Refractory hypercapnia in a patient with malignant obesity-hypoventilation syndrome and COVID-19. A case report and management proposal

Obesity-hypoventilation syndrome associated with COVID-19 rapidly leads to severe acute respiratory failure with the need for invasive mechanical ventilation, becoming a therapeutic challenge for intensive care personnel due to the absence of ventilatory strategies. The following is the case of a 51-year-old male patient with a history of Pickwickian syndrome who presented with severe SARS-CoV-2 pneumonia, which progressed early to severe acute respiratory distress syndrome requiring invasive mechanical ventilatory support with positive pressure, and the need for vasoactive support, also presenting with a malignant phenotype obesity-hypoventilation syndrome. Based on the above, we make a clinical management proposal based on the current scientific literature on obesity-hypoventilation syndrome and severe pneumonia secondary to SARS-CoV-2. Despite the high mortality related to COVID-19 and the difficulty presented during invasive mechanical ventilation, the patient's outcome was favourable. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Factors related to bacterial pneumonia in patients with COVID-19 in an intensive care unit in Barranquilla, Colombia

Objective: To determine the factors related to bacterial pneumonia in patients with COVID-19 in an intensive care unit in Barranquilla, Colombia. Design: Nested, single-center case-control study, conducted between March and August 2020. Patients: Patients over 18 years of age, a hospital stay greater than 72 h, with invasive mechanical ventilation support admitted to the intensive care unit. Interventions: None. Measurements: Clinical variables were grouped for both cases and controls. Means and standard deviation were calculated in quantitative variables and proportions in categorical variables. Fisher's exact test was used to evaluate the differences between proportions, and the Mann-Whitney U test was used for differences in means. Variables with statistically significant differences were run in an explanatory model based on binary logistic regression. Results: The frequency of bacterial pneumonia was 10.07%, finding a high consumption of empirical antibiotic therapy. A statistical association was found between the time of dexamethasone use (OR 1.520;95% CI 1.131-2.042) with the development of bacterial pneumonia. The rest of the variables were not statistically significant after adjusting the model with logistic regression. Conclusion: Low rates of bacterial pneumonia were found, with Klebsiella pneumoniae prevailing as the most frequent bacterium. Overuse of dexamethasone in intensive care unit COVID-19 patients could increase the risk of bacterial pneumonia. For this reason, it must be evaluated in greater depth to explain causality and effect. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

SARS-CoV-2 pneumonia associated with Pneumocystis jirovecii coinfection in immunocompromised patients: a case report and literature review

Pneumocystis jirovecii pneumonia is an opportunistic infection that commonly occurs in patients with severe acquired immunodeficiencies. During the current health contingency, the presence of infection and co-infection by P. jirovecii in critically ill patients is apparently increasing altogether with the risk of fatal outcomes. The following is the case of a man with severe SARS-CoV-2 pneumonia, HIV immunosuppression and P. jirovecii coinfection who developed acute respiratory distress syndrome requiring invasive mechanical positive pressure ventilatory support. Despite the in-hospital management received, antibiotic therapy, and ventilatory support, the patient presented hemodynamic deterioration with instability, dying on day 20 of hospitalization. Subsequently, a bibliographic review of the current literature is carried out, discussing aspects such as epidemiology, pathophysiology, timely diagnosis, and treatment between the relationship of P. jirovecii and SARS-CoV-2 in critically ill patients. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Primary spontaneous pneumothorax not associated with invasive mechanical ventilation in patients with COVID-19 pneumonia. Presentation of 2 cases

As the current SARS-CoV-2 virus pandemic progresses, scientific evidence of complications in the evolution of the disease is increasing. Pneumothorax is a common complication of acute respiratory distress syndrome, which significantly increases the mortality of patients. However, in COVID-19 to date there are few articles that report this complication. Below are two cases of patients with pneumonia complicated by COVID-19 with primary spontaneous pneumothorax without prior hospitalization. The first patient, a 63-year-old woman with hypertension, hypothyroidism and tobacco addiction, developed pneumonia complicated by COVID-19 with pneumothorax, recovered progressively and was discharged 20 days after admission to the unit. The second patient, a 44-year-old man with obesity, developed pneumonia complicated by COVID-19 with pneumothorax, which during his stay progressed to septic shock and he died. Timely identification of possible complications due to COVID-19 is crucial for reducing mortality, and therefore they should be suspected in all types of patients with SARS-CoV-2 pneumonia on their first admission to health centres. © 2021

Responsible Research and Innovation Associated With Risk Communication and Public Engagement on Health Emergency Preparedness at the Local Level

Responsible Research and Innovation (RRI) associated with public health emergency preparedness (PHEP) and response pose major challenges to the scientific community and civil society because a multistakeholder and interdisciplinary methodology is needed to foster public engagement. In 2017, within “Action plan on Science in Society related issues in Epidemics and Total pandemics”, twenty-three initiatives in eleven cities—Athens, Brussels, Bucharest, Dublin, Geneva, Haifa, Lyon, Milan, Oslo, Rome, and Sofia—represented effective opportunities for Mobilization and Mutual Learning on RRI issues in the matter of PHEP with different community-level groups. These experiences show that to effectively address a discourse on RRI-related issues in PHEP it is necessary to engage the local population and stakeholders, which is challenging because of needed competencies and resources. Under coronavirus disease 2019 (COVID-19) pandemic, we are proven that such a diversified multistakeholder engagement on RRI related to PHEP locally needs further elaboration and practical development. Copyright © 2022 Possenti, De Mei, Kurchatova, Green, Drager, Villa, d'Onofrio, Saadatian-Elahi, Moore, Brattekas, Karnaki, Beresniak, Popa and Greco.

Mechatronic Design and Robust Control of an Artificial Ventilator in Response to the COVID-19 Pandemic

The crisis resulting from the COVID-19 pandemic has generated an adverse situation in which thousands of people dies due to the lack of artificial ventilation devices. In this sense, this work presents a proposal for the robust mechatronic design and control of a low-cost non-invasive ventilator, for which rapid prototyping manufacture strategies such as 3D printing and product design are used. In order to guarantee the reliability of the system operation, in this work, a robust control scheme based on super-twisting sliding modes is proposed, which guarantees the trajectory tracking control corresponding to the breathing profiles required by the patients. Experimental and simulation results validate the effectiveness of the proposed prototype design. Nevertheless, the prototype is waiting to be tested and approved for use in health assistance.