Objectives As the pathophysiology of COVID-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital. Results During the first wave of the COVID-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status. Conclusion Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with COVID-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.

ObjectiveThis report aimed to describe the outcomes of the patients with severe H1N1 associated acute respiratory distress syndrome who were treated with extracorporeal membrane oxygenation therapy.MethodsThis retrospective review analyzed a single-center cohort of adult patients with H1N1-related acute respiratory distress syndrome who were managed with veno-venous extracorporeal membrane oxygenation during the winter of 2013/2014.ResultsA total of 10 patients received veno-venous extracorporeal membrane oxygenation for H1N1 influenza between January 2013 and March 2014. Seven patients were transferred to our center for extracorporeal membrane oxygenation consideration (all within 72 hours of initiating mechanical ventilation). The median patient age was forty years, and 30% were female. The median arterial oxygen partial pressure to fraction of inspired oxygen ratio was 62.5, and the median RESP score was 6. Three patients received inhaled nitric oxide, and four patients were proned as rescue therapy before extracorporeal membrane oxygenation was initiated. The median duration of mechanical ventilation was twenty-two days (range, 14 - 32). The median length of stay in the intensive care unit was twenty-seven days (range, 14 - 39). The median hospital length of stay was 29.1 days (range, 16.0 - 46.9). Minor bleeding complications occurred in 6 of 10 patients. Eight of the ten patients survived to hospital discharge.ConclusionThe survivors were relatively young and discharged with good functional status (i.e., enhancing quality-adjusted life-years-saved). Our experience shows that even a relatively new extracorporeal membrane oxygenation program can play an important role in that capacity and provide excellent outcomes for the sickest patients.

The severe acute respiratory syndrome coronavirus disease-2 (SARS-CoV-2) pandemic of 2020-2021 created unprecedented challenges for clinicians in critical care transport (CCT). These CCT services had to rapidly adjust their clinical approaches to evolving patient demographics, a preponderance of respiratory failure, and transport utilization stratagem. Organizations had to develop and implement new protocols and guidelines in rapid succession, often without the education and training that would have been involved pre-coronavirus disease 2019 (COVID-19). These changes were complicated by the need to protect crew members as well as to optimize patient care. Clinical initiatives included developing an awake proning transport protocol and a protocol to transport intubated proned patients. One service developed a protocol for helmet ventilation to minimize aerosolization risks for patients on noninvasive positive pressure ventilation (NIPPV). While these clinical protocols were developed specifically for COVID-19, the growth in practice will enhance the care of patients with other causes of respiratory failure. Additionally, these processes will apply to future respiratory epidemics and pandemics.

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18 hours after sepsis, when compared to baseline values before the CLP procedure (29.9 ± 1.1% and 57.3 ± 1.6%, respectively; P<0.05). In contrast, treatment with AICAR significantly improved both fractional shortening (26.6 ± 3.4%) and ejection fraction (52.4 ± 5.9%) when compared to vehicle treatment (P<0.05). At Western blotting analysis, the beneficial effects of AICAR were associated with increased AMPK phosphorylation, as well as increase of nuclear expression of peroxisome proliferator-activated receptor-ϒ co-activator α (PGC-1α), a major regulator of mitochondrial function and biogenesis. Conclusions: Our data indicate that AICAR confers cardioprotective effects during experimental sepsis through activation of AMPK-dependent metabolic repair mechanisms. These findings can potentially lead to a new therapeutic strategy for prevention of cardiac dysfunction in sepsis.Learning Objectives: Red cell distribution width (RDW), a quantitative measure of the variability in size of erythrocytes, has been associated with an increased hospital mortality in critically ill patients. The reason for this association remains unclear, especially on rheology. We hypothezised that an increased RDW might contribute to microcirculatory alterations in sepsis. Methods:Analysis of prospectively collected database. Microcirculatory measurements were obtained either during severe sepsis (n = 27), or septic shock (n = 95). When multiple measurements were obtained, only the first was considered. Patients' demographics, comorbidities, the Acute Physiologic and Chronic Health Evaluation (APACHE) II score on admission and the Sequential Organ Failure Assessment (SOFA) score on the day of microcirculatory assessment were collected. The microcirculation of the sublingual area was evaluated using the Sidestream Dark-Field (SDF) videomicroscopy. RDW (normal ranges: 10.9-13.4%) was obtained retrospectively from routine blood analysis on the day of microcirculation evaluation. A sub-group analysis was performed after exclusion of patients with diabetes, heart failure, autoimmune disease, recent blood transfusion, cancer and haematological diseases, which can all influence RDW independently from critically illness. Data are presented as median [IQRs] Results: 122 patients were included. Median RDW on the day of microcirculation evaluation was 13.8 [12.8-15.5] and was within normal ranges in 48 (39%) patients. We found no correlation between RDW and microcirculatory parameters (functional capillary density, FCD -r = -0.12; proportion of small perfused vessels, PPV -r=0.17; mean flow index, MFI -r=-0.17). Also, no differences in FCD, PPV and MFI were found between patients with normal and altered RDW. Similar results were also found when the sub-group analysis was performed. We found not correlation of RDW with APACHE and SOFA scores. RDW values were not different between survivors and non-survivors. Conclusions: RDW was not associated with microcirculatory alterations or survival in septic patients.