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ExtraCorporeal Liver Support (ECLS) systems were developed with the aim of supporting the liver in its detoxification function by clearing the blood from hepatic toxic molecules. We conducted a retrospective comparative analysis on patients presenting with liver failure who were treated with different extracorporeal techniques in our intensive care unit to evaluate and compare their detoxification abilities. To verify the effectiveness of the techniques, mass balance (MB) and adsorption per hour were calculated for total bilirubin (TB), direct bilirubin (DB), and bile acids (BA) from the concentrations measured. MB represents the total amount (mg or mcMol) of a molecule removed from a solution and is the only representative parameter to verify the purification effectiveness of one system as it is not affected by the continuous production of the molecules, released in the circulation from the tissues, as it is the case for the reduction rate (RR). The total adsorption per hour is calculated by the ratio between MB and the time duration and shows the adsorption ability in an hour. Our comparative study shows the superior adsorption capability of CytoSorb system regarding TB, DB, and BA, evaluated through the MB and adsorption per hour, in comparison with CPFA, MARS, Prometheus, and PAP. In conclusion, as extracorporeal purification in liver failure could be considered useful for therapeutic purposes, Cytosorb, being more performing than other systems considered, could represent the device of first choice. [ABSTRACT FROM AUTHOR]

Background: In COVID-19, higher than expected level of intrapulmonary shunt has been described, in association with a discrepancy between the initial relatively preserved lung mechanics and the hypoxia severity. This study aim was to measure the shunt fraction and variations of PaO2/FiO2 ratio and oxygen alveolar-arterial gradient (A-a O2) at different FiO2. Methods: Shunt was measured by a non-invasive system during spontaneous breathing in 12 patients hospitalized at COVID-19 Semi-Intensive Care Unit of Papa Giovanni XXIII Hospital, Bergamo, Italy, between October 22 and November 23, 2020. Results: Nine patients were men, mean age (±SD) 62±15 years, mean BMI 27.5±4.8 Kg/m2. Systemic hypertension, diabetes type 2 and previous myocardial infraction were referred in 33%, 17%, and 7%, respectively. Mean PaO2/FiO2 ratio was 234±66 and 11 patients presented a bilateral chest X-ray involvement. Mean shunt was 21±6%. Mainly in patients with a more severe respiratory failure, we found a progressive decrease of PaO2/FiO2 ratio with higher FiO2. Considering (A-a O2), we found a uniform tendency to increase with FiO2 increasing. Even in this case, the more severe were the patients, the higher was the slope, suggesting FiO2 insensitiveness due to a shunt effect, as strengthened by our measurements. Conclusion: Relying on a single evaluation of PaO2/FiO2 ratio, especially at high FiO2, could be misleading in COVID-19. We propose a two steps evaluation, the first at low SpO2 value (e.g., 92-94%) and the second one at high FiO2 (i.e., >0.7), allowing to characterize both the amendable (ventilation/perfusion mismatch), and the fixed (shunt) contribution quote of respiratory impairment, respectively. [ABSTRACT FROM AUTHOR]

Potential role of subcutaneous tocilizumab injections in patients with COVID-19 associated pneumonia Guaraldi et al.1 found a significant reduction in risk of invasive mechanical ventilation or death in patients with severe coronavirus disease 2019 (COVID-19) pneumonia who were treated with either I.V. or S.C. tocilizumab and standard of care, compared with those treated with standard of care only. Eleven (45.8%) had AST/ALT increases (<400 IU/L, but for one intensive care unit patient with multiorgan failure who had 4900/5100 U/L), four patients had thrombocytopenia (all higher than 55 × 10 SP 9 sp /L), three had mild neutropenia (all higher than 800 cells/mm SP 3 sp ). [Extracted from the article]

An editorial is presented on the Papa Giovanni XXIII Bergamo Hospital at the time of the COVID-19 outbreak. Topics inlcude the 2019 novel COVID-19 has identified as the agent responsible for the first pneumonia cases of unknown origin in Wuhan, the World Health Organization has declared the COVID-19 a public health emergency of international concern, and the hematology laboratory has seen a progressive reduction of tests required for outpatients versus inpatients due to COVID-19.

COVID-19 provoking Guillain-Barré syndrome: The Bergamo case series Keywords: COVID-19; critical illness; Guillain-Barré syndrome; mechanical ventilation EN COVID-19 critical illness Guillain-Barré syndrome mechanical ventilation e84 e85 2 09/17/21 20211001 NES 211001 ACKNOWLEDGEMENTS No funding was obtained for the present study. Amongst 1832 COVID-19 patients hospitalized between 23 February and 21 May, we diagnosed 17 cases of Guillain-Barré syndrome (GBS). [Extracted from the article]