- Infection
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Methylprednisolone pulse therapy for critically ill patients with COVID-19: a cohort study
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Keum-Ju Choi, Soo Kyun Jung, Kyung Chan Kim, Eun Jin Kim
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Acute Crit Care. 2023;38(1):57-67. Published online February 7, 2023
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DOI: https://doi.org/10.4266/acc.2022.00941
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Correction in: Acute Crit Care 2023;38(2):249
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 Abstract
 PDF
- Background
The guidelines recommend the use of dexamethasone 6 mg or an equivalent dose in patients with coronavirus disease 2019 (COVID-19) who require supplemental oxygen. Given that the severity of COVID-19 varies, we investigated the effect of a pulse dose of corticosteroids on the clinical course of critically ill patients with COVID-19. Methods: This single-center, retrospective cohort study was conducted between September and December 2021, which was when the Delta variant of the COVID-19 virus was predominant. We evaluated the mortality and oxygenation of severe to critical COVID-19 cases between groups that received dexamethasone 6 mg for 10 days (control group) and methylprednisolone 250 mg/day for 3 days (pulse group). Results: Among 44 patients, 14 and 30 patients were treated with control steroids and pulse steroids, respectively. There was no difference in disease severity, time from COVID-19 diagnosis to steroid administration, or use of remdesivir or antibacterial agents between the two groups. The pulse steroid group showed a significant improvement in oxygenation before and after steroid treatment (P<0.001) compared with the control steroid group (P=0.196). There was no difference in in-hospital mortality (P=0.186); however, the pulse steroid group had a lower mortality rate (23.3%) than the control steroid group (42.9%). There was a significant difference in the length of hospital stay between both two groups (P=0.039). Conclusions: Pulse steroids showed no mortality benefit but were associated with oxygenation improvement and shorter hospital stay than control steroids. Hyperglycemia should be carefully monitored with pulse steroids.
- Pulmonary
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Experience of percutaneous tracheostomy in critically ill COVID-19 patients
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Eun Jin Kim, Eun-Hyung Yoo, Chi Young Jung, Kyung Chan Kim
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Acute Crit Care. 2020;35(4):263-270. Published online November 12, 2020
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DOI: https://doi.org/10.4266/acc.2020.00444
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Abstract
PDF
- Background
Coronavirus disease 2019 (COVID-19) is a highly contagious disease that causes respiratory failure. Tracheostomy is an essential procedure in critically ill COVID-19 patients; however, it is an aerosol-generating technique and thus carries the risk of infection transmission. We report our experience with percutaneous tracheostomy and its safety in a real medical setting.
Methods
During the COVID-19 outbreak, 13 critically ill patients were admitted to the intensive care unit (ICU) at Daegu Catholic University Medical Center between February 24 and April 30, 2020. Seven of these patients underwent percutaneous tracheostomy using Ciaglia Blue Rhino. The medical environment, percutaneous tracheostomy method, and COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) results were retrospectively reviewed. After treatment, the COVID-19 infection status of healthcare personnel was investigated by RT-PCR.
Results
The ICU contained negative pressure cohort areas and isolation rooms, and healthcare personnel wore a powered air-purifying respirator system. We performed seven cases of percutaneous tracheostomy in the same way as in patients without COVID-19. Five patients (71.4%) tested positive for COVID-19 by RT-PCR at the time of tracheostomy. The median cycle threshold value for the RNA-dependent RNA polymerase was 30.60 (interquartile range [IQR], 25.50–36.56) in the upper respiratory tract and 35.04 (IQR, 28.40–36.74) in the lower respiratory tract. All healthcare personnel tested negative for COVID-19 by RT-PCR.
Conclusions
Percutaneous tracheostomy was performed with conventional methods in the negative pressure cohort area. It was safe to perform percutaneous tracheostomy in an environment of COVID-19 infection.
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Citations
Citations to this article as recorded by  - Sedation and Analgesia in Patients Undergoing Tracheostomy in COVID-19, a Multi-Center Registry
Christopher M. Kapp, Ardian Latifi, David Feller-Kopman, Joshua H. Atkins, Esther Ben Or, David Dibardino, Andrew R. Haas, Jeffrey Thiboutot, Christoph T. Hutchinson
Journal of Intensive Care Medicine.2022; 37(2): 240. CrossRef - Percutaneous Tracheostomy in Respiratory Failure Due to COVID-19
Samuel E. Cohen, Angelena R. Lopez, Philip K. Ng, Oren A. Friedman, George E. Chaux
Journal of Bronchology & Interventional Pulmonology.2022; 29(2): 125. CrossRef - Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019 (COVID-19)
You Shang, Jianfeng Wu, Jinglun Liu, Yun Long, Jianfeng Xie, Dong Zhang, Bo Hu, Yuan Zong, Xuelian Liao, Xiuling Shang, Renyu Ding, Kai Kang, Jiao Liu, Aijun Pan, Yonghao Xu, Changsong Wang, Qianghong Xu, Xijing Zhang, Jicheng Zhang, Ling Liu, Jiancheng Z
Journal of Intensive Medicine.2022; 2(4): 199. CrossRef - Commentary: Coronavirus disease 2019 (COVID-19) tracheostomies—The “how” but not the “why” or “when”
Benjamin Wei, Peter Abraham
JTCVS Techniques.2021; 6: 190. CrossRef - Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals
Phillip Staibano, Marc Levin, Tobial McHugh, Michael Gupta, Doron D. Sommer
JAMA Otolaryngology–Head & Neck Surgery.2021; 147(7): 646. CrossRef - Tracheostomy in COVID Times
Yatin Mehta, Gaurav Kochar
Journal of Cardiac Critical Care TSS.2021; 5(02): 082. CrossRef
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