COVID-19-related organ dysfunction and management strategies on the intensive care unit: a narrative review

Sherren, Peter B.; Ostermann, Marlies; Agarwal, Sangita; Meadows, Christopher I. S.; Ioannou, Nicholas; Camporota, Luigi

doi:10.1016/j.bja.2020.08.050

Cited by 38 publications

(30 citation statements)

References 121 publications

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“… 18 , 19 sHLH and COVID-19 critical illness can manifest similarly, possibly exacerbating the risk of propofol-related hypertriglyceridemia. 33 A recent cross-sectional study demonstrated that high triglyceride concentrations were strong predictors of a severe course of COVID-19. 34 The pathophysiology involves the overexpression of cytokines, and the inflammatory state produced during COVID-19 infection leads to significant changes in lipid metabolism, specifically affecting the lipoprotein lipase enzyme.…”

Section: Discussionmentioning

confidence: 99%

The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019

et al. 2021

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Background: Propofol is commonly used to achieve ventilator synchrony in critically ill patients with coronavirus disease 2019 (COVID-19), yet its safety in this patient population is unknown. Objective: To evaluate the safety, in particular the incidence of hypertriglyceridemia, of continuous infusion propofol in patients with COVID-19. Methods: This was a retrospective study at 1 academic medical center and 1 affiliated teaching hospital in New York City. Adult, critically ill patients with COVID-19 who received continuous infusion propofol were included. Patients who received propofol for <12 hours, were transferred from an outside hospital while on mechanical ventilation, or did not have a triglyceride concentration obtained during the infusion were excluded. Results: A total of 252 patients were included. Hypertriglyceridemia (serum triglyceride concentration ≥ 400 mg/dL) occurred in 38.9% of patients after a median cumulative dose of 4307 mg (interquartile range [IQR], 2448-9431 mg). The median time to triglyceride elevation was 3.8 days (IQR, 1.9-9.1 days). In the multivariable regression analysis, obese patients had a significantly greater odds of hypertriglyceridemia (odds ratio = 1.87; 95% CI = 1.10, 3.21). There was no occurrence of acute pancreatitis. The incidence of possible propofol-related infusion syndrome was 3.2%. Conclusion and Relevance: Hypertriglyceridemia occurred frequently in patients with COVID-19 who received propofol but did not lead to acute pancreatitis. Elevated triglyceride concentrations occurred more often and at lower cumulative doses than previously reported in patients without COVID-19. Application of these data may aid in optimal monitoring for serious adverse effects of propofol in patients with COVID-19.

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Section: Discussionmentioning

confidence: 99%

The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019

et al. 2021

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“…Similarly, ADAMTS13, the von Willebrand factor-specific protease, seems to be slightly decreased, with a subsequent imbalance of von Willebrand factor/ADAMTS13 axis when considering the strikingly elevated von Willebrand factor levels (Blasi et al, 2020;Delrue et al, 2020;Huisman et al, 2020). Hypoxemia associated with COVID-19-related pneumonia (Sherren et al, 2020) may also enhance hypercoagulability through increased synthesis of hypoxia inducible factor-1α (Marchetti, 2020), which increases procoagulant gene expression (Gupta et al, 2019).…”

Section: Hypercoagulability Favoring Thrombosis In Covid-19 Patientsmentioning

confidence: 99%

“…Moreover, microvascular thrombosis promoting kidney injury and lung microvascular thrombosis promoting hypoxemia (Sherren et al, 2020;Vinayagam and Sattu, 2020) may further increase predisposition to thrombosis.…”

Section: Endothelial Activation and Lesion Favoring Thrombosis In Covmentioning

confidence: 99%

Pathophysiological Processes Underlying the High Prevalence of Deep Vein Thrombosis in Critically Ill COVID-19 Patients

et al. 2021

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Coronavirus disease 2019 (COVID-19) predisposes to deep vein thrombosis (DVT) and pulmonary embolism (PE) particularly in mechanically ventilated adults with severe pneumonia. The extremely high prevalence of DVT in the COVID-19 patients hospitalized in the intensive care unit (ICU) has been established between 25 and 84% based on studies including systematic duplex ultrasound of the lower limbs when prophylactic anticoagulation was systematically administrated. DVT prevalence has been shown to be markedly higher than in mechanically ventilated influenza patients (6–8%). Unusually high inflammatory and prothrombotic phenotype represents a striking feature of COVID-19 patients, as reflected by markedly elevated reactive protein C, fibrinogen, interleukin 6, von Willebrand factor, and factor VIII. Moreover, in critically ill patients, venous stasis has been associated with the prothrombotic phenotype attributed to COVID-19, which increases the risk of thrombosis. Venous stasis results among others from immobilization under muscular paralysis, mechanical ventilation with high positive end-expiratory pressure, and pulmonary microvascular network injuries or occlusions. Venous return to the heart is subsequently decreased with increase in central and peripheral venous pressures, marked proximal and distal veins dilation, and drops in venous blood flow velocities, leading to a spontaneous contrast “sludge pattern” in veins considered as prothrombotic. Together with endothelial lesions and hypercoagulability status, venous stasis completes the Virchow triad and considerably increases the prevalence of DVT and PE in critically ill COVID-19 patients, therefore raising questions regarding the optimal doses for thromboprophylaxis during ICU stay.

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“…Moreover, the severity of organ damage is directly correlated with ACE2 density [55] , [56] . Therefore, most deaths in SARS-CoV-2 infection could be attributed to densely infected lungs [57] . Furthermore, although no association between the central nervous system (CNS) involvement and COVID-19 has been reported, low levels of SARS-CoV-2 have been detected in the brains of patients who died due to COVID-19 [58] .…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 new variants: Characteristic features and impact on the efficacy of different vaccines

Khan

Ali

et al. 2021

Biomedicine & Pharmacotherapy

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The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its new variants reported in different countries have posed a serious threat to human health and social fabrics worldwide. In addition, these new variants hindered the efforts of vaccines and other therapeutic developments. In this review article, we explained the emergence of new variants of SARS-CoV-2, their transmission risk, mortality rate, and, more importantly, the impact of each new variant on the efficacy of the developed vaccines reported in different literature and findings. The literature reported that with the emergence of new variants, the efficacy of different vaccines is declined, hospitalization is increased while the risk of reinfection also increased. The reports concluded that the emergence of a variant that entirely evades the immune response triggered by the vaccine is improbable. The emergence of new variants and reports of re-infections are creating a more distressing situation and therefore demands further investigation to formulate an effective therapeutic strategy.

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COVID-19-related organ dysfunction and management strategies on the intensive care unit: a narrative review

Cited by 38 publications

References 121 publications

The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019

The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019

Pathophysiological Processes Underlying the High Prevalence of Deep Vein Thrombosis in Critically Ill COVID-19 Patients

SARS-CoV-2 new variants: Characteristic features and impact on the efficacy of different vaccines

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