Critical Care Research and Practice最新文献

{"title":"Discrepancies Between Bayesian Vancomycin Models Can Affect Clinical Decisions in the Critically Ill.","authors":"Asad E Patanwala,&nbsp;Danijela Spremo,&nbsp;Minji Jeon,&nbsp;Yann Thoma,&nbsp;Jan-Willem C Alffenaar,&nbsp;Sophie Stocker","doi":"10.1155/2022/7011376","DOIUrl":"https://doi.org/10.1155/2022/7011376","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the agreement in 24-hour area under the curve (AUC₂₄) value estimates between commonly used vancomycin population pharmacokinetic models in the critically ill.</p><p><strong>Materials and methods: </strong>Adults admitted to intensive care who received intravenous vancomycin and had a serum vancomycin concentration available were included. AUC₂₄ values were determined using Tucuxi (revision cd7bd7a8) for dosing intervals with a vancomycin concentration using three models (Goti 2018, Colin 2019, and Thomson 2009) previously evaluated in the critically ill. AUC₂₄ values were categorized as subtherapeutic (<400 mg·h/L), therapeutic (400-600 mg·h/L), or toxic (>600 mg·h/L), assuming a minimum inhibitory concentration of 1 mg/L. AUC₂₄ value categorization was compared across the three models and reported as percent agreement.</p><p><strong>Results: </strong>Overall, 466 AUC₂₄ values were estimated in 188 patients. Overall, 52%, 42%, and 47% of the AUC₂₄ values were therapeutic for the Goti, Colin, and Thomson models, respectively. The agreement of AUC₂₄ values between all three models was 48% (223/466), Goti-Colin 59% (193/466), Goti-Thomson 68% (318/466), and Colin-Thomson 67% (314/466).</p><p><strong>Conclusion: </strong>In critically ill patients, vancomycin AUC₂₄ values obtained from different pharmacokinetic models are often discordant, potentially contributing to differences in dosing decisions. This highlights the importance of selecting the optimal model.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2022 ","pages":"7011376"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9767744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10423284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of ICU Mortality among Mechanically Ventilated Patients: An Inception Cohort Study from a Tertiary Care Center in Addis Ababa, Ethiopia.","authors":"Finot Debebe,&nbsp;Alberto Goffi,&nbsp;Tewodros Haile,&nbsp;Fetiya Alferid,&nbsp;Haimanot Estifanos,&nbsp;Neill K J Adhikari","doi":"10.1155/2022/7797328","DOIUrl":"https://doi.org/10.1155/2022/7797328","url":null,"abstract":"<p><strong>Background: </strong>Mechanical ventilation is a life-saving intervention for patients with critical illnesses, yet it is associated with higher mortality in resource-constrained settings. This study intended to determine factors associated with the mortality of mechanically ventilated adult intensive care unit (ICU) patients.</p><p><strong>Methods: </strong>A one-year retrospective inception cohort study was conducted using manual chart review in ICU patients (age >13) admitted to Tikur Anbessa Specialized Hospital (Addis Ababa, Ethiopia) from September 2019 to September 2020; mechanically ventilated patients were followed to hospital discharge. Demographic, clinical, and outcome data were collected; logistic regression was used to determine mortality predictors in the ICU.</p><p><strong>Result: </strong>A total of 160 patients were included; 85/160 (53.1%) were females and the mean (SD) age was 38.9 (16.2) years. The commonest indication for ICU admission was a respiratory problem (<i>n</i> = 97/160, 60.7%). ICU and hospital mortality were 60.7% (<i>n</i> = 97/160) and 63.1% (<i>n</i> = 101/160), respectively. Coma (Glasgow Coma Score <8 or 7 with an endotracheal tube (7T)) (adjusted odds ratio [AOR] 6.3, 95% confidence interval 1.19-33.00), cardiovascular diagnosis (AOR 5.05 [1.80-14.15]), and a very low serum albumin level (<2 g/dl) (AOR 4.9 [1.73-13.93]) were independent predictors of mortality (<i>P</i> < 0.05). The most commonly observed complication was ICU acquired infection (<i>n</i> = 48, 30%).</p><p><strong>Conclusions: </strong>ICU mortality in ventilated patients is high. Coma, a very low serum albumin level (<2 g/dl), and cardiovascular diagnosis were independent predictors of mortality. A multifaceted approach focused on developing and implementing context appropriate guidelines and improving skilled healthcare worker availability may prove effective in reducing mortality.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2022 ","pages":"7797328"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9754825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10461347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine Infusion for Sedation and Analgesia during Mechanical Ventilation in the ICU: A Multicenter Evaluation.","authors":"Kathryn M Pendleton,&nbsp;Laurel E Stephenson,&nbsp;Nick Goeden,&nbsp;Anna R Benson,&nbsp;Qi Wang,&nbsp;Salman B Mahmood,&nbsp;Kelly A Considine,&nbsp;Matthew E Prekker","doi":"10.1155/2022/9853344","DOIUrl":"https://doi.org/10.1155/2022/9853344","url":null,"abstract":"<p><strong>Methods: </strong>We reviewed the electronic medical record of critically ill adults who received a continuous infusion of ketamine for ≥24 hours during invasive mechanical ventilation in three hospitals over a two-year period. We captured data including ketamine indication, dose, unintended effects, and adjustments to coadministered sedatives or opioids. We analyzed these data to determine the incidence of reported unintended effects of ketamine infusion (primary outcome) and changes in exposure to coadministered sedatives or opioids during ketamine use (secondary outcome).</p><p><strong>Results: </strong>95 mechanically ventilated adults received a ketamine infusion for a median duration of 75 hours (interquartile range [IQR] 44-115) at a mean ± standard deviation (SD) infusion rate of 1.3 ± 0.5 mg/kg/hour for the first 24 hours. At least one unintended effect attributed to ketamine was documented in 24% of cases, most frequently tachycardia (6%) and sialorrhea (6%). Other sedative or opioid infusions were administered with ketamine in 76% and 92% of cases, respectively. Comparing the total amount of sedative or opioid administered in the 24 hours prior to ketamine infusion with the total amount administered during the first 24 hours on ketamine, there were no significant differences in propofol, midazolam, or dexmedetomidine exposure, but the average fentanyl exposure was higher after ketamine (2740 ± 1812 mcg) than before (1975 ± 1860 mcg) (absolute difference 766 mcg, 95% confidence interval [CI] 442 to 1089 mcg).</p><p><strong>Conclusions: </strong>In this multicenter cohort of critically ill, mechanically ventilated adults, ketamine infusion was primarily used as an adjunct to conventional sedative and opioid infusions, with noticeable but unintended effects potentially related to ketamine in nearly one-quarter of cases.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2022 ","pages":"9853344"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9729046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10697377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Residual Blood from the Arterial Blood Gas Test to Perform Therapeutic Drug Monitoring of Vancomycin: An Example of Good Clinical Practice Moving towards a Sustainable Intensive Care Unit.","authors":"T J L Smeets,&nbsp;D van de Velde,&nbsp;B C P Koch,&nbsp;H Endeman,&nbsp;N G M Hunfeld","doi":"10.1155/2022/9107591","DOIUrl":"https://doi.org/10.1155/2022/9107591","url":null,"abstract":"<p><strong>Background: </strong>Regarding sustainability in the intensive care unit (ICU), there is increasing interest in reducing material waste and avoiding unnecessary procedures. Therapeutic drug monitoring (TDM) of vancomycin, using a dedicated tube, is standard clinical care during treatment with vancomycin. Furthermore, in the ICU, on a daily basis, arterial blood gas (ABG) tests are frequently performed throughout the day. After analysis, a variable volume of blood is discarded. Lithium heparin (LiHep) syringes for ABG tests differ from normally used dipotassium ethylenediaminetetraacetic acid (K₂EDTA) tubes. The primary objective was to compare both containers and validate the use of LiHep syringes. Secondary objectives were to evaluate the potential impact on saving materials, nursing time, and costs when implementing vancomycin TDM via LiHep syringes.</p><p><strong>Methods: </strong>Vancomycin analysis from sampling in lithium heparin (LiHep) syringes for ABG tests was validated and compared with the concentrations from conventional sampling in K₂EDTA tubes. For method comparison, a Bland-Altman plot and Deming regression analysis were performed. The method was validated for inter- and intra-day precision and accuracy. Vancomycin was analyzed by means of the validated method using a particle-enhanced turbidimetric inhibition immunoassay (PETINIA) autoanalyzer. Furthermore, an analysis was conducted to evaluate the potential impact of implementing vancomycin sampling via ABG tests on savings in materials, nursing time, and costs.</p><p><strong>Results: </strong>From 18 patients, 24 plasma samples in both K₂EDTA tubes and LiHep syringes were obtained and compared. The mean relative difference between the two containers was -2.0% (-3.0 to -0.93%). Both the Deming regression analysis and the Bland-Altman plot met the acceptance criteria. Potentially, over 1000 blood draws and accompanying materials and packaging can be saved when vancomycin samples are obtained by means of scavenged LiHep syringes. The vancomycin analysis for LiHep syringes showed a total interday precision of 1.95% and an accuracy of 99.7%. The total intraday precision was 2.22%, and the accuracy was 99.2%. Accuracy and precision values were within the acceptance criteria of recovery 85 to 115% and ≤15%, respectively.</p><p><strong>Conclusion: </strong>No significant differences were found in vancomycin concentration between the two analyses, and the LiHep analysis was validated for further implementation in clinical care. Residual blood from ABG test samples can be used for TDM of vancomycin, resulting in a potential reduction of materials used and the number of blood draws. These results will contribute to a more sustainable TDM process with benefits for the patient.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2022 ","pages":"9107591"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9810402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10860061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meeting the Unmet Need in the Management of MDR Gram-Positive Infections with Oral Bactericidal Agent Levonadifloxacin.","authors":"Yatin Mehta,&nbsp;K C Mishra,&nbsp;Yashesh Paliwal,&nbsp;Pradeep Rangappa,&nbsp;Sharmili Sinha,&nbsp;Sandeep Bhapkar","doi":"10.1155/2022/2668199","DOIUrl":"https://doi.org/10.1155/2022/2668199","url":null,"abstract":"<p><p>Levonadifloxacin (intravenous) and its oral prodrug alalevonadifloxacin are broad-spectrum antibacterial agents developed for the treatment of difficult-to-treat infections caused by multidrug-resistant Gram-positive bacteria, especially methicillin-resistant <i>Staphylococcus aureus</i>, atypical bacteria, anaerobic bacteria, and biodefence pathogens as well as Gram-negative bacteria. Levonadifloxacin has a well-defined mechanism of action involving a strong affinity for DNA gyrase as well as topoisomerase IV. Alalevonadifloxacin with widely differing solubility and oral bioavailability has pharmacokinetic profile identical to levonadifloxacin. Unlike existing MRSA drugs such as vancomycin and linezolid, which cause unfavorable side effects like nephrotoxicity, bone-marrow toxicity, and muscle toxicity, levonadifloxacin/alalevonadifloxacin has demonstrated superior safety and tolerability features with no serious adverse events. Levonadifloxacin/alalevonadifloxacin could be a useful weapon in the battle against infections caused by resistant microorganisms and could be a preferred antibiotic of choice for empirical therapy in the future.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2022 ","pages":"2668199"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9185222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Neurological Complications after Mechanical Thrombectomy for Acute Ischemic Stroke: A Retrospective Single-Center Study.","authors":"Pierre Goffin,&nbsp;Romain Thouny,&nbsp;Julien Guntz,&nbsp;Denis Brisbois,&nbsp;Philippe Desfontaines,&nbsp;Pierre Demaret","doi":"10.1155/2022/5509081","DOIUrl":"https://doi.org/10.1155/2022/5509081","url":null,"abstract":"<p><strong>Introduction: </strong>The global burden of stroke is high and mechanical thrombectomy is the cornerstone of the treatment. Incidences of acute non-neurological-complications are poorly described. Improve knowledge about these complications may allow to better prevent, detect and/or manage them. The aim is to identify risk markers of death or poor evolution.</p><p><strong>Method: </strong>We conducted a retrospective single-center study to analyzed the incidence of non-neurologicalcomplications after mechanical thrombectomy in acute ischemic stroke. Patients who had experienced a stroke and undergone thrombectomy were identified using a registry in which we prospectively collected data from each patient admitted to our hospital with a diagnosis of stroke. Quantitative and qualitative variables were analyses. The association between studied variables and hospital death was assessed using simple logistic regression models.</p><p><strong>Result: </strong>361 patients were reviewed but 16 were excluded due to a lack of medical information. Between 2012 and 2019, 345 patients were included. The median admission NIHSS score was 15. Seven percent of the patients died in the ICU. The following independent risk markers of death in the ICU were identified by logistic regression: respiratory complication, hypotension, infectious complication, and hyperglycemia.</p><p><strong>Conclusion: </strong>In this large retrospective study of stroke, respiratory complications and pulmonary infections represented the most important non-neurological adverse events encountered in the ICU and associated with a risk of death.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2022 ","pages":"5509081"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9803559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10817943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Adult Sepsis Patients in the Intensive Care Units in a Tertiary Hospital in Jordan: An Observational Study.","authors":"Anas H A Abu-Humaidan,&nbsp;Fatima M Ahmad,&nbsp;Maysaa' A Al-Binni,&nbsp;Amjad Bani Hani,&nbsp;Mahmoud Abu Abeeleh","doi":"10.1155/2021/2741271","DOIUrl":"https://doi.org/10.1155/2021/2741271","url":null,"abstract":"<p><p>Sepsis is a global health issue that is commonly encountered in the intensive care unit (ICU) and is associated with high morbidity and mortality. Available data regarding sepsis in low- and middle-income countries (LMIC) is lacking compared to higher income countries, especially using updated sepsis definitions. The lack of recent data on sepsis in Jordan prompted us to investigate the burden of sepsis among Jordanian ICU patients. We conducted a prospective cohort study at Jordan University Hospital, a tertiary teaching hospital in the capital, Amman. All adult patients admitted to the adult ICUs between June 2020 and January 2021 were included in the study. Patients' clinical and demographic data, comorbidities, ICU length of stay (LOS), medical interventions, microbiological findings, and mortality rate were studied. Descriptive and inferential statistics were used to analyse data from patients with and without sepsis. We observed 194 ICU patients during the study period; 45 patients (23.3%) were diagnosed with sepsis using the Sepsis-3 criteria. Mortality rate and median ICU LOS in patients who had sepsis were significantly higher than those in other ICU patients (mortality rate, 57.8% vs. 6.0%, <i>p</i> value < 0.001, resp., and LOS 7 days vs. 4 days, <i>p</i> value < 0.001, resp.). Additionally, sepsis patients had a higher combined number of comorbidities (2.27 ± 1.51 vs. 1.27 ± 1.09, <i>p</i> value < 0.001). The use of mechanical ventilation, endotracheal intubation, and blood transfusions were all significantly more common among sepsis patients. A causative organism was isolated in 68.4% of sepsis patients with a prevalence of Gram-negative bacteria in 77.1% of cases. While the occurrence of sepsis in the ICU in Jordan is comparable to other regions in the world, the mortality rate of sepsis patients in the ICU remains high. Further studies from LMIC are required to reveal the true burden of sepsis globally.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":" ","pages":"2741271"},"PeriodicalIF":1.7,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8736695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39800925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Spontaneous and Mechanical Ventilation on Frequency-Based Measures of Heart Rate Variability.","authors":"Khlood Bubshait,&nbsp;Yasmine Alabbasi","doi":"10.1155/2021/8709262","DOIUrl":"https://doi.org/10.1155/2021/8709262","url":null,"abstract":"<p><p>Frequency-based measures of heart rate variability have been shown to be a useful physiological marker in both clinical and research settings providing insight into the functioning of the autonomic nervous system. Ongoing interactions between the autonomic nervous system control of the heart and lung occurs during each ventilation cycle because of their anatomical position within the closed thoracic cavity. Mechanical ventilation and subsequent removal change the normal ventilator mechanics producing alterations in the tidal volume, intrathoracic pressure, and oxygen delivery. A noninvasive method called heart rate variability (HRV) can be used to evaluate this interaction during ventilation and can be quantified by applying frequency-based measures of the variability between heartbeats. Although HRV is a reliable method to measure alteration of the autonomic nervous system (ANS) function and cardiopulmonary interaction, there have been limited reports concerning the changes in the frequency-based measure of HRV during both spontaneous and mechanical ventilation. The purpose of this methodological study is therefore to describe the physiological influence of both spontaneous and mechanical ventilation on frequency-based measures of HRV.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":" ","pages":"8709262"},"PeriodicalIF":1.7,"publicationDate":"2021-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8720601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39877509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of mNUTRIC-Score for Nutrition Risk Assessment and Prognosis Prediction in Critically Ill Patients with COVID-19: A Retrospective Observational Study.","authors":"Francisco G Yanowsky-Escatell,&nbsp;Areli L Ontiveros-Galindo,&nbsp;Kevin J Arellano-Arteaga,&nbsp;Luis M Román-Pintos,&nbsp;Carlos A Andrade-Castellanos,&nbsp;Diana M Hernández-Corona,&nbsp;Tonatiuh González-Heredia,&nbsp;Geannyne Villegas-Rivera","doi":"10.1155/2021/5866468","DOIUrl":"https://doi.org/10.1155/2021/5866468","url":null,"abstract":"<p><strong>Introduction: </strong>Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nutritional assessment in the critically ill population are scarce. This study was conducted to evaluate the modified Nutrition Risk in the Critically Ill (mNUTRIC)-Score as a mortality risk factor in mechanically ventilated patients with COVID-19.</p><p><strong>Methods: </strong>We conducted this retrospective observational study in critically ill patients with COVID-19. Patients' characteristics and clinical information were obtained from electronic medical records. The nutritional risk for each patient was assessed at the time of mechanical ventilation using the mNUTRIC-Score. The major outcome was 28-day mortality.</p><p><strong>Results: </strong>Ninety-eight patients were analyzed (mean age, 57.22 ± 13.66 years, 68.4% male); 46.9% of critically ill COVID-19 patients were categorized as being at high nutrition risk (mNUTRIC-Score of ≥5). A multivariate logistic regression model indicated that high nutritional risk has higher 28-day hospital mortality (OR = 4.206, 95% CI: 1.147-15.425, <i>p</i>=0.030). A multivariate Cox regression analysis showed that high-risk mNUTRIC-Score had a significantly increased full-length mortality risk during hospitalization (OR = 1.991, 95% CI: 1.219-3.252, <i>p</i>=0.006).</p><p><strong>Conclusion: </strong>The mNUTRIC-Score is an independent mortality risk factor during hospitalization in critically ill COVID-19 patients.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":" ","pages":"5866468"},"PeriodicalIF":1.7,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8694949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39641337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population.","authors":"Sarah Alexandra van Blydenstein,&nbsp;Colin Nigel Menezes,&nbsp;Nicole Miller,&nbsp;Naomi Johnson,&nbsp;Bavinash Pillay,&nbsp;Barry F Jacobson,&nbsp;Shahed Omar","doi":"10.1155/2021/3935098","DOIUrl":"https://doi.org/10.1155/2021/3935098","url":null,"abstract":"<p><strong>Introduction: </strong>The coagulation abnormalities resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been attributed to inflammation and subsequent cytokine storm. Thromboelastography (TEG) is a point-of-care test used to assess clot formation and degradation in whole blood and is an indicator of the overall real-time coagulopathic state of the patient.</p><p><strong>Methods: </strong>A single-centre, prospective, observational cohort study was conducted in South Africa, analysing the coagulation patterns of 41 patients with hypoxia related to SARS-CoV-2 using serial thromboelastography (TEG) on admission, after 48 hours, and at resolution of hypoxia/day 10. Results: Two-thirds (<i>n</i> = 26) were women. The median age was 61 (IQR 50-67), and the majority (88%) were Black patients. Almost half (22) of the patients were critically ill and ventilated, with median SOFA and SAPS2 scores of 3 and 22 (IQR2-4 and 18-30), respectively. The prevalence of hypercoagulability was 0.54 (95% CI 0.46-0.62), whilst 29/41 (0.71, CI 0.64-0.78)) met the definition of hypofibrinolysis. Differences between the hypercoagulable (HC) and non-hypercoagulable groups remained apparent at 48 hours after anticoagulation. At this time point, the K time was significantly lower (<i>p</i> ˂ 0,01), and the <i>α</i>-angle (<i>p</i> ˂ 0,01) and maximum amplitude (MA) (<i>p</i> ˂ 0,01) were significantly higher in the HC cohort. At resolution of hypoxia, or day 10, only MA was significantly higher in the hypercoagulable group compared to the non-hypercoagulable group (<i>p</i> = 0.01). The initial impairment in fibrinolysis (Ly30), <i>α</i> angle, and MA were significantly associated with mortality, with <i>p</i> values of 0.006, 0.031, and 0.04, respectively.</p><p><strong>Conclusions: </strong>In this South African population, hypercoagulability was a highly prevalent phenomenon in COVID-19 disease. It was typified by hypofibrinolysis and a persistently elevated MA, despite anticoagulation therapy.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":" ","pages":"3935098"},"PeriodicalIF":1.7,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8694947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39625832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}