2
|
Vidal-Cortés P, Díaz Santos E, Aguilar Alonso E, Amezaga Menéndez R, Ballesteros MÁ, Bodí MA, Bordejé Laguna ML, Garnacho Montero J, García Sánchez M, López Sánchez M, Martín-Loeches I, Ochagavía Calvo A, Ramírez Galleymore P, Alcántara Carmona S, Andaluz Ojeda D, Badallo Arébalo O, Barrasa González H, Borges Sa M, Castellanos-Ortega Á, Estella Á, Ferrer Roca R, Fraile Gutiérrez V, Fuset Cabanes M, Giménez-Esparza Vich C, González Iglesias C, Hernández-Tejedor A, Igeño Cano JC, Iglesias Posadilla D, Jiménez Rivera JJ, Llanos Jorge C, Llompart-Pou JA, López Camps V, Lorencio Cárdenas C, Marcos Neira P, Martín Delgado MC, Martín-Macho González M, Martín Villén L, Nuvials Casals X, Ortiz Suñer A, Quintana Díaz M, Rascado Sedes P, Recuerda Núñez M, Del Río Carbajo L, Rodríguez Aguirregabiria M, Rodríguez Oviedo A, Seijas Betolaza I, Soriano Cuesta C, Suberviola Cañas B, Vera Ching C, Vidal González Á, Zapata Fenor L, Zaragoza Crespo R. Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units. Med Intensiva 2021; 46:81-89. [PMID: 34903475 PMCID: PMC8664080 DOI: 10.1016/j.medine.2021.11.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.
Collapse
Affiliation(s)
- P Vidal-Cortés
- Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
| | - E Díaz Santos
- Medicina Intensiva, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain; Departament de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - E Aguilar Alonso
- Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - R Amezaga Menéndez
- Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - M Á Ballesteros
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - M A Bodí
- Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain; Universitat Rovira i Virgili, Tarragona, Spain
| | - M L Bordejé Laguna
- Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | | | | | - M López Sánchez
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - I Martín-Loeches
- Intensive Care Medicine, St James's Hospital, Dublin, Ireland; Trinity College Dublin, School of Medicine, Dublin, Ireland
| | - A Ochagavía Calvo
- Medicina Intensiva, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | | | - S Alcántara Carmona
- Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - D Andaluz Ojeda
- Medicina Intensiva, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - O Badallo Arébalo
- Medicina Intensiva, Hospital Universitario de Cruces, Bizkaia, Spain
| | | | - M Borges Sa
- Medicina Intensiva, Hospital Universitario Son Llátzer, Palma de Mallorca, Spain
| | | | - Á Estella
- Medicina Intensiva, Hospital Universitario de Jerez, Jerez, Spain; Departamento de Medicina, INIBICA, Universidad de Cádiz, Cádiz, Spain
| | - R Ferrer Roca
- Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - V Fraile Gutiérrez
- Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, Spain
| | - M Fuset Cabanes
- Medicina Intensiva, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - J C Igeño Cano
- Medicina Intensiva, Hospital San Juan de Dios, Córdoba, Spain
| | | | - J J Jiménez Rivera
- Medicina Intensiva, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - C Llanos Jorge
- Medicina Intensiva, Hospital QuirónSalud Tenerife, Tenerife, Spain
| | - J A Llompart-Pou
- Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - V López Camps
- Medicina Intensiva, Hospital de Sagunto, Sagunto, Spain
| | - C Lorencio Cárdenas
- Medicina Intensiva, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | - P Marcos Neira
- Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - M C Martín Delgado
- Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain; Universidad Francisco de Vitoria, Madrid, Spain
| | | | - L Martín Villén
- Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - X Nuvials Casals
- Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - A Ortiz Suñer
- Medicina Intensiva, Hospital Arnau de Vilanova, Valencia, Spain; Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia, Valencia, Spain
| | - M Quintana Díaz
- Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Departamento de Medicina Universidad Autónoma de Madrid, Madrid, Spain
| | - P Rascado Sedes
- Medicina Intensiva, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - M Recuerda Núñez
- Medicina Intensiva, Hospital Universitario Puerto Real, Cádiz, Spain
| | - L Del Río Carbajo
- Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | | | - I Seijas Betolaza
- Medicina Intensiva, Hospital Universitario de Cruces, Bizkaia, Spain
| | - C Soriano Cuesta
- Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - B Suberviola Cañas
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - C Vera Ching
- Medicina Intensiva, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | | | - L Zapata Fenor
- Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Zaragoza Crespo
- Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, Spain
| |
Collapse
|
3
|
Jiménez Rivera JJ, Llanos Jorge C, López Gude MJ, Pérez Vela JL. Perioperative management in cardiovascular surgery. Med Intensiva 2020; 45:175-183. [PMID: 33358388 DOI: 10.1016/j.medin.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/21/2022]
Abstract
Cardio-surgical patient care requires a comprehensive and multidisciplinary approach to develop strategies to improve patient safety and outcomes. In the preoperative period, prophylaxis for frequent postoperative complications, such as de novo atrial fibrillation or bleeding, and prehabilitation based on exercise training, respiratory physiotherapy and nutritional and cognitive therapy, especially in fragile patients, stand out. There have been great advances, during the intraoperative phase, such as minimally invasive surgery, improved myocardial preservation, enhanced systemic perfusion and brain protection during extracorporeal circulation, or implementation of Safe Surgery protocols. Postoperative care should include goal-directed hemodynamic theraphy, a correct approach to coagulation disorders, and a multimodal analgesic protocol to facilitate early extubation and mobilization. Finally, optimal management of postoperative complications is key, including arrhythmias, vasoplegia, bleeding, and myocardial stunning that can lead to low cardiac output syndrome or, in extreme cases, cardiogenic shock. This global approach and the high degree of complexity require highly specialised units where intensive care specialists add value and are key to obtain more effective and efficient clinical results.
Collapse
Affiliation(s)
- J J Jiménez Rivera
- Servicio de Medicina Intensiva, Hospital Universitario de Canarias, La Laguna, España.
| | - C Llanos Jorge
- Servicio de Medicina Intensiva, Hospital Quirón salud Tenerife, Santa Cruz de Tenerife, España
| | - M J López Gude
- Servicio de Cirugía Cardiovascular, Hospital Universitario Doce de Octubre, Madrid, España
| | - J L Pérez Vela
- Servicio de Medicina Intensiva, Hospital Universitario Doce de Octubre, Madrid, España
| | | |
Collapse
|
4
|
Ballesteros Sanz MÁ, Hernández-Tejedor A, Estella Á, Jiménez Rivera JJ, González de Molina Ortiz FJ, Sandiumenge Camps A, Vidal Cortés P, de Haro C, Aguilar Alonso E, Bordejé Laguna L, García Sáez I, Bodí M, García Sánchez M, Párraga Ramírez MJ, Alcaraz Peñarrocha RM, Amézaga Menéndez R, Burgueño Laguía P. [Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)]. Med Intensiva 2020; 44:371-388. [PMID: 32360034 PMCID: PMC7142677 DOI: 10.1016/j.medin.2020.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]
Abstract
On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.
Collapse
Affiliation(s)
- M Á Ballesteros Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | | | - Á Estella
- Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
| | - J J Jiménez Rivera
- Servicio de Medicina Intensiva, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España
| | | | - A Sandiumenge Camps
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - P Vidal Cortés
- Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - C de Haro
- Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Medicina Intensiva, CIBERES Enfermedades Respiratorias, Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - E Aguilar Alonso
- Servicio de Medicina Intensiva, Hospital Infanta Margarita, Cabra, Córdoba, España
| | - L Bordejé Laguna
- Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - I García Sáez
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, España
| | - M Bodí
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
| | - M García Sánchez
- Servicio de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M J Párraga Ramírez
- Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | | | - R Amézaga Menéndez
- Servicio de Medicina Intensiva, Hospital Universitari Son Espases, Palma, Islas Baleares, España
| | - P Burgueño Laguía
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| |
Collapse
|