General Critical Care

Severe ARDS secondary to COVID-19. CRRT clotted immediately and the above clot was removed from the circuit!

The objective of the study was to determine the impact of high doses of corticosteroids (equal or greater than 1 mg/kg of methylprednisolone: HDCT) in critically ill COVID-19 patients with nonresolving acute respiratory distress syndrome (ARDS) previously treated with dexamethasone.

• Prospective observational cohort study of patients with nonresolving ARDS related to COVID-19. Comparing those who received HDCT with those who did not. Primary outcome: 90-day mortality.

• 11 ICUs in the Great Paris area from September 2020 to February 2021.

• 383 patients included (59 in HDCT group, 324 in no HDCT group).

• At day 90, 51% of HDCT group and 35.8% of no HDCT group patients had died. HDCT was significantly associated with higher 90-day mortality.

A study investigated the use of inhaled prostacyclin as a therapy for Acute Respiratory Distress Syndrome (ARDS including COVID-19 patients) was published in "Respiratory Research". The study was a prospective randomized controlled single-blind multicenter trial conducted across Germany from March 2019 with final follow-up on 12th of August 2021. Patients with moderate to severe ARDS were included and randomized to receive either inhaled prostacyclin or sodium chloride (Placebo). The primary outcome was the oxygenation index on Day 5 of therapy. Secondary outcomes included mortality, secondary organ failure, disease severity and adverse events.

The primary analysis showed that prostacyclin improved oxygenation by 20 mmHg more than Placebo but this result was not statistically significant (p = 0.17). However, secondary analysis showed that oxygenation was significantly improved in patients with ARDS who were COVID-19-positive (34 mmHg, p = 0.04). Mortality did not differ between groups and secondary organ failure and adverse events were similar in both…

Results of the COVID-PACT Trial:

•Hospitalized patients in the ICU who were treated with full-dose anticoagulation for acute COVID-19 had significantly fewer thrombotic events and complications compared to those who received standard-dose anticoagulation prophylaxis, but also experienced more moderate and severe bleeding events. However, mortality was not different.

• The findings from the COVID-PACT trial in an exclusively US-based cohort of 382 on-treatment patients in the ICU with COVID. The study was stopped early due to slow recruitment but still powerful to detect difference in the measured outcome.

https://pubmed.ncbi.nlm.nih.gov/36036760/

Treatment with ivermectin did not result in a lower incidence of medical admission to a hospital due to progression of Covid-19 or of prolonged emergency department observation among outpatients with an early diagnosis of Covid-19.

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2115869?query=featured_home