Critical Care Commons^™

Distinct Temporal Trajectories And Risk Factors For Post-Acute Sequelae Of Sars-Cov-2 Infection, Chen Chen, Sairam Parthasarathy, Jacqueline M Leung, Michelle J Wu, Katherine A Drake, Vanessa K Ridaura, Howard C Zisser, William A Conrad, Victor F Tapson, James N Moy, Christopher R Defilippi, Ivan O Rosas, Bellur S Prabhakar, Mujeeb Basit, Mirella Salvatore, Jerry A Krishnan, Charles C Kim

Faculty, Staff and Students Publications

BACKGROUND: The understanding of Post-acute sequelae of SARS-CoV-2 infection (PASC) can be improved by longitudinal assessment of symptoms encompassing the acute illness period. To gain insight into the various disease trajectories of PASC, we assessed symptom evolution and clinical factors associated with the development of PASC over 3 months, starting with the acute illness period.

METHODS: We conducted a prospective cohort study to identify parameters associated with PASC. We performed cluster and case control analyses of clinical data, including symptomatology collected over 3 months following infection.

RESULTS: We identified three phenotypic clusters associated with PASC that could be characterized as …

Acute Thrombotic Thrombocytopenic Purpura: Rare And Life-Threatening Side Effect Of Recent Bnt-162b2 Covid-19 Vaccination, Jay Patel, Muhammad Umair Jahngir, Ahmad Abdulzahir, Ismael Rodriguez

HCA Healthcare Journal of Medicine

Thrombotic thrombocytopenic purpura (TTP) is a rare, potentially life-threatening disorder characterized by uncontrolled and spontaneous clot formation throughout the body. Known secondary causes of TTP include malignancy, bone marrow transplantation, pregnancy, various medications, and HIV infection. TTP in the setting of COVID-19 vaccination is rare and not well reported. Reported cases have been confined primarily to the AstraZeneca and Johnson and Johnson COVID-19 Vaccines. TTP in the setting of Pfizer BNT-162b2 vaccination has only recently been reported. We present a patient with no obvious risk factors for TTP who presented with acute altered mental status and was found to have …

Understanding Post-Covid-19 Interstitial Lung Disease (Ild): A New Fibroinflammatory Disease Entity, Puja Mehta, Ivan O Rosas, Mervyn Singer

Faculty, Staff and Students Publications

Immunomodulation and immunity from vaccination and natural infection have reduced mortality from coronavirus disease 2019 (COVID-19). However, there are ongoing concerns regarding emerging variants and residual pulmonary sequelae in survivors, given that the lungs are the principal site for the triumvirate of infection, inflammation and injury. The initial waves of acute, severe COVID-19 were profoundly inflammatory, usually manifest as organising pneumonia ± acute respiratory distress syndrome (ARDS). The extent of the fibrogenic potential of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the modifiability of the pathogenic processes and disease course are unclear. Interestingly patients can develop ‘post-COVID interstitial lung disease’ …

Prediction Value Of Krebs Von Den Lungen-6 (Kl-6) Biomarker In Covid-19 Patients: A Systematic Review And Meta-Analysis, Michal Matuszewski, Lukasz Szarpak, Zubaid Rafique, Frank W Peacock, Michal Pruc, Piotr Szwed, Francesco Chirico, Alla Navolokina, Jerzy R Ladny, Andrea Denegri

Faculty, Staff and Students Publications

The SARS-CoV-2 (COVID-19) pandemic is a major issue that necessitates the use of cutting-edge disease prediction models. The aim of the study was to assess the existing evidence regarding association between Krebs von den Lungen-6 levels and COVID-19 severity. A literature search was performed on Web of Science, PubMed, Scopus and Cochrane Central Register of Controlled Trials databases from 1 January 2020 up to 2 August 2022. The electronic database search was supplemented by searching Google Scholar. In addition, reference lists of relative articles were also reviewed. KL-6 levels among COVID-19 positive vs. negative patients varied and amounted to 443.37 …

Covid-19 Pandemic And Infant Neurodevelopmental Impairment: A Systematic Review And Meta-Analysis, Kamran Hessami, Amir Hossein Norooznezhad, Sonia Monteiro, Enrico R Barrozo, Abolfazl Shirdel Abdolmaleki, Sara E Arian, Nikan Zargarzadeh, Lara S Shekerdemian, Kjersti M Aagaard, Alireza A Shamshirsaz

Faculty, Staff and Students Publications

IMPORTANCE: Primary studies proposed that aberrant maternal antiviral immunity and/or giving birth in quarantine, such as during the ongoing COVID-19 pandemic, may be associated with the risk of neurodevelopmental impairment (NDI) in offspring.

OBJECTIVES: To evaluate the associations of birth and being raised during the COVID-19 pandemic with risk of NDI among infants and to assess the association of gestational exposure to SARS-CoV-2 with risk of NDI.

DATA SOURCES: PubMed, Web of Science, Scopus, Embase, and preprint servers were systematically searched from inception to March 25, 2022.

STUDY SELECTION: Studies evaluating the neurodevelopment of infants born during the SARS-CoV-2 pandemic …

Sars-Cov-2 Infection: Host Response, Immunity, And Therapeutic Targets, Pooja Shivshankar, Harry Karmouty-Quintana, Tingting Mills, Marie-Francoise Doursout, Yanyu Wang, Agnieszka K Czopik, Scott E Evans, Holger K Eltzschig, Xiaoyi Yuan

Faculty, Staff and Student Publications

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in a global pandemic with severe socioeconomic effects. Immunopathogenesis of COVID-19 leads to acute respiratory distress syndrome (ARDS) and organ failure. Binding of SARS-CoV-2 spike protein to human angiotensin-converting enzyme 2 (hACE2) on bronchiolar and alveolar epithelial cells triggers host inflammatory pathways that lead to pathophysiological changes. Proinflammatory cytokines and type I interferon (IFN) signaling in alveolar epithelial cells counter barrier disruption, modulate host innate immune response to induce chemotaxis, and initiate the resolution of inflammation. Here, we discuss experimental models to study SARS-CoV-2 …

Antibody Evasion By Sars-Cov-2 Omicron Subvariants Ba2121, Ba4 And Ba5, Qian Wang, Yicheng Guo, Sho Iketani, Manoj S Nair, Zhiteng Li, Hiroshi Mohri, Maple Wang, Jian Yu, Anthony D Bowen, Jennifer Y Chang, Jayesh G Shah, Nadia Nguyen, Zhiwei Chen, Kathrine Meyers, Michael T Yin, Magdalena E Sobieszczyk, Zizhang Sheng, Yaoxing Huang, Lihong Liu, David D Ho

Faculty, Staff and Student Publications

SARS-CoV-2 Omicron subvariants BA.2.12.1 and BA.4/5 have surged notably to become dominant in the United States and South Africa, respectively1,2. These new subvariants carrying further mutations in their spike proteins raise concerns that they may further evade neutralizing antibodies, thereby further compromising the efficacy of COVID-19 vaccines and therapeutic monoclonals. We now report findings from a systematic antigenic analysis of these surging Omicron subvariants. BA.2.12.1 is only modestly (1.8-fold) more resistant to sera from vaccinated and boosted individuals than BA.2. However, BA.4/5 is substantially (4.2-fold) more resistant and thus more likely to lead to vaccine breakthrough infections. Mutation at spike …

Biochemical, Biophysical, And Immunological Characterization Of Respiratory Secretions In Severe Sars-Cov-2 Infections, Michael J Kratochvil, Gernot Kaber, Sally Demirdjian, Pamela C Cai, Elizabeth B Burgener, Nadine Nagy, Graham L Barlow, Medeea Popescu, Mark R Nicolls, Michael G Ozawa, Donald P Regula, Ana E Pacheco-Navarro, Samuel Yang, Vinicio A De Jesus Perez, Harry Karmouty-Quintana, Andrew M Peters, Bihong Zhao, Maximilian L Buja, Pamela Y Johnson, Robert B Vernon, Thomas N Wight, Carlos E Milla, Angela J Rogers, Andrew J Spakowitz, Sarah C Heilshorn, Paul L Bollyky

Faculty, Staff and Student Publications

Thick, viscous respiratory secretions are a major pathogenic feature of COVID-19, but the composition and physical properties of these secretions are poorly understood. We characterized the composition and rheological properties (i.e., resistance to flow) of respiratory secretions collected from intubated COVID-19 patients. We found the percentages of solids and protein content were greatly elevated in COVID-19 compared with heathy control samples and closely resembled levels seen in cystic fibrosis, a genetic disease known for thick, tenacious respiratory secretions. DNA and hyaluronan (HA) were major components of respiratory secretions in COVID-19 and were likewise abundant in cadaveric lung tissues from these …

The Effect Of Ivermectin On Non-Severe And Severe Covid-19 Disease And Gender-Based Difference Of Its Effectiveness, Syed Muhammad Zubair, Muhammad Waleed Chaudhry, Ali Bin Sarwar Zubairi, Talha Shahzad, Aqusa Zahid, Ibrahim Ali Khan, Javaid Ahmed Khan, Muhammad Irfan

Section of Pulmonary & Critical Care

The COVID-19 pandemic has led to mortality and morbidity since December 2019. Many possible treatment options have been advised till date. The role of ivermectin in the treatment of COVID-19 disease remains controversial. The aim of our study was to evaluate the effect of ivermectin in hospitalized patients with non-severe and severe COVID-19 disease. We conducted a retrospective cohort study that compared outcomes in 2 groups of COVID-19 patients hospitalized at the largest tertiary care center of Pakistan. The study group was given ivermectin along with standard treatment of covid-19 disease; the comparison group was not. Data on mortality, inflammatory …

Ptsd In Covid-19 Frontline Workers, Samantha Gagliano

Graduate Research Projects

No abstract provided.

Persistence Of Post-Covid Lung Parenchymal Abnormalities During The Three-Month Follow-Up, Ali Bin Sarwar Zubairi, Anjiya Shaikh, Syed Muhammad Zubair, Akbar Shoukat Ali, Safia Awan, Muhammad Irfan

Section of Pulmonary & Critical Care

Introduction: COVID-19-associated pulmonary sequalae have been increasingly reported after recovery from acute infection. Therefore, we aim to explore the charactersitics of persistent lung parenchymal abnormalities in patients with COVID-19.
Material and methods: An observational study was conducted in patients with post-COVID lung parenchymal abnormalities from April till September 2020. Patients ≥18 years of age with COVID-19 who were diagnosed as post-COVID lung parenchymal abnormality based on respiratory symptoms and HRCT chest imaging after the recovery of acute infection. Data was recorded on a structured pro forma, and descriptive analysis was performed using Stata version 12.1.
Results: A total of 30 …

Allocation Plans For Crisis Triage: How Well Would They Actually Work?, David Oxman

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

COVID-19 has forced US state governments to create plans for rationing critical care resources that ensure the greatest population benefit. But a study by Jezmir and colleagues in this issue of Cell Reports Medicine raises doubts about whether these plans can distinguish those who would most benefit.

The Cardiovascular Manifestations Of Covid-19: A Review Of The Literature And Institutional Experience, Gina Polsinelli, Steven J. Korzeniewski, Oksana M. Doubrovski, James Paxton

Medical Student Research Symposium

The cardiovascular health of those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) plays a major role in rates of hospitalization, mortality risk, and rates of mechanical ventilation. In patients with COVID-19, acute myocardial injury and history of cardiovascular disease are both independently established risk factors for poor patient prognosis. In addition to myocardial injury, numerous acute cardiovascular manifestations of COVID-19 disease have been identified. Previous work on this topic typically focused either upon a general description of the acute cardiovascular manifestations and sequalae of COVID-19, or upon broad-based clinical outcomes associated with COVID-19 in patients with history of …

Covid Intensive Care Unit Through The Eyes Of Ophthalmologists, Laura Drayer Turner, Dharshana Ramanathan, Sneha Melmane, Geeta Menon

HCA Healthcare Journal of Medicine

The disproportionate impact of COVID on the mortality and morbidity of people of black, Asian and minority ethnic (BAME) backgrounds has been recognised and is under investigation. Here we present a different impact: that on the psyche. As three doctors of BAME heritage, we shared an experience of being redeployed from ophthalmology to the COVID Intensive Care Unit. We share our reflections on the experience and lessons learned.

Extracorporeal Membrane Oxygenation For Covid-19 Treatment In A Community Hospital, Daniel I. Loube, Kashif Z. Hassan, Sang H. Lee

HCA Healthcare Journal of Medicine

Coronavirus disease 2019 (COVID-19) may result in severe acute respiratory disease syndrome (ARDS) and death. For COVID-19 patients failing mechanical ventilation, extra corporeal membrane oxygenation (ECMO) has been used with varying efficacy in academic medical centers and quaternary referral centers. We report the successful use of veno-venous (VV) ECMO to treat refractory ARDS due to COVID-19 in a community hospital setting with a survival to discharge rate of 71% over a 3 month period. In a community hospital with adequate resources, VV ECMO can be an effective rescue therapy for selected COVID-19 patients who fail all other available treatments.

Meeting The Critical Need For Ventilators In Treatment Of Covid-19 Patients, Alessandro Naopli, Nicholas Satterthwaite, Lawrence Husick, Dietrich Gravenstein, Jerin Juby, Monica Purcell, Bridget Gekas, Zvi Grunwald, Mae West, Bon Ku, Chip Malloy, Michael Mahla, Mijail Serruya

Health Equity and Quality Improvement (HEQI) Summit

We have designed and built a microprocessor-controlled valve manifold having a single air input supplied from a standard ventilator, three air outlets (one per patient), and a digital control panel for setting the pressure supplied to each patient as well as the desired respiration rate. The manifold features multiple pressure sensors for system monitoring. Each inspiration limb of the manifold will be fitted with a viral filter. Each expiration limb will have a passive HME in line with a viral filter to prevent patient cross-contamination and spread of virions.

Each patient will receive one epoch of inspiration pressure followed by …