Should COVID-19 patients >75 years be Ventilated? An Outcome Study.

BACKGROUND: Elderly patients with COVID-19 disease are at increased risk for adverse outcomes. Current data regarding disease characteristics and outcomes in this population are limited. AIM: To delineate the adverse factors associated with outcomes of COVID-19 patients ≥75 years of age. DESIGN: Retrospective cohort study. METHODS: Patients were classified into mild/moderate, severe/very severe and critical disease (intubated) based on oxygen requirements. The primary outcome was in-hospital mortality. RESULTS: A total of 355 patients aged ≥75 years hospitalized with COVID-19 between 19 March and 25 April 2020 were included.Mean age was 84.3 years. One-third of the patients developed critical disease. Mean length of stay was 7.10 days. Vasopressors were required in 27%, with the highest frequency in the critical disease group (74.1%). Overall mortality was 57.2%, with a significant difference between severity groups (mild/moderate disease: 17.4%, severe/very severe disease: 71.3%, critical disease: 94.9%, P < 0.001).Increased age, dementia, and severe/very severe and critical disease groups were independently associated with increased odds for mortality while diarrhea was associated with decreased odds for mortality (OR: 0.12, 95% CI: 0.02-0.60, P < 0.05). None of the cardiovascular comorbidities were significantly associated with mortality. CONCLUSION: Age and dementia are associated with increased odds for mortality in patients ≥75 years of age hospitalized with COVID-19. Those who require intubation have the greatest odds for mortality. Diarrhea as a presenting symptom was associated with lower odds for mortality.

Health worker exposure risk during inhalation sedation with sevoflurane using the (AnaConDa ®) anaesthetic conserving device / Riesgo de exposición de los profesionales sanitarios durante sedación inhalatoria con sevoflurane a través del dispositivo anaesthetic conserving device (AnaConDa ®)

Introduction and objective Occupational exposure to sevoflurane should not exceed 2 ppm. During inhalation sedation with sevoflurane using the anaesthetic conserving device (AnaConDa®) in the post-anaesthesia care unit, waste gases can be reduced by gas extraction systems or scavenging devices such as CONTRAfluran™. However, the efficacy of these methods has not been clearly established. To determine the safest scenario for healthcare workers during inhalation sedation with sevoflurane in the post-surgical intensive care unit. Materials and methods: An experimental study on occupational exposure was conducted in a post-cardiothoracic care unit during March-August 2009. The measurements were performed in four post-cardiac surgery sedated adults in post-surgical intensive care unit and four nurses at the bedside, and at four points: scenario A, inhalation sedation without gas extraction system or contrafluran as a reference scenario; scenario B, applying a gas extraction system to the ventilator; scenario C, using contrafluran; and scenario 0, performing intravenous isolation sedation. Sevoflurane concentrations were measured in the nurses’ breathing area during patient care, and at 1.5 and 8 m from the ventilator using diffusive passive monitor badges. Results: All badges corresponding to the nurses’ breathing area were below 2 ppm. Levels of sevoflurane detected using prevention systems were lower than that in the control situation. Only one determination over 2 ppm was found, corresponding to the monitor placed nearest the gas outlet of the ventilator in scenario A. Trace concentrations of sevoflurane were found in scenario 0 during intravenous sedation. Conclusions: Administration of sevoflurane through the AnaConDa® system during inhalation sedation in post-surgical intensive care units is safe for healthcare workers, but gas extraction systems or scavenging systems, such as CONTRAfluran™ should be used to reduce occupational exposure as much as possible (AU)

Introducción y objetivo: La exposición ocupacional al sevoflurano no debe exceder de 2 ppm. Durante la sedación por inhalación con sevoflurano utilizando el dispositivo anestésico conservación ( AnaConDa ®) en la unidad de cuidados post-anestésicos , gases residuales se pueden reducir mediante sistemas de extracción de gases o dispositivos de barrido como CONTRAfluran ™ . Sin embargo , la eficacia de estos métodos no se ha establecido claramente. Para determinar el escenario más seguro para los trabajadores de la salud durante la sedación por inhalación con sevoflurano en la unidad de cuidados intensivos post- quirúrgica. Materiales y métodos: Un estudio experimental sobre la exposición laboral se llevó a cabo en una unidad de cuidados post- cardiotorácica entre marzo y agosto de 2009. Las mediciones se realizaron cada cuatro adultos sedados después de cirugía cardiaca en la unidad de cuidados intensivos post- quirúrgica y cuatro enfermeras en el lado de la cama , y en cuatro puntos : el escenario A , sedación por inhalación sin sistema de extracción de gas o contrafluran como un escenario de referencia ; escenario B, la aplicación de un sistema de extracción de gas al ventilador ; escenario C , utilizando contrafluran y escenario 0 , realizando intravenosa sedación aislamiento. Concentraciones de sevoflurano fueron medidas en la zona de respiración de las enfermeras durante el cuidado del paciente, y en el 1,5 y 8 m desde el ventilador utilizando difusivos insignias monitor pasivo. Resultados Todas las insignias correspondientes a la zona de respiración de las enfermeras estaban por debajo de 2 ppm. Los niveles de sevoflurano detectado utilizando sistemas de prevención fueron más bajos que en la situación de control. Sólo se encontró un empeño superior a 2 ppm, correspondiente al monitor colocado más cerca de la salida de gas del ventilador en el escenario A concentraciones traza de sevoflurano fueron encontrados en el escenario 0 durante la sedación intravenosa. Conclusiones: La administración de sevoflurano a través del sistema AnaConDa ® durante la sedación por inhalación en las unidades de cuidados intensivos postquirúrgicos es seguro para los trabajadores de la salud, pero los sistemas de extracción de gas o sistemas de evacuación, tales como CONTRAfluran ™ debe ser usado para reducir la exposición ocupacional tanto como sea posible (AU)

Health worker exposure risk during inhalation sedation with sevoflurane using the (AnaConDa®) anaesthetic conserving device.

INTRODUCTION AND OBJECTIVE: Occupational exposure to sevoflurane should not exceed 2 ppm. During inhalation sedation with sevoflurane using the anaesthetic conserving device (AnaConDa(®)) in the post-anaesthesia care unit, waste gases can be reduced by gas extraction systems or scavenging devices such as CONTRAfluran™. However, the efficacy of these methods has not been clearly established. To determine the safest scenario for healthcare workers during inhalation sedation with sevoflurane in the post-surgical intensive care unit. MATERIALS AND METHODS: An experimental study on occupational exposure was conducted in a post-cardiothoracic care unit during March-August 2009. The measurements were performed in four post-cardiac surgery sedated adults in post-surgical intensive care unit and four nurses at the bedside, and at four points: scenario A, inhalation sedation without gas extraction system or contrafluran as a reference scenario; scenario B, applying a gas extraction system to the ventilator; scenario C, using contrafluran; and scenario 0, performing intravenous isolation sedation. Sevoflurane concentrations were measured in the nurses' breathing area during patient care, and at 1.5 and 8 m from the ventilator using diffusive passive monitor badges. RESULTS: All badges corresponding to the nurses' breathing area were below 2 ppm. Levels of sevoflurane detected using prevention systems were lower than that in the control situation. Only one determination over 2 ppm was found, corresponding to the monitor placed nearest the gas outlet of the ventilator in scenario A. Trace concentrations of sevoflurane were found in scenario 0 during intravenous sedation. CONCLUSIONS: Administration of sevoflurane through the AnaConDa(®) system during inhalation sedation in post-surgical intensive care units is safe for healthcare workers, but gas extraction systems or scavenging systems, such as CONTRAfluran™ should be used to reduce occupational exposure as much as possible.

[Mortality in Spain. I. Infant mortality in Spain 1900-1976. Regional evaluation]. / La mortalidad en España, I. La mortalidad infantil en España 1900-1976. Valoración regional.

PIP: The overall incidence and evolution of infant mortality in Spain in the present century is assessed as a reflection of health and economic progress in the various regions and as a guide for future provision of health and social services for infants. Mortality on the 1st day of life is only included starting in 1932. In 1900 there were 128,395 deaths in the 1st year, of which 70,264 occurred in males and 58,131 in females. In 1976 there were a total of 11,590 deaths, of which 6735 were to males and 4855 to females. Rates declined from 213.29/1000 live births for males and 194.69/1000 live births for females in 1900 to 19.29 for males and 14.79 for females in 1976, a decline of 91% for males and 92% for females. Quinquennial rates declined continuously except in 1918, when an influenza outbreak occurred, and in 1937-41, during the Spanish civil war and immediate postwar period. The regions with the highest percentage decline in male infant mortality from 1900-76 were Aragon, Extremadura, Madrid, and Castilla-La Mancha, while Galicia had the smallest decline. Madrid, Castilla-La Mancha, and Navarra had the greatest decline for females, while Baleares and Galicia had the smallest declines. 3 factors in the greater than average declines in Aragon, Extremadura, and Castilla-La Mancha were probably their very high rates of infant mortality at the outset, their urbanization experience, and the considerable emigration from each. Galicia had a lower infant mortality rate at the outset and is still predominantly rural. The decline in fertility has not been as pronounced over the century as the decline in infant mortality.^ieng