SARS-CoV-2 in Spanish Intensive Care Units: Early experience with 15-day survival in Vitoria.

PURPOSE: Community transmission of SARS-CoV-2 was detected in Spain in February 2020, with 216% intensive care unit (ICU) capacity expanded in Vitoria by March 18th, 2020. METHODS: We identified patients from the two public hospitals in Vitoria who were admitted to ICU with confirmed infection by SARS-CoV-2. Data reported here were available in April 6th, 2020. Mortality was assessed in those who completed 15-days of ICU stay. RESULTS: We identified 48 patients (27 males) with confirmed SARS-CoV-2. Median [interquartile range (IQR)] age of patients was 63 [51-75] years. Symptoms began a median of 7 [5-12] days before ICU admission. The most common comorbidities identified were obesity (48%), arterial hypertension (44%) and chronic lung disease (37%). All patients were admitted by hypoxemic respiratory failure and none received non-invasive mechanical ventilation. Forty-five (94%) underwent intubation, 3 (6%) high flow nasal therapy (HFNT), 1 (2%) extracorporeal membrane oxygenation (ECMO) and 22 (46%) required prone position. After 15 days, 14/45 (31%) intubated patients died (13% within one week), 10/45 (22%) were extubated, and 21/45 (47%) underwent mechanical ventilation. Six patients had documented super-infection. Procalcitonin plasma above 0.5µg/L was associated with 16% vs. 19% (p=0.78) risk of death after 7 days. CONCLUSION: This early experience with SARS-CoV-2 in Spain suggests that a strategy of right oxygenation avoiding non-invasive mechanical ventilation was life-saving. Seven-day mortality in SARS-CoV-2 requiring intubation was lower than 15%, with 80% of patients still requiring mechanical ventilation. After 15 days of ICU admission, half of patients remained intubated, whereas one third died.

[Acute renal failure in lung transplantation: incidence, correlation with subsequent kidney disease, and prognostic value]. / Insuficiencia renal aguda y trasplante pulmonar: incidencia, correlación con patología renal posterior y valor pronóstico.

OBJECTIVE: We studied the incidence of postoperative renal failure and its association with mortality in lung transplant patients in our hospital classified according to the severity of renal failure in the immediate postoperative period, and at 30 days, 6 months, and 1 year after transplantation. MATERIAL AND METHODS: For the period March 1997 through January 2006, 144 lung transplants were performed in our hospital. Six patients were lost to follow-up. Patients were assigned to 1 of the 5 Chronic Kidney Disease (CKD) classes according to the glomerular filtration rate on admission to the intensive care unit, and at 1 month, 6 months, and 12 months. Descriptive statistics were calculated for the sample. The relationship between the CKD classification and mortality was analyzed by calculating the odds ratio with a logistic regression model. The correlation between CKD classification on admission and at 1 month, 6 months, and 1 year after transplantation was analyzed using the Spearman correlation coefficient. RESULTS: Of the 144 patients analyzed, 52 patients were in CKD class 1, 63 in class 2, 19 in class 3, 2 in class 4, and 2 in class 5, according to the glomerular filtration rate. The correlation between mortality at 1 month and CKD classification on admission was not statistically significant (odds ratio, 1.11; 95% confidence interval, 0.42-3.11; P=.82) among patients with normal kidney function (CKD class 1) and those with some degree of renal failure (CKD classes 2-5). There was no correlation between CKD classification on admission and CKD classification at 1 month, 6 months, and 1 year although a significant positive correlation was found between CKD classification at 1 month and CKD classes at 6 months and 1 year. CONCLUSIONS: We did not find any association between 1-month mortality and the degree of renal failure in the immediate postoperative period in lung transplant patients. There was a positive correlation between the degree of kidney failure at 1 month and that observed 6 and 12 months after the procedure.

Insuficiencia renal aguda y trasplante pulmonar: incidencia, correlación con patología renal posterior y valor pronóstico / Acute renal failure in lung transplantation: incidence, correlation with subsequent kidney disease, and prognostic value

OBJETIVO: Presentamos un análisis de incidencia de disfunción renal y mortalidad de los pacientes a quienes se practicó un trasplante pulmonar en nuestro centro según el grado de insuficiencia renal que desarrollaron en el postoperatorio inmediato, a los 30 días, a los 6 meses y al año de realizado el trasplante. MATERIAL Y MÉTODOS: Durante el período definido (de marzo de 1997 a enero de 2006) se realizaron 144 trasplantes de pulmón en nuestro centro. Hubo 6 pérdidas en el seguimiento de los pacientes. Se clasificó a los pacientes en 5 grupos dependiendo del valor del filtrado glomerular en el momento de ingreso en la unidad de cuidados intensivos, al mes, a los 6 y 12 meses de realizado el trasplante, según la clasificación Chronic Kidney Disease (CKD). Se realizó un análisis estadístico descriptivo de la muestra. Se estudió la relación entre el CKD y la mortalidad, medida como odds ratios, mediante regresión logística. Se realizó un análisis de correlación entre el CKD al ingresar, al mes, a los 6 meses y al año de realizado el trasplante mediante el coeficiente de correlación de Spearman. RESULTADOS: De los 144 pacientes analizados, se clasificó, atendiendo al filtrado glomerular, a 52 en el grupo I, a 63 en el grupo II, a 19 en el III, a 2 en el IV y a otros 2 en el V. La asociación entre mortalidad al mes y CKD al ingresar no evidenció significación estadística (odds ratio = 1,11; intervalo de confianza del 95%, 0,42-3,11; p = 0,82) entre los pacientes con función renal normal (CKD 1) y aquéllos con algún grado de insuficiencia renal (CKD 2-5). No se encontró correlación entre el CKD al ingreso y el CKD al mes, a los 6 meses y al año. Sin embargo, se halló una correlación positiva (significativa) entre el CKD al mes y el CKD a los 6 meses y al año. CONCLUSIONES: No encontramos diferencias de asociación con la mortalidad al mes atendiendo al grado de insuficiencia renal en el postoperatorio inmediato de los pacientes con trasplante de pulmón. Existe una correlación positiva entre el grado de insuficiencia renal al mes y el observado a los 6 y 12 meses de realizado el trasplante

OBJECTIVE: We studied the incidence of postoperative renal failure and its association with mortality in lung transplant patients in our hospital classified according to the severity of renal failure in the immediate postoperative period, and at 30 days, 6 months, and 1 year after transplantation. MATERIAL AND METHODS: For the period March 1997 through January 2006, 144 lung transplants were performed in our hospital. Six patients were lost to follow-up. Patients were assigned to 1 of the 5 Chronic Kidney Disease (CKD) classes according to the glomerular filtration rate on admission to the intensive care unit, and at 1 month, 6 months, and 12 months. Descriptive statistics were calculated for the sample. The relationship between the CKD classification and mortality was analyzed by calculating the odds ratio with a logistic regression model. The correlation between CKD classification on admission and at 1 month, 6 months, and 1 year after transplantation was analyzed using the Spearman correlation coefficient. RESULTS: Of the 144 patients analyzed, 52 patients were in CKD class 1, 63 in class 2, 19 in class 3, 2 in class 4, and 2 in class 5, according to the glomerular filtration rate. The correlation between mortality at 1 month and CKD classification on admission was not statistically significant (odds ratio, 1.11; 95% confidence interval, 0.42-3.11; P=.82) among patients with normal kidney function (CKD class 1) and those with some degree of renal failure (CKD classes 2-5). There was no correlation between CKD classification on admission and CKD classification at 1 month, 6 months, and 1 year although a significant positive correlation was found between CKD classification at 1 month and CKD classes at 6 months and 1 year. CONCLUSIONS: We did not find any association between 1-month mortality and the degree of renal failure in the immediate postoperative period in lung transplant patients. There was a positive correlation between the degree of kidney failure at 1 month and that observed 6 and 12 months after the procedure