Intensive Care Treatment Research Articles

Vaccination Status and Number of Vaccine Doses Are Independently Associated with the PaO2/FiO2 Ratio on Admission in Hospitalized COVID-19 Patients.

Introduction: Coronavirus Disease-19 (COVID-19) vaccines reduce the risk of severe disease and mortality. However, the association between vaccination status and number of doses and the PaO2/FiO2 ratio, a clinical measure of hypoxemia associated with an increased risk of intensive care treatment and mortality, has not been investigated. Methods: We retrospectively assessed a consecutive series of 116 patients admitted to hospital with a primary diagnosis of COVID-19 between January and April 2022. Demographic, clinical, and laboratory data were collected within 24 h from admission. Results: There was a significant positive relationship between the number of vaccine doses and the PaO2/FiO2 ratio (r = 0.223, p = 0.012). This association remained significant after adjusting for confounders. Vaccinated patients had significantly higher PaO2/FiO2 ratios than the unvaccinated (median: 250; IQR: 195–309 vs. 200; IQR: 156–257, p = 0.013). Conclusion: These results highlight the importance of the number of vaccine doses received in reducing the degree of hypoxia on admission in hospitalized COVID-19 patients.

C3a and C5b-9 Differentially Predict COVID-19 Progression and Outcome.

SARS-CoV-2 infection may result in severe pneumonia leading to mechanical ventilation and intensive care (ICU) treatment. Complement activation was verified in COVID-19 and implicated as a contributor to COVID-19 pathogenesis. This study assessed the predictive potential of complement factors C3a and C5b-9 for COVID-19 progression and outcome. We grouped 80 COVID-19 patients into severe COVID-19 patients (n = 38) and critically ill (n = 42) and subdivided into non-intubated (n = 48) and intubated (n = 32), survivors (n = 57) and non-survivors (n = 23). Results: A significant increase for C3a and C5b-9 levels was observed between: severely and critically ill patients (p < 0.001 and p < 0.0001), non-intubated vs intubated (p < 0.001 and p < 0.05), survivors vs non-survivors (p < 0.001 and p < 0.01). ROC analysis for the need for ICU treatment revealed a higher AUC for C5b-9 (0.764, p < 0.001) compared to C3a (AUC = 0.739, p < 0.01). A higher AUC was observed for C3a for the need for intubation (AUC = 0.722, p < 0.001) or mortality (AUC = 0.740, p < 0.0001) compared to C5b-9 (need for intubation AUC = 0.656, p < 0.05 and mortality AUC = 0.631, p = NS). Combining the two markers revealed a powerful prediction tool for ICU admission (AUC = 0.773, p < 0.0001), intubation (AUC = 0.756, p < 0.0001) and mortality (AUC = 0.753, p < 0.001). C3a and C5b-9 may be considered as prognostic tools separately or in combination for the progression and outcome of COVID-19.

Functional limitations 12 months after SARS-CoV-2 infection correlate with initial disease severity: An observational study of cardiopulmonary exercise capacity testing in COVID-19 convalescents

BackgroundCardiopulmonary Exercise Testing (CPET) provides a comprehensive assessment of pulmonary, cardiovascular and musculosceletal function. Reduced CPET performance could be an indicator for chronic morbidity after COVID-19. MethodsPatients ≥18 years with confirmed PCR positive SARS-CoV-2 infection were offered to participate in a prospective observational study of clinical course and outcomes of COVID-19. 54 patients completed CPET, questionnaires on respiratory quality of life and performed pulmonary function tests 12 months after SARS-CoV-2 infection. ResultsAt 12 months after SARS-CoV-2 infection, 46.3% of participants had a peak performance and 33.3% a peak oxygen uptake of <80% of the predicted values, respectively. Further impairments were observed in diffusion capacity and ventilatory efficiency. Functional limitations were particularly pronounced in patients after invasive mechanical ventilation and extracorporeal membrane oxygenation treatment. Ventilatory capacity was reduced <80% of predicted values in 55.6% of participants, independent from initial clinical severity. Patient reported dyspnea and respiratory quality of life after COVID-19 correlated with CPET performance and parameters of gas exchange. Risk factors for reduced CPET performance 12 months after COVID-19 were prior intensive care treatment (OR 5.58, p = 0.004), SGRQ outcome >25 points (OR 3.48, p = 0.03) and reduced DLCO (OR 3.01, p = 0.054). ConclusionsFunctional limitations causing chronic morbidity in COVID-19 survivors persist over 12 months after SARS-CoV-2 infection. These limitations were particularly seen in parameters of overall performance and gas exchange resulting from muscular deconditioning and lung parenchymal changes. Patient reported reduced respiratory quality of life was a risk factor for adverse CPET performance.

Advances in the study of subclinical AKI biomarkers.

Acute kidney injury (AKI) is a prevalent and serious illness in all clinical departments, with a high morbidity and death rate, particularly in intensive care units, where prevention and treatment are crucial. As a result, active prevention, early detection, and timely intervention for acute kidney injury are critical. The current diagnostic criteria for acute kidney injury are an increase in serum creatinine concentration and/or a decrease in urine output, although creatinine and urine output merely reflect changes in kidney function, and AKI suggests injury or damage, but not necessarily dysfunction. The human kidney plays a crucial functional reserve role, and dysfunction is only visible when more than half of the renal mass is impaired. Tubular damage markers can be used to detect AKI before filtration function is lost, and new biomarkers have shown a new subset of AKI patients known as “subclinical AKI.” Furthermore, creatinine and urine volume are only marginally effective for detecting subclinical AKI. As a result, the search for new biomarkers not only identifies deterioration of renal function but also allows for the early detection of structural kidney damage. Several biomarkers have been identified and validated. This study discusses some of the most promising novel biomarkers of AKI, including CysC, NGAL, KIM-1, lL-18, L-FABP, IGFBP7, TIMP-2, Clusterin, and Penkid. We examine their performance in the diagnosis of subclinical AKI, limitations, and future clinical practice directions.

The relationship between lung fibrosis, the epidermal growth factor receptor, and disease outcomes in COVID-19 pneumonia: a postmortem evaluation.

The aim of this study was to examine the relationship between the severity of fibrosis in lung tissue and epidermal growth factor receptor (EGFR) positivity in patients who died due to COVID-19 pneumonia, demographic characteristics, comorbidities, biochemical values, and treatments received. Fifty patients who died from COVID-19 pneumonia were included in the study. Demographic data for the patients, laboratory tests, thorax computerized tomography findings, comorbidities, length of stay in the intensive care unit (ICU), intubation times, and treatments given were noted. Postmortem Tru-cut lung biopsy was performed. EGFR positivity was examined and grouped as negative, mild, moderate, and severe. Data were analyzed statistically. EGFR involvement was negative in 11 (22%), mild in 20 (40%), moderate in 13 (26%), and severe in 6 (12%) patients. The mean C-reactive protein (CRP) values, D-dimer values, and mean length of stay in the ICU were found to be significantly different between the groups (p = 0.024; p = 0.003; p = 0.016, respectively). Methylprednisolone dose and the presence of comorbidity did not differ significantly in EGFR involvement (p = 0.79; p = 0.98, respectively). CRP and D-dimer values can be used as a guide to assess the severity of pulmonary fibrosis that develops in severe COVID-19 pneumonia patients. The dose of methylprednisolone used does not make a significant difference in the severity of fibrosis.Trail registration: Clinical Trials.gov identifier date and number 01/13/2022 NCT05290441.

The role of hypoxia and inflammation in the regulation of iron metabolism and erythropoiesis in COVID-19: The IRONCOVID study.

Coronavirus Disease (COVID‐19) can be considered as a human pathological model of inflammation combined with hypoxia. In this setting, both erythropoiesis and iron metabolism appear to be profoundly affected by inflammatory and hypoxic stimuli, which act in the opposite direction on hepcidin regulation. The impact of low blood oxygen levels on erythropoiesis and iron metabolism in the context of human hypoxic disease (e.g., pneumonia) has not been fully elucidated. This multicentric observational study was aimed at investigating the prevalence of anemia, the alterations of iron homeostasis, and the relationship between inflammation, hypoxia, and erythropoietic parameters in a cohort of 481 COVID‐19 patients admitted both to medical wards and intensive care units (ICU). Data were collected on admission and after 7 days of hospitalization. On admission, nearly half of the patients were anemic, displaying mild‐to‐moderate anemia. We found that hepcidin levels were increased during the whole period of observation. The patients with a higher burden of disease (i.e., those who needed intensive care treatment or had a more severe degree of hypoxia) showed lower hepcidin levels, despite having a more marked inflammatory pattern. Erythropoietin (EPO) levels were also lower in the ICU group on admission. After 7 days, EPO levels rose in the ICU group while they remained stable in the non‐ICU group, reflecting that the initial hypoxic stimulus was stronger in the first group. These findings strengthen the hypothesis that, at least in the early phases, hypoxia‐driven stimuli prevail over inflammation in the regulation of hepcidin and, finally, of erythropoiesis.

EUTHYROID SICK SYNDROME: PREVALENCE AND PROGNOSIS IN ELDERLY PATIENTS WITH SEPSIS

Objective: Euthyroid sick syndrome (ESS) manifests by the decreased level of serum free thyroid hormones and with the normal or decreased secretion of thyroid-stimulating hormone. The study aims to identify the prevalence of ESS in elderly patients with sepsis and evaluate its possible effect on prognosis and mortality. Material and Methods: Two hundred and three patients diagnosed with sepsis were prospectively evaluated. They were divided into two groups, a geriatric group (≥65 years), and a control group (&lt;65 years). Patients with low free T3 (fT3) and/or free T4 (fT4) were considered to have euthyroid-sick syndrome. The demographic characteristics, comorbidities, laboratory results, hospitalization data, intensive care unit (ICU) duration, treatment outcomes, and mortality rates of the patients were recorded and compared. Results: The incidence of ESS was significantly higher in the geriatric group (88.5% vs. 77.8%) (p=0.04). There was no difference between the groups in regard to mortality rate and ICU stay. However, 91.3% of deceased patients in the entire group and all deceased patients in the geriatric group were ESS (+) patients. The mean fT3 was significantly decreased in the deceased patients, and ICU patients (p=0.017). Additionally, the decreased levels of fT4 in both the entire group and the geriatric group were significantly associated with mortality and ICU stay (p-value: 0.020 and 0.019, respectively). Conclusions: The higher prevalence of ESS (88.5%) in elderly patients with sepsis was clearly demonstrated. Additionally, approximately two-fold higher mortality and ICU stay risk was documented in the ESS (+) group. Thus, simply screening of ESS in septic elderly patients will certainly contribute to treatment decisions and early prediction of complicated clinical course and poor prognosis.

I-FABP as a Potential Marker for Intestinal Barrier Loss in Porcine Polytrauma.

Polytrauma and concomitant hemorrhagic shock can lead to intestinal damage and subsequent multiple organ dysfunction syndrome. The intestinal fatty acid-binding protein (I-FABP) is expressed in the intestine and appears quickly in the circulation after intestinal epithelial cell damage. This porcine animal study investigates the I-FABP dynamics in plasma and urine after polytrauma. Furthermore, it evaluates to what extent I-FABP can also act as a marker of intestinal damage in a porcine polytrauma model. Eight pigs (Sus scrofa) were subjected to polytrauma which consisted of lung contusion, tibial fracture, liver laceration, and hemorrhagic shock followed by blood and fluid resuscitation and fracture fixation with an external fixator. Eight sham animals were identically instrumented but not injured. Afterwards, intensive care treatment including mechanical ventilation for 72 h followed. I-FABP levels in blood and urine were determined by ELISA. In addition, immunohistological staining for I-FABP, active caspase-3 and myeloperoxidase were performed after 72 h. Plasma and urine I-FABP levels were significantly increased shortly after trauma. I-FABP expression in intestinal tissue showed significantly lower expression in polytraumatized animals vs. sham. Caspase-3 and myeloperoxidase expression in the immunohistological examination were significantly higher in the jejunum and ileum of polytraumatized animals compared to sham animals. This study confirms a loss of intestinal barrier after polytrauma which is indicated by increased I-FABP levels in plasma and urine as well as decreased I-FABP levels in immunohistological staining of the intestine.

Outcome of necrotizing fasciitis and Fournier's gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years

BackgroundNecrotizing soft tissue infections (NSTI) require immediate radical debridement, broad-spectrum antibiotics and intensive care. Hyperbaric oxygen therapy (HBOT) may be performed adjunctively, but unequivocal evidence for its benefits is still lacking.MethodsWe performed a retrospective single-center study including 192 patients with necrotizing fasciitis or Fournier's gangrene to assess in-hospital mortality and outcome dependent on patient, disease and treatment characteristics with or without HBOT.ResultsThe in-hospital mortality rate was 27.6%. Factors associated with increased mortality according to multivariate analysis were higher age, affection of multiple or problem localizations (odds ratio (OR) = 2.88, P = 0.003), ineligibility for HBOT despite clinical indication (OR = 8.59, P = 0.005), pathogens in blood cultures (OR = 3.36, P = 0.002), complications (OR = 10.35, P < 0.001) and sepsis/organ dysfunction (OR = 19.58, P < 0.001). Factors associated with better survival included vacuum-assisted wound closure (OR = 0.17, P < 0.001), larger number of debridements (OR = 0.83, P < 0.001) and defect closure with mesh graft (OR = 0.06, P < 0.001) or flap (OR = 0.09, P = 0.024). When participants were stratified into subgroups without requirement of HBOT (n = 98), treated with HBOT (n = 83) and ineligible for HBOT due to contraindications (n = 11), the first two groups had similar survival rates (75.5% vs. 73.5%) and comparable outcome, although patients with HBOT suffered from more severe NSTI, reflected by more frequent affection of multiple localizations (P < 0.001), sepsis at admission (P < 0.001) and intensive care treatment (P < 0.001), more debridements (P < 0.001) and a larger number of antibiotics (P = 0.001). In the subgroup ineligible for HBOT, survival was significantly worse (36.4%, P = 0.022).ConclusionThese results point to a benefit from HBOT for treatment of NSTI in critically ill patients.

Dynamic Thiol Disulphide Homeostasis in the Follow-Up of the Prognosis of Patients Treated for COVID-19 in the Intensive Care Unit.

Introduction: Evaluation of the prognosis in the early period of intensive care patients and arranging the treatment accordingly is of vital importance. In the present study, we investigated whether serum thiol/disulphide concentration can be used in the follow-up of prognosis in the early period in patients with COVID-19 under intensive care.Methods: The study included 25 patients [their ages were between 19 and 92; 10 (40%) were male and 15 (60%) were female] who were diagnosed with COVID-19 and treated in the intensive care unit (ICU). The patients were followed for four weeks. On the first, third, and fifth days of intensive care treatment, venous blood samples were taken from the patients to analyze the thiol/disulphide parameters, and coma scores were calculated. Statistical analyses were conducted to evaluate the relationship between thiol/disulphide levels and the prognosis of COVID-19 patients.Results: At the end of the four-week follow-up of the patients included in the study, 9 were discharged and 16 died. In patients who died, the relationship between thiol/disulphide homeostasis parameters and coma scores was not statistically significant. Meanwhile, in discharged patients, the relationship between disulphide concentration, total thiol, and coma scores was statistically significant.Conclusion: The relationship between thiol/disulphide homeostasis and coma scores in COVID-19 patients treated in the intensive care unit may help to evaluate the prognosis of the disease in the early period, thus the effectiveness of medical intervention.

Nutritional support for preterm infants at the outpatient stage: how to maintain continuity? A review

Globally, 15 million babies are born prematurely each year. Improvements in intensive care methods and treatment approaches have significantly improved the survival rate of this vulnerable group of patients. Suctioning of these babies does not end when they are discharged from hospital, but continues on an outpatient basis. In modern practice, the term "catch-up growth" is used to mean compensatory acceleration of growth of the organism after a period of stunted growth, particularly as a result of a lack of nutrients. To assess catch-up growth in the outpatient phase, body weight, height and head circumference should be assessed weekly or every 2 weeks during the first 46 weeks after discharge and then according to an individual plan until the child reaches the parameters of full-term peers, making adjustments for postconceptual or adjusted age. Different scales can be used to assess the physical development of preterm infants, such as the Fenton scale or the Intergrowth 21st, each of which has advantages and disadvantages. Maintaining breastfeeding of premature babies after discharge from hospital should remain our goal because of the many advantages, but at the same time on purely breastfeeding a premature baby will not receive sufficient protein, energy and fatty acids. This is where the neonatologist and paediatrician alike come in handy with breast milk fortifiers, whose application in practice is much easier than it seems. According to the "Programme for the Optimisation of Infant Feeding in the First Year of Life in the Russian Federation", breast-milk fortification should be carried out tentatively until 4052 weeks of post-conceptional age (provided the catch-up parameters of 1025th centile have been reached). If the child is artificially fed, adapted prematurity formula (with a protein content of 2.0 to 2.2 mg/100ml) should be continued until reaching the 1025th centile, with caloric intake calculated on the basis of 130 kcal/kg with a subsequent reduction. Although premature infants are a very vulnerable group of patients and require a special approach from paediatricians, the seeming difficulties of enteral feeding are quickly resolved if simple algorithms and proven approaches are followed.

Hospitalized patients dying with SARS-CoV-2 infection-An analysis of patient characteristics and management in ICU and general ward of the LEOSS registry.

COVID-19 is a severe disease with a high need for intensive care treatment and a high mortality rate in hospitalized patients. The objective of this study was to describe and compare the clinical characteristics and the management of patients dying with SARS-CoV-2 infection in the acute medical and intensive care setting. Descriptive analysis of dying patients enrolled in the Lean European Open Survey on SARS-CoV-2 Infected Patients (LEOSS), a non-interventional cohort study, between March 18 and November 18, 2020. Symptoms, comorbidities and management of patients, including palliative care involvement, were compared between general ward and intensive care unit (ICU) by univariate analysis. 580/4310 (13%) SARS-CoV-2 infected patients died. Among 580 patients 67% were treated on ICU and 33% on a general ward. The spectrum of comorbidities and symptoms was broad with more comorbidities (≥ four comorbidities: 52% versus 25%) and a higher age distribution (>65 years: 98% versus 70%) in patients on the general ward. 69% of patients were in an at least complicated phase at diagnosis of the SARS-CoV-2 infection with a higher proportion of patients in a critical phase or dying the day of diagnosis treated on ICU (36% versus 11%). While most patients admitted to ICU came from home (71%), patients treated on the general ward came likewise from home and nursing home (44% respectively) and were more frequently on palliative care before admission (29% versus 7%). A palliative care team was involved in dying patients in 15%. Personal contacts were limited but more often documented in patients treated on ICU (68% versus 47%). Patients dying with SARS-CoV-2 infection suffer from high symptom burden and often deteriorate early with a demand for ICU treatment. Therefor a demand for palliative care expertise with early involvement seems to exist.

Early but reversible haemostatic changes in a-symptomatic females expressing COVID-19 antibodies

The coronavirus, COVID-19 pandemic spread across the globe in 2020, with an initial high case mortality in those requiring intensive care treatment due to serious complication. A vaccine programme was quickly developed and currently the UK is one of highest double vaccinated and boosted countries in the world. Despite tremendous efforts by the UK, new cases of COVID-19 are still occurring, due to viral mutation. A major problem associated with COVID-19 is the large a-symptomatic spread within the population.Little investigation into the a-symptomatic population has been carried out and therefore we pose that the residual effects of a-symptomatic infection is still largely unknown. Prior to mass vaccination, a multi-phased single cohort study of IgM and IgG COVID-19 antibody prevalence and the associated haemostatic changes were assessed in a Welsh cohort of 739 participants, at three time points. Positive antibody participants with age and gender matched negative antibody controls were assessed at 0, 3 and 6 months. Antibody positive females appeared to have lower antibody responses in comparison to their a-symptomatic male counterparts. Despite this initial testing showed a unique significant increase in TRAP-6-induced platelet aggregation, prothrombin time (PT) and clot initiation time. Despite coagulation parameters beginning to return to normal at 3 months, significant decreases are observed in both haemoglobin and haematocrit levels. The production of extracellular vesicles (EV) was also determined in this study. Although the overall number of EV does not change throughout the study, at the initial 0 months' time point a significant increase in the percentage of circulating pro-coagulant platelet derived EV is seen, which does not appear to be related to the extent of platelet activation in the subject.We conclude that early, but reversible changes in haemostatic pathways within the a-symptomatic, female, antibody positive COVID-19 individuals are present. These changes may be key in identifying a period of pro-coagulative risk for a-symptomatic female patients.

SARS-CoV-2, COVID-19, and Reproduction: Effects on Fertility, Pregnancy, and Neonatal Life.

Since its discovery in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread over the world, having a huge impact on people’s lives and health. The respiratory system is often targeted in people with the coronavirus disease 2019 (COVID-19). The virus can also infect many organs and tissues in the body, including the reproductive system. The consequences of the SARS-CoV-2 infection on fertility and pregnancy in hosts are poorly documented. Available data on other coronaviruses, such as severe acute respiratory syndrome (SARS-CoV) and Middle Eastern Respiratory Syndrome (MERS-CoV) coronaviruses, identified pregnant women as a vulnerable group with increased pregnancy-related complications. COVID-19 was also shown to impact pregnancy, which can be seen in either the mother or the fetus. Pregnant women more likely require COVID-19 intensive care treatment than non-pregnant women, and they are susceptible to giving birth prematurely and having their newborns admitted to the neonatal intensive care unit. Angiotensin converting enzyme 2 (ACE2), a key player of the ubiquitous renin-angiotensin system (RAS), is the principal host cellular receptor for SARS-CoV-2 spike protein. ACE2 is involved in the regulation of both male and female reproductive systems, suggesting that SARS-CoV-2 infection and associated RAS dysfunction could affect reproduction. Herein, we review the current knowledge about COVID-19 consequences on male and female fertility, pregnant women, and their fetuses. Furthermore, we describe the effects of COVID-19 vaccination on reproduction.

Pandemi servisinde yatan COVID-19 hastalarının yatış kan değerleri ile prognozlarının öngörülebilirliğinin değerlendirilmesi: Retrospektif bir çalışma

Objectives: Prognostic predictors are important for the rapid response and optimal use of the health system during the ongoing COVID-19 pandemic. It has been reported that many hematological parameters may deteriorate starting from the early stages in COVID-19 patients. The aim of the present study was to determine the relationship between hematological and biochemical parameters of patients followed in the service, intensive care hospitalization, and mortality. Methods: The present study is a retrospective study. Participants consist of patients hospitalized in the pandemic service between 1.09.2021 and 15.12.2021. All 366 patients hospitalized in the relevant date range were evaluated, and after exclusion criteria, the study was conducted on 242 patients. Polymerase chain reaction tests of all patients were positive. The hematological and biochemical parameters of the patients on the first day of hospitalization, their age, height, weight, gender, chronic diseases, and steroid treatments were recorded. According to service exits, patients were categorized into three groups: transfer to intensive care (discharged after intensive care treatment), resulting in death (transferred from the ward to intensive care unit and died without discharge), and discharged home (discharged home from the ward without intensive care admission). Results: Of the 242 patients included in the study, 135 (55.8%) were female and 107 (44.2%) were male. Of the patients, 213 (88%) were discharged home from the ward, 8 (3.3%) were transferred to the intensive care unit, and 21 (8.7%) died. The mean age of the patients who died (69.6±13.14 years) was significantly higher than of those transferred to the intensive care unit (61.25±15.75) and discharged home from the service (68.91±12.97). When the patients were divided into two groups as survived and dead; age, lymphocyte, blood urea nitrogen, glomerular filtration rate, aspartate aminotransferase, albumin, C reactive protein, procalcitonin, D-dimer, platelet lymphocyte ratio (TLO) and neutrophil lymphocyte Ratio (NLO) values were significantly different between the two groups. According to the regression model created with significant values, age, high NLO and D-dimer, and low TLO were found to be independent risk factors for mortality. Conclusion: In the present study, age, D-dimer, TLO and NLO measured on the day of hospitalization were found to be independent prognostic markers for mortality in COVID-19 patients.

Disease Course and Patient’s Characteristics in a Regional First Level Hospital in Western-Germany During the First Three Covid-19 Surges from March 2020 to July 2021

The worldwide spread of SARS-CoV-2 profoundly affected almost all aspects of public life and challenged international and national health institutions of all different medical care levels including Europe up from the very beginning in 2020 until today. Public and press perception might have been weighed somehow towards third level health care providers offering treatment options like ECMO therapy for Covid-19 patients with the worst disease course, the majority of patients who needed hospital care were treated in hospitals of the first level. These hospitals provided about 50% of intensive care treatments in the federal state of Rhineland Palatinate (RLP) in Germany, too [1]. According to the Destatis [2] about 71000 additional deaths were registered in Germany during the first 12 months (02/2020 – 02/2021) of pandemic of which about 50000 could be attributed to Covid-19 as given in the medical death reports. However, only few data has been published on the concrete disease course and patient´s outcome on the scale of a single treatment site. Thus, this analysis provides routine data on patient´s characteristics, treatment modalities and outcome in a single first level hospital in RLP during the first three Covid-19 surges during 03/2020 – 07/2021.

The risk factors of the functional status, quality of life, and family psychological status in children with postintensive care syndrome: A cohort study.

Intensive care treatment has a side effect of several impairments after hospital discharge, known as postintensive care syndrome (PICS). PICS in children must be well evaluated because PICS can affect their global development and quality of life. Our specific aims are to determine the impact of intensive care treatment and the risk factors which contribute to PICS. In this observational cohort study, we identified critically ill children treated in intensive care units (ICUs) for more than 24 h and survived. We evaluated the internal and external risk factors of the patients in the intensive care. We interviewed their parents to define the functional status and quality of life of the patients in 7 days before ICU admission and the psychological status of the family at the time of intensive care admission. The interview was repeated in 3 months after the intensive care discharge. There was a significant decrease in functional status and quality of life after intensive care treatment (P < 0.001). However, none of the internal risk factors were significantly associated with PICS. Neurologic involvement in the disease was associated with the significantly reduced functional status of patients, while the severity of the disease was significantly associated with both functional status and quality of life. Our study also showed a significant psychological disorder of the family in the intensive care. The occurrence of PICS in children was associated with the severity of the disease, decreased the functional status and quality of life, and contributed to psychological disorders for the family.

Psychological aspects during and after intensive care treatment of ARDS

Approximately 10% of all patients requiring intensive care develop acute respiratory distress syndrome (ARDS). The COVID-19 pandemic led to an accumulation of patients with severe ARDS. The experience of this severe respiratory failure is accompanied by feelings of existential anxiety in many patients.The complexity of the challenges and stresses that the disease and its treatment pose for the ARDS patient require an early multiprofessional approach to treatment already during intensive care. Psychological approaches are suitable to support the patient as well as the relatives in coping with the disease and to minimise risks for potential subsequent stress. Despite the long-term impairments of patients who have survived ARDS and the resulting need for follow-up care, suitable multimodal follow-up care concepts and the necessary care structures are still lacking. The article presents the psychological support during and after the intensive care treatment of ARDS.

THE ROLE OF PHYSICAL MEDICINE AND REHABILITATION IN LONG COVID-19 MANAGEMENT

COVID-19 is an infectious disease that can have a multi-system involvement, most notably, the respiratory tract. After acute infection, a considerable proportion of patients suffer from persistent symptoms and signs, defined as long COVID-19. Depending on the affected systems and organs, patients can experience various clinic pictures. Rehabilitation approaches serve a crucial role in providing functional recovery and improving quality of life for COVID-19 survivors. As a result of the wideness of the clinical spectrum of the long COVID-19, rehabilitation practices differ according to the affected systems. Therefore, the formation of multidisciplinary rehabilitation teams is an inevitable necessity. The establishment of specific centers for long COVID-19 rehabilitation will be beneficial. If it is not possible, existing rehabilitation centers should be strengthened for this purpose. Since the pulmonary system and respiratory tract are the most affected structures, one of the main issues to be considered in long COVID-19 cases is cardiopulmonary rehabilitation. Patients experience musculoskeletal disorders such as atrophy, sarcopenia, poor physical performance and contracture due to long-term hospitalization, intensive care treatment, quarantine practices and immobilization. Rehabilitation practices also focus on these disorders. All rehabilitation practices in long COVID-19 patients should start with low intensity, and parameters such as intensity and frequency should be increased as the patient's tolerance improves. In high-risk cases, parameters including oxygen saturation, blood pressure, and heart rhythm should be monitored. Health-care authorities should prioritize the rehabilitation of the long COVID-19 syndrome and invest in this area. Authorities, physicians and patients should collaborate to facilitate long COVID-19 rehabilitation and to establish a self-contained system.

Nutritional priorities in patients with severe COVID-19.

The COVID-19 pandemic has altered the profile of critical care services internationally, as professionals around the globe have struggled to rise to the unprecedented challenge faced, both in terms of individual patient management and the sheer volume of patients that require treatment and management in intensive care. This review article sets out key priorities in nutritional interventions during the patient journey, both in the acute and recovery phases. The current review covers the care of the acutely unwell patient, and the evidence base for nutritional interventions in the COVID-19 population. One of the biggest differences in caring for critically ill patients with acute respiratory failure from COVID-19 is often the time prior to intubation. This represents specific nutritional challenges, as does nursing patients in the prone position or in the setting of limited resources. This article goes on to discuss nutritional support for COVID-19 sufferers as they transition through hospital wards and into the community. Nutritional support of patients with severe COVID-19 is essential. Given the longer duration of their critical illness, combined with hypermetabolism and energy expenditure, patients with COVID-19 are at increased risk for malnutrition during and after their hospital stay.