ABSTRACT
En medio de la pandemia de COVID-19, y ante la inminencia de desabastecimiento de oxígeno en Colombia, la red de Gestión y Transferencia de Conocimiento, integrada por 19 sociedades científicas, instituciones de salud y universidades, genera una actualización al documento liderado por la Asociación Colombiana de Medicina Critica e incluye nuevos lineamientos informados en evidencia para el manejo racional de la oxigenoterapia, así como los dispositivos básicos y avanzados para la oxigenoterapia. Las recomendaciones se refieren a: uso racional de oxígeno orientado por metas, estandarización del seguimiento y ajuste de dosis, uso adecuado de los dispositivos de oxigenoterapia, uso racional de ventilación mecánica invasiva, y uso racional de la terapia con membrana de oxigenación extracorpórea. Al ejercer su juicio, se espera que los profesionales y equipos de atención tengan en cuenta estos lineamientos con el fin de hacer un uso racional y seguro de la oxigenoterapia y sus dispositivos básicos y avanzados, junto con las necesidades individuales y preferencias de las personas que están bajo su cuidado.
ABSTRACT
Resumen En medio de la pandemia de COVID-19, y ante la inminencia de desabastecimiento de oxígeno en Colombia, la red de Gestión y Transferencia de Conocimiento, integrada por 19 sociedades científicas, instituciones de salud y universidades, genera una actualización al documento liderado por la Asociación Colombiana de Medicina Critica e incluye nuevos lineamientos informados en evidencia para el manejo racional de la oxigenoterapia, así como los dispositivos básicos y avanzados para la oxigenoterapia. Las recomendaciones se refieren a: uso racional de oxígeno orientado por metas, estandarización del seguimiento y ajuste de dosis, uso adecuado de los dispositivos de oxigenoterapia, uso racional de ventilación mecánica invasiva, y uso racional de la terapia con membrana de oxigenación extracorpórea. Al ejercer su juicio, se espera que los profesionales y equipos de atención tengan en cuenta estos lineamientos con el fin de hacer un uso racional y seguro de la oxigenoterapia y sus dispositivos básicos y avanzados, junto con las necesidades individuales y preferencias de las personas que están bajo su cuidado. In the midst the COVID-19 pandemic, and given the imminence of oxygen shortages in Colombia, the Knowledge Management and Transfer Network, made up of 19 scientific societies, health institutions, and universities, generates an update to the document led by the Colombian Association of Critical Medicine and includes new evidence-informed guidelines for the rational management of oxygen therapy, as well as basic and advanced devices for oxygen therapy. The recommendations refer to five topics: goal-oriented rational use of oxygen, standardization of follow-up and dose adjustment, effective use of oxygen therapy devices, rational use of invasive mechanical ventilation, and rational use of extracorporeal oxygenation membrane therapy. When exercising their judgment, it is expected that professionals and care teams will take into account these guidelines to make rational and safe use of oxygen therapy and its basic and advanced devices, together with the individual needs and preferences of the people who are under their care.
ABSTRACT
BACKGROUND: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation. METHODS: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65-79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis. RESULTS: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16-1.49], P < .001). CONCLUSIONS: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. (ClinicalTrials.gov registration NCT02731898.).
Subject(s)
Critical Illness , Respiration, Artificial , Aged , Humans , Intensive Care Units , Retrospective Studies , Risk Factors , Simplified Acute Physiology ScoreABSTRACT
OBJECTIVES: We estimate the point seroprevalence of SARS-CoV-2 antibodies in the frontline firefighter/paramedic workforce of a South Florida fire department located in the epicentre of a State outbreak. METHODS: A cross-sectional study design was used to estimate the point seroprevalence of SARS-CoV-2 antibodies using a rapid immunoglobulin (Ig)M-IgG combined point-of-care lateral flow immunoassay among frontline firefighters/paramedics collected over a 2-day period, 16-17 April 2020. Fire department personnel were emailed a survey link assessing COVID-19 symptoms and work exposures the day prior to the scheduled drive-through antibody testing at a designated fire station. Off-duty and on-duty firefighter/paramedic personnel drove through the fire station/training facility in their personal vehicles or on-duty engine/rescue trucks for SARS-CoV-2 antibody testing. RESULTS: Among the 203 firefighters/paramedics that make up the fire department workforce, 18 firefighters/paramedics (8.9%) tested positive for SARS-CoV-2 antibodies, of which 8 firefighters/paramedics (3.9%) were IgG positive only, 8 (3.9%) were IgM positive only and 2 (0.1%) were IgG/IgM positive. The positive predictive value (PPV) of the serological test is estimated to be 33.2% and the negative predictive value is 99.3%. The average number of COVID-19 case contacts (ie, within 6 feet of an infected person (laboratory-confirmed or probable COVID-19 patient) for ≥15 min) experienced by firefighters/paramedics was higher for those with positive serology compared with those with negative (13.3 cases vs 7.31 cases; p=0.022). None of the antibody positive firefighters/paramedics reported receipt of the annual influenza vaccine compared with firefighters/paramedics who tested negative for SARS-CoV-2 antibodies (0.0% vs 21.0%; p=0.027). CONCLUSION: Rapid SARS-CoV-2 IgM-IgG antibody testing documented early-stage and late-stage infection in a firefighter workforce providing insight to a broader medical surveillance project on return to work for firefighters/paramedics. Given the relatively low PPV of the serological test used in this study back in April 2020, caution should be used in interpreting test results.