COVID-19-associated Coagulopathy Characterization using Rotational Thromboelastometry in a Prospective, Observational Cohort Study: The HemoCoV Study.

INTRODUCTION: COVID-19-associated coagulopathy includes systemic and endothelial inflammation with coagulation dysregulation related to immunothrombosis. The aim of this study was to characterize this complication of SARS-CoV-2 infection in patients with moderate to severe COVID-19. METHODS: An open-label, prospective observational study conducted in patients with COVID-19 moderate to severe acute respiratory failure admitted to an intensive care unit (ICU). Coagulation testing, including thromboelastometry, biochemical analysis and clinical variables, were collected at prespecified time points during the 30 days of ICU stay. RESULTS: The study included 145 patients, 73.8% male, with a median age of 68 years (interquartile range - IQR 55 - 74). The most prevalent comorbidities were arterial hypertension (63.4%), obesity (44.1%) and diabetes (22.1%). Simplified acute physiology score II (SAPS II) was on average 43.5 (11 - 105) and sequential organ failure assessment (SOFA) at admission was 7.5 (0 - 14). During ICU stay, 66.9% of patients underwent invasive mechanical ventilation and 18.4% extracorporeal membrane oxygenation support; thrombotic and hemorrhagic events occurred in 22.1% and 15.1% of the patients respectively; anticoagulation with heparin was present in 99.2% of patients since early ICU stay. Death occurred in 35% of patients. Longitudinal studies revealed changes in almost all coagulation tests during the ICU stay. SOFA score, lymphocyte counts, some biochemical, inflammatory and coagulation parameters, including hypercoagulability and hypofibrinolysis seen in thromboelastometry, differed significantly (p < 0.05), between ICU admission and discharge. Hypercoagulability and hypofibrinolysis persisted throughout ICU hospitalization, showing higher incidence and severity in non-survivors. CONCLUSION: COVID-19-associated coagulopathy is characterized by hypercoagulability and hypofibrinolysis from ICU admission, and persisted throughout the clinical course in severe COVID-19. These changes were more pronounced in patients with higher disease burden and in non-survivors.

Transfusion Practices in Gastrointestinal Bleeding - a Tertiary Care Single-Centre Analysis.

Acute upper or lower Gastrointestinal bleeding (GIB) is a clinical emergency in which transfusion can be lifesaving. An individualized and restrictive transfusion strategy is recommended. This study aims to analyze and evaluate GIB transfusion practices during one year in a large tertiary hospital in Lisbon, Portugal. All patients with GIB and transfusion support during 2014 were identified and clinical data collected and statistically treated. There were 1005 GIB transfusion episodes, in a total of 494 patients. Upper GIB was more common. The median haemoglobin concentration that triggered RBC transfusion was 7,6 g/dL with a median of 2 RBC per episode. In 21,9% of episodes, RBC were used in combination with other therapies, in 70,8%, only RBC were administered and in 7,3% RBC were not used at all. In the subgroup of patients receiving FC and/or PCC there were higher median of blood products transfused: RBC (3 17 units), FFP (3 units), PC (1 unit). In a large percentage of the transfusion episodes for GIB, only RBC were used whereas only 7,3% of the GIB didn't require RBC transfusion. Patients requiring FC and/or PCC, needed more allogenic components. We observed, in accordance with the latest clinical practice guidelines and the published literature, a restrictive transfusion approach in our clinical practice.

Recuperação global e marcha eficaz da pessoa idosa submetida a artroplastia da anca / Global recovery and effective gait of the elderly person undergoing hip arthroplasty

Objetivos: Apresentar um programa de intervenção de enfermagem de reabilitação a doentes idosos submetidos a artroplastia da anca em que se pretendeu avaliar e identificar alterações a nível do desem-penho do autocuidado, da força muscular, do equilíbrio corporal, da amplitude articular e dor, identificar défices de conhecimento relativamente a aspetos a ser aprendidos aquando de artroplastia da anca, im-plementar um plano de intervenção de enfermagem de reabilitação dirigido à reabilitação funcional dos doentes idosos submetidos a artroplastia da anca, de acordo com os défices identificados, avaliar os re-sultados das intervenções implementadas e validar conhecimentos adquiridos. Métodos: Foram estudados 5 casos concretos, através da metodologia do estudo de caso, em que foram avaliados, na admissão, 3º ou 4º dia de pós-operatório e alta, o desempenho nas AVD, através do Índice de Barthel, a força Muscular, através da Escala de Lower, o equilíbrio corporal, através do Índice de Tinetti, a dor, através da escala numérica da Dor e a amplitude articular das articulações coxo-femural, joelho e tíbio-társica do membro inferior operado, através de um goniómetro. Para a identificação do conhecimento ou desconhecimento relativamente a aspetos a ter em consideração aquando de artro-plastia da anca foi utilizada uma checklist construída para o efeito. Resultados: Foi verificado o aumento do desempenho a nível do autocuidado, da força muscular, do equilíbrio corporal e da amplitude articular de todas as articulações avaliadas. Foi registada a diminuição da dor. Quanto aos aspetos a ter em consideração aquando da artroplastia da anca, uma doente não demonstrou défices de conhecimento, dois doentes demonstraram dificuldades relativamente a deam-bular com auxiliar de marcha e transferências e dois doentes demonstraram dificuldades relativamente a comportamentos de prevenção de luxação da prótese. Conclusões: Do ponto de vista global houve recuperação em 4 dos doentes que integraram o pro-jeto. Apesar da evolução favorável destes doentes, a marcha eficaz no momento da alta verificou-se apenas em 3 doentes.

Aim: To present a rehabilitation nursing intervention program for elderly patients submitted to hip arthroplasty in which it was intended to evaluate and identify changes in the performance of self-care, muscular strength, body balance, joint amplitude and pain, to identify deficits of knowledge regarding aspects to be learned during hip arthroplasty, to implement a rehabilitation nursing intervention plan aimed at the functional rehabilitation of the elderly patients submitted to hip arthroplasty, according to the identified deficits, to evaluate the results of the interventions validated knowledge acquired. Methods: Five concrete cases were studied through the methodology of the case study, in which were evaluated, at admission, 3th or 4th day after surgery and at discharge, the performance in the ADL, through the Barthel Index, the muscular force, through Lower Scale, the body balance, through the Tinetti Index, the pain, through the numerical scale of pain and the joint amplitude of the limb-femoral, knee and tibio-tarsal joints of the operated lower limb, through a goniometer. For the identification of the knowledge, or lack of it, regarding aspects to be taken into account when performing hip arthroplasty, a checklist constructed for this purpose was used. Results: Increased self-care performance, muscle strength, body balance and joint amplitude of all joints were verified. Decreased pain was recorded. Regarding the aspects to be taken into consideration when performing hip arthroplasty, one patient did not demonstrate knowledge deficits, two patients had difficulty in walking with gaff and transfers and two patients showed difficulties regarding prosthesis dis-location prevention behaviors. Conclusions: From the global point of view, there was recovery in 4 of the patients who were part of the project. Despite the favorable evolution of these patients, effective gait on discharge was seen in only 3 patients.