Journal of Intensive Care Medicine

Journal Information
ISSN / EISSN : 0885-0666 / 1525-1489
Current Publisher: SAGE Publications (10.1177)
Former Publisher: Wiley (10.1046)
Total articles ≅ 2,114
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Rahul Chaturvedi, Brittany N. Burton, Suraj Trivedi, Ulrich H. Schmidt, Rodney A. Gabriel
Journal of Intensive Care Medicine; doi:10.1177/0885066620967925

The publisher has not yet granted permission to display this abstract.
Megan F. Hunt, Katharine T. Clark, Glenn Whitman, Chun Woo Choi, Romergryko G. Geocadin, Sung-Min Cho
Journal of Intensive Care Medicine; doi:10.1177/0885066620966962

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Daniel G. Fein, Dawn Zhao, Kyle Swartz, Peter Nauka, Luke Andrea, Michael Aboodi, Ariel L. Shiloh, Lewis A. Eisen
Journal of Intensive Care Medicine; doi:10.1177/0885066620965166

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Rodney A. Gabriel, Suraj Trivedi, Ulrich H. Schmidt
Journal of Intensive Care Medicine; doi:10.1177/0885066620960991

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Fiore Mastroianni, Daniel E. Leisman, Grace Fisler, Mangala Narasimhan
Journal of Intensive Care Medicine; doi:10.1177/0885066620965163

Abstract:
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 patients with solid-organ transplants and COVID-19 were identified. Eight patients were admitted to the ICU, of which 7 were intubated. Admission values of CRP (p = 0.045) and N/L ratio (p = 0.047) were associated with the need for mechanical ventilation. Seven patients (32%) died during admission, including 86% (n = 6) of patients who received mechanical ventilation. Conclusions: In solid-organ transplant recipients with COVID-19, initial CRP and N/L ratio were associated with need for mechanical ventilation.
Patrick Schober, Erik J. Lust, Leo M. A. Heunks, Lothar A. Schwarte
Journal of Intensive Care Medicine; doi:10.1177/0885066620965167

Abstract:
Purpose: Purpose of this report is to describe the feasibility of lingual pulse oximetry and lingual near-infrared spectroscopy (NIRS) in a COVID-19 patient to assess lingual tissue viability after several days of mechanical ventilation in the prone position. Materials & Methods: In a COVID-19 ICU-patient, the tongue became grotesquely swollen, hardened and protruding from the oral cavity after 20 h of mechanical ventilation uninterrupted in the prone position. To assess the doubtful viability of the tongue, pulse-oximetric hemoglobin O2-saturation (SpO2; Nellcor, OxiMax MAX-NI, Covidien, MA, USA) and NIRS-based, regional tissue O2-saturation measurements (rSO2; SenSmart, Nonin, MN, USA) were performed at the tongue. Results: At the tongue, regular pulse-oximetric waveforms with a pulse-oximetric hemoglobin O2-saturation (SpO2) of 88% were recorded, i.e. only slightly lower than the SpO2 reading at the extremities at that time (90%). Lingual NIRS-based rSO2 measurements yielded stable tissue rSO2-values of 76-78%, i.e. values expected also in other adequately perfused and oxygenated (muscle-) tissues. Conclusion: Despite the alarming, clinical finding of a grotesquely swollen, rubber-hard tongue and clinical concerns on the adequacy of the tongue perfusion and oxygenation, our measurements of both arterial pulsatility (SpO2) and NIRS-based tissue oxygenation (rSO2) suggested adequate perfusion and oxygenation of the tongue, rendering non-vitality of the tongue, e.g. by lingual venous thrombosis, unlikely. To our knowledge, this is the first clinical report of lingual rSO2 measurement.
Andrew D. May, Ann M. Parker, Ellen S. Caldwell, Catherine L. Hough, Jennifer E. Jutte, Mayra Sanchez Gonzalez, Dale M. Needham, Megan M. Hosey
Journal of Intensive Care Medicine; doi:10.1177/0885066620956564

The publisher has not yet granted permission to display this abstract.
Sumit Kapoor, SudhaM Chand, Vladyslav Dieiev, Melissa Fazzari, Tristan Tanner, David C. Lewandowski, Anil Nalla, Omar AbdulFattah, Michael S. Aboodi, Ariel L. Shiloh, et al.
Journal of Intensive Care Medicine; doi:10.1177/0885066620964392

Abstract:
Background: Covid-19 associated coagulopathy (CAC) is associated with prothrombotic state and thromboembolism. However, true incidence of thromboembolic events is difficult to determine in the ICU setting. The aim of our study was to investigate the cumulative incidence of thromboembolic events in Covid-19 patients needing intensive care unit (ICU) admission and assessing the utility of point of care ultrasound (POCUS) to screen for and diagnose lower extremity deep venous thrombosis (DVT). Methods: We conducted a prospective observational study between April 22nd and May 26th, 2020 where all adult patients with the diagnosis of Covid-19 pneumonia admitted to 8 ICUs of Montefiore Medical Center were included. POCUS exam was performed on all patients at day 1 of ICU admission and at day 7 and 14 after the first exam. Results: The primary outcome was to study the cumulative incidence of thromboembolic events in Covid-19 patients needing ICU admission. A total of 107 patients were included. All patients got POCUS exam on day 1 in the ICU, 62% got day 7 and 41% got day 14 exam. POCUS diagnosed 17 lower extremity DVTs on day 1, 3 new on day 7 and 1 new on day 14. Forty patients developed 52 thromboembolic events, with the rate of 37.3%. We found a high 45-day cumulative incidence of thromboembolic events of 37% and a high 45-day cumulative incidence of lower and upper extremity DVT of 21% and 10% respectively. Twelve (30%) patients had failure of therapeutic anticoagulation. Occurrence of a thromboembolic event was not associated with a higher risk of mortality (HR 1.08, p value = .81). Conclusions: Covid-19 patients in ICU have a high cumulative incidence of thromboembolic events, but not associated with higher mortality. POCUS is an excellent tool to help screen and diagnose DVT during a pandemic.
Kevin G. Buell, Jonathan D. Casey, Michael J. Noto, Todd W. Rice, Matthew W. Semler, Joanna L. Stollings
Journal of Intensive Care Medicine; doi:10.1177/0885066620963903

The publisher has not yet granted permission to display this abstract.
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