Characteristics and Outcomes of Patients with COVID-19 in Intensive Care in the First Year of the Pandemic: A Colombian Observational Study

Background: The COVID-19 pandemic has had a devastating impact on the world, mainly during the first year of the pandemic, where strategies such as vaccination were not available. Information on the outcomes of patients admitted to the intensive care unit (ICU) in Colombia is scarce. Our main objective was to characterize critically ill patients with COVID-19 in our region. Methods: We conducted a single-centre retrospective observational study in which we included patients with COVID-19 confirmed by RT-PCR who were admitted to the adult ICU between March 18, 2020 and March 18, 2021, in Quindío, Colombia. We identify the clinical and laboratory characteristics at admission, the support used, and their relationship with mortality during ICU hospitalization. Results: Three hundred and fifty-nine patients with a confirmed diagnosis of COVID-19 were admitted, 64% men, mean age was 62.7 years (SD±12.3), body mass index 27.9Kg/m2 (±5.8), SOFA score was 7.6 (±3.12), Pa/FiO2 96.2 (±62.3), and lung compliance 30.5 ml/cmH2O (±18.4). Mortality was 60%. The variables with the highest mortality association were obesity OR: 2.38 (95% CI:1.39 – 4.09, p: <.001), Glasgow coma scale at admission <12 : 17.5, (5.21 – 58.8, p: <.001), PaFiO2 <100: 5.63, (3.38 – 9.39, p: <.001), static lung compliance less than 50 ml / cmH2O: 3.54, (3.38 – 9.39, p: <.001), SOFA score >5: 3.75 (2.19– 6.42, p: <0.001), ferritin > 1000: 2.58, (1.66 – 4.02, p: <.001), C-reactive protein > 5: 2.52 (1.42 – 4.26, p: <.001), and LDH > 280: 2.71 (1.55 – 4.74, p: <.001). Patients who required PEEP > 10cmH2O: 2.34 (1.48 – 3.70, p: <.001), FiO2 > 60%: 4.01, (2.46 – 6.53, p: <.001), and ventilation in the prone position. Conclusion: Mortality in the first year of the pandemic in our region was high, mainly associated with obesity, inflammation, altered mental status upon admission, and increased lung elastance. Resumen Contexto: La pandemia de COVID-19 ha tenido un impacto devastador en el mundo, principalmente durante el primer año de la pandemia, donde no se disponía de estrategias como la vacunación. La información sobre los resultados de los pacientes ingresados ​​en la unidad de cuidados intensivos (UCI) en Colombia es escasa. Nuestro principal objetivo fue caracterizar a los pacientes críticos con COVID-19 en nuestra región. Métodos: Realizamos un estudio observacional retrospectivo unicéntrico donde incluimos pacientes confirmados con RT-PCR para COVID-19 que ingresaron a la UCI de adultos entre el 18 de marzo de 2020 y el 18 de marzo de 2021, en Quindío, Colombia. Identificamos las características clínicas y de laboratorio al ingreso, los soportes utilizados y su relación con la mortalidad durante la hospitalización en UCI. Resultados: Ingresaron 359 pacientes con diagnóstico confirmado de COVID-19, 64% hombres, edad 62,7 años (DE±12,3), índice de masa corporal 27,9Kg/m2 (±5,8), SOFA score 7,6 (±3,12), Pa /FiO2 96,2 (±62,3) y distensibilidad pulmonar 30,5 ml/cmH2O (±18,4). La mortalidad fue del 60%. Las variables con mayor asociación a mortalidad fueron la obesidad OR: 2,38 (IC 95%: 1,39 – 4,09, P: <0,001), escala de coma de Glasgow al ingreso <12: 17,5, (5,21 – 58,8, P: <0,001), PaFiO2 <100 : 5,63, (3,38 – 9,39, P: <0,001), distensibilidad pulmonar estática inferior a 50 ml/cmH2O: 3,54, (3,38 – 9,39, P: <0,001), puntuación SOFA >5: 3,75 (2,19– 6,42, P: <0,001), ferritina > 1000: 2,58, (1,66 – 4,02, P: <0,001), proteína C reactiva > 5: 2,52 (1,42 – 4,26, P: <0,001) y LDH > 280: 2,71 (1,55 – 4,74), P: <0,001). Pacientes que requirieron PEEP > 10cmH2O: 2,34 (1,48 – 3,70, P: <0,001), FiO2 > 60%: 4,01, (2,46 – 6,53, P: <0,001) y ventilación en decúbito prono. Conclusión: La mortalidad en el primer año de la pandemia en nuestra región fue alta, asociada principalmente a obesidad, inflamación, alteración del estado mental al ingreso y aumento de la elastancia pulmonar.

Vía aérea difícil en UCI de adultos en el Quindío: un estudio transversal

Resumen Introducción El riesgo de complicaciones y muerte relacionada con la vía aérea difícil (VAD) en el paciente crítico es mayor que en escenarios controlados como el quirófano. La estadística de VAD en cuidados intensivos en Colombia es escasa, así como los datos de intervención y recursos disponibles en las unidades. El objetivo principal fue determinar la prevalencia y características de VAD anatómica y fisiológica. Métodos Se realizó un estudio observacional, de corte transversal, multicéntrico en unidades de cuidados intensivos de adultos (UCI) del Quindío. Se enviaron enlaces a dos formularios de Google® a los intensivistas coordinadores, un formulario general y uno específico relacionado con factores de VAD anatómica (Mallampati, apnea obstructiva, columna cervical rígida, obesidad, aspecto externo, Cormack-Lehane>2, etc.) y fisiológica (trastorno de oxigenación, estado de colapso, anemia, etc.). Resultados Participaron 4 unidades, con 62 camas (83,9% de las camas existentes en el departamento);se encontraron 56 pacientes hospitalizados, 38 pacientes (67,8%) estuvieron intubados. El 29% de los pacientes presentaron algún tipo de VAD. El 100% de los enfermos clasificados como VAD tuvo parámetros de VAD fisiológica y el 27,3% VAD anatómica: 18,2% Cormack-Lehane (CL)>2, y 9,1% estenosis subglótica. La obesidad fue el mejor predictor de CL>2. LR+: 4,5, LR−: 0,001. Conclusiones La VAD fisiológica es altamente prevalente en UCI de adultos, lo que representa un reto para el intensivista y un riesgo alto de complicaciones para los pacientes. En este estudio la obesidad fue el principal factor de predicción de VAD anatómica en el paciente críticamente enfermo. Las unidades de cuidados intensivos deben contar con recursos suficientes y personal entrenado en el manejo de la VAD. Introduction The risk of complications and death related to difficult airway (DA) in critically ill patients is higher than in controlled settings such as the operating room. Statistics on DA in intensive care in Colombia are scarce, as are the intervention data and resources available in the units. The main objective was to determine the prevalence and characteristics of anatomical and physiological difficult airway. Methods An observational, cross-sectional, multicentre study was conducted in adult Intensive Care Units (ICU) in Quindío. Links to two Google® forms were sent to the Coordinating Intensivists, one general and one specific related to DA anatomical factors (Mallampati, obstructive apnoea, stiff cervical spine, obesity, external appearance, Cormack-Lehane> 2, etc.) and physiological (oxygenation disorder, state of collapse, anaemia, etc.). Results Four units participated, with 62 beds (83.9% of the beds in the department);56 hospitalized patients were found, 38 patients (67.8%) were intubated. Of the patients, 29% had some type of difficult airway. Of the patients with difficult airway, 100% had physiological DA parameters and 27.3% anatomical difficult airway: 18.2% Cormack-Lehane (CL)>2, and 9.1% subglottic stenosis. Obesity was the best predictor of CL>2. LR+: 4.5, LR−: .001. Conclusions Physiological DA is highly prevalent in the adult ICU, which represents a challenge for the intensivist, and a high risk of complications for patients. In this study, obesity was the main predictor of anatomical DA in critically ill patients. Intensive care units must have sufficient resources and personnel trained in the management of difficult airway.

Online-synchronized clinical simulation: an efficient teaching-learning option for the COVID-19 pandemic time and: beyond.

Face-to-face clinical simulation has been a powerful methodology for teaching, learning, and research, and has positioned itself in health science education. However, due to the COVID-19 pandemic, social distancing has forced universities to abandon simulation centers and make use of alternatives that allow the continuation of educational programs safely for students and teachers through virtual environments such as distance simulation. In Latin America, before the pandemic, the use of non-presential simulation was very limited and anecdotal. This article has three main objectives: to establish the efficacy of online-synchronized clinical simulation in the learning and performance of medical students on the management of patients with COVID-19 in simulation centers of three Latin American countries, to determine the quality of the online debriefing from the students' perspective, and to deepen the understanding of how learning is generated with this methodology.

Correction to: COVID-19: Biosafety in the Intensive Care Unit.

[This corrects the article DOI: 10.1007/s40475-020-00208-z.].

COVID-19: Biosafety in the Intensive Care Unit.

PURPOSE OF REVIEW: COVID-19 is a new, highly transmissible disease to which healthcare workers (HCWs) are exposed, especially in the intensive care unit (ICU). Information related to protection mechanisms is heterogeneous, and the infected HCWs' number is increasing. This review intends to summarize the current knowledge and practices to protect ICU personnel during the patient management process in the context of the current pandemic. RECENT FINDINGS: The transmission mechanisms of SARS-CoV-2 are mainly respiratory droplets, aerosols, and contact. The virus can last for a few hours suspended in the air and be viable on surfaces for several days. Some procedures carried out in the ICU can generate aerosols. The shortage of respirators, such as the N95, has generated an increase in the demand for other protective equipment in critical care settings. SUMMARY: The probability of transmission depends on the characteristics of the pathogen, the availability of quality personal protective equipment, and the human factors associated with the performance of health workers. It is necessary to have knowledge of the virus and availability of the best possible personal protection equipment, develop skills for handling equipment, and develop non-technical skills during all intensive care process; this can be achieved through structured training.

Cognitive load and performance of health care professionals in donning and doffing PPE before and after a simulation-based educational intervention and its implications during the COVID-19 pandemic for biosafety.

INTRODUCTION: The Personal Protective Equipment (PPE) is essential to avoid the COVID-19 spread to health care workers. Its use can be difficult, posing a high risk of contamination, mainly during doffing, then with the risk of becoming infected. METHODS: We conducted a prospective before-and-after design that used clinical simulation as a research methodology in a clinical simulation center of Colombia. A simulation-based educational intervention with two cases related to COVID-19 was proposed in the emergency room and the intensive care unit. We conducted A workshop for donning and doffing of personal protective equipment (PPE) and a debriefing after the first case. RESULTS: In the pre-test, 100% of participants failed donning and doffing PPE, 98.4% were contaminated, only one-person did not contaminate out of. The mean cognitive load was high (7.43±0.9 points). In the post-test, 100% were successful in donning the PPE and 94.8% in doffing; only 9.8% were contaminated. The mean of the cognitive load was low (4.1±1.4 points), and the performance was high (7.9±1.1). Of the total, 73.8% of participants reported overload in the doffing. The most difficulties were in gown/overall, and N95 mask removal. DISCUSSION: The PPE donning and doffing is critical and may be changed significantly by active training. In responding to the current COVID-19 pandemic in 2020, activities of training in donning and doffing PPE would provide a means of training personnel, reducing the cognitive load and maybe the risk of contamination and infection of health care workers.