Current Epidemiological and Clinical Features of COVID-19; a Global Perspective From China
William C. Cockerham, Geoffrey B. Cockerham in The COVID-19 Reader, 2020
At present, there is no specific antiviral treatment recommended for COVID-19, and no vaccine is available. For mildly to moderately ill patients, active symptomatic support remains key for treatment, such as maintaining hydration and nutrition and controlling fever and cough. For patients with severe infection or those with respiratory failure, oxygen inhalation through a mask, high nasal oxygen flow inhalation, non-invasive ventilation, or mechanical ventilation is needed. Extracorporeal membrane oxygenation (ECMO) can be implemented if the other methods do not work.66 Additionally, hemo-dynamic support is essential for managing septic shock,54 and antibiotics and antifungals may also be required. As corticosteroid therapy is commonly used among critically ill MERS patients,67 short courses of corticosteroids at low-to-moderate doses can be used with caution.68,69 As anxiety and fear are common among COVID-19 patients, dynamic assessment strategies should be established to monitor their mental health.70
Neonatal sepsis
Prem Puri in Newborn Surgery, 2017
Therapeutic endpoints for neonatal stabilization beyond the first hour include maintaining the initial resuscitation targets and maintaining a central venous oxygen saturation (ScvO2) of greater than 70%, normal glucose and ionized calcium levels, superior vena cava flow greater than 40 mL/kg/min, cardiac index greater than 3.3 L/min/m2, normal INR, normal anion gap, normal lactate, fluid overload of less than 10%, and absence of right to left shunt, tricuspid regurgitation, or right ventricular failure. In the case of refractory shock, pericardial effusion, pneumothorax, blood loss, hypoadrenalism, hypothyroidism, inborn errors of metabolism, or heart disease should be evaluated and treated as discussed above. If these causes are excluded, practitioners should consider extracorporeal membrane oxygenation (ECMO).65,66
Respiratory Diseases
Vincenzo Berghella in Maternal-Fetal Evidence Based Guidelines, 2022
During periods of seasonal flu, pregnant women account for excess healthcare visits related to respiratory complaints and excess hospitalizations (above what would be expected outside of pregnancy); this is true for both healthy women and those with chronic conditions. The rate of hospitalization for seasonal influenza among healthy non-pregnant women in Canada is nearly 10 times as high among healthy pregnant women. This difference in influenza hospitalization persists among women with comorbidities, thought their rate of hospitalization is overall higher [71]. Pregnant women are at increased risk for hospitalization during influenza season, and those hospitalized for respiratory illness stay longer [59, 71, 72]. During the 2009 H1N1 influenza pandemic, pregnant and postpartum women with H1N1 influenza had a 7 times higher risk of admission to the ICU than non-pregnant women in the same age group; After 20 weeks of pregnancy the relative risk of ICU admission was 13 times higher [69]. The severity of disease is demonstrated by utilization of extracorporeal membrane oxygenation (ECMO). Sixteen percent of all ECMO interventions for respiratory failure in H1N1 in Australia and New Zealand were performed on pregnant or postpartum patients, whom conventional mechanical ventilation could not adequately oxygenate [73].
Extracorporeal membrane oxygenation support in adult patients with acute respiratory distress syndrome
Published in Expert Review of Respiratory Medicine, 2020
Mechanical ventilation is an important lifesaving therapy for providing respiratory support to maintain adequate gas exchange in patients with acute respiratory distress syndrome (ARDS) until the function of the damaged lung is restored. However, some patients fail to achieve adequate oxygenation or carbon dioxide removal to sustain life despite positive-pressure ventilation. Extracorporeal membrane oxygenation (ECMO) was introduced as salvage therapy in such patients. Unlike the expectation that ECMO could reduce the risk of death by improving refractory hypoxemia or hypercapnic respiratory acidosis in patients with severe respiratory failure, earlier studies showed only an improvement of gas exchange without survival benefit from ECMO, and these disappointing results discouraged wider application [1,2]. However, since then, the Conventional Ventilator Support Versus ECMO for Severe Acute Respiratory Failure (CESAR) trial and several studies during the H1N1 influenza pandemic in 2009 reported the successful use of ECMO, again highlighting the technique in the management of severe acute respiratory failure [3–7]. These studies suggested that advances in patient selection, timing of ECMO initiation, and bedside management during ECMO support are key influencing factors in achieving positive results in parallel with improvements in circuit technology. In this review, therefore, we discuss the indications for ECMO in patients with ARDS and contemporary management of adult patients receiving ECMO for respiratory support.
Prognostic significance of early acute kidney injury in COVID-19 patients requiring mechanical ventilation: a single-center retrospective analysis
Published in Renal Failure, 2023
Michal Sitina, Vladimir Sramek, Martin Helan, Pavel Suk
A retrospective analysis of the electronic medical records of all 458 COVID-19 patients hospitalized in our ICU between March 2020 and December 2021 was performed. COVID-19 patients not requiring mechanical ventilation (MV) (n = 17), patients requiring MV for less than 24 h or who died within 24 h after admission (n = 6), patients without COVID-19 pneumonia as the main cause of admission (n = 53) and patients with a history of advanced chronic kidney disease (CKD 3–5; n = 10) were excluded from the analysis. Thus, 372 patients with COVID-19 pneumonia requiring mechanical ventilation for more than 24 h without advanced CKD were further analyzed. Eighty-six patients (23%) required treatment with extracorporeal membrane oxygenation (ECMO). We applied no age criteria for inclusion. SARS-CoV-2 infection was confirmed with polymerase chain reaction (PCR) in all patients.
Non-antibiotic therapies for sepsis: an update
Published in Expert Review of Anti-infective Therapy, 2019
Jean-Louis Vincent, Wasineenart Mongkolpun
Continuing on the lines of therapies targeting the global host response, extracorporeal removal strategies remain investigational but make good sense. Sepsis is a dysregulated response to infection, the pathophysiology of which is associated with the release into the circulation of multiple excess mediators and molecules, including cytokines, chemokines, coagulation factors, among many others. Removal of some of these excess mediators is the rationale behind extracorporeal blood purification techniques. Various devices have been designed for this purpose and can remove the molecules by convection, filtration or adsorption or some combination of these. Although this removal may be non-specific and some concern has been raised that ‘beneficial’ mediators may also be removed during the process, it is possible that if multiple mediators are present in excess, removing a small amount of the excess could still be beneficial.
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