Effectiveness of a specific follow up program for the management of the mental components of post-intensive care syndrome and chronic pain after COVID-19: results from the PAIN-COVID randomized clinical trial.

BACKGROUND: Critical COVID-19 survivors are at risk of developing Post-intensive Care Syndrome (PICS) and Chronic ICU-Related Pain (CIRP). We determined whether a specific care program improves the quality of life (QoL) of patients at risk of developing PICS and CIRP after COVID-19. METHODS: The PAIN-COVID trial was a parallel-group, single-centre, single-blinded, randomized controlled trial. The intervention consisted of a follow up program, patient education on PICS and pain, and a psychological intervention based on Rehm's self-control model in patients with abnormal depression scores (≥8) in the Hospital Anxiety and Depression Scale (HADS) at the baseline visit. QoL was evaluated with the 5-level EQ 5D (EQ 5D 5 L), mood disorders with the HADS, post-traumatic stress disorder (PTSD) with the PCL-5 checklist, and pain with the Brief Pain Inventory short form, the Douleur Neuropathique 4 questionnaire, and the Pain Catastrophizing Scale. The primary outcome was to determine if the program was superior to standard-of-care on the EQ visual analogue scale (VAS) at 6 months after the baseline visit. The secondary outcomes were EQ VAS at 3 months, and EQ index, CIRP incidence and characteristics, and anxiety, depression, and PTSD at 3 and 6 months after baseline visits. CONCLUSIONS: This program was not superior to standard care in improving QoL in critical COVID-19 survivors as measured by the EQ VAS. However, our data can help establish better strategies for the study and management of PICS and CIRP in this population. TRIAL REGISTRATION: # NCT04394169, registered on 5/19/2020.

Coagulación intravascular diseminada como forma de presentación de la enfermedad por coronavirus-19. Caso clínico / Disseminated intravascular coagulation as a form of presentation of coronavirus-19 disease. Clinical case

La enfermedad covid-19 (coronavirus disease 2019) es una infección de reciente aparición que está causando una pandemia a nivel mundial. La forma de presentación varía desde una infección asintomática hasta una neumonía con síndrome de distrés respiratorio. Presentamos el caso de un paciente que presentó una neumonía por covid-19 junto a una coagulación intravascular diseminada con trombosis arterial y venosa en múltiples localizaciones y un estado de choque que requirió ingreso en unidad de cuidados intensivos. La alteración de las pruebas de coagulación en pacientes afectos de covid-19 se ha descrito desde los primeros casos observados en Wuhan, China, así como una mayor incidencia de trombosis venosas. Al contrario, una mayor incidencia de trombosis arterial no ha sido descrita en estos pacientes. El caso inusual que presentamos podría representar una manifestación de estas alteraciones.(AU)

The covid-19 disease (coronavirus disease 2019) is a novel disease causing a world pandemic. Its presentation varies from an asymptomatic infection to a pneumonia with acute respiratory distress syndrome. We present a case presenting initially as a covid-19 pneumonia together with a disseminated intravascular coagulopathy consisting of arterial and venous thrombosis in different locations and a shock requiring admission in the intensive care unit. The abnormal coagulation test in covid-19 patients have been described since the first cases observed in Wuhan, China, as well as an increased incidence of venous thrombosis. On the contrary, a higher incidence of arterial thrombosis has not been described in these patients. The unusual case we present could be a manifestation of this altered tests.(AU)

Disseminated intravascular coagulation as a form of presentation of coronavirus-19 disease. Clinical case. / Coagulación intravascular diseminada como forma de presentación de la enfermedad por coronavirus-19. Caso clínico.

The covid-19 disease (coronavirus disease 2019) is a novel disease causing a world pandemic. Its presentation varies from an asymptomatic infection to a pneumonia with acute respiratory distress syndrome. We present a case presenting initially as a covid-19 pneumonia together with a disseminated intravascular coagulopathy consisting of arterial and venous thrombosis in different locations and a shock requiring admission in the intensive care unit. The abnormal coagulation test in covid-19 patients have been described since the first cases observed in Wuhan, China, as well as an increased incidence of venous thrombosis. On the contrary, a higher incidence of arterial thrombosis has not been described in these patients. The unusual case we present could be a manifestation of this altered tests.

Coagulación intravascular diseminada como forma de presentación de la enfermedad por coronavirus-19. Caso clínico / Disseminated intravascular coagulation as a form of presentation of coronavirus-19 disease. Clinical case

La enfermedad covid-19 (coronavirus disease 2019) es una infección de reciente aparición que está causando una pandemia a nivel mundial. La forma de presentación varía desde una infección asintomática hasta una neumonía con síndrome de distrés respiratorio. Presentamos el caso de un paciente que presentó una neumonía por covid-19 junto a una coagulación intravascular diseminada con trombosis arterial y venosa en múltiples localizaciones y un estado de choque que requirió ingreso en unidad de cuidados intensivos. La alteración de las pruebas de coagulación en pacientes afectos de covid-19 se ha descrito desde los primeros casos observados en Wuhan, China, así como una mayor incidencia de trombosis venosas. Al contrario, una mayor incidencia de trombosis arterial no ha sido descrita en estos pacientes. El caso inusual que presentamos podría representar una manifestación de estas alteraciones

The covid-19 disease (coronavirus disease 2019) is a novel disease causing a world pandemic. Its presentation varies from an asymptomatic infection to a pneumonia with acute respiratory distress syndrome. We present a case presenting initially as a covid-19 pneumonia together with a disseminated intravascular coagulopathy consisting of arterial and venous thrombosis in different locations and a shock requiring admission in the intensive care unit. The abnormal coagulation test in covid-19 patients have been described since the first cases observed in Wuhan, China, as well as an increased incidence of venous thrombosis. On the contrary, a higher incidence of arterial thrombosis has not been described in these patients. The unusual case we present could be a manifestation of this altered tests