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1.
PLoS One ; 17(3): e0265529, 2022.
Article in English | MEDLINE | ID: covidwho-1910562

ABSTRACT

PURPOSE: The COVID-19 pandemic has spread worldwide, and almost 396 million people have been infected around the globe. Latin American countries have been deeply affected, and there is a lack of data in this regard. This study aims to identify the clinical characteristics, in-hospital outcomes, and factors associated with ICU admission due to COVID-19. Furthermore, to describe the functional status of patients at hospital discharge after the acute episode of COVID-19. MATERIAL AND METHODS: This was a prospective, multicenter, multinational observational cohort study of subjects admitted to 22 hospitals within Latin America. Data were collected prospectively. Descriptive statistics were used to characterize patients, and multivariate regression was carried out to identify factors associated with severe COVID-19. RESULTS: A total of 3008 patients were included in the study. A total of 64.3% of patients had severe COVID-19 and were admitted to the ICU. Patients admitted to the ICU had a higher mean (SD) 4C score (10 [3] vs. 7 [3)], p<0.001). The risk factors independently associated with progression to ICU admission were age, shortness of breath, and obesity. In-hospital mortality was 24.1%, whereas the ICU mortality rate was 35.1%. Most patients had equal self-care ability at discharge 43.8%; however, ICU patients had worse self-care ability at hospital discharge (25.7% [497/1934] vs. 3.7% [40/1074], p<0.001). CONCLUSIONS: This study confirms that patients with SARS CoV-2 in the Latin American population had a lower mortality rate than previously reported. Systemic complications are frequent in patients admitted to the ICU due to COVID-19, as previously described in high-income countries.


Subject(s)
COVID-19 , COVID-19/epidemiology , Cohort Studies , Hospital Mortality , Hospitals , Humans , Intensive Care Units , Latin America/epidemiology , Pandemics , Prospective Studies
3.
Br J Pharmacol ; 179(14): 3831-3838, 2022 07.
Article in English | MEDLINE | ID: covidwho-1764897

ABSTRACT

Seriously ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and hospitalized in intensive care units (ICUs) are commonly given a combination of drugs, a process known as multi-drug treatment. After extracting data on drug-drug interactions with clinical relevance from available online platforms, we hypothesize that an overall interaction map can be generated for all drugs administered. Furthermore, by combining this approach with simulations of cellular biochemical pathways, we may be able to explain the general clinical outcome. Finally, we postulate that by applying this strategy retrospectively to a cohort of patients hospitalized in ICU, a prediction of the timing of developing acute kidney injury (AKI) could be made. Whether or not this approach can be extended to other diseases is uncertain. Still, we believe it represents a valuable pharmacological insight to help improve clinical outcomes for severely ill patients.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/drug therapy , COVID-19/drug therapy , Drug Interactions , Humans , Intensive Care Units , Retrospective Studies , SARS-CoV-2
4.
J Crit Care ; 69: 154014, 2022 06.
Article in English | MEDLINE | ID: covidwho-1701879

ABSTRACT

PURPOSE: Dexamethasone is the only drug that has consistently reduced mortality in patients with COVID-19, especially in patients needing oxygen or invasive mechanical ventilation. However, there is a growing concern about the relation of dexamethasone with the unprecedented rates of ICU-acquired respiratory tract infections (ICU-RTI) observed in patients with severe COVID-19. METHODS: This was a multicenter, prospective cohort study; conducted in ten countries in Latin America and Europe. We included patients older than 18 with confirmed SARS-CoV-2 requiring ICU admission. A multivariate logistic regression and propensity score matching (PSM) analysis was conducted to determine the relation between dexamethasone treatment and ICU-RTI. RESULTS: A total of 3777 patients were included. 2065 (54.7%) were treated with dexamethasone within the first 24 h of admission. After performing the PSM, patients treated with dexamethasone showed significantly higher proportions of VAP (282/1652 [17.1%] Vs. 218/1652 [13.2%], p = 0.014). Also, dexamethasone treatment was identified as an adjusted risk factor of ICU-RTI in the multivariate logistic regression model (OR 1.64; 95%CI: 1.37-1.97; p < 0.001). CONCLUSION: Patients treated with dexamethasone for severe COVID-19 had a higher risk of developing ICU-acquired respiratory tract infections after adjusting for days of invasive mechanical ventilation and ICU length of stay, suggesting a cautious use of this treatment.


Subject(s)
COVID-19 , COVID-19/drug therapy , Dexamethasone/adverse effects , Humans , Intensive Care Units , Prospective Studies , Risk Factors , SARS-CoV-2
5.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-323299

ABSTRACT

Background: SARS-CoV-2 infection presents in many cases with pneumonia and respiratory failure. It is not clear whether the time of intubation and connection to mechanical ventilation (MV) in this condition is associated with an increase in mortality or represents the natural course of the disease.We conducted an observational, prospective, single-center study to describe the characteristics and outcomes of acute respiratory distress syndrome (ARDS) patients with confirmed COVID-19 and treated with invasive MV to determine whether the time-to-intubation following hospital admission is associated with worse outcomes. Methods: We prospectively included consecutive patients with SARS-CoV-2 infection and moderate to severe ARDS, admitted to an intensive care unit (ICU) and connected to MV between March 17 and July 31, 2020. We examined their general characteristics, ventilatory management, and clinical outcomes. Time of intubation was defined as the time from hospital admission to endotracheal intubation and was categorized as early (<72 hours) or late (≥72 hours). Mann-Whitney U, Kruskal Wallis, chi-square, and Fisher’s exact, were used when appropriate. Uni and multivariate analyses between main outcome and explanatory variables were performed. Results: : A total of 183 consecutive patients were included, 28% (51/183) were female, and their median age was 62 years [54-70]. One hundred (55%) patients were subjected to early and 83 (45%) to late intubation. Patients intubated after 72 hours were older and presented more comorbidities. Mortality was higher in the group of patients with late intubation (41% versus 21%;p= 0.002), a PaO 2 /FiO 2 ratio <100 mmHg at admission (p= 0.029), and that were older than 60 years (p= 0.008). Conclusions: In acute COVID-19 patients with moderate to severe ARDS, intubation after 72 hours following hospital admission, age >60 years-old and a PaO 2 /FiO 2 ratio <100 at admission may appear to be associated with increased ICU mortality. Further studies are required to confirm our findings and establish the best timing for intubation in COVID-19 patients admitted to the ICU with respiratory failure.

6.
Rev Med Chil ; 149(4): 641-647, 2021 Apr.
Article in Spanish | MEDLINE | ID: covidwho-1395078

ABSTRACT

SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.


Subject(s)
Acute Kidney Injury , COVID-19 , Rhabdomyolysis , Acute Kidney Injury/diagnosis , Acute Kidney Injury/virology , Adult , COVID-19/complications , Female , Humans , Renal Replacement Therapy , Rhabdomyolysis/diagnosis , Rhabdomyolysis/virology
7.
J Crit Care ; 65: 164-169, 2021 10.
Article in English | MEDLINE | ID: covidwho-1272520

ABSTRACT

PURPOSE: To determine whether time-to-intubation was associated with higher ICU mortality in patients with COVID-19 on mechanical ventilation due to respiratory insufficiency. MATERIALS AND METHODS: We conducted an observational, prospective, single-center study of patients with confirmed SARS-CoV-2 infection hospitalized with moderate to severe ARDS, connected to mechanical ventilation in the ICU between March 17 and July 31, 2020. We examined their general and clinical characteristics. Time-to-intubation was the time from hospital admission to endotracheal intubation. RESULTS: We included 183 consecutive patients; 28% were female, and median age was 62 years old. Eighty-eight patients (48%) were intubated before 48 h (early) and ninety-five (52%) after 48 h (late). Patients intubated early had similar admission PaO2/FiO2 ratio (123 vs 99; p = 0.179) but were younger (59 vs 64; p = 0.013) and had higher body mass index (30 vs 28; p = 0.006) compared to patients intubated late. Mortality was higher in patients intubated late (18% versus 43%), with admission PaO2/FiO2 ratio < 100 mmHg (OR 5.2; p = 0.011), of older age (OR 1.1; p = 0.001), and with previous use of ACE inhibitors (OR 4.8; p = 0.026). CONCLUSIONS: In COVID-19 patients, late intubation, Pafi <100, older age, and previous ACE inhibitors use were associated with increased ICU mortality.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Aged , Female , Humans , Intubation, Intratracheal , Middle Aged , Prospective Studies , Respiration, Artificial , Respiratory Distress Syndrome/therapy , SARS-CoV-2
8.
Simul Healthc ; 16(6): 401-406, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1207361

ABSTRACT

SUMMARY STATEMENT: The sudden rise of critically ill patients secondary to the SARS-CoV-2 pandemic has triggered a surge in healthcare response. This project's goal was to provide essential cognitive and technical skills to healthcare professionals returning to the workforce or reassigned to critical care clinical duties during the COVID-19 pandemic. The plan included the implementation of 4 distance-based simulation training programs, with asynchronous personalized feedback. The courses allowed the acquisition of skills for the complete critical care patient management chain: use of personal protection equipment, use of a high-flow nasal cannula, endotracheal intubation, and prone positioning. Participants logged into the platform, reviewed material, practiced while recording the session, and uploaded the video through the training platform. The expert tutor remotely delivered asynchronous feedback. Participants trained remotely until achieving course approval. Remote-based simulation seems a feasible and attractive alternative to provide adequate educational solutions, especially for remote and rural areas.


Subject(s)
COVID-19 , Simulation Training , Delivery of Health Care , Humans , Pandemics , SARS-CoV-2
9.
Rev. méd. Chile ; 148(5): 674-683, mayo 2020. tab, graf
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-1006910

ABSTRACT

Our country is suffering the effects of the ongoing pandemic of coronavirus disease (COVID-19). Because the vulnerability of healthcare systems, especially the intensive care areas they can rapidly be overloaded. That challenge the ICUs simultaneously on multiple fronts making urgent to increase the number of beds, without lowering the standards of care. The purpose of this article is to discuss some aspects of the national situation and to provide recommendations on the organizational management of intensive care units such as isolation protocols, surge in ICU bed capacity, ensure adequate supplies, protect and train healthcare workers maintaining quality clinical management.


Subject(s)
Humans , Coronavirus Infections/epidemiology , Pandemics , Intensive Care Units/organization & administration , Intensive Care Units/supply & distribution , Surge Capacity
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