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1.
Rev Invest Clin ; 2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-34297015

RESUMO

BACKGROUND: Healthcare-associated infections (HAIs) are important adverse events that must be prevented. OBJECTIVE: The objective of the study was to report and study possible changes in HAI rates as well as their causes after the COVID-19 hospital surge capacity response (HSCR) in an academic referral center. METHODS: This was a before-after observational study. The Infection Prevention and Control (IPC) program (prospective surveillance, prevention bundles, antibiotic stewardship, continuing education, and feedback) was transiently disrupted after the start of HSCR (March 2020). HAI rates were compared before (January 2019-February 2020) and after (April-July 2020) HSCR, and plausible predisposing factors in affected patients were compared. RESULTS: An increase in the HAI rate from 6.2 to 11.8 cases/1000 patient-days was noted between periods due to increases in ventilator-associated pneumonia and bloodstream infection (BSI) rates. More critically ill patients were admitted during HSCR, and use of invasive devices increased. Prone positioning and infusion of muscle relaxants became commonplace. The nurse-to-patient ratio in the intensive care unit decreased, and 4 h shifts were introduced to avoid fatigue. The BSI rate decreased after the IPC program with additional measures was reintroduced in May 2020. CONCLUSIONS: The strain on the workforce and modifications to the IPC program very possibly underlay the findings. IPC programs continue to be essential during the pandemic.

2.
Salud Publica Mex ; 63(1, ene-feb): 1-11, 2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33021362

RESUMO

OBJECTIVE: To develop a score to predict the need for ICU admission in COVID-19. METHODS: We assessed patients admitted to a COVID-19 center in Mexico. Patients were segregated into a group that required ICU admission, and a group that never required ICU admission. By logistic regression, we derived predictive models including clinical, laboratory, and imaging findings. The ABC-GOALS was constructed and compared to other scores. RESULTS: We included 329 and 240 patients in the development and validation cohorts, respectively. One-hundred-fifteen patients from each cohort required ICU admission. The clinical (ABC-GOALSc), clinical+laboratory (ABC-GOALScl), clinical+laboratory+image (ABC-GOALSclx) models area under the curve were 0.79 (95%CI=0.74-0.83) and 0.77 (95%CI=0.71-0.83), 0.86 (95%CI=0.82-0.90) and 0.87 (95%CI=0.83-0.92), 0.88 (95%CI=0.84-0.92) and 0.86 (95%CI=0.81-0.90), in the development and validation cohorts, respectively. The ABC-GOALScl and ABC-GOALSclx outperformed other COVID-19 and pneumonia predictive scores. CONCLUSION: ABC-GOALS is a tool to timely predict the need for admission to ICU in COVID-19.


Assuntos
COVID-19/epidemiologia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Adulto , Área Sob a Curva , Intervalos de Confiança , Feminino , Humanos , Modelos Logísticos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
3.
Rev Invest Clin ; 72(3): 127-134, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584321

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been declared a global pandemic. Older adults have been found as a vulnerable group for developing severe forms of disease and increased mortality. OBJECTIVE: The objective of the study was to propose a pathway to assist the decision-making process for hospital resource allocation for older adults with COVID-19 using simple geriatric assessment-based tools. METHODS: We reviewed the available literature at this point of the COVID-19 outbreak, focusing in older adult care to extract key recommendations for those health-care professionals who will be treating older adults in the hospital emergency ward (HEW) in developing countries during the COVID-19 pandemic. RESULTS: We listed a series of easy recommendations for non-geriatrician doctors in the HEW and suggested simple tools for hospital resource allocation during critical care evaluation of older adults with COVID-19 in low- and middle-income countries. CONCLUSIONS: Age must not be used as the sole criterion for resource allocation among older adults with COVID-19. Simple and efficient tools are available to identify components of the comprehensive geriatric assessment, which could be useful to predict outcomes and provide high-quality care that would fit the particular needs of older adults in resource-limited settings amidst this global pandemic.


Assuntos
Betacoronavirus , Tomada de Decisão Clínica , Infecções por Coronavirus , Países em Desenvolvimento , Serviço Hospitalar de Emergência , Pandemias , Pneumonia Viral , Alocação de Recursos/normas , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento/economia , Serviço Hospitalar de Emergência/economia , Feminino , Idoso Fragilizado , Avaliação Geriátrica/métodos , Humanos , Masculino , Pandemias/economia , Preferência do Paciente , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Prognóstico , Alocação de Recursos/ética , SARS-CoV-2 , Triagem , Populações Vulneráveis
4.
Rev Invest Clin ; 72(3): 165-177, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584326

RESUMO

BACKGROUND: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. OBJECTIVE: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). METHODS: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. RESULTS: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. CONCLUSIONS: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Dor Abdominal/epidemiologia , Adulto , Idoso , Assistência Ambulatorial , Biomarcadores/sangue , Índice de Massa Corporal , COVID-19 , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Cuidados Críticos , Dispneia/etiologia , Feminino , Gastroenteropatias/epidemiologia , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , México , Pessoa de Meia-Idade , Obesidade/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Pneumonia Viral/complicações , Pneumonia Viral/terapia , SARS-CoV-2 , Índice de Gravidade de Doença , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento
5.
Postgrad Med J ; 94(1113): 386-391, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29925520

RESUMO

PURPOSE OF THE STUDY: The aim of this study was to investigate the association of fluid overload, measured by bioelectrical impedance vector analysis (BIVA) and also by accumulated fluid balance, with 30-day mortality rates in patients admitted to the emergency department (ED). DESIGN: We conducted a prospective observational study of fluid overload using BIVA, taking measures using a multiple-frequency whole-body tetrapolar equipment. Accumulated fluid balances were obtained at 24, 48 and 72 hours from ED admission and its association with 30-day mortality. PATIENTS: 109 patients admitted to the ED classified as fluid overloaded by both methods. RESULTS: According to BIVA, 71.6% (n=78) of patients had fluid overload on ED admission. These patients were older and had higher Sequential Organ Failure Assessment scores. During a median follow-up period of 30 days, 32.1% (n=25) of patients with fluid overload evaluated by BIVA died versus none with normovolaemia (p=0.001). There was no statistically significant difference in mortality between patients with and without fluid overload as assessed by accumulated fluid balance (p=0.81). CONCLUSIONS: Fluid overload on admission evaluated by BIVA was significantly related to mortality in patients admitted to the ED.


Assuntos
Estado Terminal/mortalidade , Impedância Elétrica , Insuficiência Cardíaca/mortalidade , Adulto , Fatores Etários , Idoso , Serviço Hospitalar de Emergência , Feminino , Insuficiência Cardíaca/fisiopatologia , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
6.
Crit Care Med ; 44(10): 1861-70, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27359085

RESUMO

OBJECTIVES: The 2009-2010 influenza A (H1N1pdm09) pandemic caused substantial morbidity and mortality among young patients; however, mortality estimates have been confounded by regional differences in eligibility criteria and inclusion of selected populations. In 2013-2014, H1N1pdm09 became North America's dominant seasonal influenza strain. Our objective was to compare the baseline characteristics, resources, and treatments with outcomes among critically ill patients with influenza A (H1N1pdm09) in Mexican and Canadian hospitals in 2014 using consistent eligibility criteria. DESIGN: Observational study and a survey of available healthcare setting resources. SETTING: Twenty-one hospitals, 13 in Mexico and eight in Canada. PATIENTS: Critically ill patients with confirmed H1N1pdm09 during 2013-2014 influenza season. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome measures were 90-day mortality and independent predictors of mortality. Among 165 adult patients with H1N1pdm09-related critical illness between September 2013 and March 2014, mean age was 48.3 years, 64% were males, and nearly all influenza was community acquired. Patients were severely hypoxic (median PaO2-to-FIO2 ratio, 83 mm Hg), 97% received mechanical ventilation, with mean positive end-expiratory pressure of 14 cm H2O at the onset of critical illness and 26.7% received rescue oxygenation therapy with prone ventilation, extracorporeal life support, high-frequency oscillatory ventilation, or inhaled nitric oxide. At 90 days, mortality was 34.6% (13.9% in Canada vs 50.5% in Mexico, p < 0.0001). Independent predictors of mortality included lower presenting PaO2-to-FIO2 ratio (odds ratio, 0.89 per 10-point increase [95% CI, 0.80-0.99]), age (odds ratio, 1.49 per 10 yr increment [95% CI, 1.10-2.02]), and requiring critical care in Mexico (odds ratio, 7.76 [95% CI, 2.02-27.35]). ICUs in Canada generally had more beds, ventilators, healthcare personnel, and rescue oxygenation therapies. CONCLUSIONS: Influenza A (H1N1pdm09)-related critical illness still predominantly affects relatively young to middle-aged patients and is associated with severe hypoxemic respiratory failure. The local critical care system and available resources may be influential determinants of patient outcome.


Assuntos
Estado Terminal/terapia , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/fisiopatologia , Influenza Humana/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Corticosteroides/economia , Corticosteroides/uso terapêutico , Adulto , Idoso , Antivirais/economia , Antivirais/uso terapêutico , Canadá/epidemiologia , Estado Terminal/epidemiologia , Oxigenação por Membrana Extracorpórea/economia , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Gastos em Saúde , Humanos , Influenza Humana/economia , Influenza Humana/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Respiração Artificial/economia , Respiração Artificial/métodos , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia
9.
J Vis Exp ; (196)2023 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-37458449

RESUMO

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, such as increased body fluid congestion or systemic congestion. This condition is one of the most common reasons for hospital admission and has been associated with poor outcomes. The phase angle indirectly measures intracellular status, cellular integrity, vitality, and the distribution of spaces between intracellular and extracellular body water. This parameter has been found to be a predictor of health status and an indicator of survival and other clinical outcomes. In addition, phase angle values of <4.8° upon admission were associated with higher mortality in patients with acute heart failure. However, low phase angle values may be due to alterations-such as the shifting of fluids from an intracellular body water (ICW) compartment to an ECW (extracellular body water) compartment and a concurrent decrease in body-cell mass (which can reflect malnutrition)-that are present in heart failure. Thus, a low phase angle may be due to overhydration and/or malnutrition. BIVA provides additional information about the body-cell mass and congestion status with a graphical vector (R-Xc graph). In addition, a BIVA Z-score analysis (the number of standard deviations from the mean value of the reference group) that has the same pattern as that of the ellipses for the percentiles on the original R-Xc graph can be used to detect changes in soft-tissue mass or tissue hydration and can help researchers compare changes in different study populations. This protocol explains how to obtain and interpret phase angle values and BIVA Z-score analyses, their clinical applicability, and their usefulness as a predictive marker for the prognosis of a 90-day event in patients admitted to an emergency department with acute heart failure.


Assuntos
Insuficiência Cardíaca , Desnutrição , Humanos , Insuficiência Cardíaca/diagnóstico , Composição Corporal/fisiologia , Água Corporal , Serviço Hospitalar de Emergência , Impedância Elétrica
10.
J Vis Exp ; (186)2022 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-36063016

RESUMO

Early detection and management of fluid overload are critically important in acute illness, as the impact of therapeutic intervention can result in decreased or increased mortality rates. Accurate fluid status assessment entails appropriate therapy. Unfortunately, as the gold standard method of radioisotopic fluid measurement is costly, time-consuming, and lacks sensitivity in the acute care clinical setting, other less-accurate methods are typically used, such as clinical examination or 24 h output. Bioelectrical impedance vectorial analysis (BIVA) is an alternative impedance-based approach, where the raw parameter resistance and reactance of a subject are plotted to produce a vector, the position of which can be evaluated relative to tolerance intervals in an R-Xc graph. The fluid status is then interpreted as normal or abnormal, based on the distance from the mean vector derived from a healthy reference population. The objective of the present study is to demonstrate how to evaluate the presence of fluid overload through bioelectrical impedance vectorial analysis and the impedance ratio measured with tetrapolar multi-frequency equipment in patients admitted to the emergency department.


Assuntos
Insuficiência Cardíaca , Cuidados Críticos , Impedância Elétrica , Serviço Hospitalar de Emergência , Insuficiência Cardíaca/diagnóstico , Hospitalização , Humanos
11.
Healthcare (Basel) ; 10(5)2022 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-35627947

RESUMO

BACKGROUND: The Sequential Organ Failure Assessment (SOFA) is a scoring system used for the evaluation of disease severity and prognosis of critically ill patients. The impedance ratio (Imp-R) is a novel mortality predictor. AIMS: This study aimed to evaluate the combination of the SOFA + Imp-R in the prediction of mortality in critically ill patients admitted to the Emergency Department (ED). METHODS: A retrospective cohort study was performed in adult patients with acute illness admitted to the ED of a tertiary-care referral center. Baseline SOFA score and bioelectrical impedance analysis to obtain the Imp-R were performed within the first 24 h after admission to the ED. A Cox regression analysis was performed to evaluate the mortality risk of the initial SOFA score plus the Imp-R. Harrell's C-statistic and decision curve analyses (DCA) were performed. RESULTS: Out of 325 patients, 240 were included for analysis. Overall mortality was 31.3%. Only 21.3% of non-surviving patients died after hospital discharge, and 78.4% died during their hospital stay. Of the latter, 40.6% died in the ED. The SOFA and Imp-R values were higher in non-survivors and were significantly associated with mortality in all models. The combination of the SOFA + Imp-R significantly predicted 30-day mortality, in-hospital mortality, and ED mortality with an area under the curve (AUC) of 0.80 (95% CI: 74-0.86), 0.79 (95% CI: 0.74-0.86) and 0.75 (95% CI: 0.66-0.84), respectively. The DCA showed that combining the SOFA + Imp-R improved the prediction of mortality through the lower risk thresholds. CONCLUSIONS: The addition of the Imp-R to the baseline SOFA score on admission to the ED improves mortality prediction in severely acutely ill patients admitted to the ED.

13.
Clin Nutr ESPEN ; 43: 206-211, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34024516

RESUMO

BACKGROUND & AIMS: The accuracy of estimating body composition compartments is critical in the clinical setting. Currently, there are different bioelectrical impedance analysis (BIA) devices available for obtaining raw BIA parameters. The aim of this study was to determine the level of agreement between multiple frequency (MF)-BIA and single frequency (SF)-BIA devices in obtaining raw BIA measurements (resistance (R), reactance (Xc), and phase angle (PhA)), as well as the agreement on the classification of hydration status and body cell mass by the bioelectrical impedance vector analysis (BIVA) method. METHODS: This cross-sectional study included 406 outpatients with stable chronic heart failure (HF). The raw BIA measurements at 50 kHz obtained by tetrapolar MF-BIA (Bodystat QuadScan 4000) were compared with those obtained by tetrapolar SF-BIA (RJL Quantum X). In addition, the patients were classified by their hydration status and body cell mass according to the BIVA method. RESULTS: Strong and significant correlations were observed between the two methods in all raw BIA variables (r ≥ 0.90). Lin's concordance correlation coefficient (CCC) values were almost perfect for R (CCC = 0.99; 95% CI 0.997 to 0.998), moderate for Xc (CCC = 0.93; 95% CI 0.92 to 0.94), and poor for PhA (CCC = 0.88; 95% CI 0.85 to 0.90). The agreement obtained in the two classifications (quadrants and hydration status) was >0.81. CONCLUSIONS: MF-BIA and SF-BIA demonstrated good agreement for measurement of the R parameter; however, the Xc and PhA parameters must be used carefully due to the previously reported variability. Likewise, the agreement in all classifications by the BIVA method was almost perfect.


Assuntos
Água Corporal , Insuficiência Cardíaca , Composição Corporal , Estudos Transversais , Impedância Elétrica , Insuficiência Cardíaca/diagnóstico , Humanos
14.
JPEN J Parenter Enteral Nutr ; 45(2): 414-422, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32441793

RESUMO

BACKGROUND: Fluid overload (FO) in critically ill patients is associated with increased adverse events. This study aims to compare different bioelectrical impedance analysis (BIA) parameters that demonstrate FO and their association with 30-day mortality in critical patients admitted to the emergency department (ED). METHODS: Five components of the BIA were obtained by multifrequency device-total body water (TBW), extracellular water (ECW), intracellular water (ICW), resistance (R), and reactance (Xc)-to calculate parameters (impedance vectors, impedance ratio, and the ratios of ECW to TBW, ECW to ICW, ECW to body surface area, TBW to height2 , ICW to height2 , Xc to height, and R to height) that have been used for the detection of FO. A concordance analysis (κ) was performed comparing every parameter with each other. Furthermore, different regression models (Cox regression) were created associating the FO for each parameter with 30-day mortality, adjusted for age, body mass index, sex, Sequential Organ Failure Assessment score, and serum albumin level. RESULTS: A total of 142 patients were included in the study. Only FO by impedance vector analysis (relative risk [RR] = 6.4; 95% CI, 1.5-27.9; P = .01), impedance ratio (RR = 2.7; 95% CI, 1.1-7.1; P = .04), and R (RR = 2.6; 95% CI, 1.2-5.5; P = .02) increased the probability of 30-day mortality. CONCLUSIONS: Different parameters that determine FO by BIA were associated with the mortality of patients admitted to the ED, but the impedance vector analysis was superior to any other parameter of the BIA.


Assuntos
Água Corporal , Desequilíbrio Hidroeletrolítico , Composição Corporal , Índice de Massa Corporal , Impedância Elétrica , Serviço Hospitalar de Emergência , Humanos
15.
Front Immunol ; 12: 689966, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34566957

RESUMO

Background: Most of the explanatory and prognostic models of COVID-19 lack of a comprehensive assessment of the wide COVID-19 spectrum of abnormalities. The aim of this study was to unveil novel biological features to explain COVID-19 severity and prognosis (death and disease progression). Methods: A predictive model for COVID-19 severity in 121 patients was constructed by ordinal logistic regression calculating odds ratio (OR) with 95% confidence intervals (95% CI) for a set of clinical, immunological, metabolomic, and other biological traits. The accuracy and calibration of the model was tested with the area under the curve (AUC), Somer's D, and calibration plot. Hazard ratios with 95% CI for adverse outcomes were calculated with a Cox proportional-hazards model. Results: The explanatory variables for COVID-19 severity were the body mass index (BMI), hemoglobin, albumin, 3-Hydroxyisovaleric acid, CD8+ effector memory T cells, Th1 cells, low-density granulocytes, monocyte chemoattractant protein-1, plasma TRIM63, and circulating neutrophil extracellular traps. The model showed an outstanding performance with an optimism-adjusted AUC of 0.999, and Somer's D of 0.999. The predictive variables for adverse outcomes in COVID-19 were severe and critical disease diagnosis, BMI, lactate dehydrogenase, Troponin I, neutrophil/lymphocyte ratio, serum levels of IP-10, malic acid, 3, 4 di-hydroxybutanoic acid, citric acid, myoinositol, and cystine. Conclusions: Herein, we unveil novel immunological and metabolomic features associated with COVID-19 severity and prognosis. Our models encompass the interplay among innate and adaptive immunity, inflammation-induced muscle atrophy and hypoxia as the main drivers of COVID-19 severity.


Assuntos
COVID-19 , SARS-CoV-2 , Índice de Gravidade de Doença , Adulto , Coagulação Sanguínea , Índice de Massa Corporal , COVID-19/sangue , COVID-19/imunologia , COVID-19/metabolismo , Citocinas/sangue , Armadilhas Extracelulares/imunologia , Feminino , Hemoglobinas/análise , Humanos , Masculino , Metaboloma , Pessoa de Meia-Idade , Atrofia Muscular , Neutrófilos/imunologia , Fenótipo , Prognóstico , Albumina Sérica Humana/análise , Linfócitos T/imunologia , Valeratos/sangue
16.
Cells ; 10(10)2021 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-34685525

RESUMO

The coronavirus disease 2019 (COVID-19) is related to enhanced production of NETs, and autoimmune/autoinflammatory phenomena. We evaluated the proportion of low-density granulocytes (LDG) by flow cytometry, and their capacity to produce NETs was compared with that of conventional neutrophils. NETs and their protein cargo were quantified by confocal microscopy and ELISA. Antinuclear antibodies (ANA), anti-neutrophil cytoplasmic antibodies (ANCA) and the degradation capacity of NETs were addressed in serum. MILLIPLEX assay was used to assess the cytokine levels in macrophages' supernatant and serum. We found a higher proportion of LDG in severe and critical COVID-19 which correlated with severity and inflammatory markers. Severe/critical COVID-19 patients had higher plasmatic NE, LL-37 and HMGB1-DNA complexes, whilst ISG-15-DNA complexes were lower in severe patients. Sera from severe/critical COVID-19 patients had lower degradation capacity of NETs, which was reverted after adding hrDNase. Anti-NET antibodies were found in COVID-19, which correlated with ANA and ANCA positivity. NET stimuli enhanced the secretion of cytokines in macrophages. This study unveils the role of COVID-19 NETs as inducers of pro-inflammatory and autoimmune responses. The deficient degradation capacity of NETs may contribute to the accumulation of these structures and anti-NET antibodies are related to the presence of autoantibodies.


Assuntos
Autoimunidade , COVID-19/sangue , COVID-19/imunologia , Armadilhas Extracelulares/imunologia , Imunidade Humoral , Inflamação , Neutrófilos/imunologia , Anticorpos Antinucleares , Peptídeos Catiônicos Antimicrobianos/sangue , Autoanticorpos/metabolismo , Estudos Transversais , Citocinas/metabolismo , Citocinas/farmacologia , Citometria de Fluxo , Granulócitos/metabolismo , Proteína HMGB1/sangue , Voluntários Saudáveis , Humanos , Microscopia Confocal , Monócitos/citologia , Neutrófilos/citologia , SARS-CoV-2 , Ubiquitinas/farmacologia , Catelicidinas
17.
Anaesthesiol Intensive Ther ; 53(2): 162-178, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34006046

RESUMO

Critically ill patients are often presumed to be in a state of "constant dehydration" or in need of fluid, thereby justifying a continuous infusion with some form of intravenous (IV) fluid, despite their clinical data suggesting otherwise. Overzealous fluid administration and subsequent fluid accumulation and overload are associated with poorer outcomes. Fluids are drugs, and their use should be tailored to meet the patient's individualized needs; fluids should never be given as routine maintenance unless indicated. Before prescribing any fluids, the physician should consider the patient's characteristics and the nature of the illness, and assess the risks and benefits of fluid therapy. Decisions regarding fluid therapy present a daily challenge in many hospital departments: emergency rooms, regular wards, operating rooms, and intensive care units. Traditional fluid prescription is full of paradigms and unnecessary routines as well as malpractice in the form of choosing the wrong solutions for maintenance or not meeting daily requirements. Prescribing maintenance fluids for patients on oral intake will lead to fluid creep and fluid overload. Fluid overload, defined as a 10% increase in cumulative fluid balance from baseline weight, is an independent predictor for morbidity and mortality, and thus hospital cost. In the last decade, increasing evidence has emerged supporting a restrictive fluid approach. In this manuscript, we aim to provide a pragmatic description of novel concepts related to the use of IV fluids in critically ill patients, with emphasis on the different indications and common clinical scenarios. We also discuss active deresuscitation, or the timely cessation of fluid administration, with the intention of achieving a zero cumulative fluid balance.


Assuntos
Hidratação , Preparações Farmacêuticas , Estado Terminal , Humanos , Unidades de Terapia Intensiva , Equilíbrio Hidroeletrolítico
18.
PLoS One ; 16(2): e0245772, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33534813

RESUMO

BACKGROUND: As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has remained in Latin America, Mexico has become the third country with the highest death rate worldwide. Data regarding in-hospital mortality and its risk factors, as well as the impact of hospital overcrowding in Latin America has not been thoroughly explored. METHODS AND FINDINGS: In this prospective cohort study, we enrolled consecutive adult patients hospitalized with severe confirmed COVID-19 pneumonia at a SARS-CoV-2 referral center in Mexico City from February 26th, 2020, to June 5th, 2020. A total of 800 patients were admitted with confirmed diagnosis, mean age was 51.9 ± 13.9 years, 61% were males, 85% were either obese or overweight, 30% had hypertension and 26% type 2 diabetes. From those 800, 559 recovered (69.9%) and 241 died (30.1%). Among survivors, 101 (18%) received invasive mechanical ventilation (IMV) and 458 (82%) were managed outside the intensive care unit (ICU); mortality in the ICU was 49%. From the non-survivors, 45.6% (n = 110) did not receive full support due to lack of ICU bed availability. Within this subgroup the main cause of death was acute respiratory distress syndrome (ARDS) in 95% of the cases, whereas among the non-survivors who received full (n = 105) support the main cause of death was septic shock (45%) followed by ARDS (29%). The main risk factors associated with in-hospital death were male sex (RR 2.05, 95% CI 1.34-3.12), obesity (RR 1.62, 95% CI 1.14-2.32)-in particular morbid obesity (RR 3.38, 95%CI 1.63-7.00)-and oxygen saturation < 80% on admission (RR 4.8, 95%CI 3.26-7.31). CONCLUSIONS: In this study we found similar in-hospital and ICU mortality, as well as risk factors for mortality, compared to previous reports. However, 45% of the patients who did not survive justified admission to ICU but did not receive IMV / ICU care due to the unavailability of ICU beds. Furthermore, mortality rate over time was mainly due to the availability of ICU beds, indirectly suggesting that overcrowding was one of the main factors that contributed to hospital mortality.


Assuntos
Ocupação de Leitos/estatística & dados numéricos , COVID-19/patologia , Mortalidade Hospitalar , Idoso , COVID-19/complicações , COVID-19/mortalidade , COVID-19/virologia , Causas de Morte , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , México , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/patologia , Estudos Prospectivos , Respiração Artificial , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/mortalidade , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Choque Séptico/diagnóstico , Choque Séptico/etiologia , Choque Séptico/mortalidade , Centros de Atenção Terciária
19.
Am J Infect Control ; 48(4): 446-447, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31677926

RESUMO

A multimodal preventive strategy consisting of a ventilator-associated pneumonia (VAP) preventive bundle plus 3 additional sequential interventions (noninvasive ventilation, reeducation of health care workers, and early weaning) was associated with a marked reduction in VAP rates in a Latin American hospital, including 6 consecutive months without VAP cases. A positive association between the percentage of intubated patients and VAP rates was observed.


Assuntos
Controle de Infecções/métodos , Pacotes de Assistência ao Paciente , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Humanos , Unidades de Terapia Intensiva , México/epidemiologia , Respiração Artificial
20.
Turk Thorac J ; 21(4): 274-279, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32687789

RESUMO

The use of continuous positive airway pressure (CPAP) in asthma has been a point of debate over the past several years. Various studies, including those on animals and humans have attempted to understand the role and pathophysiology of CPAP in patients with either well controlled or poorly controlled asthma. The aim of this manuscript is to review the currently available literature on the physiologic and clinical effects of CPAP in animal models of asthma and on humans with stable asthma.

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