ABSTRACT
Lors de la pandémie COVID-19 de 2020, des mesures de distanciation sociale ont été instaurées du jour au lendemain. Les familles de patients ont accompagné leurs proches aux urgences des hôpitaux et ne les ont plus revus pendant des semaines du fait du confinement. En réanimation, les soignants ont compris et souhaité la restriction des visites, afin de limiter la diffusion de l'épidémie, inquiets qu'ils étaient de voir leur capacité d'accueil débordée. Ils ont néanmoins rapidement cherché à pallier cet empêchement en créant des relations différentes avec les proches et en utilisant de nouveaux modes de communication pour permettre aux patients et à leur proches de rester en contact. D'autres modes de communication tels que les courriers, messages et contact téléphoniques ou e-visites ont été mis en place. Ces modes de communications ont cependant posé certains problèmes comme le risque de diffusion d'images de patients sédatés, sur les réseaux sociaux notamment. Par ailleurs, les familles, prises dans un environnement médiatique délivrant des informations contradictoires et anxiogènes, n'ont pas toujours compris les restrictions d'accès et ont fait peser une pression psychologique sur les équipes soignantes. Alors que la recommandation préalable à l'épidémie était de faciliter l'accès des familles en réanimation, ces nouvelles conditions ont nécessité une adaptation dont les leçons devront être tirées pour mieux faire face à des évènements de même nature dans le futur.
ABSTRACT
Social distancing steps have been set during the 2020 COVID-19 pandemic. Patients' families brought their relatives to the emergency department and did not see them again for weeks due to lockdown of the whole population. Caregivers understood and approved the restriction of visits in ICU, in order to limit epidemic spreading, worried by overwhelming of their capacity would be overwhelmed and that they would not be able to admit all the patients requiring intensive care. However, they quickly sought to compensate by creating different relationships with relatives, using new ways of communication enabling patients and their relatives to keep in touch. Letters, messages services, phone calls and e-visits were set up. This brought new risks such as patient' images diffusion on social networks. In addition, relatives, caught with contradictory stressful information provided by medias, did not always understand that they could not have a direct access to patients and put psychological pressure on healthcare providers. Considering that previous recommendations support an unrestricted access of relatives to the ICU patients, caregivers have had to deal with new rules and have got experience that will be useful in case of the occurrence of comparable events.
ABSTRACT
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to 5% to 16% hospitalization in intensive care units (ICU) and is associated with 23% to 75% of kidney impairments, including acute kidney injury (AKI). The current work aims to precisely characterize the renal impairment associated to SARS-CoV-2 in ICU patients. Forty-two patients consecutively admitted to the ICU of a French university hospital who tested positive for SARS-CoV-2 between 25 March 2020, and 29 April 2020, were included and classified in categories according to their renal function. Complete renal profiles and evolution during ICU stay were fully characterized in 34 patients. Univariate analyses were performed to determine risk factors associated with AKI. In a second step, we conducted a logistic regression model with inverse probability of treatment weighting (IPTW) analyses to assess major comorbidities as predictors of AKI. Thirty-two patients (94.1%) met diagnostic criteria for intrinsic renal injury with a mixed pattern of tubular and glomerular injuries within the first week of ICU admission, which lasted upon discharge. During their ICU stay, 24 patients (57.1%) presented AKI which was associated with increased mortality (p = 0.007), hemodynamic failure (p = 0.022), and more altered clearance at hospital discharge (p = 0.001). AKI occurrence was associated with lower pH (p = 0.024), higher PaCO2 (CO2 partial pressure in the arterial blood) (p = 0.027), PEEP (positive end-expiratory pressure) (p = 0.027), procalcitonin (p = 0.015), and CRP (C-reactive protein) (p = 0.045) on ICU admission. AKI was found to be independently associated with chronic kidney disease (adjusted OR (odd ratio) 5.97 (2.1-19.69), p = 0.00149). Critical SARS-CoV-2 infection is associated with persistent intrinsic renal injury and AKI, which is a risk factor of mortality. Mechanical ventilation settings seem to be a critical factor of kidney impairment.
ABSTRACT
Social distancing steps have been set during the 2020 COVID-19 pandemic. Patients’ families brought their relatives to the emergency department and did not see them again for weeks due to lockdown of the whole population. Caregivers understood and approved the restriction of visits in ICU, in order to limit epidemic spreading, worried by overwhelming of their capacity would be overwhelmed and that they would not be able to admit all the patients requiring intensive care. However, they quickly sought to compensate by creating different relationships with relatives, using new ways of communication enabling patients and their relatives to keep in touch. Letters, messages services, phone calls and e-visits were set up. This brought new risks such as patient’ images diffusion on social networks. In addition, relatives, caught with contradictory stressful information provided by medias, did not always understand that they could not have a direct access to patients and put psychological pressure on healthcare providers. Considering that previous recommendations support an unrestricted access of relatives to the ICU patients, caregivers have had to deal with new rules and have got experience that will be useful in case of the occurrence of comparable events.