7 research outputs found
Acid-Base Disturbances in Patients with Asthma: A Literature Review and Comments on Their Pathophysiology
Asthma is a common illness throughout the world that affects the respiratory system function, i.e., a system whose operational adequacy determines the respiratory gases exchange. It is therefore expected that acute severe asthma will be associated with respiratory acid-base disorders. In addition, the resulting hypoxemia along with the circulatory compromise due to heart−lung interactions can reduce tissue oxygenation, with a particular impact on respiratory muscles that have increased energy needs due to the increased workload. Thus, anaerobic metabolism may ensue, leading to lactic acidosis. Additionally, chronic hypocapnia in asthma can cause a compensatory drop in plasma bicarbonate concentration, resulting in non-anion gap acidosis. Indeed, studies have shown that in acute severe asthma, metabolic acid-base disorders may occur, i.e., high anion gap or non-anion gap metabolic acidosis. This review briefly presents studies that have investigated acid-base disorders in asthma, with comments on their underlying pathophysiology
Acid-Base Disturbances in Patients with Asthma: A Literature Review and Comments on Their Pathophysiology
Asthma is a common illness throughout the world that affects the
respiratory system function, i.e., a system whose operational adequacy
determines the respiratory gases exchange. It is therefore expected that
acute severe asthma will be associated with respiratory acid-base
disorders. In addition, the resulting hypoxemia along with the
circulatory compromise due to heart-lung interactions can reduce tissue
oxygenation, with a particular impact on respiratory muscles that have
increased energy needs due to the increased workload. Thus, anaerobic
metabolism may ensue, leading to lactic acidosis. Additionally, chronic
hypocapnia in asthma can cause a compensatory drop in plasma bicarbonate
concentration, resulting in non-anion gap acidosis. Indeed, studies have
shown that in acute severe asthma, metabolic acid-base disorders may
occur, i.e., high anion gap or non-anion gap metabolic acidosis. This
review briefly presents studies that have investigated acid-base
disorders in asthma, with comments on their underlying pathophysiology
The Real Impact of Age on Mortality in Critically Ill COVID-19 Patients
Objective: The impact of severe infection from COVID-19 and the resulting need for life support in an ICU environment is a fact that caused immense pressure in healthcare systems around the globe. Accordingly, elderly people faced multiple challenges, especially after admission to the ICU. On this basis, we performed this study to assess the impact of age on COVID-19 mortality in critically ill patients. Materials and Methods: In this retrospective study, we collected data from 300 patients who were hospitalized in the ICU of a Greek respiratory hospital. We split patients into two age groups using a threshold of 65 years old. The primary objective of the study was the survival of patients in a follow up period of 60 days after their admission to the ICU. Secondary objectives were to determine whether mortality is affected by other factors, including sepsis and clinical and laboratory factors, Charlson Comorbidity Index (CCI), APACHE II and d-dimers, CRP, etc. Results: The survival of all patients in the ICU was 75.7%. Those in the p-value p-value p-value = 0.320). Conclusions: Age alone as a simple number is not capable of predicting mortality in patients with severe COVID-19 in the ICU. We must use more composite clinical markers that may better reflect the biological age of patients, such as CCI. Moreover, the effective control of infections in the ICU is of utmost importance for the survival of patients, since avoiding septic complications can drastically improve the prognosis of all patients, regardless of age
Low T3 Syndrome in severely ill patients with COVID-19 infection
Introduction
The coronavirus disease (COVID-19) is an infectious disease,
caused by the SARS-CoV-2 virus, which causes severe respiratory disease.
Critical ill patients often experience a condition known as Low T3 Syndrome
(LT3S). Previous studies showed an association between low FT3 levels and
mortality among patients with COVID-19. Moreover, thyroid hormones might
be altered by cigarette consumption. Τhe aim of this study was to investigate
the association of LT3S with mortality and the severity and risk of intubation
in critically ill patients with COVID-19 infection, and to explore whether this
association is confounded by smoking.
Methods
A total of 105 critically ill patients aged ≥18 years, with laboratoryconfirmed
(RT-PCR) COVID-19 were enrolled. The study was conducted
between January 2021 and October 2021 in the Intensive Care Unit of the 1st
Department Respiratory Medicine in ‘Sotiria’ Hospital and laboratory data and
clinical information were retrieved retrospectively from the electronic patients
record. LT3S was defined as serum levels of FT3 <2.3 pg/mL with low or
normal TSH levels. Patients were divided into two groups according to serum
FT3 values: group with LT3S and group without LT3S. Mortality in the ICU was
the primary outcome of the study, while the risk of intubation was a secondary
outcome.
Results
In all, 43 out of the 105 included patients were diagnosed with
LT3S. Patients in the LT3S group were older than those with non LT3S [median
(IQR): 62 (13.7) vs 52.8 (15.5), p=0.011]. Non-statistically significantly higher
mortality rate, SOFA and APACHE II scores were observed in the LT3S group
compared to no LT3S group (p=0.080, p=0.311 and p=0.079, respectively).
Moreover, LT3S was not associated with high risk of intubation (HR=1.32; 95%
CI: 0.78–2.22). Twenty-five patients (58.1%) in the LT3S group were never
smokers, versus 41 (66.1%) patients in the non LT3S group. Never smokers
with LT3S had significantly higher mortality rate than never smokers without
LT3S (40% vs 17.1%, p=0.039), and LT3S in the never smoking subgroup was
associated with an increased risk of intubation (HR=2.21; 95% CI: 1.18–4.16).
Conclusions
LT3S was found to be associated with mortality of patients
with critical COVID-19 among never smokers but not among ex-smokers or
active smokers. This finding may denote that smoking may act as a confounder
of the association between LT3S and mortality. Further investigation is needed
to demonstrate the impact of LT3S in critically ill patients with COVID-19
infection, as well as the role of smoking in the development of the syndrome