SARS-CoV-2 Infection with Associated Rhabdomyolysis and Probable Myocarditis

ntroduction. The COVID-19 pandemic caused an outbreak of viral lung infections with severe acute respiratory syndrome complicated with acute respiratory failure. Despite the fact that the pandemic has a lengthened run, none of the therapeutic approaches have proved to be sufficiently effective according to the evidence-based criteria. We consider the use of surfactant therapy in patients with severe viral pneumonia and acute respiratory distress syndrome (ARDS) as one of the possible methods for treating COVID-19 related pneumonia. Objective. To prove the clinical efficacy and safety of orally inhaled Surfactant-BL, an authorized drug, in the combination therapy of COVID-19 related ARDS. Materials and methods. A total of 38 patients with COVID-19 related severe pneumonia and ARDS were enrolled in the study. Of these, 20 patients received the standard therapy in accordance with the temporary guidelines for the prevention, diagnosis and treatment of the novel coronavirus infection (COVID-19) of the Ministry of Health of the Russian Federation, version 9. And 18 patients received the surfactant therapy in addition to the standard therapy. Surfactant-BL was used in accordance with the instructions on how to administer the drug for the indication – prevention of the development of acute respiratory distress syndrome. A step-by-step approach to the build-up of the respiratory therapy aggressiveness was used to manage hypoxia. We used oxygen inhalation via a face mask with an oxygen inflow of 5–15 l/min, highflow oxygen therapy via nasal cannulas using Airvo 2 devices, non-invasive lung ventilation, invasive lung ventilation in accordance with the principles of protective mechanical ventilation. Results and discussion. Significant differences in the frequency of transfers to mechanical ventilation, mortality, Intensive Care Unit (ICU) and hospitalization length of stay (p <0.05) were found between the groups. Patients receiving surfactant therapy who required a transfer to mechanical ventilation accounted for 22% of cases, and the mortality rate was 16%. In the group of patients receiving standard therapy without surfactant inhalation 45% were transferred to mechanical ventilation, and 35% died. For patients receiving surfactant therapy, the hospital stay was reduced by 20% on average, and ICU stay by 30%. Conclusion. The inclusion of surfactant therapy in the treatment of COVID-19 related severe pneumonia and ARDS can reduce the progression of respiratory failure, avoid the use of mechanical ventilation, shorten the ICU and hospitalization length of stay, and improve the survival rate of this patient cohort.

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Clinical Analysis of the Prognosis of Severe Pneumonia Requiring Mechanical Ventilation

Kansenshogaku zasshi ◽

10.11150/kansenshogakuzasshi1970.73.570 ◽

1999 ◽

Vol 73 (6) ◽

pp. 570-577

Author(s):

Yoshihiro KOBASHI ◽

Kazue FUJITA ◽

Takayuki KARINO ◽

Tatsutoshi YANO ◽

Junichi NAKAMURA ◽

...

Keyword(s):

Mechanical Ventilation ◽

Severe Pneumonia ◽

Clinical Analysis

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Factors influencing weaning from mechanical ventilation in elderly patients with severe pneumonia

Geriatrics and Gerontology International ◽

10.1111/j.1447-0594.2011.00765.x ◽

2011 ◽

Vol 12 (2) ◽

pp. 277-283 ◽

Cited By ~ 6

Author(s):

Mitsuhiro Fujii ◽

Shin-ichiro Iwakami ◽

Haruhi Takagi ◽

Yukinari Itoigawa ◽

Masako Ichikawa ◽

...

Keyword(s):

Mechanical Ventilation ◽

Elderly Patients ◽

Severe Pneumonia ◽

Weaning From Mechanical Ventilation ◽

Factors Influencing

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Immunothrombotic Dysregulation in COVID-19 Pneumonia Is Associated With Respiratory Failure and Coagulopathy

Circulation ◽

10.1161/circulationaha.120.048488 ◽

2020 ◽

Vol 142 (12) ◽

pp. 1176-1189 ◽

Cited By ~ 40

Author(s):

Leo Nicolai ◽

Alexander Leunig ◽

Sophia Brambs ◽

Rainer Kaiser ◽

Tobias Weinberger ◽

...

Keyword(s):

Respiratory Failure ◽

Severe Acute Respiratory Syndrome ◽

Disease Severity ◽

Severe Pneumonia ◽

Corona Virus ◽

Coagulation Tests ◽

Myocardial Involvement ◽

Platelet Aggregates ◽

Polymerase Chain

Background: Severe acute respiratory syndrome corona virus 2 infection causes severe pneumonia (coronavirus disease 2019 [COVID-19]), but the mechanisms of subsequent respiratory failure and complicating renal and myocardial involvement are poorly understood. In addition, a systemic prothrombotic phenotype has been reported in patients with COVID-19. Methods: A total of 62 subjects were included in our study (n=38 patients with reverse transcriptase polymerase chain reaction–confirmed COVID-19 and n=24 non–COVID-19 controls). We performed histopathologic assessment of autopsy cases, surface marker–based phenotyping of neutrophils and platelets, and functional assays for platelet, neutrophil functions, and coagulation tests, as well. Results: We provide evidence that organ involvement and prothrombotic features in COVID-19 are linked by immunothrombosis. We show that, in COVID-19, inflammatory microvascular thrombi are present in the lung, kidney, and heart, containing neutrophil extracellular traps associated with platelets and fibrin. Patients with COVID-19 also present with neutrophil-platelet aggregates and a distinct neutrophil and platelet activation pattern in blood, which changes with disease severity. Whereas cases of intermediate severity show an exhausted platelet and hyporeactive neutrophil phenotype, patients severely affected with COVID-19 are characterized by excessive platelet and neutrophil activation in comparison with healthy controls and non–COVID-19 pneumonia. Dysregulated immunothrombosis in severe acute respiratory syndrome corona virus 2 pneumonia is linked to both acute respiratory distress syndrome and systemic hypercoagulability. Conclusions: Taken together, our data point to immunothrombotic dysregulation as a key marker of disease severity in COVID-19. Further work is necessary to determine the role of immunothrombosis in COVID-19.

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Mechanical Ventilation for Very Elderly Patients with Severe Pneumonia

Journal of Palliative Medicine ◽

10.1089/jpm.2014.0007 ◽

2014 ◽

Vol 17 (4) ◽

pp. 383-384 ◽

Cited By ~ 1

Author(s):

Miyuki Mitamura ◽

Kosaku Komiya ◽

Hiromi Watanabe ◽

Jun-ichi Kadota

Keyword(s):

Mechanical Ventilation ◽

Elderly Patients ◽

Severe Pneumonia ◽

Very Elderly

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One Case of Esophageal Obstruction Caused by Enteral Nutrition

Journal of Clinical Medicine Research ◽

10.32629/jcmr.v2i2.350 ◽

2021 ◽

Vol 2 (2) ◽

Author(s):

Yangzhong Wang ◽

Xiuqing Liao ◽

Xiaoli Bao ◽

Xianlin Peng ◽

Nan Tang

Keyword(s):

Mechanical Ventilation ◽

Enteral Nutrition ◽

Sodium Bicarbonate ◽

Nasogastric Tube ◽

Gastric Tube ◽

Foreign Bodies ◽

Severe Pneumonia ◽

Endoscopic Removal ◽

Esophageal Obstruction ◽

Severe Respiratory Distress

We report a case of complete esophageal obstruction caused by continuous enteral nutrition infusion via nasogastric tube. A 77 year old man received mechanical ventilation due to severe pneumonia and severe respiratory distress. He began using enteral nutrition emulsion (TPF) through a nasogastric tube on admission. 15 days later, due to the difficulty of re-inserting the nasogastric tube, endoscopy found a large number of coagulations in the esophagus, resulting in complete esophageal obstruction. We remove a small part of the foreign body with a net basket under gastroscope. After the operation, the nasogastric tube was placed in the middle of the esophagus again, which was perfused with 5% sodium bicarbonate and vinegar through the gastric tube. One week later, the esophagus was completely unobstructed by gastroscopy. A conclusion can be drawn that the precipitation and coagulation of TPF can lead to the whole esophageal obstruction. Endoscopic removal of foreign bodies, sodium bicarbonate and vinegar retention in the esophagus can treat the food obstruction caused by TPF.

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Covid-19, Congenital Heart Disease and Pregnancy: Dramatic Conjunction. Case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab291 ◽

2021 ◽

Author(s):

Walkiria Samuel Avila ◽

Marcelo Kirschbaum ◽

Marcela Santana Devido ◽

Lea Maria Macruz Ferreira Demarchi

Keyword(s):

Heart Failure ◽

Mechanical Ventilation ◽

Heart Disease ◽

Severe Pneumonia ◽

Epidemiological Data ◽

Cardiovascular Complications ◽

Multiple Organ ◽

Cardiac Resynchronization ◽

Atrioventricular Canal ◽

Emergency Cesarean

Abstract Background Epidemiological data from the COVID-19 pandemic report that patients with pre-existing cardiovascular disease have worse outcomes and higher mortality, and that pregnant women should be considered at high risk. Case summary A 25-year-old pregnant woman on the waiting list for a heart transplant, with a history of complete atrioventricular canal surgery, mitral mechanical prosthetic implant (St Jude-27), and cardiac resynchronization therapy (Boston Scientific) was hospitalized at 30 weeks of gestation for treatment of heart failure. After seven days of hospitalization, she had a positive Rt-PCR test for SARS-CoV-2 with progressive worsening of her clinical condition and acute Foetal distress. Hence emergency cesarean section was performed. After the birth, the patient required mechanical ventilation, progressing to multiple organ system failures. Conventional inotropic drugs, antibiotics, and mechanical ventilation for 30 days in the ICU provided significant clinical, hemodynamic, and respiratory improvement. However, on the 37th day, she suddenly experienced respiratory failure, gastrointestinal and airway bleeding, culminating in death. Discussion Progressive physiological changes during pregnancy cause cardiovascular complications in women with severe heart disease and higher *susceptibility to viral infection and severe pneumonia. COVID-19 is known to incite an intense inflammatory and prothrombotic response with clinical expression of severe acute respiratory syndrome, heart failure, and thromboembolic events. The overlap of these COVID-19 events with those of pregnancy in this woman with underlying heart disease contributed to an unfortunate outcome and maternal death.

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ASPECTS OF INVASIVE MECHANICAL VENTILATION IN PATIENTS WITH ARDS CAUSED BY COVID-19

Pain anesthesia and intensive care ◽

10.25284/2519-2078.2(95).2021.238291 ◽

2021 ◽

pp. 9-16

Author(s):

O. A. Loskutov ◽

I. A. Kuchynska ◽

S. M. Nedashkivskyi ◽

O. S. Demchenko

Keyword(s):

Mechanical Ventilation ◽

Multiorgan Failure ◽

Invasive Mechanical Ventilation ◽

Severe Pneumonia ◽

Ideal Body Weight ◽

Plateau Pressure ◽

Invasive Ventilation ◽

Number Of Patients ◽

Number Of Publications ◽

Main Components

Mortality among patients with severe pneumonia and / or acute respiratory distress syndrome (ARDS) due to COVID-19 infection, who underwent mechanical ventilation (MV), is characterized by a fairly high frequency. However, despite the large number of patients receiving appropriate treatment, the question of choosing the optimal ventilation parameters remains poorly understood. In our article, we reviewed the available literature data on the indications for mechanical ventilation, parameters of MV, the need for prone-positioning of patients with ARDS caused by COVID-19 infection in intensive care units to identify unresolved issues.Despite the large number of publications about respiratory support in patients with severe coronavirus infection, there are only general principles regarding the indications for switching to invasive ventilation. Most authors identified the following clinical situations: progression of hypoxemia and / or respiratory failure but with constant oxygen support with increasing percentage of oxygen in the respiratory mixture, use of high-flow cannula or non-invasive ventilation for 1 hour without improvement; persistent hypercapnia, multiorgan failure, coma, high risk of aspiration, hemodynamic instability.According to most of the studies analyzed, the main components of the ventilation strategy should be based on the principles of pulmonary protective ventilation and include the use of low tidal volumes (Vt = 4-8 ml / kg of ideal body weight) and ventilation with plateau pressure Pplat <30 cm H2O (plateau pressure - air pressure measured after an inspiratory pause of 0.5 s). At the same time, many authors recommend using prone position and high levels of positive end-expiratory pressure (PEEP) compared to low levels in patients with ARDS on the background of COVID-19.The approach to invasive mechanical ventilation in ARDS caused by SARS-CoV-2 still requires further research and answers to a number of questions.

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Incidence of hyponatremia and its utility as an indicator of morbidity in children hospitalised with community acquired pneumonia

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20200689 ◽

2020 ◽

Vol 7 (3) ◽

pp. 616

Author(s):

Thrilok Natarajan ◽

Thahsheen Nilofar Sahubar Sadique ◽

Kabilan Shanmugham

Keyword(s):

Mechanical Ventilation ◽

Hospital Stay ◽

Severe Pneumonia ◽

Hemodynamic Instability ◽

Community Acquired Pneumonia ◽

Prolonged Hospital Stay ◽

Previously Treated ◽

A Prospective Study ◽

Prolonged Hospital ◽

Relationship Of

Background: The aims of the study were to determine the incidence of hyponatremia associated with pneumonia and to assess its utility as an indicator of morbidity in children hospitalized with community acquired pneumonia between 2 months and 5 years of age.Methods: This was a prospective study of children aged 2 months to 5 years hospitalized with community acquired pneumonia. 120 children aged 2 months to 5 years with symptoms of lower respiratory tract infection and had radiological evidence of pneumonia were recruited into the study. Children with chronic diseases, previously treated with intravenous fluids and those with chronic drug intake were excluded from study.Results: Of the 120 children, 40.8% (49/120) had hyponatremia at admission. The relationship of hyponatremia to different clinical and laboratory parameters was analyzed. Sixty-one percent (31/51) of children under 1 year and 26% (18/69) of children between 1 to 5 years of age had hyponatremia (p=0.001). Hyponatremia was seen more commonly in children with severe pneumonia, with initial high temperature(p=0.001), with tachycardia (p=0.001), leukocytosis (p=0.001), increased neutrophils (p=0.001) and reactive thrombocytosis (p<0.001) and in children who had hemodynamic instability on admission (p<0.001). All 11(9.2%) children who required mechanical ventilation had hyponatremia (p<0.001). Consolidation was significantly associated with hyponatremia (p<0.001). Hyponatremia also showed a significant association with prolonged hospital stay (p<0.001).Conclusion: The incidence of hyponatremia in children hospitalised with pneumonia is 40.8%. This study concludes that the hyponatremia shows a significant association with the morbidity of the disease like requirement of intensive care and mechanical ventilation, hemodynamic instability and prolonged hospital stay. Hence the presence of hyponatremia at admission can be used as an indicator of morbidity.

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