Search

Objectives Automated sample delivery and laboratory acceptance systems (PTAS) may influence the hemolysis rate of blood samples due to g-forces, abrupt acceleration, and rapid deceleration. However, quantitative data regarding the rate of hemolysis in PTAS is limited. To fill this void, the effect of a pneumatic tube in combination with an acceptance system (PTAS) on the hemolysis rate was investigated in this study. Methods Lithium heparin plasma tubes were transported from different clinical departments to the hospital’s laboratory (a) by employees or (b) with an automated PTAS and analyzed for the presence of hemolysis based on a hemolysis index (HI) of >25. Hemolysis indices of 68.513 samples were retrieved from the laboratory information system before and after installation of the PTAS and were subjected to statistical analysis. Results A total of 32.614 samples were transported by employees, of which 3.815 samples (11.70%) were hemolytic, and 9.441 out of 35.899 samples delivered by PTAS (26.30%) were hemolytic. After the implementation of the PTAS, hemolysis rates increased in all departments. Conclusions Automated PTAS are associated with increased hemolysis rates. This has implications for routine patient management and should be considered for the transportation of samples used for the determination of hemolysis-sensitive laboratory parameters.

Summary Background In addition to respiratory symptoms, many patients with coronavirus disease 2019 (COVID-19) present with neurological complications. Several case reports and small case series described myoclonus in five patients suffering from the disease. The purpose of this article is to report on five critically ill patients with COVID-19-associated myoclonus. Material and methods The clinical courses and test results of patients treated in the study center ICU and those of partner hospitals are described. Imaging, laboratory tests and electrophysiological test results are reviewed and discussed. Results In severe cases of COVID-19 myoclonus can manifest about 3 weeks after initial onset of symptoms. Sedation is sometimes effective for symptom control but impedes respiratory weaning. No viral particles or structural lesions explaining this phenomenon were found in this cohort. Conclusion Myoclonus in patients with severe COVID-19 may be due to an inflammatory process, hypoxia or GABAergic impairment. Most patients received treatment with antiepileptic or anti-inflammatory agents and improved clinically.

Background Convalescent plasma (CP) containing antibodies derived from coronavirus disease 2019 (COVID-19) survivors has been proposed as a promising therapeutic option for severe COVID-19. Methods In our intensive care unit (ICU), 55 patients (46 male, median age 61 years) with PCR-confirmed COVID-19 (35 = 63.6% on mechanical ventilation, 7 = 14.5% on high-flow nasal oxygen, 12 = 20% on non-invasive ventilation, 1 = 1.8% without respiratory support) were treated with high-titre CP (200 mL per dose, range 1–6 doses, median 3 doses per patient, minimum titre > 1:100, Wantai test). 139 COVID-19 patients treated in the same ICU who did not receive CP served as control group. In 27 patients, the effect of CP on the individual levels of SARS-CoV-2 IgG antibodies was assessed by ELISA in serum sample pairs collected before and after CP transfusion. Results The first CP dose was administered at a median of 8 days after symptom onset. 13 patients in the plasma cohort died (28-day mortality 24.1%), compared to 42 (30.2%) in the cohort who did not receive CP (p = 0.5, Pearson Chi-squared test). Out of the 27 individuals investigated for the presence of IgG antibodies, 8 did not have detectable IgG levels before the first CP transfusion. In this subpopulation, 3 patients (37.5%) died. Not a single confirmed adverse reaction to CP was noted. Conclusions While adjunctive treatment with CP for severe and life-threatening COVID-19 was a very safe intervention, we did not observe any effect on mortality.

Background A significant portion of critically ill patients with COVID-19 are at high risk of developing ICU-acquired swallowing dysfunction (neurogenic dysphagia) as a consequence of requiring prolonged mechanical ventilation. Pharyngeal Electrical Stimulation (PES) is a simple and safe treatment for neurogenic dysphagia. Previously it has been shown that PES can restore safe swallowing in orally intubated or tracheotomised ICU-patients with neurogenic dysphagia following severe stroke. We report the case of a patient with severe neurogenic post-extubation dysphagia (PED) due to prolonged intubation and severe general muscle weakness related to COVID-19, which was successfully treated using PES.Case Presentation A 71-year-old female patient with confirmed SARS-CoV-2 infection developed neurogenic dysphagia following prolonged intubation in the ICU. To avoid aerosol generating procedures, her swallowing function was evaluated non-instrumentally as recommended by recently published international guidelines in response to the COVID-19 pandemic. Her swallowing function was markedly impaired and PES therapy was recommended. PES led to a rapid improvement of the post-extubation dysphagia (PED), as evaluated by bedside swallowing assessments using the Gugging Swallowing Screen (GUSS), Dysphagia Severity Rating Scale (DSRS) and diet screening using the Functional Oral Intake Scale (FOIS). The improved swallowing, as reflected by these measures, allowed this patient to transfer from the ICU to a non-intensive medical department five days after completing PES treatment.Conclusions PES treatment contributed to the restoration of a safe swallowing function in this critically ill patient with COVID-19 and ICU-acquired swallowing dysfunction. Early clinical bedside swallowing assessment and dysphagia intervention in COVID-19 patients is crucial to optimise their full recovery. Pharyngeal Electrical Stimulation may contribute to a safe and earlier ICU discharge of patients with ICU-acquired swallowing dysfunction. Earlier ICU discharge and reduced rates of re-intubation following PES can help alleviate some of the pressure on ICU bed capacity, which is critical in times of a health emergency such as the ongoing COVID-19 pandemic.

During treatment in an intensive care unit (ICU), traumatic brain injury (TBI) patients sometimes suffer an increase in intracranial pressure (ICP). An increase beyond a currently unknown and to-be-determined threshold is very often life-threatening and requires intervention by the clinical staff. Because this threshold value is considered unknown, ‘conventional wisdom’ of practitioners argue it to be 20 mm Hg. No published studies include statistical methods that could supply a rigorous outcome for the threshold value. Here, we use a clustering algorithm (K-means clustering) to find three-dimensional clusters of the 984 triples of ICP, temperature and patient state index (PSI, a proxy for sedation level). The algorithm outputs three clusters and two gaps. One gap separates two clusters from a third and is almost planar, and perpendicular to the ICP axis (implying a threshold across all temperatures and all sedation levels); the other is perpendicular to the temperature axis, which terminates at the aforementioned gap. The first gap provides a statistically rigorous threshold of 13.625 mm Hg for ICP intervention. The second gap defines a threshold temperature (36.5°C). The gap between the two temperature regimes does not continue into Cluster 3, implying that the intervention threshold for ICP is independent of temperature.