Critical Care Reviews Newsletter 439 21st May 2020

Welcome to the 439th Critical Care Reviews Newsletter, bringing you the best critical care research and open access articles from the last week.
The highlights of this week’s edition are randomised controlled trials on lopinavir–ritonavir in severe Covid-19 & triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in COVID-19; systematic reviews and meta analyses on furosemide stress testing in acute kidney injury & enteral nutrition in the prone position; and observational studies on interleukin-1 blockade with high-dose anakinra in COVID-19 & standardized EEG analysis in prognostication after cardiac arrest. There are also guidelines on antimicrobial therapeutic drug monitoring & advanced pulmonary and cardiac support of COVID-19 patients; narrative reviews on convalescent plasma in Covid-19 & whether to stimulate or suppress the immune responses in COVID-19; editorials on randomized clinical trials and COVID-19 & a critical care perspective on COVID-19 informed by lessons learnt from other viral epidemics; commentries on interpreting diagnostic tests for sars-cov-2, the ethics of covid-19 immunity-based licenses & CPR in the Covid-19 era; as well as correspondence on sepsis hysteria: facts versus fiction & the intubation box for COVID-19.
The full text of the issue is available via this link

Critical Care Reviews Newsletter 438 14th May 2020

The Critical Care Reviews Newsletter, brings you the best critical care research and open access articles from across the medical literature over the past seven days
The highlights of this edition are randomised controlled trials on remdesivir in adults with severe COVID-19 & fluid response evaluation in sepsis hypotension and shock; a systematic review and meta analysis on acute kidney injury superimposed COVID-19; and observational studies on respiratory pathophysiology of mechanically ventilated patients with covid-19 & aerodynamic analysis of SARS-CoV-2. There is also a guideline from the IDSA on COVID-19; narrative reviews on hypercoagulation and antithrombotic treatment in coronavirus 2019 & contemporary physiology guided approaches to cardiopulmonary resuscitation; editorials on resurgence of convalescent plasma therapy & risks posed to personnel during endotracheal intubation in patients with COVID-19; and commentariess on a once-in-a-century pandemic & Covid-19: what do we know so far about a vaccine?
The full text of the issue is available via this link

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy.

This article in JAMA by Grasselli and colleagues was first published online in April 2020.
Importance:  In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.
Objective:  To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy.
Design, Setting, and Participants:  Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020.
Exposures:  SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs.
Main Outcomes and Measures:  Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network.
Results:  Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received non-invasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio2 was greater than 50% in 89% of patients. The median Pao2/Fio2 was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged ≤63 years) and older patients (n = 514 aged ≥64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0]; P = .94). Median Fio2 was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, -10% [95% CI, -14% to 6%]; P = .006), and median Pao2/Fio2 was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, -8 to 22]; P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68]; P < .001) and had lower Pao2/Fio2 (median [IQR], 146 [105-214] vs 173 [120-222]; median difference, -27 [95% CI, -42 to -12]; P = .005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n = 786; age ≥64 years) had higher mortality than younger patients (n = 795; age ≤63 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%]; P < .001).
Conclusions and Relevance:  In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.
The full text of this article is available freely via this link.  A copy of this issue is also available in Rotherham Hospital Library on D Level.

Intensive Care Medicine Volume 46 Number 4 April 2020

To view Intensive Care Medicine’s May issue’s contents page follow this link.
Articles published in this issue include: COVID-19: a novel coronavirus and a novel challenge for critical care”, “Critical care crisis and some recommendations during the COVID-19 epidemic in China” and “Imaging changes of severe COVID-19 pneumonia in advanced stage”.
Together with other articles on COVID 19 these are freely available in full text to everyone.
To read the full text of any of these articles via the journal’s homepage requires a personal subscription to “Intensive Care Medicine” though some are available open access.  Individual articles can be ordered from the Rotherham NHS Foundation Trust Library and Knowledge Service.  Registered members of the library can make article requests online via this link.
The full text of articles from issues older than one year ago is available via this link to an archive of issues of Intensive Care Medicine.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area.

This article by Richardson and colleagues was published in JAMA online in April 2020.
Importance:  There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
Objective:  To describe the clinical characteristics and outcomes of patients with COVID-19 hospitalized in a US health care system.
Design, Setting, and Participants:  Case series of patients with COVID-19 admitted to 12 hospitals in New York City, Long Island, and Westchester County, New York, within the Northwell Health system. The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates.
Exposures:  Confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample among patients requiring admission.
Main Outcomes and Measures:  Clinical outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death. Demographics, baseline comorbidities, presenting vital signs, and test results were also collected.
Results:  A total of 5700 patients were included (median age, 63 years [interquartile range {IQR}, 52-75; range, 0-107 years]; 39.7% female). The most common comorbidities were hypertension (3026; 56.6%), obesity (1737; 41.7%), and diabetes (1808; 33.8%). At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/minute, and 27.8% received supplemental oxygen. The rate of respiratory virus co-infection was 2.1%. Outcomes were assessed for 2634 patients who were discharged or had died at the study end point. During hospitalization, 373 patients (14.2%) (median age, 68 years [IQR, 56-78]; 33.5% female) were treated in the intensive care unit care, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died. Mortality for those requiring mechanical ventilation was 88.1%. The median post discharge follow-up time was 4.4 days (IQR, 2.2-9.3). A total of 45 patients (2.2%) were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0-4.5) for readmitted patients. Among the 3066 patients who remained hospitalized at the final study follow-up date (median age, 65 years [IQR, 54-75]), the median follow-up at time of censoring was 4.5 days (IQR, 2.4-8.1).
Conclusions and Relevance:  This case series provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID-19 in the New York City area.
The full text of the article is freely available online via this link.  The paper copy is also available in the library.

COVID-19 and Italy: what next?

This article by Remuzzi and Remuzzi was published in the Lancet in April 2020.
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already taken on pandemic proportions, affecting over 100 countries in a matter of weeks. A global response to prepare health systems worldwide is imperative. Although containment measures in China have reduced new cases by more than 90%, this reduction is not the case elsewhere, and Italy has been particularly affected. There is now grave concern regarding the Italian national health system’s capacity to effectively respond to the needs of patients who are infected and require intensive care for SARS-CoV-2 pneumonia. The percentage of patients in intensive care reported daily in Italy between March 1 and March 11, 2020, has consistently been between 9% and 11% of patients who are actively infected. The number of patients infected since Feb 21 in Italy closely follows an exponential trend. If this trend continues for 1 more week, there will be 30 000 infected patients. Intensive care units will then be at maximum capacity; up to 4000 hospital beds will be needed by mid-April, 2020. Our analysis might help political leaders and health authorities to allocate enough resources, including personnel, beds, and intensive care facilities, to manage the situation in the next few days and weeks. If the Italian outbreak follows a similar trend as in Hubei province, China, the number of newly infected patients could start to decrease within 3-4 days, departing from the exponential trend. However, this cannot currently be predicted because of differences between social distancing measures and the capacity to quickly build dedicated facilities in China.
The full text of this article is available freely via this link.  A copy of this issue is also available in Rotherham Hospital Library on D Level.

Critical Care Reviews Newsletter 437 4th May 2020

The Critical Care Reviews Newsletter provides the best critical care research and open access articles from across the medical literature over the previous week.
The highlights of this week’s edition are a randomised controlled trial on anti-platelet agents in non-ST-elevation acute coronary syndrome; systematic reviews and meta analyses on timing on initiation of renal replacement therapy for severe AKI & neurologic outcome in patients undergoing eCPR; and an observational study on global critical care capacity during the COVID-19 pandemic. There are also guidelines on perioperative fluid management & coagulopathy in COVID-19; narrative reviews on `Cytokine Storm’ in COVID-19 & missed or delayed diagnosis of ARDS; editorials on cardiovascular management in critically ill patients & neurologic consultation; and commentaries on ICU beds & perioperative red blood cell transfusion; as well as correspondence on histologic pattern of lung injury in COVID-19 infection.
The full text of the issue is available via this link