Diagnosis and Testing

Letters to the Editor: The authors reply to Phenotypic Characterization of Right Ventricular Dysfunction and Prognostication in COVID-19-Induced Acute Respiratory Distress

From Critical Care Medicine In this Letter to the Editor the authors respond to Jha et al. 

Phenotypic Characterization of Right Ventricular Dysfunction and Prognostication in COVID-19–Induced Acute Respiratory Distress Syndrome

From Critical Care Medicine In this Letter to the Editor the authors write in reponse to Chotalia et al. 

Augmented Renal Clearance: An Under-Recognized Phenomenon Associated With COVID-19

From Critical Care Explorations The authors aim to increase clinician awareness of, and risk factors for ARC in patients with COVID-19, especially in comparison to other critical illnesses.

Impaired Microvascular Function in Patients With Critical COVID-19

From Critical Care Explorations The authors investigate microvascular function in patients with critical coronavirus disease 2019.

Serial Thromboelastography and the Development of Venous Thromboembolism in Critically Ill Patients With COVID-19

From Critical Care Explorations The authors test the hypothesis that relatively lower clot strength on thromboelastography maximum amplitude (MA) is associated with development of venous thromboembolism (VTE) in critically ill patients with COVID-19.

Right Ventricular Dysfunction and Its Association With Mortality in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome: Do Not Focus on Not Reliable Markers!

From Critical Care Medicine In this Letter to the Editor, the authors read the study by Chotalia et al. 

CDC Resources: Procedures

SCCM’s COVID-19 Rapid Resource Center now links to pertinent content from the Centers for Disease Control and Prevention (CDC). These resources are categorized as Procedures

Mini-Bronchoalveolar Lavage for Diagnosing Coronavirus Disease 2019–Associated Invasive Pulmonary Aspergillosis

Critical Care Explorations  The authors found a similar percentage of positive test results in mini-bronchoalveolar lavage and bronchoalveolar lavage samples in patients with suspected coronavirus disease 2019–associated pulmonary aspergillosis, indicating that mini-bronchoalveolar lavage could be a useful tool for coronavirus disease 2019–associated pulmonary aspergillosis screening in ICU patients.

Can you discuss point-of-care ultrasound and its use in COVID-19 patients?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on September 8, 2021

Online Letter to the Editor: The Intriguing, Still Undercovered, Clinical Role of Echocardiography in Critically Ill Coronavirus Disease Patients

From Critical Care Medicine. This Online Letter to the Editor was written in response to an article by  Chotalia et al. entitled “Right ventricular dysfunction and its association with mortality in coronavirus disease 2019 acute respiratory distress syndrome.”

How often do you recommend obtaining arterial blood gas analyses on the ward or in the ICU on these patients?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on August 11, 2021

Do you integrate point-of-care ultrasound at the beside in patients with COVID-19?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on July 14, 2021

Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort

From Critical Care Explorations.  In this study, the authors sought to validate prognostic scores in coronavirus disease 2019 including National Early Warning Score, Modified Early Warning Score, and age-based modifications, and define their performance characteristics.

Cardiopulmonary Exercise Testing in Critically Ill Coronavirus Disease 2019 Survivors: Evidence of a Sustained Exercise Intolerance and Hypermetabolism

From Critical Care Explorations.  In this study, the authors found prolonged reduced exercise capacity up to 6 months in critically ill coronavirus disease 2019 survivors. This disability did not result from residual pulmonary or cardiac dysfunction but rather from a metabolic disorder characterized by a sustained hypermetabolism and an impaired oxygen utilization.

Online Letter to the Editor: Optimal Management of Thrombotic Complications in Patients With Coronavirus Disease 2019

From Critical Care Medicine. This Online Letter to the Editor was written in response to an article by Mirsadraee et al. entitled “Prevalence of Thrombotic Complications in ICUTreated Patients With Coronavirus Disease 2019 Detected With Systematic CT Scanning.”

Editorial: Coronavirus Disease 2019: There Is a Heart Between the Lungs

From Critical Care Medicine. This Editorial was written in response to the article by Chotalia et al. “Right Ventricular Dysfunction and Its Association With Mortality in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome.”

A High Neutrophil-Lymphocyte Ratio Is Associated With Increased Morbidity and Mortality in Patients With Coronavirus Disease 2019

From Critical Care Explorations.  This study aimed to evaluate the prognostic potential of admission neutrophil-lymphocyte ratio in patients admitted to the medical ICU with coronavirus disease 2019. The authors concluded that the neutrophil-lymphocyte ratio at the time of hospital admission is an independent risk factor for morbidity and mortality. This prognostic indicator may assist clinicians appropriately identify patients at heightened risk for a severe disease course and tailor treatment accordingly.

For patients with COVID-19 being treated with intermediate- or full-dose enoxaparin, have anti-Xa levels been checked? If so, have higher-than-expected anti-Xa levels been found?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on March 10, 2021

At your institution, have you used procalcitonin as a trending marker to aid in the identification of pulmonary infection?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on March 10, 2021

Online Letter to the Editor: Potential Endotype Transition for Coronavirus Disease 2019–Related Sepsis With Longitudinal Transcriptome Profiling

From Critical Care Medicine. This an online Letter to the Editor in response to the article by Sweeney et al. “Validation of Inflammopathic, Adaptive, and Coagulopathic Sepsis Endotypes in Coronavirus disease 2019."

Thromboelastography Parameters and Platelet Count on Admission to the ICU and the Development of Venous Thromboembolism in Patients With Coronavirus Disease-2019

From Critical Care Explorations. The authors’ data, discussed in this article, did not support the use of thromboelastography to risk stratify critically ill adults with coronavirus disease 2019 for the development of venous thromboembolism or to guide decisions about anticoagulation.

Detection and Profiling of Human Coronavirus Immunoglobulins in Critically Ill Coronavirus Disease 2019 Patients

From Critical Care Explorations. The authors performed anticoronavirus immunoglobulin G profiling of critically ill coronavirus disease 2019 patients to better define their underlying humoral response.

First and Second Waves of Coronavirus Disease 2019 in Madrid, Spain: Clinical Characteristics and Hematological Risk Factors Associated With Critical/Fatal Illness

From Critical Care Explorations  In this study, the authors sought to determine similarities and differences in clinical characteristics between the patients from two waves of severe acute respiratory syndrome coronavirus-2 infection at the time of hospital admission, as well as to identify risk biomarkers of coronavirus disease 2019 severity.

What is the most appropriate treatment for patients (both inpatients and outpatients) who have a positive polymerase chain reaction test but no symptoms?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on February 24, 2021

Efficacy of Serum Angiotensin II Levels in Prognosis of Patients With Coronavirus Disease 2019

From Critical Care Medicine. In this study, the authors found that serum angiotensin II levels decrease significantly in patients with coronavirus disease 2019, and this decrease is correlated with lung damage.

D-dimer and Death in Critically Ill Patients With Coronavirus Disease 2019

From Critical Care Medicine.  In a large multicenter cohort study of critically ill patients with coronavirus disease 2019, the authors found higher D-dimer levels were independently associated with a greater risk of death.

Portable Magnetic Resonance Imaging for ICU Patients

From Critical Care Explorations  

In this case series of patients, the authors found use of portable MRI to be safe, feasible, and led to changes in clinical management based on imaging results.

Integral Use of Thromboelastography With Platelet Mapping to Guide Appropriate Treatment, Avoid Complications, and Improve Survival of Patients With Coronavirus Disease 2019–Related Coagulopathy

From Critical Care Explorations

In this study, the authors round that thromboelastography with platelet mapping better characterizes the spectrum of coronavirus disease 2019 coagulation-related abnormalities and may guide more tailored, patient-specific therapies in thostudyse infected with coronavirus disease 2019.

Evidence-based COVID-19 ICU Management Guide v2

This resource is a guide for evidence-based COVID-19 ICU management. This management guide was not intended to be a therapeutic guide, therefore information on any specific COVID-19 treatments have not been covered. British Columbia has a therapeutics committee in coordination with BCCDC which publish separate, regularly updated guidelines on this subject. This guide is currently available for reference by staff working in Vancouver Coastal Health in all areas managing COVID-19 patients. This is a community developed COVID-19 microlearning resource.

Spectrum of Vascular Involvement in Coronavirus Disease 2019 Pneumonia—Findings on CT Perfusion

From Critical Care Explorations

In this article, the authors observed and interpreted CT perfusion patterns of COVID-19 pulmonary features.

Metabolomics Profiling of Critically Ill Coronavirus Disease 2019 Patients: Identification of Diagnostic and Prognostic Biomarkers

From Critical Care Explorations

The authors performed metabolomics profiling of critically ill coronavirus disease 2019 patients to understand better the underlying pathologic processes and pathways, and to identify potential diagnostic/prognostic biomarkers.

Are there any issues related to the use of diagnostic and interventional radiology that would preclude the performance of certain tests in patients who are COVID-19-positive?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

Do you recommend calling pharmacy or infectious diseases for patients admitted to the ward with a positive COVID-19 test and some COVID-19 symptoms?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

What are the most common presenting signs and symptoms of COVID-19? What are the more serious signs of a life-threatening situation? What are the indications for ICU admission that non-ICU clinicians must be aware of?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on August 12, 2020.

What is the approach in the emergency department for patients who arrive with potential COVID-19 symptoms? What triage, diagnostic, and treatment practices are in place?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on October 14, 2020.

What is the difference between pulse oximetry and arterial oxygen tension

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on September 9, 2020.

Letter to the Editor: Prevalence and Clinical Correlates of Echo-Estimated Right and Left Heart Filling Pressures in Hospitalized Patients With Coronavirus Disease 2019

From Critical Care Explorations In this Letter to the Editor, the authors discuss their study in which they hypothesized that a significant proportion of coronavirus disease 2019 patients has evidence of pulmonary hypertension associated with elevated left heart filling pressure on transthoracic echocardiography.

Point-of-Care Lung Ultrasound for Detecting Severe Presentations of Coronavirus Disease 2019 in the Emergency Department: A Retrospective Analysis

From Critical Care Explorations. In this study, lung ultrasound diagnosed severe presentations of coronavirus disease 2019 with similar sensitivity to chest radiograph, CT, and reverse transcriptase-polymerase chain reaction (on first testing) and improved specificity compared to chest radiograph.
 

Novel Outcome Biomarkers Identified With Targeted Proteomic Analyses of Plasma From Critically Ill Coronavirus Disease 2019 Patients

From Critical Care Explorations. In this study, the authors found that targeted proteomics with feature classification easily distinguished both healthy control subjects and coronavirus disease 2019 tested negative ICU patients from coronavirus disease 2019 tested positive ICU patients. Multiple proteins were identified that accurately predicted coronavirus disease 2019 tested positive patient mortality.

Endothelial Injury and Glycocalyx Degradation in Critically Ill Coronavirus Disease 2019 Patients: Implications for Microvascular Platelet Aggregation

From Critical Care Explorations. The authors found that thrombosis profiling identified endothelial activation and glycocalyx degradation in coronavirus disease 2019 positive patients and believe that the data from this study suggest that medications to protect and/or restore the endothelial glycocalyx, as well as platelet inhibitors, should be considered for further study.

Thromboelastography to Detect Hypercoagulability and Reduced Fibrinolysis in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome Patients

From Critical Care Explorations. In this study, the authors investigated thromboelastography in patients with coronavirus disease 2019-associated acute respiratory distress syndrome with the goal of characterizing suspected coagulopathy and impaired fibrinolysis.
 

Probative Value of the D-Dimer Assay for Diagnosis of Deep Venous Thrombosis in the Coronavirus Disease 2019 Syndrome

From Critical Care Medicine.The authors describe the predictive utility of the D-dimer assay among patients with the coronavirus disease 2019 syndrome for unprovoked lower extremity deep venous thrombosis.

Molecular Diagnosis of Coronavirus Disease 2019

From Critical Care Explorations. In this article, the authors review current approaches to the molecular diagnosis of coronavirus disease 2019.

Evaluation of Coronavirus Disease 2019 Severity Using Urine Biomarkers

From Critical Care Explorations. The authors conducted a study to determine whether noninvasive urine biomarkers can predict the clinical severity of coronavirus disease 2019.

Review of Viral Testing (Polymerase Chain Reaction) and Antibody/Serology Testing for Severe Acute Respiratory Syndrome-Coronavirus-2 for the Intensivist

From Critical Care Explorations. As the SARS-CoV-2 pandemic develops, assays to detect the virus and infection caused by it are needed for diagnosis and management. In this article, the authors describe to clinicians how each assay is performed, what each assay detects, and the benefits and limitations of each assay.

Letter to the Editor: Corticosteroid Administration Is Associated With Improved Outcome in Patients With Severe Acute Respiratory Syndrome Coronavirus 2-Related Acute Respiratory Distress Syndrome

From Criticial Care Explorations. The authors report on the use of corticosteroids in mechanically ventilated patients with SARSCoV-2 related acute respiratory distress syndrome.

Inflammation Profiling of Critically Ill Coronavirus Disease 2019 Patients

From Critical Care Explorations The authors profiled plasma inflammatory analytes to help understand the host response to COVID19.

Altered Mental Status: Non-ICU Emergency Cards

This resource details how to assess the altered mental status of COVID-19 patients. This is SCCM curated COVID-19 microlearning content.

Does any laboratory marker correlate well with or predict severity of illness for COVID-19 patients?

In this question and answer webcast, attendees had the opportunity to post questions about managing critically ill patients with COVID-19 and other issues. Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were also addressed. Webcast held on June 19, 2020

Less Can Be More When Targeting Interleukin-6-Mediated Cytokine Release Syndrome in Coronavirus Disease 2019

Cytokine release syndrome (CRS) mediated by IL-6 is a critical driver of COVID-19 mortality. The authors review and discuss key immunologic effects of direct IL-6 blockade, downstream non-selective JAK inhibition, and selective JAK2 suppression to treat COVID-19-related CRS.

Which COVID-19 diagnostic test provides the best results?

In this question and answer webcast series, attendees had an opportunity to pose questions about managing critically ill patients with COVID-19 and other issues. Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were also answered. Recorded on: Friday, May 22, 2020

Have you considered lymphopenia as a criterion to suspect COVID-19?

In this question and answer webcast series, attendees had an opportunity to pose questions about managing critically ill patients with COVID-19 and other issues. Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were also answered. Recorded on: Friday, May 22, 2020

Is there any research on the prevalence of vitamin D deficiencies in COVID-19 patients?

In this question and answer webcast series, attendees had an opportunity to pose questions about managing critically ill patients with COVID-19 and other issues. Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were also answered. Recorded on: Friday, May 22, 2020

What strategies do you use for presenting patients who are asymptomatic?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on May 27th, 2020.

What are some typical presentations of patients with early manifestations of COVID-19? Are there any red flags?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on May 27th, 2020.

On initial assessment, how do you decide whether a patient should be admitted to the ward or to the ICU?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on May 27th, 2020.

Hypotension: Non-ICU Emergency Cards

This resource details how manage hypotension. This is SCCM curated COVID-19 microlearning content.

Letter to the Editor: The Importance of Universal Preprocedural Testing for the Novel Coronavirus 2019

From Critical Care Explorations. In this letter to the editor, the authors recommend universal preprocedural testing and other interventions to safeguard healthcare personnel and patients.

SCCM Pod-415 NIH COVID-19 Treatment Guidelines

The National Institutes of Health has released Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.

SCCM Pod-412 COVID-19 in Critically Ill Children

Gain valuable insight on the clinical management of COVID-19 and its relevance to the pediatric critical care provider (Ong J, et al. Pediatr Crit Care Med. 2020 Apr 7; Epub ahead of print) with host Elizabeth H. Mack, MD, MS, FCCM, and Jacqueline Ong, MB BChir, MMed (Paeds), MRCPCH.

SCCM Pod-410 COVID-19 Neurologic Manifestations

Review neurologic manifestations of COVID-19 and other severe respiratory viral contagions (Robinson C, et al. Crit Care Explor. 2020;2:e0107).

Diagnosis and Management of Shock

Point of Care (PoC) Refresher Training

Pediatric concerns: Symptoms, diagnosis and mortality

This presentation is an overview of symptoms, diagnosis and mortality concerns seen when treating pediatric patients with COVID-19. This is SCCM curated COVID-19 microlearning content.

Surviving Sepsis Campaign COVID-19 Guidelines: Infection Control & Testing Recommendations Chart

COVID-19 - - Quick Reference Chart. This chart is to be used as a rapid resource regarding infection control and testing when treating COVID-19 patients.

What is the role of antibody testing, and what is the PCR turnaround time, and the sensitivity and specificity?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered.