# ent

id: cord-000161-hxjxczyr
type: ORG
entity:
  Ancukiewicz M National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome ARDS Clinical Trials Network Efficacy


id: cord-000161-hxjxczyr
type: DISEASE
entity:
  influenza A H1N1 virus after vaccination with seasonal influenza vaccine WHO Rapid Pandemic Assessment Collaboration Pandemic


id: cord-000498-absjerdt
type: DISEASE
entity:
  diseases chronic obstructive pulmonary disease asthma diabetes chronic heart failure chronic renal failure cirrhosis


id: cord-000705-w52dc97h
type: WORK_OF_ART
entity:
  The National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome ARDS Clinical Trials Network


id: cord-000705-w52dc97h
type: DISEASE
entity:
  influenza A actual weight height severity of illness Acute Physiology And Chronic Health Evaluation II APACHE II organ failures


id: cord-003701-i70ztypg
type: DISEASE
entity:
  chronic pulmonary cardiovascular renal hepatic neurologic hematologic or metabolic disorders immunocompromised


id: cord-003513-hmdikgf5
type: CHEMICAL
entity:
  imipenem Tigecycline colistin ceftazidime doxycycline minocycline piperacillin tazobactam tobramycin rifampin fosfomycin


id: cord-001293-dfaxj3bv
type: GGP
entity:
  Transforming growth factor beta Th T helper TLR Toll like receptor TNF Tumor necrosis factor T reg Regulatory T lymphocyte


id: cord-028337-md9om47x
type: ORG
entity:
  Thoracic Society European Society of Intensive Care Medicine Society of Critical Care Medicine Clinical Practice Guideline Mechanical Ventilation


id: cord-030677-t94cu81n
type: ORG
entity:
  the Mayo Clinic Multidisciplinary Epidemiology and Translational Research in Intensive Care Data Mart


id: cord-030677-t94cu81n
type: DISEASE
entity:
  CS acute coronary syndrome ACS heart failure HF supraventricular tachycardia atrial fibrillation ventricular fibrillation ventricular tachycardia


id: cord-001322-7xmxcm35
type: ORG
entity:
  the European Society of Intensive Care Medicine Infectious Diseases Society of America American Thoracic Society


id: cord-001661-dj9bxhwb
type: TAXON
entity:
  cytomegalovirus influenza virus parainfluenza virus adenovirus herpes simplex virus respiratory syncytial virus


id: cord-001894-ptuelrqj
type: CELL_TYPE
entity:
  TBAS tracheobronchial aspirates TNF tumor necrosis factor VAP ventilator associated pneumonia XDR extensive drug resistant Infectious Diseases Society Of America Guidelines


id: cord-048449-mzn448zk
type: ORG
entity:
  Centre for Excellence in Emergency Preparedness General Readiness Checklist a Template for Healthcare Facilities Healthcare


id: cord-048449-mzn448zk
type: ORG
entity:
  United States Department of Health and Human Services Pandemic Influenza Plan Clinical Guidelines Applicability


id: cord-005503-hm8tvkt3
type: LAW
entity:
  Clinical Practice Guidelines for the Prevention and Management of Pain Agitation Sedation Delirium Immobility and Sleep Disruption in Adult Patients


id: cord-258087-93yfs7ve
type: PROTEIN
entity:
  MIF macrophage migration inhibitory factor MYLK myosin light chain kinase NFKB1 nuclear factor kappa light polypeptide gene enhancer


id: cord-258087-93yfs7ve
type: PROTEIN
entity:
  B cell enhancing factor PLAU plasminogen activator urokinase SFTPB surfactant pulmonary associated protein B TNF tumor necrosis factor VEGF vascular endothelial growth factor


id: cord-258087-93yfs7ve
type: GGP
entity:
  ACE angiotensin converting enzyme CXCL2 chemokine CXC motif ligand 2 F5 coagulation factor V IL 6 interleukin 6 IL 10 interleukin 10 MBL2 mannose binding lectin 2 MIF


id: cord-258087-93yfs7ve
type: GGP
entity:
  CXC motif ligand 2 F5 coagulation factor V IL 6 interleukin 6 IL 10 interleukin 10 MBL2 mannose binding lectin 2 MIF


id: cord-003832-q1422ydi
type: ORG
entity:
  The European Respiratory Society American Thoracic Society Task Force on Undifferentiated Forms of Connective Tissue Disease Associated Interstitial Lung Disease


id: cord-280233-avmisu31
type: WORK_OF_ART
entity:
  Consensus Statement on Multiple Patients Per Ventilator SCCM Website The Toughest Triage Allocating Ventilators


id: cord-003416-c22kw6f4
type: DISEASE
entity:
  influenza A H1N1 pandemic preparation for severe respiratory emergency outbreaks Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A H1N1


id: cord-048448-kfwbqp4p
type: DISEASE
entity:
  influenza A H5N1 Hong Kong Probable person to person transmission of avian influenza A H5N1 World Health Organization International Avian Influenza Investigation Team


id: cord-048448-kfwbqp4p
type: DISEASE
entity:
  influenza A virus subtype H5N1 detection The World Health Organization Global Influenza Program Surveillance Network Evolution of H5N1 avian influenza viruses


id: cord-029183-3aotgq6m
type: GGP
entity:
  aminoglycosides n 15 9 Table 3 Based on the results of the rm PCR the multidisciplinary committee proposed a modification of the routine empirical therapy in 123 77 pneumonia episodes deescalation in 63 40 and escalation in 35 22 Table 4 The proportion of antibiotic modifications


id: cord-029183-3aotgq6m
type: CL
entity:
  Proteus spp Moraxella catarrhalis 1 5 Klebsiella oxytoca 1 5 Gram positive cocci Streptococcus pneumoniae 8 1 6 Streptococcus pyogenes 0 0 Streptococcus agalactiae 0 0 Legionella pneumophila 1 1 Mycoplasma


id: cord-029183-3aotgq6m
type: GGP
entity:
  Staphylococcus n 4 Enterococcus faecium n 1 Enterococcus faecalis n 6 Lactobacillus reuteri n 1 Streptococcus alpha n 1 Streptococcus pseudopneumoniae n 1


id: cord-029183-3aotgq6m
type: GGP
entity:
  bacilli 4 Escherichia coli 3 Pseudomonas aeruginosa 2 Klebsiella pneumoniae 2 Enterobacter sp 1 Raoultella The number of Gram negative


id: cord-259747-sl9q63oc
type: PROTEIN
entity:
  F N R S Belgian National Fund for Scientific Research 3 Immunodeficiency Treatment Unit Erasme Hospital Université Libre de Bruxelles ULB Route de Lennik 808 1070 Brussels Belgium 4


id: cord-252473-i4pmux28
type: WORK_OF_ART
entity:
  Ethics and SARS Learning Lessons from the Toronto Experience Available from the Centre for Bioethics Website Thanks to Dr Laura Hawryluck Co Editor of the medical ethics commentaries section of Critical Care


id: cord-276561-b4cspbuf
type: PROTEIN
entity:
  ACE angiotensin converting enzyme AndR androgen receptor AT I angiotensin I AT II angiotensin II AT 1 7 angiotensin 1 7 AT1R angiotensin receptor type I MR mineralocorticoid receptor MasR Mas receptor


id: cord-276561-b4cspbuf
type: GGP
entity:
  ACE angiotensin converting enzyme AndR androgen receptor AT I angiotensin I AT II angiotensin II AT 1 7 angiotensin 1 7 AT1R angiotensin receptor type I MR mineralocorticoid receptor MasR Mas receptor NO nitric oxide


id: cord-290776-l6ajq6vp
type: PRODUCT
entity:
  Real Time RT PCR Diagnostic Panel Centers for Disease Control and Prevention Division of Viral Diseases Publisher s Note Springer Nature


id: cord-003532-lcgeingz
type: CELL_LINE
entity:
  pRBC O Rh D negative Fig 1 Shock Index was selected as indication for transfusion To achieve feasibility and preservation of the pRBC


id: cord-003532-lcgeingz
type: DNA
entity:
  intensive care unit P Eiben C Brathwaite Shirley S Canestrini King s College Hospital NHS Foundation Trust


id: cord-003532-lcgeingz
type: GGP
entity:
  NT ProBNP D7 OR 9 28 IC95 2 05 41 94 p 0 004 and hs cTnT D7 OR 10 93 IC95 2 139 55 795 p 0 04 were independently associated with in hospital mortality Conclusions NT ProBNP plasma


id: cord-003532-lcgeingz
type: GGP
entity:
  lactate r 0 35 p 0 0011 pulmonary vascular permeability index r 0 38 p 0 0241 first 24 h fluid administration r 0 38 p 0 0001 and sequential organ failure assessment score r 0 40 p 0 0001 Fig 1 Plasma


id: cord-003532-lcgeingz
type: GGP
entity:
  lactate 3 OR 3 11 95 CI 1 56 6 19 p 0 01 and age 63 OR 2 16 95 CI 1 05 4 45 p 0 04 were significantly associated with the response to AVP Conclusions HR lactate


id: cord-003532-lcgeingz
type: ORG
entity:
  Japan 2 Fujita Health University Department of Disaster and Traumatology Fujita Health University Toyoake Japan


id: cord-003532-lcgeingz
type: DISEASE
entity:
  dysphoric mood muscle aches lacrimation rhinorrhea pupillary dilation piloerection sweating diarrhea


id: cord-278249-vvhq9vgp
type: PROTEIN
entity:
  C C motif chemokine ligand CCL 2 CCL3 CCL4 CCL5 CCL11 CCL19 CCL20 CD40 ligand fractalkine C X C motif chemokine ligand CXCL 1


id: cord-278249-vvhq9vgp
type: GGP
entity:
  CCL19 CCL20 CD40 ligand fractalkine C X C motif chemokine ligand CXCL 1 CXCL2 CXCL10 epidermal growth factor EGF fibroblast


id: cord-278249-vvhq9vgp
type: GGP
entity:
  granzyme B interferon IFN alpha IFN beta IFN gamma interleukin IL 1α IL 1β IL 1RA IL 2 IL 3 IL 4 IL 5 IL 6 IL 7 IL 8 IL 10 IL 12 IL 13 IL 15 IL 17A IL 17E IL 33 programmed death ligand 1 PDL1 platelet


id: cord-282571-ilf73g71
type: DISEASE
entity:
  heart kidney liver skeletal muscle central nervous system and adrenal and thyroid glands besides the lungs


id: cord-300135-iwvkvs3k
type: ORG
entity:
  the American Society of Anesthesiologists Task Force on Management of the Difficult Airway Comparison


id: cord-307592-hyeshh63
type: PROTEIN
entity:
  tumor necrosis factor alpha SCF stem cell factor LIF leukemia inhibitory factor IL interleukin IFN interferon


id: cord-307592-hyeshh63
type: GGP
entity:
  VEGF vascular endothelial growth factor TNF α tumor necrosis factor alpha SCF stem cell factor LIF leukemia


id: cord-297062-dmiplvt2
type: WORK_OF_ART
entity:
  S Hussain A Alwan A Abudayah S Altayyar M Mustafa T Aldaghestani A Alghamedi A Talag or M Malik Clinical


id: cord-300897-lih5f6cj
type: CELL_LINE
entity:
  China Critical Care Clinical Trial Group Natural disaster In Intensive and Critical Care Medicine WFSICCM World Federation of Societies of Intensive and Critical Care Medicine Ministry of Health


id: cord-014464-m5n250r2
type: PROTEIN
entity:
  MCP 1 49 5 P 0 002 IL 1ra 36 5 P 0 001 and IL 8 30 2 P 0 002 The 28 day mortality 28 vs 24 control P 0 84 and 60day mortality 39 vs 32 control P 0 75


id: cord-014464-m5n250r2
type: GGP
entity:
  IL 8 30 2 P 0 002 The 28 day mortality 28 vs 24 control P 0 84 and 60day mortality 39 vs 32 control P 0 75 did not diff er signifi cantly between the two studied groups Conclusion In this fi rst clinical study of a novel sorbent hemoadsorption


id: cord-014464-m5n250r2
type: WORK_OF_ART
entity:
  Using the Commissioning for Quality and Innovation CQUIN Payment Framework Guidance on National Goals for Refi


id: cord-014464-m5n250r2
type: DISEASE
entity:
  respiratory 42 neurological 40 renal 35 hematological 27 and hepatic 17 Cardiovascular and renal dysfunctions


id: cord-293167-3bd3adip
type: DISEASE
entity:
  acute respiratory syndrome coronavirus Middle east respiratory syndrome coronavirus causes multiple organ damage


id: cord-005497-w81ysjf9
type: DNA
entity:
  1st group 1st stage 15 2 10 19 4 mmol L 2nd stage 5 2 3 9 7 6 mmol L 3rd stage 6 6 5 8 7 μmol L stage 4 9 7 8 6 12 1 μmol L stage 5 9 4 7 8 11 9 μmol L


id: cord-005497-w81ysjf9
type: DNA
entity:
  2nd group 1st stage 11 9 10 15 mmol L 2nd stage 3 7 1 7 4 1 mmol L 3rd stage 3 6 2 4 4 5 μmol L stage 4 6 5 4 4 8 2 μmol L stage 5 7 6 6 5 9 4 μmol L


id: cord-005497-w81ysjf9
type: PROTEIN
entity:
  I Boussaid D Chtourou S Sfaxi W Bahria D Hamdi M Boussen M Ben Cheikh Mongi Slim Academic Hospital Emergency Department Tunis Tunisia Critical Care 2020 24 Suppl 1 P182


id: cord-005497-w81ysjf9
type: CELL_LINE
entity:
  Greek ICU population E Nanou 1 P Vasiliou 1 E Tsigou 2 V Psallida 1 E Boutzouka 2 V Zidianakis 1 G Fildissis 1 1 Agioi Anargiroi Hospital Attiki Greece 2 Agioi Anargiroi Hospital ICU


id: cord-005497-w81ysjf9
type: DNA
entity:
  groups 11 44 and 6 35 p 0 81 6 24 and 7 41 р 0 40 1 4 and 1 6 р 1 00 6 24 and 5 29 р 0 97 respectively Rate


id: cord-005497-w81ysjf9
type: CELL_LINE
entity:
  35bed Greek university ICU C Vrettou E Douka I Papachatzakis K Sarri E Gavrielatou E Mizi S Zakynthinos 1st ICU Department University


id: cord-005497-w81ysjf9
type: GGP
entity:
  MAP R 0 03 p 0 003 R 0 03 p 0 004 Figure 1 and heart rate R 0 12 p 0 001 since systemic pressure starts to drop UFRV and UFR demonstrated good clinical response to fluid administration despite the fact that systemic blood pressure


id: cord-005497-w81ysjf9
type: ORG
entity:
  Conrick Martin Mater Misericordiae University Hospital Department of Critical Care Medicine Dublin Ireland Critical Care 2020


id: cord-005497-w81ysjf9
type: ORG
entity:
  Clinical Research Investigation and Systems Modeling of Acute Illness CRISMA Center Department of Biostatistics


id: cord-005497-w81ysjf9
type: PRODUCT
entity:
  S Erel O Ermis Ö Nadastepe L Karabıyık Gazi University School of Medicine Anesthesiology and Intensive Care


id: cord-005497-w81ysjf9
type: DISEASE
entity:
  brain injury A Semenenko 1 S Semenenko 2 A Solomonchuk 3 N Semenenko 3 Depending on the nature of the brain injury


id: cord-005497-w81ysjf9
type: DISEASE
entity:
  critically ill T Chandler R Sarkar A Bowman P Hayden Medway Maritime Hospital Critical Care Gillingham United Kingdom Critical Care 2020 24 Suppl 1 P366 Frailty


id: cord-352227-827987jf
type: GGP
entity:
  HVA 97 4 hydroxyphenyllactic acid p HPhLA 97 3 4 dihydroxybenzoic acid internal standard 98 4 hydroxyphenylpropionic acid p HPhPA 98 4 hydroxybenzoic acid


id: cord-352227-827987jf
type: GGP
entity:
  HBA p hydroxybenzoic acid p HPhAA p hydroxyphenylacetic acid p HPhPA p hydroxyphenylpropionic acid HVA homovanillic acid p HPhLA p hydroxyphenyllactic acid


id: cord-352227-827987jf
type: CHEMICAL
entity:
  acid p HPhPA p hydroxyphenylpropionic acid HVA homovanillic acid p HPhLA p hydroxyphenyllactic acid Fig 5 Correlations between aromatic


id: cord-314872-njlgggzq
type: PROTEIN
entity:
  sensitivity C reactive protein ALAT alanine aminotransferase ASAT aspartate transaminase GGT gamma glutamyl transferase


id: cord-314872-njlgggzq
type: GGP
entity:
  triglycerides P int 0 0134 and serum hsCRP P int 0 041 The strongest association was observed between sACE2 and GGT P 3 44 10 90 an important indicator of oxidative stress liver and bile duct


id: cord-320637-jn8dh4vk
type: ORG
entity:
  the Animal Use Committee of Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences


id: cord-320637-jn8dh4vk
type: ORG
entity:
  Dr Masao Yamada Department of Virology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences


id: cord-351264-zp41u14l
type: ORG
entity:
  Division of Respiratory and Critical Care Medicine Department of Medicine National University Hospital National University Health System Singapore Singapore 2


id: cord-351264-zp41u14l
type: ORG
entity:
  Chronic Programmes Alexandra Hospital National University Health System Singapore Singapore Received


id: cord-355847-1ru15s5a
type: PROTEIN
entity:
  interleukins IL 2 IL 6 IL 7 IL 10 granulocyte colonystimulating factor G CSF 10 kDa interferon gammainduced protein IP


id: cord-351600-bqw9ks4a
type: ORG
entity:
  the Institutional Ethics Committee of Union Hospital Tongji Medical College Huazhong University of Science and Technology 20200036


id: cord-341063-3rqnu5bu
type: DNA
entity:
  consciousness OR 13 62 p 0 001 ataxic respiration OR 2 24 p 0 001 aspiration pneumonia OR 7 04 p 0 001 orotracheal intubation 48h OR 13 35 p 0 001 tracheostomy OR 12 99 p 0 001 airway secretion OR 24 91 p 0 001 nasoenteral tube OR 14 9 p 0 001 gastrostomy OR 4 58 p 0 030


id: cord-341063-3rqnu5bu
type: DNA
entity:
  aPTT group 11 7 9 5 15 3 IU kg h versus 15 7 10 9 21 3 IU kg h respectively p 0 03 Safety parameters


id: cord-341063-3rqnu5bu
type: CELL_LINE
entity:
  colloid 6 hydroxyethyl starch HES n 15 groups Cardiac index CI stroke volume SVI and pulse pressure variation PPV


id: cord-341063-3rqnu5bu
type: DNA
entity:
  W Yacov 1 Y Polishuk 2 A Geal dor 2 G Yosef hay 2 1 Kaplan Medical Center Rehovot Israel 2 Kaplan medical center Rehovot Israel Critical Care 2018 22 Suppl 1


id: cord-341063-3rqnu5bu
type: GGP
entity:
  CLtot of 1 0 0 5 1 0 and 0 3 0 2 0 9 L h respectively on and off CVVH Steady state trough levels Cmin of SMT


id: cord-341063-3rqnu5bu
type: FAC
entity:
  P Bonaventure JA Jamous F Lauzier R Zarychanski C Francoeur A Turgeon CHU de Québec Université Laval Québec Canada Critical Care


id: cord-341063-3rqnu5bu
type: CHEMICAL
entity:
  Dequin 4 C Guitton 5 N Deye 6 G Plantefève 7 JP Quenot 8 A Desachy 9 T Kamel 10 S Bedon Carte 11 JL Diehl 12 N Chudeau 13 E


# bib

id: cord-000072-2ygb80sc
title: Bench-to-bedside review: Angiopoietin signalling in critical illness – a future target?
author: van Meurs, Matijs
date: 2009-03-09
txt: ./txt/cord-000072-2ygb80sc.txt
cache: ./cache/cord-000072-2ygb80sc.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689450/
doi: 10.1186/cc7153
summary:
  All three functions are involved in MODS, in which ECs are shed, blood flow regulation is hampered, vessels become leaky, cells migrate out of the vessel and into the surrounding tissue, and coagulation and inflammation pathways are activated [16] . The Ang/Tie system, which was discovered after vascular endothelial growth factor (VEGF) and its receptors, is mainly restricted to EC regulation and is the focus of this review. In sepsis, VEGF and its soluble receptor sFLT-1 (soluble VEGFR-1) are also increased in a disease severity-dependent manner [40] [41] [42] .The picture that emerges from these studies is that the Ang/Tie signalling system appears to play a crucial role in the symptoms of MODS. Ang-2 acts as an antagonist of Ang-1, stops Tie2 signalling, and sensitizes endothelium to inflammatory mediators (for example, tumour necrosis factor-α) or facilitates vascular endothelial growth factor-induced angiogenesis. Hypoxia and vascular endothelial growth factor acutely up-regulate angiopoietin-1 and Tie2 mRNA in bovine retinal pericytes

abstract:
  Multiple organ dysfunction syndrome (MODS) occurs in response to major insults such as sepsis, severe haemorrhage, trauma, major surgery and pancreatitis. The mortality rate is high despite intensive supportive care. The pathophysiological mechanism underlying MODS are not entirely clear, although several have been proposed. Overwhelming inflammation, immunoparesis, occult oxygen debt and other mechanisms have been investigated, and – despite many unanswered questions – therapies targeting these mechanisms have been developed. Unfortunately, only a few interventions, usually those targeting multiple mechanisms at the same time, have appeared to be beneficial. We clearly need to understand better the mechanisms that underlie MODS. The endothelium certainly plays an active role in MODS. It functions at the intersection of several systems, including inflammation, coagulation, haemodynamics, fluid and electrolyte balance, and cell migration. An important regulator of these systems is the angiopoietin/Tie2 signalling system. In this review we describe this signalling system, giving special attention to what is known about it in critically ill patients and its potential as a target for therapy.


id: cord-000086-bnkbwh3w
author: Kneyber, Martin CJ
date: 2009-05-15
txt: ./txt/cord-000086-bnkbwh3w.txt
cache: ./cache/cord-000086-bnkbwh3w.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717432/
doi: 10.1186/cc7880
summary:
  RSV LRTD is pathophysiologically characterized by sloughed necrotic epithelium, excessive mucus secretion, bronchial mucosal oedema and peribronchial inflammation that contributes to airway obstruction resulting in increased airway resistance with subsequent air-ANOVA: analysis of variance; ARDS: acute respiratory distress syndrome; CO 2 : carbon dioxide; Cstat: static compliance; EELV: end-expiratory lung volume; EIT: electrical impedance tomography; ELISA: enzyme-linked immunosorbent assay; ET-CO 2 : end-tidal carbon dioxide; FiO 2 : fraction of inspired oxygen; LRTD: lower respiratory tract disease; MAP: mean airway pressure; MV: mechanical ventilation; OI: oxygenation index; PaCO 2 : partial pressure of arterial carbon dioxide; PaO 2 : partial pressure of arterial oxygen; PEEP: positive end-expiratory pressure; PEFR: peak expiratory flow rate; PICU: paediatric intensive care unit; PIP: positive inspiratory pressure; Ptrach: intratracheal pressure; relative Δ EELV : relative change in end-expiratory lung volume; Rlung: lung resistance; Rrs: respiratory system resistance; RSV: respiratory syncytial virus; SPO 2 : oxygen saturation; V D : dead space; VI: ventilation index; Vte: expiratory tidal volume.

title:
  Heliox reduces respiratory system resistance in respiratory syncytial virus induced respiratory failure

abstract:
  INTRODUCTION: Respiratory syncytial virus (RSV) lower respiratory tract disease is characterised by narrowing of the airways resulting in increased airway resistance, air-trapping and respiratory acidosis. These problems might be overcome using helium-oxygen gas mixture. However, the effect of mechanical ventilation with heliox in these patients is unclear. The objective of this prospective cross-over study was to determine the effects of mechanical ventilation with heliox 60/40 versus conventional gas on respiratory system resistance, air-trapping and CO2 removal. METHODS: Mechanically ventilated, sedated and paralyzed infants with proven RSV were enrolled within 24 hours after paediatric intensive care unit (PICU)admission. At T = 0, respiratory system mechanics including respiratory system compliance and resistance, and peak expiratory flow rate were measured with the AVEA ventilator. The measurements were repeated at each interval (after 30 minutes of ventilation with heliox, after 30 minutes of ventilation with nitrox and again after 30 minutes of ventilation with heliox). Indices of gas exchange (ventilation and oxygenation index) were calculated at each interval. Air-trapping (defined by relative change in end-expiratory lung volume) was determined by electrical impedance tomography (EIT) at each interval. RESULTS: Thirteen infants were enrolled. In nine, EIT measurements were performed. Mechanical ventilation with heliox significantly decreased respiratory system resistance. This was not accompanied by an improved CO2 elimination, decreased peak expiratory flow rate or decreased end-expiratory lung volume. Importantly, oxygenation remained unaltered throughout the experimental protocol. CONCLUSIONS: Respiratory system resistance is significantly decreased by mechanical ventilation with heliox (ISCRTN98152468).


id: cord-000161-hxjxczyr
title: Clinical review: Primary influenza viral pneumonia
author: Rello, Jordi
date: 2009-12-21
txt: ./txt/cord-000161-hxjxczyr.txt
cache: ./cache/cord-000161-hxjxczyr.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811908/
doi: 10.1186/cc8183
summary:
  Primary influenza pneumonia has a high mortality rate during pandemics, not only in immunocompromised individuals and patients with underlying comorbid conditions, but also in young healthy adults. Pneumonia and the acute respiratory distress syndrome (ARDS) account for the majority of severe morbidity and mortality that accompany pandemic influenza infection [14] . A recent analysis of lung specimens from 77 fatal cases of pandemic H1N1v 2009 infection found a prevalence of concurrent bacterial pneumonia in 29% of these patients [31] . A recent World Health Organization treatment guideline for pharmacological management of 2009 pandemic H1N1v influenza A recommends the consideration of higher doses of oseltamivir (150 mg twice a day) and longer duration of treatment for patients with severe influenza pneumonia or clinical deterioration [44] . The rapid progression from initial typical influenza symptoms to extensive pulmonary involvement, with acute lung injury, can occur both in patients with underlying respiratory or cardiac morbidities and in young healthy adults, especially if obese or pregnant.

abstract:
  Primary influenza pneumonia has a high mortality rate during pandemics, not only in immunocompromised individuals and patients with underlying comorbid conditions, but also in young healthy adults. Clinicians should maintain a high index of suspicion for this diagnosis in patients presenting with influenza-like symptoms that progress quickly (2 to 5 days) to respiratory distress and extensive pulmonary involvement. The sensitivity of rapid diagnostic techniques in identifying infections with the pandemic 2009 H1N1v influenza strain is currently suboptimal. The most reliable real-time reverse transcriptase-polymerase chain reaction molecular testing is available in limited clinical settings. Despite 6 months of pandemic circulation, most novel H1N1v pandemic strains remain susceptible to oseltamivir. Ensuring an appropriate oxygenation and ventilation strategy, as well as prompt initiation of antiviral therapy, is essential in management.


id: cord-000217-chd9ezba
title: Role of CD14 in lung inflammation and infection
author: Anas, Adam
date: 2010-03-09
txt: ./txt/cord-000217-chd9ezba.txt
cache: ./cache/cord-000217-chd9ezba.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887102/
doi: 10.1186/cc8850
summary:
  Furthermore, intratracheal treatment of CD14-defi cient mice with sCD14 restored the infl ammatory response to the level present in wildtype mice, whereas treatment with wild-type alveolar macrophages restored the neutrophil infi ltration of the lung but not pulmonary TNF release [26] . Th ese fi ndings indicate that sCD14, and CD14 and TLR4 on the surface of alveolar macrophages contribute to the development of LPS-induced lung infl ammation. In line with the fi ndings that CD14 contributes to LPSinduced lung infl ammation in mice, a number of studies have shown that CD14 is essential for the host defense response in the lung against Gram-negative bacteria, such as nontypeable Haemophilus infl uenzae, a possible cause of community acquired pneumonia, and A. coli-induced pneumonia has not been investigated in mice, whereas the role of the other components of the LPS receptor complex (TLR4, MD-2, MyD88, TRIF) has been determined using gene-defi cient or mutant mice.

abstract:
  This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855.


id: cord-000492-ec5qzurk
title: Clinical Review: Gene-based therapies for ALI/ARDS: where are we now?
author: Devaney, James
date: 2011-06-20
txt: ./txt/cord-000492-ec5qzurk.txt
cache: ./cache/cord-000492-ec5qzurk.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218971/
doi: 10.1186/cc10216
summary:
  Plasmid transfer (closed Easily produced at low cost No specifi c cell targeting Electroporation-mediated gene transfer of the dsDNA circles) Very ineffi cient Na + ,K + -ATPase rescues endotoxin-induced lung injury [60] Nonviral DNA complexes Complexes protect DNA Less effi cient than viral vectors Cationic lipid-mediated transfer of the Na + ,K + -(lipoplexes or polyplexes) Modifying transgene DNA to eliminate bacterial motifs [75, 76] Development of high-effi ciency tissue-specifi c promoters [77] [78] [79] [80] Development of promoters that regulate gene expression [83] Enhanced therapeutic targeting Nebulization technologies [9] Strategies to target the pulmonary endothelium [10] Improved cellular uptake of vector Surface active agents to enhance vector spread [84] Reduce ubiquitination of viral capsid proteins [85] Better therapeutic targets Enhancement or restoration of lung epithelial and/or endothelial cell function [86] Strengthening lung defense mechanisms against injury [87] Speeding clearance of infl ammation and infection Enhancement of the repair process following ALI/ARDS [88] .

abstract:
  Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) confer substantial morbidity and mortality, and have no specific therapy. The accessibility of the distal lung epithelium via the airway route, and the relatively transient nature of ALI/ARDS, suggest that the disease may be amenable to gene-based therapies. Ongoing advances in our understanding of the pathophysiology of ALI/ARDS have revealed multiple therapeutic targets for gene-based approaches. Strategies to enhance or restore lung epithelial and/or endothelial cell function, to strengthen lung defense mechanisms against injury, to speed clearance of infection and to enhance the repair process following ALI/ARDS have all demonstrated promise in preclinical models. Despite three decades of gene therapy research, however, the clinical potential for gene-based approaches to lung diseases including ALI/ARDS remains to be realized. Multiple barriers to effective pulmonary gene therapy exist, including the pulmonary architecture, pulmonary defense mechanisms against inhaled particles, the immunogenicity of viral vectors and the poor transfection efficiency of nonviral delivery methods. Deficits remain in our knowledge regarding the optimal molecular targets for gene-based approaches. Encouragingly, recent progress in overcoming these barriers offers hope for the successful translation of gene-based approaches for ALI/ARDS to the clinical setting.


id: cord-000498-absjerdt
title: Clinical aspects and cytokine response in severe H1N1 influenza A virus infection
author: Hagau, Natalia
date: 2010-11-09
txt: ./txt/cord-000498-absjerdt.txt
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extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3220006/
doi: 10.1186/cc9324
summary:
  To and colleagues found higher plasma levels of proinflammatory cytokines and chemokine in the group of patients with acute respiratory distress syndrome (ARDS) caused by viral A(H1N1) influenza, throughout the initial 10 days after symptom onset [8] . The aim of our study was to further investigate the profile of Th1 and Th17 mediators and interferoninductible protein-10 (IP-10), an innate-immunity mediator, as early host response in a group of critical and noncritical hospitalized patients with nvA(H1N1) from Cluj-Napoca, Romania, and to correlate them with the clinical aspects. IL-15 is significantly higher at admission (P1) and 3 days later (P2) in the nvA(H1N1)-ARDS group for nonsurvivors versus survivors, so it might be pathogenic in lung injury influenza A virus infection. An increased level of IP-10 was found in the Spanish group as early response to nvA(H1N1) infection in both hospitalized and mild patient disease, as in the present study, while in the Hong Kong group IP-10 was significantly higher in critical patients only.

abstract:
  INTRODUCTION: The immune responses in patients with novel A(H1N1) virus infection (nvA(H1N1)) are incompletely characterized. We investigated the profile of Th1 and Th17 mediators and interferon-inducible protein-10 (IP-10) in groups with severe and mild nvA(H1N1) disease and correlated them with clinical aspects. METHODS: Thirty-two patients hospitalized with confirmed nvA(H1N1) infection were enrolled in the study: 21 patients with nvA(H1N1)-acute respiratory distress syndrome (ARDS) and 11 patients with mild disease. One group of 20 patients with bacterial sepsis-ARDS and another group of 15 healthy volunteers were added to compare their cytokine levels with pandemic influenza groups. In the nvA(H1N1)-ARDS group, the serum cytokine samples were obtained on admission and 3 days later. The clinical aspects were recorded prospectively. RESULTS: In the nvA(H1N1)-ARDS group, obesity and lymphocytopenia were more common and IP-10, interleukin (IL)-12, IL-15, tumor necrosis factor (TNF)α, IL-6, IL-8 and IL-9 were significantly increased versus control. When comparing mild with severe nvA(H1N1) groups, IL-6, IL-8, IL-15 and TNFα were significantly higher in the severe group. In nonsurvivors versus survivors, IL-6 and IL-15 were increased on admission and remained higher 3 days later. A positive correlation of IL-6, IL-8 and IL-15 levels with C-reactive protein and with > 5-day interval between symptom onset and admission, and a negative correlation with the PaO(2):FiO(2 )ratio, were found in nvA(H1N1) groups. In obese patients with influenza disease, a significant increased level of IL-8 was found. When comparing viral ARDS with bacterial ARDS, the level of IL-8, IL-17 and TNFα was significantly higher in bacterial ARDS and IL-12 was increased only in viral ARDS. CONCLUSIONS: In our critically ill patients with novel influenza A(H1N1) virus infection, the hallmarks of the severity of disease were IL-6, IL-15, IL-8 and TNFα. These cytokines, except TNFα, had a positive correlation with the admission delay and C-reactive protein, and a negative correlation with the PaO(2):FiO(2 )ratio. Obese patients with nvA(H1N1) disease have a significant level of IL-8. There are significant differences in the level of cytokines when comparing viral ARDS with bacterial ARDS.


id: cord-000522-d498qj2b
title: Reducing mortality in sepsis: new directions
author: Vincent, Jean-Louis
date: 2002-12-05
txt: ./txt/cord-000522-d498qj2b.txt
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mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3239386/
doi: 10.1186/cc1860
summary:
  Five topics were selected that have been shown in randomized, controlled trials to reduce mortality: limiting the tidal volume in acute lung injury or acute respiratory distress syndrome, early goal-directed therapy, use of drotrecogin alfa (activated), use of moderate doses of steroids, and tight control of blood sugar. The present article provides guidelines from experts in the field on optimal patient selection and timing for each intervention, and provides advice on how to integrate new therapies into ICU practice, including protocol development, so that mortality rates from this disease process can be reduced. The interventions discussed encompassed low tidal volume in patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) (Edward Abraham), early goal-directed therapy (EGDT) (Emanuel Rivers), drotrecogin alfa (activated) (Gordon Bernard), moderate-dose corticosteroids (Djillali Annane), and tight control of blood sugar (Greet Van den Berghe).

abstract:
  Considerable progress has been made in the past few years in the development of therapeutic interventions that can reduce mortality in sepsis. However, encouraging physicians to put the results of new studies into practice is not always simple. A roundtable was thus convened to provide guidance for clinicians on the integration and implementation of new interventions into the intensive care unit (ICU). Five topics were selected that have been shown in randomized, controlled trials to reduce mortality: limiting the tidal volume in acute lung injury or acute respiratory distress syndrome, early goal-directed therapy, use of drotrecogin alfa (activated), use of moderate doses of steroids, and tight control of blood sugar. One of the principal investigators for each study was invited to participate in the roundtable. The discussions and questions that followed the presentation of data by each panel member enabled a consensus recommendation to be derived regarding when each intervention should be used. Each new intervention has a place in the management of patients with sepsis. Furthermore, and importantly, the therapies are not mutually exclusive; many patients will need a combination of several approaches – an 'ICU package'. The present article provides guidelines from experts in the field on optimal patient selection and timing for each intervention, and provides advice on how to integrate new therapies into ICU practice, including protocol development, so that mortality rates from this disease process can be reduced.


id: cord-000705-w52dc97h
author: Ríos, Fernando G
date: 2011-08-17
txt: ./txt/cord-000705-w52dc97h.txt
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extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387643/
doi: 10.1186/cc10369
summary:
  METHOD: This was a multicenter, prospective inception cohort study including adult patients with acute respiratory failure requiring mechanical ventilation (MV) admitted to 20 ICUs in Argentina between June and September of 2009 during the influenza A (H1N1) pandemic. Although a mild form of the disease was prevalent, it soon became evident that the 2009 influenza A (H1N1) virus could also provoke severe, acute respiratory failure requiring admission to the intensive care unit (ICU) for mechanical ventilation [16] , which was reflected in the severe pathological injury found at autopsy [17] . This was a multicenter, inception cohort study that included patients aged > 15 years admitted to the ICU with a previous history of influenza-like illness, evolving to acute respiratory failure that required mechanical ventilation during the 2009 winter in the Southern Hemisphere. We report on a large, prospective cohort of 2009 influenza A (H1N1) patients that were mechanically ventilated for acute respiratory failure due to diffuse pneumonitis during the pandemic in Argentina.

title:
  Lung Function and Organ Dysfunctions in 178 Patients Requiring Mechanical Ventilation During The 2009 Influenza A (H1N1) Pandemic

abstract:
  INTRODUCTION: Most cases of the 2009 influenza A (H1N1) infection are self-limited, but occasionally the disease evolves to a severe condition needing hospitalization. Here we describe the evolution of the respiratory compromise, ventilatory management and laboratory variables of patients with diffuse viral pneumonitis caused by pandemic 2009 influenza A (H1N1) admitted to the ICU. METHOD: This was a multicenter, prospective inception cohort study including adult patients with acute respiratory failure requiring mechanical ventilation (MV) admitted to 20 ICUs in Argentina between June and September of 2009 during the influenza A (H1N1) pandemic. In a standard case-report form, we collected epidemiological characteristics, results of real-time reverse-transcriptase--polymerase-chain-reaction viral diagnostic tests, oxygenation variables, acid-base status, respiratory mechanics, ventilation management and laboratory tests. Variables were recorded on ICU admission and at days 3, 7 and 10. RESULTS: During the study period 178 patients with diffuse viral pneumonitis requiring MV were admitted. They were 44 ± 15 years of age, with Acute Physiology And Chronic Health Evaluation II (APACHE II) scores of 18 ± 7, and most frequent comorbidities were obesity (26%), previous respiratory disease (24%) and immunosuppression (16%). Non-invasive ventilation (NIV) was applied in 49 (28%) patients on admission, but 94% were later intubated. Acute respiratory distress syndrome (ARDS) was present throughout the entire ICU stay in the whole group (mean PaO(2)/FIO(2 )170 ± 25). Tidal-volumes used were 7.8 to 8.1 ml/kg (ideal body weight), plateau pressures always remained < 30 cmH(2)O, without differences between survivors and non-survivors; and mean positive end-expiratory pressure (PEEP) levels used were between 8 to 12 cm H(2)O. Rescue therapies, like recruitment maneuvers (8 to 35%), prone positioning (12 to 24%) and tracheal gas insufflation (3%) were frequently applied. At all time points, pH, platelet count, lactate dehydrogenase assay (LDH) and Sequential Organ Failure Assessment (SOFA) differed significantly between survivors and non-survivors. Lack of recovery of platelet count and persistence of leukocytosis were characteristic of non-survivors. Mortality was high (46%); and length of MV was 10 (6 to 17) days. CONCLUSIONS: These patients had severe, hypoxemic respiratory failure compatible with ARDS that persisted over time, frequently requiring rescue therapies to support oxygenation. NIV use is not warranted, given its high failure rate. Death and evolution to prolonged mechanical ventilation were common outcomes. Persistence of thrombocytopenia, acidosis and leukocytosis, and high LDH levels found in non-survivors during the course of the disease might be novel prognostic findings.


id: cord-000891-5r2in1gw
author: Giannella, Maddalena
date: 2012-06-14
txt: ./txt/cord-000891-5r2in1gw.txt
cache: ./cache/cord-000891-5r2in1gw.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580661/
doi: 10.1186/cc11387
summary:
  Suspected and unsuspected cases were compared, and significant differences were found for age (53 versus 69 median years), severe respiratory failure (68.8% versus 20%), surgery (6.3% versus 60%), median days of ICU stay before diagnosis (1 versus 4), nosocomial infection (18.8% versus 66.7%), cough (93.8% versus 53.3%), localized infiltrate on chest radiograph (6.3% versus 40%), median days to antiviral treatment (2 versus 9), pneumonia (93.8% versus 53.3%), and acute respiratory distress syndrome (75% versus 26.7%). The variables recorded were age, sex, classification of the severity of underlying conditions according to the Charlson comorbidity index [6] , type of ICU, date and cause of ICU admission, APACHE II score [7] on admission to the ICU, date of onset of influenza symptoms, clinical manifestations and radiologic findings at diagnosis, date of TA sample collection, other samples tested for influenza and result, date of initiation of antiviral treatment, complications (septic shock, acute respiratory distress syndrome (ARDS)), outcome including mortality within 30 days after influenza diagnosis, and length of ICU and hospital stay.

title:
  Should lower respiratory tract secretions from intensive care patients be systematically screened for influenza virus during the influenza season?

abstract:
  INTRODUCTION: Influenza is easily overlooked in intensive care units (ICUs), particularly in patients with alternative causes of respiratory failure or in those who acquire influenza during their ICU stay. METHODS: We performed a prospective study of patients admitted to three adult ICUs of our hospital from December 2010 to February 2011. All tracheal aspirate (TA) samples sent to the microbiology department were systematically screened for influenza. We defined influenza as unsuspected if testing was not requested and the patient was not receiving empirical antiviral therapy after sample collection. RESULTS: We received TA samples from 105 patients. Influenza was detected in 31 patients and was classified as unsuspected in 15 (48.4%) patients, and as hospital acquired in 13 (42%) patients. Suspected and unsuspected cases were compared, and significant differences were found for age (53 versus 69 median years), severe respiratory failure (68.8% versus 20%), surgery (6.3% versus 60%), median days of ICU stay before diagnosis (1 versus 4), nosocomial infection (18.8% versus 66.7%), cough (93.8% versus 53.3%), localized infiltrate on chest radiograph (6.3% versus 40%), median days to antiviral treatment (2 versus 9), pneumonia (93.8% versus 53.3%), and acute respiratory distress syndrome (75% versus 26.7%). Multivariate analysis showed admission to the surgical ICU (odds ratio (OR), 37.1; 95% confidence interval (CI), 2.1 to 666.6; P = 0.01) and localized infiltrate on chest radiograph (OR, 27.8; 95% CI, 1.3 to 584.1; P = 0.03) to be independent risk factors for unsuspected influenza. Overall mortality at 30 days was 29%. ICU admission for severe respiratory failure was an independent risk factor for poor outcome. CONCLUSION: During the influenza season, almost one third of critical patients with suspected lower respiratory tract infection had influenza, and in 48.4%, the influenza was unsuspected. Lower respiratory samples from adult ICUs should be systematically screened for influenza during seasonal epidemics.


id: cord-000892-l9862er0
author: Richard, Jean-Christophe Marie
date: 2012-07-09
txt: ./txt/cord-000892-l9862er0.txt
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mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580695/
doi: 10.1186/cc11412
summary:
  An on-line screening registry allowed a daily report of ICU beds occupancy rate by flu infected patients (Flu-OR) admitted in French ICUs. METHODS: We conducted a prospective inception cohort study with results of an on-line screening registry designed for daily assessment of ICU burden. Here, we report the exact rate of ICU bed occupancy by flu-infected patients (Flu-OR) during the pandemic in a representative subset of French ICUs. The French REVA-SRLF registry was a multi-center prospective observational survey based on a website registry, and several results of this registry have been published elsewhere [13] [14] [15] . Even if ICUs were encouraged to do a daily assessment of the presence of patients with A (H1N1), we chose to report the calculation per week first to be consistent with the French organization and the National Institute for Public Health Surveillance (NIPHS), which displayed the time course of the pandemic weekly, and also to simplify data notification for participating centers.

title:
  Interest of a simple on-line screening registry for measuring ICU burden related to an influenza pandemic

abstract:
  INTRODUCTION: The specific burden imposed on Intensive Care Units (ICUs) during the A/H1N1 influenza 2009 pandemic has been poorly explored. An on-line screening registry allowed a daily report of ICU beds occupancy rate by flu infected patients (Flu-OR) admitted in French ICUs. METHODS: We conducted a prospective inception cohort study with results of an on-line screening registry designed for daily assessment of ICU burden. RESULTS: Among the 108 centers participating to the French H1N1 research network on mechanical ventilation (REVA) - French Society of Intensive Care (SRLF) registry, 69 ICUs belonging to seven large geographical areas voluntarily participated in a website screening-registry. The aim was to daily assess the ICU beds occupancy rate by influenza-infected and non-infected patients for at least three weeks. Three hundred ninety-one critically ill infected patients were enrolled in the cohort, representing a subset of 35% of the whole French 2009 pandemic cohort; 73% were mechanically ventilated, 13% required extra corporal membrane oxygenation (ECMO) and 22% died. The global Flu-OR in these ICUs was only 7.6%, but it exceeded a predefined 15% critical threshold in 32 ICUs for a total of 103 weeks. Flu-ORs were significantly higher in University than in non-University hospitals. The peak ICU burden was poorly predicted by observations obtained at the level of large geographical areas. CONCLUSIONS: The peak Flu-OR during the pandemic significantly exceeded a 15% critical threshold in almost half of the ICUs, with an uneven distribution with time, geographical areas and between University and non-University hospitals. An on-line assessment of Flu-OR via a simple dedicated registry may contribute to better match resources and needs.


id: cord-001293-dfaxj3bv
title: Is boosting the immune system in sepsis appropriate?
author: Cavaillon, Jean-Marc
date: 2014-03-24
txt: ./txt/cord-001293-dfaxj3bv.txt
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extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035855/
doi: 10.1186/cc13787
summary:
  In response to the failure of therapies aiming to target either the up-stream microbial activators or the effector molecules of the inflammatory cascade, a new concept has emerged of boosting the immune system to counter immunosuppression that develops in patients who survive the initial, hyperinflammatory period of sepsis [1] . One can conjecture that systemic treatment with IL-7 may act in undesired places, as illustrated by the following: IL-7 worsens graft-versus-host-induced tissue inflammation [81] ; favors inflammation in colitis [82] , contributes to arthritis severity [83] ; upregulates chemokines, IFNγ, macrophage recruitment, and lung inflammation [84] ; and, finally, increases production of inflammatory cytokines by monocytes and T cells [85] . Not only are PD-1-deficient mice markedly protected from the lethality of sepsis, accompanied by a decreased bacterial burden and suppressed inflammatory cytokine response [98] , but also blockade of PD-1 or PD-L1 improves survival in a murine model of sepsis, reverses immune dysfunction, inhibits lymphocyte apoptosis, and attenuates organ dysfunction [99] [100] [101] .

abstract:
  A relative immunosuppression is observed in patients after sepsis, trauma, burns, or any severe insults. It is currently proposed that selected patients will benefit from treatment aimed at boosting their immune systems. However, the host immune response needs to be considered in context with pathogen-type, timing, and mainly tissue specificity. Indeed, the immune status of leukocytes is not universally decreased and their activated status in tissues contributes to organ failure. Accordingly, any new immune-stimulatory therapeutic intervention should take into consideration potentially deleterious effects in some situations.


id: cord-001319-mlkaowqr
title: Kinetics of circulating immunoglobulin M in sepsis: relationship with final outcome
author: Giamarellos-Bourboulis, Evangelos J
date: 2013-10-21
txt: ./txt/cord-001319-mlkaowqr.txt
cache: ./cache/cord-001319-mlkaowqr.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056013/
doi: 10.1186/cc13073
summary:
  RESULTS: Serum IgM was decreased in septic shock compared to patients with systemic inflammatory response syndrome (SIRS) and patients with severe sepsis. The current study was designed in order to embed into the changes of circulating IgM levels of patients upon progression to the more severe stages of sepsis in relation with the production of IgM from circulating lymphocytes and with the final outcome. The primary endpoint was the over-time changes of IgM serum levels of patients upon progression to septic shock in relation with the final outcome that is survival or 28-day mortality. The study end point was the kinetics of serum IgM upon progression from severe sepsis to septic shock in relation with final outcome. The time curves of IgM were designed for 30 patients with severe sepsis who progressed into septic shock.

abstract:
  INTRODUCTION: The aim of this study was to investigate the kinetics of immunoglobulin M (IgM) during the different stages of sepsis. METHODS: In this prospective multicenter study, blood sampling for IgM measurement was done within the first 24 hours from diagnosis in 332 critically ill patients; in 83 patients this was repeated upon progression to more severe stages. Among these 83 patients, 30 patients with severe sepsis progressed into shock and IgM was monitored daily for seven consecutive days. Peripheral blood mononuclear cells (PBMCs) were isolated from 55 patients and stimulated for IgM production. RESULTS: Serum IgM was decreased in septic shock compared to patients with systemic inflammatory response syndrome (SIRS) and patients with severe sepsis. Paired comparisons at distinct time points of the sepsis course showed that IgM was decreased only when patients deteriorated from severe sepsis to septic shock. Serial measurements in these patients, beginning from the early start of vasopressors, showed that the distribution of IgM over time was significantly greater for survivors than for non-survivors. Production of IgM by PBMCs was significantly lower at all stages of sepsis compared with healthy controls. CONCLUSIONS: Specific changes of circulating IgM occur when patients with severe sepsis progress into septic shock. The distribution of IgM is lower among non-survivors.


id: cord-001322-7xmxcm35
author: Walden, Andrew P
date: 2014-04-01
txt: ./txt/cord-001322-7xmxcm35.txt
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extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056764/
doi: 10.1186/cc13812
summary:
  Phenotypic data was recorded using a robust clinical database allowing a contemporary analysis of the clinical characteristics, microbiology, outcomes and independent risk factors in patients with severe CAP admitted to ICUs across Europe. A number of more recent, larger studies have focussed on identifying patients with CAP at increased risk of severe sepsis and death, as well as those who may require ventilator or vasopressor support [3, [24] [25] [26] . The aim of the study reported here was to define the clinical characteristics, microbiological aetiology, outcomes and independent risk factors for mortality in a large, contemporary cohort of patients with severe CAP admitted to ICUs across Europe. The British Thoracic Society Research Committee and The Public HealthLaboratory Service: The aetiology, management and outcome of severe community-acquired pneumonia on the intensive care unit A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit

title:
  Patients with community acquired pneumonia admitted to European intensive care units: an epidemiological survey of the GenOSept cohort

abstract:
  INTRODUCTION: Community acquired pneumonia (CAP) is the most common infectious reason for admission to the Intensive Care Unit (ICU). The GenOSept study was designed to determine genetic influences on sepsis outcome. Phenotypic data was recorded using a robust clinical database allowing a contemporary analysis of the clinical characteristics, microbiology, outcomes and independent risk factors in patients with severe CAP admitted to ICUs across Europe. METHODS: Kaplan-Meier analysis was used to determine mortality rates. A Cox Proportional Hazards (PH) model was used to identify variables independently associated with 28-day and six-month mortality. RESULTS: Data from 1166 patients admitted to 102 centres across 17 countries was extracted. Median age was 64 years, 62% were male. Mortality rate at 28 days was 17%, rising to 27% at six months. Streptococcus pneumoniae was the commonest organism isolated (28% of cases) with no organism identified in 36%. Independent risk factors associated with an increased risk of death at six months included APACHE II score (hazard ratio, HR, 1.03; confidence interval, CI, 1.01-1.05), bilateral pulmonary infiltrates (HR1.44; CI 1.11-1.87) and ventilator support (HR 3.04; CI 1.64-5.62). Haematocrit, pH and urine volume on day one were all associated with a worse outcome. CONCLUSIONS: The mortality rate in patients with severe CAP admitted to European ICUs was 27% at six months. Streptococcus pneumoniae was the commonest organism isolated. In many cases the infecting organism was not identified. Ventilator support, the presence of diffuse pulmonary infiltrates, lower haematocrit, urine volume and pH on admission were independent predictors of a worse outcome.


id: cord-001473-aki28lhp
title: Silencing airway epithelial cell-derived hepcidin exacerbates sepsis-induced acute lung injury
author: Chen, Qi Xing
date: 2014-08-06
txt: ./txt/cord-001473-aki28lhp.txt
cache: ./cache/cord-001473-aki28lhp.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243715/
doi: 10.1186/s13054-014-0470-8
summary:
  The knockdown of airway epithelial cell-derived hepcidin aggravated the polymicrobial sepsis-induced lung injury and pulmonary bacterial infection and increased mortality (53.33% in Ad-shHepc1-treated mice versus 12.5% in Ad-shNeg-treated mice, P <0.05). The severe lung injury in the airway epithelial cell-derived hepcidin knockdown mice is at least partially related to the altered intracellular iron level and function of alveolar macrophages. These results demonstrated that in the current study the intratracheal administration of Ad-shHepc1 only silenced the hepcidin gene transcription in AECs, which was in accordance with previous studies that adenovirus-mediated intratracheal gene delivery specifically inhibited targeted gene expression in lung epithelial cells but not in alveolar macrophages and other organs [29, 30] . The current study explored the role of AEC-derived hepcidin in polymicrobial sepsis-induced ALI, which is at least partially related to the altered intracellular iron level and function of alveolar macrophages.

abstract:
  INTRODUCTION: The production of antimicrobial peptides by airway epithelial cells is an important component of the innate immune response to pulmonary infection and inflammation. Hepcidin is a β-defensin-like antimicrobial peptide and acts as a principal iron regulatory hormone. Hepcidin is mostly produced by hepatocytes, but is also expressed by other cells, such as airway epithelial cells. However, nothing is known about its function in lung infections and inflammatory diseases. We therefore sought to investigate the role of airway epithelial cell-derived hepcidin in sepsis-induced acute lung injury. METHODS: Acute lung injury was induced by polymicrobial sepsis via cecal ligation and puncture (CLP) surgery. Adenovirus-mediated short hairpin RNA specific for the mouse hepcidin gene hepc1 and control adenovirus were intratracheally injected into mice. The adenovirus-mediated knockdown of hepcidin in airway epithelial cells was evaluated in vivo. Lung injury and the seven-day survival rate were assessed. The levels of hepcidin-related iron export protein ferroportin were measured, and the iron content and function of alveolar macrophages were evaluated. RESULTS: The hepcidin level in airway epithelial cells was upregulated during polymicrobial sepsis. The knockdown of airway epithelial cell-derived hepcidin aggravated the polymicrobial sepsis-induced lung injury and pulmonary bacterial infection and increased mortality (53.33% in Ad-shHepc1-treated mice versus 12.5% in Ad-shNeg-treated mice, P <0.05). The knockdown of hepcidin in airway epithelial cells also led to reduced ferroportin degradation and a low intracellular iron content in alveolar macrophages. Moreover, alveolar macrophages form the airway epithelial cell-derived hepcidin knockdown mice showed impaired phagocytic ability than those from the control mice. CONCLUSIONS: Airway epithelial cell-derived hepcidin plays an important role in CLP-induced acute lung injury. The severe lung injury in the airway epithelial cell-derived hepcidin knockdown mice is at least partially related to the altered intracellular iron level and function of alveolar macrophages.


id: cord-001536-ta1i0ata
title: Year in review 2013: critical care - respiratory infections
author: Nair, Girish B
date: 2014-10-29
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4330923/
doi: 10.1186/s13054-014-0572-3
abstract:
  Infectious complications, particularly in the respiratory tract of critically ill patients, are related to increased mortality. Severe infection is part of a multiple system illness and female patients with severe sepsis have a worse prognosis compared to males. Kallistatin is a protective hormokine released during monocyte activation and low levels in the setting of septic shock can predict adverse outcomes. Presepsin is another biomarker that was recently evaluated and is elevated in patients with severe sepsis patients at risk of dying. The Centers for Disease Control and Prevention has introduced new definitions for identifying patients at risk of ventilator-associated complications (VACs), but several other conditions, such as pulmonary edema and acute respiratory distress syndrome, may cause VACs, and not all patients with VACs may have ventilator-associated pneumonia. New studies have suggested strategies to identify patients at risk for resistant pathogen infection and therapies that optimize efficacy, without the overuse of broad-spectrum therapy in patients with healthcare-associated pneumonia. Innovative strategies using optimized dosing of antimicrobials, maximizing the pharmacokinetic and pharmacodynamic properties of drugs in critically ill patients, and newer routes of drug delivery are being explored to combat drug-resistant pathogens. We summarize the major clinical studies on respiratory infections in critically ill patients published in 2013.


id: cord-001661-dj9bxhwb
author: Kao, Kuo-Chin
date: 2015-05-15
txt: ./txt/cord-001661-dj9bxhwb.txt
cache: ./cache/cord-001661-dj9bxhwb.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449559/
doi: 10.1186/s13054-015-0949-y
summary:
  title: Diffuse alveolar damage associated mortality in selected acute respiratory distress syndrome patients with open lung biopsy INTRODUCTION: Diffuse alveolar damage (DAD) is the pathological hallmark of acute respiratory distress syndrome (ARDS), however, the presence of DAD in the clinical criteria of ARDS patients by Berlin definition is little known. A pathological finding of DAD in ARDS patients is associated with hospital mortality and there are no clinical characteristics that could identify DAD patients before open lung biopsy. The following data were collected from the hospital chart of each patient and analyzed: age, sex, underlying diseases, acute physiology and chronic health evaluation (APACHE) II score on the day of ICU admission [28] , sequential organ failure assessment (SOFA) score on the day of ICU admission and the day of open lung biopsy [29] , lung injury score (LIS) [30] , PaO 2 /FiO 2 ratio, PEEP, tidal volume, diagnostic procedures before open lung biopsy (HRCT or BAL), complications related to surgery (i.e., postoperative air leak, pneumothorax, subcutaneous emphysema, bleeding, and wound infection), pathological diagnosis, hospital mortality, and therapeutic alterations.

title:
  Diffuse alveolar damage associated mortality in selected acute respiratory distress syndrome patients with open lung biopsy

abstract:
  INTRODUCTION: Diffuse alveolar damage (DAD) is the pathological hallmark of acute respiratory distress syndrome (ARDS), however, the presence of DAD in the clinical criteria of ARDS patients by Berlin definition is little known. This study is designed to investigate the role of DAD in ARDS patients who underwent open lung biopsy. METHODS: We retrospectively reviewed all ARDS patients who met the Berlin definition and underwent open lung biopsy from January 1999 to January 2014 in a referred medical center. DAD is characterized by hyaline membrane formation, lung edema, inflammation, hemorrhage and alveolar epithelial cell injury. Clinical data including baseline characteristics, severity of ARDS, clinical and pathological diagnoses, and survival outcomes were analyzed. RESULTS: A total of 1838 patients with ARDS were identified and open lung biopsies were performed on 101 patients (5.5 %) during the study period. Of these 101 patients, the severity of ARDS on diagnosis was mild of 16.8 %, moderate of 56.5 % and severe of 26.7 %. The hospital mortality rate was not significant difference between the three groups (64.7 % vs 61.4 % vs 55.6 %, p = 0.81). Of the 101 clinical ARDS patients with open lung biopsies, 56.4 % (57/101) patients had DAD according to biopsy results. The proportion of DAD were 76.5 % (13/17) in mild, 56.1 % (32/57) in moderate and 44.4 % (12/27) in severe ARDS and there is no significant difference between the three groups (p = 0.113). Pathological findings of DAD patients had a higher hospital mortality rate than non-DAD patients (71.9 % vs 45.5 %, p = 0.007). Pathological findings of DAD (odds ratio: 3.554, 95 % CI, 1.385–9.12; p = 0.008) and Sequential Organ Failure Assessment score on the biopsy day (odds ratio: 1.424, 95 % CI, 1.187–1.707; p<0.001) were significantly and independently associated with hospital mortality. The baseline demographics and clinical characteristics were not significantly different between DAD and non-DAD patients. CONCLUSIONS: The correlation of pathological findings of DAD and ARDS diagnosed by Berlin definition is modest. A pathological finding of DAD in ARDS patients is associated with hospital mortality and there are no clinical characteristics that could identify DAD patients before open lung biopsy.


id: cord-001894-ptuelrqj
title: Polymicrobial intensive care unit-acquired pneumonia: prevalence, microbiology and outcome
author: Ferrer, Miquel
date: 2015-12-23
txt: ./txt/cord-001894-ptuelrqj.txt
cache: ./cache/cord-001894-ptuelrqj.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699341/
doi: 10.1186/s13054-015-1165-5
summary:
  Intensive care unit (ICU)-acquired pneumonia (ICUAP) is the leading infection in critically-ill patients, accounting for prolonged mechanical ventilation and length of stay, and poor outcome [1] [2] [3] [4] . Recent investigations have shown that multi-drug-resistant (MDR) or high-risk pathogens have been isolated in around half of patients with an episode of ventilator-associated pneumonia (VAP) or ICUAP confirmed microbiologically [9, 10] . The association between polymicrobial or monomicrobial etiology and patients'' outcomes was adjusted for variables potentially related to mortality, such as age, APACHE-II and SAPS scores at ICU admission, SOFA score, CPIS and arterial partial pressure of oxygen/inspired oxygen fraction (PaO 2 /FiO 2 ) ratio at onset of pneumonia, VAP or NV-ICUAP, and unilateral or bilateral chest x-ray infiltrates.

abstract:
  BACKGROUND: Microbial aetiology of intensive care unit (ICU)-acquired pneumonia (ICUAP) determines antibiotic treatment and outcomes. The impact of polymicrobial ICUAP is not extensively known. We therefore investigated the characteristics and outcomes of polymicrobial aetiology of ICUAP. METHOD: Patients with ICUAP confirmed microbiologically were prospectively compared according to identification of 1 (monomicrobial) or more (polymicrobial) potentially-pathogenic microorganisms. Microbes usually considered as non-pathogenic were not considered for the etiologic diagnosis. We assessed clinical characteristics, microbiology, inflammatory biomarkers and outcome variables. RESULTS: Among 441 consecutive patients with ICUAP, 256 (58 %) had microbiologic confirmation, and 41 (16 %) of them polymicrobial pneumonia. Methicillin-sensitive Staphylococcus aureus, Haemophilus influenzae, and several Enterobacteriaceae were more frequent in polymicrobial pneumonia. Multi-drug and extensive-drug resistance was similarly frequent in both groups. Compared with monomicrobial, patients with polymicrobial pneumonia had less frequently chronic heart disease (6, 15 % vs. 71, 33 %, p = 0.019), and more frequently pleural effusion (18, 50 %, vs. 54, 25 %, p = 0.008), without any other significant difference. Appropriate empiric antimicrobial treatment was similarly frequent in the monomicrobial (185, 86 %) and the polymicrobial group (39, 95 %), as were the initial response to the empiric treatment, length of stay and mortality. Systemic inflammatory response was similar comparing monomicrobial with polymicrobial ICUAP. CONCLUSION: The aetiology of ICUAP confirmed microbiologically was polymicrobial in 16 % cases. Pleural effusion and absence of chronic heart disease are associated with polymicrobial pneumonia. When empiric treatment is frequently appropriate, polymicrobial aetiology does not influence the outcome of ICUAP.


id: cord-002240-38aabxh1
title: New aspects in the management of pneumonia
author: Prina, Elena
date: 2016-10-01
txt: ./txt/cord-002240-38aabxh1.txt
cache: ./cache/cord-002240-38aabxh1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045574/
doi: 10.1186/s13054-016-1442-y
summary:
  The administration of intravenous immunoglobulins seems to reinforce the immune response to the infection in particular in patients with inadequate levels of antibodies and when an enriched IgM preparation has been used; however, more studies are needed to determinate their impact on outcome and to define the population that will receive more benefit. Despite the use of early and appropriate antibiotic treatment, mortality related to community-acquired pneumonia (CAP) is still high [1] , especially in patients with severe disease. In contrast, another meta-analysis [25] demonstrated a reduction in all causes of mortality in patients receiving corticosteroids (12 trials, 1974 In conclusion, all these studies confirm that the use of corticosteroids in CAP is associated with the following benefits: reduced length of hospital stay, reduced time to clinical stability, and prevention of ARDS. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial

abstract:
  Despite improvements in the management of community-acquired pneumonia (CAP), morbidity and mortality are still high, especially in patients with more severe disease. Early and appropriate antibiotics remain the cornerstone in the treatment of CAP. However, two aspects seem to contribute to a worse outcome: an uncontrolled inflammatory reaction and an inadequate immune response. Adjuvant treatments, such as corticosteroids and intravenous immunoglobulins, have been proposed to counterbalance these effects. The use of corticosteroids in patients with severe CAP and a strong inflammatory reaction can reduce the time to clinical stability, the risk of treatment failure, and the risk of progression to acute respiratory distress syndrome. The administration of intravenous immunoglobulins seems to reinforce the immune response to the infection in particular in patients with inadequate levels of antibodies and when an enriched IgM preparation has been used; however, more studies are needed to determinate their impact on outcome and to define the population that will receive more benefit.


id: cord-003307-snruk3j2
author: Schmidt, Julius J.
date: 2018-11-19
txt: ./txt/cord-003307-snruk3j2.txt
cache: ./cache/cord-003307-snruk3j2.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245758/
doi: 10.1186/s13054-018-2221-8
summary:
  BACKGROUND: Despite modern intensive care with standardized strategies against acute respiratory distress syndrome (ARDS), Pneumocystis pneumonia (PcP) remains a life-threatening disease with a high mortality rate. Based on the high burden of PcP and the likelihood of unfavorable outcome particularly in non-HIV-positive patients, chemoprophylaxis with trimethoprim-sulfame thoxazole (TMP-SMX) is recommended in high-risk populations [13] . We here report comprehensive epidemiological, clinical, laboratory, therapeutic and outcome data on 240 cases of PcP, including a high percentage of non-HIV-positive patients, in a tertiary care center over the last 17 years. For every patient, clinical data on demographic characteristics, underlying disease, status of immune competence, treatment regimens of immunosuppression, PcP therapy regimen and mortality, were gathered in the study database. Outcomes and prognostic factors of non-HIV patients with pneumocystis jirovecii pneumonia and pulmonary CMV co-infection: a retrospective cohort study

title:
  Clinical course, treatment and outcome of Pneumocystis pneumonia in immunocompromised adults: a retrospective analysis over 17 years

abstract:
  BACKGROUND: Despite modern intensive care with standardized strategies against acute respiratory distress syndrome (ARDS), Pneumocystis pneumonia (PcP) remains a life-threatening disease with a high mortality rate. Here, we analyzed a large mixed cohort of immunocompromised patients with PcP, with regard to clinical course and treatment, and aimed at identifying predictors of outcome. METHODS: This was a single-center retrospective analysis in a tertiary care institution across 17 years. Diagnosis of PcP required typical clinical features and microbiological confirmation of Pneumocystis jirovecii. Epidemiological, clinical, laboratory and outcome data were collected from patient records. RESULTS: A total of 52,364 specimens from 7504 patients were sent for microbiological assessment (3653 with clinical suspicion of Pneumocystis pneumonia). PcP was confirmed in 240 patients, about half of them HIV positive (52%). The remaining subjects were either solid organ transplant recipients (16.3%) or suffered from malignancy (15.8%) or autoimmune diseases (11.7%). Of note, 95% of patients with PcP were not receiving chemoprophylaxis. Overall in-hospital mortality was 25.4%, increasing to 58% if ICU admission was required. Multivariable regression identified lactate dehydrogenase (LDH) as predictor of in-hospital mortality (adjusted OR 1.17 (95% CI 1.09–1.27), p < 0.0001). Mortality in LDH quartiles increased from 8% to 49%, and a cutoff value of 495 U/L predicted mortality with sensitivity and specificity of 70%. With regard to treatment, 40% of patients received trimethoprim-sulfamethoxazole at doses that were lower than recommended, and these patients had a higher mortality risk (HR 1.80 (95% CI 1.10–3.44), p = 0.02). CONCLUSIONS: PcP remains a life-threatening disease among immunocompromised patients. About half of patients with PcP do not have HIV infection. Initial LDH values might serve as a stratifying tool to identify those patients at high risk of death among patients with HIV and without HIV infection. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-018-2221-8) contains supplementary material, which is available to authorized users.


id: cord-003376-2qi4aibx
author: van de Groep, Kirsten
date: 2018-12-18
txt: ./txt/cord-003376-2qi4aibx.txt
cache: ./cache/cord-003376-2qi4aibx.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299562/
doi: 10.1186/s13054-018-2261-0
summary:
  title: Effect of cytomegalovirus reactivation on the time course of systemic host response biomarkers in previously immunocompetent critically ill patients with sepsis: a matched cohort study Cytomegalovirus (CMV) reactivation is observed in 14-41% of intensive care unit (ICU) patients without known prior immune deficiency [1] [2] [3] and is associated with increased morbidity and mortality [4] [5] [6] . Therefore, this longitudinal study aimed to investigate whether the temporal course of seven host response biomarkers, including both pro-and anti-inflammatory cytokines, in previously immunocompetent ICU patients with sepsis differs between patients with and without CMV reactivation. Time trends of various markers within patients were described by symmetric percentage differences relative to their levels 2 days prior to CMV viremia onset (Fig. 2 for primary comparison, Additional file 1: Figure S1 for secondary comparison). We performed an explorative study to compare time trends of host response biomarkers in patients with reactivation that were matched to non-reactivating control patients who were either seropositive or seronegative for CMV.

title:
  Effect of cytomegalovirus reactivation on the time course of systemic host response biomarkers in previously immunocompetent critically ill patients with sepsis: a matched cohort study

abstract:
  BACKGROUND: Cytomegalovirus (CMV) reactivation in previously immunocompetent critically ill patients is associated with increased mortality, which has been hypothesized to result from virus-induced immunomodulation. Therefore, we studied the effects of CMV reactivation on the temporal course of host response biomarkers in patients with sepsis. METHODS: In this matched cohort study, each sepsis patient developing CMV reactivation between day 3 and 17 (CMV+) was compared with one CMV seropositive patient without reactivation (CMVs+) and one CMV seronegative patient (CMVs−). CMV serostatus and plasma loads were determined by enzyme-linked immunoassays and real-time polymerase chain reaction, respectively. Systemic interleukin-6 (IL-6), IL-8, IL-18, interferon-gamma–induced protein-10 (IP-10), neutrophilic elastase, IL-1 receptor antagonist (RA), and IL-10 were measured at five time points by multiplex immunoassay. The effects of CMV reactivation on sequential concentrations of these biomarkers were assessed in multivariable mixed models. RESULTS: Among 64 CMV+ patients, 45 could be matched to CMVs+ or CMVs− controls or both. The two baseline characteristics and host response biomarker levels at viremia onset were similar between groups. CMV+ patients had increased IP-10 on day 7 after viremia onset (symmetric percentage difference +44% versus −15% when compared with CMVs+ and +37% versus +4% when compared with CMVs−) and decreased IL-1RA (−41% versus 0% and −49% versus +10%, respectively). However, multivariable analyses did not show an independent association between CMV reactivation and time trends of IL-6, IP-10, IL-10, or IL-1RA. CONCLUSION: CMV reactivation was not independently associated with changes in the temporal trends of host response biomarkers in comparison with non-reactivating patients. Therefore, these markers should not be used as surrogate clinical endpoints for interventional studies evaluating anti-CMV therapy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-018-2261-0) contains supplementary material, which is available to authorized users.


id: cord-003416-c22kw6f4
author: Baek, Moon Seong
date: 2019-01-03
txt: ./txt/cord-003416-c22kw6f4.txt
cache: ./cache/cord-003416-c22kw6f4.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318967/
doi: 10.1186/s13054-018-2293-5
summary:
  title: Improvement in the survival rates of extracorporeal membrane oxygenation-supported respiratory failure patients: a multicenter retrospective study in Korean patients Recently, the EOLIA trial reported that in patients with severe acute respiratory distress syndrome (ARDS) there was no significant difference in 60-day mortality between patients who received early ECMO and those who received conventional mechanical ventilation that included ECMO as rescue therapy [6] . Factors associated with mortality in patients supported with ECMO Multiple regression analysis was performed using age, sex, year, APACHE II score, SOFA score, immunocompromised status, CNS dysfunction, corticosteroid, CRRT, prone positioning, nitric oxide, neuromuscular blocker, 1.031, 1.114) ), and prolonged ECMO duration (OR 1.020 (95% CI 1.003, 1.038)) were associated with increased odds of mortality ( Table 4 ). This multicenter study was conducted to evaluate the change in survival rates of patients who received ECMO support for acute respiratory failure in Korea.

title:
  Improvement in the survival rates of extracorporeal membrane oxygenation-supported respiratory failure patients: a multicenter retrospective study in Korean patients

abstract:
  BACKGROUND: Although the utilization of extracorporeal membrane oxygenation (ECMO) is increasing and its technology is evolving, only a few epidemiologic reports have described the uses and outcomes of ECMO. The aim of this study was to investigate the changes in utilization and survival rate in patients supported with ECMO for severe respiratory failure in Korea. METHODS: This was a multicenter study on consecutive patients who underwent ECMO across 16 hospitals in Korea. The records of all patients who required ECMO for acute respiratory failure between 2012 and 2015 were retrospectively reviewed, and the utilization of ECMO was analyzed over time. RESULTS: During the study period, 5552 patients received ECMO in Korea as a whole, and a total of 2472 patients received ECMO at the participating 16 hospitals. We analyzed 487 (19.7%) patients who received ECMO for respiratory failure. The number of ECMO procedures provided for respiratory failure increased from 104 to 153 during the study period. The in-hospital survival rate increased from 30.8% to 35.9%. The use of prone positioning increased from 6.8% to 49.0% (p < 0.001), and the use of neuromuscular blockers also increased from 28.2% to 58.2% (p < 0.001). Multiple regression analysis showed that old age (OR 1.038 (95% CI 1.022, 1.054)), use of corticosteroid (OR 2.251 (95% CI 1.153, 4.397)), continuous renal replacement therapy (OR 2.196 (95% CI 1.135, 4.247)), driving pressure (OR 1.072 (95% CI 1.031, 1.114)), and prolonged ECMO duration (OR 1.020 (95% CI 1.003, 1.038)) were associated with increased odds of mortality. CONCLUSIONS: Utilization of ECMO and survival rates of patients who received ECMO for respiratory failure increased over time in Korea. The use of pre-ECMO prone positioning and neuromuscular blockers also increased during the same period.


id: cord-003513-hmdikgf5
title: Multidrug Resistant Gram-Negative Bacteria in Community-Acquired Pneumonia
author: Cillóniz, Catia
date: 2019-03-09
txt: ./txt/cord-003513-hmdikgf5.txt
cache: ./cache/cord-003513-hmdikgf5.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408800/
doi: 10.1186/s13054-019-2371-3
summary:
  Risk stratification should take into account the local ecology (prevalence of the pathogen in a specific area) and the patient''s risk factors, especially in cases of severe CAP that are associated with higher mortality rates (20-50%) [1] . baumannii causing CAP, the authors reported that 30% of the isolates were resistant to the majority of the antibiotics; the resistant rates to imipenem and meropenem were 19 and 9%, respectively. baumannii is not a frequent cause of CAP, the capacity to rapidly develop resistance mechanisms to antibiotics and the fulminant clinical presentation (with a mortality rate around 50%) make this pathogen an important health problem, especially in tropical and subtropical areas. Burden and risk factors for pseudomonas aeruginosa community-acquired pneumonia: a multinational point prevalence study of hospitalised patients Risk factors associated with potentially antibiotic-resistant pathogens in community-acquired pneumonia Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia

abstract:
  This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2019. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2019. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.


id: cord-003532-lcgeingz
author: nan
date: 2019-03-19
txt: ./txt/cord-003532-lcgeingz.txt
cache: ./cache/cord-003532-lcgeingz.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423782/
doi: 10.1186/s13054-019-2358-0
abstract: nan
summary:
  It''s proposed to evaluate the association between myocardial injury biomarkers, high-sensitive troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-ProBNP), with inflammatory mediators (IL-6, IL-1Β , IL-8, IL-10, IL-12 / IL-23p40, IL17A, IL-21 and TNF-α ) and biomarkers, C protein reactive (CPR) and procalcitonin (PCT), in septic patients Methods: This was a prospective cohort study performed in three intensive care units, from September 2007 to September 2010 enrolling patients with sepsis (infection associated with organ dysfunction), and septic shock (hypotension refractory by fluids infusion requiring vasopressor). Blood samples were collected up to 48h after the development of first organ dysfunction (D0) and on the 7th day after inclusion in the study (D7) Results: Ninety-five patients were enrolled, with median age 64 years (interquatile?48-78), APACHE II: median 19 (14-22), SOFA: median 8 (5-10); 24.2% were admitted in ICU with sepsis and 75.8% with septic shock.

title:
  39th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium, 19-22 March 2019


id: cord-003701-i70ztypg
title: Influenza virus-related critical illness: prevention, diagnosis, treatment
author: Chow, Eric J.
date: 2019-06-12
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563376/
doi: 10.1186/s13054-019-2491-9
abstract:
  Annual seasonal influenza epidemics of variable severity result in significant morbidity and mortality in the United States (U.S.) and worldwide. In temperate climate countries, including the U.S., influenza activity peaks during the winter months. Annual influenza vaccination is recommended for all persons in the U.S. aged 6 months and older, and among those at increased risk for influenza-related complications in other parts of the world (e.g. young children, elderly). Observational studies have reported effectiveness of influenza vaccination to reduce the risks of severe disease requiring hospitalization, intensive care unit admission, and death. A diagnosis of influenza should be considered in critically ill patients admitted with complications such as exacerbation of underlying chronic comorbidities, community-acquired pneumonia, and respiratory failure during influenza season. Molecular tests are recommended for influenza testing of respiratory specimens in hospitalized patients. Antigen detection assays are not recommended in critically ill patients because of lower sensitivity; negative results of these tests should not be used to make clinical decisions, and respiratory specimens should be tested for influenza by molecular assays. Because critically ill patients with lower respiratory tract disease may have cleared influenza virus in the upper respiratory tract, but have prolonged influenza viral replication in the lower respiratory tract, an endotracheal aspirate (preferentially) or bronchoalveolar lavage fluid specimen (if collected for other diagnostic purposes) should be tested by molecular assay for detection of influenza viruses. Observational studies have reported that antiviral treatment of critically ill adult influenza patients with a neuraminidase inhibitor is associated with survival benefit. Since earlier initiation of antiviral treatment is associated with the greatest clinical benefit, standard-dose oseltamivir (75 mg twice daily in adults) for enteric administration is recommended as soon as possible as it is well absorbed in critically ill patients. Based upon observational data that suggest harms, adjunctive corticosteroid treatment is currently not recommended for children or adults hospitalized with influenza, including critically ill patients, unless clinically indicated for another reason, such as treatment of asthma or COPD exacerbation, or septic shock. A number of pharmaceutical agents are in development for treatment of severe influenza.


id: cord-003832-q1422ydi
author: Koyama, Kansuke
date: 2019-08-19
txt: ./txt/cord-003832-q1422ydi.txt
cache: ./cache/cord-003832-q1422ydi.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699073/
doi: 10.1186/s13054-019-2559-6
summary:
  title: Biomarker profiles of coagulopathy and alveolar epithelial injury in acute respiratory distress syndrome with idiopathic/immune-related disease or common direct risk factors This study aimed to investigate the biomarker profiles of coagulopathy and alveolar epithelial injury in two subtypes of ARDS: patients with direct common risk factors (dARDS) and those with idiopathic or immune-related diseases (iARDS), which are classified as "ARDS without common risk factors" based on the Berlin definition. Although no risk factors or causes are identified in this subgroup of ARDS, recent studies have shown that many patients with idiopathic interstitial pneumonia have clinical features that suggest an underlying immune process, indicating that the pathobiology of idiopathic and immunerelated diseases may partially overlap [9, 10] . The aim of this study was to examine the profiles of the plasma biomarkers that reflect coagulopathy and alveolar epithelial injury in patients with idiopathic/immune-related ARDS (iARDS) and in those with common direct risk factors (dARDS).

title:
  Biomarker profiles of coagulopathy and alveolar epithelial injury in acute respiratory distress syndrome with idiopathic/immune-related disease or common direct risk factors

abstract:
  BACKGROUND: Altered coagulation and alveolar injury are the hallmarks of acute respiratory distress syndrome (ARDS). However, whether the biomarkers that reflect pathophysiology differ depending on the etiology of ARDS has not been examined. This study aimed to investigate the biomarker profiles of coagulopathy and alveolar epithelial injury in two subtypes of ARDS: patients with direct common risk factors (dARDS) and those with idiopathic or immune-related diseases (iARDS), which are classified as “ARDS without common risk factors” based on the Berlin definition. METHODS: This retrospective, observational study included adult patients who were admitted to the intensive care unit (ICU) at a university hospital with a diagnosis of ARDS with no indirect risk factors. Plasma biomarkers (thrombin–antithrombin complex [TAT], plasminogen activator inhibitor [PAI]-1, protein C [PC] activity, procalcitonin [PCT], surfactant protein [SP]-D, and KL-6) were routinely measured during the first 5 days of the patient’s ICU stay. RESULTS: Among 138 eligible patients with ARDS, 51 were excluded based on the exclusion criteria (n = 41) or other causes of ARDS (n = 10). Of the remaining 87 patients, 56 were identified as having dARDS and 31 as having iARDS. Among the iARDS patients, TAT (marker of thrombin generation) and PAI-1 (marker of inhibited fibrinolysis) were increased, and PC activity was above normal. In contrast, PC activity was significantly decreased, and TAT or PAI-1 was present at much higher levels in dARDS compared with iARDS patients. Significant differences were also observed in PCT, SP-D, and KL-6 between patients with dARDS and iARDS. The receiver operating characteristic (ROC) analysis showed that areas under the ROC curve for PC activity, PAI-1, PCT, SP-D, and KL-6 were similarly high for distinguishing between dARDS and iARDS (PC 0.86, P = 0.33; PAI-1 0.89, P = 0.95; PCT 0.89, P = 0.66; and SP-D 0.88, P = 0.16 vs. KL-6 0.90, respectively). CONCLUSIONS: Coagulopathy and alveolar epithelial injury were observed in both patients with dARDS and with iARDS. However, their biomarker profiles were significantly different between the two groups. The different patterns of PAI-1, PC activity, SP-D, and KL-6 may help in differentiating between these ARDS subtypes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-019-2559-6) contains supplementary material, which is available to authorized users.


id: cord-003870-hr99dwi7
title: Host susceptibility to severe influenza A virus infection
author: Clohisey, Sara
date: 2019-09-05
txt: ./txt/cord-003870-hr99dwi7.txt
cache: ./cache/cord-003870-hr99dwi7.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6729070/
doi: 10.1186/s13054-019-2566-7
summary:
  Some demographic factors (pregnancy, obesity, and advanced age) appear to confer a more specific susceptibility to severe illness following infection with influenza viruses. Factors predicted to confer more specific susceptibility to influenza are placed higher in the diagram independently associated with severe disease from either seasonal or pandemic IAV [24] . Susceptibility to severe H1N1 infection was analysed in a recent genome-wide study (integrated with data on genetic variants associated with altered gene expression) which implicated an intronic SNP of GLDC, rs1755609-G [80] . Susceptible hosts may have impaired intracellular controls of viral replication (e.g. IFITM3, TMPRS22 variants), defective interferon responses (e.g. GLDC, IRF7/9 variants), or defects in cell-mediated immunity with increased baseline levels of systemic inflammation (obesity, pregnancy, advanced age). Susceptible hosts may have impaired intracellular controls of viral replication (e.g. IFITM3, TMPRS22 variants), defective interferon responses (e.g. GLDC, IRF7/9 variants), or defects in cell-mediated immunity with increased baseline levels of systemic inflammation (obesity, pregnancy, advanced age).

abstract:
  Most people exposed to a new flu virus do not notice any symptoms. A small minority develops critical illness. Some of this extremely broad variation in susceptibility is explained by the size of the initial inoculum or the influenza exposure history of the individual; some is explained by generic host factors, such as frailty, that decrease resilience following any systemic insult. Some demographic factors (pregnancy, obesity, and advanced age) appear to confer a more specific susceptibility to severe illness following infection with influenza viruses. As with other infectious diseases, a substantial component of susceptibility is determined by host genetics. Several genetic susceptibility variants have now been reported with varying levels of evidence. Susceptible hosts may have impaired intracellular controls of viral replication (e.g. IFITM3, TMPRS22 variants), defective interferon responses (e.g. GLDC, IRF7/9 variants), or defects in cell-mediated immunity with increased baseline levels of systemic inflammation (obesity, pregnancy, advanced age). These mechanisms may explain the prolonged viral replication reported in critically ill patients with influenza: patients with life-threatening disease are, by definition, abnormal hosts. Understanding these molecular mechanisms of susceptibility may in the future enable the design of host-directed therapies to promote resilience.


id: cord-003995-53115c1c
author: Guerci, Philippe
date: 2019-11-21
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873544/
doi: 10.1186/s13054-019-2649-5
title:
  Outcomes of Stenotrophomonas maltophilia hospital-acquired pneumonia in intensive care unit: a nationwide retrospective study

abstract:
  BACKGROUND: There is little descriptive data on Stenotrophomonas maltophilia hospital-acquired pneumonia (HAP) in critically ill patients. The optimal modalities of antimicrobial therapy remain to be determined. Our objective was to describe the epidemiology and prognostic factors associated with S. maltophilia pneumonia, focusing on antimicrobial therapy. METHODS: This nationwide retrospective study included all patients admitted to 25 French mixed intensive care units between 2012 and 2017 with hospital-acquired S. maltophilia HAP during intensive care unit stay. Primary endpoint was time to in-hospital death. Secondary endpoints included microbiologic effectiveness and antimicrobial therapeutic modalities such as delay to appropriate antimicrobial treatment, mono versus combination therapy, and duration of antimicrobial therapy. RESULTS: Of the 282 patients included, 84% were intubated at S. maltophilia HAP diagnosis for duration of 11 [5–18] days. The Simplified Acute Physiology Score II was 47 [36–63], and the in-hospital mortality was 49.7%. Underlying chronic pulmonary comorbidities were present in 14.1% of cases. Empirical antimicrobial therapy was considered effective on S. maltophilia according to susceptibility patterns in only 30% of cases. Delay to appropriate antimicrobial treatment had, however, no significant impact on the primary endpoint. Survival analysis did not show any benefit from combination antimicrobial therapy (HR = 1.27, 95%CI [0.88; 1.83], p = 0.20) or prolonged antimicrobial therapy for more than 7 days (HR = 1.06, 95%CI [0.6; 1.86], p = 0.84). No differences were noted in in-hospital death irrespective of an appropriate and timely empiric antimicrobial therapy between mono- versus polymicrobial S. maltophilia HAP (p = 0.273). The duration of ventilation prior to S. maltophilia HAP diagnosis and ICU length of stay were shorter in patients with monomicrobial S. maltophilia HAP (p = 0.031 and p = 0.034 respectively). CONCLUSIONS: S. maltophilia HAP occurred in severe, long-stay intensive care patients who mainly required prolonged invasive ventilation. Empirical antimicrobial therapy was barely effective while antimicrobial treatment modalities had no significant impact on hospital survival. TRIAL REGISTRATION: clinicaltrials.gov, NCT03506191


id: cord-004096-obrq7q57
title: Brainstem dysfunction in critically ill patients
author: Benghanem, Sarah
date: 2020-01-06
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6945639/
doi: 10.1186/s13054-019-2718-9
abstract:
  The brainstem conveys sensory and motor inputs between the spinal cord and the brain, and contains nuclei of the cranial nerves. It controls the sleep-wake cycle and vital functions via the ascending reticular activating system and the autonomic nuclei, respectively. Brainstem dysfunction may lead to sensory and motor deficits, cranial nerve palsies, impairment of consciousness, dysautonomia, and respiratory failure. The brainstem is prone to various primary and secondary insults, resulting in acute or chronic dysfunction. Of particular importance for characterizing brainstem dysfunction and identifying the underlying etiology are a detailed clinical examination, MRI, neurophysiologic tests such as brainstem auditory evoked potentials, and an analysis of the cerebrospinal fluid. Detection of brainstem dysfunction is challenging but of utmost importance in comatose and deeply sedated patients both to guide therapy and to support outcome prediction. In the present review, we summarize the neuroanatomy, clinical syndromes, and diagnostic techniques of critical illness-associated brainstem dysfunction for the critical care setting.


id: cord-004147-9bcq3jnm
author: Fernando, Shannon M.
date: 2020-01-13
txt: ./txt/cord-004147-9bcq3jnm.txt
cache: ./cache/cord-004147-9bcq3jnm.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958729/
doi: 10.1186/s13054-020-2730-0
summary:
  title: New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults—a multicenter retrospective cohort study CONCLUSIONS: While NOAF was not associated with death or requiring discharge to long-term care among critically ill patients, it was associated with increased length of stay in ICU and increased total costs. We primarily sought to evaluate the association between NOAF and outcomes, resource utilization, and costs among critically ill adult patients. However, NOAF was associated with higher hospital mortality among ICU patients with suspected infection (aOR 1.21 [95% CI 1.08-1.37]), sepsis (aOR 1.24 [95% CI 1.10-1.39]), and septic shock (aOR 1.28 [95% CI 1.14-1.44]). Among patients with NOAF, factors associated with increased risk of hospital mortality included increasing age, increased MODS score, history of CHF (as identified in the Data Warehouse), and sustained AF (Additional file 5: Table S5 ).

title:
  New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults—a multicenter retrospective cohort study

abstract:
  BACKGROUND: New-onset atrial fibrillation (NOAF) is commonly encountered in critically ill adults. Evidence evaluating the association between NOAF and patient-important outcomes in this population is conflicting. Furthermore, little is known regarding the association between NOAF and resource use or hospital costs. METHODS: Retrospective analysis (2011–2016) of a prospectively collected registry from two Canadian hospitals of consecutive ICU patients aged ≥ 18 years. We excluded patients with a known history of AF prior to hospital admission. Any occurrence of atrial fibrillation (AF) was prospectively recorded by bedside nurses. The primary outcome was hospital mortality, and we used multivariable logistic regression to adjust for confounders. We used a generalized linear model to evaluate contributors to total cost. RESULTS: We included 15,014 patients, and 1541 (10.3%) had NOAF during their ICU admission. While NOAF was not associated with increased odds of hospital death among the entire cohort (adjusted odds ratio [aOR] 1.02 [95% confidence interval [CI] 0.97–1.08]), an interaction was noted between NOAF and sepsis, and the presence of both was associated with higher odds of hospital mortality (aOR 1.28 [95% CI 1.09–1.36]) than either alone. Patients with NOAF had higher total costs (cost ratio [CR] 1.09 [95% CI 1.02–1.20]). Among patients with NOAF, treatment with a rhythm-control strategy was associated with higher costs (CR 1.24 [95% CI 1.07–1.40]). CONCLUSIONS: While NOAF was not associated with death or requiring discharge to long-term care among critically ill patients, it was associated with increased length of stay in ICU and increased total costs.


id: cord-004263-m1ujhhsc
author: Koekkoek, W. A. C.
date: 2020-02-03
txt: ./txt/cord-004263-m1ujhhsc.txt
cache: ./cache/cord-004263-m1ujhhsc.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6998072/
doi: 10.1186/s13054-020-2744-7
summary:
  title: The effect of cisatracurium infusion on the energy expenditure of critically ill patients: an observational cohort study METHODS: We studied a cohort of adult critically ill patients requiring invasive mechanical ventilation and treatment with continuous infusion of cisatracurium for at least 12 h. CONCLUSIONS: Our data suggest that continuous infusion of cisatracurium in mechanically ventilated ICU patients is associated with a significant reduction in EE, although the magnitude of the effect is small. Our data suggest that continuous infusion of cisatracurium in mechanically ventilated ICU patients is associated with a significant reduction in EE as estimated by the VCO 2 method, although the magnitude of the effect is small. Validation of carbon dioxide production (VCO2) as a tool to calculate resting energy expenditure (REE) in mechanically ventilated critically ill patients: a retrospective observational study

title:
  The effect of cisatracurium infusion on the energy expenditure of critically ill patients: an observational cohort study

abstract:
  BACKGROUND: Both overfeeding and underfeeding of intensive care unit (ICU) patients are associated with worse outcomes. A reliable estimation of the energy expenditure (EE) of ICU patients may help to avoid these phenomena. Several factors that influence EE have been studied previously. However, the effect of neuromuscular blocking agents on EE, which conceptually would lower EE, has not been extensively investigated. METHODS: We studied a cohort of adult critically ill patients requiring invasive mechanical ventilation and treatment with continuous infusion of cisatracurium for at least 12 h. The study aimed to quantify the effect of cisatracurium infusion on EE (primary endpoint). EE was estimated based on ventilator-derived VCO(2) (EE in kcal/day = VCO(2) × 8.19). A subgroup analysis of septic and non-septic patients was performed. Furthermore, the effects of body temperature and sepsis on EE were evaluated. A secondary endpoint was hypercaloric feeding (> 110% of EE) after cisatracurium infusion. RESULTS: In total, 122 patients were included. Mean EE before cisatracurium infusion was 1974 kcal/day and 1888 kcal/day after cisatracurium infusion. Multivariable analysis showed a significantly lower EE after cisatracurium infusion (MD − 132.0 kcal (95% CI − 212.0 to − 52.0; p = 0.001) in all patients. This difference was statistically significant in both sepsis and non-sepsis patients (p = 0.036 and p = 0.011). Non-sepsis patients had lower EE than sepsis patients (MD − 120.6 kcal; 95% CI − 200.5 to − 40.8, p = 0.003). Body temperature and EE were positively correlated (Spearman’s rho = 0.486, p < 0.001). Hypercaloric feeding was observed in 7 patients. CONCLUSIONS: Our data suggest that continuous infusion of cisatracurium in mechanically ventilated ICU patients is associated with a significant reduction in EE, although the magnitude of the effect is small. Sepsis and higher body temperature are associated with increased EE. Cisatracurium infusion is associated with overfeeding in only a minority of patients and therefore, in most patients, no reductions in caloric prescription are necessary.


id: cord-004268-raayrjmd
author: Flattres, Aurelien
date: 2020-02-03
txt: ./txt/cord-004268-raayrjmd.txt
cache: ./cache/cord-004268-raayrjmd.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6998330/
doi: 10.1186/s13054-020-2745-6
summary:
  title: Real-time shear wave ultrasound elastography: a new tool for the evaluation of diaphragm and limb muscle stiffness in critically ill patients METHODS: Two operators tested in healthy controls and in critically ill patients the intraand inter-operator reliability of the SWE using transversal and longitudinal views of the diaphragm and limb muscles. We therefore designed the present study with the aim of determining the reliability and reproducibility of SWE measurements for limb muscles and the diaphragm in both healthy subjects and in critically ill patients. This study shows that intra-and inter-operator reliability of shear modulus evaluation, a parameter of muscle quality in limb muscles and the diaphragm in both healthy controls and in critically ill patients, is excellent. No study has ever been performed to evaluate shear modulus measurement feasibility and reliability in the critically ill population at high risk of muscle edema.

title:
  Real-time shear wave ultrasound elastography: a new tool for the evaluation of diaphragm and limb muscle stiffness in critically ill patients

abstract:
  BACKGROUND: Muscle weakness following critical illness is the consequence of loss of muscle mass and alteration of muscle quality. It is associated with long-term disability. Ultrasonography is a reliable tool to quantify muscle mass, but studies that evaluate muscle quality at the critically ill bedside are lacking. Shear wave ultrasound elastography (SWE) provides spatial representation of soft tissue stiffness and measures of muscle quality. The reliability and reproducibility of SWE in critically ill patients has never been evaluated. METHODS: Two operators tested in healthy controls and in critically ill patients the intra- and inter-operator reliability of the SWE using transversal and longitudinal views of the diaphragm and limb muscles. Reliability was calculated using the intra-class correlation coefficient and a bootstrap sampling method assessed their consistency. RESULTS: We collected 560 images. Longitudinal views of the diaphragm (ICC 0.83 [0.50–0.94]), the biceps brachii (ICC 0.88 [0.67–0.96]) and the rectus femoris (ICC 0.76 [0.34–0.91]) were the most reliable views in a training set of healthy controls. Intra-class correlation coefficient for inter-operator reproducibility and intra-operator reliability was above 0.9 for all muscles in a validation set of healthy controls. In critically ill patients, inter-operator reproducibility and intra-operator 1 and 2 reliability ICCs were respectively 0.92 [0.71–0.98], 0.93 [0.82–0.98] and 0.92 [0.81–0.98] for the diaphragm; 0.96 [0.86–0.99], 0.98 [0.94–0.99] and 0.99 [0.96–1] for the biceps brachii and 0.91 [0.51–0.98], 0.97 [0.93–0.99] and 0.99 [0.97–1] for the rectus femoris. The probability to reach intra-class correlation coefficient greater than 0.8 in a 10,000 bootstrap sampling for inter-operator reproducibility was respectively 81%, 84% and 78% for the diaphragm, the biceps brachii and the rectus femoris respectively. CONCLUSIONS: SWE is a reliable technique to evaluate limb muscles and the diaphragm in both healthy controls and in critically ill patients. TRIAL REGISTRATION: The study was registered (ClinicalTrial NCT03550222).


id: cord-004299-ydm6j046
author: Lu, Yifang
date: 2020-02-06
txt: ./txt/cord-004299-ydm6j046.txt
cache: ./cache/cord-004299-ydm6j046.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006403/
doi: 10.1186/s13054-020-2757-2
abstract: nan
summary:
  title: New-onset atrial fibrillation can be falsely associated with increased length of stay in ICU due to immortal time bias New-onset atrial fibrillation can be falsely associated with increased length of stay in ICU due to immortal time bias Yifang Lu 1 and Tenggao Chen 2* Dear editor, In a recent study published in Critical Care, Fernando SM and colleagues investigated the impact of new-onset atrial fibrillation (NOAF) on clinical outcomes in critically ill patients [1] . The authors would like to thank Drs. Lu and Chen for their comments on our recent article related to outcomes and costs associated with new-onset atrial fibrillation (NOAF) in critically ill adults [1] . Drs. Lu and Chen suggest caution in the interpretation of our study results, particularly as they relate to the length of stay and costs, due to the possibility of immortal time bias.

title:
  New-onset atrial fibrillation can be falsely associated with increased length of stay in ICU due to immortal time bias


id: cord-004327-ofqay81v
author: Wu, Tung-Ho
date: 2020-02-12
txt: ./txt/cord-004327-ofqay81v.txt
cache: ./cache/cord-004327-ofqay81v.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017455/
doi: 10.1186/s13054-020-2755-4
summary:
  We aimed to evaluate the effect of performing rib fixation with the addition of video-assisted thoracoscopic surgery (VATS) on patients with ARF caused by blunt thoracic injury with ventilator dependence. METHODS: This observational study prospectively enrolled patients with multiple bicortical rib fractures with hemothorax caused by severe blunt chest trauma. CONCLUSION: Rib fixation combined with VATS could shorten the length of ventilator use and reduce the pneumonia rate in patients with severe chest blunt injury with ARF. Factors that could affect the ventilator dependence-including consciousness levels, number of fractured ribs, percentage of flail chest, lung contusion scores, AISs, and ISSs-all exhibited no statistically significant differences. In this study, rib fixation with VATS in patients with such severe blunt chest trauma and ARF could greatly decrease the length of ventilator dependence. In contrast with other studies, we performed rib fixation combined with VATS to completely manage chest wall injury, lung laceration, and pleural collections.

title:
  Facilitating ventilator weaning through rib fixation combined with video-assisted thoracoscopic surgery in severe blunt chest injury with acute respiratory failure

abstract:
  BACKGROUND: Severe blunt chest injury sometimes induces acute respiratory failure (ARF), requiring ventilator use. We aimed to evaluate the effect of performing rib fixation with the addition of video-assisted thoracoscopic surgery (VATS) on patients with ARF caused by blunt thoracic injury with ventilator dependence. METHODS: This observational study prospectively enrolled patients with multiple bicortical rib fractures with hemothorax caused by severe blunt chest trauma. All patients received positive pressure mechanical ventilation within 24 h after trauma because of ARF. Some patients who received rib fixation with VATS were enrolled as group 1, and the others who received only VATS were designated as group 2. The length of ventilator use was the primary clinical outcome. Rates of pneumonia and length of hospital stay constituted secondary outcomes. RESULTS: A total of 61 patients were included in this study. The basic demographic characteristics between the two groups exhibited no statistical differences. All patients received operations within 6 days after trauma. The length of ventilator use was shorter in group 1 (3.19 ± 3.37 days vs. 8.05 ± 8.23, P = 0.002). The rate of pneumonia was higher in group 2 (38.1% vs. 75.0%, P = 0.005). The length of hospital stay was much shorter in group 1 (17.76 ± 8.38 days vs. 24.13 ± 9.80, P = 0.011). CONCLUSION: Rib fixation combined with VATS could shorten the length of ventilator use and reduce the pneumonia rate in patients with severe chest blunt injury with ARF. Therefore, this operation could shorten the overall length of hospital stay.


id: cord-004422-oep1grwq
author: Li, Yuting
date: 2020-02-26
txt: ./txt/cord-004422-oep1grwq.txt
cache: ./cache/cord-004422-oep1grwq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045460/
doi: 10.1186/s13054-020-2764-3
summary:
  title: Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis Thus, further research is needed to determine the best approach for SBTs. In this study, we conducted a meta-analysis, which extracted results from published randomized controlled trials (RCTs) to evaluate the effectiveness and safety of two strategies, a T-piece and PSV, for weaning adult patients with respiratory failure that required mechanical ventilation, measuring extubation success and other clinically important outcomes. The inclusion criteria were as follows: (1) randomized controlled trials; (2) adult patients (> 18 years) who underwent at least two different SBT methods; (3) all authors reported our primary outcome of successful extubation rate; (4) clearly comparing PS versus T-piece with clinically relevant secondary outcomes. The major finding of our study suggests that both spontaneous breathing using T-piece and PSV are suitable methods for successful extubation of patients with critical illness from mechanical ventilation.

title:
  Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis

abstract:
  BACKGROUND: The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain. A systematic review and meta-analysis was performed to clarify the preferable SBT (T-piece or pressure support ventilation [PSV]). METHODS: We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) from inception to the 31st of July 2019. We included RCTs involving adult patients (> 18 years) who underwent at least two different SBT methods. All authors reported our primary outcome of successful extubation rate and clearly compared PS versus T-piece with clinically relevant secondary outcomes (rate of reintubation, ICU and hospital length of stay, and ICU and hospital mortality). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI). RESULTS: Ten RCTs including 3165 patients were included. The results of this meta-analysis showed that there was no significant difference in the successful extubation rate between the T-piece group and PS group (odds ratio [OR] = 0.91; 95% CI, 0.78–1.07; P = 0.27; I(2) = 79%). In addition, compared with the PS group, the T-piece group showed no significant difference in the rate of reintubation (odds ratio [OR] = 0.99; 95% CI, 0.78–1.26; P = 0.95; I(2) = 5%), ICU mortality (odds ratio [OR] = 1.22; 95% CI, 0.83–1.80; P = 0.30; I(2) = 0%), hospital mortality (odds ratio [OR] = 1.36; 95% CI, 0.99–1.87; P = 0.06; I(2) = 19%), ICU length of stay (mean difference = − 0.10; 95% CI, − 0.59 to 0.39; P = 0.69; I(2) = 13%), and hospital length of stay (mean difference = − 0.82;95% CI, − 2.2 to 0.55; P = 0.24; I(2) = 0%). CONCLUSIONS: T-piece and PSV as SBTs are considered to have comparable predictive power of successful extubation in critically ill patients. The analysis of secondary outcomes also shows no significant difference in the rate of reintubation, ICU and hospital length of stay, and ICU and hospital mortality between the two groups. Further randomized controlled studies of SBTs are still required.


id: cord-004427-dy9v9asg
title: Impact of protocolized diuresis for de-resuscitation in the intensive care unit
author: Bissell, Brittany D.
date: 2020-02-28
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048112/
doi: 10.1186/s13054-020-2795-9
abstract:
  OBJECTIVE: Administration of diuretics has been shown to assist fluid management and improve clinical outcomes in the critically ill post-shock resolution. Current guidelines have not yet included standardization or guidance for diuretic-based de-resuscitation in critically ill patients. This study aimed to evaluate the impact of a multi-disciplinary protocol for diuresis-guided de-resuscitation in the critically ill. METHODS: This was a pre-post single-center pilot study within the medical intensive care unit (ICU) of a large academic medical center. Adult patients admitted to the Medical ICU receiving mechanical ventilation with either (1) clinical signs of volume overload via chest radiography or physical exam or (2) any cumulative fluid balance ≥ 0 mL since hospital admission were eligible for inclusion. Patients received diuresis per clinician discretion for a 2-year period (historical control) followed by a diuresis protocol for 1 year (intervention). Patients within the intervention group were matched in a 1:3 ratio with those from the historical cohort who met the study inclusion and exclusion criteria. RESULTS: A total of 364 patients were included, 91 in the protocol group and 273 receiving standard care. Protocolized diuresis was associated with a significant decrease in 72-h post-shock cumulative fluid balance [median, IQR − 2257 (− 5676–920) mL vs 265 (− 2283–3025) mL; p < 0.0001]. In-hospital mortality in the intervention group was lower compared to the historical group (5.5% vs 16.1%; p = 0.008) and higher ICU-free days (p = 0.03). However, no statistically significant difference was found in ventilator-free days, and increased rates of hypernatremia and hypokalemia were demonstrated. CONCLUSIONS: This study showed that a protocol for diuresis for de-resuscitation can significantly improve 72-h post-shock fluid balance with potential benefit on clinical outcomes.


id: cord-005495-0mi0n2zn
author: De Laet, Inneke E.
date: 2020-03-24
txt: ./txt/cord-005495-0mi0n2zn.txt
cache: ./cache/cord-005495-0mi0n2zn.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092484/
doi: 10.1186/s13054-020-2782-1
summary:
  Depending on the course of disease and concomitant organ dysfunction, some cases of ACS can be managed conservatively whereas some cases of IAH may require immediate aggressive treatment including fast decision to proceed to decompressive laparotomy before reaching the value of 20 mmHg of IAP. Despite this, the optimal treatment choice for a specific patient with IAH/ ACS should take into account three critical elements: (1) the measured IAP value (or the degree/magnitude of IAP increase); (2) organ dysfunction characteristics (or the impact of increased IAP); and (3) nature and course of the underlying disease (Fig. 2 ). Large-volume fluid resuscitation, usually related to systemic inflammatory syndrome and biomediator activation, is one of the most important risk factors for the development of IAH/ ACS, due to its combined effects of increased intra-abdominal volume (both intraand extraluminal due to ascites formation, gut edema, and ileus) and decreased abdominal wall compliance due to tissue edema of the abdominal wall.

title:
  A Clinician’s Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients

abstract:
  This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.


id: cord-005497-w81ysjf9
author: nan
date: 2020-03-24
txt: ./txt/cord-005497-w81ysjf9.txt
cache: ./cache/cord-005497-w81ysjf9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092506/
doi: 10.1186/s13054-020-2772-3
abstract: nan
summary:
  The positive NC group had more plasma transfusion (p-value 0.03) and a lower median hematocrit at 24 hrs (p-value 0.013), but similar hospital length of stay (p=0.17) and mortality rate (p=0.80) Conclusions: NC at ICU admission identifies subclinical AKI in TBI patients and it maight be used to predictclinical AKI. In patients with pneumonia requiring intensive care (ICU) admission, we hypothesise that abnormal right ventricular (RV) function is associated with an increased 90-day mortality. The objective of this study was to describe the incidence of each AKI stages as defined by KDIGO definition (with evaluation of urine output, serum creatinine and initiation of renal replacement therapy (RRT)), in a mixed medical and surgical population of patients hospitalized in ICU and PCU over a 10-year period (2008-2018). This study aimed at investigating the relationship of goal-directed energy and protein adequacy on clinical outcomes which includes mortality, intensive care unit(ICU) and hospital length of stay (LOS), and length of mechanical ventilation (LOMV).

title:
  40th International Symposium on Intensive Care & Emergency Medicine: Brussels, Belgium. 24-27 March 2020


id: cord-005503-hm8tvkt3
title: Essential Noninvasive Multimodality Neuromonitoring for the Critically Ill Patient
author: Rasulo, Frank A.
date: 2020-03-24
txt: ./txt/cord-005503-hm8tvkt3.txt
cache: ./cache/cord-005503-hm8tvkt3.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092614/
doi: 10.1186/s13054-020-2781-2
summary:
  Recently, automated infrared pupillometry has been introduced into clinical practice, quickly gaining popularity due to its quantitative precision, low cost, noninvasiveness, bedside applicability, and easy-to-use technology, contributing to a modern precision-oriented approach to medicine. reported that power mode transcranial Doppler had high sensitivity and specificity for diagnosis of brain death, respectively 100% and 98% (flow velocity was assessed in the middle cerebral artery using a transtemporal approach) [32] (Fig. 9 ). Processed EEG was originally intended for the management of the anesthetic state during surgery to avoid accidental awareness and to titrate sedation in critically ill patients where clinical scales represent the gold standard. In addition, clinical scale assessment is performed by disturbing sedated or sleeping patients (processed EEG does not require modification of the sedation state) and can never identify phases of burst suppression or isoelectric traces (total suppression) [39] , which are associated with negative outcomes (e.g., delirium occurrence, prolonged mechanical ventilation, mortality).

abstract:
  This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.


id: cord-007550-2b62zaur
author: Buchtele, Nina
date: 2020-04-02
txt: ./txt/cord-007550-2b62zaur.txt
cache: ./cache/cord-007550-2b62zaur.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118965/
doi: 10.1186/s13054-020-02849-y
abstract: nan
summary:
  title: Feasibility and safety of watershed detection by contrast-enhanced ultrasound in patients receiving peripheral venoarterial extracorporeal membrane oxygenation: a prospective observational study We assessed the feasibility and safety of contrast-enhanced ultrasound (CEUS) to detect the watershed at the bedside in patients on bifemoral VA ECMO at three ICUs of a European tertiary care facility. The feasibility of CEUS was assessed based on qualitative image evaluation, the amount of contrast media administered, and the rate of bubble detection. In the remaining five patients, contrast-enhanced continuous blood flow was visible throughout the abdominal and thoracic aorta indicating watershed location close to the aortic root. This study assessed the feasibility of CEUS for watershed detection at the bedside in patients on bifemoral VA ECMO. In bifemoral VA ECMO, CEUS may help to identify patients at risk for differential hypoxia, given that left radial arterial pulsatility was present in all study patients, including those in whom the watershed was located near the aortic root.

title:
  Feasibility and safety of watershed detection by contrast-enhanced ultrasound in patients receiving peripheral venoarterial extracorporeal membrane oxygenation: a prospective observational study


id: cord-009274-32adi3hb
author: Hu, Bo
date: 2020-04-07
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7140334/
doi: 10.1186/s13054-020-2819-5
title:
  Effect of initial infusion rates of fluid resuscitation on outcomes in patients with septic shock: a historical cohort study

abstract:
  BACKGROUND: Fluid resuscitation has become the cornerstone of early septic shock management, but the optimal fluid rate is still not well studied. The goal of this investigation is to examine the relationship between fluid resuscitation rate and septic shock resolution. METHOD: We retrospectively studied adult (≥ 18 years) patients with septic shock, defined based on sepsis III definition, from January 1, 2006, through May 31, 2018, in the medical intensive care unit (MICU) of Mayo Clinic Rochester. The fluid resuscitation time was defined as the time required to infuse the initial fluid bolus of 30 ml/kg, based on the recommendations of the 2016 surviving sepsis campaign. The cohort was divided into four groups based on the average fluid rate (group 1 ≥ 0.5, group 2 0.25–0.49, group 3 0.17–0.24, and group 4 < 0.17 ml/kg/min). The primary outcome was the time to shock reversal. Multivariable regression analyses were conducted to account for potential confounders. RESULT: A total of 1052 patients met eligibility criteria and were included in the analysis. The time-to-shock reversal was significantly different among the groups (P < .001). Patients in group 1 who received fluid resuscitation at a faster rate had a shorter time to shock reversal (HR = 0.78; 95% CI 0.66–0.91; P = .01) when compared with group 4 with a median (IQR) time-to-shock reversal of 1.7 (1.5, 2.0) vs. 2.8 (2.6, 3.3) days, respectively. Using 0.25 ml/kg/min as cutoff, the higher fluid infusion rate was associated with a shorter time to shock reversal (HR = 1.22; 95% CI 1.06–1.41; P = .004) and with decreased odds of 28-day mortality (HR = 0.71; 95% CI 0.60–0.85; P < .001). CONCLUSION: In septic shock patients, initial fluid resuscitation rate of 0.25–0.50 ml/kg/min (i.e., completion of the initial 30 ml/kg IV fluid resuscitation within the first 2 h), may be associated with early shock reversal and lower 28-day mortality compared with slower rates of infusion.


id: cord-010055-exi8t6jt
author: Zhu, Guang-wen
date: 2020-04-19
txt: ./txt/cord-010055-exi8t6jt.txt
cache: ./cache/cord-010055-exi8t6jt.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168841/
doi: 10.1186/s13054-020-02850-5
abstract: nan
summary:
  title: Whether the GFR measured by renal scintigraphy under non-steady state conditions for critically ill patients with AKI can be used as a predictive parameter for clinical events Whether the GFR measured by renal scintigraphy under non-steady state conditions for critically ill patients with AKI can be used as a predictive parameter for clinical events Guang-wen Zhu 1* , Zhou Gao 2 , Abdoul Rachid 3 Whether the GFR measured by renal scintigraphy under non-steady state conditions for critically ill patients with AKI can be used as a predictive parameter for clinical events Dear Editor: To analyze kidney function in the acute setting, recently, our team completed a special renal scintigraphy for a critically ill patient with the only venous access site-PICC. A dynamic renal scintigraphy of 99mTc-DTPA was performed by PICC in this critical patient with AKI and artificially assisted ventilation.

title:
  Whether the GFR measured by renal scintigraphy under non-steady state conditions for critically ill patients with AKI can be used as a predictive parameter for clinical events


id: cord-010697-0eutz8xy
author: Roumy, Aurélien
date: 2020-05-11
txt: ./txt/cord-010697-0eutz8xy.txt
cache: ./cache/cord-010697-0eutz8xy.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216520/
doi: 10.1186/s13054-020-02937-z
summary:
  Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving technology that provides transient respiratory and circulatory support for patients with profound cardiogenic shock or refractory cardiac arrest. The interaction of blood components with the biomaterials of the extracorporeal membrane elicits a systemic inflammatory response which may increase pulmonary vascular permeability and promote the sequestration of polymorphonuclear neutrophils within the lung parenchyma. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving technology providing respiratory and circulatory support in patients with refractory cardiogenic shock or cardiac arrest [1] and which may give time to plan future therapeutic decisions such as the insertion of long-term cardiac assist devices or heart transplantation (HTX) [2] . Alveolar edema and decreased pulmonary artery perfusion lead to lung parenchymal ischemia which in turn maintains chronic inflammation and promotes neoangiogenesis and fibrosis generation and polymorphonuclear cells (PMNs), and triggers the intrinsic coagulation cascade, resulting in the rapid generation of thrombin and fibrin within the systemic circulation [13] .

title:
  Pulmonary complications associated with veno-arterial extra-corporeal membrane oxygenation: a comprehensive review

abstract:
  Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving technology that provides transient respiratory and circulatory support for patients with profound cardiogenic shock or refractory cardiac arrest. Among its potential complications, VA-ECMO may adversely affect lung function through various pathophysiological mechanisms. The interaction of blood components with the biomaterials of the extracorporeal membrane elicits a systemic inflammatory response which may increase pulmonary vascular permeability and promote the sequestration of polymorphonuclear neutrophils within the lung parenchyma. Also, VA-ECMO increases the afterload of the left ventricle (LV) through reverse flow within the thoracic aorta, resulting in increased LV filling pressure and pulmonary congestion. Furthermore, VA-ECMO may result in long-standing pulmonary hypoxia, due to partial shunting of the pulmonary circulation and to reduced pulsatile blood flow within the bronchial circulation. Ultimately, these different abnormalities may result in a state of persisting lung inflammation and fibrotic changes with concomitant functional impairment, which may compromise weaning from VA-ECMO and could possibly result in long-term lung dysfunction. This review presents the mechanisms of lung damage and dysfunction under VA-ECMO and discusses potential strategies to prevent and treat such alterations.


id: cord-014464-m5n250r2
title: Lethal influenza virus A H1N1 infection in two relatives with autosomal dominant GATA-2 deficiency
author: Sole-Violan, J
date: 2013-03-19
txt: ./txt/cord-014464-m5n250r2.txt
cache: ./cache/cord-014464-m5n250r2.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642469/
doi: 10.1186/cc11953
abstract: nan
summary:
  Results In preliminary analysis of categorical data, a signifi cantly (Fisher exact test) greater proportion of patients with compared with without the following fi ndings did not survive; history of alcohol use (P = 0.05); the presence of lethargy (P = 0.01), confusion (P = 0.03), nausea (P = 0.04), abdominal pain (P = 0.02), or the need for vasopressors (P = 0.002), oxygen, mechanical ventilation, or steroids (all P = 0.004) at presentation; and excessive bleeding at surgery (P = 0.01). Methods To prospectively re-evaluate the normal range and to analyze the potential impact of biometric data on ICG-PDR, we measured ICG-PDR (i.v. injection of 0.25 mg/kg ICG; LiMON, Pulsion, Munich, Introduction Mixed venous oxygen saturation (SVO 2 ) represents a well-recognized parameter of oxygen delivery (DO 2 )-consumption (VO 2 ) mismatch and its use has been advocated in critically ill patients in order to guide hemodynamic resuscitation [1] and oxygen delivery optimization.


id: cord-027526-ohcu28rk
author: Zhou, Xiaoyang
date: 2020-06-22
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306939/
doi: 10.1186/s13054-020-03090-3
title:
  Preventive use of respiratory support after scheduled extubation in critically ill medical patients—a network meta-analysis of randomized controlled trials

abstract:
  BACKGROUND: Respiratory support has been increasingly used after extubation for the prevention of re-intubation and improvement of prognosis in critically ill medical patients. However, the optimal respiratory support method is still under debate. This network meta-analysis (NMA) aims to evaluate the comparative effectiveness of various respiratory support methods used for preventive purposes after scheduled extubation in critically ill medical patients. METHODS: A systematic database search was performed from inception to December 19, 2019, for randomized controlled trials (RCTs) that compared a preventive use of different respiratory support methods, including conventional oxygen therapy (COT), noninvasive ventilation (NIV), high-flow oxygen therapy (HFOT), and combinational use of HFOT and NIV (HFOT+NIV), after planned extubation in adult critically ill medical patients. Study selection, data extraction, and quality assessments were performed in duplicate. The primary outcomes included re-intubation rate and short-term mortality. RESULTS: Seventeen RCTs comprising 3341 participants with 4 comparisons were included. Compared with COT, NIV significantly reduced the re-intubation rate [risk ratio (RR) 0.55, 95% confidence interval (CI) 0.39 to 0.77; moderate quality of evidence] and short-term mortality (RR 0.66, 95% CI 0.48 to 0.91; moderate quality of evidence). Compared to COT, HFOT had a beneficial effect on the re-intubation rate (RR 0.55, 95% CI 0.35 to 0.86; moderate quality of evidence) but no effect on short-term mortality (RR 0.79, 95% CI 0.56 to 1.12; low quality of evidence). No significant difference in the re-intubation rate or short-term mortality was found among NIV, HFOT, and HFOT+NIV. The treatment rankings based on the surface under the cumulative ranking curve (SUCRA) from best to worst for re-intubation rate were HFOT+NIV (95.1%), NIV (53.4%), HFOT (51.2%), and COT (0.3%), and the rankings for short-term mortality were NIV (91.0%), HFOT (54.3%), HFOT+NIV (43.7%), and COT (11.1%). Sensitivity analyses of trials with a high risk of extubation failure for the primary outcomes indicated that the SUCRA rankings were comparable to those of the primary analysis. CONCLUSIONS: After scheduled extubation, the preventive use of NIV is probably the most effective respiratory support method for comprehensively preventing re-intubation and short-term death in critically ill medical patients, especially those with a high risk of extubation failure.


id: cord-028337-md9om47x
author: Ketcham, Scott W.
date: 2020-07-03
txt: ./txt/cord-028337-md9om47x.txt
cache: ./cache/cord-028337-md9om47x.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332537/
doi: 10.1186/s13054-020-03108-w
summary:
  Patients with ARDS more often had pulmonary dysfunction as the primary cause of death (28% vs 19%; p = 0.04) and were also more likely to die while requiring significant respiratory support (82% vs 64%; p < 0.01). Specifically, two critical-care trained physicians reviewed each AHRF hospitalization to determine whether patients met Berlin Criteria [15, 16] for ARDS: (1) new or worsening respiratory symptoms began within 1 week of a known clinical insult, (2) PaO 2 /FIO 2 ≤ 300 while receiving a positive end-expiratory pressure ≥ 5 cm H 2 O, (3) bilateral opacities on chest x-ray, (4) unlikely to be cardiogenic pulmonary edema, and (5) no other explanation for these findings. In this contemporary cohort study of 385 patients who died after AHRF, the most common primary causes of death were sepsis and pulmonary dysfunction.

title:
  Causes and characteristics of death in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: a retrospective cohort study

abstract:
  BACKGROUND: Acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) are associated with high in-hospital mortality. However, in cohorts of ARDS patients from the 1990s, patients more commonly died from sepsis or multi-organ failure rather than refractory hypoxemia. Given increased attention to lung-protective ventilation and sepsis treatment in the past 25 years, we hypothesized that causes of death may be different among contemporary cohorts. These differences may provide clinicians with insight into targets for future therapeutic interventions. METHODS: We identified adult patients hospitalized at a single tertiary care center (2016–2017) with AHRF, defined as PaO(2)/FiO(2) ≤ 300 while receiving invasive mechanical ventilation for > 12 h, who died during hospitalization. ARDS was adjudicated by multiple physicians using the Berlin definition. Separate abstractors blinded to ARDS status collected data on organ dysfunction and withdrawal of life support using a standardized tool. The primary cause of death was defined as the organ system that most directly contributed to death or withdrawal of life support. RESULTS: We identified 385 decedents with AHRF, of whom 127 (33%) had ARDS. The most common primary causes of death were sepsis (26%), pulmonary dysfunction (22%), and neurologic dysfunction (19%). Multi-organ failure was present in 70% at time of death, most commonly due to sepsis (50% of all patients), and 70% were on significant respiratory support at the time of death. Only 2% of patients had insupportable oxygenation or ventilation. Eighty-five percent died following withdrawal of life support. Patients with ARDS more often had pulmonary dysfunction as the primary cause of death (28% vs 19%; p = 0.04) and were also more likely to die while requiring significant respiratory support (82% vs 64%; p < 0.01). CONCLUSIONS: In this contemporary cohort of patients with AHRF, the most common primary causes of death were sepsis and pulmonary dysfunction, but few patients had insupportable oxygenation or ventilation. The vast majority of deaths occurred after withdrawal of life support. ARDS patients were more likely to have pulmonary dysfunction as the primary cause of death and die while requiring significant respiratory support compared to patients without ARDS.


id: cord-028835-jby1btv7
title: Prone positioning in severe ARDS requiring extracorporeal membrane oxygenation
author: Rilinger, Jonathan
date: 2020-07-08
txt: ./txt/cord-028835-jby1btv7.txt
cache: ./cache/cord-028835-jby1btv7.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7341706/
doi: 10.1186/s13054-020-03110-2
summary:
  BACKGROUND: Prone positioning (PP) has shown to improve survival in patients with severe acute respiratory distress syndrome (ARDS). To this point, it is unclear if PP is also beneficial for ARDS patients treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) support. METHODS: We report retrospective data of a single-centre registry of patients with severe ARDS requiring VV ECMO support between October 2010 and May 2018. CONCLUSION: In this propensity score matched cohort of severe ARDS patients requiring VV ECMO support, prone positioning at any time was not associated with improved weaning or survival. In case of severe acute respiratory distress syndrome (ARDS), veno-venous extracorporeal membrane oxygenation (VV ECMO) support may be considered when lung-protective mechanical ventilation is not able to prevent hypoxia or hypercapnia [1] [2] [3] . We performed a retrospective analysis of ARDS patients treated with PP during ECMO support at our centre.

abstract:
  BACKGROUND: Prone positioning (PP) has shown to improve survival in patients with severe acute respiratory distress syndrome (ARDS). To this point, it is unclear if PP is also beneficial for ARDS patients treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) support. METHODS: We report retrospective data of a single-centre registry of patients with severe ARDS requiring VV ECMO support between October 2010 and May 2018. Patients were allocated to the PP group if PP was performed during VV ECMO treatment or the supine positioning group. VV ECMO weaning success and hospital survival were analysed before and after propensity score matching. RESULTS: A total of 158 patients could be analysed, and 38 patients (24.1%) received PP. There were no significant differences in VV ECMO weaning rate (47.4% vs. 46.7%, p = 0.94) and hospital survival (36.8% vs. 36.7%, p = 0.98) between the prone and supine groups, respectively. The analysis of 38 propensity score matched pairs also showed no difference in hospital survival (36.8% vs. 36.8%, p = 1.0) or VV ECMO weaning rate (47.4% vs. 44.7%, p = 0.82). Hospital survival was superior in the subgroup of patients treated with early PP (cutoff < 17 h via Youden’s Index) as compared to late or no PP (81.8% vs. 33.3%, p = 0.02). CONCLUSION: In this propensity score matched cohort of severe ARDS patients requiring VV ECMO support, prone positioning at any time was not associated with improved weaning or survival. However, early initiation of prone positioning was linked to a significant reduction of hospital mortality.


id: cord-029183-3aotgq6m
author: Monard, Céline
date: 2020-07-14
txt: ./txt/cord-029183-3aotgq6m.txt
cache: ./cache/cord-029183-3aotgq6m.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359443/
doi: 10.1186/s13054-020-03114-y
summary:
  We evaluated the relevance of a new syndromic rapid multiplex PCR test (rm-PCR) on respiratory samples to guide empirical antimicrobial therapy in adult patients with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-acquired pneumonia (VAP). CONCLUSIONS: Use of a syndromic rm-PCR test has the potential to reduce unnecessary antimicrobial exposure and increase the appropriateness of empirical antibiotic therapy in adult patients with pneumonia. Therefore, in pneumonia patients, international guidelines state that an attempt should be made to obtain respiratory samples and recommend to start early empirical treatment while awaiting for the results of culture and antimicrobial susceptibility testing (AST) [3] . The BioFire® FilmArray® Pneumonia Panel (bioMerieux S.A., Marcy-l''Etoile, France) is a novel assay able to simultaneously identify 27 of the most common pathogens involved in lower respiratory tract infections (semi-quantitative results for 11 Gram-negative and 4 Gram-positive bacteria, qualitative results for 3 atypical bacteria and 9 viruses) as well as 7 antibiotic resistance genes (Fig. 1) .

title:
  Multicenter evaluation of a syndromic rapid multiplex PCR test for early adaptation of antimicrobial therapy in adult patients with pneumonia

abstract:
  BACKGROUND: Improving timeliness of pathogen identification is crucial to allow early adaptation of antibiotic therapy and improve prognosis in patients with pneumonia. We evaluated the relevance of a new syndromic rapid multiplex PCR test (rm-PCR) on respiratory samples to guide empirical antimicrobial therapy in adult patients with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-acquired pneumonia (VAP). METHODS: This retrospective multicenter study was conducted in four French university hospitals. Respiratory samples were obtained from patients with clinical and radiological signs of pneumonia and simultaneously tested using conventional microbiological methods and the rm-PCR. A committee composed of an intensivist, a microbiologist, and an infectious diseases specialist retrospectively assessed all medical files and agreed on the most appropriate antimicrobial therapy for each pneumonia episode, according to the results of rm-PCR and blinded to the culture results. The rm-PCR-guided antimicrobial regimen was compared to the empirical treatment routinely administered to the patient in standard care. RESULTS: We included 159 pneumonia episodes. Most patients were hospitalized in intensive care units (n = 129, 81%), and episodes were HAP (n = 68, 43%), CAP (n = 54, 34%), and VAP (n = 37, 23%). Conventional culture isolated ≥ 1 microorganism(s) at significant level in 95 (60%) patients. The syndromic rm-PCR detected at least one bacteria in 132 (83%) episodes. Based on the results of the rm-PCR, the multidisciplinary committee proposed a modification of the empirical therapy in 123 (77%) pneumonia episodes. The modification was a de-escalation in 63 (40%), an escalation in 35 (22%), and undetermined in 25 (16%) patients. In microbiologically documented episodes (n = 95), the rm-PCR increased appropriateness of the empirical therapy to 83 (87%), as compared to 73 (77%) in routine care. CONCLUSIONS: Use of a syndromic rm-PCR test has the potential to reduce unnecessary antimicrobial exposure and increase the appropriateness of empirical antibiotic therapy in adult patients with pneumonia.


id: cord-029516-tj93wo1s
author: Chelly, Jonathan
date: 2020-07-22
txt: ./txt/cord-029516-tj93wo1s.txt
cache: ./cache/cord-029516-tj93wo1s.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374079/
doi: 10.1186/s13054-020-03155-3
summary:
  METHODS: A prospective randomized controlled crossover trial was carried out in a French intensive care unit to compare blood oxygen pulse saturation (SpO(2)) during DNPs performed on patients mechanically ventilated in automated and conventional ventilation modes (AV and CV, respectively). In a prospective study on 16 ICU patients undergoing MV, 668 nursing procedures were observed and blood oxygen desaturation ≤ 90% was the most frequent adverse event described, representing 29% of the overall major physiological changes reported by the authors [10] . Our study suggests AV may have a protective effect when compared to CV in terms of SpO 2 values and the incidence and severity of blood oxygen desaturation during DNPs. A prospective randomized controlled study of 60 post-cardiac surgery patients showed that in comparison to CV, INTELLiVENT-ASV® significantly reduces MV duration before inclusion-days 4 ± 4 (4-5)

title:
  Automated vs. conventional ventilation in the ICU: a randomized controlled crossover trial comparing blood oxygen saturation during daily nursing procedures (I-NURSING)

abstract:
  BACKGROUND: Hypoxia is common during daily nursing procedures (DNPs) routinely performed on mechanically ventilated patients. The impact of automated ventilation on the incidence and severity of blood oxygen desaturation during DNPs remains unknown. METHODS: A prospective randomized controlled crossover trial was carried out in a French intensive care unit to compare blood oxygen pulse saturation (SpO(2)) during DNPs performed on patients mechanically ventilated in automated and conventional ventilation modes (AV and CV, respectively). All patients with FiO(2) ≤ 60% and without prone positioning or neuromuscular blocking agents were included. Patients underwent two DNPs on the same day using AV (INTELLiVENT-ASV®) and CV (volume control, biphasic positive airway pressure, or pressure support ventilation) in a randomized order. The primary outcome was the percentage of time spent with SpO(2) in the acceptable range of 90–95% during the DNP. RESULTS: Of the 265 included patients, 93% had been admitted for a medical pathology, the majority for acute respiratory failure (52%). There was no difference between the two periods in terms of DNP duration, sedation requirements, or ventilation parameters, but patients had more spontaneous breaths and lower peak airway pressures during the AV period (p < 0.001). The percentage of time spent with SpO(2) in the acceptable range during DNPs was longer in the AV period than in the CV period (48 ± 37 vs. 43 ± 37, percentage of DNP period; p = 0.03). After adjustment, AV was associated with a higher number of DNPs carried out with SpO(2) in the acceptable range (odds ratio, 1.82; 95% CI, 1.28 to 2.6; p = 0.001) and a lower incidence of blood oxygen desaturation ≤ 85% (adjusted odds ratio, 0.50; 95% CI, 0.30 to 0.85; p = 0.01). CONCLUSION: AV appears to reduce the incidence and severity of blood oxygen desaturation during daily nursing procedures (DNPs) in comparison to CV. TRIAL REGISTRATION: This study was registered in clinical-trial.gov (NCT03176329) in June 2017. GRAPHICAL ABSTRACT: [Image: see text]


id: cord-029991-0sy417j0
author: Longhini, Federico
date: 2020-08-03
txt: ./txt/cord-029991-0sy417j0.txt
cache: ./cache/cord-029991-0sy417j0.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396943/
doi: 10.1186/s13054-020-03198-6
summary:
  BACKGROUND: Besides airway suctioning, patients undergoing invasive mechanical ventilation (iMV) benefit of different combinations of chest physiotherapy techniques, to improve mucus removal. The presence of an endotracheal tube impairs the bronchial mucus velocity transport in anaesthetized dogs [2] ; in critically ill patients undergoing invasive mechanical ventilation (iMV), it seriously impairs cough reflex and mucociliary escalator function [3, 4] , promoting the accumulation of tracheobronchial secretions, leading to sequestration and densification of secretions in the lower airways and increasing the risk of pneumonia [5] and lung atelectasis [6] . The aim of this pilot randomized physiological study is assessing the effects of HFCWO on lung aeration and ventilation distribution, as assessed by EIT, in normosecretive and hypersecretive mechanically ventilated patients. Our study shows that chest physiotherapy by HFCWO may improve lung aeration of hypersecretive mechanically ventilated patients, without affecting gas exchange.

title:
  Chest physiotherapy improves lung aeration in hypersecretive critically ill patients: a pilot randomized physiological study

abstract:
  BACKGROUND: Besides airway suctioning, patients undergoing invasive mechanical ventilation (iMV) benefit of different combinations of chest physiotherapy techniques, to improve mucus removal. To date, little is known about the clearance effects of oscillating devices on patients with acute respiratory failure undergoing iMV. This study aimed to assess (1) the effects of high-frequency chest wall oscillation (HFCWO) on lung aeration and ventilation distribution, as assessed by electrical impedance tomography (EIT), and (2) the effect of the association of HFCWO with recruitment manoeuvres (RM). METHODS: Sixty critically ill patients, 30 classified as normosecretive and 30 as hypersecretive, who received ≥ 48 h of iMV, underwent HFCWO; patients from both subgroups were randomized to receive RM or not, according to two separated randomization sequences. We therefore obtained four arms of 15 patients each. After baseline record (T0), HFCWO was applied for 10 min. At the end of the treatment (T1) or after 1 (T2) and 3 h (T3), EIT data were recorded. At the beginning of each step, closed tracheobronchial suctioning was performed. In the RM subgroup, tracheobronchial suctioning was followed by application of 30 cmH(2)O to the patient’s airway for 30 s. At each step, we assessed the change in end-expiratory lung impedance (ΔEELI) and in tidal impedance variation (ΔTIV), and the center of gravity (COG) through EIT. We also analysed arterial blood gases (ABGs). RESULTS: ΔTIV and COG did not differ between normosecretive and hypersecretive patients. Compared to T0, ΔEELI significantly increased in hypersecretive patients at T2 and T3, irrespective of the RM; on the contrary, no differences were observed in normosecretive patients. No differences of ABGs were recorded. CONCLUSIONS: In hypersecretive patients, HFCWO significantly improved aeration of the dorsal lung region, without affecting ABGs. The application of RM did not provide any further improvements. TRIAL REGISTRATION: Prospectively registered at the Australian New Zealand Clinical Trial Registry (www.anzctr.org.au; number of registration: ACTRN12615001257550; date of registration: 17th November 2015).


id: cord-030131-klhg7x8z
author: Tan, Dingyu
date: 2020-08-06
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407427/
doi: 10.1186/s13054-020-03214-9
title:
  High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: a multicenter, randomized controlled trial

abstract:
  BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy is being increasingly used to prevent post-extubation hypoxemic respiratory failure and reintubation. However, evidence to support the use of HFNC in chronic obstructive pulmonary disease (COPD) patients with hypercapnic respiratory failure after extubation is limited. This study was conducted to test if HFNC is non-inferior to non-invasive ventilation (NIV) in preventing post-extubation treatment failure in COPD patients previously intubated for hypercapnic respiratory failure. METHODS: COPD patients with hypercapnic respiratory failure who were already receiving invasive ventilation were randomized to HFNC or NIV at extubation at two large tertiary academic teaching hospitals. The primary endpoint was treatment failure, defined as either resumption of invasive ventilation or switching to the other study treatment modality (NIV for patients in the NFNC group or vice versa). RESULTS: Ninety-six patients were randomly assigned to the HFNC group or NIV group. After secondary exclusion, 44 patients in the HFNC group and 42 patients in the NIV group were included in the analysis. The treatment failure rate in the HFNC group was 22.7% and 28.6% in the NIV group—risk difference of − 5.8% (95% CI, − 23.8–12.4%, p = 0.535), which was significantly lower than the non-inferior margin of 9%. Analysis of the causes of treatment failure showed that treatment intolerance in the HFNC group was significantly lower than that in the NIV group, with a risk difference of − 50.0% (95% CI, − 74.6 to − 12.9%, p = 0.015). One hour after extubation, the mean respiratory rates of both groups were faster than their baseline levels before extubation (p < 0.050). Twenty-four hours after extubation, the respiratory rate of the HFNC group had returned to baseline, but the NIV group was still higher than the baseline. Forty-eight hours after extubation, the respiratory rates of both groups were not significantly different from the baseline. The average number of daily airway care interventions in the NIV group was 7 (5–9.3), which was significantly higher than 6 (4–7) times in the HFNC group (p = 0.006). The comfort score and incidence of nasal and facial skin breakdown of the HFNC group was also significantly better than that of the NIV group [7 (6–8) vs 5 (4–7), P < 0.001] and [0 vs 9.6%, p = 0.027], respectively. CONCLUSION: Among COPD patients with severe hypercapnic respiratory failure who received invasive ventilation, the use of HFNC after extubation did not result in increased rates of treatment failure compared with NIV. HFNC also had better tolerance and comfort than NIV. TRIAL REGISTRATION: chictr.org (ChiCTR1800018530). Registered on 22 September 2018, http://www.chictr.org.cn/usercenter.aspx


id: cord-030277-x9zvx3fp
author: Ohta, Yoshinori
date: 2020-08-10
txt: ./txt/cord-030277-x9zvx3fp.txt
cache: ./cache/cord-030277-x9zvx3fp.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416813/
doi: 10.1186/s13054-020-03207-8
summary:
  title: Effect of dexmedetomidine on inflammation in patients with sepsis requiring mechanical ventilation: a sub-analysis of a multicenter randomized clinical trial We explored the effects of administering dexmedetomidine on the levels of C-reactive protein (CRP) and procalcitonin, and thus on inflammation, in patients with sepsis enrolled in a randomized clinical trial. METHODS: The DESIRE trial was a multicenter randomized clinical trial in which adult patients with sepsis were sedated with (DEX group) or without (non-DEX group) dexmedetomidine while on mechanical ventilators. We analyzed data derived from a randomized clinical trial and found that the administration of dexmedetomidine to patients with sepsis on ventilators improved CRP and PCT levels during the first 14 days in the ICU. In the present study, the use of dexmedetomidine for sedation reduced both CRP and PCT levels in patients with sepsis. Effect of dexmedetomidine on mortality and ventilator-free days in patients requiring mechanical ventilation with sepsis: a randomized clinical trial

title:
  Effect of dexmedetomidine on inflammation in patients with sepsis requiring mechanical ventilation: a sub-analysis of a multicenter randomized clinical trial

abstract:
  BACKGROUND: Administration of dexmedetomidine has been reported to improve inflammatory response in animals. We explored the effects of administering dexmedetomidine on the levels of C-reactive protein (CRP) and procalcitonin, and thus on inflammation, in patients with sepsis enrolled in a randomized clinical trial. METHODS: The DESIRE trial was a multicenter randomized clinical trial in which adult patients with sepsis were sedated with (DEX group) or without (non-DEX group) dexmedetomidine while on mechanical ventilators. As a prespecified sub-analysis, we compared CRP and procalcitonin levels during the first 14 days of treatment between the two groups. The 14-day mortality rate, albumin level, and the number of patients with disseminated intravascular coagulation (DIC) were also assessed. We used generalized linear models to estimate the differences in these outcomes between groups. We also used the Kaplan-Meier method to estimate the 14-day mortality rate and the log-rank test to assess between-group differences. RESULTS: Our study comprised 201 patients: 100 in the DEX group and 101 in the non-DEX group. CRP and procalcitonin levels were lower in the DEX vs. non-DEX group during the 14-day treatment period [CRP—range, 5.6–20.3 vs. 8.3–21.1 mg/dL (P = 0.03); procalcitonin—range, 1.2–37.4 vs. 1.7–52.9 ng/mL (P = 0.04)]. Albumin levels were higher in the DEX group (range, 2.3–2.6 g/dL) than in the non-DEX group (range, 2.1–2.7 g/dL; P = 0.01). The percentage of patients with DIC did not significantly differ between the groups (range, 21–59% and 17–56% for the DEX and non-DEX groups, respectively; P = 0.49). The 14-day mortality rates in the DEX and non-DEX groups were 13 and 21%, respectively (P = 0.16). CONCLUSION: Sedation using dexmedetomidine reduced inflammation in patients with sepsis requiring mechanical ventilation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01760967. Registered on 4 January 2013.


id: cord-030677-t94cu81n
author: Burstein, Barry
date: 2020-08-20
txt: ./txt/cord-030677-t94cu81n.txt
cache: ./cache/cord-030677-t94cu81n.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439249/
doi: 10.1186/s13054-020-03217-6
summary:
  We sought to determine the relationship between mean arterial pressure (MAP) and mortality in the cardiac intensive care unit (CICU) patients with CS. By contrast, a recent multicenter randomized controlled trial of patients 65 years and older who were admitted to the ICU with septic shock demonstrated that permissive hypotension (MAP 60-65 mmHg) reduced vasopressor exposure without increasing the risk of mortality or AKI (including patients with and without hypertension) [9] . Hospital mortality and incidence of severe acute kidney injury (AKI) as a function of the 24-hour average mean arterial pressure (mMAP 24 ), among patients with (A) and without (B) cardiac arrest. Hospital mortality and incidence of severe acute kidney injury (AKI) as a function of the 24-hour average mean arterial pressure (mMAP 24 ), among patients with (A) and without (B) a pre-admission diagnosis of hypertension.

title:
  Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock

abstract:
  BACKGROUND: The optimal MAP target for patients with cardiogenic shock (CS) remains unknown. We sought to determine the relationship between mean arterial pressure (MAP) and mortality in the cardiac intensive care unit (CICU) patients with CS. METHODS: Using a single-center database of CICU patients admitted between 2007 and 2015, we identified patients with an admission diagnosis of CS. MAP was measured every 15 min, and the mean of all MAP values during the first 24 h (mMAP(24)) was recorded. Multivariable logistic regression determined the relationship between mMAP(24) and adjusted hospital mortality. RESULTS: We included 1002 patients with a mean age of 68 ± 13.7 years, including 36% females. Admission diagnoses included acute coronary syndrome in 60%, heart failure in 74%, and cardiac arrest in 38%. Vasoactive drugs were used in 72%. The mMAP(24) was higher (75 vs. 71 mmHg, p < 0.001) among hospital survivors (66%) compared with non-survivors (34%). Hospital mortality was inversely associated with mMAP(24) (adjusted OR 0.9 per 5 mmHg higher mMAP(24), p = 0.01), with a stepwise increase in hospital mortality at lower mMAP(24). Patients with mMAP(24) < 65 mmHg were at higher risk of hospital mortality (57% vs. 28%, adjusted OR 2.0, 95% CI 1.4–3.0, p < 0.001); no differences were observed between patients with mMAP(24) 65–74 vs. ≥ 75 mmHg (p > 0.1). CONCLUSION: In patients with CS, we observed an inverse relationship between mMAP(24) and hospital mortality. The poor outcomes in patients with mMAP(24) < 65 mmHg provide indirect evidence supporting a MAP goal of 65 mmHg for patients with CS.


id: cord-031033-v4yetn4f
title: The importance of airway and lung microbiome in the critically ill
author: Martin-Loeches, Ignacio
date: 2020-08-31
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457224/
doi: 10.1186/s13054-020-03219-4
abstract:
  During critical illness, there are a multitude of forces such as antibiotic use, mechanical ventilation, diet changes and inflammatory responses that could bring the microbiome out of balance. This so-called dysbiosis of the microbiome seems to be involved in immunological responses and may influence outcomes even in individuals who are not as vulnerable as a critically ill ICU population. It is therefore probable that dysbiosis of the microbiome is a consequence of critical illness and may, subsequently, shape an inadequate response to these circumstances. Bronchoscopic studies have revealed that the carina represents the densest site of bacterial DNA along healthy airways, with a tapering density with further bifurcations. This likely reflects the influence of micro-aspiration as the primary route of microbial immigration in healthy adults. Though bacterial DNA density grows extremely sparse at smaller airways, bacterial signal is still consistently detectable in bronchoalveolar lavage fluid, likely reflecting the fact that lavage via a wedged bronchoscope samples an enormous surface area of small airways and alveoli. The dogma of lung sterility also violated numerous observations that long predated culture-independent microbiology. The body’s resident microbial consortia (gut and/or respiratory microbiota) affect normal host inflammatory and immune response mechanisms. Disruptions in these host-pathogen interactions have been associated with infection and altered innate immunity. In this narrative review, we will focus on the rationale and current evidence for a pathogenic role of the lung microbiome in the exacerbation of complications of critical illness, such as acute respiratory distress syndrome and ventilator-associated pneumonia.


id: cord-034948-w59wxu8i
author: Kuriyama, Akira
date: 2020-11-07
txt: ./txt/cord-034948-w59wxu8i.txt
cache: ./cache/cord-034948-w59wxu8i.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648377/
doi: 10.1186/s13054-020-03358-8
summary:
  We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the cuff leak test for predicting post-extubation airway complications in intubated adult patients in critical care settings. We included studies that examined the diagnostic accuracy of cuff leak test if post-extubation airway obstruction after extubation or reintubation was explicitly reported as the reference standard. Subgroup analyses suggested that the type of cuff leak test and length of intubation might be the cause of statistical heterogeneity of sensitivity and specificity, respectively, for post-extubation airway obstruction. Consequently, we conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the cuff leak test for predicting post-extubation airway obstruction and subsequent reintubation. We included observational studies (cross-sectional and cohort studies) that examined the diagnostic accuracy of cuff leak test in critical care settings if: (1) the data were extractable into a 2 × 2 table from the reported data, (2) post-extubation airway obstruction after extubation or reintubation was explicitly reported as the reference standard.

title:
  Performance of the cuff leak test in adults in predicting post-extubation airway complications: a systematic review and meta-analysis

abstract:
  BACKGROUND: Clinical practice guidelines recommend performing a cuff leak test in mechanically ventilated adults who meet extubation criteria to screen those at high risk for post-extubation stridor. Previous systematic reviews demonstrated excellent specificity of the cuff leak test but disagreed with respect to sensitivity. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the cuff leak test for predicting post-extubation airway complications in intubated adult patients in critical care settings. METHODS: We searched Medline, EMBASE, Scopus, ISI Web of Science, the Cochrane Library for eligible studies from inception to March 16, 2020, without language restrictions. We included studies that examined the diagnostic accuracy of cuff leak test if post-extubation airway obstruction after extubation or reintubation was explicitly reported as the reference standard. Two authors in duplicate and independently assessed the risk of bias using the Quality Assessment for Diagnostic Accuracy Studies-2 tool. We pooled sensitivities and specificities using generalized linear mixed model approach to bivariate random-effects meta-analysis. Our primary outcomes were post-extubation airway obstruction and reintubation. RESULTS: We included 28 studies involving 4493 extubations. Three studies were at low risk for all QUADAS-2 risk of bias domains. The pooled sensitivity and specificity of cuff leak test for post-extubation airway obstruction were 0.62 (95% CI 0.49–0.73; I(2) = 81.6%) and 0.87 (95% CI 0.82–0.90; I(2) = 97.8%), respectively. The pooled sensitivity and specificity of the cuff leak test for reintubation were 0.66 (95% CI 0.46–0.81; I(2) = 48.9%) and 0.88 (95% CI 0.83–0.92; I(2) = 87.4%), respectively. Subgroup analyses suggested that the type of cuff leak test and length of intubation might be the cause of statistical heterogeneity of sensitivity and specificity, respectively, for post-extubation airway obstruction. CONCLUSIONS: The cuff leak test has excellent specificity but moderate sensitivity for post-extubation airway obstruction. The high specificity suggests that clinicians should consider intervening in patients with a positive test, but the low sensitivity suggests that patients still need to be closely monitored post-extubation.


id: cord-048199-5yhe786e
title: Debate: Transfusing to normal haemoglobin levels will not improve outcome
author: Alvarez, Gonzalo
date: 2001-03-08
txt: ./txt/cord-048199-5yhe786e.txt
cache: ./cache/cord-048199-5yhe786e.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC137267/
doi: 10.1186/cc987
summary:
  Although many questions remain, many laboratory and clinical studies, including a recent randomized controlled trial (RCT), have established that transfusing to normal haemoglobin concentrations does not improve organ failure and mortality in the critically ill patient. Clinical evidence is also insufficient to definitively establish a correlation between the age of RBCs being transfused and patient mortality; however, laboratory evidence has shown many storage-related changes that may result in impairment of blood flow and oxygen delivery at the microcirculatory level. RBC transfusions in particular improved outcome in critically ill patients with cardiovascular disease, but increased the risk of myocardial infarction in coronary artery bypass surgery patients. However, two recent cohort studies suggested that anaemia may increase the risk of mortality in critical illness [73] and following surgery in patients with cardiovascular disease [74] . Although many questions remain, the TRICC trial and many laboratory and clinical studies have established that transfusing to normal haemoglobin concentrations does not improve organ failure and mortality in the critically ill patient.

abstract:
  Recent evidence suggests that critically ill patients are able to tolerate lower levels of haemoglobin than was previously believed. It is our goal to show that transfusing to a level of 100 g/l does not improve mortality and other clinically important outcomes in a critical care setting. Although many questions remain, many laboratory and clinical studies, including a recent randomized controlled trial (RCT), have established that transfusing to normal haemoglobin concentrations does not improve organ failure and mortality in the critically ill patient. In addition, a restrictive transfusion strategy will reduce exposure to allogeneic transfusions, result in more efficient use of red blood cells (RBCs), save blood overall, and decrease health care costs.


id: cord-048343-nzk8m912
author: Milbrandt, Eric B
date: 2006-11-15
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1794449/
doi: 10.1186/cc5078
title:
  Bench-to-bedside review: Critical illness-associated cognitive dysfunction – mechanisms, markers, and emerging therapeutics

abstract:
  Cognitive dysfunction is common in critically ill patients, not only during the acute illness but also long after its resolution. A large number of pathophysiologic mechanisms are thought to underlie critical illness-associated cognitive dysfunction, including neuro-transmitter abnormalities and occult diffuse brain injury. Markers that could be used to evaluate the influence of specific mechanisms in individual patients include serum anticholinergic activity, certain brain proteins, and tissue sodium concentration determination via high-resolution three-dimensional magnetic resonance imaging. Although recent therapeutic advances in this area are exciting, they are still too immature to influence patient care. Additional research is needed if we are to understand better the relative contributions of specific mechanisms to the development of critical illness-associated cognitive dysfunction and to determine whether these mechanisms might be amenable to treatment or prevention.


id: cord-048447-chz8luni
title: Surfactant therapy for acute respiratory failure in children: a systematic review and meta-analysis
author: Duffett, Mark
date: 2007-06-15
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206432/
doi: 10.1186/cc5944
abstract:
  INTRODUCTION: Exogenous surfactant is used to treat acute respiratory failure in children, although the benefits and harms in this setting are not clear. The objective of the present systematic review is to assess the effect of exogenous pulmonary surfactant on all-cause mortality in children mechanically ventilated for acute respiratory failure. METHODS: We searched the MEDLINE, EMBASE, CINAHL and Ovid Healthstar databases, the bibliographies of included trials and review articles, conference proceedings and trial registries. We included prospective, randomized, controlled trials of pulmonary surfactant that enrolled intubated and mechanically ventilated children with acute respiratory failure. We excluded trials that exclusively enrolled neonates or patients with asthma. Two reviewers independently rated trials for inclusion, extracted data and assessed the methodologic quality. We quantitatively pooled the results of trials, where suitable, using a random effects model. RESULTS: Six trials randomizing 314 patients were included. Surfactant use reduced mortality (relative risk = 0.7, 95% confidence interval = 0.4 to 0.97, P = 0.04), was associated with increased ventilator-free days (weighted mean difference = 2.5 days, 95% confidence interval = 0.3 to 4.6 days, P = 0.02) and reduced the duration of ventilation (weighted mean difference = 2.3 days, 95% confidence interval = 0.1 to 4.4 days, P = 0.04). CONCLUSION: Surfactant use decreased mortality, was associated with more ventilator-free days and reduced the duration of ventilation. No serious adverse events were reported.


id: cord-048448-kfwbqp4p
title: Clinical review: Update of avian influenza A infections in humans
author: Sandrock, Christian
date: 2007-03-22
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206439/
doi: 10.1186/cc5675
abstract:
  Influenza A viruses have a wide host range for infection, from wild waterfowl to poultry to humans. Recently, the cross-species transmission of avian influenza A, particularly subtype H5N1, has highlighted the importance of the non-human subtypes and their incidence in the human population has increased over the past decade. During cross-species transmission, human disease can range from the asymptomatic to mild conjunctivitis to fulminant pneumonia and death. With these cases, however, the risk for genetic change and development of a novel virus increases, heightening the need for public health and hospital measures. This review discusses the epidemiology, host range, human disease, outcome, treatment, and prevention of cross-transmission of avian influenza A into humans.


id: cord-048449-mzn448zk
title: Clinical review: Mass casualty triage – pandemic influenza and critical care
author: Challen, Kirsty
date: 2007-04-30
txt: ./txt/cord-048449-mzn448zk.txt
cache: ./cache/cord-048449-mzn448zk.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206465/
doi: 10.1186/cc5732
summary:
  Contingency planning should, therefore, be multi-faceted, involving a robust health command structure, the facility to expand critical care provision in terms of space, equipment and staff and cohorting of affected patients in the early stages. Properly constructed plans for the delivery of critical care during an influenza pandemic must include the ability to deal with excessive demand, high and possibly extreme mortality, and the risk to the health of critical care staff. A number of intensive care scoring systems have demonstrated their power in using physiological derangement to predict mortality or higher resource requirements, whatever the presenting diagnosis [45] [46] [47] [48] [49] . Physiological scores have also been demonstrated to be good predictors of requirement for higher level care on hospital wards [50] , in medical assessment units [51, 52] and in the Emergency Department [53] .

abstract:
  Worst case scenarios for pandemic influenza planning in the US involve over 700,000 patients requiring mechanical ventilation. UK planning predicts a 231% occupancy of current level 3 (intensive care unit) bed capacity. Critical care planners need to recognise that mortality is likely to be high and the risk to healthcare workers significant. Contingency planning should, therefore, be multi-faceted, involving a robust health command structure, the facility to expand critical care provision in terms of space, equipment and staff and cohorting of affected patients in the early stages. It should also be recognised that despite this expansion of critical care, demand will exceed supply and a process for triage needs to be developed that is valid, reproducible, transparent and consistent with distributive justice. We advocate the development and validation of physiological scores for use as a triage tool, coupled with candid public discussion of the process.


id: cord-104180-f3hoz9bu
title: Recently published papers: inflammation, elucidation, manipulation?
author: Kirk-Bayley, Justin
date: 2003-07-03
txt: ./txt/cord-104180-f3hoz9bu.txt
cache: ./cache/cord-104180-f3hoz9bu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC270703/
doi: nan
abstract: nan
summary:
  They looked at end-organ epithelial cell apoptosis in a rabbit model of ARDS and at the effects of plasma on epithelial cells from recipients of the injurious ventilatory strategy, and analyzed samples from a previous trial into lung protective ventilation [8] . Choosing the right ventilation strategy for ARDS patients has more benefits than just lung protection, and therapeutic targeting of these factors that induce end organ apoptosis may be the next step. Stress doses of hydrocortisone reduce severe systemic inflammatory response syndrome and improve early outcome in a risk group of patients after cardiac surgery Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial Dose-response characteristics during long-term inhalation of nitric oxide in patients with severe acute respiratory distress syndrome: a prospective, randomized, controlled study


id: cord-252473-i4pmux28
title: Why can''t I visit? The ethics of visitation restrictions – lessons learned from SARS
author: Rogers, Sharon
date: 2004-08-31
txt: ./txt/cord-252473-i4pmux28.txt
cache: ./cache/cord-252473-i4pmux28.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/15469583/
doi: 10.1186/cc2930
summary:
  It could be argued that visitation restrictions, in light of a potential outbreak of a contagious disease, are ethically sound because of the compelling need to protect public health. In a health care institution, visitation restrictions not only affect inpatients but also have an impact on ambulatory patients who must come for diagnostic tests or interventions and who, if deprived access, might develop urgent or emergent conditions. Furthermore, to be consistent with expectations of transparency, the criteria by which exceptionality to the rules of visitation restriction exists should also be published openly throughout the organization for staff, patients and visitors. For example, although current policy allows for specific times of visitation and numbers of visitors per day, a sudden outbreak might dictate a quick lockdown of the facility without patients or family members receiving prior notice. It is ethical to accept that public health protection trumps individual rights to liberal visitation.

abstract:
  Patients want, need and expect that their relatives will be able to visit them during inpatient admissions or accompany them during ambulatory visits. The sudden outbreak of severe acute respiratory syndrome (SARS), or a similar contagious pathogen, will restrict the number of people entering the hospital. The ethical values that underlie visitor restrictions are discussed here.


id: cord-252890-of29g89s
author: Villarreal-Fernandez, Eduardo
date: 2020-06-12
txt: ./txt/cord-252890-of29g89s.txt
cache: ./cache/cord-252890-of29g89s.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03063-6
doi: 10.1186/s13054-020-03063-6
abstract: nan
summary:
  A plea for avoiding systematic intubation in severely hypoxemic patients with COVID-19-associated respiratory failure Eduardo Villarreal-Fernandez 1 , Ravi Patel 1 , Reshma Golamari 2 , Muhammad Khalid 2 , Ami DeWaters 2 and Philippe Haouzi 1* Indeed, since a profound hypoxemia appears to be the hallmark of COVID-19-associated pneumonia, the initial consensus [2] was to start invasive mechanical ventilation as soon as possible due to the overwhelming number of patients in respiratory failure presenting at the same time in a hospital and to prevent the risk of hypoxic cardiac arrest; (2) avoidance of high-flow nasal cannula (HFNC) to reduce respiratory droplet aerosolization for healthcare workers [3] in what was seen as "inevitable" intubations. After an initial increase in oxygen requirement through day 6, patients in this group were all able to be discharged at a time when most of the early-intubated patients were still mechanically ventilated (Fig. 1) .

title:
  A plea for avoiding systematic intubation in severely hypoxemic patients with COVID-19-associated respiratory failure


id: cord-253006-r2a2ozrc
title: Duration of SARS-CoV-2 viral RNA in asymptomatic carriers
author: Yan, Xiquan
date: 2020-05-24
txt: ./txt/cord-253006-r2a2ozrc.txt
cache: ./cache/cord-253006-r2a2ozrc.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02952-0
doi: 10.1186/s13054-020-02952-0
abstract: nan
summary:
  title: Duration of SARS-CoV-2 viral RNA in asymptomatic carriers Notably, patient 2 carried SARS-CoV-2 viral for 32 days continuously after exposure to COVID-19 and tested positive for viral RNA in the respiratory sample for 13 days after first positive test onset. The results indicate that asymptomatic human can carry SARS-CoV-2 viral RNA after exposure to COVID-19, and the carriage seems long-lived. Further study is needed to determine the potential for and mode of contagion of asymptomatic carriers to develop more scientific control strategies. The long duration of asymptomatic infection with SARS-CoV-2 may warrant a reassessment of quarantine as the current outbreak. The US Centers for Disease Control and Prevention recommends that contacts of asymptomatic carriers self-isolate for 14 days [4] . Quarantine of asymptomatic carriers and identification of contacts are a crucial part of these control efforts. There is a great need for further studies on the mechanism by which asymptomatic carriers could acquire and carry SARS-CoV-2 that causes COVID-19.


id: cord-254287-8q2gdy5n
title: International variation in the management of severe COVID-19 patients
author: Azoulay, Elie
date: 2020-08-05
txt: ./txt/cord-254287-8q2gdy5n.txt
cache: ./cache/cord-254287-8q2gdy5n.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03194-w
doi: 10.1186/s13054-020-03194-w
summary:
  Respondents (median 45 years [IQR, 39-53], 34% women) were from Middle Europe (25%), South Europe (23%), the United Kingdom (UK) (12%), South America (9%), North Europe (8.1%), Eastern Europe (5.3%), Middle-East (5%), North America (4.7%), Asia (3.3%), India (2.7%), Australia-New Zealand (1.3%), or Africa (0.6%); 54% were living in a large city (> 1 million inhabitants), and 55% were working in university-affiliated hospitals. For instance, prone positioning was performed in 70-85% of the cases in Asia, India, Eastern Europe, Middle Europe, South America, South Europe, and the UK, whereas Africa, Australia-New Zealand, Middle East, North America, and Scandinavia were in the 50-70% range (Fig. 3, P < 0 Antibiotic prescribing was routine for all patients in 44.2% of the respondents and biomarker-guided in 36.5%, without significant variation across regions. This survey highlights important practice variations in the management of severe COVID-19 patients, including differences at regional and individual levels.

abstract:
  BACKGROUND: There is little evidence to support the management of severe COVID-19 patients. METHODS: To document this variation in practices, we performed an online survey (April 30–May 25, 2020) on behalf of the European Society of Intensive Care Medicine (ESICM). A case vignette was sent to ESICM members. Questions investigated practices for a previously healthy 39-year-old patient presenting with severe hypoxemia from COVID-19 infection. RESULTS: A total of 1132 ICU specialists (response rate 20%) from 85 countries (12 regions) responded to the survey. The survey provides information on the heterogeneity in patient’s management, more particularly regarding the timing of ICU admission, the first line oxygenation strategy, optimization of management, and ventilatory settings in case of refractory hypoxemia. Practices related to antibacterial, antiviral, and anti-inflammatory therapies are also investigated. CONCLUSIONS: There are important practice variations in the management of severe COVID-19 patients, including differences at regional and individual levels. Large outcome studies based on multinational registries are warranted.


id: cord-255216-87ursh0s
title: First evidence of a pro-inflammatory response to severe infection with influenza virus H1N1
author: de Castro, Isabel Fernández
date: 2010-02-11
txt: ./txt/cord-255216-87ursh0s.txt
cache: ./cache/cord-255216-87ursh0s.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/cc8846
doi: 10.1186/cc8846
summary:
  This is the first work reporting the association of a pro-inflamatory immune response with a severe pandemic infection, although it is likely that more studies are needed to understand the detrimental or beneficial roles these cytokines play in the evolution of mild and severe nvH1N1 infection. By analyzing 29 cytokines and chemokines and the hemagglutination inhibition activity, Bermejo-Martin and colleagues [1] assessed the early host innate and adaptive immune responses in patients both mildly and severely infected with nvH1N1. The great majority of infections caused by the pandemic variant of the infl uenza virus (nvH1N1) are self-limited, but a small percentage of patients develop severe symptoms requiring hospitalization. This is the fi rst work reporting the association of a pro-infl amatory immune response with a severe pandemic infection, although it is likely that more studies are needed to understand the detrimental or benefi cial roles these cytokines play in the evolution of mild and severe nvH1N1 infection.

abstract:
  The great majority of infections caused by the pandemic variant of the influenza virus (nvH1N1) are self-limited, but a small percentage of patients develop severe symptoms requiring hospitalization. Bermejo-Martin and colleagues have presented a pilot study describing the differences in the early immune response for patients both mildly and severely infected with nvH1N1. Patients who develop severe symptoms after nvH1N1 infection showed Th1 and Th17 'hypercytokinemia', compared to mildly infected patients and healthy controls. The mediators involved with the Th1 and Th17 profiles are known to be involved in antiviral, pro-inflammatory and autoimmune responses. This is the first work reporting the association of a pro-inflamatory immune response with a severe pandemic infection, although it is likely that more studies are needed to understand the detrimental or beneficial roles these cytokines play in the evolution of mild and severe nvH1N1 infection.


id: cord-256237-xiv9vxdp
title: Scanning the horizon: emerging hospital-wide technologies and their impact on critical care
author: Suntharalingam, Ganesh
date: 2005-01-13
url: https://www.ncbi.nlm.nih.gov/pubmed/15693973/
doi: 10.1186/cc3046
abstract:
  This commentary represents a selective survey of developments relevant to critical care. Selected themes include advances in point-of-care diagnostic testing, glucose control, novel microbiological diagnostics and infection control measures, and developments in information technology that have implications for intensive care. The latter encompasses an early example of an artificially intelligent clinical decision support mechanism, the introduction of a national health care information technology programme (UK NPfIT) and its implications, and exotic threats to patient safety due to emergent behaviour in complex information systems.


id: cord-257361-7q0vbvvd
title: Critical care for COVID-19 during a humanitarian crisis—lessons learnt from Yemen
author: Lee, James S.
date: 2020-09-23
txt: ./txt/cord-257361-7q0vbvvd.txt
cache: ./cache/cord-257361-7q0vbvvd.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32972450/
doi: 10.1186/s13054-020-03281-y
abstract: nan
summary:
  In May 2020, Médecins Sans Frontières/Doctors Without Borders (MSF) opened three COVID-19 treatment centres (CTC) in Sanaa and Aden, Yemen [1] . MSF''s three CTCs included wards and ICUs. Invasive mechanical ventilation (IMV) received global attention but is only the visible "tip of the iceberg" for COVID-19 care. Each ICU had contextspecific resource constraints resulting in differences in the package of care related to equipment (ultrasound), investigations (laboratory, x-ray), oxygen supply, nutrition, medications, and staff (specialist doctors, nurses, physiotherapists, social workers, pharmacists, logisticians). Prone positioning had never been performed locally, but successfully taught in all 3 ICUs. Teaching critical care concepts within a few days (which typically take years of training) was challenging enough, but further complexity was added by simultaneously managing patients with a new disease, where medical knowledge of COVID-19 was evolving daily.


id: cord-258087-93yfs7ve
author: Flores, Carlos
date: 2008-10-25
txt: ./txt/cord-258087-93yfs7ve.txt
cache: ./cache/cord-258087-93yfs7ve.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/cc7098
doi: 10.1186/cc7098
summary:
  CONCLUSIONS: Although the quality of association studies seems to have improved over the years, more and better designed studies, including the replication of previous findings, with larger sample sizes extended to population groups other than those of European descent, are needed for identifying firm genetic modifiers of ALI. This quality assessment of genetic association studies with positive findings in susceptibility or outcome of ALI and ARDS identified a total of 29 articles and 16 genes. ACE, angiotensin-converting enzyme; ALI, acute lung injury; ARDS, acute respiratory distress syndrome; CAP, community-acquired pneumonia; CXCL2, chemokine CXC motif ligand 2; F5, coagulation factor V; IL-6, interleukin-6; IL-10, interleukin-10; MBL2, mannose-binding lectin-2; MIF, macrophage migration inhibitory factor; MV, mechanical ventilation; MYLK, myosin light-chain kinase; NFKB1, nuclear factor kappa light polypeptide gene enhancer in B cells; NFKBIA, nuclear factor kappa light polypeptide gene enhancer in B cells inhibitor alpha; NRF2, nuclear factor erythroid-derived 2 factor; PBEF, pre-B cell-enhancing factor; PLAU, plasminogen activator urokinase; SARS, severe acute respiratory syndrome; SFTPB, surfactant pulmonaryassociated protein B; SIRS, systemic inflammatory response syndrome; SNP, single-nucleotide polymorphism; TNF, tumor necrosis factor; TR, tandem repeat (polymorphism); VEGF, vascular endothelial growth factor. Positive genetic association studies with acute lung injury/acute respiratory distress syndrome susceptibility and/or outcome (by year of publication)

title:
  A quality assessment of genetic association studies supporting susceptibility and outcome in acute lung injury

abstract:
  INTRODUCTION: Clinical observations and animal models provide evidence that the development of acute lung injury (ALI), a phenomenon of acute diffuse lung inflammation in critically ill patients, is influenced by genetic factors. Association studies are the main tool for exploring common genetic variations underlying ALI susceptibility and/or outcome. We aimed to assess the quality of positive genetic association studies with ALI susceptibility and/or outcome in adults in order to highlight their consistency and major limitations. METHODS: We conducted a broad PubMed literature search from 1996 to June 2008 for original articles in English supporting a positive association (P ≤ 0.05) of genetic variants contributing to all-cause ALI susceptibility and/or outcome. Studies were evaluated based on current recommendations using a 10-point quality scoring system derived from 14 criteria, and the gene was considered as the unit of replication. Genes were also categorized according to biological processes using the Gene Ontology. RESULTS: Our search identified a total of 29 studies reporting positive findings for 16 genes involved mainly in the response to external stimulus and cell signal transduction. The genes encoding for interleukin-6, mannose-binding lectin, surfactant protein B, and angiotensin-converting enzyme were the most replicated across the studies. On average, the studies had an intermediate quality score (median of 4.62 and interquartile range of 3.33 to 6.15). CONCLUSIONS: Although the quality of association studies seems to have improved over the years, more and better designed studies, including the replication of previous findings, with larger sample sizes extended to population groups other than those of European descent, are needed for identifying firm genetic modifiers of ALI.


id: cord-259747-sl9q63oc
title: Unspecific post-mortem findings despite multiorgan viral spread in COVID-19 patients
author: Remmelink, Myriam
date: 2020-08-12
url: https://www.ncbi.nlm.nih.gov/pubmed/32787909/
doi: 10.1186/s13054-020-03218-5
abstract:
  BACKGROUND: Post-mortem studies can provide important information for understanding new diseases and small autopsy case series have already reported different findings in COVID-19 patients. METHODS: We evaluated whether some specific post-mortem features are observed in these patients and if these changes are related to the presence of the virus in different organs. Complete macroscopic and microscopic autopsies were performed on different organs in 17 COVID-19 non-survivors. Presence of SARS-CoV-2 was evaluated with immunohistochemistry (IHC) in lung samples and with real-time reverse-transcription polymerase chain reaction (RT-PCR) test in the lung and other organs. RESULTS: Pulmonary findings revealed early-stage diffuse alveolar damage (DAD) in 15 out of 17 patients and microthrombi in small lung arteries in 11 patients. Late-stage DAD, atypical pneumocytes, and/or acute pneumonia were also observed. Four lung infarcts, two acute myocardial infarctions, and one ischemic enteritis were observed. There was no evidence of myocarditis, hepatitis, or encephalitis. Kidney evaluation revealed the presence of hemosiderin in tubules or pigmented casts in most patients. Spongiosis and vascular congestion were the most frequently encountered brain lesions. No specific SARS-CoV-2 lesions were observed in any organ. IHC revealed positive cells with a heterogeneous distribution in the lungs of 11 of the 17 (65%) patients; RT-PCR yielded a wide distribution of SARS-CoV-2 in different tissues, with 8 patients showing viral presence in all tested organs (i.e., lung, heart, spleen, liver, colon, kidney, and brain). CONCLUSIONS: In conclusion, autopsies revealed a great heterogeneity of COVID-19-associated organ injury and the remarkable absence of any specific viral lesions, even when RT-PCR identified the presence of the virus in many organs.


id: cord-260069-v5qvqxgy
author: Yuan, Shou-Tao
date: 2020-04-07
txt: ./txt/cord-260069-v5qvqxgy.txt
cache: ./cache/cord-260069-v5qvqxgy.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02863-0
doi: 10.1186/s13054-020-02863-0
abstract: nan
summary:
  title: Practice of novel method of bedside postpyloric tube placement in patients with coronavirus disease 2019 Practice of novel method of bedside postpyloric tube placement in patients with coronavirus disease 2019 Shou-Tao Yuan 1,2 , Wen-Hao Zhang 1,2 , Lei Zou 1,2 , Jia-Kui Sun 1,2* , Ying Liu 1,2 and Qian-Kun Shi 1, 2 During our clinical work against the epidemic of coronavirus disease 2019 (COVID-19) in Wuhan [1] , we observed a high incidence of malnutrition in critically ill patients (data unpublished). Third, the guide wire is shorter in length compared with the tube; therefore, the rigid tip could not damage the digestive tract during our placing procedure There have been three patients who received our novel method of postpyloric tube placement. Considering the less expensive tube and high success rate, our novel blind bedside postpyloric placement may be easier to perform in patients with COVID-19 worldwide. A novel method of blind bedside placement of postpyloric tubes

title:
  Practice of novel method of bedside postpyloric tube placement in patients with coronavirus disease 2019


id: cord-260215-gsnjlhjd
title: Fundamentals of aerosol therapy in critical care
author: Dhanani, Jayesh
date: 2016-10-07
url: https://www.ncbi.nlm.nih.gov/pubmed/27716346/
doi: 10.1186/s13054-016-1448-5
abstract:
  Drug dosing in critically ill patients is challenging due to the altered drug pharmacokinetics–pharmacodynamics associated with systemic therapies. For many drug therapies, there is potential to use the respiratory system as an alternative route for drug delivery. Aerosol drug delivery can provide many advantages over conventional therapy. Given that respiratory diseases are the commonest causes of critical illness, use of aerosol therapy to provide high local drug concentrations with minimal systemic side effects makes this route an attractive option. To date, limited evidence has restricted its wider application. The efficacy of aerosol drug therapy depends on drug-related factors (particle size, molecular weight), device factors, patient-related factors (airway anatomy, inhalation patterns) and mechanical ventilation-related factors (humidification, airway). This review identifies the relevant factors which require attention for optimization of aerosol drug delivery that can achieve better drug concentrations at the target sites and potentially improve clinical outcomes.


id: cord-260822-4bselbkq
title: Unconventional approaches to mechanical ventilation—step-by-step through the COVID-19 crisis
author: Lotz, Christopher
date: 2020-05-18
txt: ./txt/cord-260822-4bselbkq.txt
cache: ./cache/cord-260822-4bselbkq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32423431/
doi: 10.1186/s13054-020-02954-y
abstract: nan
summary:
  Unconventional approaches to mechanical ventilation-step-by-step through the COVID-19 crisis Christopher Lotz , Quirin Notz, Peter Kranke, Markus Kredel and Patrick Meybohm * Health care systems around the world face extreme challenges during the pandemic of SARS-CoV-2. ICU ventilators provide the highest performance, fast responding efficient triggering mechanisms, and often a plethora of different ventilation modes to best suit the individual patient. There is also a case study reporting a oneventilator technique during air medical transport of twin newborns [5] and an article that pressure controlled ventilation was simultaneously achieved in two healthy volunteers via mask ventilation [6] . It is of further importance to emphasize that in case of ICU ventilator shortage, the allocation of the ventilators to each patient requires triage. In case of ICU ventilator shortage, this resource can and should be primarily used with a clear conscience in ARDS patients (Fig. 1) . Use of a single ventilator to support 4 patients: laboratory evaluation of a limited concept


id: cord-262489-cecg3geg
title: COVID-19 pneumonia: phenotype assessment requires bedside tools
author: Zhao, Zhanqi
date: 2020-05-29
txt: ./txt/cord-262489-cecg3geg.txt
cache: ./cache/cord-262489-cecg3geg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32471449/
doi: 10.1186/s13054-020-02973-9
abstract: nan
summary:
  We would like to point out that another phenotype is often presented in COVID-19-associated moderate to severe ARDS, based on our observation and discussions with colleagues treating these patients. Different from the phenotypes described in [1] , the COVID-19 patients we encountered had rather low compliance and their lungs were non-recruitable, despite of large amount of non-aerated tissue. When assessing the lung recruitability with either the bedside estimates suggested in [2] , or with electrical impedance tomography (EIT) [3, 4] , we found that instead of recruiting non-aerated lung tissue, increasing PEEP to around 15 cmH 2 O rather induced overdistension in previously ventilated regions. Lung recruitment in patients with the acute respiratory distress syndrome Lung recruitability in SARS-CoV-2 associated acute respiratory distress syndrome: a single-center, observational study The authors equally contributed to the idea presented in the manuscript, which is derived from the observation of numerous COVID-19 patients treated in the intensive care.


id: cord-263346-pu1jci26
title: Using echocardiography to guide the treatment of novel coronavirus pneumonia
author: Peng, Qian-Yi
date: 2020-04-10
txt: ./txt/cord-263346-pu1jci26.txt
cache: ./cache/cord-263346-pu1jci26.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02856-z
doi: 10.1186/s13054-020-02856-z
abstract: nan
summary:
  Abnormal findings include (1) hyperdynamic cardiac function, presented as the increase of cardiac output (CO) and ejection faction (EF) of the left ventricular (LV), with/without the decrease of peripheral vascular resistance, which is often seen in the early stage following the systemic inflammatory response; (2) acute stress-induced (takotsubo) cardiomyopathy, characterized as LV segmental contraction abnormalities and apical ballooning [1] ; (3) right ventricular (RV) enlargement and acute pulmonary hypertension, which are mainly caused by "internal factors" (including alveolar and pulmonary capillary damage caused by inflammation, hypoxia, and hypercapnia, leading to the increase of RV afterload) and "external factors" (including fluid overload, which causes the increase of RV preload, and unsuitable mechanical ventilation parameter setting, which affects the cardiac function by cardiopulmonary interaction); further, LV function will be affected because the right and left hearts are in the same pericardium; and (4) diffuse myocardial inhibition in the late stage, which is often caused by severe hypoxia, and long term of anoxia and inflammation.


id: cord-263568-ea3k2i69
title: Could the severity of COVID-19 be increased by low gastric acidity?
author: Price, Elizabeth
date: 2020-07-22
txt: ./txt/cord-263568-ea3k2i69.txt
cache: ./cache/cord-263568-ea3k2i69.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32698857/
doi: 10.1186/s13054-020-03182-0
abstract: nan
summary:
  title: Could the severity of COVID-19 be increased by low gastric acidity? Could the severity of COVID-19 be increased by low gastric acidity? Could low gastric acidity increase the risk of a severe COVID-19 illness? Although it is primarily a respiratory infection, gastrointestinal involvement from swallowed coronaviruses is reported for SARS-CoV-2 (the virus of COVID-19 [1, 2] ), as well as SARS-CoV-1 [3] and MERS-CoV viruses [4] . As well as protection related to immunological factors and possible differences in the ACE2 receptor concentrations in their lungs, children (other than infants) generally have good levels of gastric acid. To determine whether gastric acid gives some protection from COVID-19, the amount of antacids and acid-reducing drugs used by patients with severe infections could be compared with the amount used by patients with mild or no disease. If there is evidence for some protection by gastric acidity, stopping antacids and acid-reducing medications could be considered, particularly at times when patients are at increased risk.


id: cord-265022-p5cab562
title: COVID-19: ICU delirium management during SARS-CoV-2 pandemic
author: Kotfis, Katarzyna
date: 2020-04-28
url: https://doi.org/10.1186/s13054-020-02882-x
doi: 10.1186/s13054-020-02882-x
abstract:
  The novel coronavirus, SARS-CoV-2-causing Coronavirus Disease 19 (COVID-19), emerged as a public health threat in December 2019 and was declared a pandemic by the World Health Organization in March 2020. Delirium, a dangerous untoward prognostic development, serves as a barometer of systemic injury in critical illness. The early reports of 25% encephalopathy from China are likely a gross underestimation, which we know occurs whenever delirium is not monitored with a valid tool. Indeed, patients with COVID-19 are at accelerated risk for delirium due to at least seven factors including (1) direct central nervous system (CNS) invasion, (2) induction of CNS inflammatory mediators, (3) secondary effect of other organ system failure, (4) effect of sedative strategies, (5) prolonged mechanical ventilation time, (6) immobilization, and (7) other needed but unfortunate environmental factors including social isolation and quarantine without family. Given early insights into the pathobiology of the virus, as well as the emerging interventions utilized to treat the critically ill patients, delirium prevention and management will prove exceedingly challenging, especially in the intensive care unit (ICU). The main focus during the COVID-19 pandemic lies within organizational issues, i.e., lack of ventilators, shortage of personal protection equipment, resource allocation, prioritization of limited mechanical ventilation options, and end-of-life care. However, the standard of care for ICU patients, including delirium management, must remain the highest quality possible with an eye towards long-term survival and minimization of issues related to post-intensive care syndrome (PICS). This article discusses how ICU professionals (e.g., physicians, nurses, physiotherapists, pharmacologists) can use our knowledge and resources to limit the burden of delirium on patients by reducing modifiable risk factors despite the imposed heavy workload and difficult clinical challenges posed by the pandemic.


id: cord-267348-bkirv9pt
author: Sakano, Takashi
date: 2020-08-18
txt: ./txt/cord-267348-bkirv9pt.txt
cache: ./cache/cord-267348-bkirv9pt.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03234-5
doi: 10.1186/s13054-020-03234-5
abstract: nan
summary:
  title: Above and beyond: biofilm and the ongoing search for strategies to reduce ventilator-associated pneumonia (VAP) [1] that compared biofilm formation on three endotracheal tube (ETT) types with the finding that biofilm formation was reduced in silicone and noble-metal coated ETTs compared to uncoated ETTs. Their findings have significant implications during the current pandemic given the prolonged intubation times of COVID-19 patients and many develop superimposed pneumonias during their hospital course. It is intriguing that simply changing the ETT''s coating may have significant implications in this patient population with already limited pulmonary reserve that is unable to tolerate additional insults to their lung from a ventilator-associated pneumonia (VAP). However, given the prolonged intubation times of COVID-19 patients, it is likely that the ETT biofilm burden will be substantial no matter which surface coating is utilized. It is widely accepted that two mechanisms lead to VAP: aspiration of oral-gastric contents and microbial biofilm development on the ETT.

title:
  Above and beyond: biofilm and the ongoing search for strategies to reduce ventilator-associated pneumonia (VAP)


id: cord-267942-ykl2xy7y
author: Stiers, Michiel
date: 2020-08-27
txt: ./txt/cord-267942-ykl2xy7y.txt
cache: ./cache/cord-267942-ykl2xy7y.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03248-z
doi: 10.1186/s13054-020-03248-z
abstract: nan
summary:
  We have developed a modified shared ventilator design that allows for individualization of tidal volumes and driving pressures, positive end-expiratory pressure (PEEP), and inspired oxygen fraction (FiO 2 ) [6] , which can thus substantially individualize the delivered breaths, removing the need of pairing (see Fig. 1 ). We have now successfully used this ventilator setup in an in vivo model in a pair of ventilated sheep with different lung compliance, further supporting the potential of this shared ventilator setup as a lifesaving intervention in a crisis setting. We demonstrated the potential to modulate delivered tidal volumes and pressures, PEEP and FiO 2 in a shared ventilator setup in this in vivo model. This setup has allowed to safely ventilate a pair of animals with different lung compliance with a single ventilator, while monitoring and adjusting individual airway pressures and tidal volumes.

title:
  Successful ventilation of two animals with a single ventilator: individualized shared ventilator setup in an in vivo model


id: cord-270298-zv0t3d0m
title: Recently published papers: pulmonary care, pandemics, and eugenics in surviving sepsis?
author: Bouch, Christopher
date: 2006-02-01
txt: ./txt/cord-270298-zv0t3d0m.txt
cache: ./cache/cord-270298-zv0t3d0m.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/16469134/
doi: 10.1186/cc4820
summary:
  Health-care-associated pneumonia (HCAP) refers to a pulmonary infection that develops in individuals recently hospitalised, or undergoing renal replacement therapy or other long-term out-patient care. However, no study had looked at the pathogens of both HCAP and community-acquired pneumonia (CAP) and compared them with those of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). The study defined 4,543 positive pneumonias, of which 2,221 were CAP, 988 HCAP, 853 HAP and 499 VAP. The authors suggest that HCAP is a distinct entity from CAP and should be treated as a hospital-acquired type of infection from first presentation; the paper certainly supports the recently published guidelines from the American Thoracic Society [2] . The authors suggest that mitochondrial DNA haplotyping offers a new means of risk stratification in severe sepsis, although further work is clearly needed to identify possible therapeutic avenues.

abstract:
  Respiratory failure is one of the leading admission diagnoses on the critical care unit, and the journals have reflected this over the past few months. An understanding of the aetiology of pulmonary sepsis is important but your choice of ventilator gas humidification system is not. There are prophecies of more pandemics, but panic is futile because survival is all down to your genes.


id: cord-271751-46oo9xv5
title: Shining a light on the evidence for hydroxychloroquine in SARS-CoV-2
author: Ingraham, Nicholas E.
date: 2020-04-28
txt: ./txt/cord-271751-46oo9xv5.txt
cache: ./cache/cord-271751-46oo9xv5.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02894-7
doi: 10.1186/s13054-020-02894-7
abstract: nan
summary:
  Chloroquine and hydroxychloroquine seem effective in killing SARS-CoV in vitro [1, 3] . Recent reports show it also may be effective at killing SARS-CoV-2-infected cells in vitro [4] . To date, no pre-clinical studies have evaluated the efficacy of hydroxychloroquine in the current SARS-CoV-2 pandemic. A recent article published in Chinese found no benefit with chloroquine in a 1:1 randomized trial with 30 patients [6] . Until data from randomized controlled trials are available, we suggest caution utilizing hydroxychloroquine off label for patients with COVID-19. There are currently no evidence supporting hydroxychloroquine as prophylaxis, but unfortunately these data are being extrapolated to the indication potentially resulting in drug shortages for patients with rheumatic diseases who require this medication. Preliminary study of hydroxychloroquine sulfate in treating common coronavirus disease (COVID-19) patients in 2019 Hydroxychloroquine and azithromycin as a treatment of COVID-19: preliminary results of an open-label nonrandomized clinical trial


id: cord-275012-fkawgh0e
title: Inhaled nitric oxide in patients admitted to intensive care unit with COVID-19 pneumonia
author: Tavazzi, Guido
date: 2020-08-17
txt: ./txt/cord-275012-fkawgh0e.txt
cache: ./cache/cord-275012-fkawgh0e.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03222-9
doi: 10.1186/s13054-020-03222-9
abstract: nan
summary:
  title: Inhaled nitric oxide in patients admitted to intensive care unit with COVID-19 pneumonia Only 4 (25%) patients were responders, of whom 3 iNO is a free radical gas that diffuses across the alveolar-capillary membrane into the subjacent smooth muscle of pulmonary vessels enhancing endotheliumdependent vasorelaxation and improving oxygenation by increasing blood flow to ventilated lung units [3] . Overall, iNO did not improve oxygenation in COVID-19 patients with refractory hypoxaemia, when administered as a rescue treatment after prone position. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.Ethics approval and consent to participate Informed consent was collected following the ad hoc procedures defined by the local Ethics Committee of Fondazione Policlinico San Matteo IRCCS for the COVID-19 pandemic.Competing interests FM received fees for lectures from GE Healthcare, Hamilton Medical, SEDA SpA, outside the present work.


id: cord-275154-vwnpred5
title: Th1 and Th17 hypercytokinemia as early host response signature in severe pandemic influenza
author: Bermejo-Martin, Jesus F
date: 2009-12-11
url: https://www.ncbi.nlm.nih.gov/pubmed/20003352/
doi: 10.1186/cc8208
abstract:
  INTRODUCTION: Human host immune response following infection with the new variant of A/H1N1 pandemic influenza virus (nvH1N1) is poorly understood. We utilize here systemic cytokine and antibody levels in evaluating differences in early immune response in both mild and severe patients infected with nvH1N1. METHODS: We profiled 29 cytokines and chemokines and evaluated the haemagglutination inhibition activity as quantitative and qualitative measurements of host immune responses in serum obtained during the first five days after symptoms onset, in two cohorts of nvH1N1 infected patients. Severe patients required hospitalization (n = 20), due to respiratory insufficiency (10 of them were admitted to the intensive care unit), while mild patients had exclusively flu-like symptoms (n = 15). A group of healthy donors was included as control (n = 15). Differences in levels of mediators between groups were assessed by using the non parametric U-Mann Whitney test. Association between variables was determined by calculating the Spearman correlation coefficient. Viral load was performed in serum by using real-time PCR targeting the neuraminidase gene. RESULTS: Increased levels of innate-immunity mediators (IP-10, MCP-1, MIP-1β), and the absence of anti-nvH1N1 antibodies, characterized the early response to nvH1N1 infection in both hospitalized and mild patients. High systemic levels of type-II interferon (IFN-γ) and also of a group of mediators involved in the development of T-helper 17 (IL-8, IL-9, IL-17, IL-6) and T-helper 1 (TNF-α, IL-15, IL-12p70) responses were exclusively found in hospitalized patients. IL-15, IL-12p70, IL-6 constituted a hallmark of critical illness in our study. A significant inverse association was found between IL-6, IL-8 and PaO2 in critical patients. CONCLUSIONS: While infection with the nvH1N1 induces a typical innate response in both mild and severe patients, severe disease with respiratory involvement is characterized by early secretion of Th17 and Th1 cytokines usually associated with cell mediated immunity but also commonly linked to the pathogenesis of autoimmune/inflammatory diseases. The exact role of Th1 and Th17 mediators in the evolution of nvH1N1 mild and severe disease merits further investigation as to the detrimental or beneficial role these cytokines play in severe illness.


id: cord-276561-b4cspbuf
author: Liaudet, Lucas
date: 2020-06-08
url: https://www.ncbi.nlm.nih.gov/pubmed/32513242/
doi: 10.1186/s13054-020-03055-6
abstract: nan
title:
  Blocking mineralocorticoid receptor with spironolactone may have a wide range of therapeutic actions in severe COVID-19 disease


id: cord-276856-88d3vzbs
title: Single ventilator for multiple patients during COVID19 surge: matching and balancing patients
author: Petersen, Lonnie G.
date: 2020-06-18
txt: ./txt/cord-276856-88d3vzbs.txt
cache: ./cache/cord-276856-88d3vzbs.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32552914/
doi: 10.1186/s13054-020-03041-y
abstract: nan
summary:
  title: Single ventilator for multiple patients during COVID19 surge: matching and balancing patients With a potential COVID19-induced ventilator shortage, supporting multiple patients on a single ventilator seems a simple solution to maximize resources. Beyond cross-contamination and increased dead space, matching patients to ensure appropriate individual ventilation peak pressures (P peak ), tidal volumes (V tidal ), and positive endexpiratory pressures (PEEP) is a concern, especially given the dynamic clinical presentation of the COVID19 patients with complicated acute respiratory distress syndrome (ARDS). One-way valves on both inspiratory and expiratory limbs ensured unidirectional flow, which both reduces functional dead space and the risk of crosscontamination between patient A and B, and seemingly also facilitated stable ventilation of B as A deteriorated. Finally, each class of ventilators requires a specific set up; if the method is considered, use the calm before the patient surge to familiarize, and ameliorate the many risks associated with sharing a ventilator. A single ventilator for multiple simulated patients to meet disaster surge


id: cord-276904-lmqschxy
author: Courcelle, Romain
date: 2020-07-19
txt: ./txt/cord-276904-lmqschxy.txt
cache: ./cache/cord-276904-lmqschxy.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32684169/
doi: 10.1186/s13054-020-03164-2
abstract: nan
summary:
  title: Neuromuscular blocking agents (NMBA) for COVID-19 acute respiratory distress syndrome: a multicenter observational study The benefit of neuromuscular blocking agents (NMBA) in acute respiratory distress syndrome (ARDS) is debated [1] [2] [3] . COVID-19 ARDS appears different from classical ARDS [4] , and we aimed to describe the use of NMBA and analyze their association with day 28 outcome, in a multicentric observational prospective study (21 ICUs from Belgium and France). These latter had higher plateau pressure and rate of prone position and were more frequently in French ICUs. After propensity score matching of 206 patients, the rate and time to breathing without assistance at day 28 did not significantly differ between groups (Table 1 and Fig. 1 ). One can be surprised to observe that matched on severity, time to extubation at day 28 was similar between patients with short or long course of NMBA.

title:
  Neuromuscular blocking agents (NMBA) for COVID-19 acute respiratory distress syndrome: a multicenter observational study


id: cord-278249-vvhq9vgp
title: CXCL10 could drive longer duration of mechanical ventilation during COVID-19 ARDS
author: Blot, Mathieu
date: 2020-11-02
txt: ./txt/cord-278249-vvhq9vgp.txt
cache: ./cache/cord-278249-vvhq9vgp.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33138839/
doi: 10.1186/s13054-020-03328-0
summary:
  In addition, since most patients need to undergo mechanical ventilation in this context, ventilator-induced lung injury (VILI) could exacerbate tissue damage as well as local and systemic inflammation, thus acting as a "second hit." Our team has previously shown that mitochondrial alarmins (i.e., mitochondrial DNA) are released by human epithelial cells submitted to cyclic stretch, and these alarmins are also recovered from bronchoalveolar lavage (BAL) fluid obtained from either ventilated rabbits or ARDS patients. This comprehensive evaluation of systemic and pulmonary immune response showed that the higher CXCL10 concentrations in both the systemic and alveolar compartments of patients with COVID-19 ARDS were associated with a longer duration of mechanical ventilation. Finally, in both COVID-19 and non-COVID-19 patients, higher mitochondrial DNA concentrations in the plasma and ELF compartment were highly correlated with alveolar inflammation, as assessed by BALF cell count and ELF IL-8 and IL-1β concentrations.

abstract:
  BACKGROUND: COVID-19-related ARDS has unique features when compared with ARDS from other origins, suggesting a distinctive inflammatory pathogenesis. Data regarding the host response within the lung are sparse. The objective is to compare alveolar and systemic inflammation response patterns, mitochondrial alarmin release, and outcomes according to ARDS etiology (i.e., COVID-19 vs. non-COVID-19). METHODS: Bronchoalveolar lavage fluid and plasma were obtained from 7 control, 7 non-COVID-19 ARDS, and 14 COVID-19 ARDS patients. Clinical data, plasma, and epithelial lining fluid (ELF) concentrations of 45 inflammatory mediators and cell-free mitochondrial DNA were measured and compared. RESULTS: COVID-19 ARDS patients required mechanical ventilation (MV) for significantly longer, even after adjustment for potential confounders. There was a trend toward higher concentrations of plasma CCL5, CXCL2, CXCL10, CD40 ligand, IL-10, and GM-CSF, and ELF concentrations of CXCL1, CXCL10, granzyme B, TRAIL, and EGF in the COVID-19 ARDS group compared with the non-COVID-19 ARDS group. Plasma and ELF CXCL10 concentrations were independently associated with the number of ventilator-free days, without correlation between ELF CXCL-10 and viral load. Mitochondrial DNA plasma and ELF concentrations were elevated in all ARDS patients, with no differences between the two groups. ELF concentrations of mitochondrial DNA were correlated with alveolar cell counts, as well as IL-8 and IL-1β concentrations. CONCLUSION: CXCL10 could be one key mediator involved in the dysregulated immune response. It should be evaluated as a candidate biomarker that may predict the duration of MV in COVID-19 ARDS patients. Targeting the CXCL10-CXCR3 axis could also be considered as a new therapeutic approach. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03955887


id: cord-278838-qraq5aho
title: Severe varicella-zoster virus pneumonia: a multicenter cohort study
author: Mirouse, Adrien
date: 2017-06-07
url: https://www.ncbi.nlm.nih.gov/pubmed/28592328/
doi: 10.1186/s13054-017-1731-0
abstract:
  BACKGROUND: Pneumonia is a dreaded complication of varicella-zoster virus (VZV) infection in adults; however, the data are limited. Our objective was to investigate the clinical features, management, and outcomes of critically ill patients with VZV-related community-acquired pneumonia (VZV-CAP). METHODS: This was an observational study of patients with VZV-CAP admitted to 29 intensive care units (ICUs) from January 1996 to January 2015. RESULTS: One hundred and two patients with VZV-CAP were included. Patients were young (age 39 years (interquartile range 32–51)) and 53 (52%) were immunocompromised. Time since respiratory symptom onset was 2 (1–3) days. There was a seasonal distribution of the disease, with more cases during spring and winter time. All but four patients presented with typical skin rash on ICU admission. Half the patients received mechanical ventilation within 1 (1–2) day following ICU admission (the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO(2)/FiO(2)) = 150 (80–284), 80% with acute respiratory distress syndrome (ARDS)). Sequential Organ Failure Assessment (SOFA) score on day 1 (odds ratio (OR) 1.90 (1.33–2.70); p < 0.001), oxygen flow at ICU admission (OR 1.25 (1.08–1.45); p = 0.004), and early bacterial co-infection (OR 14.94 (2.00–111.8); p = 0.009) were independently associated with the need for mechanical ventilation. Duration of mechanical ventilation was 14 (7–21) days. ICU and hospital mortality rates were 17% and 24%, respectively. All patients were treated with aciclovir and 10 received adjunctive therapy with steroids. Compared to 60 matched steroid-free controls, patients treated with steroids had a longer mechanical ventilation duration, ICU length of stay, and a similar hospital mortality, but experienced more ICU-acquired infections. CONCLUSIONS: Severe VZV-CAP is responsible for an acute pulmonary involvement associated with a significant morbidity and mortality. Steroid therapy did not influence mortality, but increased the risk of superinfection. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-017-1731-0) contains supplementary material, which is available to authorized users.


id: cord-280129-a97rvtzl
author: Honore, Patrick M.
date: 2020-06-16
txt: ./txt/cord-280129-a97rvtzl.txt
cache: ./cache/cord-280129-a97rvtzl.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32546201/
doi: 10.1186/s13054-020-03088-x
abstract: nan
summary:
  authors: Honore, Patrick M.; Barreto Gutierrez, Leonel; Kugener, Luc; Redant, Sebastien; Attou, Rachid; Gallerani, Andrea; De Bels, David title: Liver injury without liver failure in COVID-19 patients: how to explain, in some cases, elevated ammonia without hepatic decompensation Liver injury without liver failure in COVID-19 patients: how to explain, in some cases, elevated ammonia without hepatic decompensation Patrick M. Both patients were treated with classical medical therapy including lactulose, but, despite increasing doses of lactulose for 3 days, ammonia levels remained unchanged. Retrospectively, we hypothesize that the pre-admission diarrhea may have resulted in secondary carnitine deficiency, as described in the literature [3] , leading to hyperammonemia unresponsive to medical therapy [4] . As we did not measure serum carnitine levels and we did not supply the patients with carnitine supplementation, the diagnosis of carnitine deficiency in these cases remains only a hypothesis. Liver injury in critically ill patients with COVID-19: a case series

title:
  Liver injury without liver failure in COVID-19 patients: how to explain, in some cases, elevated ammonia without hepatic decompensation


id: cord-280233-avmisu31
title: Safe doubling of ventilator capacity: a last resort proposal for last resorts
author: Chase, J. Geoffrey
date: 2020-05-14
txt: ./txt/cord-280233-avmisu31.txt
cache: ./cache/cord-280233-avmisu31.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02945-z
doi: 10.1186/s13054-020-02945-z
abstract: nan
summary:
  In light of the COVID-19 pandemic, this commonsense approach was recently clarified in a SCCM-ASA-AARC-AACN-ASPF-CHEST consensus statement on the Society of Critical Care Medicine (SCCM) website [1] : ''We recommend that clinicians do not attempt to ventilate more than one patient with a single ventilator while any clinically proven, safe, and reliable therapy remains available (ie, in a dire, temporary emergency)'' [1] . In-parallel is a critical point, as inspiration and expiration all take place at the same time, so there is thus no change to respiratory rate (RR) and tidal volume or driving pressure are adjusted for the number of patients. Instead of the same RR and higher tidal volume or driving pressure, in-series breathing doubles the RR and keeps the other ventilator settings the same. PC driving pressure and VC tidal volume would have to be the same as ventilators currently do not have the capability to enable alternating breath settings.


id: cord-280278-gq1hnnwh
author: Chi, Meng
date: 2020-06-08
url: https://www.ncbi.nlm.nih.gov/pubmed/32513230/
doi: 10.1186/s13054-020-02985-5
abstract: nan
title:
  A simple custom appliance against droplet and aerosol transmission of COVID-19 during advanced airway management


id: cord-281191-n9gerpwy
title: Autopsy in critical illness: is it obsolete?
author: Herridge, Margaret S
date: 2003-09-26
txt: ./txt/cord-281191-n9gerpwy.txt
cache: ./cache/cord-281191-n9gerpwy.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/14624674/
doi: nan
summary:
  It will include a brief discussion of selection bias in autopsy studies, the important role autopsy plays in tracking disease prevalence over time, its characterization of newly emerging diseases, its contribution to education and quality control programs, and its role in clinical decision-making. Fernandez-Segoviano and colleagues [4] evaluated 100 consecutive autopsies from patients in a multidisciplinary intensive care unit and noted a discrepancy rate of 22% between premortem and postmortem diagnosis. Blosser and colleagues reported a discrepancy rate of 27% on 41 autopsies from medical intensive care unit patients [5] . Autopsy findings may have important implications for quality control programs in the intensive care unit. Withdrawal of life-sustaining treatment is a frequent mode of death in critically ill bone marrow transplant patients, and end-of-life decision-making is based on clinical data. Discrepancies between clinical and post mortem diagnoses in critically ill patients: an observational study

abstract:
  The autopsy continues to have important implications for patient management in critical illness. It is not obsolete. Autopsy data help us to track shifts in disease prevalence over time and to heighten surveillance for serious diagnoses that are commonly missed. These data help us to identify important contributors to death that may be remediated through quality assurance and control programs. In discrete patient subsets, information from autopsies may reinforce the degree of certainty surrounding end-of-life decision-making.


id: cord-281663-c2okrt2b
author: Sella, Nicolò
date: 2020-09-01
txt: ./txt/cord-281663-c2okrt2b.txt
cache: ./cache/cord-281663-c2okrt2b.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03242-5
doi: 10.1186/s13054-020-03242-5
abstract: nan
summary:
  title: Positive end-expiratory pressure titration in COVID-19 acute respiratory failure: electrical impedance tomography vs. Electrical impedance tomography (EIT) offers this opportunity by bedside estimating both alveolar collapse and lung overdistension throughout a decremental PEEP trial [5] . This investigation (Ethics Committee approval: Ref: 4853/AO/20-AOP2012) aims to assess the agreement between EIT-based PEEP values and those recommended by the higher and lower PEEP/FiO 2 tables [6] in a series of consecutive intubated COVID-19 hARF patients, admitted to intensive care unit at our institution. In conclusion, we confirm the rationale for individualized PEEP setting in COVID-19 patients intubated for Fig. 1 Bland-Altman plot, evaluating the agreement between PEEP EIT and the PEEP values proposed by the higher (a) and lower (b) PEEP/FiO 2 tables from the ALVEOLI trial [6] . Electrical impedance tomography for positive end-expiratory pressure titration in COVID-19-related acute respiratory distress syndrome Higher versus lower positive endexpiratory pressures in patients with the acute respiratory distress syndrome

title:
  Positive end-expiratory pressure titration in COVID-19 acute respiratory failure: electrical impedance tomography vs. PEEP/FiO(2) tables


id: cord-281711-whr4pfx9
title: Ethics guidelines on COVID-19 triage—an emerging international consensus
author: Joebges, Susanne
date: 2020-05-06
txt: ./txt/cord-281711-whr4pfx9.txt
cache: ./cache/cord-281711-whr4pfx9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32375855/
doi: 10.1186/s13054-020-02927-1
abstract: nan
summary:
  Whereas some countries have been exposed very early [3] , others had the opportunity to prepare for the ethical challenges that emerge when intensive care resources become scarce. Whereas some guidelines (CH, A) refer to shortterm survival only as a key triaging criterion, others either do not specify survival (UK, BE) or explicitly allow for the possibility that long-term prognosis (G) or a reduced lifespan, due to old age or to comorbidities, could affect a patient''s access to a ventilator (I). Respect for the patient''s will, fair distribution, and maximization of benefits based on chance of survival are at the heart of the recently issued triaging guidelines. The allocation of scarce resources has been debated within medical ethics for a long time, and procedural criteria have been defined. Fair allocation of scarce medical resources in the time of Covid-19 Clinical ethics recommendation for the allocation of intensive care treatments, in exceptional COVID-19 pandemic: triage for intensive-care treatment under resource scarcity


id: cord-282571-ilf73g71
title: Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19
author: Ni, Wentao
date: 2020-07-13
txt: ./txt/cord-282571-ilf73g71.txt
cache: ./cache/cord-282571-ilf73g71.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32660650/
doi: 10.1186/s13054-020-03120-0
summary:
  Both SARS-CoV-2 and SARS-CoV enter host cells via the angiotensin-converting enzyme 2 (ACE2) receptor, which is expressed in various human organs. In addition to the direct viral effects and inflammatory and immune factors associated with COVID-19 pathogenesis, ACE2 downregulation and the imbalance between the RAS and ACE2/angiotensin-(1–7)/MAS after infection may also contribute to multiple organ injury in COVID-19. Autopsies of SARS patients showed that SARS-CoV infection can cause injury to multiple organs, such as the heart, kidney, liver, skeletal muscle, central nervous system, and adrenal and thyroid glands, besides the lungs [30, 31] . Several studies have shown that SARS-CoV infection can downregulate ACE2 expression on cells, thereby disrupting the physiological balance between ACE/ACE2 and Ang-II/angiotensin-(1-7) and subsequently causing severe organ injury [44] [45] [46] [47] . Expression of elevated levels of pro-inflammatory cytokines in SARS-CoV-infected ACE2+ cells in SARS patients: relation to the acute lung injury and pathogenesis of SARS

abstract:
  ABSTRACT: An outbreak of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that started in Wuhan, China, at the end of 2019 has become a global pandemic. Both SARS-CoV-2 and SARS-CoV enter host cells via the angiotensin-converting enzyme 2 (ACE2) receptor, which is expressed in various human organs. We have reviewed previously published studies on SARS and recent studies on SARS-CoV-2 infection, named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO), confirming that many other organs besides the lungs are vulnerable to the virus. ACE2 catalyzes angiotensin II conversion to angiotensin-(1–7), and the ACE2/angiotensin-(1–7)/MAS axis counteracts the negative effects of the renin-angiotensin system (RAS), which plays important roles in maintaining the physiological and pathophysiological balance of the body. In addition to the direct viral effects and inflammatory and immune factors associated with COVID-19 pathogenesis, ACE2 downregulation and the imbalance between the RAS and ACE2/angiotensin-(1–7)/MAS after infection may also contribute to multiple organ injury in COVID-19. The SARS-CoV-2 spike glycoprotein, which binds to ACE2, is a potential target for developing specific drugs, antibodies, and vaccines. Restoring the balance between the RAS and ACE2/angiotensin-(1–7)/MAS may help attenuate organ injuries. GRAPHICAL ABSTRACT: SARS-CoV-2 enters lung cells via the ACE2 receptor. The cell-free and macrophage-phagocytosed virus can spread to other organs and infect ACE2-expressing cells at local sites, causing multi-organ injury. [Image: see text]


id: cord-286771-77hs34jm
author: Cruces, Pablo
date: 2020-08-10
txt: ./txt/cord-286771-77hs34jm.txt
cache: ./cache/cord-286771-77hs34jm.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03197-7
doi: 10.1186/s13054-020-03197-7
summary:
  Protective lowtidal volume (Vt) mechanical ventilation (MV), including delivering a physiologic low Vt adjusted by ideal body weight, is currently the standard of care for patients requiring invasive respiratory support, like moderate and severe ARDS. Additionally, we found a significant progression of regional Fig. 2 Regional volumetric strain maps in a 3-h murine model of patient self-inflicted lung injury randomized to two groups: Group I: subjects with induced lung injury on low tidal volume mechanical ventilation at the beginning of the experiment (T1) and at the end of the experiment (T3) (upper left and right panels). Ventilation-induced lung injury exists in spontaneously breathing patients with acute respiratory failure: yes Can high-flow nasal cannula reduce the rate of endotracheal intubation in adult patients with acute respiratory failure compared with conventional oxygen therapy and noninvasive positive pressure ventilation?: a systematic review and meta-analysis

title:
  A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection

abstract:
  Deterioration of lung function during the first week of COVID-19 has been observed when patients remain with insufficient respiratory support. Patient self-inflicted lung injury (P-SILI) is theorized as the responsible, but there is not robust experimental and clinical data to support it. Given the limited understanding of P-SILI, we describe the physiological basis of P-SILI and we show experimental data to comprehend the role of regional strain and heterogeneity in lung injury due to increased work of breathing. In addition, we discuss the current approach to respiratory support for COVID-19 under this point of view.


id: cord-286963-rsmgx2xr
author: Choi, Yoon Hee
date: 2020-03-23
txt: ./txt/cord-286963-rsmgx2xr.txt
cache: ./cache/cord-286963-rsmgx2xr.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-2822-x
doi: 10.1186/s13054-020-2822-x
summary:
  title: Renal replacement therapy is independently associated with a lower risk of death in patients with severe acute kidney injury treated with targeted temperature management after out-of-hospital cardiac arrest BACKGROUND: The effect of renal replacement therapy (RRT) on the outcomes of severe acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) is uncertain. This study aimed to evaluate the association of RRT with 6-month mortality in patients with severe AKI treated with targeted temperature management (TTM) after OHCA. Acute kidney injury (AKI) develops frequently after out-of-hospital cardiac arrest (OHCA) and is associated with long-term mortality and poor neurological outcomes [1] [2] [3] [4] [5] [6] [7] [8] . Additional data from well-designed Table 3 Factors associated with 6-month mortality in patients who developed stage 3 acute kidney injury after an out-of-hospital cardiac arrest observational studies will be needed to clarify the longterm mortality of RRT group after OHCA.

title:
  Renal replacement therapy is independently associated with a lower risk of death in patients with severe acute kidney injury treated with targeted temperature management after out-of-hospital cardiac arrest

abstract:
  BACKGROUND: The effect of renal replacement therapy (RRT) on the outcomes of severe acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) is uncertain. This study aimed to evaluate the association of RRT with 6-month mortality in patients with severe AKI treated with targeted temperature management (TTM) after OHCA. METHODS: This was a retrospective analysis of a prospectively collected multicentre observational cohort study that included adult OHCA patients treated with TTM across 22 hospitals in South Korea between October 2015 and December 2018. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. The primary outcome was 6-month mortality and the secondary outcome was cerebral performance category (CPC) at 6 months. Multivariate Cox regression analysis was performed to define the role of RRT in stage 3 AKI. RESULTS: Among 10,426 patients with OHCA, 1373 were treated with TTM. After excluding those who died within 48 h of return of spontaneous circulation (ROSC) and those with pre-arrest chronic kidney disease, our study cohort comprised 1063 patients. AKI developed in 590 (55.5%) patients and 223 (21.0%) had stage 3 AKI. Among them, 115 (51.6%) were treated with RRT. The most common treatment modality among RRT patients was continuous renal replacement therapy (111 [96.5%]), followed by intermittent haemodialysis (4 [3.5%]). The distributions of CPC (1–5) at 6 months for the non-RRT vs. the RRT group were 3/108 (2.8%) vs. 12/115 (10.4%) for CPC 1, 0/108 (0.0%) vs. 1/115 (0.9%) for CPC 2, 1/108 (0.9%) vs. 3/115 (2.6%) for CPC 3, 6/108 (5.6%) vs. 6/115 (5.2%) for CPC 4, and 98/108 (90.7%) vs. 93/115 (80.9%) for CPC 5, respectively (P = 0.01). The RRT group had significantly lower 6-month mortality than the non-RRT group (93/115 [81%] vs. 98/108 [91%], P = 0.04). Multivariate Cox regression analyses showed that RRT was independently associated with a lower risk of death in patients with stage 3 AKI (hazard ratio, 0.569 [95% confidence interval, 0.377–0.857, P = 0.01]). CONCLUSION: Dialysis interventions were independently associated with a lower risk of death in patients with stage 3 AKI treated with TTM after OHCA.


id: cord-287333-h89tmi0w
author: Sanfilippo, Filippo
date: 2020-05-26
txt: ./txt/cord-287333-h89tmi0w.txt
cache: ./cache/cord-287333-h89tmi0w.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32456692/
doi: 10.1186/s13054-020-02998-0
abstract: nan
summary:
  title: The importance of a "socially responsible" approach during COVID-19: the invisible heroes of science in Italy The importance of a "socially responsible" approach during COVID-19: the invisible heroes of science in Italy Filippo Sanfilippo 1* , Elena Bignami 2 , Ferdinando Luca Lorini 3 and Marinella Astuto 1 We summarize the "socially responsible" approach of our ICU community in three key points. In summary, Italian ICU physicians avoided "compulsory public notoriety," behaving as "invisible heroes of science." Unfortunately, the same has not happened in other disciplines with compulsory appearance on TV, social media, and newspapers by physicians with low h-index, predatory publication attitude, and no experience in coronavirus delivering highly misleading and scientifically unsupported information. A "socially responsible" approach to public information should be implemented to all fields involved in COVID-19, and the one delivered by the Italian ICU "invisible heroes" should be a leading worldwide example for other disciplines and countries.

title:
  The importance of a “socially responsible” approach during COVID-19: the invisible heroes of science in Italy


id: cord-287490-g1r9zew2
author: Despres, Cyrielle
date: 2020-05-26
txt: ./txt/cord-287490-g1r9zew2.txt
cache: ./cache/cord-287490-g1r9zew2.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32456663/
doi: 10.1186/s13054-020-03001-6
abstract: nan
summary:
  title: Prone positioning combined with high-flow nasal or conventional oxygen therapy in severe Covid-19 patients Prone positioning combined with high-flow nasal or conventional oxygen therapy in severe Covid-19 patients Cyrielle Despres 1 , Yannick Brunin 1 , Francis Berthier 1 , Sebastien Pili-Floury 1,2 and Guillaume Besch 1,2* Dear Editor, A massive outbreak of coronavirus disease 2019 (Covid-19) occurred in France in March and April 2020. We report the case of 6 severe Covid-19 patients admitted to our critical care unit between March and April 2020, who had PP combined with either highflow nasal oxygen (HFNO) or conventional oxygen therapy (COT). The efficacy of PP combined with HFNO therapy or non-invasive ventilation was recently reported in small cohorts of non-infectious and infectious non-Covid-19 ARDS patients [2, 3] . Considering these observations, PP combined with either HFNO or COT could be proposed in spontaneously breathing, severe Covid-19 patients to avoid intubation. Prone positioning combined with high-flow nasal cannula in severe noninfectious ARDS

title:
  Prone positioning combined with high-flow nasal or conventional oxygen therapy in severe Covid-19 patients


id: cord-288284-fghu8ouc
title: Clinical review: SARS – lessons in disaster management
author: Hawryluck, Laura
date: 2005-01-13
txt: ./txt/cord-288284-fghu8ouc.txt
cache: ./cache/cord-288284-fghu8ouc.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/16137388/
doi: 10.1186/cc3041
summary:
  Infectious diseases, whether they be natural (e.g. SARS [severe acute respiratory syndrome] and influenza) or the result of bioterrorism, have the potential to create a large influx of critically ill into our already strained hospital systems. Core to any disaster management plan are leaders with clear responsibilities to coordinate efforts and develop policies to contain the disease; to coordinate resource allocation and manpower; to advise and share information regarding infection control and treatment; to share data and research endeavours; to maintain staff morale; and to provide information to various levels of government, health care institutions, front-line workers and the public [1, 13] . The model we propose (Fig. 1 ) is one of a Central Critical Care Crisis Team, composed of leaders of different subteams of multidisciplinary professionals responsible for domains of crucial importance: clinical management, infection control, education, communication, team morale, manpower and system thinking, data collection, research and, finally, lobbying to ensure resources are available to meet critical care needs.

abstract:
  Disaster management plans have traditionally been required to manage major traumatic events that create a large number of victims. Infectious diseases, whether they be natural (e.g. SARS [severe acute respiratory syndrome] and influenza) or the result of bioterrorism, have the potential to create a large influx of critically ill into our already strained hospital systems. With proper planning, hospitals, health care workers and our health care systems can be better prepared to deal with such an eventuality. This review explores the Toronto critical care experience of coping in the SARS outbreak disaster. Our health care system and, in particular, our critical care system were unprepared for this event, and as a result the impact that SARS had was worse than it could have been. Nonetheless, we were able to organize a response rapidly during the outbreak. By describing our successes and failures, we hope to help others to learn and avoid the problems we encountered as they develop their own disaster management plans in anticipation of similar future situations.


id: cord-290392-kpjp0sx4
title: Acute respiratory failure in COVID-19: is it “typical” ARDS?
author: Li, Xu
date: 2020-05-06
txt: ./txt/cord-290392-kpjp0sx4.txt
cache: ./cache/cord-290392-kpjp0sx4.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32375845/
doi: 10.1186/s13054-020-02911-9
summary:
  In December 2019, an outbreak of coronavirus disease 2019 (COVID19) , which was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), broke out in Wuhan, China [1] [2] [3] . COVID-19 was of clustering onset and mainly affected the respiratory system with some patients rapidly progressing to acute respiratory distress syndrome (ARDS); other organ functions were less involved [5, 6] . In addition, the lung compliance was relatively high in some COVID-19-related ARDS patients, which was inconsistent with the severity of hypoxemia. A previous study reported that more than 50% of patients with moderate and severe ARDS according to the Berlin definition did not show diffuse alveolar damage [17] . Currently published studies did not report the proportion of different respiratory support according to COVID-19-related ARDS classification. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China

abstract:
  In December 2019, an outbreak of coronavirus disease 2019 (COVID-19) was identified in Wuhan, China. The World Health Organization (WHO) declared this outbreak a significant threat to international health. COVID-19 is highly infectious and can lead to fatal comorbidities especially acute respiratory distress syndrome (ARDS). Thus, fully understanding the characteristics of COVID-19-related ARDS is conducive to early identification and precise treatment. We aimed to describe the characteristics of COVID-19-related ARDS and to elucidate the differences from ARDS caused by other factors. COVID-19 mainly affected the respiratory system with minor damage to other organs. Injury to the alveolar epithelial cells was the main cause of COVID-19-related ARDS, and endothelial cells were less damaged with therefore less exudation. The clinical manifestations were relatively mild in some COVID-19 patients, which was inconsistent with the severity of laboratory and imaging findings. The onset time of COVID-19-related ARDS was 8–12 days, which was inconsistent with ARDS Berlin criteria, which defined a 1-week onset limit. Some of these patients might have a relatively normal lung compliance. The severity was redefined into three stages according to its specificity: mild, mild-moderate, and moderate-severe. HFNO can be safe in COVID-19-related ARDS patients, even in some moderate-severe patients. The more likely cause of death is severe respiratory failure. Thus, the timing of invasive mechanical ventilation is very important. The effects of corticosteroids in COVID-19-related ARDS patients were uncertain. We hope to help improve the prognosis of severe cases and reduce the mortality.


id: cord-290741-y3lvewlz
author: Zeng, Yingchun
date: 2020-04-15
txt: ./txt/cord-290741-y3lvewlz.txt
cache: ./cache/cord-290741-y3lvewlz.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32293518/
doi: 10.1186/s13054-020-2840-8
abstract: nan
summary:
  title: Prognosis when using extracorporeal membrane oxygenation (ECMO) for critically ill COVID-19 patients in China: a retrospective case series Prognosis when using extracorporeal membrane oxygenation (ECMO) for critically ill COVID-19 patients in China: a retrospective case series Yingchun Zeng 1 † , Zhongxiang Cai 2 † , Yunyan Xianyu 2 † , Bing Xiang Yang 3* , Ting Song 1* and Qiaoyuan Yan 4* The World Health Organization (WHO) has characterized the disease, coronavirus disease 2019 (COVID-19), as a pandemic on March 11, 2020 (www.who.int). If severe respiratory failure persisted, then ECMO should be started as soon as possible." [6] Worldwide data on prognosis when using ECMO to treat critically ill patients with COVID-19 infection are not available, and whether ECMO plays a role in reducing patient mortality rates is currently unknown. Based on the two cohort case series in this study, nearly half of the critically ill COVID-19 patients with ECMO were dying from septic shock and multiple organ failure.

title:
  Prognosis when using extracorporeal membrane oxygenation (ECMO) for critically ill COVID-19 patients in China: a retrospective case series


id: cord-290776-l6ajq6vp
author: Frithiof, Robert
date: 2020-09-29
txt: ./txt/cord-290776-l6ajq6vp.txt
cache: ./cache/cord-290776-l6ajq6vp.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03302-w
doi: 10.1186/s13054-020-03302-w
abstract: nan
summary:
  title: Presence of SARS-CoV-2 in urine is rare and not associated with acute kidney injury in critically ill COVID-19 patients Patients infected with SARS-CoV-2 requiring intensive care due to coronavirus disease 2019 (COVID-19) frequently develop acute kidney injury (AKI) [1] , but the underlying mechanisms are poorly explored. In this report, SARS-CoV-2 RNA levels were prospectively investigated in urine of patients with upper or lower airway swab test PCR-verified COVID-19, admitted to a Swedish intensive care unit (ICU, n = 81). Nucleic acid was extracted from urine samples using NucliSENS® eMAG® (bioMerieux), and the amount of viral RNA was quantitated by detection of SARS-CoV-2 E and N-genes using real-time RT-PCR according to previously described protocols [5, 6] . In this cohort, SARS-CoV-2 RNA was not more frequently detected in urine of patients that died or developed acute kidney injury.

title:
  Presence of SARS-CoV-2 in urine is rare and not associated with acute kidney injury in critically ill COVID-19 patients


id: cord-291934-pm3ns6ge
title: Chinese herbal experience for the 2019 novel coronavirus
author: Jiang, Ronglin
date: 2020-07-21
txt: ./txt/cord-291934-pm3ns6ge.txt
cache: ./cache/cord-291934-pm3ns6ge.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32693829/
doi: 10.1186/s13054-020-03170-4
abstract: nan
summary:
  According to a large survey, more than 14% patients were transferred to the intensive care unit care (ICU), and among those who received invasive mechanical ventilation, the mortality was as high as 88.1% [2] . Here we presented the data from a single ICU of Tianyou hospital in Wuhan, and according our experience, the overall mortality decreased in patients receiving Chinese herb therapy. Despite with limited sample size, the mortality rate decreased significantly after applying Chinese herbal to these patients (4/9 vs. 14/16, p = 0.033), especially in patients who received Chinese herbal therapy during the whole disease course. Further, these patients were also divided into two groups according to whether they had used Chinese herbal; a decreased trend of mortality was also observed (9/14 vs. However, in China, Chinese herbal therapy has been fully applied to patients with COVID-19 infection in the middle stage of this epidemic and the effect is positive.


id: cord-291955-mlju5f9u
title: Should we deny ICU admission to the elderly? Ethical considerations in times of COVID-19
author: Haas, Lenneke E. M.
date: 2020-06-09
txt: ./txt/cord-291955-mlju5f9u.txt
cache: ./cache/cord-291955-mlju5f9u.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32517776/
doi: 10.1186/s13054-020-03050-x
abstract: nan
summary:
  The SARS-CoV-2 (COVID-19) pandemic leads to severe shortages of intensive care unit (ICU) facilities in many countries. In this article, we discuss the use of age as a criterion for ICU treatment in times of scarce ICU capacity by contrasting it with deciding under normal conditions. It is proxy for the medical condition of the patient, and advanced age is clearly a factor that should be weighed together with other risk factors for a poor outcome of ICU treatment. Elderly patients admitted to the ICU with COVID-19 are at increased risk of death [7, 8] . Although we need more robust data about short-and long-term outcomes of elderly patients admitted to the ICU because of COVID-19, the mortality rates reported up to now are 40 to 80% [7, 9] . It cannot be justified to withhold ICU admission for all patients above a certain age.


id: cord-292335-al6v3b9x
author: Crotty, Matthew P.
date: 2015-11-18
txt: ./txt/cord-292335-al6v3b9x.txt
cache: ./cache/cord-292335-al6v3b9x.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-015-1120-5
doi: 10.1186/s13054-015-1120-5
summary:
  METHOD: This was a single-center retrospective cohort study to evaluate the impact of antibacterials in viral pneumonia on clinical outcomes and subsequent multidrug-resistant organism (MDRO) infections/colonization. CONCLUSION: This study found that long-course antibacterial use in the setting of viral pneumonia had no impact on clinical outcomes but increased the incidence of subsequent MDRO infection/colonization. The relationship between viral and bacterial respiratory infections creates a difficult situation for clinicians determining the appropriate use of antimicrobials as they treat hospitalized patients with pneumonia while also trying to minimize the development and selection of resistant organisms. This study aimed to describe the use of continued empiric antibacterials in patients with known viral pneumonia and to determine the impact of such therapies on subsequent bacterial infections/colonization and clinical outcomes. This study compared a cohort of 174 patients with viral pneumonia and mixed viral-bacterial infection based on exposure to continued empiric antibacterials after respiratory virus identification.

title:
  Impact of antibacterials on subsequent resistance and clinical outcomes in adult patients with viral pneumonia: an opportunity for stewardship

abstract:
  INTRODUCTION: Respiratory viruses are increasingly recognized as significant etiologies of pneumonia among hospitalized patients. Advanced technologies using multiplex molecular assays and polymerase-chain reaction increase the ability to identify viral pathogens and may ultimately impact antibacterial use. METHOD: This was a single-center retrospective cohort study to evaluate the impact of antibacterials in viral pneumonia on clinical outcomes and subsequent multidrug-resistant organism (MDRO) infections/colonization. Patients admitted from March 2013 to November 2014 with positive respiratory viral panels (RVP) and radiographic findings of pneumonia were included. Patients transferred from an outside hospital or not still hospitalized 72 hours after the RVP report date were excluded. Patients were categorized based on exposure to systemic antibacterials: less than 3 days representing short-course therapy and 3 to 10 days being long-course therapy. RESULTS: A total of 174 patients (long-course, n = 67; short-course, n = 28; mixed bacterial-viral infection, n = 79) were included with most being immunocompromised (56.3 %) with active malignancy the primary etiology (69.4 %). Rhinovirus/Enterovirus (23 %), Influenza (19 %), and Parainfluenza (15.5 %) were the viruses most commonly identified. A total of 13 different systemic antibacterials were used as empiric therapy in the 95 patients with pure viral infection for a total of 466 days-of-therapy. Vancomycin (50.7 %), cefepime (40.3 %), azithromycin (40.3 %), meropenem (23.9 %), and linezolid (20.9 %) were most frequently used. In-hospital mortality did not differ between patients with viral pneumonia in the short-course and long-course groups. Subsequent infection/colonization with a MDRO was more frequent in the long-course group compared to the short-course group (53.2 vs 21.1 %; P = 0.027). CONCLUSION: This study found that long-course antibacterial use in the setting of viral pneumonia had no impact on clinical outcomes but increased the incidence of subsequent MDRO infection/colonization.


id: cord-293167-3bd3adip
title: Neurological manifestations of COVID-19: a systematic review
author: Nepal, Gaurav
date: 2020-07-13
txt: ./txt/cord-293167-3bd3adip.txt
cache: ./cache/cord-293167-3bd3adip.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32660520/
doi: 10.1186/s13054-020-03121-z
summary:
  Most patients infected by SARS-CoV-2 have presented with a mild clinical course: beginning with fever and dry cough, progressing to a form of mild or moderate respiratory disease, and resolving without specific treatment [2] . A retrospective observational study from Wuhan, China, reported that six (2.8%) patients, out of the 214 reviewed COVID-19 cases, developed ischemic stroke. A retrospective observational study from a different center in Wuhan, China, found eleven (5.0%) patients, out of 221 reviewed COVID-19 cases, developed acute ischemic stroke. Those who had COVID-19 infection with new onset of ischemic stroke were more likely to have a severe SARS-CoV-2 presentation, an advanced age (71.6 ± 15.7 years versus 52.1 ± 15.3 years), and preexisting cardiovascular risk factors including hypertension, diabetes, and previous cerebrovascular disease. A retrospective observational study from Wuhan, China, reported one (0.45%) patient, out of 221 reviewed COVID-19 cases, who developed intracerebral hemorrhage.

abstract:
  INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the global spread of coronavirus disease (COVID-19). Our understanding of the impact this virus has on the nervous system is limited. Our review aims to inform and improve decision-making among the physicians treating COVID-19 by presenting a systematic analysis of the neurological manifestations experienced within these patients. METHODS: Any study, released prior to May 20, 2020, that reported neurological manifestations in patients infected by SARS-CoV-2 was systematically reviewed using the PRISMA (Preferred Reporting Items for Systemic review and Meta-Analysis) statement. RESULTS: Our systematic review included data from 37 articles: twelve retrospective studies, two prospective studies, and the rest case reports/series. The most commonly reported neurological manifestations of COVID-19 were myalgia, headache, altered sensorium, hyposmia, and hypogeusia. Uncommonly, COVID-19 can also present with central nervous system manifestations such as ischemic stroke, intracerebral hemorrhage, encephalo-myelitis, and acute myelitis, peripheral nervous manifestations such as Guillain-Barré syndrome and Bell’s palsy, and skeletal muscle manifestations such as rhabdomyolysis. CONCLUSION: While COVID-19 typically presents as a self-limiting respiratory disease, it has been reported in up to 20% of patients to progress to severe illness with multi-organ involvement. The neurological manifestations of COVID-19 are not uncommon, but our study found most resolve with treatment of the underlying infection. Although the timeliness of this review engages current challenges posed by the COVID-19 pandemic, readers must not ignore the limitations and biases intrinsic to an early investigation.


id: cord-293690-pxiv0m7n
title: Italian pulmonologist units and COVID-19 outbreak: “mind the gap”!
author: Scala, Raffaele
date: 2020-06-29
txt: ./txt/cord-293690-pxiv0m7n.txt
cache: ./cache/cord-293690-pxiv0m7n.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32600461/
doi: 10.1186/s13054-020-03087-y
abstract: nan
summary:
  authors: Scala, Raffaele; Renda, Teresa; Corrado, Antonio; Vaghi, Adriano One fourth of > 1500 COVID-19 patients died after the admission in Lombardia ICUs; in only 11% of them, noninvasive ventilation (NIV) and/ or high flow nasal cannula (HFNC) was attempted early to prevent respiratory deterioration and invasive mechanical ventilation (IMV). The delayed admission in Lombardia overcrowded ICU of severely hypoxemic COVID-19 patients meeting the criteria for IMV without being offered a HFNC/NIV trial must have played a crucial role. Respiratory high-dependency care units (RHDCUs) are specialised cost-effective environments offering an "intermediate" level of care between ICU and ward, where NIV/HFNC, weaning from IMV and discharge of ventilator-dependent patients are provided [4] . The "gap" between the Italian RHDCU network and pre-COVID-19 respiratory needs might largely explain ICU network failure in Lombardia [4] . The expanded IPU network together with national more restrictive measures against virus dissemination after the Lombardia outbreak has contributed to the mitigation of COVID-19 impact on mortality in other regions.


id: cord-293766-vpfda3pd
title: Glucocorticoid therapy does not delay viral clearance in COVID-19 patients
author: Ji, Jingjing
date: 2020-09-21
txt: ./txt/cord-293766-vpfda3pd.txt
cache: ./cache/cord-293766-vpfda3pd.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03287-6
doi: 10.1186/s13054-020-03287-6
abstract: nan
summary:
  authors: Ji, Jingjing; Zhang, Jinxia; Shao, Ziyun; Xie, Qifeng; Zhong, Li; Liu, Zhifeng Patients were diagnosed as mild type, general type, severe type, and critical type according to the Chinese Recommendations for Diagnosis and Treatment of Novel Coronavirus (SARS-CoV-2) Infection (Trial 7th version) [4] . The current multicenter cohort study demonstrates that GC therapy does not change viral clearance and peripheral lymphocyte counts in COVID-19 patients. Low-dose corticosteroid therapy does not delay viral clearance in patients with COVID-19 Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients Jinxia Zhang, Ziyun Shao, Qifeng Xie, and Li Zhong were responsible for collecting the data. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.Ethics approval and consent to participate


id: cord-295585-dl29curs
title: Severe pulmonary embolism in COVID-19 patients: a call for increased awareness
author: Hékimian, Guillaume
date: 2020-06-02
txt: ./txt/cord-295585-dl29curs.txt
cache: ./cache/cord-295585-dl29curs.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32487231/
doi: 10.1186/s13054-020-02931-5
abstract: nan
summary:
  Coronavirus disease 2019 (COVID-19) is associated with severe systemic inflammation and important elevation of fibrinogen and D-dimers that has been associated with a poor prognosis [1, 2] . We retrospectively reviewed characteristics of patients with confirmed SARS-CoV-2 infection and acute PE who were admitted to our tertiary ICU, which serves as an ECMO referral center for the Greater Paris. The ICU database was registered with the national data protection authority (CNIL 1950673) . PE was suspected in 6 patients because of acute cor pulmonale at echocardiographic evaluation (online supplementary data). We describe a series of 8 critically ill patients with massive PE following COVID-19 infection. Four of these patients developed PE while on VV-ECMO for severe ARDS, a condition that was not reported in the 156 patients included in the EOLIA trial [3] who received ECMO and in the 350 VV-ECMO patients of the LIFE-GARDS international multicenter prospective cohort [4] . Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan


id: cord-297062-dmiplvt2
title: Presentation and outcome of Middle East respiratory syndrome in Saudi intensive care unit patients
author: Almekhlafi, Ghaleb A.
date: 2016-05-07
txt: ./txt/cord-297062-dmiplvt2.txt
cache: ./cache/cord-297062-dmiplvt2.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-016-1303-8
doi: 10.1186/s13054-016-1303-8
summary:
  authors: Almekhlafi, Ghaleb A.; Albarrak, Mohammed M.; Mandourah, Yasser; Hassan, Sahar; Alwan, Abid; Abudayah, Abdullah; Altayyar, Sultan; Mustafa, Mohamed; Aldaghestani, Tareef; Alghamedi, Adnan; Talag, Ali; Malik, Muhammad K.; Omrani, Ali S.; Sakr, Yasser BACKGROUND: Middle East respiratory syndrome coronavirus infection is associated with high mortality rates but limited clinical data have been reported. We describe the clinical features and outcomes of patients admitted to an intensive care unit (ICU) with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. METHODS: Retrospective analysis of data from all adult (>18 years old) patients admitted to our 20-bed mixed ICU with Middle East respiratory syndrome coronavirus infection between October 1, 2012 and May 31, 2014. We performed a retrospective study to describe the clinical features and outcomes of patients admitted to our ICU with laboratory-confirmed MERS-CoV infection. This report describes the clinical features and outcomes of 31critically ill patients with confirmed Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

abstract:
  BACKGROUND: Middle East respiratory syndrome coronavirus infection is associated with high mortality rates but limited clinical data have been reported. We describe the clinical features and outcomes of patients admitted to an intensive care unit (ICU) with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. METHODS: Retrospective analysis of data from all adult (>18 years old) patients admitted to our 20-bed mixed ICU with Middle East respiratory syndrome coronavirus infection between October 1, 2012 and May 31, 2014. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples. RESULTS: During the observation period, 31 patients were admitted with MERS-CoV infection (mean age 59 ± 20 years, 22 [71 %] males). Cough and tachypnea were reported in all patients; 22 (77.4 %) patients had bilateral pulmonary infiltrates. Invasive mechanical ventilation was applied in 27 (87.1 %) and vasopressor therapy in 25 (80.6 %) patients during the intensive care unit stay. Twenty-three (74.2 %) patients died in the ICU. Nonsurvivors were older, had greater APACHE II and SOFA scores on admission, and were more likely to have received invasive mechanical ventilation and vasopressor therapy. After adjustment for the severity of illness and the degree of organ dysfunction, the need for vasopressors was an independent risk factor for death in the ICU (odds ratio = 18.33, 95 % confidence interval: 1.11–302.1, P = 0.04). CONCLUSIONS: MERS-CoV infection requiring admission to the ICU is associated with high morbidity and mortality. The need for vasopressor therapy is the main risk factor for death in these patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-016-1303-8) contains supplementary material, which is available to authorized users.


id: cord-297863-ou432md0
author: Ye, Lei
date: 2020-06-12
txt: ./txt/cord-297863-ou432md0.txt
cache: ./cache/cord-297863-ou432md0.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32532324/
doi: 10.1186/s13054-020-03076-1
abstract: nan
summary:
  Based on Wuhan''s experience, it is critical to develop tailored infection prevention and control (IPC) protocols for both workplace and non-occupational settings and to conduct effective IPC training. Thus, the following suggestions were summarized based on the first-hand experience of a national medical team from Zhejiang, to facilitate the development of IPC protocols in critical care settings. Generally, all health workers should implement appropriate personal protective equipment (PPE) regarding contact and droplet precautions based on recommendations by WHO [8] . For health workers in ICU, advanced protections are required during routine intensive care and airborne precautions are considered as airborne transmission may happen during aerosol-generating procedures. All information provided in this paper is to strengthen the clinical practice in critical care settings and to better protect front-line health workers in nursing severe COVID-19 patients. Infection prevention and control during health care when COVID-19 is suspected: interim guidance

title:
  Infection prevention and control in nursing severe coronavirus disease (COVID-19) patients during the pandemic


id: cord-299650-lhphdjeu
author: Whittle, John
date: 2020-09-28
txt: ./txt/cord-299650-lhphdjeu.txt
cache: ./cache/cord-299650-lhphdjeu.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03286-7
doi: 10.1186/s13054-020-03286-7
abstract: nan
summary:
  Longitudinal IC data presented here demonstrate a progressive hypermetabolic phenotype beginning 1 week post-intubation in COVID-19 ICU patients, with significantly greater mREE versus predictive equations or ASPEN-recommended 11-14 kcal/kg ABW for obese subjects used currently to determine energy requirements. Our data support use of standard predictive equations or~20 kcal/kg as a reasonable approximation of mREE in 1st ICU week in COVID-19 patients. These data suggest personalization of nutrition delivery, including IC use [3, 5] , should be considered to provide more accurate assessments of energy expenditure and help guide nutrition delivery in COVID-19 ICU patients. Only the authors and investigators at Duke University participated in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

title:
  Persistent hypermetabolism and longitudinal energy expenditure in critically ill patients with COVID-19


id: cord-300135-iwvkvs3k
author: Lemay, Francois
date: 2020-05-26
txt: ./txt/cord-300135-iwvkvs3k.txt
cache: ./cache/cord-300135-iwvkvs3k.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32456652/
doi: 10.1186/s13054-020-02999-z
abstract: nan
summary:
  title: Description of an alternative method for optimal and comfortable two-handed face mask ventilation: the transverse mandibular technique Description of an alternative method for optimal and comfortable two-handed face mask ventilation: the transverse mandibular technique Francois Lemay 1,2* and Jeremy Cooper 3 In addition, major difficult airway algorithms already highlight the importance of oxygenation rather than intubation, and many include best attempts at facemask ventilation (FMV) while progressing in cannot intubate cannot oxygenate situations [2, 3] . We would like to share an alternative technique that provides good FMV conditions through improved jaw thrust, mask seal and ergonomic comfort. 5. It can be performed standing in front of the patient, which can be useful in critical situations when many practitioners are managing the airway. Comparison of effectiveness of two commonly used two-handed mask ventilation techniques on unconscious apnoeic obese adults

title:
  Description of an alternative method for optimal and comfortable two-handed face mask ventilation: the transverse mandibular technique


id: cord-300510-fhpkdqr0
title: Our recommendations for acute management of COVID-19
author: Mojoli, Francesco
date: 2020-05-08
txt: ./txt/cord-300510-fhpkdqr0.txt
cache: ./cache/cord-300510-fhpkdqr0.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02930-6
doi: 10.1186/s13054-020-02930-6
abstract: nan
summary:
  7. Perform early intubation if poor response to continuous positive airway pressure in terms of oxygenation: do not trust patients'' relatively good respiratory mechanics and feeling of improved dyspnoea, since these patients may have relatively normal lung compliance and the only clinical sign of fatigue may be high respiratory rate. As soon as possible according to gas exchanges (PaO 2 /FiO 2 > 150 with FiO2 < 50%) and lung ultrasound score (≤ 12), start assisted ventilation with a sigh while maintaining moderate to high positive end-expiratory pressure to prevent derecruitment. Abbreviations SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; ICU: Intensive care unit Assessment of lung aeration and recruitment by CT scan and ultrasound in acute respiratory distress syndrome patients Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China The authors read and approved the final manuscript.


id: cord-300897-lih5f6cj
title: Clinical review: Critical care medicine in mainland China
author: Du, Bin
date: 2010-02-25
txt: ./txt/cord-300897-lih5f6cj.txt
cache: ./cache/cord-300897-lih5f6cj.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/cc8222
doi: 10.1186/cc8222
summary:
  Two years later, it became the fi rst Department of Critical Care Medicine in mainland China, with a seven-bed general ICU in the Peking Union Medical College Hospital, chaired by Dr Dechang Chen, the well-recognized founding father of critical care medicine in mainland China. Th ere is no census on critical care resources in China, including the number of ICUs, intensivists, ICU nurses, and relevant facilities (for example, bedside monitors, artifi cial ventilators), because no national survey has ever been performed. Considering the above limitations and potential improve ment, we do believe that Chinese intensivists may benefi t from academic exchange with the international medical community with regard to the following: development of a series of training programs fulfi lling international standards; development of a national board exam for critical care medicine; and conduction of multicenter trials compatible with good clinical practice.

abstract:
  Critical care medicine began in mainland China in the early 1980s. After almost 30 years of effort, it has been recognized as a specialty very recently. However, limited data suggest that critical care resources, especially ICU beds, are inadequate compared with those of developed countries. National critical care societies work together to set up good practice standards, and to improve academic levels with scientific meetings, education programs, and training courses. Critical care research in mainland China is beginning to evolve, with great potential for improvement.


id: cord-303577-2gxo5mft
author: Flaczyk, Adam
date: 2020-09-16
txt: ./txt/cord-303577-2gxo5mft.txt
cache: ./cache/cord-303577-2gxo5mft.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03273-y
doi: 10.1186/s13054-020-03273-y
summary:
  We review seven major societal recommendations and guidelines addressing the management of coagulopathy in COVID-19 patients: the Centers for Disease Control and Prevention (CDC) [6] , International Society on Thrombosis and Haemostasis interim guidance (ISTH-IG) [7] , American Society of Hematology (ASH) [8, 9] , American College of Chest Physicians (ACCP) [10] , Scientific and Standardization Committee of ISTH (SCC-ISTH) [11] , Anticoagulation Forum (ACF) [12] , and American College of Cardiology (ACC) [13] . Tables 1, 2, 3, 4, 5, 6, and 7 highlights six major societal recommendations and guidelines on the management of CAC focusing on several critical care issues: (1) laboratory testing for risk stratification and triage, (2) use of biomarkers to guide anticoagulation, (3) proposals for alterations of standard prophylactic VTE anticoagulation regimens for the prevention of thrombotic complications, (4) examination of available medications preferred for anticoagulation, (5) considerations for initiation of therapeutic anticoagulation, (6) indications for thrombolytic therapy, (7) decision-making regarding withholding anticoagulation treatment, (8) use of mechanical thromboprophylaxis, (9) monitoring of anticoagulation, (10) duration of therapeutic anticoagulation, (11) necessity of anticoagulation at discharge, and (12) treatment of active bleeding.

title:
  Comparison of published guidelines for management of coagulopathy and thrombosis in critically ill patients with COVID 19: implications for clinical practice and future investigations

abstract:
  Critically ill patients with COVID-19 are at increased risk for thrombotic complications which has led to an intense debate surrounding their anticoagulation management. In the absence of data from randomized controlled clinical trials, a number of consensus guidelines and recommendations have been published to facilitate clinical decision-making on this issue. However, substantive differences exist between these guidelines which can be difficult for clinicians. This review briefly summarizes the major societal guidelines and compares their similarities and differences. A common theme in all of the recommendations is to take an individualized approach to patient management and a call for prospective randomized clinical trials to address important anticoagulation issues in this population.


id: cord-303893-47lxq8pi
title: Interferon beta-1a for COVID-19: critical importance of the administration route
author: Jalkanen, Juho
date: 2020-06-12
txt: ./txt/cord-303893-47lxq8pi.txt
cache: ./cache/cord-303893-47lxq8pi.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03048-5
doi: 10.1186/s13054-020-03048-5
abstract: nan
summary:
  Interferon beta-1a for COVID-19: critical importance of the administration route Juho Jalkanen 1 , Maija Hollmén 2 and Sirpa Jalkanen 2* Type I interferons, especially IFN-beta, have been appointed as potential leading therapeutics to tackle severe COVID-19 and are currently being evaluated in REMAP-CAP and the WHO''s Solidarity Trial. We wish to highlight the differences of these two treatment methods and also other crucial aspects of IFN-beta treatment for COVID-19 and acute respiratory distress syndrome (ARDS). Nonetheless, the purpose of i.v. administered IFN-beta for the treatment of COVID-19 and ARDS is to maximise bioavailability of the drug at the lung vasculature, as well as other vascular beds. There are a limited number of direct studies on the timing of immunomodulatory treatments such as IFN-beta, but given our basic understanding of human biology and viral defence, we suggest that IFN-beta should be given early to COVID-19 patients.


id: cord-304070-jw1lxwyd
author: Lapinsky, Stephen E
date: 2004-10-14
txt: ./txt/cord-304070-jw1lxwyd.txt
cache: ./cache/cord-304070-jw1lxwyd.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/15566586/
doi: 10.1186/cc2967
summary:
  We evaluated the feasibility and potential benefits of a handheld computer based knowledge access system linking a central academic intensive care unit (ICU) to multiple community-based ICUs. METHODS: Four community hospital ICUs with 17 physicians participated in this prospective interventional study. Before and after the intervention period, participants underwent simulated patient care scenarios designed to evaluate the information sources they accessed, as well as the speed and quality of their decision making. CONCLUSION: An updateable handheld computer system is feasible as a means of point-of-care access to medical reference material and may improve clinical decision making. In the present study we evaluated whether it would be feasible and effective to provide updateable reference information from a central academic centre to handheld computers used by critical care specialists in community hospitals. Information sources that physicians accessed to make clinical decisions were evaluated during simulated patient care scenarios, completed in the physicians'' own ICU utilizing a computerized patient simulator (SimMan; Laerdal Medical Corporation, Wappingers Falls, NY, USA).

title:
  Prospective evaluation of an internet-linked handheld computer critical care knowledge access system

abstract:
  INTRODUCTION: Critical care physicians may benefit from immediate access to medical reference material. We evaluated the feasibility and potential benefits of a handheld computer based knowledge access system linking a central academic intensive care unit (ICU) to multiple community-based ICUs. METHODS: Four community hospital ICUs with 17 physicians participated in this prospective interventional study. Following training in the use of an internet-linked, updateable handheld computer knowledge access system, the physicians used the handheld devices in their clinical environment for a 12-month intervention period. Feasibility of the system was evaluated by tracking use of the handheld computer and by conducting surveys and focus group discussions. Before and after the intervention period, participants underwent simulated patient care scenarios designed to evaluate the information sources they accessed, as well as the speed and quality of their decision making. Participants generated admission orders during each scenario, which were scored by blinded evaluators. RESULTS: Ten physicians (59%) used the system regularly, predominantly for nonmedical applications (median 32.8/month, interquartile range [IQR] 28.3–126.8), with medical software accessed less often (median 9/month, IQR 3.7–13.7). Eight out of 13 physicians (62%) who completed the final scenarios chose to use the handheld computer for information access. The median time to access information on the handheld handheld computer was 19 s (IQR 15–40 s). This group exhibited a significant improvement in admission order score as compared with those who used other resources (P = 0.018). Benefits and barriers to use of this technology were identified. CONCLUSION: An updateable handheld computer system is feasible as a means of point-of-care access to medical reference material and may improve clinical decision making. However, during the study, acceptance of the system was variable. Improved training and new technology may overcome some of the barriers we identified.


id: cord-304327-mtkgr542
title: Prehospital pulse oximetry: a red flag for early detection of silent hypoxemia in COVID-19 patients
author: Jouffroy, Romain
date: 2020-06-08
txt: ./txt/cord-304327-mtkgr542.txt
cache: ./cache/cord-304327-mtkgr542.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03036-9
doi: 10.1186/s13054-020-03036-9
abstract: nan
summary:
  Based on retrospective data, we aimed to describe the discrepancy between prehospital initial RR (RRi) and initial SpO2 (Spo2i; i.e., before oxygen supplementation, FiO2 = 21%) in COVID-19 patients suffering from ARF. After having measured the SpO2i/RRi values in COVID-19 patients, we compared them to those of non-COVID-19 patients (i.e., patients with other causes of ARF treated by the BLS teams over the previous 3 years in the same period). In summary, this retrospective study based on prehospital first responder data highlighted a relatively higher discrepancy between SpO2i and RRi in COVID-19 ARF patients, in comparison with previous non-COVID-19 ARF patients. Fig. 1 Scatter plot representing the initial SPO2 (SPO2i) and initial respiration rate (RRi) values for each patient, for COVID-19 (March 2020) and non-COVID-19 patients from the previous 3 years. RRi, initial respiratory rate; SpO2i, initial pulse oximetry value; N, number of patients included


id: cord-304746-7yzybukk
author: Li, Xinye
date: 2020-07-28
txt: ./txt/cord-304746-7yzybukk.txt
cache: ./cache/cord-304746-7yzybukk.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03183-z
doi: 10.1186/s13054-020-03183-z
summary:
  title: Cardiac injury associated with severe disease or ICU admission and death in hospitalized patients with COVID-19: a meta-analysis and systematic review BACKGROUND: Cardiac injury is now a common complication of coronavirus disease (COVID-19), but it remains unclear whether cardiac injury-related biomarkers can be independent predictors of mortality and severe disease development or intensive care unit (ICU) admission. Retrospective studies assessing the relationship between the prognosis of COVID-19 patients and levels of troponin I (TnI) and other cardiac injury biomarkers (creatine kinase [CK], CK myocardial band [CK-MB], lactate dehydrogenase [LDH], and interleukin-6 [IL-6]) were included. This systematic review and meta-analysis of 23 highquality retrospective studies systematically evaluated the risk of severe disease, ICU admission, or death associated with COVID-19-related cardiac injury performance. Our analysis suggests that COVID-19 patients with elevated TnI levels are at higher risk of developing severe disease, requiring ICU admission, and death.

title:
  Cardiac injury associated with severe disease or ICU admission and death in hospitalized patients with COVID-19: a meta-analysis and systematic review

abstract:
  BACKGROUND: Cardiac injury is now a common complication of coronavirus disease (COVID-19), but it remains unclear whether cardiac injury-related biomarkers can be independent predictors of mortality and severe disease development or intensive care unit (ICU) admission. METHODS: Two investigators searched the PubMed, EMBASE, Cochrane Library, MEDLINE, Chinese National Knowledge Infrastructure (CNKI), Wanfang, MedRxiv, and ChinaXiv databases for articles published through March 30, 2020. Retrospective studies assessing the relationship between the prognosis of COVID-19 patients and levels of troponin I (TnI) and other cardiac injury biomarkers (creatine kinase [CK], CK myocardial band [CK-MB], lactate dehydrogenase [LDH], and interleukin-6 [IL-6]) were included. The data were extracted independently by two investigators. RESULTS: The analysis included 23 studies with 4631 total individuals. The proportions of severe disease, ICU admission, or death among patients with non-elevated TnI (or troponin T [TnT]), and those with elevated TnI (or TnT) were 12.0% and 64.5%, 11.8% and 56.0%, and 8.2% and. 59.3%, respectively. Patients with elevated TnI levels had significantly higher risks of severe disease, ICU admission, and death (RR 5.57, 95% CI 3.04 to 10.22, P < 0.001; RR 6.20, 95% CI 2.52 to 15.29, P < 0.001; RR 5.64, 95% CI 2.69 to 11.83, P < 0.001). Patients with an elevated CK level were at significantly increased risk of severe disease or ICU admission (RR 1.98, 95% CI 1.50 to 2.61, P < 0.001). Patients with elevated CK-MB levels were at a higher risk of developing severe disease or requiring ICU admission (RR 3.24, 95% CI 1.66 to 6.34, P = 0.001). Patients with newly occurring arrhythmias were at higher risk of developing severe disease or requiring ICU admission (RR 13.09, 95% CI 7.00 to 24.47, P < 0.001). An elevated IL-6 level was associated with a higher risk of developing severe disease, requiring ICU admission, or death. CONCLUSIONS: COVID-19 patients with elevated TnI levels are at significantly higher risk of severe disease, ICU admission, and death. Elevated CK, CK-MB, LDH, and IL-6 levels and emerging arrhythmia are associated with the development of severe disease and need for ICU admission, and the mortality is significantly higher in patients with elevated LDH and IL-6 levels. GRAPHICAL ABSTRACT: [Image: see text]


id: cord-305946-ytabywxd
title: Predictive value of neutrophil to lymphocyte and platelet to lymphocyte ratio in COVID-19
author: Zhu, Shiping
date: 2020-08-28
txt: ./txt/cord-305946-ytabywxd.txt
cache: ./cache/cord-305946-ytabywxd.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32859254/
doi: 10.1186/s13054-020-03258-x
abstract: nan
summary:
  title: Predictive value of neutrophil to lymphocyte and platelet to lymphocyte ratio in COVID-19 Predictive value of neutrophil to lymphocyte and platelet to lymphocyte ratio in COVID-19 Shiping Zhu 1 , Lei Dong 2 and Wanru Cai 2* Keywords: Neutrophil to leucocyte ratio, Platelet to lymphocyte ratio, To the Editor, In a recent study, Dr. Ma [1] investigated the neutrophil to lymphocyte ratio (NLR) in predicting moderate-severe acute respiratory distress syndrome (ARDS) in patients with COVID-19 infection. First, uncontrolled inflammatory response plays a vital role in COVID-19 disease, and both NLR and platelet to lymphocyte ratio (PLR) have been recognized as inflammatory factors in various lung diseases [2, 3] , such as lung cancer and obstructive lung disease. However, one common limitation is that in most previous studies, NLR or PLR was included in the generalized linear models as a continuous variable, with the assumption that there was a linear association between NLR/PLR and the dependent outcomes. Neutrophil-to-lymphocyte ratio as a predictive biomarker for moderate-severe ARDS in severe COVID-19 patients


id: cord-307512-70j4vn78
title: Provision of ECPR during COVID-19: evidence, equity, and ethical dilemmas
author: Worku, Elliott
date: 2020-07-27
txt: ./txt/cord-307512-70j4vn78.txt
cache: ./cache/cord-307512-70j4vn78.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32718340/
doi: 10.1186/s13054-020-03172-2
summary:
  The logistics of patient selection, expedient cannulation, healthcare worker safety, and post-resuscitation care must be weighed against the ethical considerations of providing an intervention of contentious benefit at a time when critical care resources are being overwhelmed by pandemic demand. The first is in-hospital cannulation, whereby patients suffering an IHCA or OHCA who fail to achieve ROSC with standard CCPR and advanced cardiac life support (ACLS) may be cannulated for ECPR. b Expedient cannulation and establishment of extracorporeal perfusion is a requisite of an effective ECPR; for OHCA, this may occur: (i) on-scene cannulation by mobile ECMO practitioners and (ii) rapid retrieval to ECPR hospital recognising those patients who might benefit from ECPR, requirements for donning personal protective equipment (PPE), impaired ambulance response times, and lack of critical care resources, may preclude the use of ECPR even in those who would otherwise be eligible.

abstract:
  The use of extracorporeal cardiopulmonary resuscitation (ECPR) to restore circulation during cardiac arrest is a time-critical, resource-intensive intervention of unproven efficacy. The current COVID-19 pandemic has brought additional complexity and significant barriers to the ongoing provision and implementation of ECPR services. The logistics of patient selection, expedient cannulation, healthcare worker safety, and post-resuscitation care must be weighed against the ethical considerations of providing an intervention of contentious benefit at a time when critical care resources are being overwhelmed by pandemic demand.


id: cord-307592-hyeshh63
title: VEGF-D: a novel biomarker for detection of COVID-19 progression
author: Kong, Yaxian
date: 2020-06-23
txt: ./txt/cord-307592-hyeshh63.txt
cache: ./cache/cord-307592-hyeshh63.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03079-y
doi: 10.1186/s13054-020-03079-y
abstract: nan
summary:
  A total of 24 COVID-19 patients were enrolled in this study, including 14 (58.3%) severe patients and 10 (41.7%) critical patients (Table 1 ). Levels of VEGF-D, TNF-α, SCF, LIF, IL-2, IL-4, IL-6, IL-8, IL-10, IL-15, IL-17A, IL-18, IL-1β, and IFN-γ were significantly higher in the critical group than in the severe group (Table 1) . Strikingly, VEGF-D was identified as the most important indicator related to the severity of COVID-19 (ranked as 1, Fig. 1a ). As shown in Fig. 1e , critical patients had higher levels of VEGF-D than the severe cases during the whole course of hospitalization. We hypothesized that elevated VEGF-D level might potentially relate to the storm of blood clots occurring in COVID-19 patients. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19 All data generated or analyzed during this study are included in this published article.


id: cord-310561-67kp743f
title: Systemic hypoferremia and severity of hypoxemic respiratory failure in COVID-19
author: Shah, Akshay
date: 2020-06-09
txt: ./txt/cord-310561-67kp743f.txt
cache: ./cache/cord-310561-67kp743f.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03051-w
doi: 10.1186/s13054-020-03051-w
abstract: nan
summary:
  Therefore, we sought to characterise iron parameters, including serum iron, in COVID-19 intensive care unit (ICU) patients and relate these to disease severity. We retrospectively evaluated any serum iron profiles that were measured in critically ill patients with COVID-19 within 24 h of admission to the ICU, John Radcliffe Hospital, Oxford, UK, between March 31, 2020, and April 25, 2020. Our data suggest that serum iron may be a useful biomarker for identifying disease severity in COVID-19, whilst also being a potential therapeutic target. Serum iron was lower when compared with other cohorts of non-COVID-19 ICU patients reported previously, including those with sepsis [4] . Abbreviations: APACHEII Acute Physiology and Chronic Health Evaluation II, CRP C-reactive protein, ICU intensive care unit, IQR interquartile range, SD standard deviation Fig. 1 Associations between markers of iron status, lymphocyte count and severity of hypoxemia.


id: cord-310776-4iqu18gi
author: Supady, Alexander
date: 2020-08-20
txt: ./txt/cord-310776-4iqu18gi.txt
cache: ./cache/cord-310776-4iqu18gi.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03238-1
doi: 10.1186/s13054-020-03238-1
abstract: nan
summary:
  Following initial reports describing Interleukin-6 (IL-6) as a predictive factor for a negative outcome, extracorporeal cytokine adsorption was discussed as a possible treatment option for severe COVID-19 cases. A major advantage of extracorporeal cytokine adsorption over the other therapeutic approaches discussed in this debate is that it does not selectively block a specific receptor or signal transduction cascade, but it rather reduces particularly elevated concentrations of various inflammatory mediators such as interleukins, TNF-α, and also interferons; these factors have both pro-and anti-inflammatory functions. These two aspects may be particularly relevant, e.g., in the case of bacterial superinfection in severe COVID-19 when an adequate immune response is required. Exploring pharmacological approaches for managing cytokine storm associated with pneumonia and acute respiratory distress syndrome in COVID-19 patients Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation Impaired type I interferon activity and inflammatory responses in severe COVID-19 patients

title:
  Extracorporeal cytokine adsorption as an alternative to pharmacological inhibition of IL-6 in COVID-19


id: cord-310997-ulgemn42
author: Swai, Joel
date: 2020-09-11
txt: ./txt/cord-310997-ulgemn42.txt
cache: ./cache/cord-310997-ulgemn42.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03239-0
doi: 10.1186/s13054-020-03239-0
abstract: nan
summary:
  title: Letter to the editor—Mortality rate of acute kidney injury in SARS, MERS, and COVID-19 infection: a systematic review and meta-analysis Firstly, the mortality rate for COVID-19 patients with AKI is different in the text (i.e., 76.5%; 95% CI 61.0-89.0) from one reported in the authors'' Figure 1 (i.e., 78.0%; 95% CI 63.0-90.0). Letter to the editor-Mortality rate of acute kidney injury in SARS, MERS, and COVID-19 infection: a systematic review and meta-analysis" As the author pointed out, the reported results of mortality rate for coronavirus disease 2019 (COVID-19) patients with acute kidney injury (AKI) is different from the text and Figure 1c in the original publication of our article [1] . In addition, our research letter aimed to overview the AKI mortality in patients with different coronaviruses, but the clinical heterogeneity between studies should be also noted. Mortality rate of acute kidney injury in SARS, MERS, and COVID-19 infection: a systematic review and meta-analysis

title:
  Letter to the editor—Mortality rate of acute kidney injury in SARS, MERS, and COVID-19 infection: a systematic review and meta-analysis


id: cord-312484-epbhdx55
title: COVID-19 infection epidemic: the medical management strategies in Heilongjiang Province, China
author: Wang, Hongliang
date: 2020-03-18
txt: ./txt/cord-312484-epbhdx55.txt
cache: ./cache/cord-312484-epbhdx55.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32188482/
doi: 10.1186/s13054-020-2832-8
abstract: nan
summary:
  title: COVID-19 infection epidemic: the medical management strategies in Heilongjiang Province, China Education and training of staffs As soon as the outbreak of COVID-19 began in Wuhan, the Heilongjiang provincial health administration department started to launch training protocols for all the medical staffs. Heilongjiang province set up a multidisciplinary team (MDT) soon after the outbreak of COVID-19, including intensive care unit (ICU), emergency department, infectious disease department, respiratory department, psychological department, infection control department, administrative department, and nursing department. Medical staffs of the whole province, especially intensivist, respiratory physician, emergency physician, and infectious disease physician, were assigned to work in the designated hospitals. The group members included provincial health authorities, medical experts, and infection control experts. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China We would like to thank all the medical staffs and local authorities of Heilongjiang province for their efforts in combating the outbreak of COVID-19.


id: cord-313914-m09lw0i4
title: Extracorporeal membrane oxygenation programs for COVID-19 in China
author: Li, Chenglong
date: 2020-06-08
txt: ./txt/cord-313914-m09lw0i4.txt
cache: ./cache/cord-313914-m09lw0i4.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32513284/
doi: 10.1186/s13054-020-03047-6
abstract: nan
summary:
  Extracorporeal membrane oxygenation (ECMO), as a temporary life support technique for refractory respiratory or cardiac failure, has been applied in COVID-19 patients [1] . Referring to the present case series and the COVID-19 cohort in China, the mortality of patients undergoing ECMO ranged from 42 to 83% [2, 3] . The Chinese Society of Extracorporeal Life Support (CSECLS) performed a survey of ECMO programs for COVID-19 in China, aimed at investigating the program organization and the potential factors associated with outcomes during the pandemic. One hundred eleven individual responses from 79 ECMO programs (30 in Hubei and 49 outside Hubei) applied ECMO in patients with COVID-19 pneumonia and ARDS were analyzed. That might be the main reason for more ECMO programs outside Hubei applied ECMO in older patients (age > 65), aiming at minimizing the local mortality of COVID-19. Prognosis when using extracorporeal membrane oxygenation (ECMO) for critically ill COVID-19 patients in China: a retrospective case series


id: cord-314310-g1zmggf4
author: Honore, Patrick M.
date: 2020-10-06
txt: ./txt/cord-314310-g1zmggf4.txt
cache: ./cache/cord-314310-g1zmggf4.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33023627/
doi: 10.1186/s13054-020-03309-3
abstract: nan
summary:
  Honore * , Leonel Barreto Gutierrez, Luc Kugener, Sebastien Redant, Rachid Attou, Andrea Gallerani and David De Bels Gucyetmez et al., noting that elevated D-dimer levels have been found as a predictor for mortality in patients with COVID-19 pneumonia, concluded that therapeutic plasma exchange (TPE) seems to be a treatment that may improve outcomes by effectively removing fibrin degradation products (FDPs) and restoring coagulation status [1] . Firstly, we should emphasize three important points about our study: (1) we investigated the effect of therapeutic plasma exchange (TPE) on overall mortality, not mortality predictors, (2) we emphasized that "major thromboembolic events" were not detected, not only thromboembolic events, and (3) we did not mention the cause of deaths because all of them were multi-organ failure (MOF) caused by COVID-19 [1] . Therapeutic plasma exchange in patients with COVID-19 pneumonia in intensive care unit: a retrospective study

title:
  TPE seems to be a treatment that may improve outcomes by effectively removing fibrin degradation products and restoring coagulation status: fact or fiction?


id: cord-314737-2fun90ze
author: Cardoso, Filipe S.
date: 2020-07-28
txt: ./txt/cord-314737-2fun90ze.txt
cache: ./cache/cord-314737-2fun90ze.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03173-1
doi: 10.1186/s13054-020-03173-1
abstract: nan
summary:
  title: Age, sex, and comorbidities predict ICU admission or mortality in cases with SARS-CoV2 infection: a population-based cohort study This was a retrospective analysis from a nationwide prospective registry, including confirmed (nasal/pharynx swab real-time polymerase chain reaction) cases of SARS-CoV2 infection notified to the Directorate-General of Health from March 02 until April 21, 2020, in Portugal. The model''s calibration plot showed a very good predictive performance up to estimated probabilities of Among cases with SARS-CoV2 infection at an early phase of the epidemic in Portugal, pre-hospital characteristics like age, sex, and the number of comorbidities were useful to predict ICU admission or all-cause mortality [5] . Dr. Cardoso conceived and designed the study, performed statistical and data analyses, drafted the manuscript, revised the manuscript, and provided final approval. Dr. Fidalgo contributed to the conception and design of the study and data analysis and interpretation, contributed to drafting and revision of the manuscript, and provided final approval.

title:
  Age, sex, and comorbidities predict ICU admission or mortality in cases with SARS-CoV2 infection: a population-based cohort study


id: cord-314872-njlgggzq
author: Kornilov, Sergey A.
date: 2020-07-22
txt: ./txt/cord-314872-njlgggzq.txt
cache: ./cache/cord-314872-njlgggzq.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03141-9
doi: 10.1186/s13054-020-03141-9
abstract: nan
summary:
  We interrogated the associations between plasma concentrations of sACE2 and biomarkers of metabolic syndrome (body mass index, BMI; blood pressure; glycemic markers; and lipid levels), adiposity (plasma leptin and serum adiponectin), inflammation (high-sensitivity Creactive protein, hsCRP, white blood cell count, and interleukin-8), and liver damage (alanine aminotransferase, aspartate transaminase, and gamma-glutamyltransferase, GGT) in a large cohort of participants in a commercial wellness program who had undergone comprehensive multi-omic profiling (N = 2051; 1238 women and 813 men, aged 22 to 87 years, M = 47.3, SD = 11.71) (see [5] for details). BMI, body mass index; MAP, mean arterial blood pressure; HbA1c, glycohemoglobin A1c; HOMA-IR, homeostatic model assessment of insulin resistance; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; IL-8, interleukin 8; hsCRP, high-sensitivity C-reactive protein; ALAT, alanine aminotransferase; ASAT, aspartate transaminase; GGT, gamma-glutamyl-transferase Individuals who met World Health Organization''s diagnostic criteria for metabolic syndrome (MetS) (N = 171) displayed elevated plasma sACE2 levels compared to controls (N = 1880; P = 4.7 × 10 − 5 ); the effect was stronger in men (P int = 8.9 × 10 − 5 ).

title:
  Plasma levels of soluble ACE2are associated with sex, Metabolic Syndrome, and its biomarkers in a large cohort, pointing to a possible mechanism for increased severity in COVID-19


id: cord-315685-ute3dxwu
title: Evidence of a wide gap between COVID-19 in humans and animal models: a systematic review
author: Ehaideb, Salleh N.
date: 2020-10-06
txt: ./txt/cord-315685-ute3dxwu.txt
cache: ./cache/cord-315685-ute3dxwu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33023604/
doi: 10.1186/s13054-020-03304-8
summary:
  The systematic search identified 101 studies and 326 preprints, of which 400 articles were excluded because they were reviews, non-original articles, unrelated to the COVID-19 infection, or experimental animals that do not support SARS-CoV-2 replication such as pigs, ducks, and chickens ( Fig. 1 and Additional file 2). The aims were to investigate the pathogenesis of COVID-19 (n = 15), testing drugs and vaccines (n = 14), the host Table 1 Search strategy and selection criteria We searched the MEDLINE, as well as BioRxiv and MedRxiv preprint servers for original research describing or using an animal model of SARS-CoV-2 induced COVID published in English from January 1, 2020, to May 20, 2020. We used the search terms (COVID-19) OR (SARS-CoV-2) AND, (animal models), (hamsters), (nonhuman primates), (macaques), (rodent), (mice), (rats), (ferrets), (rabbits), (cats), and (dogs). We used the search terms (COVID-19) OR (SARS-CoV-2) AND, (animal models), (hamsters), (nonhuman primates), (macaques), (rodent), (mice), (rats), (ferrets), (rabbits), (cats), and (dogs).

abstract:
  BACKGROUND: Animal models of COVID-19 have been rapidly reported after the start of the pandemic. We aimed to assess whether the newly created models reproduce the full spectrum of human COVID-19. METHODS: We searched the MEDLINE, as well as BioRxiv and MedRxiv preprint servers for original research published in English from January 1 to May 20, 2020. We used the search terms (COVID-19) OR (SARS-CoV-2) AND (animal models), (hamsters), (nonhuman primates), (macaques), (rodent), (mice), (rats), (ferrets), (rabbits), (cats), and (dogs). Inclusion criteria were the establishment of animal models of COVID-19 as an endpoint. Other inclusion criteria were assessment of prophylaxis, therapies, or vaccines, using animal models of COVID-19. RESULT: Thirteen peer-reviewed studies and 14 preprints met the inclusion criteria. The animals used were nonhuman primates (n = 13), mice (n = 7), ferrets (n = 4), hamsters (n = 4), and cats (n = 1). All animals supported high viral replication in the upper and lower respiratory tract associated with mild clinical manifestations, lung pathology, and full recovery. Older animals displayed relatively more severe illness than the younger ones. No animal models developed hypoxemic respiratory failure, multiple organ dysfunction, culminating in death. All species elicited a specific IgG antibodies response to the spike proteins, which were protective against a second exposure. Transient systemic inflammation was observed occasionally in nonhuman primates, hamsters, and mice. Notably, none of the animals unveiled a cytokine storm or coagulopathy. CONCLUSIONS: Most of the animal models of COVID-19 recapitulated mild pattern of human COVID-19 with full recovery phenotype. No severe illness associated with mortality was observed, suggesting a wide gap between COVID-19 in humans and animal models.


id: cord-316829-wm6y6uwm
title: Logistic and organizational aspects of a dedicated intensive care unit for COVID-19 patients
author: Vargas, Maria
date: 2020-05-18
txt: ./txt/cord-316829-wm6y6uwm.txt
cache: ./cache/cord-316829-wm6y6uwm.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32423452/
doi: 10.1186/s13054-020-02955-x
abstract: nan
summary:
  Logistic and organizational aspects of a dedicated intensive care unit for COVID-19 patients Maria Vargas 1* , Giuseppe De Marco 1 , Stefania De Simone 2 and Giuseppe Servillo 1 Dear Editor, On 31 March, the World Health Organization (WHO) reported 750,890 confirmed globally confirmed cases of COVID-19 [1] . 1. The most experienced ICU physician is the work shift coordinator and stays in the green area to control the compliance of the staff with the procedures and to check the patients from the centralized monitoring area. 4. The nursing and medical staff performed the first entry in the ICU boxes and stay inside for 4 h. According to our experience, a simple logistic project and clear organizational plan may be the keys to the success of surging the ICU capacity with dedicated facilities during the COVID-19 outbreak. Lower box-organization of ICU dedicated to COVID-19 patients. The green area inside the ICU is a clean zone where the medical and nursing staff may stay during the 12-h shift.


id: cord-317729-ruvx9zwd
title: Adrenomedullin in COVID-19 induced endotheliitis
author: Wilson, Darius Cameron
date: 2020-07-09
txt: ./txt/cord-317729-ruvx9zwd.txt
cache: ./cache/cord-317729-ruvx9zwd.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32646523/
doi: 10.1186/s13054-020-03151-7
abstract: nan
summary:
  Indeed, a recent study investigating gene upregulation in patients with systemic capillary leak syndrome (SCLS), characterised by plasma leakage into peripheral tissue and transient episodes of hypotensive shock and oedema, found that ADM was not only one of the most upregulated genes, but that subsequent application to endothelial cells resulted in a protective effect on vascular barrier function [3] . Furthermore, recent clinical studies on sepsis patients upon emergency department (ED) presentation and during intensive care (ICU) treatment using the stable protein surrogate, mid-regional proadrenomedullin (MR-proADM), found that its assessment could accurately identify disease progression in patients with nonsevere clinical signs and symptoms, safely increase outpatient treatment with decreased readmission rates and no subsequent mortalities [4] , and identify patients requiring a rapid administration of antibiotics or triage to the ICU [5] . Abbreviations ADM: Adrenomedullin; ED: Emergency department; ICU: Intensive care unit; MR-proADM: Mid-regional proadrenomedullin; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; SCLS: Systemic capillary leak syndrome


id: cord-319101-2vdd10mu
title: ECMO during the COVID-19 pandemic: when is it unjustified?
author: Abrams, Darryl
date: 2020-08-17
txt: ./txt/cord-319101-2vdd10mu.txt
cache: ./cache/cord-319101-2vdd10mu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32807189/
doi: 10.1186/s13054-020-03230-9
abstract: nan
summary:
  Intensive care units (ICUs) overwhelmed by critically ill patients may create non-conventional ICU spaces and even consider triaging invasive mechanical ventilation to those most likely to benefit [2] . The use of ECMO taxes many resources, but none more so than staffing-increased nursing ratios, need for ECMO specialists, disproportionate medical provider time, not to mention other staff, such as respiratory or physical therapists, who would be needed elsewhere for the care of other patients [9] . During non-pandemic times, in hospitals or regions with sufficient staffing reserves and provider availability, it may be understandable why clinicians might attempt ECMO in a candidate with a low, but acceptable, probability of benefit (e.g., a post-partum patient with refractory shock in multisystem organ failure). Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients


id: cord-319936-5uze06rp
title: A phase 1 trial of nebulised heparin in acute lung injury
author: Dixon, Barry
date: 2008-05-06
txt: ./txt/cord-319936-5uze06rp.txt
cache: ./cache/cord-319936-5uze06rp.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/cc6894
doi: 10.1186/cc6894
summary:
  INTRODUCTION: Animal studies of acute lung injury (ALI) suggest nebulised heparin may limit damage from fibrin deposition in the alveolar space and microcirculation. Studies in animal models of ALI have demonstrated that nebulised heparin improved the PaO 2 /FiO 2 ratio and reduced histological ALI = acute lung injury; APTT = activated partial thromboplastin time; BAL = bronchoalveolar lavage; ELISA = enzyme-linked immunosorbent assay; PaO 2 /FiO 2 = arterial oxygen partial pressure to inspired oxygen fraction ratio; PTF = prothrombin fragments; TCT = thrombin clotting time; t-PA = tissue plasminogen activator. Analysis of variance was used to compare the effect of heparin dose on the P a O 2 /F i O 2 ratio, lung compliance, the alveolar dead space fraction, the APTT, the TCT and intrapulmonary PTF and t-PA levels. We found administration of nebulised heparin to mechanically ventilated patients with ALI was feasible, was not associated with serious adverse events, and increased APTT levels at higher doses.

abstract:
  INTRODUCTION: Animal studies of acute lung injury (ALI) suggest nebulised heparin may limit damage from fibrin deposition in the alveolar space and microcirculation. No human studies have been undertaken to date. We assessed the feasibility, safety and potential anticoagulant effects of administration of nebulised heparin to patients with ALI. METHODS: An open label phase 1 trial of four escalating doses of nebulised heparin was performed. A total of 16 ventilated patients with ALI were studied. The first group was administered a total of 50,000 U/day, the second group 100,000 U/day, the third group 200,000 U/day and the fourth group 400,000 U/day. Assessments of lung function included the PaO(2)/FiO(2 )ratio, lung compliance and the alveolar dead space fraction. Monitoring of anticoagulation included the activated partial thromboplastin time (APTT) and the thrombin clotting time. Bronchoalveolar lavage fluid was collected and the prothrombin fragment and tissue plasminogen activator levels were assessed. Analysis of variance was used to compare the effects of dose. RESULTS: No serious adverse events occurred for any dose. The changes over time for the PaO(2)/FiO(2 )ratio, lung compliance and the alveolar dead space fraction levels were similar for all doses. A trend to increased APTT and thrombin clotting time levels was present with higher doses (P = 0.09 and P = 0.1, respectively). For the highest dose, the APTT reached 64 seconds; following cessation of nebulised heparin, the APTT fell to 39 seconds (P = 0.06). In bronchoalveolar lavage samples a trend to reduced prothrombin fragment levels was present with higher doses (P = 0.1), while tissue plasminogen activator levels were similar for all doses. CONCLUSION: Administration of nebulised heparin to mechanically ventilated patients with ALI is feasible. Nebulised heparin was not associated with any serious adverse events, and at higher doses it increased APTT levels. Larger trials are required to further investigate the safety and efficacy of nebulised heparin. In these trials due consideration must be given to systemic anticoagulant effects. TRIAL REGISTRATION: Australian Clinical trials registry ACTRN12606000388516.


id: cord-320637-jn8dh4vk
author: Nosaka, Nobuyuki
date: 2015-06-11
txt: ./txt/cord-320637-jn8dh4vk.txt
cache: ./cache/cord-320637-jn8dh4vk.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-015-0983-9
doi: 10.1186/s13054-015-0983-9
summary:
  title: Anti-high mobility group box-1 monoclonal antibody treatment provides protection against influenza A virus (H1N1)-induced pneumonia in mice This study was undertaken to evaluate the therapeutic effects of anti-high mobility group box-1 (HMGB1) monoclonal antibody (mAb) treatment on influenza A virus (H1N1)-induced pneumonia in mice. CONCLUSIONS: Anti-HMGB1 mAb may provide a novel and effective pharmacological strategy for severe influenza virus infection in humans by reducing the inflammatory responses induced by HMGB1. Here we provide compelling data demonstrating that anti-HMGB1 mAb may provide a novel and effective pharmacological therapeutic strategy for severe influenza virus infection by reducing the inflammatory responses induced by HMGB1. Histologically, influenza virus inoculation increased neutrophil infiltration in the lung, although anti-HMGB1 mAb treatment attenuated this effect (Fig. 2c) . Reverse-transcription PCR in the lung homogenates showed that anti-HMGB1 mAb-treated mice had significantly attenuated RAGE and NF-κB (p65) expression on day 3 after virus inoculation compared with control mice (Fig. 3b) .

title:
  Anti-high mobility group box-1 monoclonal antibody treatment provides protection against influenza A virus (H1N1)-induced pneumonia in mice

abstract:
  INTRODUCTION: Provision for the emergence of an influenza pandemic is an urgent issue. The discovery of a novel anti-influenza therapeutic approach would increase the effectiveness of traditional virus-based strategies. This study was undertaken to evaluate the therapeutic effects of anti-high mobility group box-1 (HMGB1) monoclonal antibody (mAb) treatment on influenza A virus (H1N1)-induced pneumonia in mice. METHODS: Nine-week-old male C57BL/6 mice were inoculated with H1N1, then anti-HMGB1 mAb or control mAb were administered intravenously at 1, 24 and 48 hours after H1N1 inoculation and the survival rate was analyzed. Lung lavage and histopathological analysis were performed on days 3, 5, 7 and 10 after inoculation. RESULTS: Anti-HMGB1 mAb significantly improved the survival rate of H1N1-inoculated mice (1 out of 15 versus 8 out of 15 deaths in the anti-HMGB1 mAb-treated group versus the control mAb-treated group, p < 0.01), although the treatment did not affect virus propagation in the lungs. The treatment also significantly attenuated histological changes and neutrophil infiltration in the lungs of H1N1-inoculated mice. This was associated with inhibition of HMGB1 and suppression of inflammatory cytokine/chemokine expression and oxidative stress enhancement, which were observed in H1N1-inoculated mice. The expression of receptor for advanced glycation end products and nuclear factor κB was attenuated by the treatment. CONCLUSIONS: Anti-HMGB1 mAb may provide a novel and effective pharmacological strategy for severe influenza virus infection in humans by reducing the inflammatory responses induced by HMGB1. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-0983-9) contains supplementary material, which is available to authorized users.


id: cord-321440-sts3re6p
title: Unrecognized diabetes in critically ill COVID-19 patients
author: Klein, Sebastian J.
date: 2020-07-09
txt: ./txt/cord-321440-sts3re6p.txt
cache: ./cache/cord-321440-sts3re6p.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32646467/
doi: 10.1186/s13054-020-03139-3
abstract: nan
summary:
  We retrospectively analyzed the incidence of diabetes in all critically ill patients admitted to the four dedicated COVID-19 intensive care units (ICU) at the University Hospital in Innsbruck, Tyrol, Austria, which covers 180,000 inhabitants as primary hospital and also functions as a tertiary referral center for the whole region of Tyrol. Of 47 COVID-19 patients admitted to our ICUs, HbA1c was measured in 44, which were included in the analysis ( Table 1 ). Recent data demonstrating viral particles in endothelial cells of several organs suggest "endotheliitis" as a possible mechanism of organ dysfunction leading to critical illness in COVID-19 patients which may be aggravated by endothelial Abbreviations: IQR interquartile range, BMI body mass index, HbA1c glycated hemoglobin, CRP C-reactive protein, IL-6 interleukin-6, COPD chronic obstructive pulmonary disease, SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 *If specified in the patients'' health records dysfunction associated with prediabetes and diabetes [6] .


id: cord-322726-obnil3b7
author: Nakamura, Kensuke
date: 2020-06-15
txt: ./txt/cord-322726-obnil3b7.txt
cache: ./cache/cord-322726-obnil3b7.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03080-5
doi: 10.1186/s13054-020-03080-5
abstract: nan
summary:
  title: Early rehabilitation with dedicated use of belt-type electrical muscle stimulation for severe COVID-19 patients Automated EMS is expected to be an ideal mobilization for severe COVID-19 patients. Exposure to medical staff can be minimized while realizing frequent actuation with a longer duration for each bout of stimulation by assigning each COVID-19 patient a dedicated belt-type EMS, for which no belt change would be necessary (Fig. 1) . At Hitachi General Hospital, we assigned each ventilated COVID-19 patients a dedicated belt-type EMS: a measure which achieved better outcomes by administration of 50 min bouts, with three bouts per day, requiring only switching on by a nurse. In conclusion, we propose the use of dedicated belttype EMS for early rehabilitation in severe COVID-19. Fig. 1 Belt-type electrical muscle stimulation for severe COVID-19 patients. Belt-type electrical muscle stimulation EMS for intensive care unit patient with extracorporeal membrane oxygenation.

title:
  Early rehabilitation with dedicated use of belt-type electrical muscle stimulation for severe COVID-19 patients


id: cord-323327-08p122lw
title: Blocking IL-1 to prevent respiratory failure in COVID-19
author: van de Veerdonk, Frank L.
date: 2020-07-18
txt: ./txt/cord-323327-08p122lw.txt
cache: ./cache/cord-323327-08p122lw.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32682440/
doi: 10.1186/s13054-020-03166-0
summary:
  These findings open new avenues for host-directed therapies in patients with symptomatic SARS-CoV-2 infection and might in addition to antiviral treatment be enough to curb the currently unacceptably high morbidity and mortality associated with COVID-19. Although ICU patients have been treated with glucocorticoids, some experts have even argued, based on studies in Middle-Eastern respiratory syndrome coronavirus (MERS-CoV), severe acute respiratory syndrome (SARS), influenza, and respiratory syncytial virus (RSV), that they are likely to do more harm than good [1, 2] . The autoinflammatory loop can exacerbate from increase innate immune response into uncontrolled MAS a spectrum that associates with increasing ferritin levels van de Veerdonk and Netea Critical Care (2020) 24:445 patients in the early phase and reports that high dose intravenous anakinra started in patients outside of the ICU was safe and resulted in clinical benefit in 72% of patients [56] .

abstract:
  COVID-19 is an emerging disease that can manifest itself as asymptomatic or mild respiratory tract infection in the majority of individuals, but in some, it can progress into severe pneumonia and acute respiratory distress syndrome (ARDS). Inflammation is known to play a crucial role in the pathogenesis of severe infections and ARDS and evidence is emerging that the IL-1/IL-6 pathway is highly upregulated in patients with severe disease. These findings open new avenues for host-directed therapies in patients with symptomatic SARS-CoV-2 infection and might in addition to antiviral treatment be enough to curb the currently unacceptably high morbidity and mortality associated with COVID-19.


id: cord-323601-qzruawe1
title: IL6-R blocking with tocilizumab in critically ill patients with hemophagocytic syndrome
author: Dufranc, Etienne
date: 2020-04-22
txt: ./txt/cord-323601-qzruawe1.txt
cache: ./cache/cord-323601-qzruawe1.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02878-7
doi: 10.1186/s13054-020-02878-7
abstract: nan
summary:
  Because some patients may develop refractory or relapsing HLH, alternative treatments targeting specific immune pathways or cytokine signaling have been tested [1] . Tocilizumab, a monoclonal antibody targeting the receptor of IL6, fully reverses the multi-organ failure and the cytokine profile of the CAR-T cell-induced cytokinerelease syndrome [3] . In the herein study, we reviewed the outcomes of nine critically ill patients who received tocilizumab to treat HLH ( Table 1 ). In critically ill patients with severe forms of HLH, etoposide rapidly reverses cytokine storm and improves clinical condition [1] . Alternatives should thus be discussed in adult patients with chemotherapy-induced bone marrow failure, underlying autoimmune diseases requiring cytotoxic agents, or with a moderate form of HLH not related to hematological malignancies. In conclusion, IL-6-R blockade with tocilizumab may be an alternative in critically ill patients with moderate forms of HLH.


id: cord-324598-z65p60z9
author: He, Huaiwu
date: 2020-09-29
txt: ./txt/cord-324598-z65p60z9.txt
cache: ./cache/cord-324598-z65p60z9.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03301-x
doi: 10.1186/s13054-020-03301-x
summary:
  title: Influence of overdistension/recruitment induced by high positive end-expiratory pressure on ventilation–perfusion matching assessed by electrical impedance tomography with saline bolus BACKGROUND: High positive end-expiratory pressures (PEEP) may induce overdistension/recruitment and affect ventilation–perfusion matching (VQMatch) in mechanically ventilated patients. Because of the high degree of inhomogeneity in the respiratory system of ARDS patients, an increase of PEEP introduces regional lung overdistension and recruitment at the same time. Little is known on how the regional lung overdistension and recruitment influence regional ventilation-perfusion (V-Q) matching (shunt and dead space) in response to PEEP increase. The aim of the study was to investigate the association between lung overdistension/recruitment induced by PEEP and ventilation-perfusion matching in patients suffering from or being at high risk of developing ARDS. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial

title:
  Influence of overdistension/recruitment induced by high positive end-expiratory pressure on ventilation–perfusion matching assessed by electrical impedance tomography with saline bolus

abstract:
  BACKGROUND: High positive end-expiratory pressures (PEEP) may induce overdistension/recruitment and affect ventilation–perfusion matching (VQMatch) in mechanically ventilated patients. This study aimed to investigate the association between PEEP-induced lung overdistension/recruitment and VQMatch by electrical impedance tomography (EIT). METHODS: The study was conducted prospectively on 30 adult mechanically ventilated patients: 18/30 with ARDS and 12/30 with high risk for ARDS. EIT measurements were performed at zero end-expiratory pressures (ZEEP) and subsequently at high (12–15 cmH(2)O) PEEP. The number of overdistended pixels over the number of recruited pixels (O/R ratio) was calculated, and the patients were divided into low O/R (O/R ratio < 15%) and high O/R groups (O/R ratio ≥ 15%). The global inhomogeneity (GI) index was calculated to evaluate the ventilation distribution. Lung perfusion image was calculated from the EIT impedance–time curves caused by 10 ml 10% NaCl injection during a respiratory pause (> 8 s). DeadSpace(%), Shunt(%), and VQMatch(%) were calculated based on lung EIT perfusion and ventilation images. RESULTS: Increasing PEEP resulted in recruitment mainly in dorsal regions and overdistension mainly in ventral regions. ΔVQMatch(%) (VQMatch(%) at high PEEP minus that at ZEEP) was significantly correlated with recruited pixels (r = 0.468, P = 0.009), overdistended pixels (r = − 0.666, P < 0.001), O/R ratio (r = − 0.686, P < 0.001), and ΔSpO(2) (r = 0.440, P = 0.015). Patients in the low O/R ratio group (14/30) had significantly higher Shunt(%) and lower VQMatch(%) than those in the high O/R ratio group (16/30) at ZEEP but not at high PEEP. Comparable DeadSpace(%) was found in both groups. A high PEEP caused a significant improvement of VQMatch(%), DeadSpace(%), Shunt(%), and GI in the low O/R ratio group, but not in the high O/R ratio group. Using O/R ratio of 15% resulted in a sensitivity of 81% and a specificity of 100% for an increase of VQMatch(%) > 20% in response to high PEEP. CONCLUSIONS: Change of ventilation–perfusion matching was associated with regional overdistention and recruitment induced by PEEP. A low O/R ratio induced by high PEEP might indicate a more homogeneous ventilation and improvement of VQMatch. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04081155. Registered on 9 September 2019—retrospectively registered.


id: cord-325626-r7k7u7ro
title: SARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression
author: Yu, Xia
date: 2020-04-23
txt: ./txt/cord-325626-r7k7u7ro.txt
cache: ./cache/cord-325626-r7k7u7ro.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02893-8
doi: 10.1186/s13054-020-02893-8
abstract: nan
summary:
  In the study, we retrospectively collected the virological data, as well as demographic, epidemiological clinical information of 92 patients with confirmed COVID-19 in a single hospital in Zhejiang Province, China. We compared the baseline viral loads between severe patients and those mild to moderate at admission and also between those developing severe disease during hospitalization and those not. We studied 92 patients with confirmed COVID-19 who were admitted from January 19, 2020, to March 19, 2020, in the First Affiliated Hospital of Zhejiang University. The sputum specimens were collected from the lower respiratory tract of each patient at admission and the levels of viral nuclei acid were determined by a real-time PCR (RT-PCR) approach and indicated by the cycle threshold (Ct) values of RT-PCR assays [2] . We found that the viral load of the sputum specimen in the lower respiratory tract tested at baseline is closely related to the severity of COVID-19.


id: cord-325664-9ool5z9s
title: COVID-19 mortality and ICU admission: the Italian experience
author: Immovilli, Paolo
date: 2020-05-15
txt: ./txt/cord-325664-9ool5z9s.txt
cache: ./cache/cord-325664-9ool5z9s.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32414403/
doi: 10.1186/s13054-020-02957-9
abstract: nan
summary:
  authors: Immovilli, Paolo; Morelli, Nicola; Antonucci, Elio; Radaelli, Guido; Barbera, Mario; Guidetti, Donata title: COVID-19 mortality and ICU admission: the Italian experience correlation was observed between the CFR and ICU admission rate (Pearson''s r − 0.53, p value 0.014) and R 2 was 0.24, suggesting an association between mortality and the absence of treatment in ICU (Fig. 1) . However, examining the differing outbreak magnitudes in regions with different ICU availability evidenced a discrepancy in the percentage of ICU-admitted patients. Indeed, there was a higher mortality rate in the northern region where fewer patients could be admitted into an ICU. Paolo Immovilli, Nicola Morelli, Elio Antonucci, Guido Radaelli, Mario Barbera, and Donata Guidetti are responsible for study design and all authors wrote and reviewed the manuscript. There was no funding for this article.Availability of data and materials Data published online by Italian Civil Protection Department (http:// opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2 cce478eaac82fe38d4138b1; seen on March 31, 2020).Ethics approval and consent to participate Not applicable.


id: cord-325694-xx6m60hv
title: Paediatric and adult critical care medicine: joining forces against Covid-19
author: Kneyber, Martin C. J.
date: 2020-06-16
txt: ./txt/cord-325694-xx6m60hv.txt
cache: ./cache/cord-325694-xx6m60hv.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32546204/
doi: 10.1186/s13054-020-03074-3
abstract: nan
summary:
  title: Paediatric and adult critical care medicine: joining forces against Covid-19 Paediatric and adult critical care medicine: joining forces against Covid-19 This could be done by redeploying paediatric critical care physicians and nurses to adult ICUs. However, paediatric ICUs (PICU) are exclusively located in university hospitals in the Netherlands, hence redeployment potentially could reduce capacity for critically ill children [1] . PICU physicians and nurses advocated to remain in their environment and use the well-established working relationships within the PICU bedside team when caring for the adult COVID-19 patients because the general principles of intensive care medicine would not be different between children and adults [3] . Our ICUs admitted 98 adult COVID-19 patients, 12 of them were treated in the PICU by paediatric nurses and intensivists. It made PICU practitioners stronger in many ways and sets in motion a stronger relationship between paediatric and adult critical care medicine in our hospital.


id: cord-326124-jtpsydy5
author: Adam, Elisabeth H.
date: 2020-09-24
txt: ./txt/cord-326124-jtpsydy5.txt
cache: ./cache/cord-326124-jtpsydy5.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32972429/
doi: 10.1186/s13054-020-03293-8
abstract: nan
summary:
  title: Fibrin-derived peptide Bβ15-42 (FX06) as salvage treatment in critically ill patients with COVID-19-associated acute respiratory distress syndrome Here, we describe the empirical salvage treatment of critically ill COVID-19 patients in two German tertiary care University Hospitals with FX06 (F4 Pharma, Vienna, Austria), a naturally occurring peptide derived from the neo-N-terminus of fibrin (Bβ15-42). This observational case series includes six patients during their treatment in the intensive care unit. Based on our experience, the salvage use of FX06 in severe COVID-19-associated ARDS could be an effective therapy to improve pulmonary function and vascular leakage in the most severely ill patients. FX06 (fibrin-derived peptide Bbeta15-42)-a potential candidate for myocardial reperfusion therapy EA, BS, and PM analyzed and interpreted the patient data and wrote the manuscript. This study was funded by institutional funds of both University hospitals. The study was approved by the local ethics committee (University Hospital Frankfurt, Frankfurt, Germany) (#20-643).

title:
  Fibrin-derived peptide Bβ15-42 (FX06) as salvage treatment in critically ill patients with COVID-19-associated acute respiratory distress syndrome


id: cord-326315-ncfxlnpj
title: Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis
author: Cillóniz, Catia
date: 2011-09-14
txt: ./txt/cord-326315-ncfxlnpj.txt
cache: ./cache/cord-326315-ncfxlnpj.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/21914220/
doi: 10.1186/cc10444
summary:
  INTRODUCTION: The frequency and clinical significance of polymicrobial aetiology in community-acquired pneumonia (CAP) patients admitted to the ICU have been poorly studied. The aim of the present study was to describe the prevalence, clinical characteristics and outcomes of severe CAP of polymicrobial aetiology in patients admitted to the ICU. Patients with polymicrobial aetiology had previously received antibiotics less frequently, had a higher proportion of chronic respiratory and neurological diseases, less frequently presented fever at admission, had higher rates of PSI risk class V, had severe CAP according to the IDSA/ATS definition, and fulfilled ARDS criteria. Among these variables, chronic respiratory disease and ARDS criteria at hospital admission were independent predictors of polymicrobial aetiology in the multivariate analysis. • Polymicrobial aetiology is frequent among patients with CAP admitted to the ICU and may result in inappropriate empiric antimicrobial treatment.

abstract:
  INTRODUCTION: The frequency and clinical significance of polymicrobial aetiology in community-acquired pneumonia (CAP) patients admitted to the ICU have been poorly studied. The aim of the present study was to describe the prevalence, clinical characteristics and outcomes of severe CAP of polymicrobial aetiology in patients admitted to the ICU. METHODS: The prospective observational study included 362 consecutive adult patients with CAP admitted to the ICU within 24 hours of presentation; 196 (54%) patients had an established aetiology. RESULTS: Polymicrobial infection was present in 39 (11%) cases (20% of those with defined aetiology): 33 cases with two pathogens, and six cases with three pathogens. The most frequently identified pathogens in polymicrobial infections were Streptococcus pneumoniae (n = 28, 72%), respiratory viruses (n = 15, 39%) and Pseudomonas aeruginosa (n = 8, 21%). Chronic respiratory disease and acute respiratory distress syndrome criteria were independent predictors of polymicrobial aetiology. Inappropriate initial antimicrobial treatment was more frequent in the polymicrobial aetiology group compared with the monomicrobial aetiology group (39% vs. 10%, P < 0.001), and was an independent predictor of hospital mortality (adjusted odds ratio = 10.79, 95% confidence interval = 3.97 to 29.30; P < 0.001). The trend for higher hospital mortality of the polymicrobial aetiology group compared with the monomicrobial aetiology group (n = 8, 21% versus n = 17, 11%), however, was not significantly different (P = 0.10). CONCLUSIONS: Polymicrobial pneumonia occurs frequently in patients admitted to the ICU. This is a risk factor for inappropriate initial antimicrobial treatment, which in turn independently predicts hospital mortality.


id: cord-326874-rdwvsm4s
author: Wu, Chaomin
date: 2020-11-10
txt: ./txt/cord-326874-rdwvsm4s.txt
cache: ./cache/cord-326874-rdwvsm4s.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33172477/
doi: 10.1186/s13054-020-03340-4
summary:
  In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days after adjusting for age, sex, SOFA score at hospital admission, propensity score of corticosteroid treatment, comorbidities, antiviral treatment, and respiratory supports (HR 0.42; 95% CI 0.21, 0.85; p = 0.0160). CONCLUSION: In this clinical practice setting, low-dose corticosteroid treatment was associated with reduced risk of in-hospital death within 60 days in COVID-19 patients who developed ARDS. However, there was comprehensive controversy on its efficacy [9, 10] , due to the results of observational studies that showed corticosteroid treatment was associated with increased mortality and nosocomial infections for influenza and delayed virus clearance for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) [11] . In this observational study, prescription of low-to-moderate dose systemic corticosteroids was associated with lower risk of 60-day in-hospital death among COVID-19 patients who developed ARDS.

title:
  Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis

abstract:
  BACKGROUND: The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID-19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without. METHODS: In this single-center retrospective observational study, patients with ARDS caused by COVID-19 between January 20, 2020, and February 24, 2020, were enrolled. The primary outcome was 60-day in-hospital death. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality. RESULTS: A total of 382 patients [60.7 ± 14.1 years old (mean ± SD), 61.3% males] were analyzed. The median of sequential organ failure assessment (SOFA) score was 2.0 (IQR 2.0–3.0). Of these cases, 94 (24.6%) patients had invasive mechanical ventilation. The number of patients received systemic corticosteroids was 226 (59.2%), and 156 (40.8%) received standard treatment. The maximum dose of corticosteroids was 80.0 (IQR 40.0–80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0–12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days after adjusting for age, sex, SOFA score at hospital admission, propensity score of corticosteroid treatment, comorbidities, antiviral treatment, and respiratory supports (HR 0.42; 95% CI 0.21, 0.85; p = 0.0160). Corticosteroids were not associated with delayed viral RNA clearance in our cohort. CONCLUSION: In this clinical practice setting, low-dose corticosteroid treatment was associated with reduced risk of in-hospital death within 60 days in COVID-19 patients who developed ARDS.


id: cord-327622-ezgufe24
author: Kaur, Ramandeep
date: 2020-09-23
txt: ./txt/cord-327622-ezgufe24.txt
cache: ./cache/cord-327622-ezgufe24.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03231-8
doi: 10.1186/s13054-020-03231-8
summary:
  • When removing the endotracheal tube, simultaneously turn off the ventilator • Avoid disconnecting ETT from the ventilator circuit before extubation to reduce spray of contaminated aerosols 9 Transport • Place a filter between the artificial airway and the transport ventilator circuit • Use HME that has filter function (HME-F) • Consider clamping the ETT before disconnection from ventilator circuit 10 Bronchoscopy assist* 2 in vivo [44, 45] • For spontaneously breathing patients, place a surgical mask on patient''s face (Fig. 7a, b) • Use NIV mask with examination port for patients on NIV (Fig. 7d) • Use swivel adapter to insert bronchoscope for intubated patient (Fig. 7c) Abbreviations: HFNC high-flow nasal cannula, IPPB intermittent positive pressure breathing, HME heat moisture exchanger, ETT endotracheal tube, NIV non-invasive ventilation *Based on CDC guidelines, these procedures should ideally be performed in airborne infection isolation rooms entrainment or nonrebreather mask [53] .

title:
  Practical strategies to reduce nosocomial transmission to healthcare professionals providing respiratory care to patients with COVID-19

abstract:
  Coronavirus disease (COVID-19) is an emerging viral infection that is rapidly spreading across the globe. SARS-CoV-2 belongs to the same coronavirus class that caused respiratory illnesses such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). During the SARS and MERS outbreaks, many frontline healthcare workers were infected when performing high-risk aerosol-generating medical procedures as well as when providing basic patient care. Similarly, COVID-19 disease has been reported to infect healthcare workers at a rate of ~ 3% of cases treated in the USA. In this review, we conducted an extensive literature search to develop practical strategies that can be implemented when providing respiratory treatments to COVID-19 patients, with the aim to help prevent nosocomial transmission to the frontline workers.


id: cord-329381-uwae8738
title: Cardiovascular phenotypes in ventilated patients with COVID-19 acute respiratory distress syndrome
author: Evrard, Bruno
date: 2020-05-18
txt: ./txt/cord-329381-uwae8738.txt
cache: ./cache/cord-329381-uwae8738.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02958-8
doi: 10.1186/s13054-020-02958-8
abstract: nan
summary:
  title: Cardiovascular phenotypes in ventilated patients with COVID-19 acute respiratory distress syndrome COVID-19 patients with ACP tended to have lower respiratory-system compliance than their counterparts, presumably due to distinct ARDS phenotypes [6] . This first study assessing hemodynamically ventilated COVID-19 patients with TEE shows a lower **Calculated as the tidal volume divided by the driving pressure (difference between the inspiratory plateau pressure and positive end-expiratory pressure) ***One patient was diagnosed with a Tako-tsubo syndrome during transesophageal echocardiography examination performed shortly after tracheal intubation, after 6 days of high-flow nasal cannula; full recovery of left ventricular systolic function was documented under mechanical ventilation 10 days later ****Measured using the Doppler method applied at the left ventricular outflow tract *****As per April 24, with still 6 patients hospitalized in the intensive care unit, 5 of them being invasively ventilated prevalence of LV and RV failure than in flu-related ARDS patients.


id: cord-331395-12bff84n
title: COVID-19 targets the right lung
author: Li, Jingwen
date: 2020-06-15
txt: ./txt/cord-331395-12bff84n.txt
cache: ./cache/cord-331395-12bff84n.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03033-y
doi: 10.1186/s13054-020-03033-y
abstract: nan
summary:
  Jingwen Li 1 † , Xiaxia Yu 2 † , Shaoping Hu 3 , Zhicheng Lin 4 , Nian Xiong 1,5* and Yi Gao 2* Previous imaging studies of COVID-19 suggested that bilateral lungs be affected [1] . Moreover, the level of right-over-left preference of lung injury was significantly correlated with the potential need for intensive care and inpatient mortality. Pulmonary lesions were imaged by a total of 253 high resolution computed tomographic (CT) chest scans of 103 COVID-19 patients at Wuhan Red Cross Hospital. As a result, 70% (31/103) CT scans showed that the lesion volume of the right lung was larger than that of the left lung. The results suggested that patients with large lesions on the right lung be at a high mortality risk during hospitalization (OR = 2.662, P value = 0.0252 (Fig. 2c, d) .


id: cord-331700-5rfgyiit
title: Epidemiology studies in critical care
author: Martin, Greg
date: 2006-04-04
txt: ./txt/cord-331700-5rfgyiit.txt
cache: ./cache/cord-331700-5rfgyiit.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/16606434/
doi: 10.1186/cc4897
summary:
  Longitudinal epidemiology studies convey an important additional aspect of the healthcare burden from disease, and may additionally serve to compare the effectiveness and efficiency of healthcare systems, to examine specific patient care strategies and to perform quality control analyses. Data of this kind are essential for determining the optimal ICU utilization for a given condition, tracking the effectiveness and efficiency of healthcare systems according to changes in disease incidence or outcome, and for planning research studies according to the characteristics of the disease. In the present issue of Critical Care, investigators from the Intensive Care National Audit and Research Center report the results of a longitudinal study of severe sepsis encompassing England, Wales and Northern Ireland in the past 10 years [1] . EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care

abstract:
  Epidemiology studies are an essential part of clinical research, often forming the foundation for studies ranked more highly in the hierarchy of evidence-based medicine. Studies of sepsis to date have been conducted on local, regional, national and international scales, with the majority conducted in the past 5 years. Longitudinal epidemiology studies convey an important additional aspect of the healthcare burden from disease, and may additionally serve to compare the effectiveness and efficiency of healthcare systems, to examine specific patient care strategies and to perform quality control analyses.


id: cord-334117-8gadvw16
author: Hassanian-Moghaddam, Hossein
date: 2020-07-09
txt: ./txt/cord-334117-8gadvw16.txt
cache: ./cache/cord-334117-8gadvw16.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32646475/
doi: 10.1186/s13054-020-03140-w
abstract: nan
summary:
  The pandemic has been complicated by the co-occurrence of a large methanol outbreak in Iran, seemingly triggered by false claims that consumption of disinfectants and alcohols could prevent and treat COVID-19 infection. In this research letter, we describe the scale of the Iranian methanol outbreak, based on hospitalization and mortality data collated from databases of the Iranian Ministry of Health (MOH) and Legal Medicine Organization (LMO) for the period of February 23 (first documented COVID-19 case in Iran) until May 2, 2020. In terms of mortality, MOH reported that 534 patients with methanol poisoning were confirmed dead in the hospital setting, equivalent to an estimated case fatality rate of approximately 9% (534/5876). Despite these inconsistencies, the number of Iranian poisoning cases (5876 hospitalizations from late February until early May),\ is already five times higher than the second-largest methanol outbreak in history, which was recorded in Libya in March 2013 and affected 1066 patients [2] .

title:
  Double trouble: methanol outbreak in the wake of the COVID-19 pandemic in Iran—a cross-sectional assessment


id: cord-334391-0172afa1
title: The double edged interferon riddle in COVID-19 pathogenesis
author: Gupta, Rahul
date: 2020-11-01
txt: ./txt/cord-334391-0172afa1.txt
cache: ./cache/cord-334391-0172afa1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33131507/
doi: 10.1186/s13054-020-03337-z
abstract: nan
summary:
  I would like to humbly add some views to it: there has been two varying reported type I interferon responses in COVID-19 pathogenesis [2] : one stating the suppression of host antiviral type I interferons (IFNs) and interferon stimulated genes (ISGs) and other stating increased expression of different ISGs, with further inductions of chemokines and cytokines [2] . The viral Nsps (particularly Nsp1) and the ORFs (particularly ORF 6) are known to antagonise the host antiviral IFNs initially by suppressing/delaying their expressions, leading to viral persistence and propagating inflammations. Hence, neither type I IFN nor type III IFN, which are known hard-wired for providing antiviral immunity, was activated in early stages of COVID-19. Aberrant production of NETs have been known to cause severe COVID-like pathophysiologies-thrombosis, lung damage, ARDS, multiorgan damage, etc. The initial type 1IFN suppression could lead to enhanced infiltration of neutrophils, NET formation and ensuing pathophysiologies.


id: cord-335033-cwhm7v0s
author: Vergano, Marco
date: 2020-04-22
txt: ./txt/cord-335033-cwhm7v0s.txt
cache: ./cache/cord-335033-cwhm7v0s.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02891-w
doi: 10.1186/s13054-020-02891-w
abstract: nan
summary:
  title: Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the COVID-19 epidemic As of March 6, 2020, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) issued a series of recommendations [5] and relevant ethical considerations to better inform the clinicians involved in the care of critically-ill COVID-19 patients, in a setting where a disproportionate number of patients requiring life-sustaining treatments was rapidly saturating both the existing and the newly set-up ICU beds. The emerging epidemic is leading to a substantial increase in the number of patients requiring prolonged ventilatory support for acute respiratory failure, potentially resulting in severe imbalances between the population clinical needs and the overall availability of ICU resources. SIAARTI Clinical Ethics Recommendations for the Allocation of Intensive Care Treatments in exceptional, resource-limited circumstances

title:
  Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the COVID-19 epidemic


id: cord-335172-5ig907on
title: COVID-19 and the RAAS—a potential role for angiotensin II?
author: Busse, Laurence W.
date: 2020-04-07
txt: ./txt/cord-335172-5ig907on.txt
cache: ./cache/cord-335172-5ig907on.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02862-1
doi: 10.1186/s13054-020-02862-1
abstract: nan
summary:
  Likewise, patients on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) could be at a greater risk due to the mechanism by which SARS-CoV-2 enters the cell. First, because it normally binds to ACE2 during its degradation and hydrolysis into angiotensin-(1-7) [11] , it may compete with the SARS-CoV-2 for the ACE2 receptor (Fig. 1) . Second, the binding of AngII to the AT1 receptor has been shown to cause internalization and downregulation of ACE2 through an ERK1/2 and p38 MAP kinase pathway in both in vitro animal and in vivo human models [12, 13] . However, to date, the link between ACE inhibitors and ARBs and severity of illness of SARS-CoV-2 infection is purely speculative. Ang-2, angiotensin II; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; ACE1, angiotensinconverting-enzyme 1; ACE2, angiotensin-converting-enzyme 2; H 2 O, water; Na + , sodium Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus


id: cord-336314-xf6zvvl8
title: Clinical analysis of sinus bradycardia in patients with severe COVID-19 pneumonia
author: Hu, Lijuan
date: 2020-05-26
txt: ./txt/cord-336314-xf6zvvl8.txt
cache: ./cache/cord-336314-xf6zvvl8.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02933-3
doi: 10.1186/s13054-020-02933-3
abstract: nan
summary:
  title: Clinical analysis of sinus bradycardia in patients with severe COVID-19 pneumonia The initial manifestation of severe COVID-19 pneumonia patients was hypoxemic respiratory failure, accompanied by rapid increased reactive heart rate and susceptibility to supraventricular arrhythmia [2] . It is noteworthy that about 1/3 of the patients with severe illness in our study developed sinus bradycardia (Fig. 1) . However, there was no severe myocardial damage or cardiac insufficiency in our patients with sinus bradycardia. In light of those evidences, it may be speculated that the toxic role of virus on cardiac conduction system instead of that generated myocardial damage resulted in a sudden death of patients infected with COVID-19. Moreover, a possible inhibitory influence of the virus on activity of cardiac nervous conduction system including sinus node via ACE2 should not be ignored when studying the pathogenic mechanisms among these patients.


id: cord-337444-pqoq8aew
author: Doi, Kent
date: 2020-07-03
txt: ./txt/cord-337444-pqoq8aew.txt
cache: ./cache/cord-337444-pqoq8aew.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03078-z
doi: 10.1186/s13054-020-03078-z
abstract: nan
summary:
  title: Nafamostat mesylate treatment in combination with favipiravir for patients critically ill with Covid-19: a case series Through high-throughput screening of 1017 existing drugs, a clinically available serine protease inhibitor nafamostat mesylate was identified as a potent inhibitor of Middle East respiratory syndrome coronavirus entry into human epithelial cells [2] . Eleven adults with reverse transcriptase polymerase chain reaction-confirmed SARS-CoV-2 infection were admitted to the intensive care unit (ICU) at The University of Tokyo Hospital between April 6 and April 21, 2020, and treated with nafamostat mesylate in combination with favipiravir. Although the number of patients in this case series was very small, this low mortality rate suggests that combination treatment of favipiravir and nafamostat mesylate may be effective for critically ill Covid-19 patients. A clinical trial for the combination treatment of nafamostat mesylate and favipiravir against Covid-19 will be initiated in Japan (jRCTs031200026). Nafamostat mesylate blocks activation of SARS-CoV-2: new treatment option for COVID-19

title:
  Nafamostat mesylate treatment in combination with favipiravir for patients critically ill with Covid-19: a case series


id: cord-337485-nqcnd9py
title: SARS-CoV-2 detection in the lower respiratory tract of invasively ventilated ARDS patients
author: Buetti, Niccolò
date: 2020-10-16
txt: ./txt/cord-337485-nqcnd9py.txt
cache: ./cache/cord-337485-nqcnd9py.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33066801/
doi: 10.1186/s13054-020-03323-5
summary:
  Our objectives were to describe the viral shedding and the viral load in LRT and to determine their association with mortality in critically ill COVID-19 patients. Third, we assessed the association between viral presence in LRT and mortality using mixed-effect logistic models for clustered data adjusting for the time between symptoms'' onset and date of sampling. Our objectives were (1) to describe the viral shedding and the viral load in LRT and (2) to determine THE ASSOCIATION BETWEEN VIRAL PRESENCE AND MORTALITY in critically ill COVID-19 patients. The viral shedding in LRT lasted almost 30 days in median in critically ill patients, and the SARS-CoV-2 viral presence in the LRT was associated with the 6week mortality. Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral shedding in lower respiratory tract samples of critically ill patients

abstract:
  BACKGROUND: Data on SARS-CoV-2 load in lower respiratory tract (LRT) are scarce. Our objectives were to describe the viral shedding and the viral load in LRT and to determine their association with mortality in critically ill COVID-19 patients. METHODS: We conducted a binational study merging prospectively collected data from two COVID-19 reference centers in France and Switzerland. First, we described the viral shedding duration (i.e., time to negativity) in LRT samples. Second, we analyzed viral load in LRT samples. Third, we assessed the association between viral presence in LRT and mortality using mixed-effect logistic models for clustered data adjusting for the time between symptoms’ onset and date of sampling. RESULTS: From March to May 2020, 267 LRT samples were performed in 90 patients from both centers. The median time to negativity was 29 (IQR 23; 34) days. Prolonged viral shedding was not associated with age, gender, cardiac comorbidities, diabetes, immunosuppression, corticosteroids use, or antiviral therapy. The LRT viral load tended to be higher in non-survivors. This difference was statistically significant after adjusting for the time interval between onset of symptoms and date of sampling (OR 3.78, 95% CI 1.13–12.64, p = 0.03). CONCLUSIONS: The viral shedding in LRT lasted almost 30 days in median in critically ill patients, and the viral load in the LRT was associated with the 6-week mortality.


id: cord-338134-smrokdsq
author: Honore, Patrick M.
date: 2020-05-15
txt: ./txt/cord-338134-smrokdsq.txt
cache: ./cache/cord-338134-smrokdsq.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-02943-1
doi: 10.1186/s13054-020-02943-1
abstract: nan
summary:
  title: Therapeutic plasma exchange as a routine therapy in septic shock and as an experimental treatment for COVID-19: we are not sure Therapeutic plasma exchange as a routine therapy in septic shock and as an experimental treatment for COVID-19: we are not sure Patrick M. who concluded that their practice has changed based on their experience, and they now often utilize therapeutic plasma exchange (TPE) earlier in the clinical course of septic shock with multiple organ failure (MODS) and acute respiratory distress syndrome (ARDS) rather than using it as a "rescue therapy" [1] . stated that a major difference between TPE and modern extracorporeal adsorption strategies is based on the fact that the exchange of septic shock plasma with fresh frozen plasma may not lead to an unselective depletion of pro-and anti-inflammatory cytokines and will rather replenish protective factors (within FFPs) that have been consumed by the sepsis [2] .

title:
  Therapeutic plasma exchange as a routine therapy in septic shock and as an experimental treatment for COVID-19: we are not sure


id: cord-338990-vrtzyo2o
title: COVID-19 and ethics in the ICU
author: Nelson, Sarah E.
date: 2020-08-25
txt: ./txt/cord-338990-vrtzyo2o.txt
cache: ./cache/cord-338990-vrtzyo2o.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03250-5
doi: 10.1186/s13054-020-03250-5
abstract: nan
summary:
  This includes an "obligation to provide urgent medical care during disasters … even in the face of greater than usual risks to physicians'' own safety, health, or life." Given the large scope of the pandemic and the deadliness of SARS-CoV-2, these statements may not adequately address this ethical quandary. Based on these principles, 6 recommendations have been made for the current outbreak: maximizing benefits including using scarce resources responsibly and saving more lives/years of life, prioritizing COVID-19 resources (i.e., PPE, vaccines) to healthcare workers, invoking equality using random allocation or lottery to distribute resources to those with similar prognoses, thoughtful consideration of resource allocation (e.g., prioritizing older patients, among the most affected by SARS-CoV-2, to receive a vaccine), prioritizing those who have participated in COVID-19-related research, and providing equal resources to those with COVID-19 and those with other medical conditions [9] . Several ethical dilemmas associated with the COVID-19 pandemic affect intensive care physicians.


id: cord-340205-cwn0gx7h
author: Chen, Yih-Ting
date: 2020-07-16
txt: ./txt/cord-340205-cwn0gx7h.txt
cache: ./cache/cord-340205-cwn0gx7h.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03134-8
doi: 10.1186/s13054-020-03134-8
abstract: nan
summary:
  title: Mortality rate of acute kidney injury in SARS, MERS, and COVID-19 infection: a systematic review and meta-analysis There was no evidence of statistical heterogeneity among studies reporting AKI mortality in SARS (I2: 0.0%, p = 0.589) and MERS (I2: 0.0%, p =v0.758), but there was for COVID-19 infection (I2: 97.0%, p < 0.001) (Fig. 1 ). Possible mechanisms of higher AKI mortality following coronavirus infections are multifactorial (e.g., severe sepsis-related multiorgan failure, direct kidney involvement, and acute respiratory distress syndrome) [26] [27] [28] , although comparative pathogenesis of kidney involvement among the three infections remains unclear. A single center observational study of the clinical characteristics and short-term outcome of 20 kidney transplant patients admitted for SARS-CoV2 pneumonia Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

title:
  Mortality rate of acute kidney injury in SARS, MERS, and COVID-19 infection: a systematic review and meta-analysis


id: cord-341063-3rqnu5bu
author: nan
date: 2018-03-29
txt: ./txt/cord-341063-3rqnu5bu.txt
cache: ./cache/cord-341063-3rqnu5bu.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-018-1973-5
doi: 10.1186/s13054-018-1973-5
abstract: nan
summary:
  Procacitonin (PCT) emerges as a possible predictive tool in cardiothoracic intensive care unit (CTICU).We aim at testing the predictive power of PCT for early morbidity, prolonged ventilation, ICU and hospital stay, in patients developing early fever after cardiac surgery Methods: A retrospective descriptive study done in tertiary cardiac center, enrolling patients who stayed for more than 24 hours post-operatively in the CTICU Risk stratification included additive Euro score and PCT immunoluminometricaly prior to surgery and every 48 hours in response to onset of fever. Prognostic accuracy of quick sequential organ failure assessment (qSOFA) score for mortality: systematic review and meta-analysis Introduction: The purpose of this study was to summarize the evidence assessing the qSOFA [1] , calculated in admission of the patient in emergency department (ED) or intensive care unit (ICU), as a predictor of mortality.

title:
  38th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 20-23 March 2018


id: cord-343940-fdnmeuh8
title: Incidence of ARDS and outcomes in hospitalized patients with COVID-19: a global literature survey
author: Tzotzos, Susan J.
date: 2020-08-21
txt: ./txt/cord-343940-fdnmeuh8.txt
cache: ./cache/cord-343940-fdnmeuh8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32825837/
doi: 10.1186/s13054-020-03240-7
abstract: nan
summary:
  title: Incidence of ARDS and outcomes in hospitalized patients with COVID-19: a global literature survey Seventeen studies reporting results from 2486 hospitalized COVID-19 patients in five countries fitted the inclusion criteria (Tables 1 and 2 ). Calculation of weighted averages for these parameters incorporating data from individual studies for which data is available indicate that among hospitalized COVID-19 patients, approximately 1/3 (33%) develop ARDS, 1/4 (26%) require transfer to Patient numbers for Chen T study not included an ICU, 1/6 (16%) receive IMV, and 1/6 (16%) die (Table 1 ). For COVID-19 patients transferred to an ICU, nearly 2/3 (63%) receive IMV and 3/4 (75%) have ARDS ( Table 2 ). Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China Treatment for severe acute respiratory distress syndrome from COVID-19 Authors'' contributions SJT conducted the literature search and survey. The authors read and approved the final manuscript.


id: cord-344965-h945xi7y
title: Pooled prevalence of deep vein thrombosis among coronavirus disease 2019 patients
author: Wang, Ying
date: 2020-07-28
txt: ./txt/cord-344965-h945xi7y.txt
cache: ./cache/cord-344965-h945xi7y.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03181-1
doi: 10.1186/s13054-020-03181-1
abstract: nan
summary:
  reported that there was an extremely high incidence (85.4%) of lower extremity deep venous thrombosis (DVT) among 48 patients with severe coronavirus disease 2019 in Wuhan, China [1] . Thus, we performed a meta-analysis to estimate the pooled prevalence of DVT in confirmed COVID-19 patients. Articles reporting the prevalence of DVT in confirmed COVID-19 patients were included. The meta-regression and subgroup analysis were used to investigate the potential heterogeneity sources (such as sample size, prevalence of prophylaxis in COVID-19 patients, location, design of studies, screening methods of DVT, and COVID-19 patients in intensive care unit (ICU)). The pooled prevalence of DVT in Table 1 Characteristics of the included studies COVID-19 patients treated in ICU was 23% (95% CI 11-38%, P < 0.01, I 2 = 96.44%, Q = 421.29, P < 0.01), which was significantly higher than in COVID-19 patients treated in non-ICU (5%, 95% CI 1-11%, P < 0.01, I 2 = 92.17%, Q = 89.42, P < 0.01) (Fig. 1c, d) . Deep vein thrombosis in hospitalized patients with coronavirus disease 2019 (COVID-19) in Wuhan, China: prevalence, risk factors, and outcome


id: cord-345973-fb3gkc0f
title: Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance
author: Thibault, Ronan
date: 2020-07-19
txt: ./txt/cord-345973-fb3gkc0f.txt
cache: ./cache/cord-345973-fb3gkc0f.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03159-z
doi: 10.1186/s13054-020-03159-z
summary:
  Five to 10% of the coronavirus SARS-CoV-2-infected patients, i.e., with new coronavirus disease 2019 (COVID-19), are presenting with an acute respiratory distress syndrome (ARDS) requiring urgent respiratory and hemodynamic support in the intensive care unit (ICU). Up to 30% of the coronavirus SARS-CoV-2-infected patients are presenting with an acute respiratory distress syndrome (ARDS) requiring urgent respiratory and hemodynamic support in the intensive care unit (ICU) [2] . This article was written in the emergency of the epidemic by an expert group, based on the international recommendations on nutrition in the ICU on March 29, and will be updated according to new knowledge about the COVID-19. Indirect calorimetry (IC) should be proposed only for patients staying for more than 10 days in the ICU or those on full parenteral nutrition (PN) to avoid overfeeding IC is the reference method to assess the energy requirements in the non-COVID-19 ICU patients [18] .

abstract:
  Five to 10% of the coronavirus SARS-CoV-2-infected patients, i.e., with new coronavirus disease 2019 (COVID-19), are presenting with an acute respiratory distress syndrome (ARDS) requiring urgent respiratory and hemodynamic support in the intensive care unit (ICU). However, nutrition is an important element of care. The nutritional assessment and the early nutritional care management of COVID-19 patients must be integrated into the overall therapeutic strategy. The international recommendations on nutrition in the ICU should be followed. Some specific issues about the nutrition of the COVID-19 patients in the ICU should be emphasized. We propose a flow chart and ten key issues for optimizing the nutrition management of COVID-19 patients in the ICU.


id: cord-346307-xejs2va1
title: Treatment with angiotensin II in COVID-19 patients may not be beneficial
author: Rysz, Susanne
date: 2020-09-04
txt: ./txt/cord-346307-xejs2va1.txt
cache: ./cache/cord-346307-xejs2va1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32887650/
doi: 10.1186/s13054-020-03233-6
abstract: nan
summary:
  The authors refer to the ATHOSIII trial as support for the use of ANGII in catecholamine-resistant vasodilatory shock despite the known concern for thrombotic and infectious complications associated with ANGII [2] . In addition, the authors suggest to use ANGII in COVID-19 patients recently exposed to angiotensin-converting enzyme inhibitors. In a recent COVID-19 case series, ANGII levels were markedly elevated and linearly associated with viral load and lung injury [4] . Moreover, in a prepublished report currently under journal review, infusion of ANGII in a porcine model rapidly (within hours) induced a clinical syndrome closely reflecting the one seen in COVID-19 patients, including histological changes in the lungs with severe thickening of the alveolar walls, possible hyaline membranes, and clotting of vessels, as previously reported in the human COVID-19 phenotype [5] . Angiotensin II infusion in COVID-19-associated vasodilatory shock: a case series Treatment with angiotensin II in COVID-19 patients may not be beneficial.


id: cord-346394-rk8jkf19
title: Effect of flow and cannula size on generated pressure during nasal high flow
author: Pinkham, Maximilian
date: 2020-05-24
txt: ./txt/cord-346394-rk8jkf19.txt
cache: ./cache/cord-346394-rk8jkf19.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32448344/
doi: 10.1186/s13054-020-02980-w
abstract: nan
summary:
  The data show that in order to deliver higher pressure during NHF, then the flow rate and/or cannula size need to be increased. The results are taken from a bench experiment with inelastic orifices, and patients rarely have a closed system; however, the bench data demonstrate that a small reduction of the leak around the cannula, by occluding a larger area of the nare, may lead to a substantial increase of delivered pressure, particularly in the upper range of NHF rates. Fig. 1 The graph shows the positive airway pressure, cmH2O, that is generated by nasal high flow (NHF) using a smaller cannula (O.D. 6.1 mm) and larger cannula (O.D. 7.2 mm) in "nares" with two different diameters: 10 mm (left panel) and 9 mm (right panel) in the bench top model. Pressure generated by NHF can be increased by higher flow and by occluding a larger area of the nare, which can be achieved by increasing the cannula size


id: cord-347833-b3yrxkt0
author: Ahlström, Björn
date: 2020-09-04
txt: ./txt/cord-347833-b3yrxkt0.txt
cache: ./cache/cord-347833-b3yrxkt0.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32887659/
doi: 10.1186/s13054-020-03203-y
summary:
  We aimed to investigate whether intensive care-treated sepsis is an independent risk factor for a later diagnosis of dementia in a large cohort of intensive care unit (ICU) patients. CONCLUSION: Although dementia is more common among patients treated with sepsis in the ICU, sepsis was not an independent risk factor for later dementia in the Swedish national critical care cohort. The following covariates were chosen from available variables through directed acyclic graph analysis and a literature review: sepsis; age [1] and sex, all of which have been previously described as independent risk factors for dementia [33] ; CCI; SAPS3 box 2+3; hospital length of stay (H-LoS); ICU-LoS; invasive ventilator therapy; and RRT. However, after adjusting for age, sex, CCI score, SAPS3 box 2+3, H-LoS, ICU-LoS, invasive ventilator therapy, and RRT, sepsis was no longer an independent risk factor for dementia (HR 1.01, 95% CI 0.91-1.11) (Fig. 4) 

title:
  A nationwide study of the long-term prevalence of dementia and its risk factors in the Swedish intensive care cohort

abstract:
  BACKGROUND: Developing dementia is feared by many for its detrimental effects on cognition and independence. Experimental and clinical evidence suggests that sepsis is a risk factor for the later development of dementia. We aimed to investigate whether intensive care-treated sepsis is an independent risk factor for a later diagnosis of dementia in a large cohort of intensive care unit (ICU) patients. METHODS: We identified adult patients admitted to an ICU in 2005 to 2015 and who survived without a dementia diagnosis 1 year after intensive care admission using the Swedish Intensive Care Registry, collecting data from all Swedish general ICUs. Comorbidity, the diagnosis of dementia and mortality, was retrieved from the Swedish National Patient Registry, the Swedish Dementia Registry, and the Cause of Death Registry. Sepsis during intensive care served as a covariate in an extended Cox model together with age, sex, and variables describing comorbidities and acute disease severity. RESULTS: One year after ICU admission 210,334 patients were alive and without a diagnosis of dementia; of these, 16,115 (7.7%) had a diagnosis of sepsis during intensive care. The median age of the cohort was 61 years (interquartile range, IQR 43–72). The patients were followed for up to 11 years (median 3.9 years, IQR 1.7–6.6). During the follow-up, 6312 (3%) patients were diagnosed with dementia. Dementia was more common in individuals diagnosed with sepsis during their ICU stay (log-rank p < 0.001), however diagnosis of sepsis during critical care was not an independent risk factor for a later dementia diagnosis in an extended Cox model: hazard ratio (HR) 1.01 (95% confidence interval 0.91–1.11, p = 0.873). Renal replacement therapy and ventilator therapy during the ICU stay were protective. High age was a strong risk factor for later dementia, as was increasing severity of acute illness, although to a lesser extent. However, the severity of comorbidities and the length of ICU and hospital stay were not independent risk factors in the model. CONCLUSION: Although dementia is more common among patients treated with sepsis in the ICU, sepsis was not an independent risk factor for later dementia in the Swedish national critical care cohort. TRIAL REGISTRATION: This study was registered a priori with the Australian and New Zeeland Clinical Trials Registry (registration no. ACTRN12618000533291).


id: cord-351264-zp41u14l
author: Quah, Pipetius
date: 2020-06-04
txt: ./txt/cord-351264-zp41u14l.txt
cache: ./cache/cord-351264-zp41u14l.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03006-1
doi: 10.1186/s13054-020-03006-1
abstract: nan
summary:
  title: Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature Pipetius Quah 1* , Andrew Li 1 and Jason Phua 1, 2 The understanding of outcomes in the intensive care unit (ICU) for the coronavirus disease 2019 (COVID-19) remains poor. Studies have reported close to 100% mortality amongst patients requiring mechanical ventilation [1] , and this together with the hypothesis that COVID-19 may not cause classic acute respiratory distress syndrome (ARDS) has led to concerns regarding the use of mechanical ventilation [2, 3] . We searched PubMed for studies published between Dec 1, 2019, and May 8, 2020, with at least ten ICU patients with COVID-19 and reported ICU mortality data. We conclude that while there is a need for further studies which capture patients'' final dispositions, the current preliminary data does not suggest unusually high ICU mortality rates for COVID-19.

title:
  Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature


id: cord-351600-bqw9ks4a
author: Zhang, Shuai
date: 2020-07-16
txt: ./txt/cord-351600-bqw9ks4a.txt
cache: ./cache/cord-351600-bqw9ks4a.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03123-x
doi: 10.1186/s13054-020-03123-x
summary:
  title: Development and validation of a risk factor-based system to predict short-term survival in adult hospitalized patients with COVID-19: a multicenter, retrospective, cohort study We aimed to explore the risk factors of 14-day and 28-day mortality and develop a model for predicting 14-day and 28-day survival probability among adult hospitalized patients with COVID-19. Nomogram scoring systems for predicting the 14-day and 28-day survival probability of patients with COVID-19 were developed and exhibited strong discrimination and calibration power in the two external validation cohorts (C-index, 0.878 and 0.839). CONCLUSION: Older age, high lactate dehydrogenase level, evaluated neutrophil-to-lymphocyte ratio, and high direct bilirubin level were independent predictors of 28-day mortality in adult hospitalized patients with confirmed COVID-19. We aimed to explore the risk factors of 28-day mortality and develop a nomogram scoring system for predicting 28-day survival probability among patients with COVID-19.

title:
  Development and validation of a risk factor-based system to predict short-term survival in adult hospitalized patients with COVID-19: a multicenter, retrospective, cohort study

abstract:
  BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a public health emergency of global concern. We aimed to explore the risk factors of 14-day and 28-day mortality and develop a model for predicting 14-day and 28-day survival probability among adult hospitalized patients with COVID-19. METHODS: In this multicenter, retrospective, cohort study, we examined 828 hospitalized patients with confirmed COVID-19 hospitalized in Wuhan Union Hospital and Central Hospital of Wuhan between January 12 and February 9, 2020. Among the 828 patients, 516 and 186 consecutive patients admitted in Wuhan Union Hospital were enrolled in the training cohort and the validation cohort, respectively. A total of 126 patients hospitalized in Central Hospital of Wuhan were enrolled in a second external validation cohort. Demographic, clinical, radiographic, and laboratory measures; treatment; proximate causes of death; and 14-day and 28-day mortality are described. Patients’ data were collected by reviewing the medical records, and their 14-day and 28-day outcomes were followed up. RESULTS: Of the 828 patients, 146 deaths were recorded until May 18, 2020. In the training set, multivariate Cox regression indicated that older age, lactate dehydrogenase level over 360 U/L, neutrophil-to-lymphocyte ratio higher than 8.0, and direct bilirubin higher than 5.0 μmol/L were independent predictors of 28-day mortality. Nomogram scoring systems for predicting the 14-day and 28-day survival probability of patients with COVID-19 were developed and exhibited strong discrimination and calibration power in the two external validation cohorts (C-index, 0.878 and 0.839). CONCLUSION: Older age, high lactate dehydrogenase level, evaluated neutrophil-to-lymphocyte ratio, and high direct bilirubin level were independent predictors of 28-day mortality in adult hospitalized patients with confirmed COVID-19. The nomogram system based on the four factors revealed good discrimination and calibration, suggesting good clinical utility.


id: cord-352227-827987jf
author: Chernevskaya, Ekaterina
date: 2020-06-08
txt: ./txt/cord-352227-827987jf.txt
cache: ./cache/cord-352227-827987jf.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03031-0
doi: 10.1186/s13054-020-03031-0
summary:
  METHODS: In this prospective observational pilot study, we analyzed the temporal dynamics of the gut microbiome and the AMM spectrum across two distinct subgroups—acute critical ill (ACI) patients with nosocomial pneumonia and chronically critically ill (CCI) patients (9 subjects each group)—as well as performed comparison with 23 healthy volunteers. We discovered significant associations between gut microbial taxa levels and metabolite concentrations in blood serum as well as in feces in each of the ACI and the CCI patients. The aim of this study was to analyze the association between the serum and fecal levels of AMM and compare them with the composition of the gut microbiota in critically ill patients in the acute and chronic stages. The aim of this study was to analyze the association between the serum and fecal levels of AMM and compare them with the composition of the gut microbiota in critically ill patients in the acute and chronic stages.

title:
  Serum and fecal profiles of aromatic microbial metabolites reflect gut microbiota disruption in critically ill patients: a prospective observational pilot study

abstract:
  BACKGROUND: High serum levels of certain aromatic microbial metabolites (AMM) are associated with severity and mortality in critically ill patients. Omics-based studies suggest gut dysbiosis and reduced microbiome diversity in critical conditions. However, the landscape of gut microbial metabolites is still to be outlined, not to mention the interplay correlation between the metabolome and gut microbiome in critically ill patients. The aim of this study was to analyze the association between serum and fecal levels of AMM and compare them with the composition of gut microbiota in critically ill patients in the acute and chronic stages. METHODS: In this prospective observational pilot study, we analyzed the temporal dynamics of the gut microbiome and the AMM spectrum across two distinct subgroups—acute critical ill (ACI) patients with nosocomial pneumonia and chronically critically ill (CCI) patients (9 subjects each group)—as well as performed comparison with 23 healthy volunteers. The AMM levels for each patient were measured using GC-MS in simultaneously taken serum and fecal samples (SFS). These parameters were compared with 16S rRNA fecal microbiome profiles. RESULTS: The observed proportions of bacterial taxa suggest a significant gut dysbiosis in the ACI and the CCI patients. Stronger imbalance in microbiome composition and dynamics observed in the ACI patients compared to the CCI ones resonates with a higher severity in the former group. The total levels of AMM in serum samples were higher for the ACI patients than for the CCI patients (3.7 (1.4–6.3) and 1.1 (1.0–1.6) μM, respectively; p = 0.0003). The qualitative composition of the SFS was also altered. We discovered significant associations between gut microbial taxa levels and metabolite concentrations in blood serum as well as in feces in each of the ACI and the CCI patients. CONCLUSIONS: Aromatic microbial metabolite profiles in the gut and the serum are interlinked and reflect a disruption of the gut microbial community in critically ill patients.


id: cord-353344-tzyu6j6n
title: Biomarkers for antimicrobial stewardship: a reappraisal in COVID-19 times?
author: van Berkel, Miranda
date: 2020-10-06
txt: ./txt/cord-353344-tzyu6j6n.txt
cache: ./cache/cord-353344-tzyu6j6n.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33023606/
doi: 10.1186/s13054-020-03291-w
abstract: nan
summary:
  PCT appears to increase in COVID patients with severe disease and/or in those presenting with secondary bacterial infections [6] . The use of biomarkers to predict secondary infections in ICU patients warrants reappraisal in times of COVID-19. We demonstrate that COVID-19 patients who do not develop a bacterial infection present with high initial CRP levels and lowmoderate PCT levels that gradually decrease over time. Furthermore, our data show that, during ICU admission, PCT levels of > 1.00 μg/L rule in, whereas concentrations of < 0.25 μg/L rule out secondary bacterial infections with good predictive values. As CRP is consistently elevated, this biomarker does not have predictive value for bacterial infections in the initial phase of COVID-19. b Serial values of PCT (left panel) and CRP (right panel) in patients (n = 33) with COVID-19 who did develop (n = 33) or did not (n = 33) develop a secondary infection.


id: cord-354355-i6ot4ef8
author: Decavele, Maxens
date: 2020-09-21
txt: ./txt/cord-354355-i6ot4ef8.txt
cache: ./cache/cord-354355-i6ot4ef8.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03292-9
doi: 10.1186/s13054-020-03292-9
abstract: nan
summary:
  title: Endobronchial ultrasound is feasible and safe to diagnose pulmonary embolism in non-transportable SARS-CoV-2 ARDS patients requiring extracorporeal lung support The diagnosis of pulmonary embolism (PE) may be challenging in these patients because computed tomography pulmonary angiogram (CTPA) requires an intrahospital transport with potential adverse effects and also may increase the risk of acute kidney failure (contrast-induced nephropathy). This is even more the case in up to 10% of SARS-Cov-2 ARDS patients who require venovenous extracorporeal membrane oxygenation (vv-ECMO) as an extracorporeal lung support [1] . Here, we describe the feasibility, safety, and diagnostic accuracy of endobronchial ultrasound (EBUS) to detect PE in patients with severe SARS-CoV-2 ARDS requiring vv-ECMO. This case series of EBUS to diagnose PE in severe SARS-CoV-2 ARDS patients requiring vv-ECMO suggests that the EBUS procedure is safe and reliable to detect lobar and even segmental PE at bedside. Martin Dres received personal fees and travel expenses from Lungpacer outside the submitted work.

title:
  Endobronchial ultrasound is feasible and safe to diagnose pulmonary embolism in non-transportable SARS-CoV-2 ARDS patients requiring extracorporeal lung support


id: cord-355847-1ru15s5a
author: Convertino, Irma
date: 2020-06-11
txt: ./txt/cord-355847-1ru15s5a.txt
cache: ./cache/cord-355847-1ru15s5a.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s13054-020-03020-3
doi: 10.1186/s13054-020-03020-3
summary:
  Several drugs, endowed with modulating activity on cytokine pathways, including anti-IL-6, anti-TNF, and Janus kinase (JAK) inhibitors, currently approved for the treatment of immune-mediated inflammatory diseases, have been suggested or could be yet taken into account for experimental use in COVID-19 patients with ARDS and/or pneumonia ( Fig. 1 ). In addition, a multicenter open-label randomized clinical trial is studying the benefit risk profile of siltuximab, as a single therapeutic option or in combination with anakinra, at a single dose of 11 mg/kg, in comparison with tocilizumab or anakinra, alone or in combination, in ARDS patients with COVID-19 [20] . Based on the results expected with tocilizumab and siltuximab, other anti-IL-6 drugs, currently approved for rheumatoid arthritis, namely sarilumab and sirukumab, could be studied in ARDS and pneumonia patients with COVID-19. Anti-JAK drugs (such as ruxolitinib, tofacitinib, baricitinib, oclacitinib, fedratinib, upadacitinib, and peficitinib) [39] should be considered also among the options for clinical investigations in COVID-19-related ARDS and pneumonia patients.

title:
  Exploring pharmacological approaches for managing cytokine storm associated with pneumonia and acute respiratory distress syndrome in COVID-19 patients

abstract:
  Sars-CoV-2 complications include pneumonia and acute respiratory distress syndrome (ARDS), which require intensive care unit admission. These conditions have rapidly overwhelmed healthcare systems, with detrimental effects on the quality of care and increased mortality. Social isolation strategies have been implemented worldwide with the aim of reducing hospital pressure. Among therapeutic strategies, the use of immunomodulating drugs, to improve prognosis, seems promising. Particularly, since pneumonia and ARDS are associated with a cytokine storm, drugs belonging to therapeutic classes as anti-IL-6, anti-TNF, and JAK inhibitors are currently studied. In this article, we discuss the potential advantages of the most promising pharmacological approaches.


