Bronchoscopy-guided percutaneous tracheostomy during the COVID-19 pandemic.

BACKGROUND: Assessment of the efficacy and complications associated with performing bronchoscopy-guided percutaneous tracheostomy in COVID-19 and non-COVID-19 patients. METHODS: Prospective observational study conducted between March of 2020 and February of 2022. All adult patients who underwent elective bronchoscopy-guided percutaneous tracheostomy were included. The efficacy of the procedure was evaluated based either on the success rate in the execution or on the need for conversion to open technique. Percutaneous tracheostomy-related complications were registered during the procedure. We performed 6-month follow-up for identifying late complications. RESULTS: During the study period, 312 bronchoscopy-guided percutaneous tracheostomies were analyzed. One hundred and eighty-three were performed in COVID-19 patients and 129 among non-COVID-19 patients. Overall, 64.1% (200) of patients were male, with a median age of 66 (interquartile range 54-74), and 65% (205) presented at least 1 comorbidity. Overall, oxygen desaturation was the main complication observed (20.8% [65]), being more frequent in the COVID-19 group occurring in 27.3% (50) with a statistically significant difference versus the non-COVID-19 patients' group (11.6% [15]); P < .01). Major complications such as hypotension, arrhythmias, and pneumothorax were more frequently observed among COVID-19 patients as well but with no significant differences. Percutaneous tracheostomy could be executed quickly and satisfactorily in all the patients with no need for conversion to the open technique. Likewise, no suspension of the procedure was required in any case. During 6-month follow-up, we found an incidence of 0.96% (n = 3) late complications, 2 tracheal granulomas, and 1 ostomal infection. CONCLUSION: Bronchoscopy-guided percutaneous tracheostomy can be considered an effective and safe procedure in COVID-19 patients. Nevertheless, it is highly remarkable that in the series under study, a great number of COVID-19 patients presented oxygen desaturation during the procedure.

Evaluation of the discrimination and calibration of predictive scores of mortality in ECMO for patients with COVID-19.

BACKGROUND: The criteria for the selection of COVID-19 patients that could benefit most from ECMO organ support are yet to be defined. In this study, we evaluated the predictive performance of ECMO mortality predictive models in patients with COVID-19. We also performed a cost-benefit analysis depending on the mortality predicted probability. We conducted a retrospective cohort study in COVID-19 patients who received ECMO at two tertiary care hospitals between March 2020 to July 2021. MATERIALS AND METHODS: We evaluated the discrimination (C-statistic), calibration (Cox calibration), and accuracy of the prediction of death due to severe ARDS in V-V ECMO score (PRESERVE), the Respiratory Extracorporeal Membrane Oxygenation Survival Score (RESP) score, and the PREdiction of Survival on ECMO Therapy-Score (PRESET) score. In addition, we compared the RESP score with Plateau pressure instead of Peak pressure. RESULTS: We included a total of 36 patients, 29 (80%) of them male and with a median (IQR) APACHE of 10 (8-15). The PRESET score had the highest discrimination (AUROCs 0.81 [95%CI 0.67-0.94]) and calibration (calibration-in-the-large 0.5 [95%CI -1.4 to 0.3]; calibration slope 2.2 [95%CI 0.7/3.7]). The RESP score with Plateau pressure had higher discrimination than the conventional RESP score. The cost per QALY in the USA, adjusted to life expectancy, was higher than USD 100 000 in patients older than 45 years with a PRESET > 10. CONCLUSION: The PRESET score had the highest predictive performance and could help in the selection of patients that benefit most from this resource-demanding and highly invasive organ support.

“CARACTERISTICAS CLÍNICAS Y RESULTADOS DEL SOPORTE CON MEMBRANA DE CIRCULACIÓN EXTRACORPÓREA EN PACIENTES CON COVID-19: UN ESTUDIO DE COHORTE NACIONAL” CHARACTERISTICS AND OUTCOMES IN EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT IN COVID-19 PATIENTS: A NATIONWIDE COHORT-STUDY IN ARGENTINA

Introducción: Uno de los grandes retos durante la pandemia por la COVID-19 fue el manejo del soporte ventilatorio. La Oxigenación por Membrana Extracorpórea (ECMO) fue la principal estrategia para el manejo del síndrome de dificultad respiratoria aguda refractaria. Objetivo: El objetivo de este proyecto fue evaluar las características de los pacientes con COVID-19 que requirieron soporte con ECMO. Materiales y métodos: Estudio de cohorte retrospectivo, multicéntrico, de pacientes adultos que requirieron de (ECMO) en los centros participantes. Se registraron características clínicas y paraclínicas. Se realizó comparación entre los pacientes sobrevivientes y no sobrevivientes. Además, se analizó el tiempo transcurrido desde el inicio de los síntomas hasta la colocación de ECMO, el tiempo desde la ventilación mecánica y la canulación. Resultados: Se incluyeron 26 pacientes en el análisis. La mortalidad durante ECMO fue del 42,3% (n = 11) y la hospitalaria global fue del 65,3% (n = 17). La cohorte de pacientes no fue diferente, en términos de características sociodemográficas y predicadores de mortalidad al ingreso a UCI entre los sobrevivientes y no sobrevivientes. Se realizó ECMO móvil en 10 pacientes, mientras que 16 fueron canulados in situ en los centros participantes. La mediana de tiempo desde el inicio de los síntomas hasta ECMO fue de 14, 5 días (RIC 10, 7 - 21, 5), 11 días (RIC 9,5-15,5) en el grupo de supervivientes y 17 días (RIC 12, 5 - 27 ) en los no supervivientes. La mediana de tiempo de VMI fue de 28, 5 (RIC 13 - 38, 25) días. La presión de conducción (12 vvs 10 cmH2O;p<0.01), la complacencia (37,2 vs 21,4 ml/cmH20;p<0,01), y el poder mecánico (17,4 vs 11,3 J/min;p=0,051) del sistema respiratorio mostraron diferencias estadísticamente significativas al comparar sobrevivientes y no sobrevivientes, durante el 3er día de soporte con ECMO. Conclusiones: En nuestra cohorte, la mortalidad tras ECMO y a los 30 días de estancia hospitalaria fue del 42,3% similar a la data recogida por la Extracorporeal life support organisation (ELSO) COVID-19. En este estudio se proporcionó información sobre pacientes que requirieron ECMO durante la primera ola de COVID-19 en Argentina.

“CARACTERISTICAS CLÍNICAS Y RESULTADOS DEL SOPORTE CON MEMBRANA DE CIRCULACIÓN EXTRACORPÓREA EN PACIENTES CON COVID-19: UN ESTUDIO DE COHORTE NACIONAL”

Resumen Introducción: Uno de los grandes retos durante la pandemia por la COVID-19 fue el manejo del soporte ventilatorio. La Oxigenación por Membrana Extracorpórea (ECMO) fue la principal estrategia para el manejo del síndrome de dificultad respiratoria aguda refractaria. Objetivo: El objetivo de este proyecto fue evaluar las características de los pacientes con COVID-19 que requirieron soporte con ECMO. Materiales y métodos: Estudio de cohorte retrospectivo, multicéntrico, de pacientes adultos que requirieron de (ECMO) en los centros participantes. Se registraron características clínicas y paraclínicas. Se realizó comparación entre los pacientes sobrevivientes y no sobrevivientes. Además, se analizó el tiempo transcurrido desde el inicio de los síntomas hasta la colocación de ECMO, el tiempo desde la ventilación mecánica y la canulación. Resultados: Se incluyeron 26 pacientes en el análisis. La mortalidad durante ECMO fue del 42,3% (n = 11) y la hospitalaria global fue del 65,3% (n = 17). La cohorte de pacientes no fue diferente, en términos de características sociodemográficas y predicadores de mortalidad al ingreso a UCI entre los sobrevivientes y no sobrevivientes. Se realizó ECMO móvil en 10 pacientes, mientras que 16 fueron canulados in situ en los centros participantes. La mediana de tiempo desde el inicio de los síntomas hasta ECMO fue de 14, 5 días (RIC 10, 7 - 21, 5), 11 días (RIC 9,5-15,5) en el grupo de supervivientes y 17 días (RIC 12, 5 - 27 ) en los no supervivientes. La mediana de tiempo de VMI fue de 28, 5 (RIC 13 - 38, 25) días. La presión de conducción (12 vvs 10 cmH2O;p<0.01), la complacencia (37,2 vs 21,4 ml/cmH20;p<0,01), y el poder mecánico (17,4 vs 11,3 J/min;p=0,051) del sistema respiratorio mostraron diferencias estadísticamente significativas al comparar sobrevivientes y no sobrevivientes, durante el 3er día de soporte con ECMO. Conclusiones: En nuestra cohorte, la mortalidad tras ECMO y a los 30 días de estancia hospitalaria fue del 42,3% similar a la data recogida por la Extracorporeal life support organisation (ELSO) COVID-19. En este estudio se proporcionó información sobre pacientes que requirieron ECMO durante la primera ola de COVID-19 en Argentina. Introduction: One of the great challenges during the COVID-19 pandemic was the management of ventilatory support. Extracorporeal membrane oxygenation (ECMO) was the main strategy for the management of refractory acute respiratory distress syndrome. Objective: Retrospective, multicentre cohort study of adult patients who required Extracorporeal Membrane Oxygenation (ECMO) in participating centres. Clinical and paraclinical characteristics were recorded. A comparison was made between surviving and non-surviving patients. In addition, time from symptom onset to ECMO placement, time from mechanical ventilation, and cannulation were analysed. Material and methods: Retrospective, multicentre cohort study of adult patients who required Extracorporeal Membrane Oxygenation (ECMO) in participating centres. Clinical and paraclinical characteristics were recorded. A comparison was made between surviving and non-surviving patients. In addition, time from symptom onset to ECMO placement, time from mechanical ventilation, and cannulation were analysed. Results: Twenty-six patients were included in the analysis. Mortality during ECMO was 42.3% (n = 11) and overall hospital mortality was 65.3% (n = 17). The patient cohort did not differ in terms of sociodemographic characteristics and predictors of mortality at ICU admission between survivors and non-survivors. Mobile ECMO was performed in 10 patients, while 16 were cannulated in situ at the participating centres. The median time from symptom onset to ECMO was 14.5 days (IQR 10.7-21.5), 11 days (IQR 9.5-15.5) in the survivor group, and 17 days (IQR 12, 5-27) in non-survivors. The median IMV time was 28.5 (IQR 13 - 38.25) days. Driving pressure (12 vs 10 cmH2O;p<.01), compliance (37.2 vs 21.4 ml/cmH20;p<.01), and mechanical power ( 17.4 vs 11.3 J/min;p=.051) o the respiratory system showed statistically significant differences when comparing survivors and non-survivors, during the 3rd day of ECMO support. Conclusion: In our cohort, mortality after ECMO and after 30 days of hospital stay, was 42.3%, similar to that stated on the extracorporeal life support organisation (ELSO) COVID-19 registry dashboard. Information about patients with COVID-19 who required ECMO during the first wave in Argentina was provided in this analysis.

[Extracorporeal membrane oxygenation in COVID-19] / Membrana de circulación extracorpórea en enfermedad por coronavirus (COVID-19).

Introduction: The role of the use of Extracorporeal Membrane Oxygenation (ECMO) in patients with coronavirus disease (COVID-19) is under discussion. Whereas in patients with Acute Respiratory Distress Syndrome (ARDS) the ECMO is a usual rescue measure used to optimize the oxygenation as a bridge to pulmonary rehabilitation, in patients that have refractory hypoxemic respiratory failure with recovery potential, the use of ECMO could also be beneficial. Objective: The purpose of this work is to report the first case of COVID-19 that required ECMO in Argentina, with a good response. Methodology: We describe the first case of COVID-19 that required ECMO in Argentina, in a patient without comorbidities, with good clinical results. Results: The use of ECMO in the reported case provided a substantial benefit in oxygenation, acting as a bridge to lung recovery, without presenting complications associated with its application. Conclusion: In critically ill patients with refractory hypoxemia, but with high recovery potential, ECMO support can be considered as a rescue measure.

Introducción: El uso de membrana de circulación extracorpórea (ECMO) en pacientes con síndrome de distrés respiratorio agudo (SDRA) es una medida de rescate que busca optimizar la oxigenación como puente a la rehabilitación pulmonar. Su rol en la enfermedad por coronavirus (COVID-19) no está definido, sin embargo, en pacientes con insuficiencia respiratoria hipoxémica refractaria, y con potencial de recuperación, su uso podría resultar beneficioso. Objetivo: El propósito de este trabajo es informar el primer caso de COVID-19 que requirió ECMO en Argentina, con buena respuesta. Metodología: Se describe el primer caso de COVID-19 que requirió ECMO en Argentina, en un paciente sin comorbilidades, con buen resultado clínico. Resultados: El uso de ECMO en el caso reportado aportó un sustancial beneficio en la oxigenación actuando como puente a la recuperación pulmonar, sin presentar complicaciones asociadas a su aplicación. Conclusión: Conclusión: En pacientes críticamente enfermos con hipoxemia refractaria, pero con potencial de recuperación, el soporte con ECMO puede ser considerado como una medida de rescate.

COVID-19 en la terapia intensiva: Análisis de la experiencia durante el primer mes de la pandemia

Se trata de un análisis de características clínicas, hallazgos radiológicos, variables de laboratorio y mecánica respiratoria en pacientes con enfermedad por coronavirus 2019 (COVID-19) durante el primer mes de la pandemia en Buenos Aires. Es un estudio descriptivo de casos, de un solo centro. Se incluyeron todos los casos confirmados de COVID-19 internados en la unidad de terapia intensiva de adultos (UTIA) del Hospital Italiano de Buenos Aires. Todos los casos se confirmaron por reacción en cadena de la polimerasa con transcriptasa inversa. Un total de 7 pacientes con COVID-19 fueron atendidos en la UTIA. La mediana de edad fue de 71 años (intervalos intercuartílicos: 52-75), 4 hombres y 3 mujeres. Las manifestaciones clínicas más comunes fueron fiebre (7), tos (5), astenia (4) y disnea (3). Entre los hallazgos radiológicos, cinco de ellos mostraron opacidades intersticiales y un paciente consolidación pulmonar bilateral. Cinco requirieron ventilación mecánica invasiva y múltiples sesiones de decúbito prono. Ninguno murió durante la hospitalización, aunque aún tres permanecen en UCI. This is an analysis of clinical characteristics, images findings, laboratory variables and respiratory mechanics in patients with coronavirus disease 2019 (COVID-19) during the first month of the pandemic outbreak in Buenos Aires. In this descriptive case study of a single-centre, we included all confirmed cases of COVID-19 hospitalized in intensive care unit (ICU). All cases were confirmed by reverse transcription polymerase chain reaction. A total of 7 patients with confirmed COVID-19 were referred to out ICU. The median age was 71 years (interquartile range 52-75), including 4 men and 3 women. Patients most common clinical manifestations were fever (7), cough (5), asthenia (4) and shortness of breath (3). Among the radiological findings, five of them showed interstitial opacities and one patient had bilateral pulmonary consolidation. Five required invasive mechanical ventilation and multiple prone sessions. None died during hospitalization, although three still remain in the ICU. According to imaging examination, 71.4% showed interstitial opacities and one patient bilateral consolidation. Five patients required invasive mechanical ventilation and multiple prone sessions. None of them died during hospitalization, although three still remain in the ICU.

COVID-19 en la terapia intensiva: Análisis de la experiencia durante el primer mes de la pandemia

This is an analysis of clinical characteristics, images findings, laboratory variables and respiratory mechanics in patients with coronavirus disease 2019 (COVID-19) during the first month of the pandemic outbreak in Buenos Aires. In this descriptive case study of a single-centre, we included all confirmed cases of COVID-19 hospitalized in intensive care unit (ICU). All cases were confirmed by reverse transcription polymerase chain reaction. A total of 7 patients with confirmed COVID-19 were referred to out ICU. The median age was 71 years (interquartile range 52-75), including 4 men and 3 women. Patients most common clinical manifestations were fever (7), cough (5), asthenia (4) and shortness of breath (3). Among the radiological findings, five of them showed interstitial opacities and one patient had bilateral pulmonary consolidation. Five required invasive mechanical ventilation and multiple prone sessions. None died during hospitalization, although three still remain in the ICU. According to imaging examination, 71.4% showed interstitial opacities and one patient bilateral consolidation. Five patients required invasive mechanical ventilation and multiple prone sessions. None of them died during hospitalization, although three still remain in the ICU. radiológicos, variables de laboratorio y mecánica respiratoria en pacientes con enfermedad por coronavirus 2019 (COVID-19) durante el primer mes de la pandemia en Buenos Aires. Es un estudio descriptivo de casos, de un solo centro. Se incluyeron todos los casos confirmados de COVID-19 internados en la unidad de terapia intensiva de adultos (UTIA) del Hospital Italiano de Buenos Aires. Todos los casos se confirmaron por reacción en cadena de la polimerasa con transcriptasa inversa. Un total de 7 pacientes con COVID-19 fueron atendidos en la UTIA. La mediana de edad fue de 71 años (intervalos intercuartílicos: 52-75), 4 hombres y 3 mujeres. Las manifestaciones clínicas más comunes fueron fiebre (7), tos (5), astenia (4) y disnea (3). Entre los hallazgos radiológicos, cinco de ellos mostraron opacidades intersticiales y un paciente consolidación pulmonar bilateral. Cinco requirieron ventilación mecánica invasiva y múltiples sesiones de decúbito prono. Ninguno murió durante la hospitalización, aunque aún tres permanecen en UCI.

COVID-19 en la terapia intensiva: Análisis de la experiencia durante el primer mes de la pandemia

This is an analysis of clinical characteristics, images findings, laboratory variables and respiratory mechanics in patients with coronavirus disease 2019 (COVID-19) during the first month of the pandemic outbreak in Buenos Aires. In this descriptive case study of a single-centre, we included all confirmed cases of COVID-19 hospitalized in intensive care unit (ICU). All cases were confirmed by reverse transcription polymerase chain reaction. A total of 7 patients with confirmed COVID-19 were referred to out ICU. The median age was 71 years (interquartile range 52-75), including 4 men and 3 women. Patients most common clinical manifestations were fever (7), cough (5), asthenia (4) and shortness of breath (3). Among the radiological findings, five of them showed interstitial opacities and one patient had bilateral pulmonary consolidation. Five required invasive mechanical ventilation and multiple prone sessions. None died during hospitalization, although three still remain in the ICU. According to imaging examination, 71.4% showed interstitial opacities and one patient bilateral consolidation. Five patients required invasive mechanical ventilation and multiple prone sessions. None of them died during hospitalization, although three still remain in the ICU.

[COVID-19 in the intensive care unit. Analysis of the experience during the first month of pandemic]

This is an analysis of clinical characteristics, images findings, laboratory variables and respiratory mechanics in patients with coronavirus disease 2019 (COVID-19) during the first month of the pandemic outbreak in Buenos Aires. In this descriptive case study of a single-centre, we included all confirmed cases of COVID-19 hospitalized in intensive care unit (ICU). All cases were confirmed by reverse transcription polymerase chain reaction. A total of 7 patients with confirmed COVID-19 were referred to out ICU. The median age was 71 years (interquartile range 52-75), including 4 men and 3 women. Patients most common clinical manifestations were fever (7), cough (5), asthenia (4) and shortness of breath (3). Among the radiological findings, five of them showed interstitial opacities and one patient had bilateral pulmonary consolidation. Five required invasive mechanical ventilation and multiple prone sessions. None died during hospitalization, although three still remain in the ICU. According to imaging examination, 71.4% showed interstitial opacities and one patient bilateral consolidation. Five patients required invasive mechanical ventilation and multiple prone sessions. None of them died during hospitalization, although three still remain in the ICU.