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INTRODUCCIÓN: El paciente critico afecto por SARS-COV2 tiene riesgo de desnutrición. La necesidad de evitar la sobrecarga de volumen y las maniobras que retrasan alcanzar los requerimientos nutricionales como la pronación hacen que el abordaje nutricional de estos pacientes sea complejo. Para asegurar un tratamiento adecuado, se desarrolló un protocolo de soporte nutricional como guía de práctica clínica adaptado al paciente COVID19. OBJETIVO: Describir el protocolo de soporte nutricional creado en nuestro centro, el cumplimiento del mismo y analizar los resultados de su aplicación en los pacientes afectos de SARS-CoV2, ingresados en la unidad de cuidados intensivos (UCI) del Consorcio Hospital General Universitario de Valencia (CHGUV) de Marzo a Mayo del 2020. MATERIAL Y METODOS: Diseño observacional, descriptivo, retrospectivo y longitudinal para evaluar el cumplimiento de un protocolo de soporte nutricional. RESULTADOS Se incluyeron 31 pacientes. No se puede establecer un seguimiento nutricional en ocho pacientes. De los 23 pacientes restantes, ocho alcanzan el 80% de los requerimientos calóricos antes del décimo día tras el inicio del tratamiento (grupo buen cumplimiento) y quince a partir del undécimo día (grupo mal cumplimiento). El grupo con buen cumplimiento obtuvo 75% (n=6) curación y 25% éxitus (n=2), en comparación al grupo con ¨mal cumplimiento¨ donde un 53% (n=8) se fueron de alta a planta respecto un 47% (n=7) que fallecieron (Chi square test, p-value 0.019). Aquellos pacientes que alcanzaron el 80% de las necesidades calóricas en algún momento del ingreso en UCI tuvieron menor duración de ingreso frente a los que no lo alcanzaron (mediana días ingreso 14, IQR 10-16 y mediana días ingreso 22, IQR 13-39, p-valor=0.025). CONCLUSIONES La creación de un protocolo nutricional durante las primeras semanas de la pandemia por SARS-COV2 podría estar asociada con una mejoría de los resultados clínicos al favorecer la curación y disminuir las complicaciones asociadas.
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Introduction: The critical patient affected by SARS-CoV-2 is at risk of malnutrition. The need to avoid volume overload and manoeuvres that delay reaching nutritional requirements such as pronation make the nutritional approach to these patients complex. To ensure adequate treatment, a nutritional support protocol was developed as a clinical practice guideline adapted to the COVID-19 patient. Objective: To describe and analyse the results of introducing a nutritional support protocol aimed at SARS-CoV-2 patients admitted to the intensive care unit (ICU) of the Consorcio Hospital General Universitario de Valencia (CHGUV) from March to May 2020. Material and methods: Observational, descriptive, retrospective and longitudinal design to evaluate compliance with a nutritional support protocol. Results: Thirty-one consecutive patients were included but nutritional follow-up could not be performed in eight. Of the remaining 23 patients, only eight reached 80% of caloric requirements before the tenth day after starting treatment (good compliance group) and 15 after the eleventh day (poor compliance group). In the group with «good compliance¼ 75% (n = 6) were discharged and 25% died (n = 2), compared to the group with «bad compliance¼ where 53% (n = 8) were discharged and 47% (n = 7) died (Chi square test, p-value = 0.019). Those patients who reached 80% of caloric needs during ICU stay had a shorter length of stay compared to those who did not (median days of admission = 14, IQR = 10-16 and median days of admission = 22, IQR = 13-39, p-value = 0.025). Conclusions: Introducing a nutritional protocol during the first weeks of the SARS-CoV-2 pandemic could improve clinical outcomes by promoting healing and reducing associated complications.
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After the COVID-19 pandemic, learning content virtualization has been promoted by educational institutions, leading to the development of audiovisual resources to support teaching. These materials often consist of videos of variable duration envisaged as a complement to other training strategies in order to facilitate the acquisition of specific learning contents. This work presents a collaborative experience among teachers for audiovisual content generation, tailored to the specific contents of different math-related basic subjects in five different engineering degrees at the University of Cantabria. © GKA Ediciones, authors.
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BACKGROUND: We explored the experience of clinicians from the Spanish Society of Anesthesiology (SEDAR) in airway management of COVID-19 patients. METHODS: An software-based survey including a 32-item questionnaire was conducted from April 18 to May 17, 2020. Participants who have been involved in tracheal intubations in patients with suspected or confirmed COVID-19 infection were included anonymously after obtaining their informed consent. The primary outcome was the preferred airway device for tracheal intubation. Secondary outcomes included the variations in clinical practice including the preferred video laryngoscope, plans for difficult airway management, and personal protective equipment. RESULTS: 1125 physicians completed the questionnaire with a response rate of 40,9%. Most participants worked in public hospitals and were anesthesiologists. The preferred device for intubation was the video laryngoscope (5.1/6), with the type of device in decreasing order as follows: Glidescope, C-MAC, Airtraq, McGrath and King Vision. The most frequently used device for intubation was the video laryngoscope (70,5%), using them in descending order as follow: the Airtraq, C-MAC, Glidescope, McGrath and King Vision. Discomfort of intubating wearing personal protective equipment and the frequency of breaching a security step was statistically significant, increasing the risk of cross infection between patients and healthcare workers. The opinion of senior doctors differed from younger physicians in the type of video-laryngoscope used, the number of experts involved in tracheal intubation and the reason that caused more stress during the airway management. CONCLUSIONS: Most physicians preferred using a video-laryngoscope with remote monitor and disposable Macintosh blade, using the Frova guide.
Subject(s)
COVID-19 , Laryngoscopes , Physicians , Airway Management , Humans , Intubation, Intratracheal , Laryngoscopy , SARS-CoV-2 , Spain , Surveys and QuestionnairesABSTRACT
Objectives COVID-19 was declared pandemic by March 2020. Clinical, analytical, and radiological findings have been reported. Detailed different evolution of patients of the same local outbreak has been scarcely reported. We report 6 selected cases of such an evolution. Clinical cases The clinical, radiological, analytical evolution of 6 patients is reported. Patients were selected as it were epidemiological close contacts, and showed particular different clinical evolution. Results The clinical course at the start of infection (first week) was similar among patients. In relationship with clinical evolution, middle to severe course were related with inflammation markers levels evolution (D-dimer, IL-6, ferritin, lymphocytes count, etc.). Specially lung alterations were observed, but neurological/neuropsychiatric findings are still common. In evolution, 2 patients showed middle symptoms, but the 2 most severely affected died. Conclusions It remains to be elucidated the different evolutive pathways and outcomes of COVD-19. In our 6 patients of the same local outbreak, clinical, laboratory and radiological features were different. We discuss some aspects of the pathophysiology of the disease, otherthan the widely described of the respiratory system.
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OBJECTIVES: COVID-19 was declared pandemic by March 2020. Clinical, analytical, and radiological findings have been reported. Detailed different evolution of patients of the same local outbreak has been scarcely reported. We report 6 selected cases of such an evolution. CLINICAL CASES: The clinical, radiological, analytical evolution of 6 patients is reported. Patients were selected as it were epidemiological close contacts, and showed particular different clinical evolution. RESULTS: The clinical course at the start of infection (first week) was similar among patients. In relationship with clinical evolution, middle to severe course were related with inflammation markers levels evolution (D-dimer, IL-6, ferritin, lymphocytes count, etc.). Specially lung alterations were observed, but neurological/neuropsychiatric findings are still common. In evolution, 2 patients showed middle symptoms, but the 2 most severely affected died. CONCLUSIONS: It remains to be elucidated the different evolutive pathways and outcomes of COVD-19. In our 6 patients of the same local outbreak, clinical, laboratory and radiological features were different. We discuss some aspects of the pathophysiology of the disease, other than the widely described of the respiratory system.
Subject(s)
COVID-19 , Humans , Inflammation , Lung , Pandemics , SARS-CoV-2ABSTRACT
BACKGROUND: We explored the experience of clinicians from the Spanish Society of Anesthesiology in airway management of COVID-19 patients. METHODS: An software-based survey including a 32-item questionnaire was conducted from April 18 to May 17, 2020. Participants who have been involved in tracheal intubations in patients with suspected or confirmed COVID-19 infection were included anonymously after obtaining their informed consent. The primary outcome was the preferred airway device for tracheal intubation. Secondary outcomes included the variations in clinical practice including the preferred video laryngoscope, plans for difficult airway management, and personal protective equipment. RESULTS: 1125 physicians completed the questionnaire with a response rate of 40,9%. Most participants worked in public hospitals and were anesthesiologists.The preferred device for intubation was the video laryngoscope (5.1/6), with the type of device in decreasing order as follows: Glidescope, C-MAC, Airtraq, McGrath and King Vision. The most frequently used device for intubation was the video laryngoscope (70,5%), using them in descending order as follow: the Airtraq, C-MAC, Glidescope, McGrath and King Vision.Discomfort of intubating wearing personal protective equipment and the frequency of breaching a security step was statistically significant, increasing the risk of cross infection between patients and physicians. The opinion of senior doctors differed from younger physicians in the type of video-laryngoscope used, the number of experts involved in tracheal intubation and the reason that caused more stress during the airway management. CONCLUSIONS: Most physicians preferred using a video-laryngoscope with remote monitor and disposable Macintosh blade, using the Frova guide.
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The real estimate of the infection fatality rate of SARS-CoV-2 is a pivotal aspect of the COVID-19 pandemic. However, this number is still debated, since both the numerator and the denominator are uncertain. Data analysis from the most affected areas in the world minimizes computational errors and represents a unique approach for estimating infection fatality rate. We first extracted data from PubMed/Medline, Google, traditional media and social media to obtain the rate of SARS-CoV-2 antibodies seroprevalence in the most affected and best-studied areas in the world: Val Seriana (Italy), Ischgl (Austria) and Manaus (Brasil). We then searched mortality data from national institutes of statistics and calculated excess mortality. We estimated the infection fatality rate considering several scenarios according to the mortality attributable to COVID-19 and the proportion of the population infected with the virus. We found that the seropositivity was surprisingly close to 40% in all the considered areas. We calculated the SARS-CoV-2 infection fatality rate for Val Seriana, using from half to the entire excess mortality (1208 deaths) and considering from 40% to 80% of the population as being infected with SARS-CoV-2. In the most conservative scenario, infection fatality rate was as low as 0.55%, while in the worst-case one it was 2.2%. We found that the seroconversion rate in the most affected areas worldwide is about 40%. We consequently estimated the infection fatality rate to be between 0.55% and 2.2% in an area with a relatively elderly population. © 2021 The Author(s). Published by MRE Press.
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Background: Patients with cancer may be more susceptible to infection and at increased risk of more severe COVID-19 disease;however, prognostic factors are not yet clearly identified. The LunG canceR pAtients coVid19 Disease (GRAVID) study aimed to describe clinical characteristics, outcomes, and predictors of poor outcome in patients with lung cancer and COVID-19. Methods: In this large nationwide study, we reviewed medical records of patients with lung cancer and confirmed COVID-19 diagnosis from 65 Spanish hospitals. Clinical features, treatments and disease outcomes were collected. The primary endpoint was to determine all-cause mortality;secondary endpoints were hospitalization and admission to intensive care units (ICU). Risk factors for poor prognosis were identified by univariate and multivariate logistic regression models. Results: Overall, 447 patients were included for analysis. Mean age was 67 1 ± 9 8 years;332 (74 3%) were men, and 383 (85 7%) current/former smokers. NSCLC was the most frequent type of cancer (377, 84 5%), consisting mainly of adenocarcinoma (228, 51 0%), and stage III metastatic or unresectable disease (354, 79 2%). Two-hundred and sixty-six (59 5%) patients were receiving anticancer treatment, mostly first-line chemotherapy. In total, 350 (78 3%) patients were hospitalized for a mean of 13 4 ± 11 4 days, nine (2 0%) patients were admitted to the ICU, and 146 (32 7%) died. Advanced disease and the use of corticosteroids to treat COVID-19 during hospitalization were predictors of mortality. Hospitalized, non-endof-life stage patients with lymphocytopenia and high LDH had an increased risk of death. Severity of COVID-19 correlated to higher mortality, ICU admission, and mechanical ventilation rates. Conclusions: Due to their underlying comorbidities and immunocompromised status, patients with lung cancer and COVID-19 show high hospitalization and mortality rates. These outcomes, alongside the identification of prognostic factors, may inform physicians on the risks and benefits in this population, in order to provide individualized oncological care.
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OBJECTIVES: COVID-19 was declared pandemic by March 2020. Clinical, analytical, and radiological findings have been reported. Detailed different evolution of patients of the same local outbreak has been scarcely reported. We report 6 selected cases of such an evolution. CLINICAL CASES: The clinical, radiological, analytical evolution of 6 patients is reported. Patients were selected as it were epidemiological close contacts, and showed particular different clinical evolution. RESULTS: The clinical course at the start of infection (first week) was similar among patients. In relationship with clinical evolution, middle to severe course were related with inflammation markers levels evolution (D-dimer, IL-6, ferritin, lymphocytes count, etc.). Specially lung alterations were observed, but neurological/neuropsychiatric findings are still common. In evolution, 2 patients showed middle symptoms, but the 2 most severely affected died. CONCLUSIONS: It remains to be elucidated the different evolutive pathways and outcomes of COVD-19. In our 6 patients of the same local outbreak, clinical, laboratory and radiological features were different. We discuss some aspects of the pathophysiology of the disease, other than the widely described of the respiratory system.
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Objective: to collect and confirm the scientific information available regarding SARS-CoV-2 during the gestational process and its effects on the obstetric patient during delivery and puerperium, and on the newborn. Method: a bibliographic review of the evidence available was conducted in three international databases: PubMed, Science Direct and Cochrane. Standardized terms were used, as well as free language, synonyms and truncation, combining them with Boolean operators based on the capacity of each database. Likewise, the webpages of official organizations and scientific societies addressing the matter of pregnancy and COVID-19 were also consulted. Results: in total, 14 articles and 9 clinical practice guidelines were selected, as well as technical reports from different national and international organizations. There is limited bibliography, and with low scientific evidence, given the novelty of the pandemic caused by this coronavirus, but scientific documents were retrieved which addressed pregnancy and fetus, delivery, puerperium and newborns. It is believed that the SARS-CoV-2 virus has less adverse reactions in the pregnant woman and her newborn than other viruses from the same class Each pregnant woman infected and her newborn should be subject to early identification and evaluation, in an individual and multidisciplinary way in order to prevent adverse results and complications. There is no evidence of the vertical transmission of the SARS-CoV-2 virus. There are discrepancies regarding the management of newborns of pregnant women infected by COVID-19. Conclusion: there are many knowledge gaps regarding the management of pregnant women, delivery, puerperium and newborns, because there is limited evidence available. © 2020 DAE Editorial, Grupo Paradigma. All rights reserved.