Critical Care Commons^™

Inaccurate Conclusions By Tang And Colleagues, Y. Y. Greenstein

Journal Articles

No abstract provided.

Erratum: What Is The Source? Identifying The Cause Of Septic Shock In A Patient (Annals Of The American Thoracic Society (2020) 17 (236-239) Doi: 10.1513/Annalsats.201907-562cc), N. Sidhu, N. U. Baloch, Y. Greenstein

Journal Articles

Copyright © 2020 by the American Thoracic Society. The authors would like to correct the author order in their article published in the February 2020 issue of AnnalsATS (1). The correct author order should be as follows: Nimrita Sidhu, Noor Ul-Ain Baloch, and Yonatan Greenstein. For the convenience of our readers, AnnalsATS is replacing the online version of the article with a corrected version; we apologize for the error.

When Predictions Are Used To Allocate Scarce Health Care Resources: Three Considerations For Models In The Era Of Covid-19., Dm Kent, Jk Paulus, Rr Sharp, N Hajizadeh

Journal Articles

No abstract provided.

Recommendations For Core Critical Care Ultrasound Competencies As A Part Of Specialist Training In Multidisciplinary Intensive Care: A Framework Proposed By The European Society Of Intensive Care Medicine (Esicm), A. Wong, L. Galarza, L. Forni, D. De Backer, M. Slama, B. Cholley, P. Mayo, A. Mclean, F. Duška, +17 Additional Authors

Journal Articles

© 2020 The Author(s). Critical care ultrasound (CCUS) is an essential component of intensive care practice. Although existing international guidelines have focused on training principles and determining competency in CCUS, few countries have managed to operationalize this guidance into an accessible, well-structured programme for clinicians training in multidisciplinary intensive care. We seek to update and reaffirm appropriate CCUS scope so that it may be integrated into the international Competency-based Training in Intensive Care Medicine. The resulting recommendations offer the most contemporary and evolved set of core CCUS competencies for an intensive care clinician yet described. Importantly, we discuss the rationale …

Repurposing Orthopaedic Residents Amid Covid-19: Critical Care Prone Positioning Team., O. F. Rahman, D. P. Murray, R. M. Zbeda, A. D. Volpi, A. Z. Mo, N. A. Wessling, B. A. Mina, M. S. Mendez-Zfass, C. Carpati

Journal Articles

No abstract provided.

Powerless In The Icu: Perspectives From Icus In The Face Of Covid-19., P Ramachandran, L Swamy, V Kaul, A Agrawal, M Narasimhan

Journal Articles

No abstract provided.

Lung Ultrasonography As An Alternative To Chest Computed Tomography In Covid-19 Pneumonia?, A. Vieillard-Baron, A. Goffi, P. Mayo

Journal Articles

No abstract provided.

Major Thrombotic Event Despite Anticoagulation In A Patient With Covid-19., B. Ataallah, A. Sharma, S. Tamanna, J. Ng, G. Haggerty

Journal Articles

The outbreak of coronavirus disease 2019 (known as COVID-19), which started in Wuhan, China in December 2019, is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has been associated with both venous and arterial thromboembolism likely secondary to significant cytokine activation and inflammation. Reports on the incidence of thrombotic complications, however, are not well documented. Our case will examine a young man diagnosed with COVID-19 who developed an acute, severe bilateral saddle pulmonary embolism while on prophylactic dose anticoagulation after being admitted to the hospital and treated for two weeks with significant improvement.

Pulmonary Embolism In Patients Hospitalized With Covid-19 (From A New York Health System), H. Xu, A. Martin, A. Singh, M. Narasimhan, J. Lau, M. Weinberg, R. Jauhar, G. Rao

Journal Articles

© 2020 Elsevier Inc. Pulmonary embolisms (PEs) in coronavirus disease 2019 (COVID-19) have increasingly been reported in observational studies. However, limited information describing their clinical characteristics and outcomes exists. Our study aims to describe clinical features and risk stratification strategies of hospitalized COVID-19 patients with PE. We retrospectively analyzed 101 hospitalized patients with COVID-19 infection and acute PE. Clinical outcomes measured were intensive care unit admission, mechanical ventilation, bleeding and transfusion events, acute kidney injury (AKI) and mortality. Pulmonary severity index (PESI) scores were used for risk stratification. The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) …

Management Of Gastroduodenal Artery Pseudoaneurysm Rupture With Duodenal Ulcer Complicated By Coil Migration., D. Chang, P. Patel, S. Persky, J. Ng, A. Kaell

Journal Articles

Rupture of visceral artery aneurysms or visceral artery pseudoaneurysms is an unusual cause of upper gastrointestinal bleeding. Although most visceral artery aneurysms and visceral artery pseudoaneurysms occur in the splenic artery or hepatic artery, they can rarely occur in the gastroduodenal artery. These are at high risk for rupture, with a 40%-70% mortality. We report a case of recurrent upper gastrointestinal bleeding due to gastroduodenal artery pseudoaneurysm despite endoscopic treatment and endovascular embolization complicated by coil migration into the duodenum.

Covid-19 Presenting As Stroke, A. Avula, K. Nalleballe, N. Narula, S. Sapozhnikov, V. Dandu, S. Toom, A. Glaser, D. Elsayegh

Journal Articles

© 2020 Elsevier Inc. Objective: Acute stroke remains a medical emergency even during the COVID-19 pandemic. Most patients with COVID-19 infection present with constitutional and respiratory symptoms; while others present with atypical gastrointestinal, cardiovascular, or neurological manifestations. Here we present a series of four patients with COVID-19 that presented with acute stroke. Methods: We searched the hospital databases for patients that presented with acute stroke and concomitant features of suspected COVID-19 infection. All patients who had radiographic evidence of stroke and PCR-confirmed COVID-19 infection were included in the study. Patients admitted to the hospital with PCR- confirmed COVID-19 disease whose …

The Role Of Chest Imaging In Patient Management During The Covid-19 Pandemic: A Multinational Consensus Statement From The Fleischner Society., G. D. Rubin, C. J. Ryerson, L. B. Haramati, N. Sverzellati, J. P. Kanne, S. Raoof, N. W. Schluger, A. Volpi, J. Yim, A. N. Leung, +10 Additional Authors

Journal Articles

With more than 900,000 confirmed cases worldwide and nearly 50,000 deaths during the first three months of 2020, the COVID-19 pandemic has emerged as an unprecedented healthcare crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, healthcare delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and healthcare workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. …

General And Intensive Care Outcomes For Hospitalized Patients With Solid Organ Transplants With Covid-19, F. Mastroianni, D. E. Leisman, G. Fisler, M. Narasimhan

Journal Articles

© The Author(s) 2020. Purpose: COVID-19 has been associated with a dysregulated inflammatory response. Patients who have received solid-organ transplants are more susceptible to infections in general due to the use of immunosuppressants. We investigated factors associated with mechanical ventilation and outcomes in solid-organ transplant recipients with COVID-19. Materials and Methods: We conducted a retrospective cohort study of all solid-organ transplant recipients admitted with a diagnosis of COVID-19 in our 23-hospital health system over a 1-month period. Descriptive statistics were used to describe hospital course and laboratory results and bivariate comparisons were performed on variables to determine differences. Results: Twenty-two …

Cytokine Storm Of A Different Flavor: The Different Cytokine Signature Of Sars-Cov2 The Cause Of Covid-19 From The Original Sars Outbreak., D. O. Griffin, A. Jensen, M. Khan, J. Chin, K. Chin, J. Saad, R. Parnell, C. Awwad, D. Patel

Journal Articles

We present a case series of three patients with COVID-19 who had a cytokine panel which revealed elevation of interleukin-6 (IL-6), but normal levels of interleukin-10 (IL-10), interferon-gamma (INF-γ) and interleukin-8 (IL-8) in contrast to the cytokine signature described in Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS). We also documented evidence of a compromised T-cell IFN-gamma response in two of these patients.

In Response To Na Et Al.’S Long-Term Mortality Of Patients Discharged From The Hospital After Successful Critical Care: Do We Need More Comprehensive Data?, A. M. Esquinas, H. M. Karim, B. Mina

Journal Articles

No abstract provided.

Increased Prevalence Of Vte Reported By Klok And Colleagues, The Numbers Don't Add Up, Y. Y. Greenstein

Journal Articles

No abstract provided.

Study Of Alteplase For Respiratory Failure In Sars-Cov2/Covid-19: Study Design Of The Phase Iia Stars Trial., H. B. Moore, C. D. Barrett, E. E. Moore, R. Jhunjhnuwala, R. C. Mcintyre, P. K. Moore, J. Wang, N. Hajizadeh, A. Sauaia, M. B. Yaffe, +1 Additional Author

Journal Articles

Background:The COVID-19 pandemic has caused a large surge of acute respiratory distress syndrome (ARDS). Prior phase I trials (non COVID-19) demonstrated improvement in pulmonary function in ARDS patients using fibrinolytic therapy. A follow-up trial using the widely available tissue-plasminogen activator (alteplase) is now needed to assess optimal dosing and safety in this critically ill patient population. Objective:To describe the design and rationale of a Phase IIa trial to evaluate the safety and efficacy of alteplase treatment for moderate/severe COVID-19-induced ARDS. Patients/Methods:A rapidly adaptive, pragmatic, open label, randomized, controlled, phase IIa clinical trial will be conducted with three groups: intravenous(IV) alteplase …

Seizure And Covid-19: Association And Review Of Potential Mechanism., R. Joseph, N. Narula, A. Daouk, N. Katyal, S. Acharya, A. Avula, R. Maroun

Journal Articles

Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, this highly transmissible virus has since spread rapidly around the world. Though respiratory complication is the primarily reported manifestation though rare, yet serious neurological complications are being frequently reported in the literature. In selected coronavirus disease-2019 (COVID-19) cases neurologic complications may manifest as seizures. In this paper, we have reviewed current literature on seizures linked with SARS- COV 2 infection including published or pre-print original articles, review articles, and case reports. We have discussed the electroencephalogram (EEG), imaging, and Cerebrospinal fluid (CSF) findings in COVID-19 patients …

Locked-In With Covid-19, A. Avula, A. Gill, R. Nassar, K. Nalleballe, S. Siddamreddy, M. Chalhoub

Journal Articles

© 2020 Elsevier Ltd Coronavirus Disease 2019 (COVID-19) can be associated with various neurological manifestations including acute strokes. Hyper acute diagnosis and treatment are key factors which decrease mortality and morbidity in stroke patients. The COVID-19 pandemic has introduced a great strain on the healthcare system, and as a result clinicians are facing several barriers in diagnosing and treating strokes. Delayed presentation of strokes is a problem as some in the general population defer the decision to seek immediate medical attention fearing contracting the virus. Also playing a role is the paucity of healthcare professionals available during a pandemic. Recent …

Critical Care Transesophageal Echocardiography In Patients During The Covid-19 Pandemic, F Teran, Km Burns, M Narasimhan, A Goffi, P Mohabir, Jm Horowitz, E Yuriditsky, A Nagdev, S Koenig, R Arntfield, +3 Additional Authors

Journal Articles

No abstract provided.

How I Do It: High Flow, Non-Invasive Ventilation And Awake (Non-Intubation) Proning In Covid-19 Patients With Respiratory Failure., S Raoof, S Nava, C Carpati, Ns Hill

Journal Articles

No abstract provided.

Lessons Learned In Critical Care At A 23 Hospital Health System In New York During The Coronavirus Disease 2019 Pandemic., G Zaidi, M Narasimhan

Journal Articles

No abstract provided.

Powerless In The Icu: Perspectives From Intensive Care Units In The Face Of Covid-19., P Ramachandran, L Swamy, V Kaul, A Agrawal, M Narasimhan

Journal Articles

No abstract provided.

Preparing For The Covid-19 Pandemic: Our Experience In New York, Z Hasan, M Narasimhan

Journal Articles

No abstract provided.

Tissue Plasminogen Activator (Tpa) Treatment For Covid-19 Associated Acute Respiratory Distress Syndrome (Ards): A Case Series, J Wang, N Hajizadeh, Ee Moore, Rc Mcintyre, Pk Moore, La Veress, Mb Yaffe, Hb Moore, Cd Barrett

Journal Articles

No abstract provided.

Association Of Anticoagulation Dose And Survival In Hospitalized Covid-19 Patients: A Retrospective Propensity Score-Weighted Analysis, F. Ionescu, I. Jaiyesimi, I. Petrescu, P. R. Lawler, E. Castillo, Y. Munoz-Maldonado, Z. Imam, M. Narasimhan, A. E. Abbas, G. B. Nair, +1 Additional Author

Journal Articles

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Background: Hypercoagulability may contribute to COVID-19 pathogenicity. The role of anticoagulation (AC) at therapeutic (tAC) or prophylactic doses (pAC) is unclear. Objectives: We evaluated the impact on survival of different AC doses in COVID-19 patients. Methods: Retrospective, multi-center cohort study of consecutive COVID-19 patients hospitalized between March 13 and May 5, 2020. Results: A total of 3480 patients were included (mean age, 64.5 years [17.0]; 51.5% female; 52.1% black and 40.6% white). 18.5% (n = 642) required intensive care unit (ICU) stay. 60.9% received pAC (n …

Current Smoking With Or Without Chronic Bronchitis Is Independently Associated With Goblet Cell Hyperplasia In Healthy Smokers And Copd Subjects, Victor Kim, Stephanie Jeong, Huaqing Zhao, Mehmet Kesimer, Richard C. Boucher, J. Michael Wells, Stephanie A. Christenson, Meilan K. Han, Mark Dransfield, Robert Paine, Christopher B. Cooper, Igor Barjaktarevic, Russell Bowler, Jeffrey L. Curtis, Robert J. Kaner, Sarah L. O'Beirne, Wanda K. O'Neal, Stephen I. Rennard, Fernando J. Martinez, Prescott G. Woodruff

Journal Articles: Pulmonary & Critical Care Med

COPD, chronic bronchitis (CB) and active smoking have all been associated with goblet cell hyperplasia (GCH) in small studies. Active smoking is strongly associated with CB, but there is a disconnect between CB clinical symptoms and pathology. Chronic cough and sputum production poorly correlate with the presence of GCH or COPD. We hypothesized that the primary determinant of GCH in ever smokers with or without airflow obstruction is active smoking. Goblet Cell Density (GCD) was measured in 71 current or former smokers [32 subjects without COPD and 39 COPD subjects]. Endobronchial mucosal biopsies were stained with Periodic Acid Schiff-Alcian Blue, …

Co-Morbidity Patterns Identified Using Latent Class Analysis Of Medications Predict All-Cause Mortality Independent Of Other Known Risk Factors: The Copdgene® Study, Yisha Li, Margaret Ragland, Erin Austin, Kendra Young, Katherine Pratte, John E. Hokanson, Terri H Beaty, Elizabeth A. Regan, Stephen I. Rennard, Christina Wern, Michael R. Jacobs, Ruth Tal-Singer, Barry J. Make, Gregory L. Kinney, Copdgene Investigators

Journal Articles: Pulmonary & Critical Care Med

PURPOSE: Medication patterns include all medications in an individual's clinical profile. We aimed to identify chronic co-morbidity treatment patterns through medication use among COPDGene participants and determine whether these patterns were associated with mortality, acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and quality of life.

MATERIALS AND METHODS: Participants analyzed here completed Phase 1 (P1) and/or Phase 2 (P2) of COPDGene. Latent class analysis (LCA) was used to identify medication patterns and assign individuals into unobserved LCA classes. Mortality, AECOPD, and the St. George's Respiratory Questionnaire (SGRQ) health status were compared in different LCA classes through survival analysis, logistic …

Blood Eosinophil Counts In Clinical Trials For Chronic Obstructive Pulmonary Disease, Dave Singh, Mona Bafadhel, Christopher E. Brightling, Frank C. Sciurba, Jeffrey L. Curtis, Fernando J. Martinez, Cara B. Pasquale, Debora D. Merrill, Norbert Metzdorf, Stefano Petruzzelli, Ruth Tal-Singer, Christopher Compton, Stephen I. Rennard, Ubaldo J. Martin

Journal Articles: Pulmonary & Critical Care Med

No abstract provided.

Heme Metabolism Genes Downregulated In Copd Cachexia, Ava C. Wilson, Preeti L. Kumar, Sool Lee, Margaret M. Parker, Itika Arora, Jarrett D. Morrow, Emiel F.M. Wouters, Richard Casaburi, Stephen I. Rennard, David A. Lomas, Alvar Agusti, Ruth Tal-Singer, Mark T. Dransfield, J. Michael Wells, Surya P. Bhatt, George Washko, Victor J. Thannickal, Hemant K. Tiwari, Craig P. Hersh, Peter J. Castaldi, Edwin K. Silverman, Merry-Lynn N. Mcdonald

Journal Articles: Pulmonary & Critical Care Med

INTRODUCTION: Cachexia contributes to increased mortality and reduced quality of life in Chronic Obstructive Pulmonary Disease (COPD) and may be associated with underlying gene expression changes. Our goal was to identify differential gene expression signatures associated with COPD cachexia in current and former smokers.

METHODS: We analyzed whole-blood gene expression data from participants with COPD in a discovery cohort (COPDGene, N = 400) and assessed replication (ECLIPSE, N = 114). To approximate the consensus definition using available criteria, cachexia was defined as weight-loss > 5% in the past 12 months or low body mass index (BMI) (<  20 kg/m

RESULTS: The prevalence of …