Background. Immune dysregulation and hypoxemia are two important pathophysiological problems in patients with COVID-19 that affect peripheral blood count parameters. We hypothesized that assessment of the neutrophil–lymphocyte ratio (NLR) and red blood cell distribution width index (RDW-SD) could predict death in patients with severe and critical COVID-19. Methods. Seventy patients admitted to the intensive care unit (ICU) for COVID-19 acute respiratory failure were included in the study. RDW-SD and NLR on the day of ICU admission and peak values during the entire hospitalization were assessed. The primary endpoint was death before ICU discharge. Results. Patients who died had higher NLR on admission (20.3, IQR 15.3–30.2 vs. 11.0, IQR 6.8–16.9; p = 0.003) and higher RDW-SD (48.1 fL; IQR 43.1–50.5 vs. 43.9 fL; IQR 40.9–47.3, p = 0.01) than patients discharged from the ICU. NLR and RDW-SD values on ICU admission accurately predicted death in 76% (AUC = 0.76; 95%CI 0.65–0.86; p = 0.001; cut-off > 14.38) and 72% of cases (AUC = 0.72; 95%CI 0.60–0.82; p = 0.003; cut-off > 44.7 fL), respectively. Multivariable analysis confirmed that NLR > 14.38 on the day of ICU admission was associated with a 12-fold increased risk of death (logOR 12.43; 95%CI 1.61–96.29, p = 0.02), independent of other blood counts, clinical and demographic parameters. Conclusions. Neutrophil–lymphocyte ratio determined on the day of ICU admission may be a useful biomarker predicting death in patients with severe and critical COVID-19.

Background: Advanced hemodynamic monitoring supports making therapeutic decisions in critically ill patients. New technologies, including mobile health, have been introduced into the hemodynamic monitoring armamentarium. However, each monitoring method has potential limitations—content, technical and organizational. The aim of this study was to assess the comparability between measurements obtained with two arterial pressure cardiac output methods: Capstesia™ smartphone hemodynamic software (CS) and LiDCO Rapid™ uncalibrated hemodynamic monitor (LR). Methods: The initial analysis included 16 patients in the period 06–09 2020 without limitations that could make the results obtained unreliable. Eighty pairs of cardiac output measurements were obtained. The comparability of cardiac output results obtained with both methods was assessed using the Spearman’s rank correlation coefficient (R), the intra-class correlation (CCC) and the Bland–Altman curves analysis (B-A). Results: The median (IQR) cardiac output measured with CS and LR were 4.6 (3.9–5.7) and 5.5 (4.6–7.4) L min⁻¹, respectively. In the B-A analysis, CS cardiac output values were on average 1.2 (95% CI −2.1–4.4) L min^-1 lower than LR values. The correlation between cardiac output with CS and LR was moderate (r = 0.5; p = 0.04). After adjusting for the presence of the dicrotic notch on the pulse waveform, in the group of eight patients with a visible dicrotic notch, the CS and LR results differed by only 0.1 (95% CI −0.8–1.1) L min⁻¹, the correlation between CS and LR was close to complete (r = 0.96; p < 0.001), and the percentage error was 40%, with a CCC-CS of 0.98 (95% CI 0.95–0.99). Conclusions: The Capstesia^TM smartphone software can provide an alternative method of cardiac output assessment in patients meeting arterial pressure cardiac output evaluation criteria with a clearly discernible dicrotic notch on the arterial pulse pressure waveform. It is necessary to confirm the obtained observations on a larger group of patients; however, it may potentially make objective hemodynamic measurements ubiquitous in patients with invasive arterial pressure monitoring with a clearly discernible dicrotic notch.

Wprowadzenie: Potrzeba przedłużonej wentylacji mechanicznej u pacjentów z krwotokiem podpajęczynówkowym (SAH) zwiększa ryzyko rozwoju zapalenia płuc związanego z wentylacją mechaniczną (VAP). Cel pracy: Ocena częstości występowania VAP i określenie jego czynników etiologicznych. Materiał i metody: Grupa badana składała się z 58 krytycznie chorych pacjentów leczonych od stycznia 2019 do października 2021 roku. Zebrano dane demograficzne i kliniczne, w tym sposób pobrania materiału z dróg oddechowych, wyniki badań laboratoryjnych i mikrobiologicznych. Wyniki: Ponad 97% pacjentów zostało zaintubowanych w dniu przyjęcia na OIT. Mediana czasu trwania wentylacji mechanicznej wynosiła 8 dni (IQR: 3–19). Przy przyjęciu pobrano 47 próbek mikrobiologicznych z dróg oddechowych (39 aspiratów dotchawiczych, 8 popłuczyn oskrzelowo-płucnych), z których 26 (55%) stanowiło florę fizjologiczną. W kolejnych dniach VAP zdiagnozowano u 9 spośród 47 pacjentów (19%). Mediana czasu od przyjęcia do rozpoznania wynosiła 3,5 dnia (IQR: 3–4,5). Gatunki wielolekooporne stwierdzono u 3 pacjentów (K. pneumoniae ESBL+). Śmiertelność wewnątrzszpitalna wśród pacjentów z VAP kształtowała się na poziomie 62%. Żaden z pacjentów z SAH i VAP nie został odłączony od respiratora. Wnioski: U pacjentów z SAH często występuje VAP o wczesnym początku (EO-VAP), a jego etiologia nie jest związana z kolonizacją bakteryjną stwierdzoną przy przyjęciu na OIT. Nawet w przypadku EO-VAP należy podejrzewać bakterie wielolekooporne (MDR), które najczęściej powodują szpitalne zapalenie płuc. Rokowanie u pacjentów z SAH, u których rozwinie się VAP, jest złe.

Background: Subarachnoid hemorrhage (SAH) can cause remote organ failure through complex systemic reactions. Acute respiratory failure (ARF) in the course of SAH may have a diverse etiology, including cardiogenic origin. The aim of the study was to evaluate the utility of urine metanephrine measurement in identifying the ARF phenotype in patients with SAH. Methods: A prospective single-center study was conducted between January 2022 and February 2023. The study included consecutive adult patients admitted to the Intensive Care Unit (ICU) within 24 h of SAH diagnosis and requiring mechanical ventilation due to ARF within the first 48 h of stay. Demographic and clinical data were collected. Metanephrine (MET) was determined in 24-h urine collection. The inflammatory profile was assessed by measuring serum levels of interleukin-6 (IL-6), CRP, and PCT. Cardiogenic ARF phenotype was diagnosed when concomitant elevation of hsTpI, CK-MB, and NT-proBNP was observed upon admission. Results: The study group consisted of 18 patients. The cardiogenic etiology group (n = 4) was characterized by higher MET concentrations (249 vs. 63.5 ng/mL; p = 0.007) and a lower oxygenation index (190 vs. 296 mmHg; p < 0.05) on admission. In the non-cardiogenic etiology group (n = 14), higher levels of IL-6 were found (34 vs. 8.3 pg/mL; p = 0.013). MET significantly correlated with the oxygenation index (R = −1.0; p < 0.001) on day 1 and with lactate levels on days 2 and 3 of stay (R = 1.0; p < 0.001). Baseline MET concentration accurately predicted the ARF phenotype (AUC 0.93; 95% CI 0.786–1.000, p = 0.008). Conclusions: Urine metanephrine levels show potential in differentiating the etiology of ARF and correlate with severity markers in critically ill SAH patients at an early stage. These preliminary results highlight the importance of a targeted approach to ARF diagnostics after SAH, which could support appropriate therapeutic decisions, although further validation in larger cohorts is required.