The Latest in Critical Care, 3/4/24 (Issue #32)

Covid brain fog quantified; new pediatric sepsis diagnosis criteria; avoiding hyperoxia in trauma patients; CDC gives up on Covid isolation

Mar 04, 2024

New data quantify post-Covid “brain fog”

Apr 24

People with persistent symptoms after Covid-19 infection (“long Covid”) often describe difficulty focusing and thinking, or “brain fog”. New large datasets are shining light on this phenomenon, most recently in NEJM. Since early in the pandemic, the UK’s

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Avoiding hyperoxia may have benefited trauma patients

PulmCCM

Apr 24

Avoiding hyperoxia may have benefited trauma patients

Targeting low-normal oxygenation in critically ill trauma patients was shown to be safe and probably beneficial, as compared to maintaining higher oxygenation levels. Authors performed a multicenter, cluster-randomized, stepped-wedge trial enrolling almost 14,000 patients at eight level 1 trauma centers, at Colorado, Vanderbilt and OHSU. The trauma centers were randomized to cross over from usual care to a practice of targeting normoxemia (defined here as SpO2 90% to 96% or paO2 60 to 100 mmHg). At 90 days, there was a non-significant reduction in hospital mortality in the post-implementation groups (8.7% vs 11.4%, confidence interval 0.33 to 1.02 favoring benefit).

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CDC slashes advised Covid isolation period

The CDC has reduced the recommended isolation period after Covid from 5 days to “just don’t cough right in anyone’s face”.

Well, not exactly—the official new recommendation is to isolate for at least 24 hours after the last fever without antipyretics, if symptoms are improving.

Recognizing the virus in this phase of illness is often still extremely transmissible, the infected person is advised to wear a mask for five more days after ending self-isolation.

The new guidance is also intended for people with RSV or influenza. Since many people with viral respiratory infections go untested, this would simplify counseling and also help to normalize mask-wearing during infectious periods, public health officials hope.

New criteria for diagnosis of pediatric sepsis

PulmCCM

Mar 4

New criteria for diagnosis of pediatric sepsis

The diagnosis of pediatric sepsis will abandon the so-called SIRS criteria in favor of a simple organ-failure score. An international consensus society of pediatric critical care medicine recommended the so-called Phoenix-4 criteria for organ dysfunction, which score one point each for life-threatening dysfunction of the respiratory, cardiovascular, coagulation, or neurologic systems. A score of 2 or higher on the Phoenix-4 in a child with suspected or confirmed infection would diagnose sepsis.

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The Latest in Critical Care, 3/4/24 (Issue #32)

Covid brain fog quantified; new pediatric sepsis diagnosis criteria; avoiding hyperoxia in trauma patients; CDC gives up on Covid isolation

New data quantify post-Covid “brain fog”

Avoiding hyperoxia may have benefited trauma patients

CDC slashes advised Covid isolation period

New criteria for diagnosis of pediatric sepsis

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