Journal of intensive care medicine
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J Intensive Care Med · Mar 2021
Observational StudyPoint-of-Care Lung Ultrasound for COVID-19: Findings and Prognostic Implications From 105 Consecutive Patients.
The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward. ⋯ Most patients hospitalized with COVID-19 had lung ultrasound abnormalities on admission and a higher lung ultrasound score was associated with worse clinical outcomes except death. A low total lung ultrasound score (<5) had a negative predictive value of 100% for the need of intensive respiratory support. Point-of-care ultrasound can aid in the risk stratification for patients with COVID-19 admitted to general wards.
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J Intensive Care Med · Mar 2021
Sepsis and Septic Shock Definitions in Patients With Cancer Admitted in ICU.
In 2016, a new definition of sepsis and septic shock was adopted. Some studies based on the general population demonstrated that the Sequential Organ Failure Assessment (SOFA) score is more accurate than the systemic inflammatory response syndrome (SIRS) criteria to predict hospital mortality of infected patients requiring intensive care. ⋯ The new definition of sepsis and septic shock is applicable in an ICU oncological population with the same reliability as in the general population. The SOFA score is more accurate than qSOFA and SIRS criteria to predict hospital mortality.
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J Intensive Care Med · Feb 2021
Sepsis Mortality Is high in Patients With Connective Tissue Diseases Admitted to the Intensive Care Unit (ICU).
Patients with connective tissue diseases (CTD) such as systemic lupus erythematosus (SLE) have an increased risk for infections. This study investigated the outcome and characteristics of CTD patients under intensive care unit (ICU) treatment for sepsis. ⋯ In-hospital sepsis mortality is high in CTD patients. SSc diagnoses and SOFA were independently associated with mortality. Additionally, common ICU scores were good predictors for mortality.
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J Intensive Care Med · Feb 2021
Sedation, Analgesia, and Paralysis in COVID-19 Patients in the Setting of Drug Shortages.
The rapid spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to a global pandemic. The 2019 coronavirus disease (COVID-19) presents with a spectrum of symptoms ranging from mild to critical illness requiring intensive care unit (ICU) admission. Acute respiratory distress syndrome is a major complication in patients with severe COVID-19 disease. ⋯ Additionally, they have unique pharmaceutical properties, limitations, and adverse effects. This narrative review summarizes the literature on alternative drug therapies for the management of sedation, analgesia, and paralysis in COVID-19 patients. Also, this document serves as a resource for clinicians in current and future respiratory illness pandemics in the setting of drug shortages.
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J Intensive Care Med · Feb 2021
Evaluation of Oxygenation in 129 Proning Sessions in 34 Mechanically Ventilated COVID-19 Patients.
A minority of patients with Severe Acutre Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) disease-2019 (Covid-19) develop pulmonary features consistent with the Acute Respiratory Distress Syndrome (ARDS). Prone positioning (PP) is an intervention with proven survival benefits in moderate-to-severe and severe ARDS. It is advocated in international guidelines as an intervention in mechanically ventilated Covid-19 patients, despite very few published trials investigating its efficacy in Covid-19. ⋯ Paired analysis of the partial pressure of arterial oxygen(PaO2): fraction of inspired oxygen(FiO2) ratio (PF ratio) (n = 89) and FiO2 (n = 129) was recorded within 3 hours of both the initiation and termination of PP and differences were assessed with the paired Student's t-test and Wilcoxon Signed-Rank test. Proning improved the PF ratio by 43.5 ± 54.9 from 99.8 ± 37.5 to 151.9 ± 58.9 (43.6% increase) [p < 0.0001] and reduced FiO2 by 0.17 ± 0.2 from 0.68 ± 0.2 to 0.51 ± 0.2 (25% decrease) [p < 0.0001]. 82% of proning maneouveres resulted in an improvement in the PF ratio. In summary, PP improved arterial oxygenation and reduced oxygen requirements in most Covid-19 patients in this single- center, retrospective analysis.