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Callewaert C, Pezavant M, Vandaele R, Meeus B, Vankrunkelsven E, Van Goethem P, Plumacker A, Misset B, Darcis G, Piret S, De Vleeschouwer L, Staelens F, Van Varenbergh K, Tombeur S, Ottevaere A, Montag I, Vandecandelaere P, Jonckheere S, Vandekerckhove L, Tobback E, Wieers G, Marot JC, Anseeuw K, D’Hoore L, Tuyls S, De Tavernier B, Catteeuw J, Lotfi A, Melnik A, Aksenov A, Grandjean D, Stevens M, Gasthuys F, Guyot H. Sniffing out safety: canine detection and identification of SARS-CoV-2 infection from armpit sweat. Front Med (Lausanne) 2023; 10:1185779. [PMID: 37822474 PMCID: PMC10563588 DOI: 10.3389/fmed.2023.1185779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/14/2023] [Indexed: 10/13/2023] Open
Abstract
Detection dogs were trained to detect SARS-CoV-2 infection based on armpit sweat odor. Sweat samples were collected using cotton pads under the armpits of negative and positive human patients, confirmed by qPCR, for periods of 15-30 min. Multiple hospitals and organizations throughout Belgium participated in this study. The sweat samples were stored at -20°C prior to being used for training purposes. Six dogs were trained under controlled atmosphere conditions for 2-3 months. After training, a 7-day validation period was conducted to assess the dogs' performances. The detection dogs exhibited an overall sensitivity of 81%, specificity of 98%, and an accuracy of 95%. After validation, training continued for 3 months, during which the dogs' performances remained the same. Gas chromatography/mass spectrometry (GC/MS) analysis revealed a unique sweat scent associated with SARS-CoV-2 positive sweat samples. This scent consisted of a wide variety of volatiles, including breakdown compounds of antiviral fatty acids, skin proteins and neurotransmitters/hormones. An acceptability survey conducted in Belgium demonstrated an overall high acceptability and enthusiasm toward the use of detection dogs for SARS-CoV-2 detection. Compared to qPCR and previous canine studies, the detection dogs have good performances in detecting SARS-CoV-2 infection in humans, using frozen sweat samples from the armpits. As a result, they can be used as an accurate pre-screening tool in various field settings alongside the PCR test.
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Affiliation(s)
- Chris Callewaert
- Center for Microbial Ecology and Technology (CMET), Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Maria Pezavant
- Faculty of Veterinary Medicine, Clinique Vétérinaire Universitaire (CVU), University of Liège, Liège, Belgium
| | | | | | | | | | | | - Benoit Misset
- CHU-Sart-Tilman, Intensive Care Unit, University of Liège, Liège, Belgium
| | - Gilles Darcis
- CHU-Sart-Tilman, Infectious Diseases – Internal Medicine, Public Health Sciences, University of Liège, Liège, Belgium
| | - Sonia Piret
- CHU-Bruyères, Intensive Care Unit, University of Liège, Liège, Belgium
| | | | | | | | | | | | | | | | - Stijn Jonckheere
- Laboratory of Clinical Microbiology, Jan Yperman Hospital, Ypres, Belgium
| | - Linos Vandekerckhove
- HIV Cure Research Center, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Els Tobback
- Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgium
| | - Gregoire Wieers
- General Internal Medicine, Clinique Saint-Pierre Ottignies, Ottignies, Belgium
- Namur Research Institute for Life Sciences (Narilis) and Department of Medicine, University of Namur, Namur, Belgium
| | | | - Kurt Anseeuw
- Department of Emergency Medicine, ZNA, Antwerp, Belgium
| | - Leen D’Hoore
- Belgian Defence, Brussels, Belgium
- Department of Emergency Medicine, ZNA, Antwerp, Belgium
| | - Sebastiaan Tuyls
- Respiratory Medicine, GasthuisZusters (GZA) Hospital Group, Antwerp, Belgium
| | - Brecht De Tavernier
- Emergency Medicine and Intensive Care, GasthuisZusters (GZA) Hospital Group, Antwerp, Belgium
| | | | - Ali Lotfi
- Department of Chemistry, University of Connecticut, Storrs, CT, United States
| | - Alexey Melnik
- Department of Chemistry, University of Connecticut, Storrs, CT, United States
| | - Alexander Aksenov
- Department of Chemistry, University of Connecticut, Storrs, CT, United States
| | - Dominique Grandjean
- Nosaïs Program, Ecole Nationale Vétérinaire d’Alfort (Alfort School of Veterinary Medicine), University Paris-Est, Maisons-Alfort, France
| | | | - Frank Gasthuys
- Department of Surgery, Anesthesiology and Orthopedics of Large Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Hugues Guyot
- Faculty of Veterinary Medicine, Clinique Vétérinaire Universitaire (CVU), University of Liège, Liège, Belgium
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Engelen MM, Van Thillo Q, Betrains A, Gyselinck I, Martens CP, Spalart V, Ockerman A, Devooght C, Wauters J, Gunst J, Wouters C, Vandenbriele C, Rex S, Liesenborghs L, Wilmer A, Meersseman P, Van den Berghe G, Dauwe D, Belmans A, Thomeer M, Fivez T, Mesotten D, Ruttens D, Heytens L, Dapper I, Tuyls S, De Tavernier B, Verhamme P, Vanassche T. Modulation of thromboinflammation in hospitalized COVID-19 patients with aprotinin, low molecular weight heparin, and anakinra: The DAWn-Antico study. Res Pract Thromb Haemost 2022; 6:e12826. [PMID: 36324831 PMCID: PMC9618401 DOI: 10.1002/rth2.12826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/08/2022] Open
Abstract
Background Thromboinflammation plays a central role in severe COVID-19. The kallikrein pathway activates both inflammatory pathways and contact-mediated coagulation. We investigated if modulation of the thromboinflammatory response improves outcomes in hospitalized COVID-19 patients. Methods In this multicenter open-label randomized clinical trial (EudraCT 2020-001739-28), patients hospitalized with COVID-19 were 1:2 randomized to receive standard of care (SOC) or SOC plus study intervention. The intervention consisted of aprotinin (2,000,000 IE IV four times daily) combined with low molecular weight heparin (LMWH; SC 50 IU/kg twice daily on the ward, 75 IU/kg twice daily in intensive care). Additionally, patients with predefined hyperinflammation received the interleukin-1 receptor antagonist anakinra (100 mg IV four times daily). The primary outcome was time to a sustained 2-point improvement on the 7-point World Health Organization ordinal scale for clinical status, or discharge. Findings Between 24 June 2020 and 1 February 2021, 105 patients were randomized, and 102 patients were included in the full analysis set (intervention N = 67 vs. SOC N = 35). Twenty-five patients from the intervention group (37%) received anakinra. The intervention did not affect the primary outcome (HR 0.77 [CI 0.50-1.19], p = 0.24) or mortality (intervention n = 3 [4.6%] vs. SOC n = 2 [5.7%], HR 0.82 [CI 0.14-4.94], p = 0.83). There was one treatment-related adverse event in the intervention group (hematuria, 1.49%). There was one thrombotic event in the intervention group (1.49%) and one in the SOC group (2.86%), but no major bleeding. Conclusions In hospitalized COVID-19 patients, modulation of thromboinflammation with high-dose aprotinin and LMWH with or without anakinra did not improve outcome in patients with moderate to severe COVID-19.
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Affiliation(s)
- Matthias M. Engelen
- Department of Cardiovascular DiseasesUniversity Hospitals LeuvenLeuvenBelgium,Department of Cardiovascular Sciences, Center for Molecular and Vascular BiologyKU LeuvenLeuvenBelgium
| | | | - Albrecht Betrains
- Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory DisordersKU LeuvenLeuvenBelgium
| | - Iwein Gyselinck
- BREATHE Lab, Department CHROMETAKU LeuvenLeuvenBelgium,Department of Respiratory DiseasesUZ LeuvenLeuvenBelgium
| | - Caroline P. Martens
- Department of Cardiovascular Sciences, Center for Molecular and Vascular BiologyKU LeuvenLeuvenBelgium
| | - Valérie Spalart
- Department of Cardiovascular DiseasesUniversity Hospitals LeuvenLeuvenBelgium,Department of Cardiovascular Sciences, Center for Molecular and Vascular BiologyKU LeuvenLeuvenBelgium
| | - Anna Ockerman
- Department of Cardiovascular DiseasesUniversity Hospitals LeuvenLeuvenBelgium
| | - Caroline Devooght
- Department of Cardiovascular DiseasesUniversity Hospitals LeuvenLeuvenBelgium
| | - Joost Wauters
- Department of General Internal Medicine, Medical Intensive Care UnitUniversity Hospitals LeuvenLeuvenBelgium
| | - Jan Gunst
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular MedicineKU LeuvenLeuvenBelgium
| | - Carine Wouters
- Pediatric RheumatologyUniversity Hospitals LeuvenLeuvenBelgium,Laboratory of Adaptive Immunology & Immunobiology, Department of Microbiology and ImmunologyKU LeuvenLeuvenBelgium
| | - Christophe Vandenbriele
- Department of Cardiovascular DiseasesUniversity Hospitals LeuvenLeuvenBelgium,Department of Cardiovascular Sciences, Center for Molecular and Vascular BiologyKU LeuvenLeuvenBelgium
| | - Steffen Rex
- Department of Cardiovascular SciencesUniversity Hospitals LeuvenLeuvenBelgium,Department of AnesthesiologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Laurens Liesenborghs
- Department of Cardiovascular Sciences, Center for Molecular and Vascular BiologyKU LeuvenLeuvenBelgium
| | - Alexander Wilmer
- Department of General Internal Medicine, Medical Intensive Care UnitUniversity Hospitals LeuvenLeuvenBelgium
| | - Philippe Meersseman
- Department of General Internal Medicine, Medical Intensive Care UnitUniversity Hospitals LeuvenLeuvenBelgium
| | - Greet Van den Berghe
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular MedicineKU LeuvenLeuvenBelgium
| | - Dieter Dauwe
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular MedicineKU LeuvenLeuvenBelgium
| | - Ann Belmans
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I‐BioStat), KU LeuvenLeuvenBelgium
| | - Michiel Thomeer
- Department of Respiratory MedicineZiekenhuis Oost‐LimburgGenkBelgium,Department of Medicine and Life SciencesHasselt UniversityDiepenbeekBelgium
| | - Tom Fivez
- Department of Medicine and Life SciencesHasselt UniversityDiepenbeekBelgium,Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain TherapyZiekenhuis Oost‐LimburgGenkBelgium
| | - Dieter Mesotten
- Department of Medicine and Life SciencesHasselt UniversityDiepenbeekBelgium,Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain TherapyZiekenhuis Oost‐LimburgGenkBelgium
| | - David Ruttens
- Department of Respiratory MedicineZiekenhuis Oost‐LimburgGenkBelgium
| | - Luc Heytens
- Department of Intensive CareGZA Hospital GroupAntwerpBelgium
| | - Ilse Dapper
- Department of Intensive CareGZA Hospital GroupAntwerpBelgium
| | | | | | - Peter Verhamme
- Department of Cardiovascular DiseasesUniversity Hospitals LeuvenLeuvenBelgium,Department of Cardiovascular Sciences, Center for Molecular and Vascular BiologyKU LeuvenLeuvenBelgium
| | - Thomas Vanassche
- Department of Cardiovascular DiseasesUniversity Hospitals LeuvenLeuvenBelgium,Department of Cardiovascular Sciences, Center for Molecular and Vascular BiologyKU LeuvenLeuvenBelgium
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Malbrain MLNG, Van Regenmortel N, Saugel B, De Tavernier B, Van Gaal PJ, Joannes-Boyau O, Teboul JL, Rice TW, Mythen M, Monnet X. Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy. Ann Intensive Care 2018; 8:66. [PMID: 29789983 PMCID: PMC5964054 DOI: 10.1186/s13613-018-0402-x] [Citation(s) in RCA: 269] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 04/23/2018] [Indexed: 02/07/2023] Open
Abstract
In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition. In this paradigm-shifting review, we discuss different fluid management strategies including early adequate goal-directed fluid management, late conservative fluid management and late goal-directed fluid removal. In addition, we expand on the concept of the “four D’s” of fluid therapy, namely drug, dosing, duration and de-escalation. During the treatment of patients with septic shock, four phases of fluid therapy should be considered in order to provide answers to four basic questions. These four phases are the resuscitation phase, the optimization phase, the stabilization phase and the evacuation phase. The four questions are “When to start intravenous fluids?”, “When to stop intravenous fluids?”, “When to start de-resuscitation or active fluid removal?” and finally “When to stop de-resuscitation?” In analogy to the way we handle antibiotics in critically ill patients, it is time for fluid stewardship.
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Affiliation(s)
- Manu L N G Malbrain
- Intensive Care Unit, University Hospital Brussels (UZB), Laarbeeklaan 101, 1090, Jette, Belgium. .,Faculteit Geneeskunde en Farmacie, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Niels Van Regenmortel
- Intensive Care Unit, ZiekenhuisNetwerk Antwerpen, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerpen 6, Belgium
| | - Bernd Saugel
- Department of Anesthesiology, Centre of Anesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Brecht De Tavernier
- Intensive Care Unit, ZiekenhuisNetwerk Antwerpen, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerpen 6, Belgium
| | - Pieter-Jan Van Gaal
- Intensive Care Unit, ZiekenhuisNetwerk Antwerpen, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerpen 6, Belgium
| | | | - Jean-Louis Teboul
- Medical Intensive Care Unit, Hopitaux universitaires Paris-Sud, AP-HP, Université Paris-Sud, Le Kremlin-Bicetre, France
| | - Todd W Rice
- University College London Hospitals, National Institute of Health Research Biomedical Research Centre, London, UK
| | - Monty Mythen
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Xavier Monnet
- Medical Intensive Care Unit, Hopitaux universitaires Paris-Sud, AP-HP, Université Paris-Sud, Le Kremlin-Bicetre, France
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Malbrain MLNG, De Tavernier B, Haverals S, Slama M, Vieillard-Baron A, Wong A, Poelaert J, Monnet X, Stockman W, Elbers P, Lichtenstein D. Executive summary on the use of ultrasound in the critically ill: consensus report from the 3rd Course on Acute Care Ultrasound (CACU). Anaesthesiol Intensive Ther 2017; 49:393-411. [PMID: 29192422 DOI: 10.5603/ait.a2017.0072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/18/2017] [Indexed: 11/25/2022] Open
Abstract
Over the past decades, ultrasound (US) has gained its place in the armamentarium of monitoring tools in the intensive care unit (ICU). Critical care ultrasonography (CCUS) is the combination of general CCUS (lung and pleural, abdominal, vascular) and CC echocardiography, allowing prompt assessment and diagnosis in combination with vascular access and therapeutic intervention. This review summarises the findings, challenges lessons from the 3rd Course on Acute Care Ultrasound (CACU) held in November 2015, Antwerp, Belgium. It covers the different modalities of CCUS; touching on the various aspects of training, clinical benefits and potential benefits. Despite the benefits of CCUS, numerous challenges remain, including the delivery of CCUS training to future intensivists. Some of these are discussed along with potential solutions from a number of national European professional societies. There is a need for an international agreed consensus on what modalities are necessary and how best to deliver training in CCUS.
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Affiliation(s)
- Manu L N G Malbrain
- Intensive Care Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerpen, Belgium.
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