Critical Care - Theses
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ItemPresentations to the Emergency Department Post-admission with COVID-19: A Retrospective Chart Review( 2022)Background: Post COVID-19 syndrome or “Long COVID”, is heavily associated with increased duration and severity of illness following recovery from COVID-19. The aim of the study was to determine the characteristics and outcomes of patients with subsequent presentations to an Emergency Department (ED) following positive COVID-19 PCR diagnosis. Methods: This was a retrospective chart-review data from patients admitted to Austin Health ED who had a confirmed positive COVID-19 PCR, for the period July 2020 – August 2020 and October 2021. All patients who received a positive COVID-19 PCR and met the inclusion criteria were eligible. The primary outcomes were number of subsequent presentations and long covid symptoms. Results: Among the 254 patients who met the inclusion criteria, 127 tested positive during Alpha wave 2020, and 126 tested positive during Delta wave 2021. During the Alpha wave, 25 of 127 (20%) patients had subsequent presentations to ED. During the Delta wave of October 2021, 23 of 126 (18%) patients had subsequent presentations to ED. During both Alpha and Delta waves, the strongest predictor of representations was Shortness of Breath (91%) and was associated with a higher triage category. Patients who presented to ED with a higher triage category had several associated comorbidities; T2DM (75%), active cancer (21%), hypertension (72%) and cardiac illnesses (60%). Patients with associated comorbidities had an increased representation rate to ED following discharge. Conclusion: There was a higher proportion of ED representations post COVID from the alpha wave, with the commonest diagnoses of Congestive Heart Failure.
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ItemThe cytokine response to COVID-19 and the effects of immunomodulation in the intensive care unit( 2022)Critically ill patients are at risk of immune dysregulation and organ dysfunction. New therapeutic techniques to treat various critical illness states are constantly emerging. One technique which has shown therapeutic promise in severe COVID-19 is immunomodulation. However, the broad immunological effects of these therapeutics in intensive care unit (ICU) patients, and whether such strategies could be applied to other critical illness states, such as trauma, remain poorly understood. This was a single-centre prospective observational case-control study of COVID-19 and trauma patients that were admitted to the Royal Melbourne Hospital ICU. Blood samples from patients were taken on days 1, 3, and 5 post-ICU admission and on a single occasion for healthy volunteers. Plasma cytokine concentrations were measured using a cytokine bead array. A total of 26 COVID-19, 20 trauma and 18 healthy participants were enrolled. We quantified concentrations of 34 unique soluble proteins in the plasma. Molecules such as IL-8, MPO, MMP-9, were higher in the COVID-19 cohort than trauma over the duration of ICU stay. IL-6 and myoglobin were highest in the trauma group from day 1, and the COVID-19 group increased to similar levels by day 5. COVID-19 patients treated with Baricitinib displayed lower levels of IL-6 and IL-8. Although the human cytokine response to these two critical illness syndromes was highly variable, key differences were identified between trauma and COVID-19 patients that indicate distinct, individual responses to generalised severe inflammation and treatment with immunomodulators, highlighting the importance of specifying critical care strategies to the patient’s immune status.