ABSTRACT
The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.
ABSTRACT
The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.
Subject(s)
COVID-19 , Critical Illness/therapy , Humans , Intensive Care Units , Pandemics , SARS-CoV-2Subject(s)
Humans , Attention , Pathology , Communicable Diseases , Intensive Care Units , Patients , SpainSubject(s)
Communicable Diseases , Intensive Care Units , Communicable Diseases/epidemiology , Critical Care , Humans , SpainABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Foreign Bodies/diagnostic imaging , Incidental Findings , Oropharynx/diagnostic imaging , Seizures/complications , Intubation/methods , Laryngoscopy , Encephalomalacia/complications , Oropharynx/injuries , Oropharynx/surgeryABSTRACT
OBJETIVO: Evaluar cómo influye el retraso en la administración de la primera dosis de antibiótico y la inadecuación de la pauta seleccionada en la supervivencia de los pacientes en shock séptico. DISEÑO: Estudio prospectivo de cohortes observacional realizado entre septiembre de 2005 y septiembre de 2010. ÁMBITO: Pacientes hospitalizados en la UCI de un hospital de tercer nivel. PACIENTES: Trescientos cuarenta y dos pacientes con cuadro de shock séptico. INTERVENCIONES: Ninguna. Variables de interés principales: Se determinó el tiempo hasta la administración del antibiótico (diferencia entre la presentación del shock séptico y la primera dosis de antibiótico) y la adecuación del mismo (susceptibilidad in vitro de los microorganismos aislados). RESULTADOS: La mortalidad en UCI fue del 26,4% y a nivel hospitalario del 33,5%. La mediana de retraso en la administración de la primera dosis de tratamiento antibiótico fue de 1,7 h. Los pacientes fallecidos recibieron el antibiótico significativamente más tarde (1,3 ± 14,5 h frente a 5,8 ± 18,02; p = 0,001) que los supervivientes. El porcentaje de inadecuación del tratamiento antibiótico fue del 12%. Los pacientes tratados inadecuadamente presentaron cifras de mortalidad hospitalaria significativamente más altas (33,8% frente a 51,2%; p = 0,03) respecto a los que recibieron una pauta antibiótica adecuada. La coexistencia de retraso e inadecuación en el tratamiento antibiótico se asoció a una menor supervivencia de los pacientes. CONCLUSIONES: Tanto el retraso como la inadecuación del tratamiento antibiótico tienen efectos negativos sobre la supervivencia de los pacientes en shock séptico independientemente de las características de estos o de su estado de gravedad
OBJECTIVE: To assess how antibiotic administration delay and inadequacy influence survival in septic shock patients. DESIGN: A prospective, observational cohort study was carried out between September 2005 and September 2010. SCOPE: Patients admitted to the ICU of a third level hospital. PATIENTS: A total of 342 septic shock patients Interventions: None Variables of interest: The time to antibiotic administration (difference between septic shock presentation and first administered dose of antibiotic) and its adequacy (in vitro susceptibility testing of isolated pathogens) were determined. RESULTS: ICU and hospital mortality were 26.4% and 33.5%, respectively. The median delay to administration of the first antibiotic dose was 1.7 h. Deceased patients received antibiotics significantly later than survivors (1.3 ± 14.5 h vs. 5.8 ± 18.02 h; P = .001). Percentage drug inadequacy was 12%. Those patients who received inadequate antibiotics had significantly higher mortality rates (33.8% vs. 51.2%; P = .03). The coexistence of treatment delay and inadequacy was associated to lower survival rates. CONCLUSIONS: Both antibiotic administration delay and inadequacy exert deleterious effects upon the survival of septic shock patients, independently of their characteristics or severity
Subject(s)
Humans , Anti-Bacterial Agents/administration & dosage , Sepsis/drug therapy , Shock, Septic/drug therapy , Time-to-Treatment/statistics & numerical data , Early Diagnosis , Survival Analysis , Treatment Outcome , Prospective Studies , Medication Therapy Management , Microbial Sensitivity TestsABSTRACT
OBJECTIVE: To assess how antibiotic administration delay and inadequacy influence survival in septic shock patients. DESIGN: A prospective, observational cohort study was carried out between September 2005 and September 2010. SCOPE: Patients admitted to the ICU of a third level hospital. PATIENTS: A total of 342 septic shock patients INTERVENTIONS: None VARIABLES OF INTEREST: The time to antibiotic administration (difference between septic shock presentation and first administered dose of antibiotic) and its adequacy (in vitro susceptibility testing of isolated pathogens) were determined. RESULTS: ICU and hospital mortality were 26.4% and 33.5%, respectively. The median delay to administration of the first antibiotic dose was 1.7h. Deceased patients received antibiotics significantly later than survivors (1.3±14.5h vs. 5.8±18.02h; P=.001). Percentage drug inadequacy was 12%. Those patients who received inadequate antibiotics had significantly higher mortality rates (33.8% vs. 51.2%; P=.03). The coexistence of treatment delay and inadequacy was associated to lower survival rates. CONCLUSIONS: Both antibiotic administration delay and inadequacy exert deleterious effects upon the survival of septic shock patients, independently of their characteristics or severity.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Shock, Septic/drug therapy , Time-to-Treatment , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Community-Acquired Infections/drug therapy , Community-Acquired Infections/mortality , Cross Infection/drug therapy , Cross Infection/mortality , Drug Administration Schedule , Drug Resistance, Microbial , Female , Hospital Mortality , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Prospective Studies , Severity of Illness Index , Shock, Septic/mortality , Spain/epidemiology , Tertiary Care Centers/statistics & numerical dataABSTRACT
Streptococcus parauberis is known as an etiological agent of mastitis in cows and for producing streptococcosis in farmed fish, although its presence in foods has seldom been reported. In this work, two bacterial isolates were recovered from a spoiled vacuum-packaged refrigerated seafood product. Both isolates were identified by 16S rRNA gene sequencing, exhibiting 99% homology with respect to S. parauberis. Both isolates were also characterized by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Genetic analysis revealed the clonal homogeneity of the isolates and their grouping together with other S. parauberis strains in a different cluster with respect to Streptococcus uberis strains. Proteomic analysis by MALDI-TOF MS allowed for the identification of five mass peaks in the range of 2200-6000 m/z that resulted to be specific to the species S. parauberis and allowed its rapid and direct identification with respect to other pathogenic and spoilage bacteria potentially present in seafood and other food products. This study represents, to our knowledge, the first report of S. parauberis in seafood in general and in vacuum-packed food products in particular. Moreover, it provides a rapid method based on MALDI-TOF MS for the identification of S. parauberis.
Subject(s)
Food Contamination/analysis , Food Packaging/methods , Seafood/microbiology , Streptococcus/classification , Streptococcus/isolation & purification , Bacterial Typing Techniques , DNA, Bacterial/genetics , Food Microbiology/methods , Genotype , Phenotype , Proteomics , RNA, Ribosomal, 16S/genetics , Sequence Analysis, DNA , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/methods , Streptococcus/genetics , VacuumABSTRACT
Objetivo. Comparar las cinéticas y activaciones, unificar las purificaciones y determinar las secuencias de los terminales-N de los plasminógenos Ovis aries y humano. Materiales y métodos. Los plasminógenos fueron purificados por el mismo método: cromatografías de afinidad e intercambio iónico, activados con urocinasa, la secuencia de los terminales-N se realizó por el método de Edman Resultados. La afinidad de la plasmina Ovis aries por el sustrato cromogénico fue de 0.45 mM, 11.8 veces mayor que la afinidad de la plasmina humana (5.3 mM). Conclusiones. Se confirma y unifica el método de purificación de los plasminógenos del plasma, para todos los mamíferos. La alta afinidad de la plasmina Ovis aries confirma una mayor afinidad de las plasminas animales por el sustrato cromogénico, en comparación con la plasmina humana.
Subject(s)
Humans , Animals , Fibrinolysin , Fibrinolysis , KineticsABSTRACT
Objetivo: Validar la escala Risk Quantification of Early Outcome After Lung Transplantation (RQLT) en una cohorte de enfermos trasplantados de pulmón. Diseño: Prospectivamente se recogieron los parámetros incluidos en la escala RQLT. Pacientes: Se analizaron 74 enfermos trasplantados de pulmón en el Hospital Universitario Marqués de Valdecilla (Santander) entre septiembre de 2004 y marzo de 2008. Variables de interés principales: Asociación de la puntuación de la escala RQLT con la mortalidad a 30 días y la estancia en unidad de cuidados intensivos prolongada. Ajuste de la escala mediante modelo de regresión logística teniendo como variable dependiente la mortalidad a 30 días. Valoración de la eficacia diagnóstica mediante curva receiver operating characteristics, y calibración del sistema sobre la muestra mediante el test de bondad del ajuste de Hosmer y Lemeshow. Resultados: La mortalidad a 30 días en los enfermos trasplantados de pulmón es significativamente mayor conforme aumenta el valor del RQLT, y muestra una odds ratio de 2,20 (1,24-3,93) por cada punto de más en la escala. El área bajo la curva receiver operating characteristics, con respecto a la mortalidad a 30 días, fue de 0,79 (0,68-0,88); p=0,01. El test de bondad de ajuste de Hosmer y Lemeshow describió un valor p=0,58. Conclusiones: La escala RQLT es una herramienta útil como indicador de mortalidad a 30 días en los pacientes trasplantados (AU)
Objective: To validate the «Risk Quantification of Early Outcome After Lung Transplantation» (RQLT) scale in a cohort of lung transplantation patients. Design: The parameters included in the RQLT scale were recorded prospectively. Patient: A total of 74 lung transplant patients in the University Hospital Marquis of Valdecilla (Santander) were analyzed between September 2004 and March 2008. Main variables of interest: This was the association of the score on the RQLT scale with mortality at 30 days and prolonged ICU stay. The dependent variable of mortality at 30 days was adjustment of scale using the logistic regression model. Diagnostic efficacy was evaluated using the ROC curve and calibration of the system on the sample with the Hosmer and Lemeshow goodness of fit test. Results: The 30-day mortality in lung transplant patients increases significantly as the RQLT score increases, with an odds ratio (OR) of 2.20 (1.24-3.93) for each point increase on the RQLT scale. The area under the ROC curve for 30-day mortality was 0.79 (0.68-0.88; P=0.01). The Hosmer and Lemeshow goodness of fit test described a value p=0.58. Conclusions: The RQLT scale is a useful tool as an indicator of 30-day mortality in transplant patients (AU)
Subject(s)
Humans , Lung Transplantation/mortality , Risk Adjustment/methods , Prospective Studies , Postoperative Complications/epidemiology , Predictive Value of Tests , Proportional Hazards ModelsABSTRACT
OBJECTIVE: To validate the "Risk Quantification of Early Outcome After Lung Transplantation" (RQLT) scale in a cohort of lung transplantation patients. DESIGN: The parameters included in the RQLT scale were recorded prospectively. PATIENT: A total of 74 lung transplant patients in the University Hospital Marquis of Valdecilla (Santander) were analyzed between September 2004 and March 2008. MAIN VARIABLES OF INTEREST: This was the association of the score on the RQLT scale with mortality at 30 days and prolonged ICU stay. The dependent variable of mortality at 30 days was adjustment of scale using the logistic regression model. Diagnostic efficacy was evaluated using the ROC curve and calibration of the system on the sample with the Hosmer and Lemeshow goodness of fit test. RESULTS: The 30-day mortality in lung transplant patients increases significantly as the RQLT score increases, with an odds ratio (OR) of 2.20 (1.24-3.93) for each point increase on the RQLT scale. The area under the ROC curve for 30-day mortality was 0.79 (0.68-0.88; P=0.01). The Hosmer and Lemeshow goodness of fit test described a value p=0.58. CONCLUSIONS: The RQLT scale is a useful tool as an indicator of 30-day mortality in transplant patients.
Subject(s)
Lung Transplantation/mortality , Risk Assessment , Adolescent , Adult , Female , Humans , Male , Middle Aged , Prospective Studies , Time Factors , Treatment Outcome , Young AdultABSTRACT
Objetivo: Analizar la frecuencia y el espectro de las enfermedades más relevantes encontradas en las autopsias de los enfermos a los que se les realizó un trasplante pulmonar y en las autopsias de los fallecidos en el primer mes postrasplante. Valorar la concordancia de los diagnósticos pre mórtem y post mórtem, y compararlos mediante la escala de Goldman et al modificada por Battle et al. Material y método: Análisis retrospectivo y longitudinal de las historias clínicas y de los registros de autopsias de los enfermos trasplantados de pulmón en nuestro centro (Hospital Universitario Marqués de Valdecilla) desde 1997 hasta 2007 que fallecieron en el período postoperatorio temprano (primer mes postrasplante). La discordancia entre el diagnóstico clínico y el diagnóstico anatomopatológico se clasificó de acuerdo a la clasificación de Goldman et al (N Engl JMed: 1983) y Battle et al (JAMA: 1987). En la comparación de los grupos se utilizó el test de la t de Student para las variables cuantitativas y la prueba de la Chi cuadrado para las variables cualitativas. Resultados: Los 5 errores de clase I se circunscriben a enfermedades respiratorias: 2 rechazos agudos no diagnosticados, una tromboembolia pulmonar bilateral, una embolia grasa y un infarto hemorrágico del pulmón injertado. Encontramos una diferencia significativa (p=0,05) entre los días de supervivencia de los enfermos del grupo con errores de clase I (6±4,52 días) y los enfermos del grupo sin discrepancia (15,42±8,99). Conclusiones: El breve período de tiempo existente entre el trasplante y el fallecimiento del enfermo hace que se reduzca la posibilidad de llegar a un diagnóstico correcto. Este dato debe hacer extremar las posibilidades diagnósticas en las enfermedades potencialmente mortales en este período, de este modo la tasa de estudios necrópsicos en este período debería ser del 100% (AU)
Objective: To analyze the prevalence and frequency spectrum of the most relevant diseases found in the autopsies of patients who underwent a lung transplant and died in the first month after transplantation. To evaluate the consistency of the pre-and post-mortem diagnoses, comparing them with the Goldman et al. scale modified by Battle et al. Material and methods: Retrospective and longitudinal analysis, comparison of the medical records and records of autopsies of patients who received a lung transplant in our center (University Hospital Marques de Valdecilla) from 1997 to 2007, who died in the early postoperative period (first month post-transplant). The discordance between clinical and pathological diagnosis was classified according to the classification of Goldman et al. and Battle et al. The Student t test for quantitative variables and chi-square for qualitative variables were used for the comparison of the groups. Results: The five class I errors are limited to respiratory diseases: 2 undiagnosed acute rejection, 1 bilateral pulmonary thromboembolism, 1 fat embolism and 1 hemorrhagic infarction of the lung graft. We found a significant difference (p=0.05) between days of survival of patients with group Class I errors (6±4.52 days) and patients from the group with no discrepancy (15.42±8.99). Conclusion: The short time between transplant and death of the patient reduces the possibility of reaching a correct diagnosis. Because of this information, diagnostic possibilities must be maximized in life-threatening diseases during this period. Therefore, the rate of autopsy studies in this period should be 100% (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Lung Transplantation/mortality , Postoperative Complications/mortality , Acute Disease , Autopsy , Cause of Death , Graft Rejection/diagnosis , Graft Rejection/mortality , Postoperative Complications/diagnosis , Retrospective Studies , Spain/epidemiologySubject(s)
Calcitonin/blood , Cytomegalovirus Infections/blood , Cytomegalovirus Infections/diagnosis , Glycoproteins/blood , Lung Diseases/blood , Lung Diseases/diagnosis , Lung Transplantation/adverse effects , Protein Precursors/blood , Calcitonin Gene-Related Peptide , Cytomegalovirus Infections/etiology , Humans , Lung Diseases/etiology , Lung Diseases/virology , Male , Middle AgedABSTRACT
OBJECTIVE: To analyze the prevalence and frequency spectrum of the most relevant diseases found in the autopsies of patients who underwent a lung transplant and died in the first month after transplantation. To evaluate the consistency of the pre-and post-mortem diagnoses, comparing them with the Goldman et al. scale modified by Battle et al. MATERIAL AND METHODS: Retrospective and longitudinal analysis, comparison of the medical records and records of autopsies of patients who received a lung transplant in our center (University Hospital Marques de Valdecilla) from 1997 to 2007, who died in the early postoperative period (first month post-transplant). The discordance between clinical and pathological diagnosis was classified according to the classification of Goldman et al. and Battle et al. The Student t test for quantitative variables and chi-square for qualitative variables were used for the comparison of the groups. RESULTS: The five class I errors are limited to respiratory diseases: 2 undiagnosed acute rejection, 1 bilateral pulmonary thromboembolism, 1 fat embolism and 1 hemorrhagic infarction of the lung graft. We found a significant difference (p=0.05) between days of survival of patients with group Class I errors (6+/-4.52 days) and patients from the group with no discrepancy (15.42+/-8.99). CONCLUSION: The short time between transplant and death of the patient reduces the possibility of reaching a correct diagnosis. Because of this information, diagnostic possibilities must be maximized in life-threatening diseases during this period. Therefore, the rate of autopsy studies in this period should be 100%.
Subject(s)
Lung Transplantation/mortality , Postoperative Complications/mortality , Acute Disease , Aged , Autopsy , Cause of Death , Embolism, Fat/diagnosis , Embolism, Fat/mortality , Female , Graft Rejection/diagnosis , Graft Rejection/mortality , Hemorrhage/diagnosis , Hemorrhage/mortality , Humans , Infarction/diagnosis , Infarction/mortality , Male , Middle Aged , Postoperative Complications/diagnosis , Pulmonary Embolism/diagnosis , Pulmonary Embolism/mortality , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/mortality , Retrospective Studies , Shock/diagnosis , Shock/mortality , Spain/epidemiologyABSTRACT
No disponible
