Editorial

5 pages, 463 KiB

Open AccessEditorial

COVID-19 Hurricane: Recovering the Worldwide Health System with the RE.RE.RE. (REsponse–REstoration–REengineering) Approach—Who Will Get There First?

by Luigi Vetrugno, Cristian Deana and Salvatore Maurizio Maggiore

Healthcare 2022, 10(4), 602; https://doi.org/10.3390/healthcare10040602 - 23 Mar 2022

Cited by 2 | Viewed by 1302

Abstract

In 2007, I was (LV) attending to a one-month period of my pediatric residency at the Children’s Hospital in New Orleans [...] Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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Research

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12 pages, 916 KiB

Open AccessArticle

Incidence and Determinants of Acute Kidney Injury after Prone Positioning in Severe COVID-19 Acute Respiratory Distress Syndrome

by Riccardo La Rosa, Benedetta Grechi, Riccardo Ragazzi, Valentina Alvisi, Giacomo Montanari, Elisabetta Marangoni, Carlo Alberto Volta, Savino Spadaro and Gaetano Scaramuzzo

Healthcare 2023, 11(21), 2903; https://doi.org/10.3390/healthcare11212903 - 04 Nov 2023

Cited by 1 | Viewed by 852

Abstract

(1) Background: Acute kidney injury (AKI) is common among critically ill COVID-19 patients, but its temporal association with prone positioning (PP) is still unknown, and no data exist on the possibility of predicting PP-associated AKI from bedside clinical variables. (2) Methods: We analyzed [...] Read more.

(1) Background: Acute kidney injury (AKI) is common among critically ill COVID-19 patients, but its temporal association with prone positioning (PP) is still unknown, and no data exist on the possibility of predicting PP-associated AKI from bedside clinical variables. (2) Methods: We analyzed data from 93 COVID-19-related ARDS patients who underwent invasive mechanical ventilation (IMV) and at least one PP cycle. We collected hemodynamic variables, respiratory mechanics, and circulating biomarkers before, during, and after the first PP cycle. PP-associated AKI (PP-AKI) was defined as AKI diagnosed any time from the start of PP to 48 h after returning to the supine position. A t-test for independent samples was used to test for the differences between groups, while binomial logistical regression was performed to assess variables independently associated with PP-associated AKI. (3) Results: A total of 48/93 (52%) patients developed PP-AKI, with a median onset at 24 [13.5–44.5] hours after starting PP. No significant differences in demographic characteristics between groups were found. Before starting the first PP cycle, patients who developed PP-AKI had a significantly lower cumulative fluid balance (CFB), even when normalized for body weight (p = 0.006). Central venous pressure (CVP) values, measured before the first PP (OR 0.803, 95% CI [0.684–0.942], p = 0.007), as well as BMI (OR 1.153, 95% CI = [1.013–1.313], p = 0.031), were independently associated with the development of PP-AKI. In the multivariable regression analysis, a lower CVP before the first PP cycle was independently associated with ventilator-free days (OR 0.271, 95% CI [0.123–0.936], p = 0.011) and with ICU mortality (OR:0.831, 95% CI [0.699–0.989], p = 0.037). (4) Conclusions: Acute kidney injury occurs frequently in invasively ventilated severe COVID-19 ARDS patients undergoing their first prone positioning cycle. Higher BMI and lower CVP before PP are independently associated with the occurrence of AKI during prone positioning. Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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8 pages, 853 KiB

Open AccessArticle

Thromboelastography Profile Is Associated with Lung Aeration Assessed by Point-of-Care Ultrasound in COVID-19 Critically Ill Patients: An Observational Retrospective Study

by Daniele Guerino Biasucci, Maria Grazia Bocci, Danilo Buonsenso, Luca Pisapia, Ludovica Maria Consalvo, Joel Vargas, Domenico Luca Grieco, Gennaro De Pascale and Massimo Antonelli

Healthcare 2022, 10(7), 1168; https://doi.org/10.3390/healthcare10071168 - 22 Jun 2022

Cited by 4 | Viewed by 1213

Abstract

Background. To evaluate relationships between lung aeration assessed by lung ultrasound (LUS) with viscoelastic profiles obtained by thromboelastography (TEG) in COVID-19 respiratory failure. Methods. Retrospective analysis in a tertiary ICU in Rome, Italy. Forty invasively ventilated adults with COVID-19 underwent LUS and TEG [...] Read more.

Background. To evaluate relationships between lung aeration assessed by lung ultrasound (LUS) with viscoelastic profiles obtained by thromboelastography (TEG) in COVID-19 respiratory failure. Methods. Retrospective analysis in a tertiary ICU in Rome, Italy. Forty invasively ventilated adults with COVID-19 underwent LUS and TEG assessment. A simplified LUS protocol consisting in scanning six areas, three per side, was adopted. A score from 0 to 3 was assigned to each area. TEG^®6s was used to obtain viscoelastic hemostatic assay parameters which were compared to LUS score. Results. There was a significant inverse correlation between LUS score and static compliance of the respiratory system (Crs, rs −0.75; p < 0.001). We found a significant association between LUS and functional fibrinogen maximum amplitude (FF-MA): among 18 patients with LUS score ≤ 12, median FF-MA was 31 mm [IQR 28–39] whilst, among 22 patients with LUS score > 12, it was 46.3 mm [IQR 40–53], p = 0.0004. Median of the citrated recalcified kaolin-activated maximum amplitude (CK-MA) was 66.1 mm [64.4–68] in the LUS score ≤ 12 group, and 69.6 [68.5–70.7] when LUS score > 12, p < 0.002. Conclusions. The hypercoagulable profile as defined by elevated FF-MA and CK-MA may be associated with a low degree of lung aeration as assessed by LUS. Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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9 pages, 668 KiB

Open AccessEditor’s ChoiceArticle

Can Lung Ultrasound Be the Ideal Monitoring Tool to Predict the Clinical Outcome of Mechanically Ventilated COVID-19 Patients? An Observational Study

by Luigi Vetrugno, Francesco Meroi, Daniele Orso, Natascia D’Andrea, Matteo Marin, Gianmaria Cammarota, Lisa Mattuzzi, Silvia Delrio, Davide Furlan, Jonathan Foschiani, Francesca Valent and Tiziana Bove

Healthcare 2022, 10(3), 568; https://doi.org/10.3390/healthcare10030568 - 18 Mar 2022

Cited by 11 | Viewed by 1519

Abstract

Background: During the COVID-19 pandemic, lung ultrasound (LUS) has been widely used since it can be performed at the patient’s bedside, does not produce ionizing radiation, and is sufficiently accurate. The LUS score allows for quantifying lung involvement; however, its clinical prognostic role [...] Read more.

Background: During the COVID-19 pandemic, lung ultrasound (LUS) has been widely used since it can be performed at the patient’s bedside, does not produce ionizing radiation, and is sufficiently accurate. The LUS score allows for quantifying lung involvement; however, its clinical prognostic role is still controversial. Methods: A retrospective observational study on 103 COVID-19 patients with respiratory failure that were assessed with an LUS score at intensive care unit (ICU) admission and discharge in a tertiary university COVID-19 referral center. Results: The deceased patients had a higher LUS score at admission than the survivors (25.7 vs. 23.5; p-value = 0.02; cut-off value of 25; Odds Ratio (OR) 1.1; Interquartile Range (IQR) 1.0−1.2). The predictive regression model shows that the value of LUSt0 (OR 1.1; IQR 1.0–1.3), age (OR 1.1; IQR 1.0−1.2), sex (OR 0.7; IQR 0.2−3.6), and days in spontaneous breathing (OR 0.2; IQR 0.1–0.5) predict the risk of death for COVID-19 patients (Area under the Curve (AUC) 0.92). Furthermore, the surviving patients showed a significantly lower difference between LUS scores at admission and discharge (mean difference of 1.75, p-value = 0.03). Conclusion: Upon entry into the ICU, the LUS score may play a prognostic role in COVID-19 patients with ARDS. Furthermore, employing the LUS score as a monitoring tool allows for evaluating the patients with a higher probability of survival. Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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11 pages, 778 KiB

Open AccessEditor’s ChoiceArticle

Establishing a New ECMO Referral Center Using an ICU-Based Approach: A Feasibility and Safety Study

by Ryszard Gawda, Maciej Piwoda, Maciej Marszalski, Katarzyna Lyp, Jolanta Piwoda, Magdalena Maj, Maciej Gawor, Maciej Molsa, Marek Pietka and Tomasz Czarnik

Healthcare 2022, 10(3), 414; https://doi.org/10.3390/healthcare10030414 - 22 Feb 2022

Cited by 3 | Viewed by 2518

Abstract

Background: A high-volume center with a multidisciplinary team is regarded as the optimal place for providing extracorporeal membrane oxygenation (ECMO). We hypothesize that an ECMO center can also be successfully created and subsequently developed entirely by intensivists in a mid-size mixed intensive care [...] Read more.

Background: A high-volume center with a multidisciplinary team is regarded as the optimal place for providing extracorporeal membrane oxygenation (ECMO). We hypothesize that an ECMO center can also be successfully created and subsequently developed entirely by intensivists in a mid-size mixed intensive care unit (ICU). Methods: A model was created for setting up a new ECMO referral center within the structure of an existing mixed ICU in a tertiary hospital. A retrospective analysis was carried out of the first 33 patients treated in the initial period of the center’s activity, from mid 2018 to the end of 2020. Results: An ECMO center was established and developed entirely based on the resources of an existing mixed ICU. Thirty-three patients were treated. They had an overall survival rate at 90 days of 60.6%. In veno-venous (VV) mode ECMO duration, ICU length of stay, and SOFA score were significantly higher than in veno-arterial mode. No significant differences in clinical characteristics were observed between survivors and non-survivors on VV-ECMO. Conclusions: A regional ECMO center can be set up as an integral part of a mixed ICU in a tertiary hospital. Extracorporeal therapy, such as continuous renal replacement therapy and mechanical ventilation can be managed entirely by intensivists. Further studies are needed to show that the ICU-based approach to setting up a new ECMO center is no less effective than the multidisciplinary approach. Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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10 pages, 850 KiB

Open AccessEditor’s ChoiceArticle

Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow?

by Júlio César Garcia de Alencar, Juliana Martes Sternlicht, Alicia Dudy Muller Veiga, Julio Flávio Meirelles Marchini, Juliana Carvalho Ferreira, Carlos Roberto Ribeiro de Carvalho, Izabel Marcilio, Katia Regina da Silva, Vilson Cobello Junior, Marcelo Consorti Felix, Luz Marina Gomez Gomez, Heraldo Possolo de Souza, Denis Deratani Mauá, Emergency USP COVID Group and HCFMUSP COVID-19 Study Group

Healthcare 2022, 10(2), 206; https://doi.org/10.3390/healthcare10020206 - 21 Jan 2022

Cited by 2 | Viewed by 2912

Abstract

Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and [...] Read more.

Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients. Methods: We performed a unicentric retrospective cohort study considering all COVID-19 patients consecutively admitted between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortality. Results: A total of 592 (20%) patients of 3020 admitted with COVID-19 were intubated during study period, and 310 patients who were intubated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005–1.03). Conclusion: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality. Trial registration: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068). Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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Review

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9 pages, 450 KiB

Open AccessEditor’s ChoiceReview

Current Practice of High Flow through Nasal Cannula in Exacerbated COPD Patients

by Andrea Bruni, Eugenio Garofalo, Daniela Procopio, Silvia Corrado, Antonio Caroleo, Eugenio Biamonte, Corrado Pelaia and Federico Longhini

Healthcare 2022, 10(3), 536; https://doi.org/10.3390/healthcare10030536 - 15 Mar 2022

Cited by 3 | Viewed by 3990

Abstract

Acute Exacerbation of Chronic Obstructive Pulmonary Disease is a form of severe Acute Respiratory Failure (ARF) requiring Conventional Oxygen Therapy (COT) in the case of absence of acidosis or the application of Non-Invasive Ventilation (NIV) in case of respiratory acidosis. In the last [...] Read more.

Acute Exacerbation of Chronic Obstructive Pulmonary Disease is a form of severe Acute Respiratory Failure (ARF) requiring Conventional Oxygen Therapy (COT) in the case of absence of acidosis or the application of Non-Invasive Ventilation (NIV) in case of respiratory acidosis. In the last decade, High Flow through Nasal Cannula (HFNC) has been increasingly used, mainly in patients with hypoxemic ARF. However, some studies were also published in AECOPD patients, and some evidence emerged. In this review, after describing the mechanism underlying potential clinical benefits, we analyzed the possible clinical application of HFNC to AECOPD patients. In the case of respiratory acidosis, the gold-standard treatment remains NIV, supported by strong evidence in favor. However, HFNC may be considered as an alternative to NIV if the latter fails for intolerance. HFNC should also be considered and preferred to COT at NIV breaks and weaning. Finally, HFNC should also be preferred to COT as first-line oxygen treatment in AECOPD patients without respiratory acidosis. Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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Other

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6 pages, 2000 KiB

Open AccessEditor’s ChoiceCase Report

Severe Recurrent COVID-Associated Pulmonary Aspergillosis: A Challenging Case

by Luigi Vetrugno, Gian Marco Anzellotti, Regina Frontera, Zoe Parinisi, Barbara Sessa, Cristian Deana and Salvatore Maurizio Maggiore

Healthcare 2022, 10(12), 2483; https://doi.org/10.3390/healthcare10122483 - 08 Dec 2022

Cited by 1 | Viewed by 1094

Abstract

We report a rare case of severe COVID-19-associated pulmonary aspergillosis presenting as invasive pulmonary aspergillosis and subsequently invasive tracheobronchial aspergillosis during hospitalization in a critically ill patient who developed a further Aspergillus infection after home discharge. He needed readmission to the ICU and [...] Read more.

We report a rare case of severe COVID-19-associated pulmonary aspergillosis presenting as invasive pulmonary aspergillosis and subsequently invasive tracheobronchial aspergillosis during hospitalization in a critically ill patient who developed a further Aspergillus infection after home discharge. He needed readmission to the ICU and mechanical ventilation. We therefore strongly encourage a high degree of attention to fungal complications, even after viral recovery and ICU discharge. Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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8 pages, 8413 KiB

Open AccessCase Report

Combination of Multidisciplinary Therapies Successfully Treated Refractory Ventricular Arrhythmia in a STEMI Patient: Case Report and Literature Review

by Nung-Sheng Lin, Yen-Yue Lin, Yung-Hsi Kao, Chih-Pin Chuu, Kuo-An Wu, Jenq-Shyong Chan and Po-Jen Hsiao

Healthcare 2022, 10(3), 507; https://doi.org/10.3390/healthcare10030507 - 10 Mar 2022

Cited by 1 | Viewed by 2167

Abstract

Ventricular fibrillation (VF) is a life-threatening cardiac arrhythmia that can lead to loss of cardiac function and sudden cardiac death. The most common cause of VF is ischemic cardiomyopathy, especially in the context of an acute coronary event. Prompt treatment with resuscitation and [...] Read more.

Ventricular fibrillation (VF) is a life-threatening cardiac arrhythmia that can lead to loss of cardiac function and sudden cardiac death. The most common cause of VF is ischemic cardiomyopathy, especially in the context of an acute coronary event. Prompt treatment with resuscitation and defibrillation can be lifesaving. Refractory VF, or pulseless ventricular tachycardia (pVT), refers to cases that do not respond to traditional advanced cardiac life-support (ACLS) measures, and it has a low survival rate. Some new life-saving interventions and novel techniques have been proposed as viable treatment options for patients presenting with refractory VF/pVT out-of-hospital cardiac arrest; these include extracorporeal membrane oxygenation (ECMO), esmolol, stellate ganglion block (SGB), and double sequential defibrillation (DSD). Recently, DSD has been discussed and used more frequently, but its survival rate is still not promising. We report a case of refractory VF caused by acute myocardial infarction that was treated with ACLS, DSD, ECMO, and cardiac catheterization in sequence, with a successful outcome. Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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