Secondary infections in critically ill patients with COVID-19: effects of intravenous IgM-enriched immunoglobulin therapy

Introduction: Critically ill patients with severe COVID-19 have an increased risk of bacterial and fungal superinfections due to a dysregulated immune response characterized by lymphopenia and low immunoglobulins levels. The intravenous immunoglobulins are involved in pathogen/toxin scavenging and inhibition of inflammatory mediators gene transcription with anti-apoptotic effects on immune system cells. This research aimed to describe the effects of intravenous IgM-enriched immunoglobulins in COVID-19 patients with sepsis due to secondary infections and low IgM levels. Method(s): We performed an observational retrospective study, including patients admitted to our intensive care unit (ICU) between March 2020 and February 2021 with severe COVID-19 and sepsis due to a superinfection (known or suspected) treated with intravenous IgM-enriched immunoglobulins. We collected demographic data and comorbidities. We noted hemodinamic data, antimicrobial and adiuvant therapies, laboratory results at ICU admission (T0), at the beginning (T1) and at the end (T2) of the IgM-enriched immunoglobulins infusion and at ICU discharge (T3). Result(s): In our cohort of 36 patients (Table 1) the prevalence of documented secondary infections was 83%. We observed a significant reduction of leukocytes from T0 to T3 (10.4 [8.3-14.5] x 103/ mmc vs 7.1 [4.8-11.2] x 103/ mmc, p < 0.01) and the SOFA score from T0 to T2 (7 [6-19] vs 5 [3-7], p < 0.01) and from T0 to T3 (7 [6-10] vs 4 [2-9], p < 0.01);from T1 to T2 (7 [6-9] vs 5 [3-7], p < 0.01) and from T1 to T3 (7 [6-9] vs 4 [2-9], p < 0.01). Cardiovascular SOFA showed a statistically significant reduction from T1 to T2 (4 [3-4] vs 0 [0-3], p < 0.01). Conclusion(s): The IgM-enriched immunoglobulins could improve organ function, as evidenced by the reduction of the SOFA score. Although the latest Surviving Sepsis Campaign guidelines suggest against using of IgM-enriched immunoglobulins, our study supports its use as an adjunctive therapy in COVID-19 patients with septic shock.

Long term follow-up of patients admitted to ICU for acute respiratory failure from SARS-CoV-2 infection

Introduction: The clinical features and acute complications of patients with severe COVID-19 have long been described. However, little information is available about the quality of life and long-term persistent symptoms after discharge from ICU [1]. The purpose of this study is to describe the symptoms, the neurological, functional and psychological status 6 months after discharge from ICU. Methods: We performed an observational prospective monocentric study. We considered patients admitted to ICU for acute respiratory failure from SARS-CoV-2 infection from March 2020 to March 2021 and discharged alive. Patients underwent a telephone interview 6 months after discharge. We asked for residual symptoms. Neurological, psychological and functional status was assessed using validated questionnaires. Results: Of the 111 eligible patients, 6 (5.4%) died after discharge and 35 (31,5%) were lost to follow-up. Demographic characteristics of the population are presented in Table 1. At 6 months after discharge, 9 (12.8%) patients reported no symptoms. Dyspnoea was present in 45 (64.3%) patients, asthenia in 39 (55.7%). 32 patients (45.7%) reported memory deficit, 28 (40%) peripheral neuropathy, 17 (24.3%) artrhalgias and 6 (8.6%) dysphagia. Palpitations were present in 16 (22.8%) patients and 10 (14.3%) patients experienced insomnia or agitation. The PC-PTSD-5 was positive in 21 (30%) patients. Based on PCFS Scale, 13 (18.6%) patients reported no functional limitations, 14 (20%) negligible functional limitations, 24 (34.3%) slight functional limitations, 5 (7.1%) moderate functional limitations and 14 (20%) severe functional limitations. The GOS-E score was 6 [5-8] and it was inversely correlated with the number of hypoxia episodes (Spearman rho = - 0.25, CI 95% - 0.47 to - 0.01, p = 0.03). Conclusions: At 6 months after ICU discharge, only a few patients reported no symptoms or functional limitations. Dyspnoea, asthenia and neurological symptoms were the most frequently described. (Table Presented).

Excess oxygen administration and adverse outcomes in patients with SARS-CoV-2 pneumonia requiring invasive mechanical ventilation: a retrospective study

Introduction: Even if life-saving in most cases, excess O2 may have adverse effects. We described the prevalence of hyperoxemia and excess O2 administration in patients with severe acute respiratory syndrome due to novel coronavirus (SARS-CoV-2) and explored the association with mortality in the intensive care unit (ICU) or ventilatorassociated pneumonia (VAP). Methods: Retrospective single-centre study on 134 patients with SARS-CoV-2 requiring mechanical ventilation for ≥ 48 h. We calculated the excess O2 administered based on an ideal arterial O2 tension ( PaO2) target of 55-80 mmHg. We defined hyperoxemia as PaO2 > 100 mmHg and hyperoxia + hyperoxemia as an inspired O2 fraction (FiO2) > 60% + PaO2 > 100 mmHg. Risk factors for ICU-mortality and VAP were assessed with multivariate analyses. Results: Each patient received an excess O2 of 1121 [829-1449] l per day of mechanical ventilation. Hyperoxemia was found in 38 [27-55] % of arterial blood gases, hyperoxia + hyperoxemia in 11 [5-18] %. The FiO2 was not reduced in 69 [62-76] % of cases of hyperoxemia. Adjustments were more frequent with higher PaO2 or initial FiO2 levels. ICU-mortality was 32%. VAP was diagnosed in 48.5% of patients. Hyperoxemia (odds ratio [OR] 1.300 95% confidence interval [1.097- 1.542]) and hyperoxia + hyperoxemia (OR 1.144 [1.008-1.298]) were associated with higher risk for ICU-mortality, independently of age, Sequential Organ failure Assessment score at ICU-admission and mean PaO2/FiO2. Hyperoxemia (OR 1.033 [1.006-1.061]), hyperoxia + hyperoxemia (OR 1.038 [1.003-1.075]) and daily excess O2 (OR 1.001 [1.000- 1.001]) were identified as risk factors for VAP, independently of body mass index, blood transfusions, days of neuromuscular blocking agents before VAP, prolonged prone positioning and mean PaO2/FiO2 before VAP. Conclusions: Excess O2 administration and hyperoxemia were common in mechanically ventilated patients with SARS-CoV-2 and may be associated with ICU-mortality and greater risk for VAP.

Microvascular dysfunction in pediatric patients with SARS-COV-2 pneumonia: Report of three severe cases☆☆☆

The coronavirus 19 (COVID-19) pandemic has affected hundreds of millions of people worldwide: in most of cases children and young people developed asymptomatic or pauci-symptomatic clinical pictures. However authors have showed that there are some categories of childhood more vulnerable to COVID-19 infection such as newborns or children with comorbidities. We report for the first time to the best of our knowledge about microvascular dysfunction in three pediatric clinical cases who developed COVID-19 infections with need of pediatric critical care. We found that sublingual microcirculation is altered in children with severe COVID-19 infection. Our findings confirmed most of data already observed by other authors in adult population affected by severe COVID-19 infection, but with distinct characteristics than microcirculation alterations previous observed in a clinical case of MIS-C. However we cannot establish direct correlation between microcirculation analysis and clinical or laboratory parameters in our series, by our experience we have found that sublingual microcirculation analysis allow clinicians to report directly about microcirculation dysfunction in COVID-19 patients and it could be a valuable bedside technique to monitor thrombosis complication in this population.

Stuck inside. A longitudinal study of older person's experiences of COVID-19 restrictions

In March 2020, the Argentinean government established the mandatory and preventive social isolation of the entire population. The isolation lasted for eight months and led to a sudden change in the social and individual life of the residents of Buenos Aires City. This measure had a drastic and direct impact on people's emotional well-being. The purpose of this article is to explore the subjective experience of 319 participants of 65 years of age and over, residents of Buenos Aires City, focusing on their feelings, emotions, and their own assessment of the gains experienced during the mandatory social isolation. Using data collected through a three-wave panel survey, we examine the temporal variability of the responses. The questionnaires ran between June and August 2020, during which time the epidemiological curve reached its highest levels. For the analysis of the textual data, we used a content analysis approach. A typology of emotion trajectories was developed, reporting both stable and oscillating characteristics that account for positive or negative emotional valences. Most cases show oscillating emotion trajectories that show a shift towards negative valences. The study observed that women experience emotional discomfort to a greater extent than men.

CovidSense: A Smartphone-based Initiative for Fighting COVID-19 Spreading

Coronavirus Disease COVID-19 is a new strain of coronavirus, first identified in clusters with pneumonia-like symptoms with manifestation mainly of fever (>37.8oC), runny nose, dry cough, anosmia, loss of taste, and fatigue. Testing for COVID-19 can be carried out on samples obtained by various methods, including nasopharyngeal swab or sputum sample. Results are generally available within a few hours to one day. Taking into consideration the worldwide COVID-19 pandemic impact (more than 35.500.000 incidences and more than 1.000.000 deaths so far), it is clear that there is an immediate need to devise an effective tool that can be used both at the hospital and home sites to provide a reliable risk index of confronting COVID-19. Here, the potentialities of a smartphone-based app, namely CovidSense, that could provide a reliable COVID-19 risk index to the user before performing any relevant clinical test, monitor his/her symptoms and provide guidance for further actions are presented. CovidSense is a holistic approach for COVID-19 risk assessment that captures both the status of the respiratory system, via acquisition and AI-based analysis of breathing and coughing sounds, along with the Autonomic Nervus System/Immune System status, via the capturing and analysis of the Heart Rate Variability. The analytical description and functionality of the CovidSense included here manifests the usefulness of such approach in continuous symptoms monitoring, allowing people with early symptoms, quarantined and sensitive groups, such as older adults and patients with comorbidities, to become active participants in the effort of fighting the spread of COVID-19, by monitoring their status and get engaged in appropriate preventative actions. CovidSense paves the way for solutions using technological artifacts, such as smartphones, to foster inclusiveness and joint efforts in successfully addressing global health problems, such as the COVID-19 pandemic. © 2020 ACM.