Effect of tocilizumab on intensive care patients with Covid-19 pneumonia, a retrospective cohort study.

BACKGROUND: In this study, the efficacy of an IL-6 antagonist, Tocilizumab, administered in the early period was studied in intensive care patients with COVID-19 pneumonia followed by hypoxic and systemic inflammation not receiving mechanical ventilation support. METHODS: Patients with COVID-19 pneumonia who have signs of hypoxia and systemic inflammation and/or who have acute bilateral infiltrates on chest radiograph and who received tocilizumab treatment were compared with the patients who received standard medical therapy. Patients who were followed up with COVID-19 pneumonia and respiratory failure between March 2020 and March 2021 were retrospectively evaluated in the study. A 400 mg - 800 mg iv dose (depending on weight) of Tocilizumab was administered. The primary endpoint was determined as intensive care unit mortality. RESULTS: A total of 213 patients who were admitted with respiratory failure associated with COVID-19 to our third-level intensive care unit were evaluated. Of these patients, the study was conducted with 50 patients in the tocilizumab treatment group and 92 patients in the standard treatment group. During the intensive care period, 26 patients (28.3%) in the standard treatment group and 12 patients (24%) in the group receiving tocilizumab died. The adjusted hazard ratio for mortality in the tocilizumab group was 0.39 (95% confidence interval [CI], 0.186 to 0.808; p = 0.001 by log-rank test). During the intensive care period, 22 patients (24.8%) in the standart treatment group and 16 patients (32%) in the tocilizumab group were intubated. The adjusted hazard ratio for a primary outcome intubation in the tocilizumab group was 0.71 (95% confidence interval [CI], 0.355 to 1.424; p = 0.184 by log-rank test).

Extracorporeal membrane oxygenation experiences during COVID-19 pandemic, third wave with younger patients: A retrospective observational study.

OBJECTIVES: In this article, the results of severe coronavirus disease 2019 (COVID-19) cases followed with extracorporeal membrane oxygenation (ECMO) support in a 3-month period in the third wave when there were an increased number of cases of young patients in our intensive care unit (ICU) were presented. METHODS: The study was carried out with all COVID-19 patients who were given ECMO support in our tertiary referral hospital ICU after obtaining the consent of the Ministry of Health Scientific Research Platform and after the approval of the local ethics committee. Patient data were obtained retrospectively from intensive care bedside follow-up charts and computer records. The demographic and clinical characteristics of the patients were presented in average, median, and percentages. The data of the patients were evaluated and compared with the current literature. RESULTS: ECMO treatment was applied in seven patients who were followed up with severe COVID-19 pneumonia in the last 3 months. Venovenous extracorporeal membrane oxygenation (VV-ECMO) was applied to all patients. Five (71.5%) of seven patients were weaned from ECMO. Four (57.2%) of seven patients were discharged from the ICU and hospital in good health. While two of the patients had a cesarean section (C/S) before ECMO, one patient underwent C/S under ECMO. All three newborns were delivered via C/S and all were premature (C/S dates were 35 weeks, 32 weeks, and 27 weeks), and all were discharged from the hospital in good health. CONCLUSION: Our experience shows that ECMO in COVID-19 patients is a lifesaving treatment option that can be successfully applied in severe acute respiratory distress syndrome cases who do not respond to conventional treatments.

Neuromuscular Electrical Stimulator as a Protective Treatment against Intensive Care Unit Muscle Wasting in Sepsis/Septic Shock Patients.

OBJECTIVE: To investigate the efficacy of neuromuscular electrical stimulation (NMES) application in preventing muscle wasting in intensive care unit (ICU) patients diagnosed with sepsis/septic shock. STUDY DESIGN: A single-centre, unblinded, parallel-group, prospective, randomised clinical study. PLACE AND DURATION OF STUDY: Ondokuz Mayis University, Faculty of Medicine Hospital, Level 3 ICU, between October 28th 2018, and October 1st, 2020. METHODOLOGY: Eighty patients from a single centre who were diagnosed with sepsis/septic shock, followed up at level 3 ICU, and met the criteria were included. The patients were evaluated in 2 groups: One who received physiotherapy alone (n=40) and the other who received physiotherapy + NMES (n=40). The development of intensive care unit-muscle wasting was evaluated in patients of both groups. Muscle wasting was identified by anthropometric and ultrasonographic measurements. The day the patients were diagnosed with sepsis was determined as the first day and the bilateral anthropometric and ultrasonographic measurements of the biceps brachii and rectus femoris muscles were obtained on days 3, 7, 14, 21, and 28. RESULTS: There was no significant difference between the groups in the ultrasonographic and anthropometric measurements on days 1, 3, and 7 (p>0.005). However, the ultrasonographic measurements of the group that received physiotherapy + NMES demonstrated a significantly lower loss in the upper extremities on days 14 and 21 compared to the group that received physiotherapy alone (p=0.003 and p=0.028, respectively). No significant difference was found in the anthropometric measurements. CONCLUSION: The NMES, which have been increasingly used as new treatment protocols in the prevention of ICU-AW, yield favourable results in patients with sepsis/septic shock. KEY WORDS: Intensive care unit, Acquired weakness, Neuromuscular electrical stimulation, Muscle wasting, Sepsis.

The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: The objective of this study was to investigate the use of early APRV mode as a lung protective strategy compared to conventional methods with regard to ARDS development. METHODS: The study was designed as a randomized, non-blinded, single-center, superiority trial with two parallel groups and a primary endpoint of ARDS development. Patients under invasive mechanical ventilation who were not diagnosed with ARDS and had Lung Injury Prediction Score greater than 7 were included in the study. The patients were assigned to APRV and P-SIMV + PS mode groups. RESULTS: Patients were treated with P-SIMV+PS or APRV mode; 33 (50.8%) and 32 (49.2%), respectively. The P/F ratio values were higher in the APRV group on day 3 (p = 0.032). The fraction of inspired oxygen value was lower in the APRV group at day 7 (p = 0.011).While 5 of the 33 patients (15.2%) in the P-SIMV+PS group developed ARDS, one out of the 32 patients (3.1%) in the APRV group developed ARDS during follow-up (p = 0.197). The groups didn't differ in terms of vasopressor/inotrope requirement, successful extubation rates, and/or mortality rates (p = 1.000, p = 0.911, p = 0.705, respectively). Duration of intensive care unit stay was 8 (2-11) days in the APRV group and 13 (8-81) days in the P-SIMV+PS group (p = 0.019). CONCLUSIONS: The APRV mode can be used safely in selected groups of surgical and medical patients while preserving spontaneous respiration to a make benefit of its lung-protective effects. In comparison to the conventional mode, it is associated with improved oxygenation, higher mean airway pressures, and shorter intensive care unit stay. However, it does not reduce the sedation requirement, ARDS development, or mortality.

Management of Acute Respiratory Distress Syndrome with H1N1 Influenza Virus in Pregnancy: Successful Mechanical Ventilation and Weaning with Airway Pressure Release Ventilation.

In pregnancy, infection with H1N1 influenza virus may produce symptoms similar to infection with seasonal influenza virus. Patients may rarely come with a clinical condition causing severe acute respiratory distress syndrome (ARDS) and death. Therefore, mechanical-ventilation strategies to manage these events are vital. We report a case of ARDS after an infection with H1N1 influenza A in a 33-year-old patient pregnant at 27-weeks. The ARDS was successfully managed by airway pressure release ventilation (APRV). APRV can be used successfully as an alternative to conventional mechanical ventilation modes in pregnant patients experiencing severe respiratory failure.