Kinetics of Plasma Cytokines During Two Different Modalities of Extracorporeal Blood Purification in the Critically Ill Covid 19 Patients: A Cohort Study.

Background: In the absence of direct therapy for COVID-19, extracorporeal blood treatment (EBT) could represent an option for cytokine removal. Objective: This study aimed to describe and compare cytokine removal during intermittent haemodialysis (IHD) and continuous renal replacement therapy (CRRT) in COVID-19 patients with Acute Kidney Injury (AKI). Methods: It was a cohort study that studied patients with COVID-19-related AKI according to KDIGO criteria and admitted at Intensive Care Unit (ICU). Blood samples were collected at the start and end of both IHD using high flux (HF) membranes (10 patients) and continuous venovenous haemodiafiltration (CVVHDF:10 patients) in two sessions for measuring 13 different plasma interleukins and calculating the cytokine removal rate. Results: There was no difference between the two groups regarding mechanical ventilation, vasoactive drug, age or prognostic scores. Patients treated by CRRT presented higher levels of IL-2 and IL-8 than patients treated by IHD at dialysis start. Cytokine removal ranged from 9% to 78%. Patients treated by CRRT presented higher cytokine removal for IL-2, IL-6 IL-8, IP-10 and TNF. The removal rates of IL-4, IL-10, IL-17A, IFN, MCP-1 and TGF-B1 were similar in two groups. After one session of CVVHDF (24 h), IL-2 and IL-1ß levels did not vary significantly, whereas IL-4, IL-6, IL-8, IL-10, IL-17A, TNF, IFN, IP-10, MCP-1, IL-12p70 and TGF-B1 decreased by 33.8-76%, and this decrease was maintained over the next 24 h. In IHD groups, IL-2, IL-6, TNF, IP-10 and IL-1ß levels did not decrease significantly whereas IL-4, IL-8, IL-10, IL-17A, IFN, MCP-1, IL-12p70 and TGF-B1 decreased by 21.8-72%; however, cytokine levels returned to their initial values after 24 h. Conclusion: Cytokine removal is lower in IHD using HF membranes than in CVVHDF, and in IHD the removal is transient and selective, which can be associated with mortality during cytokines storm-related COVID-19.

Quantitative EEG evaluation in patients with acute encephalopathy.

OBJECTIVE: To investigate the use of quantitative EEG (qEEG) in patients with acute encephalopathies (AEs) and EEG background abnormalities. METHOD: Patients were divided into favorable outcome (group A, 43 patients) and an unfavorable outcome (group B, 5 patients). EEGLAB software was used for the qEEG analysis. A graphic of the spectral power from all channels was generated for each participant. Statistical comparisons between the groups were performed. RESULTS: In group A, spectral analysis revealed spectral peaks (theta and alpha frequency bands) in 84% (38/45) of the patients. In group B, a spectral peak in the delta frequency range was detected in one patient. The remainder of the patients in both groups did not present spectral peaks. Statistical analysis showed lower frequencies recorded from the posterior electrodes in group B patients. CONCLUSION: qEEG may be useful in the evaluations of patients with AEs by assisting with the prognostic determination.

Quantitative EEG evaluation in patients with acute encephalopathy / Analise quantitativa do EEG em pacientes com encefalopatias agudas

Objective To investigate the use of quantitative EEG (qEEG) in patients with acute encephalopathies (AEs) and EEG background abnormalities. Method Patients were divided into favorable outcome (group A, 43 patients) and an unfavorable outcome (group B, 5 patients). EEGLAB software was used for the qEEG analysis. A graphic of the spectral power from all channels was generated for each participant. Statistical comparisons between the groups were performed. Results In group A, spectral analysis revealed spectral peaks (theta and alpha frequency bands) in 84% (38/45) of the patients. In group B, a spectral peak in the delta frequency range was detected in one patient. The remainder of the patients in both groups did not present spectral peaks. Statistical analysis showed lower frequencies recorded from the posterior electrodes in group B patients. Conclusion qEEG may be useful in the evaluations of patients with AEs by assisting with the prognostic determination. .

Objetivos Investigar o uso do EEG quantitativo (qEEG) em pacientes com encefalopatias agudas (EAs ) e anormalidades da atividade de base no EEG. Método s pacientes foram divididos em prognóstico favorável (grupo A, 43 pacientes) e desfavorável (grupo B, 5 pacientes). O programa EEGLAB foi utilizado para a análise do qEEG. Um gráfico da potência espectral de todos os canais foi gerado para cada participante. Os dois grupos foram comparados estatisticamente. Resultados No grupo A, a análise espectral revelou picos (frequências teta e alfa) em 84% (38/45) dos pacientes. No grupo B, um pico espectral na frequência delta foi detectado em um paciente. Os pacientes remanescentes dos dois grupos não apresentaram picos espectrais. A análise estatística mostrou menores frequências registradas nos eletrodos posteriores dos pacientes do grupo B. Conclusão O qEEG pode ser útil na avaliação de pacientes com EAs auxiliando na determinação do prognóstico. .

Constipação intestinal prediz o tempo de ventilação mecânica em unidade de terapia intensiva / Constipation predicts duration of mechanical ventilation in intensive care unit

JUSTIFICATIVA E OBJETIVOS: Estudos recentes têm identificado a constipação intestinal (CI) como fator prognóstico independente na evolução de pacientes críticos e mostrado que seu tratamento pode resultar em melhor prognóstico. O objetivo deste estudo foi avaliar a incidência de CI em pacientes com nutrição enteral internados em unidade de terapia intensiva (UTI) e sua associação com o tempo de ventilação mecânica (VM), de internação e a mortalidade. MÉTODO: Foram incluídos prospectivamente 26 pacientes de ambos os sexos, acima de 18 anos, com uso de dieta enteral de forma exclusiva por no mínimo três dias durante a internação na UTI, de novembro de 2011 a janeiro de 2012. Foram registrados dados demográficos, diagnósticos, dias em VM, duração da terapia de nutrição enteral, hábito intestinal e desfecho clínico. RESULTADOS: A idade média dos pacientes foi 60,5 ± 18,7anos, sendo que 50% eram homens. O tempo de VM foi de 9,0± 7,3 dias e a mediana do tempo de internação na UTI foi de 13,0 (7,0-18,0) dias. Os pacientes constipados (n = 13; 50%) demoraram mais tempo para atingir a meta nutricional prescrita. Além disso, apresentaram tempo de VM duas vezes maior que os sem constipação. Em análise de regressão linear para predição de tempo de VM, a constipação foi preditora de maior tempo de VM, mesmo após ajuste por gênero e gravidade (p = 0,043). No entanto, a CI não esteve associada ao tempo de internação na UTI ou ao óbito. CONCLUSÃO: A presença de CI em pacientes críticos é preditora de maior tempo de VM. Portanto, a criação e implantação de protocolos para o seu tratamento na UTI é de fundamental importância.

BACKGROUND AND OBJECTIVES: Recent studies have demonstrated that intestinal constipation (IC) is an independent prognostic factor in critically ill patient's evolution. In addition, constipation treatment can result in better outcome. The purpose of this study is to evaluate the incidence of IC in intensive care unit (ICU) patients receiving enteral nutrition, and its association with duration of mechanical ventilation (MV) and length of stay, and mortality in ICU. METHOD: We prospectively evaluated 26 patients of both genders, older than 18 years, exclusively receiving enteral nutrition for at least three days who were admitted to an ICU from November/2011 to January/2012. Demographic data, diagnosis, duration of MV and enteral nutrition, bowel habits, and outcomes were registered. RESULTS: Patients' average age was 60.5 ± 18.7 years old, and 50% were male. Duration of MV was 9.0 ± 7.3 days and median length of ICU stay was 13.0 (7.0-18.0) days. Patients with constipation (n = 13, 50%) took longer time to meet nutritional requirements. In addition, duration of MV was twofold higher in IC patients compared to non-IC patients. In linear regression analysis for prediction of MV time, IC was a predictor of longer duration of MV, even after adjustment for gender and illness severity (p = 0.043). However, IC was not associated with length of stay in ICU or mortality. CONCLUSION: The presence of constipation in critically ill patients predicts longer duration of MV. Therefore, creation and implementation of clinical protocols for IC treatment is of fundamental importance.