Türk Yoğun Bakım Uzmanları Derneği 19. Ulusal Kongresi

Türk Yoğun Bakım Uzmanları Derneği 19. Ulusal Kongresi ve 11. Avrasya Yoğun Bakım Toplantısı 9-12 Kasım 2022’de Cornelia Diamond Golf Resort Hotel, Antalya’da gerçekleştirildi. 

http://yogunbakimkongresi.org/BildiriGonderimi

http://www.jcritintensivecare.org/content.php?id=49#25

[SS-012]

Adsorption Therapy as an Extracorporeal Blood Purification Technique in Severe Covid-19 Patients

Mehmet Eren Yüksel¹, Nazan Has Selmi², Çağlayan Merve Ayaz³, Seval İzdeş¹

¹Ankara Yildirim Beyazit University School of Medicine, Department of Anesthesiology and Intensive Care, Ankara, Turkey

²Ankara City Hospital, Department of Anesthesiology and Intensive Care, Ankara, Turkey

³Ankara City Hospital, Infectious Diseaseas and Clinical Microbiology Department, Ankara, Turkey

Introduction: Cytokine storm during the course of severe Coronavirus disease (Covid-19) leads to acute respiratory distress syndrome (ARDS) and multiple organ failure, which are the main reasons of high morbidity and mortality rates in patients with Covid-19. Clearance of proinflammatory cytokines and chemokines from the bloodstream may alleviate symptoms and decrease mortality in patients with Covid-19.

Objective: We applied adsorption therapy with HA330 cartridge as an extracorporeal blood purification technique to critically ill Covid-19 patients in the intensive care unit (ICU). Thereafter, we evaluated the effectiveness of adsorption therapy by investigating the changes in cytokine levels, complete blood count and biochemistry panel, changes in clinical status before and after treatment, and mortality.

Methods: Local ethics committee approval for this study was obtained from Ankara City Hospital (E2-21-983). Fourteen (82.3%) male and 3 (17.6%) female adult severe Covid-19 patients who were treated with HA330 adsorption cartridge (Jafron©, Zhuhai City, China) in the ICU between April 2020 and October 2021 at Ankara City Hospital were reviewed retrospectively. Median age of the patients was 53.5 (interquartile range (IQR):45-62.5). Adsorption therapy was applied once to 17 patients, twice to 13 patients and three times to 9 patients for 3 hours daily for 3 consecutive days. Laboratory values and clinical results before and after adsorption therapy were noted.

Results: A statistically significant correlation was not identified between number of adsorption therapy sessions and laboratory values except a decrease in interleukin-6 (IL-6). Four out of 17 critically ill Covid-19 patients survived after adsorption therapy with HA330 cartridge (23.5%).

Conclusion: Adsorption cartridge HA330 reduced IL-6 levels in biochemistry panel of severe Covid-19 patients in the ICU.

Keywords: Adsorption, Blood purification, Coronavirus-19, Cytokine filter

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PS-12 Is There A Relationship Between Cytomegalovirus Infection And Spontaneous Pneumothorax Incidence In Severe Covid-19 Patients?

Mehmet Eren Yüksel¹, Ahmet Bilal Kandemir¹, İlknur Aydar², Seval İzdeş¹

¹Ankara Yildirim Beyazit University School of Medicine, Department of Anesthesiology and Intensive Care, Ankara, Turkey

²Hacettepe University School of Medicine, Department of Thoracic Surgery, Ankara, Turkey

Objectives

We encountered spontaneous pneumothorax in 3 critically ill patients with a prolonged course of Coronavirus-19 (Covid-19) disease within 3 consecutive days in the intensive care unit (ICU). These 3 patients were tested positive for antibodies against Cytomegalovirus (CMV) infection (anti-CMV-IgG+). We wanted to investigate whether anti-CMV-IgM and anti-CMV-IgG positivity increased the incidence of spontaneous pneumothorax in severe Covid-19 patients.

Materials-Methods

Local ethics committee approval for this study was obtained from Ankara City Hospital (E2-21-981, date:10.11.2021). Twenty-seven female (40.3%) and 40 male (59.7%) adult patients with severe Covid-19 disease hospitalized in the tertiary ICU between April 2020 and October 2021 were included in this study. Median age of the patients was 70 (52-77). Mean ICU follow-up period was 23.86 days (min-max:1-90). Electronic records of these 67 patients were retrospectively reviewed for spontaneous pneumothorax, anti-CMV-IgM and anti-CMV-IgG antibiodies.

Results

Anti-CMV-IgM was positive in 1 patient (1.5%) and negative in 66 patients (98.5%). Anti-CMV-IgG was positive in 61 patients (91%) and negative in 6 patients (9%). Spontaneous pneumothorax was encountered in 9 patients (13.4%). Three patients with pneumothorax had neither anti-CMV-IgM nor anti-CMV-IgG. Six patients with pneumothorax had only anti-CMV-IgG antibodies. None of the severe Covid-19 patients with pneumothorax had anti-CMV-IgM antibodies.There was not a statistically significant relationship between anti-CMV-IgM antibodies and the development of spontanous pnemothorax (p=1). However, there was a statistically significant relationship between anti-CMV-IgG antibodies and spontaneous pneumothorax incidence in severe Covid-19 patients (p=0,028).

Conclusion

Severe Covid-19 patients with anti-CMV-IgG antibodies may be more susceptible to the development of spontaneous pneumothorax. However, a prospective multi-center study with a larger sample size should provide more information about the relationship between CMV infection and spontaneous pneumothorax incidence in severe Covid-19 patients.