Comparison of Cumulative Corticosteroid Doses for Critically Ill Patients with COVID-19

Introduction: Dexamethasone is the first medication that improved survival in patients with Coronavirus disease-2019 (COVID-19); however, the effects of corticosteroids with different cumulative doses on disease outcome must be elucidated. Our study aimed to compare clinical features, hospital mortality, and secondary infections in patients with COVID-19 receiving different cumulative doses of systemic corticosteroids. Materials and Methods: A retrospective, observational study was conducted on patients with COVID-19 admitted to intensive care unit between 21st March 2020 and 20th September 2020 to determine who did not receive systemic corticosteroids, who received low-to-moderate cumulative doses of corticosteroids as recommended by the RECOVERY trial [proposed 6 mg of dexamethasone (equivalent to 32 mg methylprednisolone)] for 10 days (total dose of ≤320 mg of methylprednisolone or equivalent doses of corticosteroids), and who received high cumulative doses of corticosteroids (total dose of >320 mg methylprednisolone equivalent). Results: Among 134 patients, 35 (26%) did not receive systemic corticosteroids, 34 (25%) received low-to-moderate cumulative doses of corticosteroids, and 65 (49%) received high cumulative doses of corticosteroids. Secondary bacterial (31.4% vs. 41.2% and 63.1%, p=0.006) and opportunistic infections (2.9% vs. 5.9% and 21.5%, p=0.011) were more frequently observed in the low-to-moderate- and high-dose corticosteroid groups compared with those in the no corticosteroid group. Hospital mortality was 20% in patients who did not receive steroids and 29.4% and 46.2% in patients who received low-to-moderate and high doses of corticosteroids, respectively (p=0.012). High cumulative doses of systemic corticosteroids were found to be the independent determinant for hospital mortality [Odds ratio (OR): 6.302 (1.856-21.394); p=0.003] and secondary infection [OR: 3.334 (1.313-8.496); p=0.011]. Conclusion: Comparison among patients administered with and without systemic corticosteroids revealed that high cumulative doses may be associated with adverse events in critically ill patients with COVID-19

Nutritional practices in medical intensive care units: Multicenter, one-day point prevalence study Pratiques nutritionnelles dans les unités de soins intensifs médicaux : étude de prévalence ponctuelle multicentrique sur une journée

Background/Aim: Nutritional planning is an important aspect of Intensive Care Unit (ICU) care. The present study aimed to evaluate the nutritional practices adopted in medical ICUs in Turkiye and to investigate their compliance with current international guidelines. Methods: This multicenter, cross-sectional study was performed on a predetermined study date. Centers were required to fill three groups of questionnaires: One on ICU characteristics and facilities, one on patients included, and one on outcomes of patients. Forms on patients had questions on demographics and their nutritional status. Results: A total of 12 sites participated and 132 patients were recorded in the study and 109 patients were included in analyses. The median age was 72 [57–83] years and 55 (50%) of them was female. The median APACHE II score was 23 [18–29], median SOFA score was 6 [4–9] and median BMI was 25.32 [21.22–29.38]. More than 50% of patients were fed enterally; for most, it was started within the first 24 hours of admission. On the study day, the median energy intake of the patients during the last 24 hours was 21.62 [15.9–27.3] kcal/kg and the median amount of protein intake was 1.02 [0.7–1.3] g/kg, representing 83.1% and 78.9% of the targets, respectively. A total of 64 (58.7%) patients were alive on the 28th day of the study, of them 23 (21.1% of all patients) were still in the ICU. Conclusion: Nutrition therapy in medical ICUs was initiated early after ICU admission, the enteral route was preferred and target calories were calculated using weight-based formulas. These results suggest that multi-dimensional planning of critical care management of patients by intensivists may provide better nutritional care for the critically ill