2021 Annual Update in Intensive Care and Emergency Medicine 2021 Edited by Jean-Louis Vincent 123 webofmedical.com Annual Update in Intensive Care and Emergency Medicine webofmedical.com The series Annual Update in Intensive Care and Emergency Medicine is the continuation of the series entitled Yearbook of Intensive Care and Emergency Medicine in Europe and Intensive Care Medicine: Annual Update in the United States. More information about this series at http://www.com/series/8901 webofmedical.com Jean-Louis Vincent Editor Annual Update in Intensive Care and Emergency Medicine 2021 webofmedical.com Editor Jean-Louis Vincent Department of Intensive Care Erasme University Hospital Université libre de Bruxelles Brussels Belgium jlvincent@intensive.org ISSN 2191-5709 ISSN 2191-5717 (electronic) Annual Update in Intensive Care and Emergency Medicine ISBN 978-3-030-73230-1 ISBN 978-3-030-73231-8 (eBook) https://doi.1007/978-3-030-73231-8 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and trans- mission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc.
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This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland webofmedical.com Contents Part I Sepsis 1 Effect of Sex and Gender in Sepsis and Septic Shock: A Narrative Review������������������������������������������������������������������������������������ 3 A. Leone 2 Complex Immune Dysregulation in COVID-19 and Implications for Treatment ���������������������������������������������������������������������� 15 M. Giamarellos-Bourboulis 3 Measuring Vitamin C in Critically Ill Patients: Clinical Importance and Practical Difficulties—Is It Time for a Surrogate Marker? ���������� 25 S. van der Horst, and A.
de Man 4 Controversies on Non-renal Extracorporeal Therapies in Critically Ill COVID-19 Patients�������������������������������������������������������������� 35 S. Ronco 5 Secondary Infections in Critically Ill Patients with COVID-19������������ 43 G. Florio Part II Shock 6 Heart Dysfunction in Septic Patients: From Physiology to Echocardiographic Patterns��������������������������������������������������������������������� 55 A. Cecconi 7 Non-adrenergic Vasopressors in Septic Shock: Overview and Update�������������������������������������������������������������������������������������������������� 67 E.
Sakr 8 Pathophysiology and Clinical Implications of the Veno-arterial PCO2 Gap���������������������������������������������������������������������������������������������������� 79 Z. Liaudet 9 Still a Place for Aortic Counterpulsation in Cardiac Surgery and Patients with Cardiogenic Shock?���������������������������������������������������� 93 M.com v vi Contents Part III The Microcirculation 10 The Clinical Relevance of High-Altitude Microcirculation Studies: The Example of COVID-19�������������������������������������������������������� 103 G. Hilty 11 Observation of Leukocyte Kinetics Using Handheld Vital Microscopes During Surgery and Critical Illness���������������������������������� 111 Z. Arbous Part IV Airway and Non-invasive Ventilation 12 Tracheostomy for COVID-19: Evolving Best Practice �������������������������� 125 T.
McGrath 13 Modernizing Tracheostomy Practice to Improve Resource Utilization and Survivorship Outcomes�������������������������������������������������� 139 G. McGrath 14 Helmet Non-invasive Ventilation in Acute Hypoxemic Respiratory Failure Due to COVID-19���������������������������������������������������� 153 S. Arabi Part V Acute Respiratory Distress Syndrome 15 Mechanisms of Hypoxemia in the Acute Respiratory Distress Syndrome���������������������������������������������������������������������������������������������������� 167 I. Mauri 16 To Prone or Not to Prone ARDS Patients on ECMO������������������������������ 177 O.
García-de-Acilu 17 Mesenchymal Stromal Cell Therapy in Typical ARDS and Severe COVID-19�������������������������������������������������������������������������������������� 191 F. Pelosi Part VI Renal Issues 18 Acute Kidney Injury in ECMO Patients ������������������������������������������������ 207 M. Lumlertgul 19 Management of Acute Metabolic Acidosis in the ICU: Sodium Bicarbonate and Renal Replacement Therapy �������������������������������������� 223 K. Fujii 20 Critically Ill Patients with Acute Kidney Injury: Focus on Nutrition������������������������������������������������������������������������������������������������������ 233 L.com Contents vii Part VII Acute Brain Injury 21 Carbon Dioxide Management in TBI: From Theory to Practice �������������������������������������������������������������������������������������������������� 245 E.
Citerio 22 Monitoring and Modifying Brain Oxygenation in Patients at Risk of Hypoxic Ischemic Brain Injury After Cardiac Arrest�������������� 253 M. Åneman 23 ICU Delirium in the Era of the COVID-19 Pandemic���������������������������� 267 K. Ely Part VIII Emergencies 24 Advanced Management of Intermediate-High Risk Pulmonary Embolism�������������������������������������������������������������������������������� 283 T. Brosnahan 25 Enhancing Non-ICU Clinician Capability and ICU Bed Capacity to Manage Pandemic Patient Surge ���������������������������������������� 295 H.
Kaplan Index�������������������������������������������������������������������������������������������������������������������� 305 webofmedical.com Abbreviations AKI Acute kidney injury APACHE Acute Physiology And Chronic Health Evaluation ARDS Acute respiratory distress syndrome COVID Coronavirus disease CRP C-reactive protein CRRT Continuous renal replacement therapy CSF Cerebrospinal fluid DO2 Oxygen delivery ECMO Extracorporeal membrane oxygenation GCS Glasgow Coma Scale ICU Intensive care unit IFN Interferon IL Interleukin LV Left ventricular MAP Mean arterial pressure NO Nitric oxide NOS Nitric oxide synthase PEEP Positive end-expiratory pressure RBC Red blood cell RCT Randomized controlled trial RRT Renal replacement therapy RV Right ventricular SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 SOFA Sequential organ failure assessment TBI Traumatic brain injury TNF Tumor necrosis factor VAP Ventilator-associated pneumonia webofmedical.com ix Part I Sepsis webofmedical.com Effect of Sex and Gender in Sepsis and Septic Shock: A Narrative Review 1 A.1 Introduction Most diseases are expressed differently in men and women. While nearly 80% of cases of autoimmune disease occur in women, cancer is more frequent in men. This sexual dimorphism effect is also present in infectious diseases [1], which are one of the leading causes of mortality in the world. In the intensive care unit (ICU), sepsis and septic shock are frequent and still have high mortality rates, reaching 45% for patients with septic shock [2].
Patient outcomes seem to rely on different phenotypes [3]. Sexual dimorphism could be approached as a first step in the personalized management of septic patients. In this narrative review, we describe sex differences in infectious diseases in patients admitted to the ICU. Leone Department of Anesthesiology and Intensive Care, Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Marseille, France Microbes, Evolution, Phylogénie et Infections, Institut de Recherche pour le Développement, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France e-mail: alexandre.lopez@ap-hm.
Lakbar Microbes, Evolution, Phylogénie et Infections, Institut de Recherche pour le Développement, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France Department of Anesthesiology and Intensive Care Unit, Toulouse, France © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 3 J.), Annual Update in Intensive Care and Emergency Medicine 2021, Annual Update in Intensive Care and Emergency Medicine, webofmedical.com https://doi. Lopez et al.2 Epidemiology Men are more likely to develop infectious disease than women, with a mean annual relative risk (RR) of 1. Over the last decade, large-scale studies have reported a higher incidence of sepsis in men than in women [4]. To understand the extent of this challenge, one should know that the number of men admitted to the ICU for sepsis and septic shock is higher than the number of men admitted to the ICU for other medical reasons [5].
Despite this find- ing, a multicenter study did not find any differences in patient sex on the decision to admit to the ICU [6].1 Source of Infection Epidemiological studies suggest different susceptibility to infectious diseases according to sex (Fig. Men are more likely to have lower respiratory tract infections than women [7], whereas sinusitis and tonsillitis occur more frequently in women than in men because of differences in respiratory tract anatomy [8]. Men are overrepresented among patients with severe bloodstream infections, with a relative risk of 1.05) [9], and among patients Bloodstream infection Respiratory tract Gastrointestinal tract infection infection Bone infection Skin infection Genital and urinary tract infection Fig.1 Differences in source of infection according to sex webofmedical.com 1 Effect of Sex and Gender in Sepsis and Septic Shock: A Narrative Review 5 Table 1.1 Differences in sex distribution according to source of infection Source of infection Common causative bacteria More frequent in Respiratory tract Streptococcus pneumonia Men Chlamydophila pneumoniae Legionella spp. Mycoplasma pneumoniae Mycobacterium tuberculosis Pseudomonas aeruginosa Acinetobacter baumanii Bloodstream Escherichia coli Men Staphylococcus aureus Coagulase-negative staphylococci Streptococcus pneumonia Klebsiella spp Gastrointestinal tract Salmonella typhi Men Helicobacter pylori Yersina enterocolitica Escherichia coli Enterobacteria Enterococcus faecalis, Enterococcus faecium Urinary tract Escherichia coli Women Enterococcus spp.
Staphylococcus saprophyticus Klebsiella pneumonia with digestive infections [10], probably in relation to differences in dietary and hygiene behavior between men and women. However, an animal study showed that the female intestinal mucosa was more resistant to hypoxia and acidosis than that of males and that the production of pro-inflammatory markers was increased in males. This production was decreased after administration of flutamide, a tes- tosterone antagonist [11]. In contrast, women are more likely to develop urinary and genital tract infections than men.
Differences in anatomy, physiology, and cell biology of the lower urinary tract may explain this finding. Moreover, the urinary microbiome and hormonal regulation may amplify the rate of urinary and genital tract infections in the female population [12].1 summarizes this sexual dimorphism in source of infection.2 Sepsis and Septic Shock Population-based cohort studies have identified an increase in the incidence of sep- sis over time, probably due to an improvement in clinical diagnosis after the new Sepsis 3 definitions, but also to an increasing proportion of frail patients in the population [13]. In a recent review [14] of large multicenter studies, 54–61% of patients admitted to the ICU for sepsis or septic shock were men. Offner et al.
iden- tified male sex as an independent risk-factor for severe infections after trauma (odds ratio [OR] 1. Lopez et al. As the production of sex hormones evolves with aging, age interferes with the relationship between sex hormones and infectious diseases. In children, most stud- ies show that sepsis distribution is similar in boys and girls.
In adults, the widest difference in sepsis incidence between the sexes occurs between 25 and 30 years of age [16]. However, a small difference between male and female patients is still observed at extreme ages [16]. In elderly patients, sepsis tends to affect women at older ages than men [4].3 Sepsis and Shock Septic Outcomes Sepsis and septic shock are a worldwide public health problem. Sepsis involves life- threatening organ dysfunction, and has a global incidence of almost 50 million cases per year worldwide, with a mortality rate of nearly 20% [16].
In a meta- analysis, the frequency of septic shock was estimated at 10.4% for patients diag- nosed at ICU admission and 8.4% for patients diagnosed at any time during an ICU stay [17]. In general, women seem to have better clinical outcomes than men, who have longer ICU and in-hospital lengths of stay [18]. A retrospective analysis of a large clinical database reported that male patients with sepsis were more likely to require mechanical ventilation (P = 0.012) and vasoactive agents (dopamine [P = 0.093]) during an ICU stay than women [18]. Men are also more likely to develop acute kidney injury than women [19].
All-cause ICU mortality and in-hospital mortality rates for septic shock are 37% and 39%, respectively [17]. In terms of differences according to sex, contrasting evidence is reported. Most epidemiological studies do not show sex differences in terms of sepsis-related deaths [20]. In a retrospective analysis of patients admitted to a polyvalent ICU, a higher mortality rate was found in older women with sepsis than in men [21].
However, age confounds the relationship between sex and mortal- ity. In European countries, the median age at death in men in 2015 was 78 years, compared with 83 years in women [22]. Men are at higher risk of dying from major trauma, cancer, and cardiovascular diseases than women [1]. This can affect the findings associated with sepsis mortality.