Nationwide Incidence and Outcomes of Patients With Coronavirus Disease 2019 Requiring Intensive Care in Iceland.

OBJECTIVES: To determine the nationwide demographics and hospital mortality of patients with severe acute respiratory syndrome coronavirus 2 infection requiring admission to the ICU for coronavirus disease 2019 in Iceland. DESIGN: Prospective observational study. SETTING: All ICUs in Iceland (Landspitali University Hospital and Akureyri Regional Hospital). PATIENTS: All patients admitted to the ICU for management of coronavirus disease 2019 between March 14, 2020, and April 13, 2020, with follow-up through May 5, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 27 patients were admitted to the ICU for coronavirus disease 2019 out of 1,788 severe acute respiratory syndrome coronavirus 2 positive cases, rendering an overall admission ratio of 1.5% (95% CI, 1.0-2.2%). The population rate of ICU admission for coronavirus disease 2019 was 7.4 (95% CI, 4.9-10.8) admissions per 100,000 individuals. The hospital mortality of patients admitted to the ICU was 15% (95% CI, 4-34%), and the mortality of patients receiving mechanical ventilation was 19% (95% CI, 4-46%). CONCLUSIONS: We report a lower overall ratio of ICU admissions for coronavirus disease 2019 among severe acute respiratory syndrome coronavirus 2 positive patients and a lower hospital mortality for patients treated in the ICU for coronavirus disease 2019 compared with initial reports from Italy and China. Our results could be explained by the early adoption of widespread testing and a successful national response to the pandemic.

Tuning of shell thickness of solid lipid particles impacts the chemical stability of encapsulated ω-3 fish oil.

HYPOTHESIS: This study demonstrates that tuning the shell thickness of lipid particles can modulate their oxidative stability. We hypothesized that a thick crystallized shell around the incorporated fish oil would improve the oxidative stability due to the reduced diffusion of prooxidants and oxygen. EXPERIMENTS: We prepared solid lipid nanoparticles (5%w/w lipid phase, 1.5%w/w surfactant, pH 7) by using different ratios of tristearin as carrier lipid and ω-3 fish oil as incorporated liquid lipid stabilized by high- or low-melting lecithin. The physical, polymorphic and oxidative stability of the lipid particles was assessed. FINDINGS: The high-melting lecithin was the key in inducing the formation of a solidified tristearin shell around the lipid particles by interfacial heterogeneous nucleation. Lipid particles containing a higher ratio of tristearin showed a better oxidative stability. The results revealed that a crystallized tristearin layer above 10nm was required to inhibit oxidation of the incorporated fish oil. This cut-off was shown for lipid particles containing 50-60% fish oil. This research gives important insights into understanding the relation between the thickness of the crystallized shell around the lipid particles and their chemical stability.

Influence of co-surfactants on crystallization and stability of solid lipid nanoparticles.

HYPOTHESIS: The purpose of this study was to find a suitable co-surfactant to replace non-food grade bile salts in solid lipid nanoparticle (SLN) formulations. The hypothesis was that the molecular structure and physical properties of co-surfactant modulate the stabilization of SLNs upon polymorphic transition. EXPERIMENTS: Tristearin SLNs were prepared by using two main surfactants: saturated high-melting lecithin, and unsaturated low-melting lecithin. As co-surfactants we used sodium taurodeoxycholate (i.e. bile salt), Pluronic F68, Tween 60 and 80, and amino acids tyrosine, tryptophan, and phenylalanine. The influence of co-surfactants on crystallization behavior and physical stability of SLNs was investigated by differential scanning calorimetry and static light scattering, respectively. FINDINGS: The results showed that the aromatic amino acids had optimal structures and properties to act as effective co-surfactants in SLNs. Our study suggests that ideal co-surfactants are amphiphilic with pronounced hydrophobic areas, but highly water soluble so that they can have a reservoir of molecules readily available for interfacial stabilization. They adsorb fast to the interfaces, but without inducing polymorphic transition. This work demonstrates how the right structure can facilitate the desired function.

Formation of solid shell nanoparticles with liquid ω-3 fatty acid core.

A major challenge for food and pharmaceutical industries is the engineering of nanostructures that can efficiently encapsulate bioactive compounds with enhanced physical and chemical stability, and high load. The influence of surfactant properties on the physical and chemical stability of (i) nanostructured lipid carriers (NLC) containing tristearin and ω-3 fish oil, (ii) tristearin solid lipid nanoparticles (SLN), and (iii) ω-3 fish oil-in-water emulsions was investigated. As surfactants we used low (LM)- and high-melting (HM) lecithins. Results indicated that the presence of fish oil reduced the crystallisation temperature, melting temperature, and melting enthalpy of tristearin. NLC stabilized with HM-lecithin inhibited the oxidation of ω-3 fatty acids ≥90% compared to those stabilized with LM-lecithin. This was attributed to the solidified surfactant layer of HM-lecithin inducing crystallisation of the shell by interfacial heterogeneous nucleation. The results showed that the saturated HM-lecithin was the key in controlling the crystallisation behaviour, and thereby enabled the formation of oxidatively and physically stable lipid nanoparticles.

[Intensive care patients with influenza A (H1N1) infection in Iceland 2009]. / Gjörgaeslusjúklingar med inflúensu A (H1N1) á Islandi 2009.

BACKGROUND: We describe the main characteristics of patients that required intensive care due to the influenza (H1N1) outbreak in 2009. METHODS: Retrospective and prospective analysis of medical records from patients admitted to ICU with positive RT-PCR for (H1N1). RESULTS: During a six week period in the fall of 2009, 16 patients were admitted to intensive care in Iceland with confirmed H1N1 infection. Mean age was 48 years (range 1-81). Most patients were considered quite healthy but the majority had risk factors such as smoking, obesity or hypertension. All but one had fever, cough, dyspnea and bilateral infiltrates on chest x-ray and developed any organ failures (mean SOFA score 7). 12 needed mechanical ventilation and two extra corporeal membrane oxygenation (ECMO). Mean APACHE II score was 20. No patient died in the ICU but one elderly patient with multiple underlying diseases died a few days after being discharged from the ICU. CONCLUSIONS: (1) The incidence of severe influenza A (H1N1) that leads to ICU admission appears to be high in Iceland. (2) Many patients developed acute respiratory distress syndrome in addition to other organ failures, and required additional measures for oxygenation such as prone position, nitric oxide inhalation and ECMO. (3) 28 day mortality was low. (4) This study will aid in future outbreak planning in Iceland. Key words: influenza A, pneumonia, multiple organ failure, death rate, intensive care, ventilator therapy, ECMO.

[Energy expenditure and nutritional support in intensive care patients]. / Orkunotkun og naering gjörgaeslusjúklinga.

STUDY OBJECTIVES: Nutritional support of ICU patients is usually guided by estimations of their caloric needs. However, recent studies have shown that energy expenditure (EE) of critically ill patients is not as high as previously thought. The goal of this study was to measure EE in ICU patients, compare it with estimated EE and evaluate nutritional support. METHODS: Energy expenditure was measured with indirect calorimetry in a broad group of ICU patients requiring mechanical ventilation >48 hours. In comparison EE was estimated with the Harris-Benedict equation. Nutritional support during ICU stay was registered. RESULTS: Mean measured EE of 56 patients was 1820 +/- 419 kcal/day or 22 kcal/kg/day. The Harris- Benedict equation underestimated EE by 11%, but adding a stress factor resulted in 15% overestimation. Mean nutritional support was 1175 +/- 442 kcal/day or 67% of EE. The energy deficit was greatest during the first week of ICU stay. Mean protein administration was 0,44 g/kg/day. CONCLUSION: Measured EE of ICU patients was less than nutritional support recommended by international guidelines. These results are in accordance with recent studies. Nutritional support was only 67% of measured energy expenditure and protein content less than recommended. Further studies are needed as it has not be shown how this might influence outcome.