Storm In Patients Research Articles

Detection of Early Cytokine Storm in Patients with Septic Shock After Abdominal Surgery.

Objectives: To explore the characteristics of cytokine storm in patients with septic shock after abdominal surgery, examine its relationship with clinical data, and determine intervention timings.Materials and Methods: We prospectively observed a cohort of patients with abdominal infection admitted to the surgical intensive care unit (ICU) after surgery (shock group). A control group of healthy individuals was used for comparison. Plasma samples and clinical data recorded at 0, 12, 24, 48, and 72 h after surgery were collected. Cytokines (tumor necrosis factor-α, interleukin [IL]-6, IL-8, IL-10, monocyte chemotactic protein [MCP]-1, IL-1 β, interferon-γ, IL-12p70, MCP-1α, IL-4, IL-2, and IL-13) were detected using the Luminex® technique.Results: Concentrations of most cytokines were significantly higher in the shock group. When a cytokine storm intensity curve was considered with the vasopressor dependency index and a Sequential Organ Failure Assessment (SOFA) score, time point of maximum cytokine storm intensity was earlier than that of the maximum vasopressor dependency index and SOFA score in the shock group.Conclusions: Cytokine storm occurred in patients with septic shock shortly after the abdominal surgery and may be a main mechanism leading to septic shock. Cytokine storm interventions should ideally be initiated within 24 h after surgery and be guided by cytokine storm biomarkers.

The immunology of COVID-19: is immune modulation an option for treatment?

SummaryIn December, 2019, an outbreak of COVID-19 emerged in Wuhan, China and quickly spread globally. As of May 7, 2020, there were 3 672 238 confirmed infections and 254 045 deaths attributed to COVID-19. Evidence has shown that there are asymptomatic carriers of COVID-19 who can transmit the disease to others. The virus incubation time shows a wide range (0–24 days) and the virus displays a high infectivity. It is therefore urgent to develop an effective therapy to treat patients with COVID-19 and to control the spread of the causative agent, severe respiratory syndrome coronavirus 2. Repurposing of approved drugs is widely adopted to fight newly emerged diseases such as COVID-19, as these drugs have known pharmacokinetic and safety profiles. As pathological examination has confirmed the involvement of immune hyperactivation and acute respiratory distress syndrome in fatal cases of COVID-19, several disease-modifying anti-rheumatic drugs (DMARDS), such as hydroxychloroquine and tocilizumab, have been proposed as potential therapies for the treatment of COVID-19. In this Review, we discuss the immunological aspects of COVID-19 and the potential implication of DMARDs in treating this disease.

SAT-464 A Case of Impending Thyroid Storm in a Patient with Subacute Thyroiditis Following an Influenza Vaccine

Introduction: Thyroid storm is a rare, potentially fatal condition, affecting 1% of individuals with thyrotoxicosis. Although it can theoretically be seen in any cause of thyrotoxicosis, the most likely underlying etiology is Graves’ disease. The rarity of thyroid storm due to thyroiditis makes the diagnosis challenging as the clinical and biochemical features overlap Grave’s disease. Here we describe a rare case of severe thyrotoxicosis in a woman due to subacute thyroiditis that developed after receiving an influenza vaccine.Case report: A 30 year-old Caucasian female with no known past medical history presented to the ED with worsening sore throat, odynophagia and anterior neck pain. Symptoms began 4 weeks ago prior to presentation, 1 day after receiving an influenza vaccine. Other symptoms included loss of appetite, chills, fever, fatigue, malaise, abdominal pain, diarrhea, palpitations, heat intolerance and 5lbs weight loss. She was treated by her primary care provider for suspected pharyngitis with a course of corticosteroids and antibiotics. Two weeks later, given worsening symptoms, was referred to the emergency room. On exam, she appeared anxious and was tachycardic (124 beats per minute) and tachypneic (28 breaths per minute). She had no lid lag, stare, thyromegaly or thyroid bruit. However, there was significant tenderness on palpation of the anterior neck. Laboratory evaluation was notable for TSH <0.01 uIU/mL (0.39 - 4.0.8), free T4 5.19 ng/dL (0.58 - 1.64), free T3 10 pg/ml (2.53-3.87), ESR 95 mm/hr (0-20) and CRP 9.339 mg/dl (0.0-0.9) consistent with thyrotoxicosis. Given Burh-Wartofsky score of 45, there was a concern for impending thyroid storm. She received hydrocortisone, methimazole and beta blockers and was admitted to the intensive care unit. She responded dramatically to treatment and was discharged within 24 hours on prednisone and metoprolol. The 24-hour radioactive iodine uptake (RAIU) was 2.7% 2 weeks post admission, consistent with a diagnosis of subacute thyroiditis. TSI was negative. Family history was negative for autoimmune disease. She continued on beta blockers with a steroid taper for 8 weeks. Thyroid function tests and inflammatory markers normalized within 3 months.Conclusion:Aside from the described patient, only three other cases of thyrotoxic crisis due to subacute thyroiditis have been reported in the literature. This case underscores the importance of thoroughly investigating the etiology of severe thyrotoxcosis, given the management and prognosis varies depending on underlying cause. Thyroiditis should be considering in the differential diagnosis of thyroid storm in patients who do not have a personal or family history of autoimmunity and present with neck tenderness in the setting of a precipitating event. Subacute thyroiditis is very uncommon after influenza vaccine, there have been 4 reported cases.

HiJAKing SARS-CoV-2? The potential role of JAK inhibitors in the management of COVID-19.

JAK kinase inhibitors are being investigated as a way of managing cytokine storm in severe COVID-19 patients.

Современная пандемия COVID-19 и лекарственные средства

Представлена информация о лекарственных средствах, уменьшающих репликацию вируса и цитокиновый шторм при COVID-19.

Hypercalcemia and electric storm in patient with primary hyperparathyroidism

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Electrical Storm in Patients with Inappropriate Implantable Cardioverter-Defibrillator Therapy: Current Trends in Clinical Practice between Guidelines and Technology Progress

The term “Electrical Storm” (ES) indicates cardiac electrical instability manifested by several episodes of ventricular tachyarrhythmias within a short time. In the contemporary implantable cardioverter-defibrillator (ICD) era, ES is defined as recurrent (three or more separate episodes) of ICD discharges over 24 hours. Some ESs are due to inappropriate repetitive shock and are potentially lethal for the patient. The most common causes of inappropriate ICD shock include supraventricular tachycardia with high ventricular response and oversening of peaked T waves or R wave, myopotentials or electrical noise. Appropriate diagnosis and treatment are critical in the Emergency Department. To approach these patients systematically, it is important to understand, that there are four causes of shock. Modern ICD incorporate sophisticated tachycardia detection algorithms within their programming designed to minimize devices’ detection mistakes and ICD-related information can also be checked using remote home monitoring systems. However, these opportunities are often not utilized to their full benefit. Thus, careful attention should be paid to the programming of the device. Fine tuning of the detection and differentiation algorithms is critical, and best done by a practitioner who understands the subtle differences among the different manufacturers. The racommendations for those problems should be revised.

Electrical storm in patient with implanted ICD as the first sign of cardiac device-related endocarditis

Electrical storm in patient with implanted ICD as the first sign of cardiac device-related endocarditis

Stalling cytokine storm in patients with COVID-19 infection with low-dose radiation

Stalling cytokine storm in patients with COVID-19 infection with low-dose radiation

Emergency in False-Electrical Storm in Patients with Implanted Cardioverter Defibrillator

Emergency in False-Electrical Storm in Patients with Implanted Cardioverter Defibrillator

Pseudo-Electrical Storm in Patients with Implanted Cardioverter Defibrillator

The Electrical Storm indicates cardiac electrical instability manifested by several episodes of ventricular tachyarrhythmias within a short time. Pseudo-ES is defined as recurrent inappropriate implantable cardioverter-defibrillator discharges over 24 hours. Far from being a minor complication, Pseudo-ES is usually physical and psychological harmful and potentially lethal.

Pseudo-Electrical Storm in Patients with Implanted Cardioverter Defibrillator

The Electrical Storm indicates cardiac electrical instability manifested by several episodes of ventricular tachyarrhythmias within a short time. Pseudo-ES is defined as recurrent inappropriate implantable cardioverter-defibrillator discharges over 24 hours. Far from being a minor complication, Pseudo-ES is usually physical and psychological harmful and potentially lethal.

Catheter ablation of electrical storm in patients with arrhythmogenic right ventricular cardiomyopathy

Therapeutic strategies for electrical storm (ES) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) are not well defined. The purpose of this study was to report the acute and long-term results of ventricular tachycardia (VT) radiofrequency catheter ablation (RFCA) as a treatment of ES in patients with ARVC. This multicenter study retrospectively enrolled 23 consecutive patients with ARVC (mean age 43.6 ± 16.7 years; all men) who underwent 24 RFCA procedures for ES between 2003 and2015. Thirteen patients (57%) had a previous VT RFCA procedure; 14 (61%) had right ventricular dysfunction and 7 (30%) left ventricular ejection fraction ≤ 50%. The clinical VT was inducible in 19 procedures (79%). Epicardial ablation was performed in 4 procedures (17%). The median number of targeted VTs was 1 (range 1-6). Complete acute success (no VT inducible) was achieved in 11 procedures (46%) and partial acute success (clinical VT nor inducible) in 11 (46%). After a median follow-up of 3.9 years (range 1 month-10 years), ES recurred in 2 patients and end-stage heart failure developed in 4 (17%), leading to 1 death and 3 heart transplantations. At 1-year follow-up, the probability of freedom from VT recurrence was 75% and did not significantly predict long-term survival. At the last evaluation, 8 patients (35%) were free of non-β-blocker antiarrhythmic drugs as compared with 1 (4%) at baseline (P = .02). Catheter ablation was efficient to prevent ES recurrence in patients with ARVC. However, these patients were at high risk of evolution toward ARVC-related heart failure that was not associated with VT recurrence.

Incidence, predictors, and clinical impact of electrical storm in patients with left ventricular assist devices: New insights from the ASSIST-ICD study

Ventricular arrhythmias (VAs) can occur after continuous flow left ventricular assist device (LVAD) implantation as a single arrhythmic event or as electrical storm (ES) with multiple repetitive VA episodes. We aimed at analyzing the incidence, predictors, and clinical impact of ES in LVAD recipients. Patients analyzed were those included in the multicenter ASSIST-ICD observational study. ES was consensually defined as occurrence of ≥3 separate episodes of sustained VAs within a 24-hour interval. Of 652 patients with an LVAD, 61 (9%) presented ES during a median follow-up period of 9.1 (interquartile range [IQR] 2.5-22.1) months. The first ES occurred after 17 (IQR 4.0-56.2) days post LVAD implantation, most of them during the first month after the device implantation (63%). The incidence then tended to decrease during the initial years of follow-up and increased again after the third year post LVAD implantation. History of VAs before LVAD implantation and heart failure duration > 84 months were independent predictors of ES. The occurrence of ES was associated with an increased early mortality since 20 patients (33%) died within the first 2 weeks of ES. Twenty-two patients (36.1%) presented at least 1 recurrence of ES, occurring 43.0 (IQR 8.0-69.0) days after the initial ES. Patients experiencing ES had a significantly lower 1-year survival rate than did those free from ES (log-rank, P=.039). There is a significant incidence of ES in patients with an LVAD. The short-term mortality after ES is high, and one-third of patients will die within 15 days. Whether radiofrequency ablation of arrhythmias improves outcomes would require further studies.

Effectiveness of amiodarone and lidocaine combination in termination of monomorphic ventricular tachycardia electrical storm in patient with dilated cardiomyopathy and severe left ventricular dysfunction

Effectiveness of amiodarone and lidocaine combination in termination of monomorphic ventricular tachycardia electrical storm in patient with dilated cardiomyopathy and severe left ventricular dysfunction

Outcomes after catheter ablation for treatment of electrical storm in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia

Catheter ablation is an effective treatment for ARVC/D-associated ventricular tachycardia (VT), however its benefit as an urgent treatment for electrical storm (ES) remains to be assessed. Report the acute and long-term results of catheter ablation in patients with ARVC/D presenting with ES. Consecutive patients with a diagnosis of ARVC/D who underwent urgent catheter ablation for ES from five different French centers were retrospectively included. Between 2003 and 2015, 23 patients with ARVC/D (mean age 43.6 ± 16.7 years) underwent 24 VT catheter ablation procedures for ES. Median time from ARVC diagnosis to ES was 3.4 years [−4.4–39.2]. A total of 53% of patients had previous VT ablation and 78% had an implantable cardioverter-defibrillator. All but 2 patients were on beta-blockers and/or antiarrhythmic therapy. Four patients presented with cardiogenic shock. Diffuse RV structural abnormalities was present in 70% of patients, 61% had RV systolic dysfunction and 35% of patients had left ventricular ejection fraction < 50%. Only 8% of patients had more than 1 documented VT whereas 63% had multiple induced sustained VT. The clinical VT was inducible in 79% of the procedures. The median number of targeted VTs and sites were 1 [1–6] and 1 [1–5], respectively. Acute success defined as inability to induce any sustained VT was obtained in 53% but the clinical VT remained non-inducible in 100% of procedures. At 1 follow-up year, cumulative probability of freedom from VT recurrence was 75%. During a median follow-up time of 3.9 years (1 month–10 years), only one ES reoccurred when 17% patients developed end-stage heart failure with one death and three hearts transplantation unrelated to arrhythmia. Catheter ablation is efficient in reducing the arrhythmic burden in patients with advanced ARVC/D presenting with ES. However, ES could be associated with poor homodynamic long-term outcome.

2116Outcomes after catheter ablation for treatment of electrical storm in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia

2116Outcomes after catheter ablation for treatment of electrical storm in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia

Fosphenytoin for control of electrical storm in acute myocardial infarction and Purkinje fiber‐mediated arrhythmias

Purkinje fiber-mediated arrhythmias in the setting of acute myocardial infarction are poorly responsive to conventional antiarrhythmic therapy, increases overall mortality and often requires radiofrequency ablation (RFA) for control. In this study, we report the use of intravenous Fosphenytoin for the control of arrhythmic storm in patients with acute myocardial infarction. Six patients with acute myocardial infarction (5 AW/1 LW) and Purkinje-triggered ventricular arrhythmias refractory to conventional antiarrhythmics were treated with intravenous Fosphenytoin before considering RFA. Arrhythmia control was obtained in all patients after the initial bolus dose. Breakthrough episodes were seen in 5/6 within 24-36hours of the initial bolus, necessitating a second bolus. Complete arrhythmia control was obtained in all patients within 72hours and 5/6 patients were successfully discharged from the hospital. One patient succumbed to sepsis in hospital while another patient succumbed to Sub Dural Hematoma after 3 months. Intravenous Fosphenytoin should be considered before RFA for control of Purkinje fiber-mediated refractory arrhythmias in acute myocardial infarction patients.

Application of comprehensive nursing intervention in preventing complicated sympathetic storms in patients with acute myocardial infarction by coronary intervention

Objective To explore the effect of comprehensive nursing intervention in the prevention of sympathetic storms in patients with acute myocardial infarction. Methods A total of 101 cases of patients with acute myocardial infarction who underwent coronary intervention in our hospital from June 2014 to June 2017 were selected as the subjects of this study.All the patients were divided into control group(n=50) and observation group(n=51) by random number table method.The control group was treated with routine perioperative care, and the observation group was given comprehensive nursing intervention on the basis of routine nursing.The improvement of mood state, adverse reaction and sympathetic storm were evaluated and compared in different stages between the two groups. Results There was no significant difference in the scores of negative emotions (SAS, SDS) between the two groups (P> 0.05). SAS and SDS of control group had no significant change during hospitalization, 20 minutes before surgery and 24 hours after surgery.SAS and SDS scores of the observation group were lower than those of the control group 20 minutes before surgery and 24 hours after surgery.The difference had statistical significance (P<0.05). After nursing, the occurrence rate of sympathia storm risk events such as elevated blood pressure, tachycardia, pulse elevated and stenocardia of the observation group during perioperative period were lower than those of the control group, and the differences were statistically significant(P<0.05). During perioperative period, the incidence of sympathetic storm in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). Conclusions Comprehensive nursing intervention has a significant effect on the prevention of coronary intervention in patients with acute myocardial infarction.It can effectively adjust the emotional state of patients, reduce blood pressure and heart rate fluctuation, reduce the incidence of sympathetic storm, and improve surgical prognosis. Key words: Acute myocardial infarction; Comprehensive nursing intervention; Coronary intervention; Sympathetic storm

Long-term outcome of catheter ablation and other form of therapy for electrical storm in patients with implantable cardioverter-defibrillators

PurposeRadiofrequency catheter ablation (RFCA) for electrical storm (ES) has become a widely used therapeutic method. Its effectiveness in comparison to other forms of ES treatment is however uncertain.MethodsThis single-centre retrospective study investigated the long-term clinical outcome after RFCA for ES and compared long-time effects of ablation to other forms of treatment. The study population consisted of 70 consecutive patients hospitalised between January 2010 and June 2015 due to ES. Patients were recruited for the study if the following criteria were fulfilled: first ES caused by ventricular tachycardia (VT) or ventricular fibrillation (VF), implanted cardioverter defibrillator or cardiac resynchronisation therapy device and left ventricular ejection fraction < 50%. The follow-up data on VT/ES recurrence was obtained from pacemaker/implanted cardioverter defibrillator memory. Data on all-cause mortality was collected during outpatient visits or by telephone contact.ResultsOf the 70 patients enrolled, 28 (40%) were treated with RFCA (group A) and 42 (60%) received other forms of treatment for ES (group B). During a mean (±SD) 864 (629) days of follow-up, death occurred in 4 (14.3%) patients in the ablation group and in 16 (38.1%) patients treated with other methods [p = 0.03]. There was no significant between-group difference in VT/VF and ES recurrence. Statistical analysis revealed that the presence of cardiac resynchronisation therapy device during ES, stroke and/or transient ischaemic attack and lower baseline hematocrit level were the multivariate predictors of all-cause mortality.ConclusionsIn patients treated with RFCA for ES, all-cause mortality was significantly lower compared to the group treated with other methods.