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Update on Acute Severe Respiratory Infections

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Special Issue Editor

Prof. Dr. Jean-Francois Timsit

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Guest Editor

1. Medical and Infectious Diseases ICU, APHP Bichat Hospital F, 75018 Paris, France
2. UMR 1137, IAME, Université Paris Cité, 75018 Paris, France
Interests: severe infections; pneumonia; catheter related infections; sepsis; survival models; high quality databases; ARDS; nosocomial; multiresistant bacteria; outcome

Special Issue Information

Dear Colleagues,

Severe pneumonia is a major problem in ICU and in general medicine. With the growing interest in new diagnostic techniques and in light of the recent pandemic, the management of severe pneumonia is changing. New antibiotics and non-antibiotic therapeutic strategies have emerged. This Special Issue has been designed to provide up-to-date information in this field for intensive care physicians and other clinicians involved in the care of patients with pneumonia.

Prof. Dr. Jean-Francois Timsit
Guest Editor

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Keywords

pneumonia
severe pneumonia
lung
ICU
COVID-19
antibiotics
non-antibiotic
intensive care
acute severe respiratory infections
diagnostic techniques
therapeutic strategies

Published Papers (2 papers)

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Research

17 pages, 1538 KiB

Open AccessArticle

Nebulized Recombinant Tissue Plasminogen Activator (rt-PA) for Acute COVID-19-Induced Respiratory Failure: An Exploratory Proof-of-Concept Trial

by Pratima Chowdary, Banwari Agarwal, Maria Rita Peralta, Sanjay Bhagani, Simon Lee, James Goldring, Marc Lipman, Emal Waqif, Mark Phillips, Helen Philippou, Jonathan H. Foley, Nicola J. Mutch, Robert A. S. Ariëns, Kathleen A. Stringer, Federico Ricciardi, Marie Watissée, Derralynn Hughes, Amit Nathwani, Anne Riddell, David Patch, Jim Buckley, Mark De Neef, Rahul Dimber, Cecilia Diaz-Garcia, Honey Patel, Aarti Nandani, Upuli Dissanayake, Nick Chadwick, Ahmed A. A. M. M. Alkhatip, Peter Watkinson, Eamon Raith, Suveer Singh, Tony Wolff, Rajeev Jha, Simon E. Brill, Ameet Bakhai, Alison Evans, Farhat Gilani and Keith Gomez Show full author list Hide full author list

J. Clin. Med. 2023, 12(18), 5848; https://doi.org/10.3390/jcm12185848 - 08 Sep 2023

Cited by 1 | Viewed by 1156

Abstract

Acute lung injury in COVID-19 results in diffuse alveolar damage with disruption of the alveolar-capillary barrier, coagulation activation, alveolar fibrin deposition and pulmonary capillary thrombi. Nebulized recombinant tissue plasminogen activator (rt-PA) has the potential to facilitate localized thrombolysis in the alveolar compartment and improve oxygenation. In this proof-of-concept safety study, adults with COVID-19-induced respiratory failure and a <300 mmHg PaO₂/FiO₂ (P/F) ratio requiring invasive mechanical ventilation (IMV) or non-invasive respiratory support (NIRS) received nebulized rt-PA in two cohorts (C1 and C2), alongside standard of care, between 23 April–30 July 2020 and 21 January–19 February 2021, respectively. Matched historical controls (MHC; n = 18) were used in C1 to explore efficacy. Safety co-primary endpoints were treatment-related bleeds and <1.0–1.5 g/L fibrinogen reduction. A variable dosing strategy with clinical efficacy endpoint and minimal safety concerns was determined in C1 for use in C2; patients were stratified by ventilation type to receive 40–60 mg rt-PA daily for ≤14 days. Nine patients in C1 (IMV, 6/9; NIRS, 3/9) and 26 in C2 (IMV, 12/26; NIRS, 14/26) received nebulized rt-PA for a mean (SD) of 6.7 (4.6) and 9.1(4.6) days, respectively. Four bleeds (one severe, three mild) in three patients were considered treatment related. There were no significant fibrinogen reductions. Greater improvements in mean P/F ratio from baseline to study end were observed in C1 compared with MHC (C1; 154 to 299 vs. MHC; 154 to 212). In C2, there was no difference in the baseline P/F ratio of NIRS and IMV patients. However, a larger improvement in the P/F ratio occurred in NIRS patients (NIRS; 126 to 240 vs. IMV; 120 to 188) and fewer treatment days were required (NIRS; 7.86 vs. IMV; 10.5). Nebulized rt-PA appears to be well-tolerated, with a trend towards improved oxygenation, particularly in the NIRS group. Randomized clinical trials are required to demonstrate the clinical effect significance and magnitude. Full article

(This article belongs to the Special Issue Update on Acute Severe Respiratory Infections)

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15 pages, 675 KiB

Open AccessArticle

Predictors of Length of Stay, Rehospitalization and Mortality in Community-Acquired Pneumonia Patients: A Retrospective Cohort Study

by Giorgia Lüthi-Corridori, Maria Boesing, Andrea Roth, Stéphanie Giezendanner, Anne Barbara Leuppi-Taegtmeyer, Philipp Schuetz and Joerg D. Leuppi

J. Clin. Med. 2023, 12(17), 5601; https://doi.org/10.3390/jcm12175601 - 28 Aug 2023

Cited by 1 | Viewed by 1011

Abstract

Background: Community-acquired pneumonia (CAP) represents one of the leading causes of hospitalization and has a substantial impact on the financial burden of healthcare. The aim of this study was to identify factors associated with the length of hospital stay (LOHS), rehospitalization and mortality of patients admitted for CAP. Methods: A retrospective cohort study was conducted with patients presenting to a Swiss public hospital between January 2019 and December 2019. Zero-truncated negative binomial and multivariable logistic regression analyses were performed to assess risk factors. Results: A total of 300 patients were analyzed (median 78 years, IQR [67.56, 85.50] and 53% males) with an average LOHS of 7 days (IQR [5.00, 9.00]). Of the 300 patients, 31.6% (97/300) were re-hospitalized within 6 months, 2.7% (8/300) died within 30 days and 11.7% (35/300) died within 1 year. The results showed that sex (IRR = 0.877, 95% CI = 0.776–0.992, p-value = 0.036), age (IRR = 1.007, 95% CI = 1.002–1.012, p-value = 0.003), qSOFA score (IRR = 1.143, 95% CI = 1.049–1.246, p-value = 0.002) and atypical pneumonia (IRR = 1.357, 95% CI = 1.012–1.819, p-value = 0.04) were predictive of LOHS. Diabetes (OR = 2.149, 95% CI = 1.104–4.172, p-value = 0.024), a higher qSOFA score (OR = 1.958, 95% CI = 1.295–3.002, p-value = 0.002) and rehabilitation after discharge (OR = 2.222, 95% CI = 1.017–4.855, p-value = 0.044) were associated with a higher chance of being re-hospitalized within 6 months, whereas mortality within 30 days and within one year were both associated with older age (OR = 1.248, 95% CI = 1.056–1.562, p-value = 0.026 and OR = 1.073, 95% CI = 1.025–1.132, p-value = 0.005, respectively) and the presence of a cancer diagnosis (OR = 32.671, 95% CI = 4.787–369.1, p-value = 0.001 and OR = 4.408, 95% CI = 1.680–11.43, p-value = 0.002, respectively). Conclusion: This study identified routinely available predictors for LOHS, rehospitalization and mortality in patients with CAP, which may further advance our understanding of CAP and thereby improve patient management, discharge planning and hospital costs. Full article

(This article belongs to the Special Issue Update on Acute Severe Respiratory Infections)

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