- |||||||||| dexamethasone / Generic mfg.
METHYLPREDNISOLONE-INDUCED HYPERLACTATEMIA: A CASE REPORT () - Jan 4, 2024 - Abstract #SCCM2024SCCM_2332;
Steroid-induced elevations in lactate have been reported after perioperative use of high-dose dexamethasone in patients undergoing cardiopulmonary bypass, and in a single patient with COPD receiving a steroid burst.2,3 The mechanism is likely via steroid-induced hepatic gluconeogenesis, insulin resistance, and aerobic glycolysis...This reaction occurs at a 1:10 ratio (LPR of ~10). When oxygen is not available, pyruvate accumulates, cellular acidosis develops, and the ratio of NADH-to-NAD increases, subsequently increasing the LPR (LPR>>10).1 Clinicians should be aware of this unusual complication and consider early assessment of the LPR to prevent unnecessary fluid resuscitation and imaging.
- |||||||||| hydrocortisone / Generic mfg., midazolam hydrochloride / Generic mfg.
SEVERE PARECHOVIRUS MENINGOENCEPHALITIS IN NEONATES AND INFANTS: CASE SERIES AND LITERATURE REVIEW () - Jan 4, 2024 - Abstract #SCCM2024SCCM_2257;
All experienced refractory status epilepticus requiring midazolam and pentobarbital infusions...Patients required on average 15.5 days of ventilation (ranging from 7 to 33 days) and were treated with IVIG, and either methylprednisolone or hydrocortisone...Seizures can be refractory requiring barbiturate infusion. Patients are at risk for short and long-term neurologic sequelae and need close post-discharge follow-up.
- |||||||||| hydrocortisone / Generic mfg.
TAPER VERSUS NON-TAPER DISCONTINUATION STRATEGY OF HYDROCORTISONE IN SEPTIC SHOCK () - Jan 4, 2024 - Abstract #SCCM2024SCCM_2250;
Patients are at risk for short and long-term neurologic sequelae and need close post-discharge follow-up. The abrupt withdrawal of hydrocortisone after the resolution of septic shock did not impact hemodynamic stability among this patient population and may be associated with decreased medication burden and adverse events.
- |||||||||| hydrocortisone / Generic mfg.
IMPACT OF ANGIOTENSIN II ON MORTALITY IN SEPTIC SHOCK () - Jan 4, 2024 - Abstract #SCCM2024SCCM_2244;
Patients who received Ang2 had a lower in-hospital mortality and shorter ICU and hospital lengths of stay. Larger studies are necessary to determine statistical significance.
- |||||||||| hydrocortisone / Generic mfg.
TIMING OF STRESS-DOSE STEROID INITIATION IN ADULT PATIENTS WITH SEPTIC SHOCK () - Jan 4, 2024 - Abstract #SCCM2024SCCM_2194;
Early initiation of stress-dose hydrocortisone was associated with significant improvement in ventilation and vasopressor requirements, length of vasopressor therapy, mortality, and resolution of septic shock compared to late initiation. However, the time to septic shock resolution was not significantly different between the two groups.
- |||||||||| hydrocortisone / Generic mfg.
EVALUATION OF STRESS-DOSE STEROID TAPERS IN SEPTIC SHOCK () - Jan 4, 2024 - Abstract #SCCM2024SCCM_2187;
Based on risk of secondary adrenal insufficiency, steroid tapers were not needed for a majority of patients in this review. Increases in mortality influenced outcomes, however, this is not indicative of a causal relationship.
- |||||||||| hydrocortisone / Generic mfg.
IMPACT OF CRRT ON INSULIN SENSITIVITY: ROLE OF THE MICROELEMENTS () - Jan 4, 2024 - Abstract #SCCM2024SCCM_2087;
On admission patient required mechanical ventilation, vasopressor support (norepinephrine 18 ug/min, vasopressin 0.03 UI/min) and stress dose hydrorcortisone...Causes of Cr deficiency in the ICU include CRRT overdose, high dose vasopressors leading to intestinal ischemia, diarrhea and nutritional deficit. Measuring Cr in serum and dialysis ultrafiltrate fluid is easy and can help to direct the therapy with oral Cr picolinate.
- |||||||||| Cubicin (daptomycin) / Merck (MSD)
A RARE CASE OF DAPTOMYCIN-INDUCED EOSINOPHILIC PNEUMONIA () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1968;
The diagnosis of eosinophilic pneumonia can be difficult, as symptoms and imaging can mimic other respiratory conditions. Additionally bronchoalveolar lavage can be limited in unstable patient populations, and manifestations such as peripheral eosinophilia are rarely present and not diagnostic.
- |||||||||| Paxlovid (nirmatrelvir/ritonavir) / Pfizer
INTRACTABLE COVID-19 INFECTION IN THE IMMUNOCOMPROMISED () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1937;
A month into treatment, he had recurrent episodes of symptomatic COVID-19 infection requiring supplemental oxygen, managed as an outpatient twice with Paxlovid and subsequently requiring three hospitalizations...He was managed with Remdesevir,Dexamethasone and intravenous immunoglobulins (IVIG).Patient improved and was weaned off of O2 for the first time since COVID-19 diagnosis.Interestingly, during these episodes his tests remained positive...We want to highlight the unexpected resolution of respiratory failure with the addition of IVIG supporting our hypothesis of persistent infection. Obtaining further insight into this patient population and formulating new treatment strategies is essential.
- |||||||||| Anoro Ellipta (umeclidinium/vilanterol) / Innoviva, GSK, Breo Ellipta (fluticasone furoate / vilanterol) / GSK, Innoviva
COMPARING DIFFERENT FORMS OF TRIPLE INHALED THERAPY IN REDUCING HOSPITALIZATIONS () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1884;
Furthermore, the study does not account for patients who are noncompliant on triple inhaled therapy and those who were treated in the outpatient setting. A prospective cohort study would be more beneficial in establishing a superior form of triple inhaled therapy.
- |||||||||| lidocaine topical / Generic mfg., dexamethasone injection / Generic mfg.
WATCH YOUR TONGUE: A CHALLENGING AIRWAY SECONDARY TO SEVERE MACROGLOSSIA POST-CRANIOTOMY () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1810;
Her airway was secured by an awake nasal fiberoptic intubation using light sedation and topicalization with lidocaine...The etiology is possibly multi-factorial with a combination of mechanical compression leading to venous and lymphatic obstruction, dependent edema due to prone positioning compounded by trauma during intubation. Use of nasotracheal intubation, bite block, tongue massage and AEC helped in a safe extubation and successful outcome in our patient.
- |||||||||| dexamethasone / Generic mfg.
CLINICAL TRIAL EMULATION AS A METHOD FOR CAUSAL INFERENCE IN CRITICAL CARE () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1784;
This analysis suggests that EHR data can be used to emulate trails to the effectiveness of treatments within an RCT. Trial emulation can be a powerful tool to evaluate whether the results of RCT are present in real world treatment and may provide information on post-hoc analysis of treatment effectiveness within patient groups, or in hypotheses generation for future trials.
- |||||||||| dapsone / Generic mfg.
WHY SO BLUE? SEROTONIN SYNDROME IN DAPSONE-INDUCED METHEMOGLOBINEMIA () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1707;
Description: A 54-year-old woman, with depression (on paroxetine and bupropion), and diffuse large B-cell lymphoma (on rituximab, dexamethasone, cytarabine, and oxaliplatin, last dosed one month before admission) presented to the hospital with shortness of breath, headaches and demonstrated hypoxemia...She was treated with IV crystalloids, IV lorazepam and discontinuation of antidepressants...Early identification and intervention, such as discontinuing offending agents, are vital to prevent life-threatening progression. This case underlines the necessity of heightened vigilance for increased serotonergic activity in patients using SSRIs and MAO inhibitors, and the consideration of alternative treatments.
- |||||||||| Invega Sustenna (paliperidone palmitate extended-release 1-month injection) / J&J
ACUTE EOSINOPHILIC PNEUMONIA: A CASE REPORT () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1649;
Her medications included antipsychotics and monthly paliperidone palmitate injection administered two days prior...They were soon changed due to a negative MRSA swab and doxycycline was started for coverage of atypical organisms...After intubation she started dexamethasone 20?mg/day for the initial diagnosis of ARDS...Never before has a case of paliperidone palmitate induced AEP been documented. Although the diagnosis of AEP is typically established by the demonstration of eosinophilia in the BAL fluid analysis, in some cases, eosinophilia may be absent, and a lung biopsy may be necessary for confirmation.
- |||||||||| trimethoprim/sulfamethoxazole / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
A RARE CAUSE OF SEVERE PEDIATRIC ACUTE RESPIRATORY DISTRESS SYNDROME () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1646;
CD40LD is rare and requires a prompt multidisciplinary approach for a timely diagnosis. Management includes supportive care, treating opportunistic infections, and eventual hematopoietic stem cell transplant.
- |||||||||| Kineret (anakinra) / SOBI
A RARE CASE OF EHRLICHIOSIS COMPLICATED BY SECONDARY HLH AND SUPER-REFRACTORY STATUS EPILEPTICUS () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1616;
He was treated with doxycycline...Despite receiving appropriate antibiotic coverage, his hyperinflammatory state continued to deteriorate, requiring the initiation of anakinra and dexamethasone...Arkansas has the highest incidence of Ehrlichiosis in the United States. Ehrlichiosis needs to be high on the differential for pediatric patients presenting with fever and altered mental status.
- |||||||||| EFFECTIVENESS OF MEDICATIONS TO TREAT BRONCHIOLITIS IN THE PICU () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1584;
Use of bronchodilators, steroids, HTS, NAC, or DA to treat patients with bronchiolitis in the PICU is not associated with reduced PICU LOS, rate of intubation, or duration of intubation. Additional study with more granular severity of illness scores and timing of therapies is needed to verify our results.
- |||||||||| dexamethasone / Generic mfg.
CONGENITAL VALLECULAR CYST: A CASE REPORT () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1498;
We conclude that, rare causes such as laryngeal cysts should be taken into account when a child presents with signs and symptoms of upper airway obstruction. We have also come to the conclusion that use of the C-MAC video laryngoscope contributed to diagnosis of vallecular cyst.
- |||||||||| methylprednisolone sodium succinate / Generic mfg.
METABOLIC MASQUERADE: A RARE PRESENTATION OF LEIGH SYNDROME () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1496;
This case demonstrates the medical challenge of diagnosing Leigh syndrome due to its non-specific characterized signs and symptoms that may also be consistent with other neurological diagnosis. Although a uniformly fatal disease with no specific treatment, expediting the diagnostic work-up when there is high clinical suspicion can allow clinicians to discuss overall prognosis and in cases of familial inheritance, guide future family planning.
- |||||||||| dexamethasone / Generic mfg.
ASSOCIATION OF INSULIN USE AND GLYCEMIC STATUS WITH DEXAMETHASONE DOSE PATTERNS IN COVID-19 PATIENTS () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1411;
Although a uniformly fatal disease with no specific treatment, expediting the diagnostic work-up when there is high clinical suspicion can allow clinicians to discuss overall prognosis and in cases of familial inheritance, guide future family planning. In this retrospective study, COVID-19 patients with higher doses of dexamethasone had a higher insulin requirement, although no difference was noted in the mean daily glucose level.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
POSTPARTUM MYXEDEMA COMA () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1408;
The optimal mode of thyroid hormone replacement is controversial, but IV administration is often preferred. Some recommend adding liothyronine if clinical response is poor.
- |||||||||| prednisone / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
CLIPPERS: A CHALLENGING BRAINSTEM DISORDER () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1394;
Interruption of therapy or inability to start treatment may result in potential worsening relapse which may become severely disabling. Steroids sparing immunosuppressant medications may be used to maintain remission.
- |||||||||| hydrocortisone / Generic mfg., acyclovir / Generic mfg.
AN UNUSUAL CASE OF FULMINANT HEMORRHAGIC VARICELLA INFECTION IN AN IMMUNOCOMPETENT PATIENT () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1385;
The authors consider this a case of academic interest, emphasizing the possibility of life-threatening VZV infection in healthy adults and the significance of vaccination with special consideration for high-risk adults working in crowded settings. Given their high mortality rate, community physicians and intensivists must have a low index of suspicion and be prompt with the diagnosis and treatment of VZV complications.
- |||||||||| Fycompa (perampanel) / Eisai, Catalyst Pharma
STEROID-RESPONSIVE ENCEPHALOPATHY ASSOCIATED WITH AUTOIMMUNE THYROIDITIS (SREAT) () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1370;
On hospital day (HD) 2, she continued to have seizures and treatment escalation included ketogenic diet, ketamine drip, phenobarbital, and perampanel...Diagnosis is supported by elevated antithyroid peroxidase antibody or antithyroglobulin antibody and improvement with steroids. She is doing well on steroid taper.
- |||||||||| tizanidine / Generic mfg.
ERYTHEMA MULTIFORME AND TIZANIDINE: A RARE ASSOCIATION () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1332;
While rare, tizanidine should be considered as a trigger for EM. This is especially important to recognize when differentiating between serious dermatological conditions such as EM, SJS, and toxic epidermal necrolysis.
- |||||||||| piperacillin sodium/tazobactam sodium / Generic mfg., hydrocortisone / Generic mfg.
REFRACTORY SHOCK DUE TO PARVIMONAS BACTEREMIA () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1327;
He continued to require norepinephrine for several days despite other adjunct therapies, such as hydrocortisone...Performing a comprehensive evaluation including chest, abdomen, and pelvis CT scan, as well as endoscopy/colonoscopy, to screen for potential occult gastrointestinal tract malignancy at an early localized stage is of utmost importance. Our patient
- |||||||||| dexamethasone / Generic mfg.
ASSOCIATION OF DEXAMETHASONE DOSING WITH OUTCOMES AMONG PATIENTS WITH COVID-19 () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1324;
The results may be affected by selection bias, given the higher severity of illness among patients treated with high dose-dexamethasone. Further prospective randomized controlled studies with different doses of corticosteroids are warranted.
- |||||||||| dexamethasone / Generic mfg., carfilzomib / Generic mfg., fluconazole oral / Generic mfg.
CRYPTOCOCCAL MENINGITIS: A DIAGNOSTIC CONUNDRUM IN AN ENCEPHALOPATHIC PATIENT WITH MULTIPLE MYELOMA () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1322;
Description: A 74-year-old male, diagnosed with cardiac disease and kappa light chain multiple myeloma (MM) on second line treatment (carfilzomib) and weekly dexamethasone presented with acute encephalopathy...Therapy included a single high dose of amphotericin, flucytosine, fluconazole, and serial lumbar punctures, leading to initial improved mental status...Cryptococcosis typically afflicts those with T-cell immunodeficiency such as HIV or lymphoma but rarely reported in MM since cell mediated immunity is largely preserved. However, the duration of MM and cumulative dose of treatment along with steroid use likely suppressed cellular immunity and heightened susceptibility to fungal infections in our patient.
- |||||||||| Olumiant (baricitinib) / Incyte, Eli Lilly, Actemra IV (tocilizumab) / Roche, JW Pharma
ADDITION OF REMDESIVIR TO DUAL-THERAPY DEXAMETHASONE AND BARICITINIB OR TOCILIZUMAB FOR COVID-19 () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1300;
However, the duration of MM and cumulative dose of treatment along with steroid use likely suppressed cellular immunity and heightened susceptibility to fungal infections in our patient. There was no difference in progression to mechanical ventilation or in-hospital mortality in patients receiving dual therapy versus triple therapy with COVID-19, but there were higher rates of bradycardia in patients receiving triple therapy.
- |||||||||| TUBERCULOUS MENINGITIS: A RARE PRESENTATION WITHOUT EVIDENCE OF SEEDING OR REACTIVATION () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1261;
In the adult population, TBM is mostly described as a chronic reactivation of previous disease state due to recent immunosuppression. This case however shows an extremely rare presentation of TBM without evidence of primary infection seeding the meninges, history of TB infection, recent travel, or immunosuppressive conditions.
- |||||||||| PATTERNS OF USE OF MEDICATIONS TO TREAT BRONCHIOLITIS IN THE PICU () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1247;
Bronchodilators, steroids, and HTS are frequently used to treat bronchiolitis. There is large inter-hospital variability in bronchodilator, steroid, and HTS use that can be leveraged to study medication effectiveness.
- |||||||||| Remicade (infliximab) / Merck (MSD), Mitsubishi Tanabe, J&J, Rituxan (rituximab) / Biogen, Zenyaku Holdings, Roche
A RARE AND LIFE-THREATENING PRESENTATION OF EHRLICHIA-INDUCED HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1220;
Description: A 55-year-old man with hypertension, diabetes, and rheumatoid arthritis on infliximab presented with fever, weakness, confusion, and oliguria...His bone marrow biopsy was compatible with HLH, and high dose dexamethasone and rituximab were started...HLH was thought to be related to Ehrlichiosis considering rapid response to doxycycline...Due to prevalence of tickborne diseases in Kentucky, infectious work-up was performed that uncovered his secondary cause of HLH (Pasternak et al, 2023). We recommend a complete history and evaluation for Ehrlichia when indicated in those with HLH, as early intervention may improve outcomes.
- |||||||||| WHEN IT () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1209;
Initially she was treated with antibiotics, corticosteroids, and epinephrine...After initiation of etoposide and dexamethasone, she had not only improvement in facial edema and lung compliance, but vasopressor support...There was a profound clinical response to etoposide, likely resulting in the deactivation of circulating inflammatory cytokines which lead to profound vasoplegic shock. HLH continues to be a challenging condition to diagnose and treat with high rates of mortality, but having a high index of suspicion in those with AITL can lead to earlier diagnosis and management with profound clinical response.
- |||||||||| Kineret (anakinra) / SOBI, Rituxan (rituximab) / Biogen, Zenyaku Holdings, Roche
ACUTE ANEMIA DUE TO SYNDROMIC TRANSFORMATION: SJOGREN TO EVANS TO MACROPHAGE ACTIVATION SYNDROME () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1205;
In addition to blood transfusions, she was treated with dexamethasone, anakinra and subsequently placed on rituximab. While MAS is commonly associated with rheumatologic disorders such as JIA, SLE and RA, our case highlights a rare association of it with Sjogren
- |||||||||| THYROTOXIC PERIODIC PARALYSIS: A BREATHLESS PRESENTATION OF GRAVES DISEASE IN A YOUNG HISPANIC MALE () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1036;
Magnetic resonance imaging of his spine was normal and his symptoms resolved with ketorolac, dexamethasone, and diazepam...Further studies were consistent with acute thyrotoxicosis and he was started on propranolol, methimazole, and hydrocortisone...Due to the classic association of TPP with male gender and Asian descent, it is likely underrecognized and underreported in other demographics. High index of suspicion is needed, as with appropriate treatment the clinical course is very favorable.
- |||||||||| hydrocortisone / Generic mfg.
SEVERE HYPONATREMIA AFTER PNEUMOCOCCAL VACCINE IN A PATIENT WITH SECONDARY ADRENAL INSUFFICIENCY () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1029;
Description: A 56-year-old woman with Type 2 Diabetes mellitus, hypertension and bilateral adrenalectomy (Maintained on hydrocortisone 10?mg AM and 5?mg PM) was admitted to the ICU with altered mental status, generalized malaise, decreased appetite, fever, non-productive cough, nausea, vomiting, and hypotension...This scenario may have been avoided by either giving a stress dose prior to vaccination or further increasing the sick day dosing at home. Either of these alterations carries risk however, and Endocrine and Immunology input will be invaluable when managing these patients in the future.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
A CRITICAL CASE OF CLINICAL MYXEDEMA COMA WITH ATYPICAL THYROID FUNCTION TESTS () - Jan 4, 2024 - Abstract #SCCM2024SCCM_1026;
This case illustrates why the diagnosis and subsequent management of MC should not be solely based on TFT as it can be widely variable and affected by comorbid conditions and physiological factors. Instead, clinicians should use suspicious clinical features to guide diagnosis and management, especially in Critical Care Medicine where these critical cases are most commonly encountered.
- |||||||||| dexamethasone / Generic mfg.
ASYMPTOMATIC BRADYCARDIA INDUCED BY INTRAVENOUS IMMUNOGLOBULIN IN A PATIENT WITH MYASTHENIA GRAVIS () - Jan 4, 2024 - Abstract #SCCM2024SCCM_928;
She was then started on dexamethasone and, one day later, IVIG...On literature review, there have been only two reported cases of IVIG induced bradycardia in patients without a cardiac history. This case report, along with the two previously indicated cases, represents a growing body of evidence that IVIG induced arrhythmias, particularly bradycardia, may be more common than previously thought in patients without a cardiac history.
- |||||||||| dexamethasone / Generic mfg.
STANDARD VERSUS AUGMENTED CORTICOSTEROID DOSING IN MECHANICALLY VENTILATED PATIENTS DUE TO COVID-19 (Connections Central - Star Research Theater) - Jan 4, 2024 - Abstract #SCCM2024SCCM_849;
This case report, along with the two previously indicated cases, represents a growing body of evidence that IVIG induced arrhythmias, particularly bradycardia, may be more common than previously thought in patients without a cardiac history. Daily corticosteroid doses greater than dexamethasone 6?mg or equivalent were not associated with reduced ventilator-free days among mechanically ventilated patients with COVID-19.
- |||||||||| dexamethasone / Generic mfg., methotrexate / Generic mfg.
Clinical: Chikungunya Arthritis Treatment with Methotrexate and Dexamethasone: A Randomized, Double-blind, Placebo-controlled Trial. (Pubmed Central) - Jan 4, 2024
Daily corticosteroid doses greater than dexamethasone 6?mg or equivalent were not associated with reduced ventilator-free days among mechanically ventilated patients with COVID-19. In this relatively small cohort, all of whom received background dexamethasone, there was a greater numerical improvement trend in prespecified outcome measures, but methotrexate in combination with dexamethasone was not superior to dexamethasone in chronic chikungunya arthritis.
- |||||||||| Avastin (bevacizumab) / Roche
Journal: Bevacizumab in the Treatment of Refractory Brain Edema in High-grade Glioma. (Pubmed Central) - Jan 4, 2024
We report the case of a 14-year-old boy with a steroid-dependent refractory tumor whose longstanding dexamethasone treatment was successfully discontinued after a course of bevacizumab. The use of bevacizumab despite the absence of clear evidence of radionecrosis allowed a significant decrease in the amount of the brain edema.
|
