Critical care clinics
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Initial reporting suggested that kidney involvement following COVID-19 infection was uncommon but this is now known not to be the case. Acute kidney injury (AKI) may arise through several mechanisms and complicate up to a quarter of patients hospitalized with COVID-19 infection being associated with an increased risk for both morbidity and death. ⋯ The mainstay of treatment remains the prevention of worsening kidney damage and in some cases they need for renal replacement therapies (RRT). Although the use of other blood purification techniques has been proposed as potential treatments, results to-date have not been definitive.
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Critical care clinics · Jul 2022
ReviewSevere COVID-19 and Multisystem Inflammatory Syndrome in Children in Children and Adolescents.
Severe complications related to COVID-19 occur infrequently in children and adolescents. these life-threatening complications are mainly acute respiratory failure from acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C). MIS-C is a postinfectious complication occurring approximately 3 to 6 weeks mostly after an asymptomatic or mild SARS-CoV-2 infection. For both types of complications, supportive ICU care is often required. For MIS-C critical illness, immunomodulation is prescribed to reverse hyperinflammation and its cardiac and other sequelae.
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Critical care clinics · Jul 2022
ReviewHigh-Flow Nasal Oxygen and Noninvasive Ventilation for COVID-19.
High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) via facemask or helmet have been increasingly used in managing acute hypoxemic respiratory failure (AHRF) owing to COVID-19 with the premise of reducing the need for invasive mechanical ventilation and possibly mortality. Their use carries the risk of delaying intubation and nosocomial infection transmission. To date, most studies on the effectiveness of these modalities are observational and suggest that HFNO and NIV have a role in the management of AHRF owing to COVID-19. Trials are ongoing and are evaluating different aspects of noninvasive respiratory support in patients with AHRF owing to COVID-19.
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With an ever-increasing number of COVID-19 survivors, providers are tasked with addressing the longer lasting symptoms of COVID-19, or postacute sequelae of SARS-CoV-2 infection (PASC). For critically ill patients, existing knowledge about postintensive care syndrome (PICS) represents a useful structure for understanding PASC. Post-ICU clinics leverage a multidisciplinary team to evaluate and treat the physical, cognitive, and psychological sequelae central to both PICS and PASC in critically ill patients. While management through both pharmacologic and nonpharmacologic modalities can be used, further research into both the optimal treatment and prevention of PASC represents a key public health imperative.
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Extracorporeal membrane oxygenation (ECMO) is an intervention for severe acute respiratory distress syndrome (ARDS). Although COVID-19-related ARDS has some distinct features, its overall clinical presentation resembles ARDS from other etiologies. ⋯ Current evidence suggests that ECMO in COVID-19-related ARDS has similar efficacy and safety profile as for non-COVID-19 ARDS. The high number of severe COVID-19 cases and demand for therapies, such as ECMO, poses a unique opportunity to increase the understanding on how to optimize this intervention.