Impacto de la Pandemia por SARS-CoV-2 en el Perfil de Ingreso y Egreso de una Unidad de Cuidados Intensivos según Escala de Categorización Kinesiológica / Impact of the SARS-CoV-2 Pandemic on the Admission and Discharge Profile of an Intensive Care Unit according to the Kinesiological Categorization Scale

Introducción. La pandemia por coronavirus trajo consigo una modificación y una reestructuración de las unidades de cuidados intensivos(UCI). Además se produjo un cambio en el perfil de pacientes que ingresan y egresan en estas unidades. Objetivo. Valorar el impacto de la presente pandemia en el perfil de ingreso y egreso de pacientes en UCI según escala de categorización kinesiológica de la unidad. Métodos. Estudio observacional descriptivo que incluyó 50 sujetos de UCI que contaran con escala de categorización kinesiológica (ECK) al ingreso y egreso de la unidad. La ECK contemplo 3 item de evaluación: Función ventilatoria, manejod e secreciones, grado de cooperación y nivel de actividad. El registro de la ECK se planteó de manera retrospectiva para los periodos Julio-agosto 2018 (prepandemia) y Julio - Agosto 2020 (pandemia). Se utilizó estadística descriptiva, utilizando porcentaje y/o promedio para cada variable según corresponda. Resultados. Al observar la función ventilatoria, el requerimiento de soporte ventilatorio varió de un 64% a un 16% pre ­ pandemia, y de un 100% a un 88% durante la pandemia. Respecto al manejo de secreciones, se observó que los sujetos con tos efectiva varío desde un 60% a un 22% en el periodo pandemia Por otra parte, los pacientes que requirieron succión traqueal de manera constante en pandemia, se mantuvo. entre un 88% a un 92% durante la estadía en UCI. En relación al grado de cooperación, un 78% de los pacientes con COVID-19 ingresó con una dependencia severa o nula cooperación, y al momento del egreso de UCI un 54% se mantenía en la misma condición. Respecto al nivel de actividad, durante el periodo pandemia, un 100% de los ingresos y un 96% de los egresos presentó dependencia total. Conclusión. La pandemia causada por SARS-CoV-2 ha influido directamente en el perfil de ingreso y egreso de pacientes UCI, lo cual enfrentó al personal de salud a un aumento considerable en la carga de trabajo.

Introduction. The coronavirus led to a modification and a building of new intensive care units (ICU). In addition, there was a change in the profile of patients admitted and discharged from these units. Objetive. Assess the impact of this pandemy on the admission and discharge profile of patients in the ICU according to a kinesiological categorization scale of the unit. Methods. Descriptive observational study that included 50 ICU subjects who had a Kinesiology Categorization Scale (ECK) at admission and discharge from the unit. The ECK contemplates 3 evaluation elements: ventilatory function, management and secretions, degree of cooperation and level of activity. The ECK registry was considered retrospectively for the periods July-August 2018 (pre-pandemy) and July-August 2020 (pandemy). Descriptive statistics was developed, using percentage and/or average for each variable as appropriate. Results: Looking at ventilatory function, the requirement for ventilatory support varied from 64% to 16% pre-pandemic, and from 100% to 88% during the pandemic. Regarding the management of secretions, it was shown that the subjects with effective cough varied from 60% to 22% in the pandemic period. On the other hand, the patients who required tracheal suctioning constantly in the pandemic were maintained. between 88% and 92% during the ICU stay. Regarding the degree of cooperation, 78% of the patients with COVID-19 were admitted with a severe dependency or no cooperation, and at the time of discharge from the ICU, 54% were pressed in the same condition. Regarding the level of activity, during the pandemic period, 100% of income and 96% of expenses presented total dependency. Conclusion. The pandemy caused by SARS-CoV-2 has directly influenced the admission and discharge profile of ICU patients, which confronted health personnel with a considerable increase in workload.

Safety and Efficacy of a MEURI Program for the Use of High Dose Ivermectin in COVID-19 Patients.

Background: In the absence of antiviral alternatives, interventions under research for COVID-19 might be offered following guidelines from WHO for monitored emergency use of unregistered and experimental interventions (MEURI). Ivermectin is among several drugs explored for its role against SARS-CoV-2, with a well-known safety profile but conflicting data regarding clinical utility for COVID-19. The aim of this report is to inform on the results of a MEURI Program of high-dose ivermectin in COVID-19 carried out by the Ministry of Health of the Province of La Pampa, Argentina. Methods: COVID-19 subjects, within 5 days of symptoms onset were invited to participate in the program, which consisted in the administration of ivermectin 0.6 mg/kg/day for 5 days plus standard of care. Active pharmacosurveillance was performed for 21 days, and hepatic laboratory assessments were performed in a subset of patients. Frequency of Intensive Care Unit (ICU) admission and COVID-19-related mortality of subjects in the ivermectin intention to treat group were compared with that observed in inhabitants of the same province during the same period not participating in the program. Results: From 21,232 subjects with COVID-19, 3,266 were offered and agreed to participate in the ivermectin program and 17,966 did not and were considered as controls. A total of 567 participants reported 819 adverse events (AEs); 3.13% discontinued ivermectin due to adverse events. ICU admission was significantly lower in the ivermectin group compared to controls among participants ≥40 year-old (1.2 vs. 2.0%, odds ratio 0.608; p = 0.024). Similarly, mortality was lower in the ivermectin group in the full group analysis (1.5 vs. 2.1%, odds ratio 0.720; p = 0.029), as well as in subjects ≥ 40 year- old (2.7 vs. 4.1%, odds ratio 0.655; p = 0.005). Conclusions: This report highlights the safety and possible efficacy of high dose ivermectin as a potentially useful intervention deserving public health-based consideration for COVID-19 patients.

Severity and Outcomes in Association with Known Exposures and Susceptibilities among Afro-Caribbean Patients with Hospital-acquired Acute Kidney Injury / Severidad y resultados clínicos asociados con exposiciones y susceptibilidades conocidas entre pacientes afrocaribeños con lesión renal aguda adquirida en el hospital

ABSTRACT Objective: To investigate the severity and outcomes associated with known exposures and susceptibilities in Afro-Caribbean patients with hospital-acquired acute kidney injury (HA-AKI). Methods: This was a single centre hospital-based cohort study. Acute kidney injury was diagnosed and staged by the criteria of Kidney Disease: Improving Global Outcomes. Results: Among 107 Afro-Caribbean patients who were newly diagnosed with HA-AKI within a one-year period, hypertension (51.4%) and diabetes mellitus (34.6%) were the most common co-existing susceptibilities. None of the selected susceptibilities led to a higher demand for renal replacement therapy (RRT) or a higher risk of 90-day mortality, except in a small subgroup with underlying malignancy in which 12 out of 28 (42.9%) demised at ≤ 90 days after AKI (odds ratio (OR): 2.36; 95% confidence interval (CI): 1.05, 5.87; p = 0.05). The risk for the requirement for dialysis was nine-fold higher if the patient had oliguria/anuria (OR: 9.06; 95% CI: 3.06, 29.04; p ≤ 0.001). Oliguria/anuria was also found to be a major risk factor for 90-day mortality (OR: 4.46; 95% CI: 1.83, 10.84; p < 0.001). Sepsis was the most frequent exposure (66%) with a high chronic kidney disease conversion rate of 25.7% (OR: 1.296; 95% CI: 0.70, 2.38). Patients with HA-AKI and sepsis had a three-fold higher mortality among hospitalized patients with AKI (OR: 2.87; 95% CI: 1.05, 7.87; p = 0.03). Both complicated non-cardiac major surgeries and cardiac surgeries were significantly associated with requirement for RRT (57.1% versus 56.3% and OR: 5.01; 95% CI: 1.04, 24.1; p = 0.02 versus OR: 6.02; 95% CI: 1.95, 18.57; p ≤ 0.001, respectively). The requirement for RRT in patients with HA-AKI was also significantly associated with admission to the intensive care unit (ICU) (42.1%; OR: 4.6; 95% CI: 1.54, 13.77; p = 0.004), systemic hypotension (OR: 5.86; 95% CI: 2.07, 16.62; p = 0.001) and haemorrhagic shock (OR: 5.78; 95% CI: 1.63, 20.51; p = 0.003). The former two groups carried a significantly higher 90-day mortality rate (OR: 6.22; 95% CI: 2.15, 17.99; p ≤ 0.001 versus OR: 5.54; 95% CI: 2.14, 14.33; p ≤ 0.001, respectively). Conclusion: We observed that certain exposures (such as sepsis, oliguria, systemic hypotension, haemorrhagic shock, ICU admission and complicated major surgeries) had a significant influence on severity and adverse renal outcomes and this was independent of susceptibilities.

RESUMEN Objetivo: Investigar la severidad y los resultados clínicos asociados con exposiciones y susceptibilidades conocidas en pacientes afrocaribeños con lesión renal aguda adquirida en el hospital (LRA-AH). Métodos: Se trató de un estudio de cohorte basado en un solo centro hospitalario. La lesión renal aguda fue diagnosticada y estadificada según los criterios de la enfermedad renal: mejorar los resultados globales. Resultados: Entre los 107 pacientes afrocaribeños que fueron diagnosticados recientemente con LRA-AH en el período de un año, la hipertensión (51.4%) y la diabetes mellitus (34.6%) fueron las susceptibilidades coexistentes más comunes. Ninguna de las susceptibilidades seleccionadas condujo a una mayor demanda de terapia de reemplazo renal (TRR) o a un mayor riesgo de mortalidad de 90 días, excepto en un pequeño subgrupo con malignidad subyacente en el que 12 de 28 (42.9%) fallecen a ≤ 90 días después de LRA (odds ratio (OR): 2.36; 95% intervalo de confianza (CI): 1.05, 5.87; p = 0.05). El riesgo de la necesidad de diálisis fue nueve veces mayor si el paciente tenía oliguria/anuria (OR: 9.06; 95% IC: 3.06, 29.04; p ≤ 0.001). También se descubrió que la oliguria/anuria era un factor de riesgo importante para la mortalidad en 90 días (OR: 4.46; 95% IC: 1.83, 10.84; p < 0.001). Sepsis fue la exposición más frecuente (66%) con una tasa de conversión de la enfermedad renal crónica alta de 25.7% (OR: 1.296; 95% IC: 0.70, 2.38). Los pacientes con LRA-AH y sepsis tuvieron una mortalidad tres veces mayor entre los pacientes hospitalizados con LRA (OR: 2.87; 95% IC: 1.05, 7.87; p = 0.03). Tanto las cirugías principales no cardíacas complicadas como las cirugías cardíacas se asociaron significativamente con la necesidad de TRR (57.1% versus 56.3% y OR: 5.01; 95% IC: 1.04, 24.1; p = 0.02 versus OR: 6.02; 95% IC: 1.95, 18.57; p ≤ 0.001, respectivamente). La necesidad de TRR en pacientes con LRA-AH también se asoció significativamente con la admisión a la unidad de cuidados intensivos (UCI) (42.1%; OR: 4.6; 95% IC: 1.54, 13.77; p = 0.004), hipotensión sistémica (OR: 5.86; 95% IC: 2.07, 16.62; p = 0.001) y choque hemorrágico (OR: 5.78; 95% IC: 1.63, 20.51; p = 0.003). Los dos grupos anteriores tuvieron una tasa de mortalidad de 90 días significativamente mayor (OR: 6.22; 95% IC: 2.15, 17.99; p ≤ 0.001 versus OR: 5.54; 95% IC: 2.14, 14.33; p ≤ 0.001, respectivamente). Conclusión: Observamos que ciertas exposiciones (tales como sepsis, oliguria, hipotensión sistémica, shock hemorrágico, admisión en la UCI, y cirugías principales complicadas) tuvieron una influencia significativa en la severidad y los resultados clínicos renales adversos, con independencia de las susceptibilidades.