The Use of High-Dose Corticosteroids Versus Low-Dose Corticosteroids With and Without Tocilizumab in COVID-19 Acute Respiratory Distress Syndrome
Katz, Alyson; Altshuler, Diana; Papadopoulos, John; Amoroso, Nancy; Goldenberg, Ronald; Tarras, Elizabeth; Krolikowski, Kelsey; Hagedorn, Jacklyn; Fridman, David; Chen, Xian Jie Cindy; Iturrate, Eduardo; Brosnahan, Shari B
BACKGROUND/UNASSIGNED:Corticosteroids and tocilizumab have been shown to improve survival in patients who require supplemental oxygen from coronavirus disease 2019 (COVID-19) pneumonia. The optimal dose of immunosuppression for the treatment of COVID-19 acute respiratory distress syndrome (ARDS) is still unknown. OBJECTIVE/UNASSIGNED:The objective of this study was to evaluate the effectiveness and safety of high- versus low-dose corticosteroids with or without tocilizumab for the treatment of COVID-19 ARDS. METHODS/UNASSIGNED:This was a retrospective study of patients admitted to the intensive care unit (ICU) requiring mechanical ventilation who received high- versus low-dose corticosteroids with or without tocilizumab. The primary outcome was survival to discharge. Safety outcomes included infections and incidence of hyperglycemia. RESULTS/UNASSIGNED:= 0.01). The highest rate of a bacterial pneumonia was in patients who received high-dose corticosteroids with tocilizumab. CONCLUSIONS/UNASSIGNED:In critically ill patients with COVID-19 ARDS requiring mechanical ventilation, we found no difference in high- versus low-dose corticosteroids with regard to survival to hospital discharge. However, patients receiving only low-dose corticosteroids without tocilizumab did worse than the other groups. Larger prospective studies are needed to determine the optimal immunosuppression dosing strategy in this patient population.
Inhaled pulmonary vasodilators are not associated with improved gas exchange in mechanically ventilated patients with COVID-19: A retrospective cohort study
Lubinsky, Anthony Steven; Brosnahan, Shari B; Lehr, Andrew; Elnadoury, Ola; Hagedorn, Jacklyn; Garimella, Bhaskara; Bender, Michael T; Amoroso, Nancy; Artigas, Antonio; Bos, Lieuwe D J; Kaufman, David
PURPOSE/OBJECTIVE:Measure the effect of inhaled pulmonary vasodilators on gas exchange in mechanically ventilated patients with COVID-19. METHODS:ratio, oxygenation Index (OI), and ventilatory ratio (VR) after initiation of inhaled pulmonary vasodilators. RESULTS:, OI and VR did not significantly change over a five day period starting the day prior to drug initiation in patients who received either iNO or iEPO assessed with a fixed effects model. CONCLUSION/CONCLUSIONS:Inhaled pulmonary vasodilators were not associated with significant improvement in gas exchange in mechanically ventilated patients with COVID-19.
Prevalence and symptomatology of post COVID syndrome in patients who required hospitalization during acute illness [Meeting Abstract]
Nayar, C; Bhatt, A; Hagedorn, J; Amoroso, N E; Condos, R; Hasan, E; Brosnahan, S
Background The long-term effects of SARS-CoV-2 are just now coming to light. These remaining symptoms are sometimes referred to as "Post-COVID syndrome." The types and incidence of prolonged symptoms from the acute viral illness are unknown. Yet understanding the prevalence and which symptoms persist would help normalize post COVID syndrome and help providers recognize these issues in their COVID survivors. Methods We conducted a single-center retrospective analysis with patients discharged from New York University (NYU) Langone Hospital with primary diagnosis of COVID-19. Each patient was then called and given a phone survey 45-60 days post discharge. In the survey they were consented and asked about residual symptoms. Study data were collected and managed using REDCap electronic data capture tools hosted at NYU hospital. Patient surveys were then merged with their medical record from their COVID hospitalization. All statistical analysis was processed in SPSS. The study was approved through our institutional IRB. Results Overall, 101 patients were surveyed post discharge. The median age was 59, with the most common co-morbidities being DM (N = 20) and HTN (N = 45). Most patients (N= 57) reported residual lethargy and malaise as compared to prior. Thirty-eight patients continued to have limited exercise tolerance. Thirty- eight patients experienced shortness of breath more than prior to getting COVID, while 24 patients continued to have shortness of breath while walking within their house. Some experienced chest pain with breathing (N=5), dry cough (N=14) and productive cough (N=5) that was not present prior to COVID infection. Conclusion We found that COVID patients continued to have symptoms 2 months post discharge. More than half of patients reached reported continued lethargy post discharge. Other symptoms were quite common, with 1/4-1/3 having continued shortness of breath and decreased exercise tolerance. The full pathophysiology between continued symptoms and post COVID syndrome is not yet known; however, clinicians need to understand the prevalence to treat patients accordingly. Physicians should help to normalize these symptoms to patients. Treatment should include supportive care such as rehab and physical therapy with consideration of referral to post COVID centers
Where to start? A single center retrospective analysis of early liberation from mechanical ventilation in vv ECMO patients with acute respiratory failure [Meeting Abstract]
Gunther, I; Toy, B; Andriotis, A; Hagedorn, J; Morgenstern, T; Staccone, L; Smith, D; Lubinsky, A
Intro: The optimal strategy for weaning of respiratory support during lung recovery of patients requiring VV ECMO for acute respiratory failure is unknown. We hypothesized that earlier liberation from the ventilator in these patients may correlate with improved outcomes.
Method(s): We retrospectively reviewed all VV ECMO patients at our center from November 2015 to May 2019. Patients who were on VV ECMO as bridge to transplant or for isolated intraoperative indications were excluded. The final study population included 18 patients; 6 were liberated from mechanical ventilation prior to ECMO decannulation and 12 were decannulated from ECMO, but remained mechanically ventilated. Demographics and outcomes were compared between the two groups.
Result(s): Patients liberated from the ventilator prior to ECMO were treated for asthma, pneumonia and vasculitis (33% each) versus predominantly pneumonia (58%), had a lower rate of pre-existing lung disease (17% vs 33%), and lower APACHE II scores (median of 21 vs 24). These patients had longer duration of ECMO (220 vs 205 hours), less ventilator days (5 vs 20.5 days), higher average Richmond Agitation Scores (-1 vs -3), fewer days until they were able to get out of bed (4.5 vs 15 days), shorter ICU stays (16 vs 29 days), and were more likely to survive to hospital discharge (100% vs 67%).
Conclusion(s): Early ventilator liberation of patients on VV ECMO was associated with improved outcomes. Our study is limited by small sample size, retrospective design, and potential for confounding due to baseline differences between groups