Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

OBJECTIVE: To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. DESIGN: Cohort, prospective and observational study. SETTING: Post-intensive care multidisciplinary program. PATIENTS OR PARTICIPANTS: Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. INTERVENTIONS: Inclusion in the post-ICU multidisciplinary program. MAIN VARIABLES OF INTEREST: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. RESULTS: 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF); brachial plexopathy (10.7% IMV vs 0% ONAF); decrease in grip strength: right hand 20.67kg (±8.27) in VMI vs 31.8kg (±11.59) in ONAF and left hand 19.39kg (±8.45) in VMI vs 30.26kg (±12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. CONCLUSIONS: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

[Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?] / Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos?

Objective: To describe the sequelae one month after hospital discharge in patients who required admission to intensive care for severe COVID-19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design: Cohort, prospective and observational study. Setting: Post-intensive care multidisciplinary program. Patients or participants: Patients who survived admission to the intensive care unit (ICU) for severe COVID-19 pneumonia from April 2020 to October 2021. Interventions: Inclusion in the post-ICU multidisciplinary program. Main variables of interest: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results: One hundred and four patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs. 10.4% ONAF); brachial plexopathy (10.7% IMV vs. 0% ONAF); decrease in grip strength: right hand 20.67 kg (± 8.27) in VMI vs. 31.8 kg (± 11.59) in ONAF and left hand 19.39 kg (± 8.45) in VMI vs. 30.26 kg (± 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs. 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

[Postoperative cardiac morbidity/mortality in high-risk elderly patients undergoing non-cardiac surgery]. / Morbimortalidad cardíaca postoperatoria en pacientes ancianos de alto riesgo intervenidos de cirugía mayor no cardíaca. Grupo de Estudio de Morbimortalidad Postoperatoria (GEMPO).

OBJECTIVE: To analyze cardiac morbidity and mortality after major noncardiac surgery in high-risk elderly patients. PATIENTS AND METHOD: Retrospective study of patients 65 years old or older in the postoperative intensive care unit between January 1990 and September 1996, after major noncardiac surgery, with histories of known ischemic heart disease (IHD group) or with two or more coronary risk factors (CRF group). We analyzed age, number of risk factors, type of ischemic heart disease, type and nature of surgery and cardiac morbidity or mortality. RESULTS: Five hundred twenty-nine patients were studied. Mean age was 72.1 +/- 5.1 years. The CRF group contained 366 patients (69.1%); the IHD group contained 163 (30.2%) patients with angina or histories of myocardial infarction. Rates of morbidity in the two groups were 10.1% and 25.8%, respectively (p < 0.001); the cardiac death rates were 2.18% and 5.5%, respectively (p = 0.08). No effect of number of coronary risk factors, type of ischemic heart disease, or type of surgery was found. Emergency surgery was associated with greater morbidity (p < or = 0.0011 and p < 0.001, respectively) and mortality (p < 0.001 in both groups). Age over 75 years was related to increased rates of morbidity (p = 0.003) and mortality (p = 0.031). CONCLUSIONS: In our practice elderly patients with known ischemic heart disease undergoing major noncardiac surgery suffer more postoperative cardiac complications than do those who only have coronary risk factors. Mortality, however, is similar. The only factors associated with increased morbidity and mortality are emergency surgery and age over 75 years.