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Abstract Previous studies suggested that ongoing treatment with renin–angiotensin–aldosterone system (RAAS) inhibitor drugs may alter the course of SARS‐CoV‐2 infection and promote the development of more severe forms of the disease. The authors conducted a comparative, observational study to retrospectively analyze data collected from 394 patients admitted to ICU due to SARS‐CoV‐2 pneumonia. The primary aim of the study was to establish an association between the use of RAAS inhibitor drugs and mortality in the ICU. The secondary aims of the study were to establish an association between the use of RAAS inhibitor drugs and clinical severity at ICU admission, the need for tracheal intubation, total days of mechanical ventilation, and the ICU length of stay. The authors found no statistically significant difference in ICU mortality between patients on RAAS inhibitor drugs at admission and those who were not (31.3% versus 26.2% mortality, p‐value 0.3). However, the group of patients taking RAAS inhibitor drugs appeared to be more critical at ICU admission, and this difference became statistically significant in the subgroup of non‐hypertensive patients. ICU mortality in the subgroup of non‐hypertensive patients treated with RAAS inhibitor drugs also tended to be higher. Overexpression of the angiotensin‐converting enzyme 2 (ACE2) in human cells, induced by RAAS inhibitor drugs, promotes viral entry‐replication of SARS‐CoV‐2 and alters the basal balance of the RAAS, which may explain the findings observed in the present study. These phenomena may be amplified in non‐hypertensive patients treated with RAAS inhibitor therapy.

Abstract The liver is a complex organ that performs vital functions of synthesis, heat production, detoxification and regulation; its failure carries a highly critical risk. At the end of the last century, some artificial liver devices began to develop with the aim of being used as supportive therapy until liver transplantation (bridge-to-transplant) or liver regeneration (bridge-to-recovery). The well-recognized devices are the Molecular Adsorbent Recirculating System™ (MARS™), the Single-Pass Albumin Dialysis system and the Fractionated Plasma Separation and Adsorption system (Prometheus™). In the following years, experimental works and early clinical applications were reported, and to date, many thousands of patients have already been treated with these devices. The ability of artificial liver support systems to replace the liver detoxification function, at least partially, has been proven, and the correction of various biochemical parameters has been demonstrated. However, the complex tasks of regulation and synthesis must be addressed through the use of bioartificial systems, which still face several developmental problems and very high production costs. Moreover, clinical data on improved survival are conflicting. This paper reviews the progress achieved and new data published on artificial liver support systems over the past decade and the prospects for these devices.

Abstract Background The rapid spread of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), and coronavirus disease 2019 (COVID‐19), has caused more than 3.9 million cases worldwide. Currently, there is great interest to assess venous thrombosis prevalence, diagnosis, prevention, and management in patients with COVID‐19. Objectives To determine the prevalence of venous thromboembolism (VTE) in critically ill patients with COVID‐19, using lower limbs venous ultrasonography screening. Methods Beginning March 8, we enrolled 25 patients who were admitted to the intensive care unit (ICU) with confirmed SARS‐CoV‐2 infections. The presence of lower extremity deep vein thrombosis (DVT) was systematically assessed by ultrasonography between day 5 and 10 after admission. The data reported here are those available up to May 9, 2020. Results The mean (± standard deviation) age of the patients was 68 ± 11 years, and 64% were men. No patients had a history of VTE. During the ICU stay, 8 patients (32%) had a VTE; 6 (24%) a proximal DVT, and 5 (20%) a pulmonary embolism. The rate of symptomatic VTE was 24%, while 8% of patients had screen‐detected DVT. Only those patients with a documented VTE received a therapeutic anticoagulant regimen. As of May 9, 2020, 5 patients had died (20%), 2 remained in the ICU (8%), and 18 were discharged (72%). Conclusions In critically ill patients with SARS‐CoV‐2 infections, DVT screening at days 5‐10 of admission yielded a 32% prevalence of VTE. Seventy‐five percent of events occurred before screening. Earlier screening might be effective in optimizing care in ICU patients with COVID‐19.