intensive care unit (ICU) in HIV-infected adults. There is little data about the epidemiology of respiratory viruses in this population. METHODS: HIV-infected adults admitted to two intensive care units over a 6-year period for an acute respiratory failure and explored for respiratory viruses with multiplex polymerase chain reaction (mPCR) were retrospectively selected. Objectives were to describe the prevalence of respiratory viruses, coinfections with non-viral pathogens, and hospital outcome. RESULTS: A total of 123 episodes were included. An HIV infection was newly diagnosed in 9% of cases and 72% of the population were on antiretroviral therapy. Real-time mPCR tests identified at least one respiratory virus in the respiratory tract of 33 (27%) patients, but with a non-viral copathogen in two-thirds of cases. Rhinovirus was predominant, documented in 15 patients, followed by Influenza and Respiratory Syncytial Viruses (both n = 6). The prevalence of respiratory virus-associated infection did not vary along with the level of the CD4 T-cell deficiency, except for Rhinovirus which was more prevalent in patients with a CD4 lymphocyte count below 200 cells/µL (n = 13 (20%) vs. n = 2 (4%), p < 0.01). In multivariate analysis, respiratory virus-associated infection was not associated with a worse prognosis. CONCLUSIONS: Viruses are frequently identified in the respiratory tract of HIV-infected patients with acute respiratory failure that requires ICU admission, but with a non-viral copathogen in two-thirds of cases. Rhinovirus is the predominant viral specie; its prevalence is highest in patients with a CD4 lymphocyte count below 200 cells/µL.


id: cord-311176-dlwph5za
title: Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus
author: Alshahrani, Mohammed S.
date: 2018-01-10
txt: ./txt/cord-311176-dlwph5za.txt
cache: ./cache/cord-311176-dlwph5za.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/29330690/
doi: 10.1186/s13613-017-0350-x
summary:
  The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. METHODS: We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. In this retrospective cohort study, we found that ECMO rescue therapy was associated with lower in-hospital mortality, better oxygenation, and fewer organ failures compared to historical control (usual care) in patients with severe MERS-CoV. described the use of ECMO in two patients with acute respiratory failure secondary to MERS-CoV infection in France, where both patients developed severe hypoxia and increasing oxygen requirements, leading to mechanical ventilation and ECMO use. Extracorporeal membrane oxygenation for severe influenza A (H1N1) acute respiratory distress syndrome: a prospective observational comparative study

abstract:
  BACKGROUND: Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS‐CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. METHODS: We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. RESULTS: Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05). CONCLUSIONS: ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.


id: cord-316647-jj8anf5g
author: Shang, You
date: 2020-06-06
txt: ./txt/cord-316647-jj8anf5g.txt
cache: ./cache/cord-316647-jj8anf5g.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13613-020-00689-1
doi: 10.1186/s13613-020-00689-1
summary:
  RESULTS: A comprehensive document with 46 statements are presented, including protection of medical personnel, etiological treatment, diagnosis and treatment of tissue and organ functional impairment, psychological interventions, immunity therapy, nutritional support, and transportation of critically ill COVID-19 patients. Statement 8 Convalescent plasma therapy should probably be used for severe and critically ill patients with COVID-19 (Grade 2+, weak recommendation). However, critically ill patients with COVID-19 have a longer mechanical ventilation time, and daily sedatives interruption is not suggested for patients receiving deep sedation in order to reduce lung damage during early stage of severe ARDS. Light sedation is suggested for severe COVID-19 patients receiving HFNC oxygen therapy and non-invasive mechanical ventilation, and also for critically ill patients in the recovering stage (expert opinion). Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a randomized clinical trial

title:
  Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China

abstract:
  BACKGROUND: The ongoing coronavirus disease 2019 (COVID-2019) pandemic has swept all over the world, posing a great pressure on critical care resources due to large number of patients needing critical care. Statements from front-line experts in the field of intensive care are urgently needed. METHODS: Sixteen front-line experts in China fighting against the COVID-19 epidemic in Wuhan were organized to develop an expert statement after 5 rounds of expert seminars and discussions to provide trustworthy recommendation on the management of critically ill COVID-19 patients. Each expert was assigned tasks within their field of expertise to provide draft statements and rationale. Parts of the expert statement are based on epidemiological and clinical evidence, without available scientific evidences. RESULTS: A comprehensive document with 46 statements are presented, including protection of medical personnel, etiological treatment, diagnosis and treatment of tissue and organ functional impairment, psychological interventions, immunity therapy, nutritional support, and transportation of critically ill COVID-19 patients. Among them, 5 recommendations were strong (Grade 1), 21 were weak (Grade 2), and 20 were experts’ opinions. A strong agreement from voting participants was obtained for all recommendations. CONCLUSION: There are still no targeted therapies for COVID-19 patients. Dynamic monitoring and supportive treatment for the restoration of tissue vascularization and organ function are particularly important.


id: cord-316681-b46ycocg
title: COVID-19-associated invasive pulmonary aspergillosis
author: Rutsaert, Lynn
date: 2020-06-01
txt: ./txt/cord-316681-b46ycocg.txt
cache: ./cache/cord-316681-b46ycocg.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13613-020-00686-4
doi: 10.1186/s13613-020-00686-4
abstract: nan
summary:
  In our 24-bedded mixed ICU, we have encountered an unexpectedly high number of COVID-19 patients developing invasive pulmonary aspergillosis. Invasive pulmonary aspergillosis (IPA) is a well-known complication in immunocompromised patients and is encountered frequently in haematopoietic stem cell or solid organ transplant recipients [2] . Severe influenza infection is a wellknown risk factor for developing IPA in non-neutropenic patients; a syndrome termed influenza-associated aspergillosis (IAA) [4] [5] [6] . Between March 12th and April 25th 2020, 34 COVID-19 patients were admitted to our ICU, of whom 20 (59%) required invasive mechanical ventilation. In the absence of host factors, as defined by the European Organisation for Research and Treatment of Cancer (EORTC) diagnostic criteria, invasive or high-risk diagnostics (biopsy, CT scan) are required to support the diagnosis of IPA [7] . Because all patients with clinical features of possible IPA were suffering from severe respiratory failure and hemodynamic instability, we initiated antifungal therapy as soon as cultures or galactomannan assays were positive.


id: cord-322773-zimkzbr1
title: Recruitability and effect of PEEP in SARS-Cov-2-associated acute respiratory distress syndrome
author: Beloncle, François M.
date: 2020-05-12
txt: ./txt/cord-322773-zimkzbr1.txt
cache: ./cache/cord-322773-zimkzbr1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32399901/
doi: 10.1186/s13613-020-00675-7
summary:
  In a large series of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2)-associated respiratory failure, the majority of intubated Open Access *Correspondence: francois.beloncle@univ-angers.fr 1 Département de Médecine Intensive-Réanimation, CHU d'' Angers, Université d'' Angers, 4 rue Larrey, 49933 Angers Cedex 9, France Full list of author information is available at the end of the article patients were ventilated with high level of positive endexpiratory pressure (PEEP) [1] . In the present series of 25 SARS-Cov-2-associated ARDS, the initial respiratory mechanics assessment performed soon after intubation at PEEP 15 cmH 2 O and 5 cmH 2 O allowed to identify 16 patients as potentially highly recruitable and 9 as poorly recruitable based on the previously reported R/I ratio [7] . In this series of SARS-Cov2-associated ARDS, early respiratory mechanics assessment (at 15 and 5 cmH 2 O of PEEP) and R/I ratio calculation showed a mix of highly recruitable and poorly recruitable patients.

abstract:
  BACKGROUND: A large proportion of patients with a SARS-Cov-2-associated respiratory failure develop an acute respiratory distress syndrome (ARDS). It has been recently suggested that SARS-Cov-2-associated ARDS may differ from usual non-SARS-Cov-2-associated ARDS by higher respiratory system compliance (C(RS)), lower potential for recruitment with positive end-expiratory pressure (PEEP) contrasting with severe shunt fraction. The purpose of the study was to systematically assess respiratory mechanics and recruitability in SARS-Cov-2-associated ARDS. METHODS: Gas exchanges, C(RS) and hemodynamics were assessed at 2 levels of PEEP (15 cmH(2)O and 5 cmH(2)O) within 36 h (day1) and from 4 to 6 days (day 5) after intubation. The recruited volume was computed as the difference between the volume expired from PEEP 15 to 5 cmH(2)O and the volume predicted by compliance at PEEP 5 cmH(2)O (or above airway opening pressure). The recruitment-to-inflation (R/I) ratio (i.e. the ratio between the recruited lung compliance and C(RS) at PEEP 5 cmH(2)O) was used to assess lung recruitability. A R/I ratio value higher than or equal to 0.5 was used to define highly recruitable patients. RESULTS: The R/I ratio was calculated in 25 of the 26 enrolled patients at day 1 and in 15 patients at day 5. At day 1, 16 (64%) were considered as highly recruitable (R/I ratio median [interquartile range] 0.7 [0.55–0.94]) and 9 (36%) were considered as poorly recruitable (R/I ratio 0.41 [0.31–0.48]). The PaO(2)/FiO(2) ratio at PEEP 15 cmH(2)O was higher compared to PEEP 5 cmH(2)O only in highly recruitable patients (173 [139–236] vs 135 [89–167] mmHg; p < 0.01). Neither PaO(2)/FiO(2) or C(RS) measured at PEEP 15 cmH(2)O or at PEEP 5 cmH(2)O nor changes in PaO(2)/FiO(2) or C(RS) in response to PEEP changes allowed to identify highly or poorly recruitable patients. CONCLUSION: In this series of 25 patients with SARS-Cov-2 associated ARDS, 64% were considered as highly recruitable and only 36% as poorly recruitable based on the R/I ratio performed on the day of intubation. This observation suggests that a systematic R/I ratio assessment may help to guide initial PEEP titration to limit harmful effect of unnecessary high PEEP in the context of Covid-19 crisis.


id: cord-325461-q8igdvq4
title: Pulmonary vascular dysfunction in ARDS
author: Ryan, Donal
date: 2014-08-22
txt: ./txt/cord-325461-q8igdvq4.txt
cache: ./cache/cord-325461-q8igdvq4.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13613-014-0028-6
doi: 10.1186/s13613-014-0028-6
summary:
  We consider the factors that influence pulmonary arterial pressure, both in normal lungs and in the presence of ARDS, including the important effects of mechanical ventilation. (Am J Respir Crit Care Med 182:1123–1128, 2010) have recently reported that elevated pulmonary vascular resistance (PVR) and TPG were independently associated with increased mortality in ARDS, in a large trial with protocol-defined management strategies and using lung-protective ventilation. Studies were identified after a literature search using key terms (ARDS or acute respiratory distress or ALI or acute lung injury) together with any of the following: pulmonary haemodynamics, pulmonary artery pressure, pulmonary vascular resistance, pulmonary vascular dysfunction, right ventricle, right ventricular failure, acute cor pulmonale, or pulmonary artery catheter. There are very few studies which have measured pulmonary vascular resistance in ARDS patients ventilated with lower tidal volumes, perhaps due to the reduction in the use of the pulmonary artery catheter just as lung-protective ventilation was gaining widespread acceptance [60] .

abstract:
  Acute respiratory distress syndrome (ARDS) is characterised by diffuse alveolar damage and is frequently complicated by pulmonary hypertension (PH). Multiple factors may contribute to the development of PH in this setting. In this review, we report the results of a systematic search of the available peer-reviewed literature for papers that measured indices of pulmonary haemodynamics in patients with ARDS and reported on mortality in the period 1977 to 2010. There were marked differences between studies, with some reporting strong associations between elevated pulmonary arterial pressure or elevated pulmonary vascular resistance and mortality, whereas others found no such association. In order to discuss the potential reasons for these discrepancies, we review the physiological concepts underlying the measurement of pulmonary haemodynamics and highlight key differences between the concepts of resistance in the pulmonary and systemic circulations. We consider the factors that influence pulmonary arterial pressure, both in normal lungs and in the presence of ARDS, including the important effects of mechanical ventilation. Pulmonary arterial pressure, pulmonary vascular resistance and transpulmonary gradient (TPG) depend not alone on the intrinsic properties of the pulmonary vascular bed but are also strongly influenced by cardiac output, airway pressures and lung volumes. The great variability in management strategies within and between studies means that no unified analysis of these papers was possible. Uniquely, Bull et al. (Am J Respir Crit Care Med 182:1123–1128, 2010) have recently reported that elevated pulmonary vascular resistance (PVR) and TPG were independently associated with increased mortality in ARDS, in a large trial with protocol-defined management strategies and using lung-protective ventilation. We then considered the existing literature to determine whether the relationship between PVR/TPG and outcome might be causal. Although we could identify potential mechanisms for such a link, the existing evidence does not allow firm conclusions to be drawn. Nonetheless, abnormally elevated PVR/TPG may provide a useful index of disease severity and progression. Further studies are required to understand the role and importance of pulmonary vascular dysfunction in ARDS in the era of lung-protective ventilation.


id: cord-325599-2gutb4m1
author: Lapidus, Nathanael
date: 2020-10-16
txt: ./txt/cord-325599-2gutb4m1.txt
cache: ./cache/cord-325599-2gutb4m1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33063241/
doi: 10.1186/s13613-020-00749-6
summary:
  METHODS: Two estimation methods of ICU_ALOS were compared: the average LOS of already discharged patients at the date of estimation (DPE), and a standard parametric method used for analyzing time-to-event data which fits a given distribution to observed data and includes the censored stays of patients still treated in the ICU at the date of estimation (CPE). In this study, we present a detailed examination of the timeline of the whole cohort of consecutive COVID-19 patients admitted to a devoted ICU of the Zhongnan hospital of Wuhan University (ZHWU) in which we investigated the evolution of the ALOS estimation according to the accumulation of the cases, using two methods of estimation. The study also recalls that appropriate methods of estimation require the inclusion of censored cases in the analysis, and we also demonstrate the important bias associated with calculations only based on the stays of already discharged patients.

title:
  Biased and unbiased estimation of the average length of stay in intensive care units in the Covid-19 pandemic

abstract:
  BACKGROUND: The average length of stay (LOS) in the intensive care unit (ICU_ALOS) is a helpful parameter summarizing critical bed occupancy. During the outbreak of a novel virus, estimating early a reliable ICU_ALOS estimate of infected patients is critical to accurately parameterize models examining mitigation and preparedness scenarios. METHODS: Two estimation methods of ICU_ALOS were compared: the average LOS of already discharged patients at the date of estimation (DPE), and a standard parametric method used for analyzing time-to-event data which fits a given distribution to observed data and includes the censored stays of patients still treated in the ICU at the date of estimation (CPE). Methods were compared on a series of all COVID-19 consecutive cases (n = 59) admitted in an ICU devoted to such patients. At the last follow-up date, 99 days after the first admission, all patients but one had been discharged. A simulation study investigated the generalizability of the methods' patterns. CPE and DPE estimates were also compared to COVID-19 estimates reported to date. RESULTS: LOS ≥ 30 days concerned 14 out of the 59 patients (24%), including 8 of the 21 deaths observed. Two months after the first admission, 38 (64%) patients had been discharged, with corresponding DPE and CPE estimates of ICU_ALOS (95% CI) at 13.0 days (10.4–15.6) and 23.1 days (18.1–29.7), respectively. Series' true ICU_ALOS was greater than 21 days, well above reported estimates to date. CONCLUSIONS: Discharges of short stays are more likely observed earlier during the course of an outbreak. Cautious unbiased ICU_ALOS estimates suggest parameterizing a higher burden of ICU bed occupancy than that adopted to date in COVID-19 forecasting models. FUNDING: Support by the National Natural Science Foundation of China (81900097 to Dr. Zhou) and the Emergency Response Project of Hubei Science and Technology Department (2020FCA023 to Pr. Zhao).


id: cord-328569-1lx3fkv3
author: Bagate, François
date: 2020-11-04
txt: ./txt/cord-328569-1lx3fkv3.txt
cache: ./cache/cord-328569-1lx3fkv3.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33150525/
doi: 10.1186/s13613-020-00769-2
summary:
  title: Rescue therapy with inhaled nitric oxide and almitrine in COVID-19 patients with severe acute respiratory distress syndrome BACKGROUND: In COVID-19 patients with severe acute respiratory distress syndrome (ARDS), the relatively preserved respiratory system compliance despite severe hypoxemia, with specific pulmonary vascular dysfunction, suggests a possible hemodynamic mechanism for VA/Q mismatch, as hypoxic vasoconstriction alteration. Some authors have hypothesized that potential relatively preserved respiratory system compliance (Crs) despite severe hypoxemia in COVID-19 patients suggests a possible hemodynamic mechanism for ventilation/perfusion (VA/Q) mismatch as hypoxic vasoconstriction alteration [5] . Individual values of the ratio of oxygen partial pressure to inspired oxygen fraction in arterial blood in patients with severe acute respiratory distress syndrome secondary to coronavirus disease 2019, according to position (prone or supine) and administration of inhaled nitric oxide with or without almitrine. Correlations between respiratory mechanics and oxygenation response to the combination of inhaled nitric oxide and almitrine in ten patients with severe acute respiratory distress syndrome secondary to coronavirus disease 2019.

title:
  Rescue therapy with inhaled nitric oxide and almitrine in COVID-19 patients with severe acute respiratory distress syndrome

abstract:
  BACKGROUND: In COVID-19 patients with severe acute respiratory distress syndrome (ARDS), the relatively preserved respiratory system compliance despite severe hypoxemia, with specific pulmonary vascular dysfunction, suggests a possible hemodynamic mechanism for VA/Q mismatch, as hypoxic vasoconstriction alteration. This study aimed to evaluate the capacity of inhaled nitric oxide (iNO)–almitrine combination to restore oxygenation in severe COVID-19 ARDS (C-ARDS) patients. METHODS: We conducted a monocentric preliminary pilot study in intubated patients with severe C-ARDS. Respiratory mechanics was assessed after a prone session. Then, patients received iNO (10 ppm) alone and in association with almitrine (10 μg/kg/min) during 30 min in each step. Echocardiographic and blood gases measurements were performed at baseline, during iNO alone, and iNO–almitrine combination. The primary endpoint was the variation of oxygenation (PaO(2)/FiO(2) ratio). RESULTS: Ten severe C-ARDS patients were assessed (7 males and 3 females), with a median age of 60 [52–72] years. Combination of iNO and almitrine outperformed iNO alone for oxygenation improvement. The median of PaO(2)/FiO(2) ratio varied from 102 [89–134] mmHg at baseline, to 124 [108–146] mmHg after iNO (p = 0.13) and 180 [132–206] mmHg after iNO and almitrine (p < 0.01). We found no correlation between the increase in oxygenation caused by iNO–almitrine combination and that caused by proning. CONCLUSION: In this pilot study of severe C-ARDS patients, iNO–almitrine combination was associated with rapid and significant improvement of oxygenation. These findings highlight the role of pulmonary vascular function in COVID-19 pathophysiology.


id: cord-335975-m6lkrehi
title: Proceedings of Réanimation 2018, the French Intensive Care Society International Congress
author: nan
date: 2018-02-05
txt: ./txt/cord-335975-m6lkrehi.txt
cache: ./cache/cord-335975-m6lkrehi.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13613-017-0345-7
doi: 10.1186/s13613-017-0345-7
abstract: nan
summary:
  A qSOFA score relying on 3 simple clinical criteria (respiratory rate, mental status and systolic blood pressure) has been proposed to better identify septic patients with associated higher mortality outside the intensive care unit (Seymour CW et al., JAMA 2016) . We propose to determine whether the arterial oxygen pressure (PaO2) at intensive care unit (ICU) admission affects mortality at day 28 (D28) in patients with septic shock subjected to mechanical out-of-hospital ventilation. Conclusion: In this study, we report a significant association between hyperoxemia at ICU admission and mortality at D28 in patients with septic shock subjected to pre-hospital invasive mechanical ventilation. The aim of this study was to describe outcome of pediatric patient with hematologic disease hospitalized in our intensive care unit for respiratory failure and to investigate the clinical variables associated with mortality.


id: cord-344647-jr85915d
title: Acute kidney injury in patients with SARS-CoV-2 infection
author: Joseph, Adrien
date: 2020-09-03
txt: ./txt/cord-344647-jr85915d.txt
cache: ./cache/cord-344647-jr85915d.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32880774/
doi: 10.1186/s13613-020-00734-z
summary:
  Acute Kidney Injury (AKI) is a frequent complication of severe SARS-CoV-2 infection but data are scarce in ICUs. AKI has been previously reported with an average incidence of 11% (8-17%) overall, with highest ranges in the critically ill (23%; 14-35%) [2] [3] [4] . Different applications of the Kidney Disease Improving Global Outcomes (KDIGO) criteria for AKI, in particular different methods to estimate missing baseline creatinine and handling urinary output, can cause important variations of estimated incidence [5, 6] and may contribute to the discrepancies among these studies. High levels of IL-6 have been associated with the development of severe disease [24, 25] and acute respiratory distress syndrome [8] during COVID-19 infection, but the role of inflammation markers in COVID-19-induced-AKI remains speculative [7] . Our study suggests a tremendously high incidence of AKI in our cohort of critically ill COVID-19 patients, along with an independent association between AKI and outcome.

abstract:
  BACKGROUND: Acute Kidney Injury (AKI) is a frequent complication of severe SARS-CoV-2 infection. Multiple mechanisms are involved in COVID-19-associated AKI, from direct viral infection and secondary inflammation to complement activation and microthrombosis. However, data are limited in critically-ill patients. In this study, we sought to describe the prevalence, risk factors and prognostic impact of AKI in this setting. METHODS: Retrospective monocenter study including adult patients with laboratory confirmed SARS-CoV-2 infection admitted to the ICU of our university Hospital. AKI was defined according to both urinary output and creatinine KDIGO criteria. RESULTS: Overall, 100 COVID-19 patients were admitted. AKI occurred in 81 patients (81%), including 44, 10 and 27 patients with AKI stage 1, 2 and 3 respectively. The severity of AKI was associated with mortality at day 28 (p = 0.013). Before adjustment, the third fraction of complement (C3), interleukin-6 (IL-6) and ferritin levels were higher in AKI patients. After adjustment for confounders, both severity (modified SOFA score per point) and AKI were associated with outcome. When forced in the final model, C3 (OR per log 0.25; 95% CI 0.01–4.66), IL-6 (OR per log 0.83; 95% CI 0.51–1.34), or ferritin (OR per log 1.63; 95% CI 0.84–3.32) were not associated with AKI and did not change the model. CONCLUSION: In conclusion, we did not find any association between complement activation or inflammatory markers and AKI. Proportion of patients with AKI during severe SARS-CoV-2 infection is higher than previously reported and associated with outcome.


id: cord-345591-zwh1xj5u
author: Al-Dorzi, Hasan M.
date: 2016-10-24
txt: ./txt/cord-345591-zwh1xj5u.txt
cache: ./cache/cord-345591-zwh1xj5u.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/27778310/
doi: 10.1186/s13613-016-0203-z
summary:
  title: The critical care response to a hospital outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: an observational study BACKGROUND: Middle East respiratory syndrome coronavirus (MERS-CoV) has caused several hospital outbreaks, including a major outbreak at King Abdulaziz Medical City, a 940-bed tertiary-care hospital in Riyadh, Saudi Arabia (August–September 2015). Eight HCWs had MERS requiring ICU admission (median stay = 28 days): Seven developed acute respiratory distress syndrome, four were treated with prone positioning, four needed continuous renal replacement therapy and one had extracorporeal membrane oxygenation. The Middle East respiratory syndrome (MERS) coronavirus is a recently identified virus that is closely related to the severe acute respiratory syndrome coronavirus (SARS-CoV) [1] , causes severe hypoxemic respiratory failure with multiorgan failure and frequently requires admission to the intensive care unit (ICU) [2, 3] .

title:
  The critical care response to a hospital outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: an observational study

abstract:
  BACKGROUND: Middle East respiratory syndrome coronavirus (MERS-CoV) has caused several hospital outbreaks, including a major outbreak at King Abdulaziz Medical City, a 940-bed tertiary-care hospital in Riyadh, Saudi Arabia (August–September 2015). To learn from our experience, we described the critical care response to the outbreak. METHODS: This observational study was conducted at the Intensive Care Department which covered 5 ICUs with 60 single-bedded rooms. We described qualitatively and, as applicable, quantitatively the response of intensive care services to the outbreak. The clinical course and outcomes of healthcare workers (HCWs) who had MERS were noted. RESULTS: Sixty-three MERS patients were admitted to 3 MERS-designated ICUs during the outbreak (peak census = 27 patients on August 25, 2015, and the last new case on September 13, 2015). Most patients had multiorgan failure. Eight HCWs had MERS requiring ICU admission (median stay = 28 days): Seven developed acute respiratory distress syndrome, four were treated with prone positioning, four needed continuous renal replacement therapy and one had extracorporeal membrane oxygenation. The hospital mortality of ICU MERS patients was 63.4 % (0 % for the HCWs). In response to the outbreak, the number of negative-pressure rooms was increased from 14 to 38 rooms in 3 MERS-designated ICUs. Patients were managed with a nurse-to-patient ratio of 1:0.8. Infection prevention practices were intensified. As a surrogate, surface disinfectant and hand hygiene gel consumption increased by ~30 % and 17 N95 masks were used per patient/day on average. Family visits were restricted to 2 h/day. Although most ICU staff expressed concerns about acquiring MERS, all reported to work normally. During the outbreak, 27.0 % of nurses and 18.4 % of physicians working in the MERS-designated ICUs reported upper respiratory symptoms, and were tested for MERS-CoV. Only 2/196 (1.0 %) ICU nurses and 1/80 (1.3 %) physician tested positive, had mild disease and recovered fully. The total sick leave duration was 138 days for nurses and 30 days for physicians. CONCLUSIONS: Our hospital outbreak of MERS resulted in 63 patients requiring organ support and prolonged ICU stay with a high mortality rate. The ICU response required careful facility and staff management and proper infection control and prevention practices.


id: cord-345674-wkwqlnz2
author: Kobayashi, Jun
date: 2020-05-20
txt: ./txt/cord-345674-wkwqlnz2.txt
cache: ./cache/cord-345674-wkwqlnz2.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13613-020-00681-9
doi: 10.1186/s13613-020-00681-9
summary:
  Given the extent of the COVID-19 pandemic, and the large numbers of hospitalized patients requiring respiratory support, clinical use of inhaled nitric oxide may become an alternate rescue therapy before extracorporeal membrane oxygenation for the management of acute respiratory distress syndrome in patients with COVID-19. While there is no specific recommended antiviral treatment, and vaccines have yet to be developed, the authors provided a powerful pharmacological strategy for the treatment of critically ill patients with COVID-19 acute respiratory distress syndrome (ARDS). In this review article, the drug applications for COVID-19 are well described according to disease severity; however, nitric oxide (NO) inhalation therapy, which is not described in this review, may be included in the strategy as a promising therapeutic candidate. Protocol of a randomized controlled trial testing inhaled nitric oxide in mechanically ventilated patients with severe acute respiratory syndrome in COVID-19 (SARS-CoV-2).

title:
  Nitric oxide inhalation as an interventional rescue therapy for COVID-19-induced acute respiratory distress syndrome

abstract:
  COVID-19 is an emerging disease of public health concern. While there is no specific recommended treatment for COVID-19, nitric oxide has the potential to be of therapeutic value for managing acute respiratory distress syndrome in patients with COVID-19. However, inhaled nitric oxide has not yet been formally evaluated. Given the extent of the COVID-19 pandemic, and the large numbers of hospitalized patients requiring respiratory support, clinical use of inhaled nitric oxide may become an alternate rescue therapy before extracorporeal membrane oxygenation for the management of acute respiratory distress syndrome in patients with COVID-19.


id: cord-346062-q0trgj12
title: Ethical dilemmas due to the Covid-19 pandemic
author: Robert, René
date: 2020-06-17
txt: ./txt/cord-346062-q0trgj12.txt
cache: ./cache/cord-346062-q0trgj12.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13613-020-00702-7
doi: 10.1186/s13613-020-00702-7
summary:
  The devastating pandemic that has stricken the worldwide population induced an unprecedented influx of patients in ICUs, raising ethical concerns not only surrounding triage and withdrawal of life support decisions, but also regarding family visits and quality of end-of-life support. As a result, four new options never applied to date were considered with the common aim of saving a maximum number of lives: to prioritize ICU beds for patients with the best prognosis; to increase at all costs the number of ICU beds, thereby creating stepdown ICUs; to organize transfer to distant ICUs with more beds available, or to accelerate withdrawal of life support in ICUs. Additionally, to protect the patients'' relatives, visits for families were prohibited or strongly limited and adequate communication between caregivers and families was disrupted, counteracting more than 20 years of research aimed at improving interaction with families and quality of care during EOL [1] .

abstract:
  The devastating pandemic that has stricken the worldwide population induced an unprecedented influx of patients in ICUs, raising ethical concerns not only surrounding triage and withdrawal of life support decisions, but also regarding family visits and quality of end-of-life support. These ingredients are liable to shake up our ethical principles, sharpen our ethical dilemmas, and lead to situations of major caregiver sufferings. Proposals have been made to rationalize triage policies in conjunction with ethical justifications. However, whatever the angle of approach, imbalance between utilitarian and individual ethics leads to unsolvable discomforts that caregivers will need to overcome. With this in mind, we aimed to point out some critical ethical choices with which ICU caregivers have been confronted during the Covid-19 pandemic and to underline their limits. The formalized strategies integrating the relevant tools of ethical reflection were disseminated without deviating from usual practices, leaving to intensivists the ultimate choice of decision.


id: cord-346115-xilbhy37
title: COVID-19: scientific reasoning, pragmatism and emotional bias
author: Gattinoni, Luciano
date: 2020-10-12
txt: ./txt/cord-346115-xilbhy37.txt
cache: ./cache/cord-346115-xilbhy37.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33044591/
doi: 10.1186/s13613-020-00756-7
abstract: nan
summary:
  Yet, we should not be criticized when we suggest that Tobin and co-authors had expressed views that premature intubation in this COVID context is "fatal". For example, recently in the American Journal of Respiratory and Critical Care Medicine, we can find: "the surest way to increase COVID-19 mortality is the liberal use of intubation and mechanical ventilation" [3] . However, the contention that mechanical ventilation is "the surest way to increase COVID-19 mortality" -is not supported by clinical data and therefore, once again such a statement is yet to be proved or disproved. say "Patients with acute severe asthma develop large pleural Open Access *Correspondence: gattinoniluciano@gmail.com 1 Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany Full list of author information is available at the end of the article pressure swings, yet autopsy studies in patients dying because of status asthmaticus are remarkable for the absence of pulmonary edema" [1] .


id: cord-355038-o2hr5mox
title: Proceedings of Réanimation 2020, the French Intensive Care Society International Congress
author: nan
date: 2020-02-11
txt: ./txt/cord-355038-o2hr5mox.txt
cache: ./cache/cord-355038-o2hr5mox.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32048060/
doi: 10.1186/s13613-020-0623-7
abstract: nan
summary:
  Conclusion: In patients with moderate-to-severe ARDS, a higher tidal volume under PSV within the 72 h following neuromuscular blockers cessation is independently associated with the 28-day mortality.Compliance with ethics regulations: Yes. Kaplan-Meier estimate of the cumulative probability of survival according to the mean tidal volume (Vt)-lower of higher than 8 ml/ kg-under pressure support ventilation (PSV) during the "transition period" transfusion is associated with adverse events, and equipoise remains on the optimal transfusion strategy in oncologic patients in surgical setting. Compliance with ethics regulations: Yes. Patients and methods: In a retrospective monocentric study (01/2013-01/2017) conducted in cardio-vascular surgical intensive care unit (ICU) in Henri Mondor teaching hospital, all consecutive adult patients who underwent peripheral VA-ECMO were included, with exclusion of those dying in the first 24 h. Compliance with ethics regulations: Yes. Rationale: Acute respiratory failure is the leading reason for intensive care unit (ICU) admission in immunocompromised patients and the need for invasive mechanical ventilation has become a major clinical end-point in randomized controlled trials (RCT).


