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Background: The Sequential Organ Failure Assessment (SOFA) score has been developed to score the severity of organ dysfunction in critically ill sepsis patients and has been proven to have a high predictive value for intensive care unit (ICU) mortality in severely ill patients. Our goal was to evaluate the prognostic value of the SOFA score as well as trends in SOFA score for ICU mortality in COVID-19 patients. Methods: All consecutive patients with confirmed COVID-19 pneumonia admitted to the ICU between March 13th, 2020, and October 17th, 2020 were included in this retrospective cohort study. The worst SOFA score was evaluated daily. Multiple logistic regression models were used to evaluate the predictive value of SOFA in ICU mortality. Results: 103 patients were included in this study. 30 patients (29%) died during their ICU stay and 73 (71%) patients were discharged alive. The ICU admission SOFA score was 5.2 ± 3.3 in ICU non-survivors vs. 4.3 ± 2.9 in ICU survivors (P = 0.15). The maximum SOFA score in ICU non-survivors was 11.7 ± 4.7 vs. 7.4 ± 4.3 in ICU survivors. SOFA scores increased the first week in both survivors and non-survivors, but the increase was less pronounced in survivors. In the multiple logistic regression models, neither admission SOFA score nor combination with delta SOFA in the first 48 hours was statistically significantly related to ICU mortality. Only the maximum SOFA score remained significant (OR = 1.23, 95% CI: 1.11–1.37, P < 0.001) in the multiple logistic models with an AUC of 0.91. Conclusions: Evaluation of SOFA scores in the first 48 hours after ICU admission is not a good prognostic indicator in COVID-19 patients. Only the maximum SOFA score was predictive for ICU mortality.

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Many critically ill patients infected with SARS-CoV-2 have been submitted to an intensive care unit (ICU). Patients with a SARS-CoV-2 infection that survive critical illness are confronted with months of physical impairments. To maximize recovery, it is important to understand the musculoskeletal involvement in critically ill patients infected with SARS-CoV-2. The aim of the present study was to assess the myocellular changes in SARS-CoV-2 patients that occur throughout the first week of ICU admission. In n = 22 critically ill patients infected with SARS-CoV-2, a biopsy sample from the vastus lateralis muscle was obtained at day 1–3 and day 5–8 following ICU admission. Fluorescence microscopy was used to assess type I and type II muscle fiber size and distribution, myonuclear content, and muscle tissue capillarization. Transmission electron microscopy was used to support quantitative data at an ultrastructural level. Changes in type I and type II muscle fiber size showed large inter-individual variation. The average change in type I fiber size was +309 ± 1834 µm2, ranging from −2129 µm2 (−31%) to +3375 µm2 (+73%). The average change in type II fiber size was −224 ± 1256 µm2, ranging from −1410 µm2 (−36%) to +2592 µm2 (+48%). Ultrastructural observations showed myofibrillar and hydropic degeneration, and fiber necrosis. This study shows that ICU patients admitted with SARS-CoV-2 suffer from substantial muscle fiber damage during ICU admission. These results are a call for action towards more specialized rehabilitation programs for patients admitted to the ICU with SARS-CoV-2 infection.

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Abstract Background: Patients infected with severe acute respiratory syndrome coronavirus (SARS-CoV-2) can develop severe illness necessitating intensive care admission. Critically ill patients are susceptible for the development of second- ary bacterial infections. Due to a combination of virus- and drug-induced immunosuppression, critically ill patients with corona virus disease 2019 (COVID-19) may even have a higher risk of developing a secondary infection. These secondary infections can aggravate the severity of illness and increase the risk of death. Further research on second- ary infections in COVID-19 patients is essential. Therefore, the objective of this study was to investigate the incidence and associated risk factors of secondary bacterial infections and to identify the most common groups of pathogens in critically ill COVID-19 patients. Methods: This mono-center, retrospective observational cohort study was performed at the intensive care unit (ICU) of the Jessa Hospital, Hasselt, Belgium. All adult COVID-19 patients admitted to the ICU from 13th March 2020 until 17th October 2020, were eligible for inclusion in the study. Data from the resulting 116 patients were prospectively entered into a customized database. The resulting database was retrospectively reviewed to investigate three types of secondary bacterial infections (secondary pneumonia, bloodstream infections of unknown origin, catheter-related sepsis). Results: Of 94 included patients, 68% acquired at least one of the studied secondary bacterial infections during their ICU stay. Almost two thirds of patients (65.96%, n = 62) acquired a secondary pneumonia, whereas 29.79% (n = 28) acquired a bacteremia of unknown origin and a smaller proportion of patients (14.89%, n = 14) acquired a catheter-related sepsis. Male gender (P = 0.05), diabetes mellitus (P = 0.03) and the cumulative dose of corticoster- oids (P = 0.004) were associated with increased risk of secondary bacterial infection. The most common pathogens detected in the cultures of patients with secondary pneumonia were Gram-negative bacilli. Bacteremia of unknown origin and catheter-related sepsis were mostly caused by Gram-positive cocci. Conclusion: This study confirms that the incidence of secondary bacterial infections is very high in critically ill COVID-19 patients. These patients are at highest risk of developing secondary pneumonia. Male gender, a history of diabetes mellitus and the administration of corticosteroids were associated with increased risk of secondary bacterial infection.

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Introduction Auto-intoxication represents a considerable number of Intensive care unit (ICU) admissions. Literature focusing on characteristics and outcomes of ICU-admitted auto-intoxicated patients is limited. Objectives We aimed to identify the quantity of intensive care admissions attributable to auto-intoxication in a Belgian tertiary center, to examine characteristics and outcomes of these patients, and to assess the impact of the covid-19 pandemic on these variables. Methods In this retrospective cohort study, all patients admitted to the ICU of JESSA hospital, Hasselt, Belgium with a diagnosis of auto-intoxication between January 1st 2017 and December 31th 2022, were included in the study. We collected data on patient characteristics, comorbidities, type of intoxication and outcomes including the length of ICU and hospital stay and mortality. Results In total, 342 patients were included in the dataset, covering 2.44% of all ICU admissions from January 1st 2017 to December 31th 2022. Although auto-intoxication occurred in all age-categories, the age group from 18 to 29 years old, showed the highest prevalence (24%). More woman (57,6%) than man (42,4%) were included in the study. Of all included patients, 21.6% had a history of previous suicide attempt and 36.5% of previous auto-intoxication. The most common substances ingested were sedatives (44.4%), illicit drugs (20.2%), analgesics (17.8%) and antidepressants (16.7%) whereas in 54.1% of the cases, a combination of substances was ingested. Type of intoxication was separated into four groups: suicide attempt, accidental, iatrogenic and recreational use with suicide attempt accounting for 71.3% of all auto-intoxications. The prevalence of ICU-admitted auto-intoxicated patients remained stable over the 5-year study period. An impact of the Covid-19 pandemic on this prevalence could not be established. Overall mortality was low with an ICU- and hospital mortality of 1.75% and 2.6% respectively. Total mortality at time of dataset closure, on the other hand, was 7.2%. Conclusions The impact of auto-intoxication on ICU resource utilisation is relatively high and the risk of recidivism is substantial. ICU- and in-hospital mortality after auto-intoxication is low, although these patients have a substantial risk for death in years to come after hospital discharge

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Authors: HassaninJalil1‡, FlorencePolfliet1‡, KristofNijs1, LiesbethBruckers2, GerritDeWachter3, InaCallebautI1,4, LeneSalimans1, MarcVandeVelde5,6, BjörnStessel1,4 Hospital/Institute: 1. Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium, 2. I-Biostat, Data Science Institute, Hasselt University, Hasselt, Belgium, 3. Department of Orthopedic Surgery, Jessa Hospital, Hasselt, Belgium, 4. Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium, 5. Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium, 6. Department of Anaesthesiology, University Hospital, Leuven, Belgium ‡ These authors share first authorship on this work. *bjorn.stessel@jessazh.be Objective: This study aimed to investigate if ultrasound-guided forearm nerve block is superior to forearm IVRA in producing a surgical block in patients undergoing carpal tunnel release. Background: With the ultrasound, nerve blocks are now more reliable and safer to perform. Consequently, ultrasound-guided proximal brachial plexus blockade is considered the gold standard in regional anaesthesia during distal upper extremity surgery [1]. Distal peripheral nerve blocks provide extra advantages such as the avoidance of complications like pneumothorax and phrenic paralysis. Second, these distal peripheral blocks can preserve the motor function of the digits as well as the motor function of the more proximal muscles [2]. Compared to general anaesthesia or intravenous regional anaesthesia (IVRA), the use of a block room to perform peripheral nerve block techniques (outside of the operating room) may improve operating theatre efficiency [3]. This randomized controlled superiority trial was set out to compare ultrasound-guided forearm median and ulnar nerve block and forearm IVRA in patients undergoing carpal tunnel release. Methods: In this observer-blinded, randomized controlled superiority trial, 100 patients undergoing carpal tunnel release were randomized to receive ultrasound-guided forearm nerve block (n = 50) or forearm IVRA (n = 50). The primary outcome was anaesthetic efficacy evaluated by classifying the blocks as complete vs incomplete. Complete anaesthesia was defined as total sensory block, incomplete anaesthesia as mild pain requiring more analgesics or need of general anaesthesia. Pain intensity on a numeric rating scale (0–10) was recorded. Surgeon satisfaction with haemostasis, surgical time, and OR stay time were recorded. Patient satisfaction with the quality of the block was assessed at POD 1. This study is reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement Results: In total, 43 (86%) of the forearm nerve blocks were evaluated as complete, compared to 33 (66%) of the forearm IVRA (p = 0.019). After the forearm nerve block, pain intensity was lower at discharge (-1.76 points lower, 95% CI (-2.92, -0.59), p = 0.0006) compared to patients treated with forearm IVRA. No differences in pain experienced at the start of the surgery, during surgery, and at POD1, nor in surgical time or total OR stay was observed between groups. Surgeon (p = 0.0016) and patient satisfaction (p = 0.0023) were slightly higher after forearm nerve block. Conclusions: An ultrasound-guided forearm nerve block is superior compared to forearm IVRA in providing a surgical block in patients undergoing carpal tunnel release