Usefulness of Inhaled Sedation in Patients With Severe ARDS Due to COVID-19.

BACKGROUND: Sedation in intensive care is fundamental for optimizing clinical outcomes. For many years the world has been facing high rates of opioid use, and to combat the increasing opioid addiction plans at both national and international level have been implemented.1 The COVID-19 pandemic posed a major challenge for health systems and also increased the use of sedatives and opioid analgesia for prolonged periods of time, and at high doses, in a significant proportion of patients. In our institutions, the shortage of many drugs for intravenous (IV) analgosedation forces us to alternatives to replace out-of-stock drugs or to seek sedation goals, which are difficult to obtain with traditional drugs at high doses.2 METHODS: This was an analytical retrospective cohort study evaluating the follow-up of subjects with inclusion criteria from ICU admission to discharge (alive or dead). Five end points were measured: need for high-dose opioids (≥ 200 µg/h), comparison of inhaled versus IV sedation of opioid analgesic doses, midazolam dose, need for muscle relaxant, and risk of delirium. RESULTS: A total of 283 subjects were included in the study, of whom 230 were administered IV sedation and 53 inhaled sedation. In the inhaled sedation group, the relative risks (RRs) were 0.5 (95% CI 0.4-0.8, P = .045) for need of high-dose fentanyl, 0.3 (95% CI 0.20-0.45, P < .001) for need of muscle relaxant, and 0.8 (95% CI 0.61-1.15, P = .25) for risk of delirium. The median difference of fentanyl dose between the inhaled sedation and IV sedation groups was 61 µg/h or 1,200 µg/d (2.2 ampules/d, P < .001), and that of midazolam dose was 5.7 mg/h. CONCLUSIONS: Inhaled sedation was associated with lower doses of opioids, benzodiazepines, and muscle relaxants compared to IV sedation. This therapy should be considered as an alternative in critically ill patients requiring prolonged ventilatory support and where IV sedation is not possible, always under adequate supervision of ICU staff.

Conversión a hipotiroidismo en tratamiento con I131 por hipertiroidismo secundario a enfermedad de Graves Hospital de San José, enero 2005 - diciembre 2008 / Time to development of hypothyroidism following I131 therapy for hyperthyroidism due to Graves disease San José Hospital, January 2005 - December 2008

El hipertiroidismo tiene alta prevalencia e incidencia en Colombia y requiere diagnóstico y tratamiento adecuados por los riesgos cardiovasculares y oftalmológicos que conlleva. Debido a los diferentes resultados el tiempo de conversión a hipotiroidismo pos administración de I131 hallados en la literatura, se realizó un estudio de cohorte retrospectiva en pacientes con enfermedad de Graves que recibieron I131 en los servicios de endocrinología, medicina interna y medicina nuclear del Hospital de San José, de enero de 2005 a diciembre de 2008. El objetivo principal fue establecer el tiempo mediano de conversión a hipotiroidismo y el secundario fue determinar si la edad tiene influencia. Se revisaron diez referencias bibliográficas, catorce revistas y tres textos guía. El análisis de sobrevida se basó en curvas de Kaplan-Meyer mediante el empleo del programa estadístico STATA 10; 89 historias clínicas cumplieron con los criterios de inclusión. El 76% de los pacientes con enfermedad de Graves manejados con I131 presentaron conversión a hipotiroidismo en los primeros seis meses, el resto en el curso de los seis meses siguientes con un pico a los nueve. El tiempo mediano fue de seis meses. La eficacia se registra a los seis meses y es un marcador de eficacia terapéutica para hipotiroidismo por enfermedad de Graves. Cuando no hay conversión, se recomienda el seguimiento estricto de los pacientes con el fin de elegir la terapéutica apropiada.

Hyperthyroidism has a high prevalence and incidence in Colombian population and requires diagnostic tools and adequate treatment for it carries risks for cardiovascular problems and ophthalmopathology. A retrospective cohort study was conducted due to the different results found in literature on the time at which hypothyroidism occurred following I131 therapy in patients with Graves Disease who received this treatment at the Endocrinology, Internal Medicine and Nuclear Medicine departments at the San José Hospital, from January, 2005 to December, 2008. The primary objective was to establish the median time to hypothyroidism development and the secondary objective was to determine if it is age-related. Ten bibliographic references were reviewed, 14 journals and three guide texts. The survival analysis was based on the Kaplan-Meier curves using the STATA 10 statistical program. Eighty-nine of the reviewed clinical records met the inclusion criteria. It was found that 76% of patients with Graves Disease who received I131 therapy developed hypothyroidism during the first six months and the remaining patients within the following six months with a peak at nine months. The median time to hypothyroidism development was six months. These findings allow us to state that therapy efficacy may be registered at six months and that it is a marker of therapeutic efficacy for hypothyroidism due to Graves Disease. A strict follow-up is recommended in patients in whom hypothyroidism does not occur in order to select the appropriate treatment regime.