RESUMO
In this feasibility study, we carried out in an interdisciplinary team standardised, ultrasound-guided, minimally invasive autopsy (US-MIA) directly at the bedside of patients who died of COVID-19 in the intensive care unit of the Rechts der Isar Hospital of the Technical University Munich (TUM). The aim of the study was to verify the feasibility, time efficiency and infection hygiene aspects of the process, as well as the quality of the tissue samples. Our results show that bedside US-MIA is suitable for obtaining tissue samples before the onset of postmortem autolysis, and that it can also be carried out quickly and safely. The potential of US-MIA, which has gained little recognition so far, deserves special attention in the context of postmortem diagnosis, research and quality assurance. In the future, these strengths of US-MIA could help to lead postmortem diagnosis into the modern age of pathological deep analytics ("omics").
Assuntos
COVID-19 , Humanos , Autopsia/métodos , Hospitais Universitários , Ultrassonografia de Intervenção , Unidades de Terapia IntensivaRESUMO
Introduction: Septic shock is associated with high mortality and hemodynamic impairment. The use of corticoids is a common therapeutic tool in critically ill patients. However, data on the mechanisms and prognostic ability of hemodynamic improvement by adjunctive steroids are rare. This study primarily aimed to evaluate short-term effects of hydrocortisone therapy on catecholamine requirement and hemodynamics derived from transpulmonary thermodilution (TPTD) in 30 critically ill patients with septic shock and a 28 days mortality rate of 50%. Methods: Hydrocortisone was administered with an intravenous bolus of 200â mg, followed by a continuous infusion of 200â mg per 24â h. Hemodynamic assessment was performed immediately before as well as 2, 8, 16, and 24â h after the initiation of corticoids. For primary endpoint analysis, we evaluated the impact of hydrocortisone on vasopressor dependency index (VDI) and cardiac power index (CPI). Results: Adjunctive hydrocortisone induced significant decreases of VDI from 0.41 (0.29-0.49) mmHg-1 at baseline to 0.35 (0.25-0.46) after 2â h (P < .001), 0.24 (0.12-0.35) after 8â h (P < .001), 0.18 (0.09-0.24) after 16â h (P < .001) and 0.11 (0.06-0.20) mmHg-1 after 24â h (P < .001). In parallel, we found an improvement in CPI from 0.63 (0.50-0.83) W/m2 at baseline to 0.68 (0.54-0.85) after 2â h (P = .208), 0.71 (0.60-0.90) after 8â h (P = .033), 0.82 (0.6-0.98) after 16â h (P = .004) and 0.90 (0.67-1.07) W/m2 after 24â h (P < .001). Our analyses revealed a significant reduction in noradrenaline requirement in parallel with a moderate increase in mean arterial pressure, systemic vascular resistance index, and cardiac index. As a secondary endpoint, our results showed a significant decrease in lung water parameters. Moreover, changes in CPI (ΔCPI) and VDI (ΔVDI) after 24â h of hydrocortisone therapy revealed accurate prognostic ability to predict 28 days mortality (AUC = 0.802 vs 0.769). Conclusion: Adjunctive hydrocortisone leads to a rapid decrease in catecholamine requirement and a substantial circulatory improvement in critically ill patients with septic shock.
Assuntos
Choque Séptico , Humanos , Hidrocortisona/uso terapêutico , Termodiluição/métodos , Estado Terminal/terapia , Hemodinâmica , Norepinefrina , Vasoconstritores/uso terapêutico , Vasoconstritores/farmacologiaAssuntos
Injúria Renal Aguda/microbiologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/microbiologia , Aspergilose Pulmonar Invasiva/microbiologia , Mananas/sangue , Pneumonia Viral/microbiologia , Síndrome Respiratória Aguda Grave/microbiologia , Injúria Renal Aguda/complicações , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/virologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/genética , Biomarcadores/sangue , Líquido da Lavagem Broncoalveolar/química , Proteína C-Reativa/metabolismo , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Progressão da Doença , Evolução Fatal , Galactose/análogos & derivados , Humanos , Interleucina-6/sangue , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/virologia , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , SARS-CoV-2 , Síndrome Respiratória Aguda Grave/complicações , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/virologiaRESUMO
Fusarium spp., common soil moulds, are emerging fungal pathogens in immunocompromised subjects. We report the first case of Fusarium solani peritonitis in a patient with liver cirrhosis. Because of the high morbidity and mortality associated with fusariosis, an aggressive approach to treatment as well as identification of the species and drug susceptibilities is warranted.