Impacto de la Pandemia por SARS-CoV-2 en el Perfil de Ingreso y Egreso de una Unidad de Cuidados Intensivos según Escala de Categorización Kinesiológica / Impact of the SARS-CoV-2 Pandemic on the Admission and Discharge Profile of an Intensive Care Unit according to the Kinesiological Categorization Scale

Introducción. La pandemia por coronavirus trajo consigo una modificación y una reestructuración de las unidades de cuidados intensivos(UCI). Además se produjo un cambio en el perfil de pacientes que ingresan y egresan en estas unidades. Objetivo. Valorar el impacto de la presente pandemia en el perfil de ingreso y egreso de pacientes en UCI según escala de categorización kinesiológica de la unidad. Métodos. Estudio observacional descriptivo que incluyó 50 sujetos de UCI que contaran con escala de categorización kinesiológica (ECK) al ingreso y egreso de la unidad. La ECK contemplo 3 item de evaluación: Función ventilatoria, manejod e secreciones, grado de cooperación y nivel de actividad. El registro de la ECK se planteó de manera retrospectiva para los periodos Julio-agosto 2018 (prepandemia) y Julio - Agosto 2020 (pandemia). Se utilizó estadística descriptiva, utilizando porcentaje y/o promedio para cada variable según corresponda. Resultados. Al observar la función ventilatoria, el requerimiento de soporte ventilatorio varió de un 64% a un 16% pre ­ pandemia, y de un 100% a un 88% durante la pandemia. Respecto al manejo de secreciones, se observó que los sujetos con tos efectiva varío desde un 60% a un 22% en el periodo pandemia Por otra parte, los pacientes que requirieron succión traqueal de manera constante en pandemia, se mantuvo. entre un 88% a un 92% durante la estadía en UCI. En relación al grado de cooperación, un 78% de los pacientes con COVID-19 ingresó con una dependencia severa o nula cooperación, y al momento del egreso de UCI un 54% se mantenía en la misma condición. Respecto al nivel de actividad, durante el periodo pandemia, un 100% de los ingresos y un 96% de los egresos presentó dependencia total. Conclusión. La pandemia causada por SARS-CoV-2 ha influido directamente en el perfil de ingreso y egreso de pacientes UCI, lo cual enfrentó al personal de salud a un aumento considerable en la carga de trabajo.

Introduction. The coronavirus led to a modification and a building of new intensive care units (ICU). In addition, there was a change in the profile of patients admitted and discharged from these units. Objetive. Assess the impact of this pandemy on the admission and discharge profile of patients in the ICU according to a kinesiological categorization scale of the unit. Methods. Descriptive observational study that included 50 ICU subjects who had a Kinesiology Categorization Scale (ECK) at admission and discharge from the unit. The ECK contemplates 3 evaluation elements: ventilatory function, management and secretions, degree of cooperation and level of activity. The ECK registry was considered retrospectively for the periods July-August 2018 (pre-pandemy) and July-August 2020 (pandemy). Descriptive statistics was developed, using percentage and/or average for each variable as appropriate. Results: Looking at ventilatory function, the requirement for ventilatory support varied from 64% to 16% pre-pandemic, and from 100% to 88% during the pandemic. Regarding the management of secretions, it was shown that the subjects with effective cough varied from 60% to 22% in the pandemic period. On the other hand, the patients who required tracheal suctioning constantly in the pandemic were maintained. between 88% and 92% during the ICU stay. Regarding the degree of cooperation, 78% of the patients with COVID-19 were admitted with a severe dependency or no cooperation, and at the time of discharge from the ICU, 54% were pressed in the same condition. Regarding the level of activity, during the pandemic period, 100% of income and 96% of expenses presented total dependency. Conclusion. The pandemy caused by SARS-CoV-2 has directly influenced the admission and discharge profile of ICU patients, which confronted health personnel with a considerable increase in workload.

A systematic review of clinical characteristics, co-morbidities and outcomes of COVID-19 in children and adolescents

Background: COVID-19 is a major global health challenge that has affected all age groups and gender, with over 5 million deaths reported worldwide to date. The objective of this study is to assess available information on COVID-19 in children and adolescents with respect to clinical characteristics, co-morbidities, and outcomes, and identify gaps in the literatures for appropriate actions. Methodology: Electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for observational studies such as case series, cross-sectional and cohort studies published from December 2019 to September 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide. Data extracted included (i) patient demography (age and gender), (ii) clinical characteristics including vaccination status and presence of co-morbidities, (iii) clinical management including the use of sequential organ failure assessment (SOFA) scores, oxygen requirement, use of mechanical ventilation, and (iv) disease outcomes including length of hospital and intensive care unit (ICU) admission, recovery, complications with sequelae, or death. Data were analyzed using descriptive statistics. Results: A total of 11 eligible studies were included with a total of 266 children and adolescents; 137 (51.5%) females and 129 (48.5%) males. The mean age of the children was 9.8 years (range of 0 ­ 19 years), and children ≥ 6 years were more affected (40.7%) than age groups 1 ­ 5 years (31.9%) and < 1 year (27.4%). The major co-morbidities were respiratory diseases including pre-existing asthma (3.4%), neurologic conditions (3.4%) and cardiac pathology (2.3%). Majority (74.8%, 199/266) of the patients were discharged without sequelae, 0.8% (2/266) were discharged with sequalae from one study, and mortality of 1.9% (5/266) was reported, also from one study. SOFA scores of patients at admission were not stated in any of the study, while only one study reported patient vaccination status. Conclusion: It is recommended that safe vaccines for children < 1 year of age should be developed in addition to other preventive measures currently in place. SOFA scores should be used to assess risk of COVID-19 severity and monitor prognosis of the disease, and vaccination status of children should be documented as this may impact the management and prognosis of the disease.

Severity and Outcomes in Association with Known Exposures and Susceptibilities among Afro-Caribbean Patients with Hospital-acquired Acute Kidney Injury / Severidad y resultados clínicos asociados con exposiciones y susceptibilidades conocidas entre pacientes afrocaribeños con lesión renal aguda adquirida en el hospital

ABSTRACT Objective: To investigate the severity and outcomes associated with known exposures and susceptibilities in Afro-Caribbean patients with hospital-acquired acute kidney injury (HA-AKI). Methods: This was a single centre hospital-based cohort study. Acute kidney injury was diagnosed and staged by the criteria of Kidney Disease: Improving Global Outcomes. Results: Among 107 Afro-Caribbean patients who were newly diagnosed with HA-AKI within a one-year period, hypertension (51.4%) and diabetes mellitus (34.6%) were the most common co-existing susceptibilities. None of the selected susceptibilities led to a higher demand for renal replacement therapy (RRT) or a higher risk of 90-day mortality, except in a small subgroup with underlying malignancy in which 12 out of 28 (42.9%) demised at ≤ 90 days after AKI (odds ratio (OR): 2.36; 95% confidence interval (CI): 1.05, 5.87; p = 0.05). The risk for the requirement for dialysis was nine-fold higher if the patient had oliguria/anuria (OR: 9.06; 95% CI: 3.06, 29.04; p ≤ 0.001). Oliguria/anuria was also found to be a major risk factor for 90-day mortality (OR: 4.46; 95% CI: 1.83, 10.84; p < 0.001). Sepsis was the most frequent exposure (66%) with a high chronic kidney disease conversion rate of 25.7% (OR: 1.296; 95% CI: 0.70, 2.38). Patients with HA-AKI and sepsis had a three-fold higher mortality among hospitalized patients with AKI (OR: 2.87; 95% CI: 1.05, 7.87; p = 0.03). Both complicated non-cardiac major surgeries and cardiac surgeries were significantly associated with requirement for RRT (57.1% versus 56.3% and OR: 5.01; 95% CI: 1.04, 24.1; p = 0.02 versus OR: 6.02; 95% CI: 1.95, 18.57; p ≤ 0.001, respectively). The requirement for RRT in patients with HA-AKI was also significantly associated with admission to the intensive care unit (ICU) (42.1%; OR: 4.6; 95% CI: 1.54, 13.77; p = 0.004), systemic hypotension (OR: 5.86; 95% CI: 2.07, 16.62; p = 0.001) and haemorrhagic shock (OR: 5.78; 95% CI: 1.63, 20.51; p = 0.003). The former two groups carried a significantly higher 90-day mortality rate (OR: 6.22; 95% CI: 2.15, 17.99; p ≤ 0.001 versus OR: 5.54; 95% CI: 2.14, 14.33; p ≤ 0.001, respectively). Conclusion: We observed that certain exposures (such as sepsis, oliguria, systemic hypotension, haemorrhagic shock, ICU admission and complicated major surgeries) had a significant influence on severity and adverse renal outcomes and this was independent of susceptibilities.

RESUMEN Objetivo: Investigar la severidad y los resultados clínicos asociados con exposiciones y susceptibilidades conocidas en pacientes afrocaribeños con lesión renal aguda adquirida en el hospital (LRA-AH). Métodos: Se trató de un estudio de cohorte basado en un solo centro hospitalario. La lesión renal aguda fue diagnosticada y estadificada según los criterios de la enfermedad renal: mejorar los resultados globales. Resultados: Entre los 107 pacientes afrocaribeños que fueron diagnosticados recientemente con LRA-AH en el período de un año, la hipertensión (51.4%) y la diabetes mellitus (34.6%) fueron las susceptibilidades coexistentes más comunes. Ninguna de las susceptibilidades seleccionadas condujo a una mayor demanda de terapia de reemplazo renal (TRR) o a un mayor riesgo de mortalidad de 90 días, excepto en un pequeño subgrupo con malignidad subyacente en el que 12 de 28 (42.9%) fallecen a ≤ 90 días después de LRA (odds ratio (OR): 2.36; 95% intervalo de confianza (CI): 1.05, 5.87; p = 0.05). El riesgo de la necesidad de diálisis fue nueve veces mayor si el paciente tenía oliguria/anuria (OR: 9.06; 95% IC: 3.06, 29.04; p ≤ 0.001). También se descubrió que la oliguria/anuria era un factor de riesgo importante para la mortalidad en 90 días (OR: 4.46; 95% IC: 1.83, 10.84; p < 0.001). Sepsis fue la exposición más frecuente (66%) con una tasa de conversión de la enfermedad renal crónica alta de 25.7% (OR: 1.296; 95% IC: 0.70, 2.38). Los pacientes con LRA-AH y sepsis tuvieron una mortalidad tres veces mayor entre los pacientes hospitalizados con LRA (OR: 2.87; 95% IC: 1.05, 7.87; p = 0.03). Tanto las cirugías principales no cardíacas complicadas como las cirugías cardíacas se asociaron significativamente con la necesidad de TRR (57.1% versus 56.3% y OR: 5.01; 95% IC: 1.04, 24.1; p = 0.02 versus OR: 6.02; 95% IC: 1.95, 18.57; p ≤ 0.001, respectivamente). La necesidad de TRR en pacientes con LRA-AH también se asoció significativamente con la admisión a la unidad de cuidados intensivos (UCI) (42.1%; OR: 4.6; 95% IC: 1.54, 13.77; p = 0.004), hipotensión sistémica (OR: 5.86; 95% IC: 2.07, 16.62; p = 0.001) y choque hemorrágico (OR: 5.78; 95% IC: 1.63, 20.51; p = 0.003). Los dos grupos anteriores tuvieron una tasa de mortalidad de 90 días significativamente mayor (OR: 6.22; 95% IC: 2.15, 17.99; p ≤ 0.001 versus OR: 5.54; 95% IC: 2.14, 14.33; p ≤ 0.001, respectivamente). Conclusión: Observamos que ciertas exposiciones (tales como sepsis, oliguria, hipotensión sistémica, shock hemorrágico, admisión en la UCI, y cirugías principales complicadas) tuvieron una influencia significativa en la severidad y los resultados clínicos renales adversos, con independencia de las susceptibilidades.

Application research on ICU admission time management / 中国实用护理杂志

Objective To explore the effects of ICU admission time management on the prognosis of critically ill patients. Methods A total of 449 patients in ICU were selected and divided into experimental group (229 patients and 80 nurses) and control group (220 patients and 81 nurses). The experimental group was given ICU admission time management, and the control group was given routine nursing and grading nursing. The prognostic data including the cure rate, mortality and the incidence of complication were analyzed retrospectively. Results The scores of ICU early warning, critical patient care assessment, arrhythmia identification, intracavitary pressure monitoring and application, critically ill patients′communication factors and assessment of anxiety and depression were 50.00%(40/80), 51.25%(41/80), 48.75%(39/80), 47.50%(38/80), 48.75%(39/80), 46.25%(37/80) in experimental group, and those in control group were 7.41%(6/81), 6.17%(5/81), 9.88%(8/81), 8.64%(7/81), 7.41%(6/81), 6.17%(5/81), there were significant differences(χ2=29.42-40.07, P<0.01). Help role, education guidance, management ability, ensure quality, work role and the total score of the nurses′ position competence dimension in experimental group were (78.23 ± 10.25), (76.15 ± 10.89), (77.06 ± 11.88), (77.85 ± 10.93), (78.54 ± 10.29), (552.96±82.58) points respectively, and those in control group were (72.23±10.21), (70.23±11.20), (70.23± 12.03), (72.36±10.44), (73.52±10.81), (503.61±84.39) points, there were significant differences (t=5.041-7.420, P<0.01). There was no significant difference in diagnosis ability and diagnostic interventions (P>0.05). The cure rate, mortality and the incidence of complication in experimental group were 91.70%(210/229), 1.31%(3/229), 6.99%(16/229) , and those in control group were 70.00%(154/220), 6.82%(15/220), 25.00%(55/220), there were significant differences (χ2=34.44, 8.85, 27.35,P<0.01). ICU stay time in experimental group was (6.18±3.16) d, and that in control group was (11.52±3.39) d, there was significant difference(t=12.273,P<0.01). Conclusions Applying continuous special management in ICU admission time can increase the cure rate and decrease the hospitalization time and the incidence of complication.

Application research on ICU admission time management / 中国实用护理杂志

Objective To explore the effects of ICU admission time management on the prognosis of critically ill patients. Methods A total of 449 patients in ICU were selected and divided into experimental group (229 patients and 80 nurses) and control group (220 patients and 81 nurses). The experimental group was given ICU admission time management, and the control group was given routine nursing and grading nursing. The prognostic data including the cure rate, mortality and the incidence of complication were analyzed retrospectively. Results The scores of ICU early warning, critical patient care assessment, arrhythmia identification, intracavitary pressure monitoring and application, critically ill patients′communication factors and assessment of anxiety and depression were 50.00%(40/80), 51.25%(41/80), 48.75%(39/80), 47.50%(38/80), 48.75%(39/80), 46.25%(37/80) in experimental group, and those in control group were 7.41%(6/81), 6.17%(5/81), 9.88%(8/81), 8.64%(7/81), 7.41%(6/81), 6.17%(5/81), there were significant differences(χ2=29.42-40.07, P<0.01). Help role, education guidance, management ability, ensure quality, work role and the total score of the nurses′ position competence dimension in experimental group were (78.23 ± 10.25), (76.15 ± 10.89), (77.06 ± 11.88), (77.85 ± 10.93), (78.54 ± 10.29), (552.96±82.58) points respectively, and those in control group were (72.23±10.21), (70.23±11.20), (70.23± 12.03), (72.36±10.44), (73.52±10.81), (503.61±84.39) points, there were significant differences (t=5.041-7.420, P<0.01). There was no significant difference in diagnosis ability and diagnostic interventions (P>0.05). The cure rate, mortality and the incidence of complication in experimental group were 91.70%(210/229), 1.31%(3/229), 6.99%(16/229) , and those in control group were 70.00%(154/220), 6.82%(15/220), 25.00%(55/220), there were significant differences (χ2=34.44, 8.85, 27.35,P<0.01). ICU stay time in experimental group was (6.18±3.16) d, and that in control group was (11.52±3.39) d, there was significant difference(t=12.273,P<0.01). Conclusions Applying continuous special management in ICU admission time can increase the cure rate and decrease the hospitalization time and the incidence of complication.

Epidemiology and Outcomes of Pediatric Burn Injuries in Cairo University Hospital- Egypt.

Aim: To identify the epidemiology and outcome of pediatric burn injuries. Study Design: Retrospective hospital -based analytical study. Place and Duration of Duration: Burn unit at Cairo university hospital, in the period between the first of January 2007 till December 2011. Methodology: The study retrospectively evaluated 564 children with different burn injuries, who were admitted to Cairo University Hospital during the period of the study. Data about age, sex, burn size, etiology of burn, and outcome of admission to the intensive care unit were retrieved from the medical records and the burn treatment registry. In addition, average length of hospital stay (ALOS) and bed occupancy rate (BOR) were calculated. Further analysis was done in the last year of the study (2011), by interviewing mothers of the patients and residents in charge. Results: The average age of the children was 5.9 years (SD: ± 4.1).Under five children were found to be the most susceptible to burn injuries accounting for about 70% of the affected population There was no significant difference in the number of patients between genders (P= 0.3). While scald type of burn was the most prevalent etiology of burn injuries representing more than 60% of all causes. Total burn surface area. (TBSA)% was greater among females, patients from rural residencies and flame type of burn. The non- survivors represented 2.5% of the studied sample. Intensive care unit (ICU) admission was mainly due to renal impairment, sepsis and respiratory stress due to inhalation injury. LOS and decreasing in the BOR reflects better advances in care. Conclusion: Under five children are the most susceptible age group to burn injuries, this could be prevented by raising awareness of patients. More attention should be paid to reduce complications that necessitate ICU admission.