The impact on mortality associated with covid-19 today exceeds five million deaths worldwide, and the number of deaths continues to rise. The complications of the survivors, socio-economic implications at a global level, economic limitations in the health systems, and physical and emotional exhaustion of health personnel are detrimental. Therapeutic strategies are required to limit the evolution of the disease, improve the prognosis of critically ill patients, and, in countries with low purchasing power, create affordable alternatives that can help contain the evolution towards the severity of infected people with mild to moderate symptoms. The misinformation and myths that today are more frequent on social networks and the implementation of practices without scientific support is a problem that aggravates the general panorama. This review aims to concentrate on the best evidence for treating SARS-CoV-2 infection in a simple and summarized manner, addressing therapies from their bases to the most innovative alternatives available today.

Background: High concentrations of supplemental oxygen (FiO₂ > 0.6) are commonly used to treat acute hypoxemia in critically ill patients. However, the effects of High FiO₂ in patients with COVID-19 remain unclear, particularly regarding its impact on hypoxic pulmonary vasoconstriction (HPV) and ventilation–perfusion (V/Q) mismatch. Objective: This study aims to evaluate whether administering lower concentrations of inspired oxygen (FiO₂ < 0.6) is associated with improved outcomes—namely reduced need for mechanical ventilation and mortality—in patients with COVID-19 and severe pulmonary involvement. Methods: This retrospective observational cohort included 201 patients with confirmed COVID-19. Patients were grouped by mean FiO₂ during the first 24–48 h: High FiO₂ (≥0.60) or Low FiO₂ (<0.60). The primary outcome was the requirement for mechanical ventilation; the secondary outcome was in-hospital mortality. A composite endpoint (mechanical ventilation and in-hospital death) was also evaluated. Analyses included logistic regression and Kaplan–Meier survival with log-rank testing. Results: High FiO₂ (≥0.60) was associated with higher odds of the composite outcome (mechanical ventilation and in-hospital death). In multivariable analysis, Low FiO₂ remained associated with lower odds (adjusted OR 0.18; 95% CI 0.08–0.39; p < 0.001). Unadjusted rates were 43.1% vs. 16.1% for mechanical ventilation and 34.3% vs. 8.1% for in-hospital death (High vs. Low FiO₂; both p < 0.001). Event-free survival favored the Low FiO₂ group (log-rank p < 0.001). The model showed excellent discrimination (AUC 0.96; 95% CI 0.92–0.99). Conclusions: Higher early FiO₂ exposure was associated with worse clinical outcomes in severe COVID-19. These findings are consistent with physiological models in which excess oxygen may attenuate hypoxic pulmonary vasoconstriction and increase shunt/dead space. Prospective studies are warranted to assess causality and refine oxygen targets.

The intra-aortic balloon pump continues to be a useful ventricular assist device in cardiac surgery. Complications are estimated to be 7% to 40%, significantly high to catastrophic. We describe an aortic injury associated with the use of the device and an interdisciplinary management for the diagnostic and therapeutic approach. (Level of Difficulty: Intermediate.)

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Early postoperative risk stratification after surgical aortic valve replacement remains challenging in patients with severe aortic stenosis and reduced left ventricular ejection fraction. Although postoperative troponin elevation is expected after open-heart surgery, the discriminatory value of ICU admission high-sensitivity cardiac troponin T (hs-cTnT) in this specific myocardial phenotype remains uncertain. We evaluated whether ICU admission hs-cTnT provides useful early discrimination for 30-day all-cause mortality after surgical aortic valve replacement in patients with severe aortic stenosis and reduced left ventricular ejection fraction and compared its performance with other postoperative ICU biomarkers. We conducted a single-center retrospective cohort study of 184 adults with severe aortic stenosis and left ventricular ejection fraction ≤40% who underwent surgical aortic valve replacement between 2020 and 2024 and had complete 30-day follow-up. ICU admission hs-cTnT was available in 183 patients. Biomarkers included ICU admission hs-cTnT, ICU admission lactate, peak ICU C-reactive protein, and ICU admission B-type natriuretic peptide. Discrimination was assessed using receiver operating characteristic analysis, DeLong comparisons, repeated stratified 5-fold cross-validation, and bootstrap optimism correction. Multivariable models were interpreted as exploratory because of the limited number of mortality events. Thirty-day mortality occurred in 29 of 184 patients (15.8%). ICU admission hs-cTnT showed poor discrimination for 30-day mortality in the hs-cTnT analytic cohort and remained non-discriminatory after repeated cross-validation. In the common four-biomarker cohort, lactate outperformed hs-cTnT by DeLong testing, whereas the four-biomarker model did not significantly improve discrimination beyond lactate alone. Bootstrap optimism correction attenuated the apparent performance of multimarker models, supporting cautious interpretation. Exploratory analyses also suggested that mortality did not increase monotonically across hs-cTnT quartiles. In patients with severe aortic stenosis and reduced left ventricular ejection fraction undergoing surgical aortic valve replacement, ICU admission hs-cTnT did not provide reliable early mortality discrimination. Lactate remained the strongest early individual biomarker, whereas multimarker models showed exploratory discrimination but require external validation. These findings support a phenotype-specific interpretation of postoperative hs-cTnT rather than reliance on universal postoperative troponin assumptions.