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Pérez-Juan E, Maqueda-Palau M, Feliu-Roig C, Gómez-Arroyo JM, Sáez-Romero D, Ortiz-Monjo A. Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19. Enferm Intensiva (Engl Ed) 2023; 34:176-185. [PMID: 37248133 PMCID: PMC10201329 DOI: 10.1016/j.enfie.2022.12.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/20/2022] [Indexed: 05/31/2023]
Abstract
The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. OBJECTIVES To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. METHODS Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. RESULTS A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (P = .002), location (P = .000) and median duration of hours per PD episode (P = .001). CONCLUSIONS The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.
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Affiliation(s)
- E Pérez-Juan
- Unidad de Cuidados Intensivos, Hospital Comarcal de Manacor, Manacor, Spain; Institut d'investigació sanitària Illes Balears (idISBa), Cures cronicitat i evidències en salut (cuREs), Palma, Spain.
| | - M Maqueda-Palau
- Institut d'investigació sanitària Illes Balears (idISBa), Cures cronicitat i evidències en salut (cuREs), Palma, Spain; Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma, Spain
| | | | | | - D Sáez-Romero
- Unidad de Cuidados Intensivos, Hospital Son Llàtzer, Palma, Spain
| | - A Ortiz-Monjo
- Unidad de Cuidados Intensivos, Hospital Son Llàtzer, Palma, Spain
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González-Castro A, Cuenca Fito E, Fernandez A, Peñasco Y, Modesto I Alport V, Medina Villanueva A, Fajardo A, Escude-Acha P. [Cost-effectiveness analysis high flow oxygen therapy in the treatment of SARS-CoV-2 pneumonia]. J Healthc Qual Res 2023; 38:152-157. [PMID: 36400703 PMCID: PMC9595363 DOI: 10.1016/j.jhqr.2022.10.004] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/29/2022] [Accepted: 10/17/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION high-oxygen nasal cannulas in patients with respiratory failure secondary to SARS-CoV-2 pneumonia have not been studied from a cost-effectiveness point of view. METHODS Retrospective analysis of patients who had entered the COVID-area of an intensive medicine service in a third reference hospital, between March-December 2020. An effectiveness cost analysis was carried out comparing 2therapeutic decisions: the experimental strategy was defined as a mixed strategy consisting of the initial application of high flow nasal oxygen (HFNO) and application of VMI only to HFNO failures. The optimal rational decision was defined as maximizing expected profit, and economic efficiency was assessed by calculating the Incremental Cost-Effectiveness Ratio (ICER) for years of life gained. RESULTS Of the 185 patients tested, 101 (55%) received invasive mechanical ventilation immediately and 84 (45%) were treated with HFNO at the outset. In the cost-effectiveness analysis, comparing both therapeutic strategies, the probability that the experimental strategy would be more effective was 0.974, reaching statistical significance: Difference in average proportions -0.113; 95% CI:-0.018 to -0.208. This corresponds to an NNT of 9 patients. The optimal decision was HFNO's strategy followed by VMI in HFNO failures. This option had an RCEI of 5582 euros per year of life gained. CONCLUSIONS It is important to establish in the future reliable markers in the use of HFNO so that this therapy improves its cost-effective benefits.
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Affiliation(s)
- A González-Castro
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | - E Cuenca Fito
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - A Fernandez
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Y Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Unidad de Cuidados Intensivos Pediátricos, Hospital Universitari i Politècnic La Fe, Valencia, España; Unidad de Cuidados Intensivos Pediátricos, Hospital Central de Asturias, Oviedo, Asturias, España; Unidad de Cuidados Intensivos, Hospital de Quilpué, Valparaíso, Chile
| | - V Modesto I Alport
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - A Medina Villanueva
- Unidad de Cuidados Intensivos Pediátricos, Hospital Central de Asturias, Oviedo, Asturias, España
| | - A Fajardo
- Unidad de Cuidados Intensivos, Hospital de Quilpué, Valparaíso, Chile
| | - P Escude-Acha
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
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Barja-Martínez E, García-González S, Jiménez-García E, Thuissard-Vasallo IJ, Arias-Rivera S, Blanco-Abril S. Prone positioning in COVID-19 patients with acute respiratory distress syndrome and invasive mechanical ventilation. Enferm Intensiva (Engl Ed) 2023:S2529-9840(23)00018-6. [PMID: 36934077 DOI: 10.1016/j.enfie.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/13/2022] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes. METHODS Retrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. RESULTS A total of 139 proning cycles were performed. The mean number of cycles were 2 [1-3] and the mean duration per cycle was of 22h [15-24]. The prevalence of adverse events this population was 84.9 %, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin <21mg/dl, the number of proning cycles and severe disease. We observed a significant increase in the PaO2/FiO2 at different time points during the prone positioning, and a significant decrease after it. CONCLUSIONS There is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients.
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Trenado Alvarez J, Solà Muñoz S, Campos Escala O, Morales Alvarez J, Azeli Jarosch Y, Jiménez Fabrega X. Transfer support and coordination of critical patients during the COVID-19 pandemic by a regional command center. Med Intensiva 2022; 47:293-295. [PMID: 36464583 PMCID: PMC9606036 DOI: 10.1016/j.medine.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Affiliation(s)
- J. Trenado Alvarez
- Sistema d’Emergències Mèdiques de Catalunya, Barcelona, Spain,Servei de Medicina Intensiva UCI-Semicritics, Hospital Universitario Mutua de Terrassa, Barcelona, España; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - S. Solà Muñoz
- Sistema d’Emergències Mèdiques de Catalunya, Barcelona, Spain
| | | | | | - Y. Azeli Jarosch
- Sistema d’Emergències Mèdiques de Catalunya, Barcelona, Spain,Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona, Spain
| | - X. Jiménez Fabrega
- Sistema d’Emergències Mèdiques de Catalunya, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain,Corresponding author
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Barja-Martínez E, García-González S, Jiménez-García E, Thuissard-Vasallo IJ, Arias-Rivera S, Blanco-Abril S. Decúbito prono en pacientes COVID-19 con síndrome de distrés respiratorio agudo y ventilación mecánica invasiva. Enferm Intensiva 2022. [PMID: 36311904 DOI: 10.1016/j.enfi.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022]
Abstract
Objetivos: Identificar eventos adversos secundarios al decúbito prono (DP) en pacientes con COVID-19 con síndrome de distrés respiratorio agudo (SDRA) moderado/severo, analizar los factores de riesgo para el desarrollo de úlceras por presión (UPP) en DP y describir la evolución oximétrica de estos pacientes durante el DP. Método: Estudio descriptivo retrospectivo realizado sobre 63 pacientes ingresados en la UCI de un hospital de segundo nivel, con neumonía por SARS-CoV-2, SDRA moderado/severo, ventilación mecánica invasiva, que precisaron maniobras de DP, durante marzo y abril de 2020. Se usó un muestreo no probabilístico consecutivo y se analizaron las variables seleccionadas a través de una regresión logística. Resultados: Se realizaron un total de 139 sesiones de pronación. La mediana de sesiones fue de 2 [1-3] y la duración de 22 horas [15-24] por sesión. La aparición de eventos adversos ocurrió en un 84,9% de los casos, siendo las fisiológicas (ej. hiper/hipotensión) las más frecuentes. Al comparar pacientes pronados que mantuvieron la integridad cutánea (34 de 63 pacientes, un 54%) versus los que desarrollaron UPP (29 de 63, un 46%), estos últimos presentaron los siguientes factores de riesgo: mayor edad, ser hipertensos, pre-albúmina <21mg/dl, mayor número de sesiones de prono y mayor gravedad al ingreso. Se observó un incremento significativo entre la PaO2/FiO2 previa al DP y en los diferentes cortes temporales durante el prono, además de una caída significativa tras despronar. Conclusiones: Existe una alta incidencia de eventos adversos debidos al DP, siendo los de tipo fisiológico los más frecuentes. La identificación de varios factores de riesgo para el desarrollo de UPP ayudará a prevenir la aparición de estas lesiones durante la pronación. La terapia de DP en pacientes COVID-19 con SDRA moderado/severo ha demostrado una mejora en los parámetros de oxigenación.
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Giménez-Esparza Vich C, Alcántara Carmona S, García Sánchez M. Delirium in COVID-19. Practical aspects of a frequent association. Medicina Intensiva (English Edition) 2022; 46:336-340. [PMID: 35527194 PMCID: PMC9042944 DOI: 10.1016/j.medine.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/15/2021] [Accepted: 12/25/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - S Alcántara Carmona
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - M García Sánchez
- Servicio de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Pandolfi S, Valdenassi L, Bjørklund G, Chirumbolo S, Lysiuk R, Lenchyk L, Doşa MD, Fazio S. COVID-19 Medical and Pharmacological Management in the European Countries Compared to Italy: An Overview. IJERPH 2022; 19:4262. [PMID: 35409942 PMCID: PMC8998583 DOI: 10.3390/ijerph19074262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/16/2022] [Accepted: 03/30/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: Italy accounts for more than 150,000 deaths due to the COVID-19 pandemic, leading the top rank in SARS-CoV-2-caused deceases in Europe. A survey on the different ways by which the COVID-19 pandemic emergency was managed in the foreign European countries compared to Italy is the purpose of this paper. (2) Methods: A literature search and various mathematical algorithms to approach a rank scoring scale were used to describe in detail the different approaches used by European countries to manage the COVID-19 pandemic emergency. (3) Results: The study showed that Italy stands at the bottom ranking for COVID-19 management due to its high mortality rate. Possible causes of the observed huge numbers of hospitalization and deaths were (a) the demographic composition of the European country; (b) its decentralized healthcare system organization; (c) the role of correct pharmacology in the early stages before hospitalization. Post-mortem examinations were of paramount importance to elucidate the etiopathogenesis of COVID-19 and to tailor a suitable and proper therapy in the early symptomatic stages of COVID-19, preventing hospitalization. (4) Conclusions: Factors such as the significant impact on elderly people, the public health organization prevalently state-owned and represented mainly by hospitals, and criticism of the home therapy approach toward SARS-CoV-2-infected people, may have concurred in increasing the number of COVID-19 deaths in Italy.
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Solà-Muñoz S, Azeli Y, Trenado J, Jiménez X, Bisbal R, López À, Morales J, García X, Sánchez B, Fernández J, Soto MÁ, Ferreres Y, Cantero C, Jacob J. Effect of a Prioritization Score on the Inter-Hospital Transfer Time Management of Severe COVID-19 Patients. A Quasi-Experimental Intervention Study. Int J Qual Health Care 2022; 34:6548674. [PMID: 35289365 PMCID: PMC8992311 DOI: 10.1093/intqhc/mzac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/21/2022] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background The overburdening of the healthcare system during the coronavirus disease 19 (COVID-19) pandemic is driving the need to create new tools to improve the management of inter-hospital transport for patients with a severe COVID-19 infection. Objective The aim of this study was to analyse the usefulness of the application of a prioritization score (IHTCOVID-19) for inter-hospital transfer of patients with COVID-19 infection. Methods The study has a quasi-experimental design and was conducted on the Medical Emergency System, the pre-hospital emergency department of the public company belonging to the Autonomous Government of Catalonia that manages urgent healthcare in the region. Patients with a severe COVID-19 infection requiring inter-hospital transport were consecutively included. The pre-intervention period was from 1 to 31 March 2020, and the intervention period with the IHTCOVID-19 score was from 1 to 30 April 2020 (from 8 am to 8 pm). The prioritization score comprises four priority categories, with Priority 0 being the highest and Priority 3 being the lowest. Inter-hospital transfer (IHT) management times (alert-assignment time, resource management time and total central management time) and their variability were evaluated according to whether or not the IHTCOVID-19 score was applied. Results A total of 344 IHTs were included: 189 (54.9%) in the pre-intervention period and 155 (45.1%) in the post-intervention period. The majority of patients were male and the most frequent age range was between 50 and 70 years. According to the IHTCOVID-19 score, 12 (3.5%) transfers were classified as Priority 0, 66 (19.4%) as Priority 1, 247 (71.8%) as Priority 2 and 19 (5.6%) as Priority 3. Overall, with the application of the IHTCOVID-19 score, there was a significant reduction in total central management time [from 112.4 (inter-quartile range (IQR) 281.3) to 89.8 min (IQR 154.9); P = 0.012]. This significant reduction was observed in Priority 0 patients [286.2 (IQR 218.5) to 42.0 min (IQR 58); P = 0.018] and Priority 1 patients [130.3 (IQR 297.3) to 75.4 min (IQR 91.1); P = 0.034]. After applying the IHTCOVID-19 score, the average time of the process decreased by 22.6 min, and variability was reduced from 618.1 to 324.0 min. Conclusion The application of the IHTCOVID-19 score in patients with a severe COVID-19 infection reduces IHT management times and variability.
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Affiliation(s)
- Silvia Solà-Muñoz
- Address reprint requests to: Silvia Solà-Muñoz, Area of Research and Development, Sistema d’Emergències Mèdiques, Pablo Iglesias 101-115, L’Hospitalet de Llobregat, Barcelona 08908, Spain. Tel: +34 93 264 44 00; E-mail:
| | - Youcef Azeli
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
- Sociedad Española de Medicina de Urgencias y Emergencias, Red de Investigación de Emergencias Prehospitalarias RINVEMER, nuñez de balboa 116 3° office 9, Madrid 28020, Spain
- Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili (IISPV), Avda, Josep Laporte, 2 Planta 0 – E2 color taronja, Reus, Tarragona 43204, Spain
| | - Josep Trenado
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
- Intensive Care Unit, Hospital Universitari Mutua de Terrassa, Plaça del Doctor Robert, 5, Terrassa, Barcelona 08221, Spain
| | - Xavier Jiménez
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
- Sociedad Española de Medicina de Urgencias y Emergencias, Red de Investigación de Emergencias Prehospitalarias RINVEMER, nuñez de balboa 116 3° office 9, Madrid 28020, Spain
| | - Roger Bisbal
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Àngels López
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Jorge Morales
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Xaime García
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Bernat Sánchez
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - José Fernández
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Av. Colom 16-20, Tortosa, Tarragona 43500, Spain
- Unidat de Recerca, Gerència Territorial Terres de l´Ebre, Institut Català de la Salut, Ctra. de la Simpàtica, 44, Tortosa, Tarragona 43500, Spain
| | - Maria Ángeles Soto
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Yolanda Ferreres
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Cristina Cantero
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Javier Jacob
- Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Universitat de Barcelona, Carrer de la Feixa Llarga, s/n, Barcelona 08907, Spain
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Blanco-Schweizer P, Sánchez-Ballesteros J, Herrán-Monge R, Prieto-deLamo A, de Ayala-Fernández JA, García-García M. Interhospital transport of COVID-19 patients on ECMO and comparison with historic controls. Med Intensiva 2021; 45:e65-e67. [PMID: 34839888 PMCID: PMC8613977 DOI: 10.1016/j.medine.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022]
Affiliation(s)
- P Blanco-Schweizer
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain.
| | - J Sánchez-Ballesteros
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| | - R Herrán-Monge
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| | - A Prieto-deLamo
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| | - J A de Ayala-Fernández
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| | - M García-García
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
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Sanfilippo F, Messina A, Cecconi M, Astuto M. Ten answers to key questions for fluid management in intensive care. Med Intensiva 2021; 45:552-562. [PMID: 34839886 DOI: 10.1016/j.medine.2020.10.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022]
Abstract
This review focuses on fluid management of critically ill patients. The topic is addressed based on 10 single questions with simplified answers that provide clinicians with the basic information needed at the point of care in treating patients in the Intensive Care Unit. The review has didactic purposes and may serve both as an update on fluid management and as an introduction to the subject for novices in critical care. There is an urgent need to increase awareness regarding the potential risks associated with fluid overload. Clinicians should be mindful not only of the indications for administering fluid loads and of the type of fluids administered, but also of the importance to set safety limits. Lastly, it is important to implement proactive strategies seeking to establish negative fluid balance as soon as the clinical conditions are considered to be stable and the risk of deterioration is low.
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Affiliation(s)
- F Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy.
| | - A Messina
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - M Cecconi
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - M Astuto
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy; School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy
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González-Castro A, Cuenca Fito E, Fernandez-Rodriguez A, Escudero Acha P, Rodríguez Borregán JC, Peñasco Y. High flow oxygen therapy in the treatment of SARS-CoV-2 pneumonia. Med Intensiva 2021:S2173-5727(21)00177-6. [PMID: 34887233 DOI: 10.1016/j.medine.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 11/24/2022]
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12
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Belenguer Muncharaz A, Hernández-Garcés H, López-Chicote C, Ribes-García S, Ochagavía-Barbarín J, Zaragoza-Crespo R. Effectiveness of non-invasive ventilation in intensive care unit admitted patients due to SARS-CoV-2 pneumonia. Med Intensiva 2021; 45:e56-e58. [PMID: 34776402 PMCID: PMC8547964 DOI: 10.1016/j.medine.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Belenguer Muncharaz
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain; Unidad Predepartamental Medicina, Facultad de Ciencias de la Salud, Universitat Jaume I (UJI), Castellón de la Plana, Spain.
| | - H Hernández-Garcés
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain
| | - C López-Chicote
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain
| | - S Ribes-García
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain
| | - J Ochagavía-Barbarín
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain
| | - R Zaragoza-Crespo
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain
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13
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Reddy RS, Gautam AP, Tedla JS, Ferreira AS, Reis LFF, Bairapareddy KC, Kakaraparthi VN, Gular K. The Aftermath of the COVID-19 Crisis in Saudi Arabia: Respiratory Rehabilitation Recommendations by Physical Therapists. Healthcare (Basel) 2021; 9:1560. [PMID: 34828606 PMCID: PMC8619334 DOI: 10.3390/healthcare9111560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022] Open
Abstract
Since late 2019, the number of COVID-19 patients has gradually increased in certain regions as consecutive waves of infections hit countries. Whenever this wave hits the corresponding areas, the entire healthcare system must respond quickly to curb the diseases, morbidities, and mortalities in intensive care settings. The healthcare team involved in COVID-19 patients' care must work tirelessly without having breaks. Our understanding of COVID-19 is limited as new challenges emerge with new COVID-19 variants appearing in different world regions. Though medical therapies are finding solutions to deal with the disease, there are few recommendations for respiratory rehabilitation therapies. A group of respiratory rehabilitation care professionals in Saudi Arabia and international experts have agreed with the World Health bodies such as the World Health Organization (WHO) on the treatment and rehabilitation of patients with COVID-19. Professionals participating in COVID-19 patient treatment, rehabilitation, and recovery formulated respiratory rehabilitation guidelines based on the DELPHI Method, combining scientific research and personal practical experience. As a result, it is envisaged that the number of individuals in the region suffering from respiratory ailments due to post-COVID-19 will decrease. This narrative review and clinical expertise guidelines may give physiotherapists acceptable and standard clinical guideline protocols for treating COVID-19 patients.
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Affiliation(s)
- Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, King Khalid University, Abha 61413, Saudi Arabia; (R.S.R.); (J.S.T.); (V.N.K.); (K.G.)
| | - Ajay Prashad Gautam
- Department of Medical Rehabilitation Sciences, King Khalid University, Abha 61413, Saudi Arabia; (R.S.R.); (J.S.T.); (V.N.K.); (K.G.)
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, King Khalid University, Abha 61413, Saudi Arabia; (R.S.R.); (J.S.T.); (V.N.K.); (K.G.)
| | - Arthur Sá Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, Rio de Janeiro 21032-060, Brazil; (A.S.F.); (L.F.F.R.)
| | - Luis Felipe Fonseca Reis
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, Rio de Janeiro 21032-060, Brazil; (A.S.F.); (L.F.F.R.)
| | | | - Venkata Nagaraj Kakaraparthi
- Department of Medical Rehabilitation Sciences, King Khalid University, Abha 61413, Saudi Arabia; (R.S.R.); (J.S.T.); (V.N.K.); (K.G.)
| | - Kumar Gular
- Department of Medical Rehabilitation Sciences, King Khalid University, Abha 61413, Saudi Arabia; (R.S.R.); (J.S.T.); (V.N.K.); (K.G.)
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14
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Hernández-Tejedor A, Martín Delgado MC. An ethics crisis within the health crisis due to COVID-19. Med Intensiva 2021; 45:563-565. [PMID: 34776405 PMCID: PMC8542435 DOI: 10.1016/j.medine.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 11/01/2022]
Affiliation(s)
| | - M C Martín Delgado
- Junta Directiva de SEMICYUC, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
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15
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de Boer M, Coghlan RJ, Russell B, Philip JAM. The underrepresentation of palliative care in global guidelines for responding to infectious disease outbreaks: a systematic narrative review. Int Health 2021; 14:453-467. [PMID: 34750636 PMCID: PMC9450641 DOI: 10.1093/inthealth/ihab075] [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: 06/24/2021] [Revised: 09/11/2021] [Accepted: 10/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The importance of palliative care provision has been highlighted in previous humanitarian emergencies. This review aimed to examine the breadth and depth of palliative care inclusion within global guidelines for responding to infectious disease outbreaks. METHODS The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Electronic searches of MEDLINE, Embase, Cumulative Index to Nursing and Allied Health, PsychInfo and grey literature were performed. Inclusion criteria were guidelines (recommendations for clinical practice or public health policy) for responding to infectious disease outbreaks in the general adult population. Results were limited to the English language, between 1 January 2010 and 17 August 2020. Analysis of the included articles involved assessing the breadth (number of palliative care domains covered) and depth (detail with which the domains were addressed) of palliative care inclusion. RESULTS A total of 584 articles were retrieved and 43 met the inclusion criteria. Two additional articles were identified through handsearching. There was limited inclusion of palliative care in the guidelines examined. CONCLUSIONS There is an opportunity for the development of guidelines that include information on palliative care implementation in the context of infectious disease outbreaks in order to reduce the suffering of key vulnerable populations worldwide.
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Affiliation(s)
- Meghan de Boer
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Building 181, University of Melbourne, Grattan St, Melbourne, Victoria, Australia, 3010
| | - Rachel J Coghlan
- Centre for Humanitarian Leadership, Deakin University, 221 Burwood Highway, Burwood Victoria, Australia, 3125
| | - Bethany Russell
- Palliative Nexus Research Group, University of Melbourne and St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, Victoria, Australia, 3065.,Department of Palliative Care, St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, Victoria, Australia, 3065
| | - Jennifer A M Philip
- Palliative Nexus Research Group, University of Melbourne and St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, Victoria, Australia, 3065.,Department of Palliative Care, St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, Victoria, Australia, 3065.,Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, Victoria, Australia, 3000.,Department of Palliative Care, Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, Australia, 3050
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16
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Estella Á. Intensive Care Medicine: Quiet leadership versus protagonist in times of SARS-CoV-2 pandemic crisis. Med Intensiva 2021; 45:566-567. [PMID: 34732315 PMCID: PMC8557809 DOI: 10.1016/j.medine.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Á Estella
- Servicio de Medicina Intensiva, Hospital Universitario de Jerez, Cádiz, Spain; Departamento de Medicina, Universidad de Cádiz, Cádiz, Spain.
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17
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Franqueza JL, Rosas E, Ioan AM, Durante-López A, Pérez-Calvo C, Santos A. When success means focusing on the oxygen delivery. A case of conventional management of severe hypoxemia in SARS-CoV-2. Med Intensiva 2021; 45:379-380. [PMID: 34629587 PMCID: PMC7298484 DOI: 10.1016/j.medin.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- J L Franqueza
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - E Rosas
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A-M Ioan
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Durante-López
- Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - C Pérez-Calvo
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Santos
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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18
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Franqueza JL, Rosas E, Ioan AM, Durante-López A, Pérez-Calvo C, Santos A. When success means focusing on the oxygen delivery. A case of conventional management of severe hypoxemia in SARS-CoV-2. Med Intensiva 2021; 45:379-380. [PMID: 34294236 PMCID: PMC8294004 DOI: 10.1016/j.medine.2020.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/01/2020] [Indexed: 11/12/2022]
Affiliation(s)
- J L Franqueza
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - E Rosas
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A-M Ioan
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Durante-López
- Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - C Pérez-Calvo
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Santos
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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19
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Donato M, Carini FC, Meschini MJ, Saubidet IL, Goldberg A, Sarubio MG, Olmos D, Reina R. Consensus for the management of analgesia, sedation and delirium in adults with COVID-19-associated acute respiratory distress syndrome. Rev Bras Ter Intensiva 2021; 33:48-67. [PMID: 33886853 PMCID: PMC8075332 DOI: 10.5935/0103-507x.20210005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/29/2020] [Indexed: 01/08/2023] Open
Abstract
Objective To propose agile strategies for a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for patients with COVID-19-associated acute respiratory distress syndrome, considering the high risk of infection among health workers, the humanitarian treatment that we must provide to patients and the inclusion of patients’ families, in a context lacking specific therapeutic strategies against the virus globally available to date and a potential lack of health resources. Methods A nonsystematic review of the scientific evidence in the main bibliographic databases was carried out, together with national and international clinical experience and judgment. Finally, a consensus of recommendations was made among the members of the Committee for Analgesia, Sedation and Delirium of the Sociedad Argentina de Terapia Intensiva. Results Recommendations were agreed upon, and tools were developed to ensure a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for adult patients with acute respiratory distress syndrome due to COVID-19. Discussion Given the new order generated in intensive therapies due to the advancing COVID-19 pandemic, we propose to not leave aside the usual good practices but to adapt them to the particular context generated. Our consensus is supported by scientific evidence and national and international experience and will be an attractive consultation tool in intensive therapies.
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Affiliation(s)
- Manuel Donato
- Hospital General de Agudos José María Penna - Buenos Aires, Argentina.,Ministerio de Salud de la Nación Argentina - Buenos Aires, Argentina.,Instituto de Efectividad Clínica y Sanitaria - Buenos Aires, Argentina
| | | | | | - Ignacio López Saubidet
- Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" - Buenos Aires, Argentina
| | - Adela Goldberg
- Sanatorio de La Trinidad Mitre - Buenos Aires, Argentina
| | | | - Daniela Olmos
- Hospital Municipal Príncipe de Asturias - Córdoba, Argentina
| | - Rosa Reina
- Hospital Interzonal General de Agudos General San Martín - La Plata, Argentina
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20
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Hernández-Tejedor A, Martín Delgado MC. An ethics crisis within the health crisis due to COVID-19. Med Intensiva 2021; 45:S0210-5691(21)00056-5. [PMID: 33867176 PMCID: PMC7997308 DOI: 10.1016/j.medin.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/22/2022]
Affiliation(s)
| | - M C Martín Delgado
- Junta Directiva de SEMICYUC, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
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21
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González-Castro A, Cuenca Fito E, Fernandez-Rodriguez A, Escudero Acha P, Rodríguez Borregán JC, Peñasco Y. High flow oxygen therapy in the treatment of SARS-CoV-2 pneumonia. Med Intensiva 2021; 46:S0210-5691(21)00003-6. [PMID: 33551112 PMCID: PMC7816877 DOI: 10.1016/j.medin.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 01/08/2023]
Affiliation(s)
- A González-Castro
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - E Cuenca Fito
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - A Fernandez-Rodriguez
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - P Escudero Acha
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J C Rodríguez Borregán
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Y Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
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22
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da Silva Fernandes C, Sousa Albuquerque Brandão MG, de Sousa Lima MM, do Nascimento JC, Galindo Neto NM, Moreira Barros L. Práticas seguras no manejo de vias aéreas de pacientes con Covid-19: revisión integradora. Rev Cuid 2021. [DOI: 10.15649/cuidarte.1356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introdução: A pandemia causada pelo vírus SARS-CoV-2 no início de 2020 alterou práticas dos profissionais de saúde com a finalidade em atenuar os riscos de contaminação dos trabalhadores da linha de frente de assistência à saúde, principalmente, atividades relacionadas ao manejo de vias aéreas de pacientes com Covid-19. Objetivo: identificar as práticas necessárias para garantir a segurança dos profissionais de saúde no manejo de vias aéreas de pacientes suspeitos ou diagnosticados com Covid-19. Materiais e métodos: revisão integrativa realizada em dez bases de dados relevantes na área da saúde, sendo a amostra composta por 17 pesquisas. As práticas identificadas foram elencadas conforme os quatro procedimentos pontuados pela literatura: intubação endotraqueal, extubação, broncoscopia e traqueostomia. Resultados: as principais recomendações mencionadas foram: intubação endotraqueal: realizada por equipe experiente, treinada, mínima e profissionais de grupos de risco para Covid-19 não devem fazer parte desta equipe; extubação: não utilizar cateter nasal de alto fluxo após o procedimento; broncoscopia: realizar em sala isolada e com pressão negativa; traqueostomia: poderá ser considerada precocemente, mas o risco-benefício deve ser avaliado. Conclusão: as práticas identificadas poderão direcionar o gerenciamento de vias aéreas e nortear a construção de tecnologias assistenciais, educacionais ou gerenciais.
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23
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Moreno G, Carbonell R, Bodí M, Rodríguez A. [Systematic review of the prognostic utility of D-dimer, disseminated intravascular coagulation, and anticoagulant therapy in COVID-19 critically ill patients]. Med Intensiva 2021; 45:42-55. [PMID: 32646669 PMCID: PMC7298463 DOI: 10.1016/j.medin.2020.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022]
Abstract
During the new pandemic caused by SARS-CoV-2, there is short knowledge regarding the management of different disease areas, such as coagulopathy and interpretation of D-dimer levels, its association with disseminated intravascular coagulation (DIC) and controversy about the benefit of anticoagulation. Thus, a systematic review has been performed to define the role of D-dimer in the disease, the prevalence of DIC and the usefulness of anticoagulant treatment in these patients. A literature search was performed to analyze the studies of COVID-19 patients. Four recommendations were drawn based on expert opinion and scientific knowledge, according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The present review suggests the presence of higher levels of D-dimer in those with worse prognosis, there may be an overdiagnosis of DIC in the course of the disease and there is no evidence on the benefit of starting anticoagulant treatment based only on isolated laboratory data.
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Affiliation(s)
- G Moreno
- Servicio de Medicina Intensiva, Hospital Universitari Joan XXIII, URV/IISPV, Tarragona, España.
| | - R Carbonell
- Servicio de Medicina Intensiva, Hospital Universitari Joan XXIII, URV/IISPV, Tarragona, España
| | - M Bodí
- Servicio de Medicina Intensiva, Hospital Universitari Joan XXIII, URV/IISPV, Tarragona, España
| | - A Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitari Joan XXIII, URV/IISPV, Tarragona, España
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24
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Claverias L, Gómez J, Rodríguez A, Albiol J, Esteban F, Bodí M. Support to the organization of the Intensive Care Units during the pandemic through maps created from the Clinical Information Systems. Medicina Intensiva (English Edition) 2021. [PMCID: PMC7700764 DOI: 10.1016/j.medine.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Ramírez P, Gordón M, Martín-Cerezuela M, Villarreal E, Sancho E, Padrós M, Frasquet J, Leyva G, Molina I, Barrios M, Gimeno S, Castellanos Á. Acute respiratory distress syndrome due to COVID-19. Clinical and prognostic features from a medical Critical Care Unit in Valencia, Spain. Med Intensiva 2021; 45:27-34. [PMID: 38620897 PMCID: PMC7836701 DOI: 10.1016/j.medin.2020.06.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
Abstract
Objective Information from critically ill coronavirus disease 2019 (COVID-19) patients is limited and in many cases coming from health systems approaches different from the national public systems existing in most countries in Europe. Besides, patient follow-up remains incomplete in many publications. Our aim is to characterize acute respiratory distress syndrome (ARDS) patients admitted to a medical critical care unit (MCCU) in a referral hospital in Spain. Design Retrospective case series of consecutive ARDS COVID-19 patients admitted and treated in our MCCU. Setting 36-bed MCCU in referral tertiary hospital. Patients and participants SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal/pharyngeal swabs. Interventions None. Main variables of interest Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Results Forty-four ARDS COVID-19 patients were included in the study. Median age was 61.50 (53.25 - 67) years and most of the patients were male (72.7%). Hypertension and dyslipidemia were the most frequent co-morbidities (52.3 and 36.4% respectively). Steroids (1mg/Kg/day) and tocilizumab were administered in almost all patients (95.5%). 77.3% of the patients needed invasive mechanical ventilation for a median of 16 days [11-28]. Prone position ventilation was performed in 33 patients (97%) for a median of 3 sessions [2-5] per patient. Nosocomial infection was diagnosed in 13 patients (29.5%). Tracheostomy was performed in ten patients (29.4%). At study closing all patients had been discharged from the CCU and only two (4.5%) remained in hospital ward. MCCU length of stay was 18 days [10-27]. Mortality at study closing was 20.5% (n 9); 26.5% among ventilated patients. Conclusions The seven-week period in which our MCCU was exclusively dedicated to COVID-19 patients has been challenging. Despite the severity of the patients and the high need for invasive mechanical ventilation, mortality was 20.5%.
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Affiliation(s)
- P Ramírez
- Critical care department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M Gordón
- Critical care department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M Martín-Cerezuela
- Critical care department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - E Villarreal
- Critical care department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - E Sancho
- Critical care department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M Padrós
- Critical care department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - J Frasquet
- Microbiology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - G Leyva
- Critical care department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - I Molina
- Critical care department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M Barrios
- Critical care department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - S Gimeno
- Critical care department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Á Castellanos
- Critical care department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
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26
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Lobo-Valbuena B, García-Arias M, Pérez RB, Delgado DV, Gordo F. [Characteristics of critical patients with COVID-19 in a Spanish second-level hospital]. Med Intensiva 2021; 45:56-58. [PMID: 33160704 PMCID: PMC7831452 DOI: 10.1016/j.medin.2020.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 01/16/2023]
Affiliation(s)
- B Lobo-Valbuena
- Intensivista - Unidad de Cuidados Intensivos del Hospital Universitario del Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain.
| | - Mª García-Arias
- Supervisora de Enfermería de la Unidad de Cuidados Intensivos del Hospital Universitario del Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - R B Pérez
- Anestesista - Servicio de Anestesia del Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - D V Delgado
- Responsable de la Unidad de Apoyo a la Investigación. Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - F Gordo
- Jefe de Servicio de la Unidad de Cuidados Intensivos del Hospital Universitario del Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
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27
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Abstract
Ethical issues around triage have been at the forefront of debates during the Covid-19 pandemic. This essay compares both discussion and guidelines around triage and the reality of what happened in the United States and in Europe, both in anticipation of and during the first wave of the pandemic. Why did the issue generate so many vivid debates in the United States and so few in most European countries, although the latter were also affected by the rationing of health care resources? Are countries with socialized health care systems better equipped to face the hard choices of triaging? Important lessons in transparency, trust, and accountability for policy-makers can be drawn from this comparison, demonstrating that fostering public involvement and ethical debate remains a critical element for the sustained acceptance of any triage plan.
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Domínguez-Gil B, Fernández-Ruiz M, Hernández D, Crespo M, Colmenero J, Coll E, Rubio JJ. Organ Donation and Transplantation During the COVID-19 Pandemic: A Summary of the Spanish Experience. Transplantation 2021; 105:29-36. [PMID: 33165237 DOI: 10.1097/tp.0000000000003528] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Spain has been amongst the countries most affected by the COVID-19 pandemic, which has posed significant challenges to the donation and transplantation program. Despite a dramatic decrease of donation and transplantation activities during the critical early weeks of the outbreak, the program has recovered and is learning to cope with COVID-19. METHODS We describe the 4 pillars upon which the Spanish donation and transplantation program has been rebuilt. RESULTS (1) Standards have been developed and progressively updated for the evaluation and selection of potential donors and recipients with regards to SARS-CoV-2 infection. (2) Spain has been actively generating evidence to assess the validity of our standards and to understand the natural history of the infection in transplant recipients. No case of donor-derived COVID-19 has been reported to date. COVID-19 has been more frequent and has had a more aggressive course in recipients of solid organ transplants than in the general population, but this seems largely explained by the demographics and comorbidity of transplant patients. (3) As a result of this evidence and experience, recommendations have been issued for the management of COVID-19 in solid organ transplant recipients and candidates on the waiting list. (4) Finally, concrete guidance has been issued for centers to manage the donation and transplantation programs in relation to a dynamic and heterogeneous epidemiologic scenario. CONCLUSIONS The Spanish experience confronting the impact of COVID-19 upon donation and transplantation may help serve the needs of a broader community in other countries.
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Affiliation(s)
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Domingo Hernández
- Nephrology Service, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Marta Crespo
- Nephrology Service, Hospital del Mar, Barcelona, Spain
| | | | | | - Juan José Rubio
- Intensive Care Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Sanfilippo F, Messina A, Cecconi M, Astuto M. Ten answers to key questions for fluid management in intensive care. Med Intensiva 2020; 45:S0210-5691(20)30338-7. [PMID: 33323286 DOI: 10.1016/j.medin.2020.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 07/27/2020] [Revised: 10/05/2020] [Accepted: 10/17/2020] [Indexed: 12/16/2022]
Abstract
This review focuses on fluid management of critically ill patients. The topic is addressed based on 10 single questions with simplified answers that provide clinicians with the basic information needed at the point of care in treating patients in the Intensive Care Unit. The review has didactic purposes and may serve both as an update on fluid management and as an introduction to the subject for novices in critical care. There is an urgent need to increase awareness regarding the potential risks associated with fluid overload. Clinicians should be mindful not only of the indications for administering fluid loads and of the type of fluids administered, but also of the importance to set safety limits. Lastly, it is important to implement proactive strategies seeking to establish negative fluid balance as soon as the clinical conditions are considered to be stable and the risk of deterioration is low.
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Affiliation(s)
- F Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy.
| | - A Messina
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - M Cecconi
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - M Astuto
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy; School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy
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Rodríguez Yago M, Alcalde Mayayo I, Gómez López R, Parias Ángel M, Pérez Miranda A, Canals Aracil M, Civantos Fuentes E, Rodríguez Núñez A, Manrique Martínez I, López-herce Cid J, Zeballos Sarrato G, Calvo Macías C, Hernández-tejedor A. Recommendations on cardiopulmonary resuscitation in patients with suspected or confirmed SARS-CoV-2 infection (COVID-19). Executive summary. Medicina Intensiva (English Edition) 2020; 44:566-576. [DOI: 10.1016/j.medine.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The SARS-CoV-2 pandemic has created new scenarios that require modifications to the usual cardiopulmonary resuscitation protocols. The current clinical guidelines on the management of cardiorespiratory arrest do not include recommendations for situations that apply to this context. Therefore, the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), in collaboration with the Spanish Group of Pediatric and Neonatal CPR and with the Teaching Life Support in Primary Care program of the Spanish Society of Family and Community Medicine (SEMFyC), have written these recommendations, which are divided into five parts that address the main aspects for each healthcare setting. This article consists of an executive summary of them.
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Fraile Gutiérrez V, Ayuela Azcárate J, Pérez Torres D, Zapata L, Rodríguez Yakushev A, Ochagavía Calvo A. Narrative review of ultrasound in the management of the critically ill patient with SARS-CoV-2 infection (COVID-19): clinical applications in intensive care medicine. Medicina Intensiva (English Edition) 2020; 44:551-565. [DOI: 10.1016/j.medine.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The clinical picture of SARS-CoV-2 infection (COVID-19) is characterized in its more severe form, by an acute respiratory failure which can worsen to pneumonia and acute respiratory distress syndrome (ARDS), and get complicated with thrombotic events and heart dysfunction. Therefore, admission to the Intensive Care Unit (ICU) is common. Ultrasound, which has become an everyday tool in the ICU, can be very useful during COVID-19 pandemic, since it provides the clinician with information which can be interpreted and integrated within a global assessment during the physical examination. A description of some of the potential applications of ultrasound is depicted in this document, in order to supply the physicians taking care of these patients with a adapted guide to the intensive care setting. Some of its applications since ICU admission include verification of the correct position of the endotracheal tube, contribution to safe cannulation of lines, and identification of complications and thrombotic events. Furthermore, pleural and lung ultrasound can be an alternative diagnostic test to assess the degree of involvement of the lung parenchyma by means of the evaluation of specific ultrasound patterns, identification of pleural effusions and barotrauma. Echocardiography provides information of heart involvement, detects cor pulmonale and shock states.
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Blanco-Schweizer P, Sánchez-Ballesteros J, Herrán-Monge R, Prieto-deLamo A, de Ayala-Fernández JA, García-García M. Interhospital transport of COVID-19 patients on ECMO and comparison with historic controls. Med Intensiva 2020; 45:S0210-5691(20)30323-5. [PMID: 33153825 PMCID: PMC7546264 DOI: 10.1016/j.medin.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/17/2020] [Accepted: 09/26/2020] [Indexed: 01/08/2023]
Affiliation(s)
- P Blanco-Schweizer
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain.
| | - J Sánchez-Ballesteros
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| | - R Herrán-Monge
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| | - A Prieto-deLamo
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| | - J A de Ayala-Fernández
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| | - M García-García
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
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Claverías L, Gómez J, Rodríguez A, Albiol J, Esteban F, Bodí M. Support to the organization of the Intensive Care Units during the pandemic through maps created from the Clinical Information Systems. Med Intensiva 2020; 45:59-61. [PMID: 33020015 PMCID: PMC7531993 DOI: 10.1016/j.medin.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Laura Claverías
- Unidad de Cuidados Intensivos. Hospital Universitario Joan XXIII, Tarragona, España; Instituto de Investigación Sanitaria Pere Virgili. Universidad Rovira i Virgili, Tarragona, España
| | - Josep Gómez
- Unidad de Cuidados Intensivos. Hospital Universitario Joan XXIII, Tarragona, España; Instituto de Investigación Sanitaria Pere Virgili. Universidad Rovira i Virgili, Tarragona, España
| | - Alejandro Rodríguez
- Unidad de Cuidados Intensivos. Hospital Universitario Joan XXIII, Tarragona, España; Instituto de Investigación Sanitaria Pere Virgili. Universidad Rovira i Virgili, Tarragona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, España
| | - Jordi Albiol
- Unidad de Cuidados Intensivos. Hospital Universitario Joan XXIII, Tarragona, España
| | - Federico Esteban
- Unidad de Cuidados Intensivos. Hospital Universitario Joan XXIII, Tarragona, España; Instituto de Investigación Sanitaria Pere Virgili. Universidad Rovira i Virgili, Tarragona, España
| | - María Bodí
- Unidad de Cuidados Intensivos. Hospital Universitario Joan XXIII, Tarragona, España; Instituto de Investigación Sanitaria Pere Virgili. Universidad Rovira i Virgili, Tarragona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, España.
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Belenguer Muncharaz A, Hernández-Garcés H, López-Chicote C, Ribes-García S, Ochagavía-Barbarín J, Zaragoza-Crespo R. Effectiveness of non-invasive ventilation in intensive care unit admitted patients due to SARS-CoV-2 pneumonia. Med Intensiva 2020; 45:S0210-5691(20)30276-X. [PMID: 33077244 PMCID: PMC7472969 DOI: 10.1016/j.medin.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022]
Affiliation(s)
- A Belenguer Muncharaz
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, España; Unidad Predepartamental Medicina, Facultad de Ciencias de la Salud, Universitat Jaume I (UJI), Castellón de la Plana, España.
| | - H Hernández-Garcés
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, España
| | - C López-Chicote
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, España
| | - S Ribes-García
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, España
| | - J Ochagavía-Barbarín
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, España
| | - R Zaragoza-Crespo
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, España
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35
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Palacio Sanguino A, Acosta Ospina LE, Callejas de Luca E. Decisiones de final de vida en tiempos de pandemia. Rev Esp Geriatr Gerontol 2020; 55:313-314. [PMID: 32747158 PMCID: PMC7266751 DOI: 10.1016/j.regg.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 11/28/2022]
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36
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Estella Á. Intensive Care Medicine: Quiet leadership versus protagonist in times of SARS-CoV-2 pandemic crisis. Med Intensiva 2020; 45:S0210-5691(20)30262-X. [PMID: 32962810 PMCID: PMC7462450 DOI: 10.1016/j.medin.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Á Estella
- Servicio de Medicina Intensiva, Hospital Universitario de Jerez, Cádiz, España; Departamento de Medicina, Universidad de Cádiz, Cádiz, España.
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37
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Affiliation(s)
- Jonathan Koffman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Jamie Gross
- London North West University Healthcare NHS Trust, Harrow, UK
| | - Simon Noah Etkind
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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38
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Rodríguez Yago MA, Alcalde Mayayo I, Gómez López R, Parias Ángel MN, Pérez Miranda A, Canals Aracil M, Civantos Fuentes E, Rodríguez Núñez A, Manrique Martínez I, López-Herce Cid J, Zeballos Sarrato G, Calvo Macías C, Hernández-Tejedor A. [Recommendations on cardiopulmonary resuscitation in patients with suspected or confirmed SARS-CoV-2 infection (COVID-19). Executive summary]. Med Intensiva 2020; 44:566-576. [PMID: 32425289 PMCID: PMC7229968 DOI: 10.1016/j.medin.2020.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
La pandemia por SARS-CoV-2 ha generado nuevos escenarios que requieren modificaciones de los protocolos habituales de reanimación cardiopulmonar. Las guías clínicas vigentes sobre el manejo de la parada cardiorrespiratoria no incluyen recomendaciones para situaciones aplicables a este contexto. Por ello, el Plan Nacional de Reanimación Cardiopulmonar de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias, en colaboración con el Grupo Español de RCP Pediátrica y Neonatal y con el programa de Enseñanza de Soporte Vital en Atención Primaria de la Sociedad Española de Medicina Familiar y Comunitaria, ha redactado las siguientes recomendaciones, que están divididas en 5 partes que tratan los principales aspectos para cada entorno asistencial. En este artículo se presenta un resumen ejecutivo de las mismas.
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Affiliation(s)
- M A Rodríguez Yago
- Servicio de Medicina Intensiva, Hospital Universitari Son Espases, Palma, España.
| | - I Alcalde Mayayo
- Servicio de Medicina Intensiva, Hospital QuirónSalud Palma Planas, Palma, España
| | - R Gómez López
- Servicio de Medicina Intensiva, Hospital QuirónSalud Miguel Domínguez, Pontevedra, España
| | - M N Parias Ángel
- Servicio de Medicina Intensiva, Hospital Santa Bárbara, Puertollano, España
| | - A Pérez Miranda
- Servicio de Urgencias, Hospital Nuestra Señora de los Reyes, Valverde, El Hierro, España
| | | | | | - A Rodríguez Núñez
- Unidad de Cuidados Intensivos Pediátricos, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - I Manrique Martínez
- Presidente del GERCPyN. Instituto Valenciano de Pediatría y Puericultura, Valencia, España
| | - J López-Herce Cid
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - G Zeballos Sarrato
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - C Calvo Macías
- Coordinador del Grupo de Trabajo de RCP Pediátrica y Neonatal del CERP, Málaga, España
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Fraile Gutiérrez V, Ayuela Azcárate JM, Pérez-Torres D, Zapata L, Rodríguez Yakushev A, Ochagavía A. [Ultrasound in the management of the critically ill patient with SARS-CoV-2 infection (COVID-19): narrative review]. Med Intensiva 2020; 44:551-65. [PMID: 32527471 DOI: 10.1016/j.medin.2020.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
La infección por SARS-CoV-2 (COVID-19) se caracteriza por producir en las formas graves, un cuadro de insuficiencia respiratoria que puede evolucionar hacia neumonía y síndrome de distrés respiratorio agudo (SDRA), presentar complicaciones como fenómenos trombóticos y disfunción cardiaca, lo que motiva el ingreso en la Unidad de Cuidados Intensivos (UCI). La ecografía, convertida en una herramienta de uso habitual en la UCI, puede ser muy útil durante la pandemia por COVID-19 ya que la información obtenida por el clínico puede ser interpretada e integrada en la valoración global durante la exploración del paciente. Este documento describe algunas de sus aplicaciones, adaptadas al paciente crítico con COVID-19, con el objetivo de proporcionar una guía a los médicos responsables. Alguna de sus aplicaciones desde el ingreso en la UCI incluyen: confirmar la correcta posición del tubo endotraqueal, facilitar la inserción segura de las vías e identificar complicaciones y fenómenos trombóticos. Además, la ecografía pleuropulmonar puede ser una alternativa diagnóstica válida que permite evaluar el grado de afectación pulmonar, mediante el análisis de patrones ecográficos específicos, la identificación de derrame pleural y barotrauma. La ecocardiografía proporciona información acerca de la afectación cardiaca, detección del cor pulmonale y estados de shock.
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Rodríguez-Pardo J, Fuentes B, Alonso de Leciñana M, Campollo J, Calleja Castaño P, Carneado Ruiz J, Egido Herrero J, García Leal R, Gil Núñez A, Gómez Cerezo J, Martín Martínez A, Masjuán Vallejo J, Palomino Aguado B, Riera López N, Simón de las Heras R, Vivancos Mora J, Díez Tejedor E. Acute stroke care during the COVID-19 pandemic. Ictus Madrid Program recommendations. Neurología (English Edition) 2020. [PMCID: PMC7211680 DOI: 10.1016/j.nrleng.2020.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction The COVID-19 pandemic has resulted in complete saturation of healthcare capacities, making it necessary to reorganise healthcare systems. In this context, we must guarantee the provision of acute stroke care and optimise code stroke protocols to reduce the risk of SARS-CoV-2 infection and rationalise the use of hospital resources. The Madrid Stroke multidisciplinary group presents a series of recommendations to achieve these goals. Methods We conducted a non-systematic literature search using the keywords “stroke” and “COVID-19” or “coronavirus” or “SARS-CoV-2.” Our literature review also included other relevant studies known to the authors. Based on this literature review, a series of consensus recommendations were established by the Madrid Stroke multidisciplinary group and its neurology committee. Results These recommendations address 5 main objectives: (1) coordination of action protocols to ensure access to hospital care for stroke patients; (2) recognition of potentially COVID-19-positive stroke patients; (3) organisation of patient management to prevent SARS-CoV-2 infection among healthcare professionals; (4) avoidance of unnecessary neuroimaging studies and other procedures that may increase the risk of infection; and (5) safe, early discharge and follow-up to ensure bed availability. This management protocol has been called CORONA (Coordinate, Recognise, Organise, Neuroimaging, At home). Conclusions The recommendations presented here may assist in the organisation of acute stroke care and the optimisation of healthcare resources, while ensuring the safety of healthcare professionals.
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Rodríguez-Pardo J, Fuentes B, Alonso de Leciñana M, Campollo J, Calleja Castaño P, Carneado Ruiz J, Egido Herrero J, García Leal R, Gil Núñez A, Gómez Cerezo JF, Martín Martínez A, Masjuán Vallejo J, Palomino Aguado B, Riera López N, Simón de Las Heras R, Vivancos Mora J, Díez Tejedor E. Acute stroke care during the COVID-19 pandemic. Ictus Madrid Program recommendations. Neurologia 2020; 35:258-263. [PMID: 32364127 PMCID: PMC7180371 DOI: 10.1016/j.nrl.2020.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/22/2022] Open
Abstract
Introducción La pandemia por COVID-19 ha obligado a una reorganización de los sistemas sanitarios y ha comportado una saturación excepcional de sus recursos. En este contexto es vital asegurar la atención al ictus agudo y optimizar los procesos asistenciales del código ictus para reducir el riesgo de contagios y racionalizar el uso de recursos hospitalarios. Para ello, desde el Grupo Multidisciplinar Ictus Madrid proponemos una serie de recomendaciones. Métodos Revisión bibliográfica no sistemática de las publicaciones disponibles con los términos «stroke» y «COVID-19» o «coronavirus» o «SARS-CoV-2», así como otras conocidas por los autores. En base a esta se redacta un documento de recomendaciones que es sometido a consenso por el Grupo Multidisciplinar Ictus Madrid y su Comité de Neurología. Resultados Las recomendaciones se estructuran en cinco líneas fundamentales: 1) coordinar la actuación para garantizar el acceso a la asistencia hospitalaria de los pacientes con ictus; 2) reconocer a los pacientes con ictus potencialmente infectados por COVID-19, 3) organización adecuada para garantizar la protección de los profesionales sanitarios frente al riesgo de contagio por COVID-19, 4) en la realización de neuroimagen y otros procedimientos que conlleven contactos de riesgo de infección COVID-19 hay que procurar reducirlos y asegurar la protección, y 5) alta y seguimiento seguros procurando optimizar la ocupación hospitalaria. Resumimos el procedimiento de forma esquemática con el acrónimo CORONA (COordinar, Reconocer, Organizar, Neuroimagen, Alta). Conclusiones Estas recomendaciones pueden servir de apoyo para la organización del sistema sanitario en la atención al ictus agudo y la optimización de sus recursos, garantizando la protección de sus profesionales.
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Affiliation(s)
- J Rodríguez-Pardo
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPaz, Madrid, España.
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPaz, Madrid, España
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPaz, Madrid, España
| | - J Campollo
- Servicio de Radiología (Sección de Neurorradiología), Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - P Calleja Castaño
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Carneado Ruiz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, España
| | - J Egido Herrero
- Servicio de Neurología, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, Madrid, España
| | - R García Leal
- Servicio de Neurocirugía, Hospital Universitario Gregorio Marañón, Universidad Autónoma de Madrid, Madrid, España
| | - A Gil Núñez
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Universidad Autónoma de Madrid, Madrid, España
| | - J F Gómez Cerezo
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, Madrid, España
| | - A Martín Martínez
- Servicio de Urgencias Hospitalarias, Hospital Severo Ochoa, Madrid, España
| | - J Masjuán Vallejo
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | - B Palomino Aguado
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | - N Riera López
- Servicio de Urgencias Médicas de Madrid, SUMMA-112, Madrid, España
| | - R Simón de Las Heras
- Servicio de Neurología (Sección Neuropediatría), Hospital Universitario 12 de Octubre, Madrid, España
| | - J Vivancos Mora
- Servicio de Neurología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - E Díez Tejedor
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPaz, Madrid, España.
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