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Article: Corticosteroid treatment for persistent pulmonary infiltrates following COVID-19 infection: Clearing the fog?

Ntiamoah, Prince / Biehl, Michelle / Ruesch, Victoria / Mehta, Atul C / Farha, Samar

2024 Volume 19, Issue 1, Page(s) 74–80

Abstract: Background: Systemic corticosteroids have been shown to improve outcomes in severe coronavirus disease 2019 (COVID-19) pneumonia; however, their role in post-COVID-19 persistent lung abnormalities is not well defined. Here, we describe our experience ... ...

Abstract	Background: Systemic corticosteroids have been shown to improve outcomes in severe coronavirus disease 2019 (COVID-19) pneumonia; however, their role in post-COVID-19 persistent lung abnormalities is not well defined. Here, we describe our experience with corticosteroids in patients with persistent lung infiltrates following COVID-19 infection. Research question: What is the efficacy of systemic corticosteroids in improving lung function and radiological abnormalities in patients following COVID-19 pneumonia? Study design and methods: This is a single-center retrospective study evaluating patients with persistent respiratory symptoms and abnormal chest computed tomography findings. Patients were divided into two groups based on treatment with corticosteroids: "steroid group" and "nonsteroid group." Clinical data were collected from the electronic medical records. Results: Between March 2020 and December 2021, 227 patients were seen in the post-COVID-19 pulmonary clinic, of which 75 were included in this study. The mean age was 56 years, 63% were female, and 75% were white. The main physiologic deficit was reduced Diffusing capacity of the Lungs for Carbon Monoxide (DLCO) at 72% (±22). On chest imaging, the most common findings were ground-glass opacities (91%) and consolidation (29%). Thirty patients received corticosteroid (steroid group) and 45 did not (nonsteroid group). Patients treated with corticosteroids had lower DLCO (DLCO [%]: steroid group 63 ± 17, nonsteroid group 78 ± 23; Conclusion: The use of systemic corticosteroids in patients with persistent respiratory symptoms and radiological abnormalities post-COVID-19 was associated with significant improvement in pulmonary function testing and imaging. Prospective studies are needed to confirm whether these findings are the effect of corticosteroid therapy or disease evolution over time.
Language	English
Publishing date	2024-01-25
Publishing country	India
Document type	Journal Article
ZDB-ID	2241287-6
ISSN	1998-3557 ; 1817-1737
ISSN (online)	1998-3557
ISSN	1817-1737
DOI	10.4103/atm.atm_121_23
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Article ; Online: Post-intensive care syndrome and COVID-19 - Implications post pandemic.

Biehl, Michelle / Sese, Denise

Cleveland Clinic journal of medicine

2020

Abstract: Post-intensive care syndrome (PICS) describes new or worsening physical, cognitive, or mental impairments in a patient following critical illness or intensive care. The COVID-19 pandemic will likely result in many more patients with PICS and its ... ...

Abstract	Post-intensive care syndrome (PICS) describes new or worsening physical, cognitive, or mental impairments in a patient following critical illness or intensive care. The COVID-19 pandemic will likely result in many more patients with PICS and its associated health and economic challenges. Screening and assessment tools done during hospitalization, at discharge, and post discharge should be utilized to facilitate services and strategies to improve PICS outcomes for patient and their families.
Keywords	covid19
Language	English
Publishing date	2020-08-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	639116-3
ISSN	1939-2869 ; 0891-1150
ISSN (online)	1939-2869
ISSN	0891-1150
DOI	10.3949/ccjm.87a.ccc055
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Article ; Online: Update to post-acute sequelae of SARS-CoV-2 infection: Caring for the 'long-haulers'.

Vehar, Susan / Boushra, Marina / Ntiamoah, Prince / Biehl, Michelle

Cleveland Clinic journal of medicine

2021

Abstract: An estimated 10% of COVID-19 survivors continue to experience symptoms several weeks to months after the appearance of initial symptoms, a condition termed post-acute sequelae of SARS-CoV-2 infection (PASC). These patients, also called "long-haulers," ... ...

Abstract	An estimated 10% of COVID-19 survivors continue to experience symptoms several weeks to months after the appearance of initial symptoms, a condition termed post-acute sequelae of SARS-CoV-2 infection (PASC). These patients, also called "long-haulers," most commonly report protracted symptoms of fatigue, cough, dyspnea, chest tightness, difficulty concentrating, arthralgia, olfactory dysfunction, and headache. While age, comorbid medical conditions, and COVID-19 severity are suspected risk factors for PASC, young and previously healthy individuals with mild COVID-19 are also at risk. Recognition of symptoms, evaluation, supportive treatment, and attention to medical comorbidities are the cornerstones of medical management.
Language	English
Publishing date	2021-10-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	639116-3
ISSN	1939-2869 ; 0891-1150
ISSN (online)	1939-2869
ISSN	0891-1150
DOI	10.3949/ccjm.88a.21010-up
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Article ; Online: Post-acute sequelae of SARS-CoV-2 infection: Caring for the 'long-haulers'.

Vehar, Susan / Boushra, Marina / Ntiamoah, Prince / Biehl, Michelle

Cleveland Clinic journal of medicine

2021 Volume 88, Issue 5, Page(s) 267–272

Abstract	An estimated 10% of COVID-19 survivors continue to experience symptoms several weeks to months after the appearance of initial symptoms, a condition termed post-acute sequelae of SARS-CoV-2 infection (PASC). These patients, also called "long-haulers," most commonly report protracted symptoms of fatigue, cough, dyspnea, chest tightness, difficulty concentrating, arthralgia, olfactory dysfunction, and headache. While age, comorbid medical conditions, and COVID-19 severity are risk factors, young and previously healthy individuals with mild COVID-19 are also at risk. Recognition of symptoms, evaluation, supportive treatment, and attention to medical comorbidities are the cornerstones of medical management.
MeSH term(s)	COVID-19/complications ; COVID-19/diagnosis ; COVID-19/etiology ; COVID-19/physiopathology ; COVID-19/therapy ; Chronic Disease ; Disease Progression ; Humans ; Risk Factors
Language	English
Publishing date	2021-05-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	639116-3
ISSN	1939-2869 ; 0891-1150
ISSN (online)	1939-2869
ISSN	0891-1150
DOI	10.3949/ccjm.88a.21010
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Article ; Online: Severe covid-19 pneumonia: pathogenesis and clinical management.

Attaway, Amy H / Scheraga, Rachel G / Bhimraj, Adarsh / Biehl, Michelle / Hatipoğlu, Umur

BMJ (Clinical research ed.)

2021 Volume 372, Page(s) n436

Abstract: Severe covid-19 pneumonia has posed critical challenges for the research and medical communities. Older age, male sex, and comorbidities increase the risk for severe disease. For people hospitalized with covid-19, 15-30% will go on to develop covid-19 ... ...

Abstract	Severe covid-19 pneumonia has posed critical challenges for the research and medical communities. Older age, male sex, and comorbidities increase the risk for severe disease. For people hospitalized with covid-19, 15-30% will go on to develop covid-19 associated acute respiratory distress syndrome (CARDS). Autopsy studies of patients who died of severe SARS CoV-2 infection reveal presence of diffuse alveolar damage consistent with ARDS but with a higher thrombus burden in pulmonary capillaries. When used appropriately, high flow nasal cannula (HFNC) may allow CARDS patients to avoid intubation, and does not increase risk for disease transmission. During invasive mechanical ventilation, low tidal volume ventilation and positive end expiratory pressure (PEEP) titration to optimize oxygenation are recommended. Dexamethasone treatment improves mortality for the treatment of severe and critical covid-19, while remdesivir may have modest benefit in time to recovery in patients with severe disease but shows no statistically significant benefit in mortality or other clinical outcomes. Covid-19 survivors, especially patients with ARDS, are at high risk for long term physical and mental impairments, and an interdisciplinary approach is essential for critical illness recovery.
MeSH term(s)	COVID-19/complications ; COVID-19/diagnosis ; COVID-19/therapy ; Humans ; Respiration, Artificial ; Respiratory Distress Syndrome/diagnosis ; Respiratory Distress Syndrome/therapy ; Respiratory Distress Syndrome/virology ; SARS-CoV-2/pathogenicity
Language	English
Publishing date	2021-03-10
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.n436
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Article ; Online: Neuropsychiatric assessment and management of the ICU survivor.

Dean, Erin A / Biehl, Michelle / Bash, Kathryn / Weleff, Jeremy / Pozuelo, Leopoldo

Cleveland Clinic journal of medicine

2021 Volume 88, Issue 12, Page(s) 669–679

Abstract: Any survivor among the millions of patients admitted to the intensive care unit (ICU) for critical illness each year is susceptible to persistent health problems that continue after discharge and may lead to post-intensive care syndrome (PICS), defined ... ...

Abstract	Any survivor among the millions of patients admitted to the intensive care unit (ICU) for critical illness each year is susceptible to persistent health problems that continue after discharge and may lead to post-intensive care syndrome (PICS), defined as new or worsening dysfunction from physical impairment, cognitive impairment, or emotional impairment, or a combination. Considering the increased rates of ICU survival and the growing elderly population more likely to utilize ICU resources, critical care practitioners have broadened their focus on outcomes and care of ICU survivors to include the acute post-ICU survival period as well as months and even years after ICU discharge. This review focuses on the neuropsychiatric aspects of PICS in ICU survivors including diagnostic, screening, and treatment recommendations. It also highlights the value of post-ICU clinics and the unique role of the consultation psychiatrist in the care of this patient population.
MeSH term(s)	Aged ; Cognitive Dysfunction/diagnosis ; Cognitive Dysfunction/therapy ; Critical Care ; Critical Illness ; Humans ; Intensive Care Units ; Survivors
Language	English
Publishing date	2021-12-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	639116-3
ISSN	1939-2869 ; 0891-1150
ISSN (online)	1939-2869
ISSN	0891-1150
DOI	10.3949/ccjm.88a.20169
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Article ; Online: The safety and efficacy of the IPACK block in primary total knee arthroplasty: a retrospective chart review.

Biehl, Michelle / Wild, Lisa / Waldman, Kyle / Haq, Farzana / Easteal, Ronald A / Sawhney, Monakshi

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2020 Volume 67, Issue 9, Page(s) 1271–1273

MeSH term(s)	Arthroplasty, Replacement, Knee ; Humans ; Nerve Block/adverse effects ; Pain, Postoperative/prevention & control ; Retrospective Studies
Language	English
Publishing date	2020-04-06
Publishing country	United States
Document type	Letter ; Review
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/s12630-020-01652-1
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Article ; Online: The Incremental Burden of Acute Respiratory Distress Syndrome: Long-term Follow-up of a Population-Based Nested Case-Control Study.

Biehl, Michelle / Ahmed, Adil / Kashyap, Rahul / Barwise, Amelia / Gajic, Ognjen

Mayo Clinic proceedings

2018 Volume 93, Issue 4, Page(s) 445–452

Abstract: Objective: To evaluate the long-term survival of patients at similar risk for hospital-acquired acute respiratory distress syndrome (ARDS) who did and did not develop ARDS.: Methods: We conducted long-term follow-up of a population-based nested case- ... ...

Abstract	Objective: To evaluate the long-term survival of patients at similar risk for hospital-acquired acute respiratory distress syndrome (ARDS) who did and did not develop ARDS. Methods: We conducted long-term follow-up of a population-based nested case-control study in a consecutive cohort of adult Olmsted County, Minnesota, patients admitted from January 1, 2001, through December 31, 2010. Patients in whom ARDS developed during their hospital stay (cases) were matched to similar-risk patients without ARDS (controls) by 6 characteristics: age, sex, sepsis, high-risk surgery, ratio of oxygen saturation to fraction of inspired oxygen, and ARDS risk according to the Lung Injury Prediction Score. Hospital mortality, discharge disposition, and long-term survival were compared. Results: Patients who developed hospital-acquired ARDS (n=400) had higher hospital mortality than at-risk controls (n=400) (35% vs 5%; P<.001). Among hospital survivors (252 matched pairs), ARDS cases were more likely to be discharged to rehabilitation (13% vs 4%) and long-term care (30% vs 15%) facilities, whereas more controls were discharged home (71% vs 41%). After discharge, differences in survival persisted beyond 90 days (adjusted hazard ratio [HR], 1.76; 95% CI, 1.2-2.5; P=.002) and 6 months (adjusted HR, 1.73; 95% CI, 1.2-2.6; P<.001). Conclusion: These results suggest that in a population-based matched case-control study of patients with similar characteristics at the time of hospital admission, those who developed hospital-acquired ARDS had worse long-term survival.
MeSH term(s)	Adult ; Aged ; Case-Control Studies ; Cost of Illness ; Disease-Free Survival ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care)/statistics & numerical data ; Patient Discharge/statistics & numerical data ; Respiratory Distress Syndrome, Adult/mortality ; Time Factors
Language	English
Publishing date	2018-03-01
Publishing country	England
Document type	Journal Article
ZDB-ID	124027-4
ISSN	1942-5546 ; 0025-6196
ISSN (online)	1942-5546
ISSN	0025-6196
DOI	10.1016/j.mayocp.2017.11.025
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Article ; Online: Acute skeletal muscle loss in SARS-CoV-2 infection contributes to poor clinical outcomes in COVID-19 patients.

Attaway, Amy / Welch, Nicole / Dasarathy, Dhweeja / Amaya-Hughley, Jocelyn / Bellar, Annette / Biehl, Michelle / Dugar, Siddharth / Engelen, Marielle P K J / Zein, Joe / Dasarathy, Srinivasan

Journal of cachexia, sarcopenia and muscle

2022 Volume 13, Issue 5, Page(s) 2436–2446

Abstract: Background: Chronic disease causes skeletal muscle loss that contributes to morbidity and mortality. There are limited data on the impact of dynamic muscle loss on clinical outcomes in COVID-19. We hypothesized that acute COVID-19-related muscle loss ( ... ...

Abstract	Background: Chronic disease causes skeletal muscle loss that contributes to morbidity and mortality. There are limited data on the impact of dynamic muscle loss on clinical outcomes in COVID-19. We hypothesized that acute COVID-19-related muscle loss (acute sarcopenia) is associated with adverse outcomes. Methods: A retrospective analysis of a prospective clinical registry of COVID-19 patients was performed in consecutive hospitalized patients with acute COVID-19 (n = 95) and compared with non-COVID-19 controls (n = 19) with two temporally unique CT scans. Pectoralis muscle (PM), erector spinae muscle (ESM) and 30 day standardized per cent change in cross sectional muscle area were quantified. Primary outcomes included mortality and need for intensive care unit (ICU) admission. Multivariate linear and logistic regression were performed. Cox proportional hazard ratios were generated for ICU admission or mortality for the per cent muscle loss standardized to 30 days. Results: The COVID-19 CT scan cohort (n = 95) had an average age of 63.3 ± 14.3 years, comorbidities including COPD (28.4%) and diabetes mellitus (42.1%), and was predominantly Caucasian (64.9%). The proportion of those admitted to the ICU was 54.7%, with 10.5% requiring tracheostomy and overall mortality 16.8%. Median duration between CT scans was 32 days (IQR: 16-63 days). Significant reductions in median per cent loss was noted for PM (-2.64% loss [IQR: -0.28, -5.47] in COVID-19 vs. -0.06 loss [IQR: -0.01, -0.28] in non-COVID-19 CT controls, P < 0.001) and ESM (-1.86% loss [IQR: -0.28, -5.47] in COVID-19 vs. -0.06 loss [IQR: -0.02, -0.11]) in non-COVID-19 CT controls, P < 0.001). Multivariate linear regression analysis of per cent loss in PM was significantly associated with mortality (-10.8% loss [95% CI: -21.5 to -0.19]) and ICU admission (-11.1% loss [95% CI: -19.4 to -2.67]), and not significant for ESM. Cox proportional hazard ratios demonstrated greater association with ICU admission (adj HR 2.01 [95% CI: 1.14-3.55]) and mortality (adj HR 5.30 [95% CI: 1.19-23.6]) for those with significant per cent loss in PM, and greater association with ICU admission (adj HR 8.22 [95% CI: 1.11-61.04]) but not mortality (adj HR 2.20 [95% CI: 0.70-6.97]) for those with significant per cent loss in ESM. Conclusions: In a well-characterized cohort of 95 hospitalized patients with acute COVID-19 and two temporally distinct CT scans, acute sarcopenia, determined by standardized reductions in PM and ESM, was associated with worse clinical outcomes. These data lay the foundation for evaluating dynamic muscle loss as a predictor of clinical outcomes and targeting acute sarcopenia to improve clinical outcomes for COVID-19.
MeSH term(s)	Aged ; COVID-19 ; Cross-Sectional Studies ; Humans ; Middle Aged ; Muscle, Skeletal ; Prospective Studies ; Retrospective Studies ; SARS-CoV-2 ; Sarcopenia/epidemiology ; Sarcopenia/etiology
Language	English
Publishing date	2022-07-19
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2586864-0
ISSN	2190-6009 ; 2190-5991
ISSN (online)	2190-6009
ISSN	2190-5991
DOI	10.1002/jcsm.13052
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Article ; Online: Implementation of a Virtual Interprofessional ICU Learning Collaborative: Successes, Challenges, and Initial Reactions From the Structured Team-Based Optimal Patient-Centered Care for Virus COVID-19 Collaborators.

Zec, Simon / Zorko Garbajs, Nika / Dong, Yue / Gajic, Ognjen / Kordik, Christina / Harmon, Lori / Bogojevic, Marija / Singh, Romil / Sun, Yuqiang / Bansal, Vikas / Vu, Linh / Cawcutt, Kelly / Litell, John M / Redmond, Sarah / Fitzpatrick, Eleanor / Kooda, Kirstin J / Biehl, Michelle / Dangayach, Neha S / Kaul, Viren /

Chae, June M / Leppin, Aaron / Siuba, Mathew / Kashyap, Rahul / Walkey, Allan J / Niven, Alexander S

Critical care explorations

2023 Volume 5, Issue 6, Page(s) e0922

Abstract: Initial Society of Critical Care Medicine Discovery Viral Infection and Respiratory illness Universal Study (VIRUS) Registry analysis suggested that improvements in critical care processes offered the greatest modifiable opportunity to improve critically ...

Abstract	Initial Society of Critical Care Medicine Discovery Viral Infection and Respiratory illness Universal Study (VIRUS) Registry analysis suggested that improvements in critical care processes offered the greatest modifiable opportunity to improve critically ill COVID-19 patient outcomes. Objectives: The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 ICU Collaborative was created to identify and speed implementation of best evidence based COVID-19 practices. Design setting and participants: This 6-month project included volunteer interprofessional teams from VIRUS Registry sites, who received online training on the Checklist for Early Recognition and Treatment of Acute Illness and iNjury approach, a structured and systematic method for delivering evidence based critical care. Collaborators participated in weekly 1-hour videoconference sessions on high impact topics, monthly quality improvement (QI) coaching sessions, and received extensive additional resources for asynchronous learning. Main outcomes and measures: Outcomes included learner engagement, satisfaction, and number of QI projects initiated by participating teams. Results: Eleven of 13 initial sites participated in the Collaborative from March 2, 2021, to September 29, 2021. A total of 67 learners participated in the Collaborative, including 23 nurses, 22 physicians, 10 pharmacists, nine respiratory therapists, and three nonclinicians. Site attendance among the 11 sites in the 25 videoconference sessions ranged between 82% and 100%, with three sites providing at least one team member for 100% of sessions. The majority reported that topics matched their scope of practice (69%) and would highly recommend the program to colleagues (77%). A total of nine QI projects were initiated across three clinical domains and focused on improving adherence to established critical care practice bundles, reducing nosocomial complications, and strengthening patient- and family-centered care in the ICU. Major factors impacting successful Collaborative engagement included an engaged interprofessional team; an established culture of engagement; opportunities to benchmark performance and accelerate institutional innovation, networking, and acclaim; and ready access to data that could be leveraged for QI purposes. Conclusions and relevance: Use of a virtual platform to establish a learning collaborative to accelerate the identification, dissemination, and implementation of critical care best practices for COVID-19 is feasible. Our experience offers important lessons for future collaborative efforts focused on improving ICU processes of care.
Language	English
Publishing date	2023-06-05
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000922
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