Rehabilitación intrahospitalaria en el paciente con Covid-19 / In-hospital rehabilitation in patients with Covid-19

La enfermedad Covid-19 se declaró pandemia en el mes de marzo de 2020. Sus manifestaciones clínicas son variadas: desde pacientes asintomáticos hasta enfermedad respiratoria severa y falla multiorgánica, lo cual puede conducir a la muerte. Los pacientes con enfermedad severa o crítica que requieren hospitalización en la unidad de cuidados intensivos (UCI), pueden presentar complicaciones directas o indirectas a las lesiones causadas por la infección, como el síndrome de des acondicionamiento físico, el síndrome post-UCI, entre otros. Se describe el abordaje de la evaluación y la rehabilitación en el paciente adulto hospitalizado con infección por Covid-19, con énfasis en la rehabilitación respiratoria. El presente documento se fundamenta en la literatura disponible actualmente y presenta recomendaciones dirigidas al escenario nacional.

Covid-19 disease was declared a pandemic in March 2020. Its clinical manifestations are varied: from asymptomatic patients to severe respiratory disease and multi-organ failure, which can lead to death. Patients with severe or critical illness who require hospitalization in the intensive care unit (ICU) may present direct or indirect complications to the lesions caused by the infection, such as the physical conditioning syndrome, post-ICU syndrome, among others. The approach to evaluation and rehabilitation in the hospitalized adult patient with Covid-19 infection is described, with emphasis on respiratory rehabilitation. This document is based on currently available literature and presents recommendations for the national setting.

Characterization of adverse drug reactions causing admission to an intensive care unit.

AIMS: This study aimed to determine the occurrence of adverse drug reactions (ADRs) that caused admission to the intensive care unit (ICU) of a university hospital. METHODS: Clinical records were reviewed for patients meeting the inclusion criteria who were admitted to the ICU between September and December 2012. Suspected cases of ADRs were documented. Nine researchers later evaluated causality using the Naranjo Algorithm, preventability using the Schumock and Thornton criteria, and clinical classification based on the dose-time-susceptibility system. RESULTS: In total, 96 patients presented 108 cases of ADR (13.8%, 95% confidence interval 11.2-16.4%) as the cause of admission. The most frequent ADRs were bradyarrhythmias and upper gastrointestinal bleeding (12%). Therapeutic failure accounted for 20%. The most commonly associated medications were acetylsalicylic acid (16%) and losartan (10%). Forty-six cases were categorized as possible, and only one as definite. According to the dose-time-susceptibility classification, in 82% of the cases, the dosage was collateral (within the therapeutic range), and 90% were independent of time; the factors most associated with susceptibility to ADRs were comorbidities (42%) and age (49%). Forty-four percent of the ADRs were considered possibly preventable. CONCLUSIONS: ADRs contribute significantly to ICU admissions, and a significant number of ADRs are preventable. National studies are needed to assess their incidence and to establish classification standards to reduce their clinical impact.