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      Nitric oxide ventilation improves recirculation and right ventricular function during veno-venous extracorporeal membrane oxygenation in a COVID-19 patient

      case-report
      Author(s): , MD, PhD 1 , * , , MD 2 , 3 , , BSN 2 , , MD, PhD 2 , 4 , , MD, PhD 1 , 5 , , MD, PhD 2 , 6 , , MD 2 , 4
      Publication date (Electronic):
      Journal: Journal of Cardiothoracic and Vascular Anesthesia
      Publisher: The Author(s). Published by Elsevier Inc.
      Keywords: COVID-19, acute respiratory distress syndrome, extra-corporeal membrane oxygenation, inhaled nitric oxide, ARDS, acute respiratory distress syndrome, COVID-19, coronavirus disease 2019, ECMO, extracorporeal membrane oxygenation, iNO, inhaled nitric oxide, PAH, pulmonary artery hypertensions, PEEP, positive end expiratory pressure, RV, right ventricular, TR, tricuspid regurgitation, TTE, transthoracic echocardiography, V-V, veno-venous, VT, tidal volume

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          Abstract

          COVID-19 patients are prone to pulmonary artery hypertension (PAH) and right ventricular pressure overload due to severe bilateral infiltrates, high ventilation pressures, persistent hypoxemia, pulmonary fibrosis and/or pulmonary embolism. In patients on extra-corporeal membrane oxygenation (ECMO), this potentially leads to increased recirculation. In the current report, we present a case in which continuous inhaled nitric oxide (iNO)-enriched ventilation was effective in terms of PAH and recirculation reduction in a COVID-19 patient on veno-venous ECMO.

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          Incidence of thrombotic complications in critically ill ICU patients with COVID-19

          F.A. Klok, M.J.H.A. Kruip, N.J.M. van der Meer … (2020)
          Introduction COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available. Methods We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID-19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital. Results We studied 184 ICU patients with proven COVID-19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%) and 139 (76%) were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20-41), of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17-37%) and arterial thrombotic events in 3.7% (95%CI 0-8.2%). PE was the most frequent thrombotic complication (n = 25, 81%). Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004-1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time > 3 s or activated partial thromboplastin time > 5 s (aHR 4.1, 95%CI 1.9-9.1), were independent predictors of thrombotic complications. Conclusion The 31% incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high-prophylactic doses, even in the absence of randomized evidence.
          Article 0 comments Cited 2557 times – based on 0 reviews     Review now
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            Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review

            Zheng Ye, Yun Zhang, Yi Wang … (2020)
            Coronavirus disease 2019 (COVID-19) outbreak, first reported in Wuhan, China, has rapidly swept around the world just within a month, causing global public health emergency. In diagnosis, chest computed tomography (CT) manifestations can supplement parts of limitations of real-time reverse transcription polymerase chain reaction (RT-PCR) assay. Based on a comprehensive literature review and the experience in the frontline, we aim to review the typical and relatively atypical CT manifestations with representative COVID-19 cases at our hospital, and hope to strengthen the recognition of these features with radiologists and help them make a quick and accurate diagnosis. Key Points • Ground glass opacities, consolidation, reticular pattern, and crazy paving pattern are typical CT manifestations of COVID-19. • Emerging atypical CT manifestations, including airway changes, pleural changes, fibrosis, nodules, etc., were demonstrated in COVID-19 patients. • CT manifestations may associate with the progression and prognosis of COVID-19.
            Article 0 comments Cited 600 times – based on 0 reviews     Review now
            Article has an altmetric score of 79
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              Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact.

              Armand Mekontso Dessap, Florence Boissier, Cyril Charron … (2016)
              Increased right ventricle (RV) afterload during acute respiratory distress syndrome (ARDS) may induce acute cor pulmonale (ACP).
              Article 0 comments Cited 222 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cardiothorac Vasc Anesth
                Journal ID (iso-abbrev): J Cardiothorac Vasc Anesth
                Title: Journal of Cardiothoracic and Vascular Anesthesia
                Publisher: The Author(s). Published by Elsevier Inc.
                ISSN (Print): 1053-0770
                ISSN (Electronic): 1532-8422
                Publication date PMC-release: 5 October 2020
                Publication date (Electronic): 5 October 2020
                Affiliations
                [1 ]Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
                [2 ]Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
                [3 ]Department of Anesthesiology, Maastricht University Medical Center+, Maastricht, the Netherlands
                [4 ]Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands
                [5 ]Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
                [6 ]Academy for Postgraduate Medical Training, Maastricht University Medical Center+, Maastricht, the Netherlands
                Author notes
                [* ]Correspondence to Samuel Heuts, MD, PhD, Department of Cardiothoracic Surgery, P. Debyelaan 25 6229HX, Maastricht, the Netherlands
                Article
                Publisher Item ID: S1053-0770(20)31055-7
                DOI: 10.1053/j.jvca.2020.09.137
                PMC ID: 7534592
                PubMed ID: 33077329
                SO-VID: 0003db1e-3553-4d2b-b006-8b05b63cc6c0
                Copyright © © 2020 The Author(s). Published by Elsevier Inc.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                Subject: Case Report

                Keywords: covid-19,acute respiratory distress syndrome,extra-corporeal membrane oxygenation,inhaled nitric oxide,ards, acute respiratory distress syndrome,covid-19, coronavirus disease 2019,ecmo, extracorporeal membrane oxygenation,ino, inhaled nitric oxide,pah, pulmonary artery hypertensions,peep, positive end expiratory pressure,rv, right ventricular,tr, tricuspid regurgitation,tte, transthoracic echocardiography,v-v, veno-venous,vt, tidal volume
                Data availability:
                Keywords: covid-19, acute respiratory distress syndrome, extra-corporeal membrane oxygenation, inhaled nitric oxide, ards, acute respiratory distress syndrome, covid-19, coronavirus disease 2019, ecmo, extracorporeal membrane oxygenation, ino, inhaled nitric oxide, pah, pulmonary artery hypertensions, peep, positive end expiratory pressure, rv, right ventricular, tr, tricuspid regurgitation, tte, transthoracic echocardiography, v-v, veno-venous, vt, tidal volume

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