Decreased CRRT Filter Lifespan in COVID-19 ICU Patients.

(1) Background: Increased thromboembolic events and an increased need for continuous renal replacement therapy (CRRT) have been frequently reported in COVID-19 patients. Our aim was to investigate CRRT filter lifespan in intensive care unit (ICU) COVID-19 patients. (2) Methods: We compared CRRT adjusted circuit lifespan in COVID-19 patients admitted for SARS-CoV-2 infection to a control group of patients admitted for septic shock of pulmonary origin other than COVID-19. Both groups underwent at least one session of CRRT for AKI. (3) Results: Twenty-six patients (13 in each group) were included. We analysed 117 CRRT circuits (80 in the COVID-19 group and 37 in the control group). The adjusted filter lifespan was shorter in the COVID-19 group (17 vs. 39 h, p < 0.001). This trend persisted after adjustment for confounding factors (-14 h, p = 0.037). Before CRRT circuit clotting, the COVID-19 group had a more procoagulant profile despite higher heparin infusion rates. Furthermore, we reported a decreased relation between activated partial thromboplastin time (aPTT) and cumulative heparin dose in COVID-19 patients when compared to historical data of 23,058 patients, suggesting a heparin resistance. (4) Conclusion: COVID-19 patients displayed a shorter CRRT filter lifespan that could be related to a procoagulant profile and heparin resistance.

One year after ICU admission for severe community-acquired pneumonia of bacterial, viral or unidentified etiology. What are the outcomes?

INTRODUCTION: Multiplex polymerase chain reaction (mPCR) for respiratory virus testing is increasingly used in community-acquired pneumonia (CAP), however data on one-year outcome in intensive care unit (ICU) patients with reference to the causative pathogen are scarce. MATERIALS AND METHODS: We performed a single-center retrospective study in 123 ICU patients who had undergone respiratory virus testing for CAP by mPCR and with known one-year survival status. Functional status including dyspnea (mMRC score), autonomy (ADL Katz score) and need for new home-care ventilatory support was assessed at a one-year post-ICU follow-up. Mortality rates and functional status were compared in patients with CAP of a bacterial, viral or unidentified etiology one year after ICU admission. RESULTS: The bacterial, viral and unidentified groups included 19 (15.4%), 37 (30.1%), and 67 (54.5%) patients, respectively. In multivariate analysis, one-year mortality in the bacterial group was higher compared to the viral group (HR 2.92, 95% CI 1.71-7.28, p = 0.02) and tended to be higher compared to the unidentified etiology group (p = 0.06); but no difference was found between the viral and the unidentified etiology group (p = 0.43). In 64/83 one-year survivors with a post-ICU follow-up consultation, there were no differences in mMRC score, ADL Katz score and new home-care ventilatory support between the groups (p = 0.52, p = 0.37, p = 0.24, respectively). Severe dyspnea (mMRC score = 4 or death), severe autonomy deficiencies (ADL Katz score ≤ 2 or death), and major adverse respiratory events (new home-care ventilatory support or death) were observed in 52/104 (50.0%), 47/104 (45.2%), and 65/104 (62.5%) patients, respectively; with no difference between the bacterial, viral and unidentified group: p = 0.58, p = 0.06, p = 0.61, respectively. CONCLUSIONS: CAP of bacterial origin had a poorer outcome than CAP of viral or unidentified origin. At one-year, impairment of functional status was frequently observed, with no difference according to the etiology.

Anatomy of a Suicide: A Case Report.

BACKGROUND Penetrating neck injuries (PNI) have a relatively low incidence constituting just 1.6% to 3.0% of overall suicide attempts. Nonetheless, the anatomical challenges as well as the likelihood of vascular and airway lesions make it one of the most lethal injury types of all Abbreviated Injury Scale regions. Traditional PNI management which divides PNI into anatomical zones is being reconsidered in light of high numbers of negative surgical explorations, weak correlation between the area of wounds and organ injury and significantly longer hospitalizations. CASE REPORT A 52-year-old female was admitted after a self-inflicted, right para tracheal stab wound. A cervico-thoracic computed tomography (CT) scan excluded vascular and other organ lesions. A right pneumothorax was treated with a chest drain and a right exploratory cervicotomy was performed. A pharyngoscopy and an esophagoscopy showed no lesions. CONCLUSIONS Advanced Trauma Life Support (ATLS) principles determine the initial assessment of PNI. Invasive airway management was required if orotracheal intubation is unfeasible. Hemodynamically unstable patients with platysma, vascular or aerodigestive lesions require surgery. Laryngotracheal injuries require panendoscopy and bronchoscopy prior to surgical exploration. Pharyngo-esophageal injuries may be treated conservatively. Esophageal lesions require timing dependent surgery. Recently, a "no zone" approach irrespective of anatomical classification shows improved results in stable PNI. Multidetector helical CT with angiography (MDCT-A) significantly reduces negative exploratory surgery. Consensus regarding the best management of PNI is shifting, as increasing evidence suggests a "no-zone" approach is more beneficial and cost effective.