Healthcare Resource Utilization and Direct Medical Costs Associated with Post COVID-19 Condition in Colombia, 2020-2021

Objectives: This study aimed to estimate the direct medical costs of patients with post COVID-19 condition in a Colombian insurance company with more than 2.5 million affiliates. Method(s): We conducted a bottom-up cost-of-illness study of adults with persistent symptoms after at least three months of hospital discharge due to COVID-19. We surveyed patients that were hospitalized between March 2020 and August 2021. We asked about healthcare resource utilization (HCRU), which included laboratories and images, medications, consults, rehospitalizations, and others, associated with post COVID-19 condition. The answers were verified using the company's outpatient and inpatient service authorization records. Costs were estimated from the third payer perspective and expressed in American dollars using an exchange rate of 1USD$=3,743COP. Result(s): We included 202 participants, 51.5% were male, mean age of 55.6 years old, 49% had a comorbidity (41.9% hypertension), and 46 patients (22.8%) required an intensive care unit. A total of 159 (78.7%) patients reported at least one symptom after discharge. Of these, 132 (65.3%) persisted with at least one symptom during the telephone survey. Seventy-five (47.2%) of the 159 patients with persistent symptoms reported HCRU. Of these, 93.3% consulted a physician (mean consultations: 2.1 SD 1.1;mean consultations with specialists: 2.4 SD 2.0), and 9.3% were re-hospitalized. The average direct medical costs of post COVID-19 condition were US$824 (95%CI 195-1,454). Costs in outpatient were US$373 (95%CI 158-588), and in inpatient, US$3,285 (95%CI -167-6,738). Conclusion(s): It is crucial to follow up and identify patients discharged from the hospital who persist with symptoms after three months since we observed a greater HCRU, including prolonged recovery therapiesCopyright © 2023

Prone position in spontaneous breathing: A further lesson from COVID-19

During the pandemic, various strategies were implemented to avoid intubation and invasive mechanical ventilation. The prone position has clear beneficial effects in improving oxygenation by various mechanisms while generating haemodynamic changes that can optimize the function of the right ventricle. The evidence of prone position in patients with acute respiratory distress syndrome on invasive mechanical ventilation is overwhelming and makes it necessary to consider it in the first 24 hours in patients with PaO2 / FiO2 ≤ 150 mmHg. The prone position in spontaneous breathing can improve oxygenation in patients with respiratory failure and if implemented through a protocol that includes adequate selection of patients it can avoid intubation of patients in respiratory failure. This review summarizes the historical antecedents, the physiological bases of the prone position in the awake patient, as well as the evidence that evaluates its application in the patient with COVID-19 while summarizing the protocol and the experience of a centre that uses this strategy as a proposal for multicentre studies. © 2022 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

COVID-19: Faustus & Mephistopheles

The SARS-CoV-2 pandemic has been an unprecedented event in recent history, a public health crisis, which has tested humanity as a species. The actions of the scientific professionals have stood out during the pandemic, whose joint efforts identified and began the careful study of its pathophysiology and the means to combat it. During the initial phases, and in the absence of scientific evidence, procedures and recommendations were developed based on plausibility and the desire to offer a therapeutic option and compassionate management. The subsequent course, with multicentre research works, demonstrated the limitation of many previous recommendations, ruling out therapeutic options and confirming the essential actions for the management of this crisis, leaving clear recommendations for future outbreaks, epidemics or pandemics: trained healthcare professional, suitable resources, development of protocols based on evidence-based medicine and government strategies in the health services, to change the evolution of the pandemic. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Relationship between tracheostomization and survival in mechanically ventilated patients with respiratory symptoms suggestive of COVID-19 in Cartagena, Colombia

Introduction. COVID-19 has generated one of the highest disease burdens in the 21st century. To date, there are more than 280 million estimated cases globally. Many aspects of this condition are still unknown, which causes controversy in how to approach critically ill patients. Tracheostomy is an intervention that has been shown to be beneficial in the management of respiratory disease, however, there is an evidence gap on the effectiveness and safety of this intervention in critically ill COVID-19 patients. Consequently, the aim of this study was to relate the time elapsed from the onset of the clinical condition, during intubation and days of mechanical ventilation, to performing the tracheostomy, with the survival of patients with symptoms suggestive of COVID-19. Methodology. Retrospective cross-sectional study, conducted between March 2020 and February 2021 in two fourth-level hospitals in the city of Cartagena, Colombia. It included patients older than 18 years who were admitted to the intensive care unit due to the need for invasive mechanical ventilation for viral respiratory symptoms. Those with incomplete medical records and hospitalized for other respiratory causes were excluded. Results. A total of 122 patients were included in the study with a median age of 63 years (IQR 22;20-89), with 66.4% (n = 81) being male. No significant correlation was found between the number of days from the onset of the clinical condition to the performance of tracheostomy (p = 0.12), nor between the time elapsed from endotracheal intubation to the performance of tracheostomy, with respect to survival (p = 0.53). However, there was a relationship between the number of days of invasive mechanical ventilation and the final outcome (p = 0.02). Discussion. Although it has been reported that tracheostomy is one of the riskiest procedures in the management of patients with severe respiratory symptoms, during the COVID-19 pandemic the literature describes that this intervention increases survival, decreases the time required for mechanical ventilation and reduces the length of stay in the intensive care unit. The number of complications is very low in comparison to the benefit it confers, and it was observed that the local behavior is very similar to that reported in the literature. Conclusions. Time from symptom onset or endotracheal intubation to the performance of tracheostomy does not correlate with survival in patients with respiratory symptomatology suggestive of COVID-19 who are mechanically ventilated and tracheostomized.