Rauf, Ibtisam

Blood transfusion is a common therapeutic intervention in hospitalized patients. There are numerous indications for transfusion, including anemia and coagulopathy with deficiency of single or multiple coagulation components such as platelets or coagulation factors. Nevertheless, the practice of transfusion in critically ill patients has been controversial mainly due to a lack of evidence and the need to consider the appropriate clinical context for transfusion. Further, transfusion carries many risk factors that must be balanced with benefits. Therefore, transfusion practice in ICU patients has constantly evolved, and we endeavor to present a contemporary review of transfusion practices in this population guided by clinical trials and expert guidelines.

Abstract Background Acute respiratory failure is one of the most common causes of hospitalizations in the US. By 2030, the number of Americans with dementia is expected to reach nearly 9 million and 12 million in 2040. Dementia increases the risk of respiratory illnesses, including pneumonia. This study delves into the intricate interplay between dementia and acute respiratory failure. Methods Our retrospective study analyzed adult patients with acute respiratory failure and secondary diagnosis of dementia using ICD-10 codes in the National Inpatient Sample (NIS) Database from 2017 to 2020. An analysis was conducted on various demographic factors such as age, race, and gender. The study's primary endpoint was mortality, with mechanical ventilation, tracheostomy, and length of stay as secondary endpoints. To account for other variables that could have affected the results, we utilized a multivariate logistic regression with p < 0.05 considered significant. Results The study included 1,795,630 patients admitted with ARF, 112,175 of whom had dementia. The mean age in the dementia group was 80 years, compared to 65 years in the control group. Additionally, 62% of the dementia group were females, while the control group had 55% females. 73% of both groups were Caucasian white. Comorbidities observed in the dementia group include hypertension (81% vs. 72%), diabetes mellitus (36% vs. 35%), supraventricular tachycardia (29% vs. 20%), and sepsis (6% vs. 5%) with p-value less than 0.01. Rates and odds of mortality were higher in the dementia group (15,704 (14%) vs. 151,511 (9%), p-value < 0.01, aOR 1.08, p-value < 0.01). Patients with dementia had lower rates of in-hospital mechanical ventilation, but higher adjusted odds (27% vs. 28%; p < 0.01; aOR + 1.2, p < 0.01). Patients with dementia had lower rates and adjusted odds of undergoing a tracheostomy during their stay (762 (0.7) vs. 16,834 (1), p-value < 0.01, aOR 0.91 p-value 0.33).. Patients with dementia had a longer length of stay (LOS) than those without, with a mean difference of + 0.3 days and p-value < 0.01. Conclusions Clinicians should be aware that dementia was found to be an independent risk factor for mortality in patients admitted with acute respiratory failure.

Eosinophilic granulomatosis with polyangiitis (EGPA) also referred to as Churg-Strauss syndrome is a rare vasculitis of the small to medium vessels. We present a rare case of acute coronary artery dissection brought on by EGPA, which generally has a poor prognosis. A 41-year-old male with history of bronchial asthma presented to the emergency room with a 2-week history of dyspnea, cough with clear phlegm, and fever. For the past eight months he had experienced episodes with similar symptoms relieved by steroids. CT chest showed bilateral upper lobe patchy opacities with extensive workup for infectious etiology being negative. He had peripheral eosinophilia with sinusitis. He had acute coronary syndrome and Coronary angiogram showed Right coronary artery dissection. After making a diagnosis of EGPA based on American college of Rheumatology criteria, he was successfully treated with high dose immunosuppression. Coronary artery dissection is a fatal and uncommon complication of EGPA which is usually diagnosed postmortem. Early recognition of this condition ante mortem and aggressive treatment can be lifesaving as demonstrated in our case.

Obstructive sleep apnea (OSA) is a common disease with a high degree of association with and possible etiological factor for several cardiovascular diseases. Patients who are admitted to the Intensive Care Unit (ICU) are incredibly sick, have multiple co-morbidities, and are at substantial risk for mortality. A study of cardiovascular manifestations and disease processes in patients with OSA admitted to the ICU is very intriguing, and its impact is likely significant. Although much is known about these cardiovascular complications associated with OSA, there is still a paucity of high-quality evidence trying to establish causality between the two. Studies exploring the potential impact of therapeutic interventions, such as positive airway pressure therapy (PAP), on cardiovascular complications in ICU patients are also needed and should be encouraged. This study reviewed the literature currently available on this topic and potential future research directions of this clinically significant relationship between OSA and cardiovascular disease processes in the ICU and beyond.

Multisystem inflammatory syndrome is a life-threatening condition associated with elevated inflammatory markers and multiple organ injury. A diagnosis of exclusion, it has been reported after severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) in children and adults; recently it has been described in some post-COVID-19 vaccinated individuals. The prognosis with supportive care and immunomodulatory therapy is good, although some individuals may require treatment in the intensive care unit (ICU). Here we report a case of a 58-year-old man who developed multi-organ failure after receiving the second dose of the Moderna mRNA-1273 COVID-19 vaccine. He required critical organ support in the ICU. An extensive workup was done to rule out alternative infectious and inflammatory processes. Following a period of gradual in-hospital convalescence, our patient made a full recovery. To our knowledge, this is the first comprehensively described case of multisystem inflammatory syndrome associated with Moderna mRNA-1273 COVID-19 vaccine in an adult over 50 years of age.

A 68-year-old man presented to the Emergency Department with undifferentiated shock. During the three days prior, he experienced a non-specific viral-like illness. On examination his blood pressure was 70/40 mm Hg with cool, clammy, and mottled extremities and flat neck veins. Laboratory investigations revealed a positive influenza B screen alongside elevated hemoglobin and hematocrit. Following aggressive fluid resuscitation his blood pressure had marginally improved and he was transferred to the intensive care unit (ICU). Vasopressor support with cautious fluid resuscitation continued and at 7- and 10-hours following presentation, serum albumin levels were extremely low. Idiopathic systemic capillary leak syndrome triggered by influenza B infection was diagnosed. Following a 9-day ICU stay the patient made a complete recovery and remains stable on intravenous immunoglobulin therapy. This case highlights the importance judicious fluid resuscitation and serum albumin levels when confronted with refractory shock.

Background There are limited data on unconscious bias in healthcare, but there is consistent evidence that it alters clinical decision-making. COVID-19 exacerbated many pre-existing disparities, and this paper seeks to identify, deconstruct, and propose mitigation strategies for a few of them. Discussion Five of the largest disparities amplified by the pandemic are discussed in this paper. Older people, Black people, uninsured people, rural communities, and people with lower education levels have been disproportionally affected in both morbidity and mortality. Conclusions The disparities discussed above did not occur in a vacuum but are the result of systemic issues. Equity starts with understanding and addressing the root cause, and it can be worked toward with practical and impactful solutions.