A novel scale based on biomarkers associated with COVID-19 severity can predict the need for hospitalization and intensive care, as well as enhanced probabilities for mortality.

Prognostic scales may help to optimize the use of hospital resources, which may be of prime interest in the context of a fast spreading pandemics. Nonetheless, such tools are underdeveloped in the context of COVID-19. In the present article we asked whether accurate prognostic scales could be developed to optimize the use of hospital resources. We retrospectively studied 467 files of hospitalized patients after COVID-19. The odds ratios for 16 different biomarkers were calculated, those that were significantly associated were screened by a Pearson's correlation, and such index was used to establish the mathematical function for each marker. The scales to predict the need for hospitalization, intensive-care requirement and mortality had enhanced sensitivities (0.91 CI 0.87-0.94; 0.96 CI 0.94-0.98; 0.96 CI 0.94-0.98; all with p < 0.0001) and specificities (0.74 CI 0.62-0.83; 0.92 CI 0.87-0.96 and 0.91 CI 0.86-0.94; all with p < 0.0001). Interestingly, when a different population was assayed, these parameters did not change considerably. These results show a novel approach to establish the mathematical function of a marker in the development of highly sensitive prognostic tools, which in this case, may aid in the optimization of hospital resources. An online version of the three algorithms can be found at: http://benepachuca.no-ip.org/covid/index.php.

Adherencia Al Paquete De Medidas Abcdef Durante La Pandemia De Covid-19 ABCDEF bundle implementation in Argentina during COVID-19 pandemic

INTRODUCCIÓN: El objetivo de este estudio fue describir el conocimiento y el uso reportado del paquete de medidas ABCDEF en las unidades de cuidados intensivos (UCI) de adultos de la República Argentina durante la pandemia por SARS-CoV-2. MÉTODOS: Se realizó un estudio cualitativo a través de una encuesta nacional dirigida a profesionales de la salud. RESULTADOS: Se recibieron 396 cuestionarios completos de profesionales de 21 provincias argentinas y la Ciudad Autónoma de Buenos Aires. El 66% de los participantes contestó que conoce el paquete y lo aplica con diferentes grados de implementación. El 42,9% informó que usa al menos una herramienta validada para evaluar el dolor. Más de la mitad de los encuestados afirman realizar vacaciones de sedación y pruebas de ventilación espontánea diariamente. Las escalas de sedación fueron utilizadas por el 66,6% de los participantes en forma rutinaria. El 62% utiliza herramientas validadas para la detección de delirium. Respecto de la movilización temprana y ejercicio de los pacientes, el 91,8% de los profesionales entrevistados comunicaron que realizan rehabilitación neuromuscular en su UCI. Finalmente, sólo el 6,8% informó que su unidad estaba abierta las 24 horas para las visitas familiares. Las principales barreras a la aplicación del paquete de medidas fueron los recursos humanos y hospitalarios limitados, la resistencia al cambio, la falta de información y el aislamiento por COVID-19. CONCLUSIÓN: El 66% de los participantes contestó que conoce el paquete y lo aplica con diferentes grados de implementación.

Adherencia Al Paquete De Medidas Abcdef Durante La Pandemia De Covid-19

RESUMEN INTRODUCCIÓN: El objetivo de este estudio fue describir el conocimiento y el uso reportado del paquete de medidas ABCDEF en las unidades de cuidados intensivos (UCI) de adultos de la República Argentina durante la pandemia por SARS-CoV-2. MÉTODOS: Se realizó un estudio cualitativo a través de una encuesta nacional dirigida a profesionales de la salud. RESULTADOS: Se recibieron 396 cuestionarios completos de profesionales de 21 provincias argentinas y la Ciudad Autónoma de Buenos Aires. El 66% de los participantes contestó que conoce el paquete y lo aplica con diferentes grados de implementación. El 42,9% informó que usa al menos una herramienta validada para evaluar el dolor. Más de la mitad de los encuestados afirman realizar vacaciones de sedación y pruebas de ventilación espontánea diariamente. Las escalas de sedación fueron utilizadas por el 66,6% de los participantes en forma rutinaria. El 62% utiliza herramientas validadas para la detección de delirium. Respecto de la movilización temprana y ejercicio de los pacientes, el 91,8% de los profesionales entrevistados comunicaron que realizan rehabilitación neuromuscular en su UCI. Finalmente, sólo el 6,8% informó que su unidad estaba abierta las 24 horas para las visitas familiares. Las principales barreras a la aplicación del paquete de medidas fueron los recursos humanos y hospitalarios limitados, la resistencia al cambio, la falta de información y el aislamiento por COVID-19. CONCLUSIÓN: El 66% de los participantes contestó que conoce el paquete y lo aplica con diferentes grados de implementación. INTRODUCTION: The aim of this study was to assess the knowledge and use of the ABCDEF bundle in the intensive care units (ICU) from Argentina during COVID-19 pandemic. METHODS: A nationwide online survey was conducted on physicians, nurses and physiotherapists. RESULTS: 396 complete questionnaires were received from professionals from 21 Argentine provinces and the Autonomous City of Buenos Aires. 66% of the participants answered that they knew the bundle and applied it with different degrees of implementation. 42.9% reported using at least one validated tool to assess pain. Spontaneous awakening trials and spontaneous breathing trials are performed by the majority of the responders. Sedation scales were used by 66.6% of the participants routinely. Delirium monitoring was implemented by 62%. Regarding early mobilization and exercise of patients, 91.8% of the professionals interviewed reported that they perform neuromuscular rehabilitation in their ICU. Finally, only 6.8% reported that their unit was open 24 hours for family visits. Main barriers for bundle implementation were limited human and hospital resources, resistance to change, lack of information and isolation due to COVID-19. CONCLUSION: 66% of the participants answered that they know the package and apply it with different degrees of implementation.

Tocilizumab reduces COVID-19 mortality and pathology in a dose and timing-dependent fashion: a multi-centric study.

Life-threatening COVID-19 is associated with strong inflammation, where an IL-6-driven cytokine storm appears to be a cornerstone for enhanced pathology. Nonetheless, the specific inhibition of such pathway has shown mixed outcomes. This could be due to variations in the dose of tocilizumab used, the stage in which the drug is administered or the severity of disease presentation. Thus, we performed a retrospective multicentric study in 140 patients with moderate to critical COVID-19, 79 of which received tocilizumab in variable standard doses (< 400 mg, 400-800 mg or > 800 mg), either at the viral (1-7 days post-symptom onset), early inflammatory (8-15) or late inflammatory (16 or more) stages, and compared it with standard treated patients. Mortality, reduced respiratory support requirements and pathology markers were measured. Tocilizumab significantly reduced the respiratory support requirements (OR 2.71, CI 1.37-4.85 at 95%) and inflammatory markers (OR 4.82, CI 1.4-15.8) of all patients, but mortality was only reduced (4.1% vs 25.7%, p = 0.03) when the drug was administered at the early inflammatory stage and in doses ranging 400-800 mg in severely-ill patients. Despite the apparent inability of Tocilizumab to prevent the progression of COVID-19 into a critical presentation, severely-ill patients may be benefited by its use in the early inflammatory stage and moderate doses.

Consensus for the management of analgesia, sedation and delirium in adults with COVID-19-associated acute respiratory distress syndrome. / Consenso para el manejo de la analgesia, sedación y delirium en adultos con síndrome de distrés respiratorio agudo por COVID-19.

OBJECTIVE: To propose agile strategies for a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for patients with COVID-19-associated acute respiratory distress syndrome, considering the high risk of infection among health workers, the humanitarian treatment that we must provide to patients and the inclusion of patients' families, in a context lacking specific therapeutic strategies against the virus globally available to date and a potential lack of health resources. METHODS: A nonsystematic review of the scientific evidence in the main bibliographic databases was carried out, together with national and international clinical experience and judgment. Finally, a consensus of recommendations was made among the members of the Committee for Analgesia, Sedation and Delirium of the Sociedad Argentina de Terapia Intensiva. RESULTS: Recommendations were agreed upon, and tools were developed to ensure a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for adult patients with acute respiratory distress syndrome due to COVID-19. DISCUSSION: Given the new order generated in intensive therapies due to the advancing COVID-19 pandemic, we propose to not leave aside the usual good practices but to adapt them to the particular context generated. Our consensus is supported by scientific evidence and national and international experience and will be an attractive consultation tool in intensive therapies.

OBJETIVO: Proponer estrategias agile para este abordaje integral de la analgesia, sedación, delirium, implementación de movilidad temprana e inclusión familiar del paciente con síndrome de dificultad respiratoria aguda por COVID-19, considerando el alto riesgo de infección que existe entre los trabajadores de salud, el tratamiento humanitario que debemos brindar al paciente y su familia, en un contexto de falta estrategias terapéuticas específicas contra el virus globalmente disponibles a la fecha y una potencial falta de recursos sanitarios. METODOS: Se llevó a cabo una revision no sistemática de la evidencia científica en las principales bases de datos bibliográficos, sumada a la experiencia y juicio clínico nacional e internacional. Finalmente, se realizó un consenso de recomendaciones entre los integrantes del Comité de Analgesia, Sedación y Delirium de la Sociedad Argentina de Terapia Intensiva. RESULTADOS: Se acordaron recomendaciones y se desarrollaron herramientas para asegurar un abordaje integral de analgesia, sedación, delirium, implementación de movilidad temprana e inclusión familiar del paciente adulto con síndrome de dificultad respiratoria aguda por COVID-19. DISCUSIÓN: Ante el nuevo orden generado en las terapias intensivas por la progresión de la pandemia de COVID-19, proponemos no dejar atrás las buenas prácticas habituales, sino adaptarlas al contexto particular generado. Nuestro consenso está respaldado en la evidencia científica, la experiencia nacional e internacional, y será una herramienta de consulta atractiva en las terapias intensivas.

Both Chloroquine and Lopinavir/Ritonavir Are Ineffective for COVID-19 Treatment and Combined Worsen the Pathology: A Single-Center Experience with Severely Ill Patients.

The off-label use of antiviral and antimalarial drugs has been considered by many researchers as a fast and relatively safe alternative to provide therapeutic options to treat COVID-19, but the assessment of such drug-specific effectiveness in this regard is far from complete. Especially, the current body of knowledge about COVID-19 therapeutics needs more data regarding drug effectiveness and safety in the severely ill patients with comorbidities. In the present article, we retrospectively analyze data from 61 patients that received treatment with chloroquine, lopinavir/ritonavir, both drugs administered together, or a standard treatment with no antiviral drugs, and the study was carried in severely ill patients. We found that either drug is ineffective at treating COVID-19, as they are not able to reduce hospitalization length, mortality, C-reactive protein (CRP), lactate dehydrogenase (LDH), d-Dimer, or ferritin, or to enhance gasometric parameters, lymphocytes, total leukocytes, and neutrophil levels, whereas both drugs administered together decrease circulating lymphocytes, increase LDH and ferritin levels, and more importantly, enhance mortality. In this way, our results show that both drugs are ineffective and even potentially harmful alternatives against SARS-CoV-2.