Extracorporeal membrane oxygenation in adult patients with sepsis and septic shock: Why, how, when, and for whom

Sepsis and septic shock remain the leading causes of death in intensive care units.Some patients with sepsis fail to respond to routine treatment and rapidly progress to refractory respiratory and circulatory failure,necessitating extracorporeal membrane oxygenation(ECMO).However,the role of ECMO in adult patients with sepsis has not been fully established.According to existing studies,ECMO may be a viable salvage therapy in carefully selected adult patients with sepsis.The choice of venovenous,venoarterial,or hybrid ECMO modes is primarily determined by the patient’s oxygenation and hemodynamics(distributive shock with preserved cardiac output,septic cardiomyopathy(left,right,or biventricular heart failure),or right ventricular failure caused by acute respiratory distress syndrome).Veno-venous ECMO can be used in patients with sepsis and severe acute respiratory distress syndrome when conventional mechanical ventilation fails,and early application of veno-arterial ECMO in patients with sepsis-induced refractory cardiogenic shock may be critical in improving their chances of survival.When ECMO is indicated,the choice of an appropriate mode and determination of the optimal timing of initiation and weaning are critical,particularly in an experienced ECMO center.Furthermore,some special issues,such as ECMO flow,anticoagulation,and antibiotic therapy,should be noted during the management of ECMO support.

Patients with Prolonged Positivity of SARS-CoV-2 RNA Benefit from Convalescent Plasma Therapy:A Retrospective Study

Convalescent plasma therapy has been implemented in a few cases of severe coronavirus disease 2019.No report about convalescent plasma therapy in treating patients with prolonged positivity of SARS-CoV-2 RNA has been published.In this study,we conducted a retrospective observational study in 27 patients with prolonged positivity of SARS-CoV-2 RNA,the clinical benefit of convalescent plasma therapy were analyzed.q RT-PCR test of SARS-CoV-2 RNA turned negative(B 7 days)in a part of patients(early negative group,n=15)after therapy,others(late negative group,n=12)turned negative in more than 7 days.Pulmonary imaging improvement was confirmed in 7 patients in early negative group and 8 in late negative group after CP therapy.Viral load decreased in early negative group compared with late negative group at day 3,5,7 after implementing convalescent plasma therapy.Patients in early negative group had a shorter median length of hospital stay.In conclusion,convalescent plasma therapy might help eliminate virus and shorten length of hospital stay in patients with prolonged positivity of SARS-CoV-2 RNA.

Dynamic Changes of Antibodies to SARS-CoV-2 in COVID-19 Patients at Early Stage of Outbreak

The coronavirus disease 2019(COVID-19),caused by SARS-CoV-2,has spread around the world with high mortality.To diagnose promptly and accurately is the vital step to effectively control its pandemic.Dynamic characteristics of SARSCoV-2-specific antibodies which are important for diagnosis of infection have not been fully demonstrated.In this retrospective,single-center,observational study,we enrolled the initial 131 confirmed cases of COVID-19 at Jin-Yin-Tan Hospital who had at least one-time antibody tested during their hospitalization.The dynamic changes of IgM and IgG antibodies to SARS-CoV-2 nucleocapsid protein in 226 serum samples were detected by ELISA.The sensitivities of IgM and IgG ELISA detection were analyzed.Result showed that the sensitivity of the IgG ELISA detection(92.5%)was significantly higher than that of the IgM(70.8%)(P\0.001).The meantimes of seroconversion for IgM and IgG were6 days and 3 days,respectively.The IgM and IgG antibody levels peaked at around 18 days and 23 days,and then IgM fell to below the baseline level at about day 36,whereas IgG maintained at a relatively high level.In conclusion,antibodies should be detected to aid in diagnosis of COVID-19 infection.IgG could be a sensitive indicator for retrospective diagnosis and contact tracing,while IgM could be an indicator of early infection.

CORRECTION:Correction to: Dynamic Changes of Antibodies to SARS-CoV-2 in COVID-19 Patients at Early Stage of Outbreak

Due to type-setting error,the affiliation of author Huaqing Shu and Shuzhen Wang was mislabeled.The affiliation footnotes in the byline for Huaqing Shu and Shuzhen Wang should read as given above.We apologized for these errors.