1
|
Luján M, Cinesi Gómez C, Peñuelas O, Ferrando C, Heili-Frades SB, Carratalá Perales JM, Mas A, Sayas Catalán J, Mediano O, Roca O, García Fernández J, González Varela A, Sempere Montes G, Rialp Cervera G, Hernández G, Millán T, Ferrer Monreal M, Egea Santaolalla C. Multidisciplinary Consensus on the Management of Non-Invasive Respiratory Support in the COVID-19 Patient. Arch Bronconeumol 2024; 60:285-295. [PMID: 38521646 DOI: 10.1016/j.arbres.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
Acute respiratory failure due to COVID-19 pneumonia often requires a comprehensive approach that includes non-pharmacological strategies such as non-invasive support (including positive pressure modes, high flow therapy or awake proning) in addition to oxygen therapy, with the primary goal of avoiding endotracheal intubation. Clinical issues such as determining the optimal time to initiate non-invasive support, choosing the most appropriate modality (based not only on the acute clinical picture but also on comorbidities), establishing criteria for recognition of treatment failure and strategies to follow in this setting (including palliative care), or implementing de-escalation procedures when improvement occurs are of paramount importance in the ongoing management of severe COVID-19 cases. Organizational issues, such as the most appropriate setting for management and monitoring of the severe COVID-19 patient or protective measures to prevent virus spread to healthcare workers in the presence of aerosol-generating procedures, should also be considered. While many early clinical guidelines during the pandemic were based on previous experience with acute respiratory distress syndrome, the landscape has evolved since then. Today, we have a wealth of high-quality studies that support evidence-based recommendations to address these complex issues. This document, the result of a collaborative effort between four leading scientific societies (SEDAR, SEMES, SEMICYUC, SEPAR), draws on the experience of 25 experts in the field to synthesize knowledge to address pertinent clinical questions and refine the approach to patient care in the face of the challenges posed by severe COVID-19 infection.
Collapse
Affiliation(s)
- Manel Luján
- Servei de Pneumologia, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Oscar Peñuelas
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Medicina Intensiva Hospital Universitario de Getafe, Madrid, Spain
| | - Carlos Ferrando
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Department of Anesthesia and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
| | - Sarah Béatrice Heili-Frades
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario Fundación Jiménez Díaz Quirón Salud, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), CIBERES, REVA Network, Madrid, Spain
| | | | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
| | | | - Olga Mediano
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Sleep Unit, Pneumology Department. Hospital Universitario de Guadalajara, Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), Universidad de Alcalá, Madrid, Spain
| | - Oriol Roca
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Parc Taulí-I3PT, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Javier García Fernández
- Servicio de Anestesiología, UCI Quirúrgica y U. Dolor. H. U. Puerta de Hierro, Madrid, Spain
| | | | | | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | - Teresa Millán
- Servicio de Medicina Intensiva Hospital Universitario Son Espases, Facultad de Medicina de las Islas Baleares, Spain
| | - Miquel Ferrer Monreal
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; UVIIR, Servei de Pneumologia, Institut de Respiratori, Clínic Barcelona, IDIBAPS. Universitat de Barcelona, Barcelona, Spain
| | | |
Collapse
|
2
|
Garnacho-Montero J, Gordillo-Escobar E, Trenado J, Gordo F, Fisac L, García-Prieto E, López-Martin C, Abella A, Jiménez JR, García-Garmendia JL. A Nationwide, Prospective Study of Tracheal Intubation in Critically Ill Adults in Spain: Management, Associated Complications, and Outcomes. Crit Care Med 2024; 52:786-797. [PMID: 38259143 DOI: 10.1097/ccm.0000000000006198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVES Our aims were to explore current intubation practices in Spanish ICUs to determine the incidence and risk factors of peri-intubation complications (primary outcome measure: major adverse events), the rate and factors associated with first-pass success, and their impact on mortality as well as the changes of the intubation procedure observed in the COVID-19 pandemic. DESIGN Prospective, observational, and cohort study. SETTING Forty-three Spanish ICU. PATIENTS A total of 1837 critically ill adult patients undergoing tracheal intubation. The enrollment period was six months (selected by each center from April 16, 2019, to October 31, 2020). INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS At least one major adverse peri-intubation event occurred in 40.4 % of the patients (973 major adverse events were registered) the most frequent being hemodynamic instability (26.5%) and severe hypoxemia (20.3%). The multivariate analysis identified seven variables independently associated with a major adverse event whereas the use of neuromuscular blocking agents (NMBAs) was associated with reduced odds of major adverse events. Intubation on the first attempt was achieved in 70.8% of the patients. The use of videolaryngoscopy at the first attempt was the only protective factor (odds ratio 0.43; 95% CI, 0.28-0.66; p < 0.001) for first-attempt intubation failure. During the COVID-19 pandemic, the use of videolaryngoscopy and NMBAs increased significantly. The occurrence of a major peri-intubation event was an independent risk factor for 28-day mortality. Cardiovascular collapse also posed a serious threat, constituting an independent predictor of death. CONCLUSIONS A major adverse event occurred in up to 40% of the adults intubated in the ICU. Peri-intubation hemodynamic instability but not severe hypoxemia was identified as an independent predictor of death. The use of NMBAs was a protective factor for major adverse events, whereas the use of videolaringoscopy increases the first-pass success rate of intubation. Intubation practices changed during the COVID-19 pandemic.
Collapse
Affiliation(s)
- José Garnacho-Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Elena Gordillo-Escobar
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Josep Trenado
- Servicio Medicina Intensiva UCI-Semicritics, Hospital Universitari MutuaTerrassa, Universitat de Barcelona, Barcelona, Spain
| | - Federico Gordo
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada-Madrid, Grupo de Investigación en Patología Crítica, Facultad de Medicina, Universidad Francisco de Vitoria (Pozuelo de Alarcón-Madrid), Madrid, Spain
| | - Lourdes Fisac
- Servicio Medicina Intensiva, Hospital Universitario de Burgos, Burgos, Spain
| | - Emilio García-Prieto
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Cristina López-Martin
- Unidad Clínica de Cuidados Intensivos. Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Ana Abella
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada-Madrid, Grupo de Investigación en Patología Crítica, Facultad de Medicina, Universidad Francisco de Vitoria (Pozuelo de Alarcón-Madrid), Madrid, Spain
| | - Juan Ramón Jiménez
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - José Luis García-Garmendia
- Servicio de Cuidados Críticos y Urgencias, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, Spain
| |
Collapse
|
3
|
González-Castro A, Huertas Martín C, Cuenca Fito E, Peñasco Y, Gonzalez C, Rodríguez Borregán JC. Duration of the first prone positioning maneuver and its association with 90-day mortality in patients with acute respiratory failure due to COVID-19: A retrospective study of time terciles. Med Intensiva 2024:S2173-5727(24)00087-0. [PMID: 38688818 DOI: 10.1016/j.medine.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/11/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To investigate the association between the duration of the first prone positioning maneuver (PPM) and 90-day mortality in patients with C-ARDS. DESIGN Retrospective, observational, and analytical study. SETTING COVID-19 ICU of a tertiary hospital. PATIENTS Adults over 18 years old, with a confirmed diagnosis of SARS-CoV-2 disease requiring PPM. INTERVENTIONS Multivariable analysis of 90-day survival. MAIN VARIABLES OF INTEREST Duration of the first PPM, number of PPM sessions, 90-day mortality. RESULTS 271 patients undergoing PPM were analyzed: first tertile (n = 111), second tertile (n = 95) and third tertile (n = 65). The results indicated that the median duration of PDP was 14 h (95% CI: 10-16 h) in the first tertile, 19 h (95% CI: 18-20 h) in the second tertile and 22 h (95% CI: 21-24 h) in the third tertile. Comparison of survival curves using the Logrank test did not reach statistical significance (p = 0.11). Cox Regression analysis showed an association between the number of pronation sessions (patients receiving between 2 and 5 sessions (HR = 2.19; 95% CI: 1.07-4.49); and those receiving more than 5 sessions (HR = 6.05; 95% CI: 2.78-13.16) and 90-day mortality. CONCLUSIONS while the duration of PDP does not appear to significantly influence 90-day mortality, the number of pronation sessions is identified as a significant factor associated with an increased risk of mortality.
Collapse
Affiliation(s)
- Alejandro González-Castro
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Grupo Internacional de Ventilación Mecánica, WeVent
| | - Carmen Huertas Martín
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Elena Cuenca Fito
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Yhivian Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Camilo Gonzalez
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | |
Collapse
|
4
|
Bodí M, Samper MA, Sirgo G, Esteban F, Canadell L, Berrueta J, Gómez J, Rodríguez A. Assessing the impact of real-time random safety audits through full propensity score matching on reliable data from the clinical information system. Int J Med Inform 2024; 184:105352. [PMID: 38330523 DOI: 10.1016/j.ijmedinf.2024.105352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/21/2024] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Evidence-based care processes are not always applied at the bedside in critically ill patients. Numerous studies have assessed the impact of checklists and related strategies on the process of care and patient outcomes. We aimed to evaluate the effects of real-time random safety audits on process-of-care and outcome variables in critical care patients. METHODS This prospective study used data from the clinical information system to evaluate the impact of real-time random safety audits targeting 32 safety measures in two intensive care units during a 9-month period. We compared endpoints between patients attended with safety audits and those not attended with safety audits. The primary endpoint was mortality, measured by Cox hazard regression after full propensity-score matching. Secondary endpoints were the impact on adherence to process-of-care measures and on quality indicators. RESULTS We included 871 patients; 228 of these were attended in ≥ 1 real-time random safety audits. Safety audits were carried out on 390 patient-days; most improvements in the process of care were observed in safety measures related to mechanical ventilation, renal function and therapies, nutrition, and clinical information system. Although the group of patients attended in safety audits had more severe disease at ICU admission [APACHE II score 21 (16-27) vs. 20 (15-25), p = 0.023]; included a higher proportion of surgical patients [37.3 % vs. 26.4 %, p = 0.003] and a higher proportion of mechanically ventilated patients [72.8 % vs. 40.3 %, p < 0.001]; averaged more days on mechanical ventilation, central venous catheter, and urinary catheter; and had a longer ICU stay [12.5 (5.5-23.3) vs. 2.9 (1.7-5.9), p < 0.001], ICU mortality did not differ significantly between groups (19.3 % vs. 18.8 % in the group without safety rounds). After full propensity-score matching, Cox hazard regression analysis showed real-time random safety audits were associated with a lower risk of mortality throughout the ICU stay (HR 0.31; 95 %CI 0.20-0.47). CONCLUSIONS Real-time random safety audits are associated with a reduction in the risk of ICU mortality. Exploiting data from the clinical information system is useful in assessing the impact of them on the care process, quality indicators, and mortality.
Collapse
Affiliation(s)
- Maria Bodí
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain; CIBERES, Spain.
| | - Manuel A Samper
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Gonzalo Sirgo
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Federico Esteban
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Laura Canadell
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Julen Berrueta
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Josep Gómez
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Alejandro Rodríguez
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain; CIBERES, Spain
| |
Collapse
|
5
|
Langford BJ, Leung V, Lo J, Akl EA, Nieuwlaat R, Lotfi T, Brown KA, Daneman N, Schwartz KL, Schünemann HJ. Antibiotic prescribing guideline recommendations in COVID-19: a systematic survey. EClinicalMedicine 2023; 65:102257. [PMID: 37842549 PMCID: PMC10568086 DOI: 10.1016/j.eclinm.2023.102257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
Background COVID-19 and antimicrobial resistance (AMR) are two intersecting public health crises. Antimicrobial overuse in patients with COVID-19 threatens to worsen AMR. Guidelines are fundamental in encouraging antimicrobial stewardship. We sought to assess the quality of antibiotic prescribing guidelines and recommendations in the context of COVID-19, and whether they incorporate principles of antimicrobial stewardship. Methods We performed a systematic survey which included a search using the concepts "antibiotic/antimicrobial" up to November 15, 2022 of the eCOVID-19 living map of recommendations (RecMap) which aggregates guidelines across a range of international sources and all languages. Guidelines providing explicit recommendations regarding antibacterial use in COVID-19 were eligible for inclusion. Guideline and recommendation quality were assessed using the AGREE II and AGREE-REX instruments, respectively. We extracted guideline characteristics including panel representation and the presence or absence of explicit statements related to antimicrobial stewardship (i.e., judicious antibiotic use, antimicrobial resistance or adverse effects as a consequence of antibiotic use). We used logistic regression to evaluate the relationship between guideline characteristics including quality and incorporation of antimicrobial stewardship principles. Protocol registration (OSF): https://osf.io/4pgtc. Findings Twenty-eight guidelines with 63 antibiotic prescribing recommendations were included. Recommendations focused on antibiotic initiation (n = 52, 83%) and less commonly antibiotic selection (n = 13, 21%), and duration of therapy (n = 15, 24%). Guideline and recommendation quality varied widely. Twenty (71%) guidelines incorporated at least one concept relating to antimicrobial stewardship. Including infectious diseases expertise on the guideline panel (OR 9.44, 97.5% CI: 1.09-81.59) and AGREE-REX score (OR 3.26, 97.5% CI: 1.14-9.31 per 10% increase in overall score) were associated with a higher odds of guidelines addressing antimicrobial stewardship. Interpretation There is an opportunity to improve antibiotic prescribing guidelines in terms of both quality and incorporation of antimicrobial stewardship principles. These findings can help guideline developers better address antibiotic stewardship in future recommendations beyond COVID-19. Funding This project was funded by Michael G. DeGroote Cochrane Canada and McMaster GRADE centres.
Collapse
Affiliation(s)
- Bradley J. Langford
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Public Health Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Valerie Leung
- Public Health Ontario, Toronto, Canada
- Toronto East Health Network, Toronto, Canada
| | - Jennifer Lo
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Elie A. Akl
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Michael G. DeGroote Cochrane Canada Centre, Hamilton, Canada
- McMaster GRADE Centre, Hamilton, Canada
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Michael G. DeGroote Cochrane Canada Centre, Hamilton, Canada
- McMaster GRADE Centre, Hamilton, Canada
| | - Kevin A. Brown
- Public Health Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Kevin L. Schwartz
- Public Health Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Unity Health Toronto, Toronto, Canada
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Michael G. DeGroote Cochrane Canada Centre, Hamilton, Canada
- McMaster GRADE Centre, Hamilton, Canada
- Humanitas University, Milan, Italy
| |
Collapse
|
6
|
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. ENFERMERIA INTENSIVA 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] [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.
Collapse
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
| |
Collapse
|
7
|
de Miguel-Balsa E, Blasco-Ruso T, Gómez-Medrano N, Mirabet-Guijarro M, Martínez-Pérez A, Alcalá-López A. Effect of the duration of prone position in ARDS patients during the SARS-CoV-2 pandemic. Med Intensiva 2023; 47:575-582. [PMID: 37147214 PMCID: PMC10110926 DOI: 10.1016/j.medine.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To describe the characteristics of patients with acute respiratory distress syndrome (ARDS) due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV), and to analyze the effect of prone position >24 h (prolonged) (PPP) compared to prone decubitus <24 h (PP). DESIGN A retrospective observational descriptive study was carried out, with uni- and bivariate analyses. SETTING Department of Intensive Care Medicine. Hospital General Universitario de Elche (Elche, Alicante, Spain). PARTICIPANTS Patients with SARS-CoV-2 pneumonia (2020-2021) on IMV due to moderate-severe ARDS, ventilated in prone position (PP). INTERVENTIONS IMV. PP maneuvers. MAIN VARIABLES OF INTEREST Sociodemographic characteristics, analgo-sedation, neuromuscular blockade (NMB), PD duration, ICU stay and mortality, days of IMV, non-infectious complications, healthcare associated infections. RESULTS Fifty-one patients required PP, and of these, 31 (69.78%) required PPP. No differences were observed in terms of patient characteristics (gender, age, comorbidities, initial severity, antiviral and antiinflammatory treatment received). Patients on PPP had poorer tolerance to supine ventilation (61.29% vs 89.47%, p = 0.031), longer hospital stay (41 vs 30 days, p = 0.023), more days of IMV (32 vs 20 days, p = 0.032), longer duration of NMB (10.5 vs 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39% vs 15%, p = 0.014). CONCLUSIONS PPP was associated with greater resource use and complications in patients with moderate-severe ARDS due to COVID-19.
Collapse
Affiliation(s)
- Eva de Miguel-Balsa
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain; Department of Clinical Medicine, Faculty of Medicine, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain.
| | - Teresa Blasco-Ruso
- Department of Clinical Medicine, Faculty of Medicine, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain
| | - Norma Gómez-Medrano
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - María Mirabet-Guijarro
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Alba Martínez-Pérez
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Adoración Alcalá-López
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
| |
Collapse
|
8
|
Garnacho Montero J. Farewell from the Editor-in-Chief: eight years is nothing. Med Intensiva 2023; 47:491-492. [PMID: 37634918 DOI: 10.1016/j.medine.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023]
Affiliation(s)
- José Garnacho Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| |
Collapse
|
9
|
Fuset-Cabanes MP, Hernández-Platero LL, Sabater-Riera J, Gordillo-Benitez M, Di Paolo F, Cárdenas-Campos P, Maisterra-Santos K, Pons-Serra M, Sastre-Pérez P, García-Zaloña A, Puentes-Yañez J, Pérez-Fernández X. Days spent on non-invasive ventilation support: can it determine when to initiate VV- ECMO? Observational study in a cohort of Covid-19 patients. BMC Pulm Med 2023; 23:310. [PMID: 37626354 PMCID: PMC10464376 DOI: 10.1186/s12890-023-02605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The study evaluates the impact of the time between commencing non-invasive ventilation (NIV) support and initiation of venovenous extracorporeal membrane oxygenation (VV-ECMO) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS). METHODS Prospective observational study design in an intensive Care Unit (ICU) of a tertiary hospital in Barcelona (Spain). All patients requiring VV-ECMO support due to COVID-19 associated ARDS between March 2020 and January 2022 were analysed. Survival outcome was determined at 90 days after VV-ECMO initiation. Demographic data, comorbidities at ICU admission, RESP (respiratory ECMO survival prediction) score, antiviral and immunomodulatory treatments received, inflammatory biomarkers, the need for vasopressors, the thromboprophylaxis regimen received, and respiratory parameters including the length of intubation previous to ECMO and the length of each NIV support (high-flow nasal cannula, continuous positive airway pressure and bi-level positive airway pressure), were also collated in order to assess risk factors for day-90 mortality. The effect of the time lapse between NIV support and VV-ECMO on survival was evaluated using logistic regression and adjusting the association with all factors that were significant in the univariate analysis. RESULTS Seventy-two patients finally received VV-ECMO support. At 90 days after commencing VV-ECMO 35 patients (48%) had died and 37 patients (52%) were alive. Multivariable analysis showed that at VV-ECMO initiation, age (p = 0.02), lactate (p = 0.001), and days from initiation of NIV support to starting VV-ECMO (p = 0.04) were all associated with day-90 mortality. CONCLUSIONS In our small cohort of VV-ECMO patients with COVID-19 associated ARDS, the time spent between initiation of NIV support and VV-ECMO (together with age and lactate) appeared to be a better predictor of mortality than the time between intubation and VV-ECMO.
Collapse
Affiliation(s)
| | - LLuisa Hernández-Platero
- Critical Care Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
- Pediatric Intensive Care Unit, SJD Barcelona Hospital, Barcelona, Spain
| | - Joan Sabater-Riera
- Critical Care Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Fabio Di Paolo
- Critical Care Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - María Pons-Serra
- Critical Care Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Paola Sastre-Pérez
- Critical Care Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | | |
Collapse
|
10
|
Bermúdez-Ruiz MDC, Vilar Sánchez I, Aparicio Pérez C, Carmona Flores R, Rodríguez-Gómez J, de la Fuente-Martos C. Clinical experience of prophylactic enoxaparin dosage adjustment guided by AntiXa factor levels in critical care patients with COVID-19-induced pneumonia: observational study. Med Intensiva 2023; 47:471-474. [PMID: 37308357 PMCID: PMC10201310 DOI: 10.1016/j.medine.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 06/14/2023]
Affiliation(s)
| | - Irene Vilar Sánchez
- Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | | | - Jorge Rodríguez-Gómez
- Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto de Investigación Maimones de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
| | - Carmen de la Fuente-Martos
- Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto de Investigación Maimones de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| |
Collapse
|
11
|
Del Carmen Bermúdez-Ruiz M, Vilar Sánchez I, Aparicio Pérez C, Carmona Flores R, Rodríguez-Gómez J, de la Fuente-Martos C. [Clinical experience in prophylactic enoxaparin dosage adjustment guided by anti-Xa factor levels in critical care patients with COVID-19 pneumonia: Observational study]. Med Intensiva 2023:S0210-5691(23)00110-9. [PMID: 37359238 PMCID: PMC10165054 DOI: 10.1016/j.medin.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Affiliation(s)
| | - Irene Vilar Sánchez
- Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía. Córdoba, España
| | | | | | - Jorge Rodríguez-Gómez
- Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía. Córdoba, España
- Instituto de Investigación Maimones de Investigación Biomédica de Córdoba. (IMIBIC), Córdoba, España
| | - Carmen de la Fuente-Martos
- Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía. Córdoba, España
- Instituto de Investigación Maimones de Investigación Biomédica de Córdoba. (IMIBIC), Córdoba, España
| |
Collapse
|
12
|
Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care? Med Intensiva 2022; 47:257-266. [PMID: 36621347 PMCID: PMC9760609 DOI: 10.1016/j.medine.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. DESIGN Cohort, prospective and observational study. SETTING Post-intensive care multidisciplinary program. PATIENTS OR PARTICIPANTS Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. INTERVENTIONS Inclusion in the post-ICU multidisciplinary program. MAIN VARIABLES OF INTEREST Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. RESULTS 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF); brachial plexopathy (10.7% IMV vs 0% ONAF); decrease in grip strength: right hand 20.67kg (±8.27) in VMI vs 31.8kg (±11.59) in ONAF and left hand 19.39kg (±8.45) in VMI vs 30.26kg (±12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. CONCLUSIONS The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.
Collapse
|
13
|
Sánchez-García AM, Martínez-López P, Gómez-González AM, Rodriguez-Capitán J, Jiménez-López RJ, García Almeida JM, Avanesi-Molina E, Zamboschi N, Rueda-Molina C, Doncel-Abad V, Molina-Ramos AI, Cabrera-César E, Ben-Abdellatif I, Gordillo-Resina M, Pérez-Mesa E, Nieto-González M, Nuevo-Ortega P, Reina-Artacho C, Sánchez Fernández PL, Jiménez-Navarro MF, Estecha-Foncea MA. ["Multidisciplinary Approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to Intensive Care?"]. Med Intensiva 2022; 47:257-266. [PMID: 36506823 PMCID: PMC9721276 DOI: 10.1016/j.medin.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. DESIGN Cohort, prospective and observational study. SETTING Post-intensive care multidisciplinary programPatients or participants: Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021Interventions: Inclusion in the post-ICU multidisciplinary programMain variables of interest: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admissionResults. 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF); brachial plexopathy (10.7% IMV vs 0% ONAF); decrease in grip strength: right hand 20.67kg (+/- 8.27) in VMI vs 31.8kg (+/- 11.59) in ONAF and left hand 19.39kg (+/- 8.45) in VMI vs 30.26kg (+/- 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. CONCLUSIONS The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.
Collapse
Affiliation(s)
- A M Sánchez-García
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - P Martínez-López
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - A M Gómez-González
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - J Rodriguez-Capitán
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - R J Jiménez-López
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Familiar y Comunitaria, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - J M García Almeida
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - E Avanesi-Molina
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Salud Mental, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - N Zamboschi
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - C Rueda-Molina
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - V Doncel-Abad
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - A I Molina-Ramos
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - E Cabrera-César
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Neumología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - I Ben-Abdellatif
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - M Gordillo-Resina
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - E Pérez-Mesa
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - M Nieto-González
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - P Nuevo-Ortega
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - C Reina-Artacho
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - P L Sánchez Fernández
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
- Servicio de Cardiología. Hospital Universitario de Salamanca-IBSAL. Universidad de Salamanca, Salamanca, España
| | - M F Jiménez-Navarro
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - M A Estecha-Foncea
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, España
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| |
Collapse
|
14
|
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] [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
| |
Collapse
|