RESUMEN
The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.
RESUMEN
BACKGROUND: The aim of this study was to assess the efficacy of tigecycline in the treatment of infections due to carbapenemase-producing Klebsiella pneumoniae (CPKP) in critically ill patients. METHODS: A retrospective observational study was conducted in critically ill patients receiving different tigecycline doses for severe CPKP infections. We evaluated demographic data, localization and severity of infection, response to therapy, and mortality. RESULTS: Fifteen patients received tigecycline for 16 episodes of CPKP infection. The main infections were pneumonia (31%), urinary tract infection (31%), peritonitis (20%), catheter-related bacteraemia (12%), and meningitis (6%). Most infections were complicated with severe sepsis (44%), septic shock (12%), and/or bacteraemia (19%). The daily maintenance dose of tigecycline was 200 mg in 10 episodes and 100 mg in 6 episodes. The overall 30-day mortality rate was 25%. Univariate analysis showed that mortality was significantly associated (p < 0.01) with mean APACHE II and SOFA scores and the presence of immunosuppression, but not with the tigecycline dose. CONCLUSIONS: Tigecycline appears to be an effective therapy for severe infections due to CPKP in critically ill patients. Mortality is related to the severity of the underlying disease. We observed no benefit from a higher maintenance dose of tigecycline, although the number of patients included in the study was too small to draw any general conclusions in this regard.
Asunto(s)
Antibacterianos/uso terapéutico , Proteínas Bacterianas/biosíntesis , Infecciones por Klebsiella/tratamiento farmacológico , Klebsiella pneumoniae/efectos de los fármacos , Minociclina/análogos & derivados , beta-Lactamasas/biosíntesis , Adulto , Anciano , Antibacterianos/efectos adversos , Antibacterianos/farmacología , Enfermedad Crítica , Farmacorresistencia Bacteriana Múltiple , Femenino , Humanos , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/aislamiento & purificación , Masculino , Persona de Mediana Edad , Minociclina/efectos adversos , Minociclina/farmacología , Minociclina/uso terapéutico , Estudios Retrospectivos , TigeciclinaRESUMEN
OBJECTIVE: To present our experience with the implementation of a donation protocol following controlled cardiac death (Maastricht type III donation). DESIGN: A retrospective descriptive and observational study was made. SETTING: Intensive Care Unit of a third-level university hospital. PATIENTS: Eight patients in an irreversible state, in which withdrawal of all life support had been agreed, were evaluated as potential donors. INTERVENTIONS: Application of the adopted protocol. VARIABLES OF INTEREST: Clinical data of donors, evaluation of a donation protocol following cardiac death, warm ischemia times, and short-term outcome of the recipients. RESULTS: Eight patients were evaluated. In one case donation was not possible because no cardiac arrest developed in the 120 minutes after extubation. The 7 remaining patients were effective kidney donors. Warm ischemia times were less than 23 minutes in all cases. Although 7 of the 14 recipients suffered delayed graft function, all of them achieved good renal function. CONCLUSION: Donation after cardiac death in patients in an overwhelming and irreversible state represents a potential source of donors not previously considered in this country. The prior development of a consensus-based protocol can help increase the number of organs in combination with those obtained after brain death. In our experience, the results of kidney transplants obtained from donors after cardiac death are good, and the success of these types of protocols could be extended to other organs such as the liver and lungs.
Asunto(s)
Muerte , Obtención de Tejidos y Órganos/clasificación , Obtención de Tejidos y Órganos/normas , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios RetrospectivosRESUMEN
This group is a product of the collaboration agreement signed by SOMIAMA (Sociedad de Medicina Intensiva de Madrid) and SAR MADRID (Sociedad de Anestesiología, Reanimación y Terapéutica del Dolor de Madrid) under which the organisations agreed to create joint working groups to improve critical patient care. Pain, discomfort, agitation, and delirium cause suffering, delay discharge, and can lead to serious complications in patients admitted to medical and surgical critical care units and post-anaesthesia care units. The main objectives in this type of unit include: Ensuring the comfort of patients suffering or recovering from a critical illness.Avoiding complications associated with the measures, particularly pharmacological, taken to ensure that comfort.
Asunto(s)
Analgesia , Anestesia , Delirio , Humanos , Delirio/prevención & control , Unidades de Cuidados Intensivos , DolorRESUMEN
OBJECTIVES: To analyze clinical features associated to mortality in oncological patients with unplanned admission to the Intensive Care Unit (ICU), and to determine whether such risk factors differ between patients with solid tumors and those with hematological malignancies. DESIGN: An observational study was carried out. SETTING: A total of 123 Intensive Care Units across Spain. PATIENTS: All cancer patients with unscheduled admission due to acute illness related to the background oncological disease. INTERVENTIONS: None. MAIN VARIABLES: Demographic parameters, severity scores and clinical condition were assessed, and mortality was analyzed. Multivariate binary logistic regression analysis was performed. RESULTS: A total of 482 patients were included: solid cancer (n=311) and hematological malignancy (n=171). Multivariate regression analysis showed the factors independently associated to ICU mortality to be the APACHE II score (OR 1.102; 95% CI 1.064-1.143), medical admission (OR 3.587; 95% CI 1.327-9.701), lung cancer (OR 2.98; 95% CI 1.48-5.99) and mechanical ventilation after the first 24h of ICU stay (OR 2.27; 95% CI 1.09-4.73), whereas no need for mechanical ventilation was identified as a protective factor (OR 0.15; 95% CI 0.09-0.28). In solid cancer patients, the APACHE II score, medical admission, antibiotics in the previous 48h and lung cancer were identified as independent mortality indicators, while no need for mechanical ventilation was identified as a protective factor. In the multivariate analysis, the APACHE II score and mechanical ventilation after 24h of ICU stay were independently associated to mortality in hematological cancer patients, while no need for mechanical ventilation was identified as a protective factor. Neutropenia was not identified as an independent mortality predictor in either the total cohort or in the two subgroups. CONCLUSIONS: The risk factors associated to mortality did not differ significantly between patients with solid cancers and those with hematological malignancies. Delayed intubation in patients requiring mechanical ventilation might be associated to ICU mortality.
Asunto(s)
Neoplasias Hematológicas , Neoplasias Pulmonares , Humanos , Estudios Prospectivos , Unidades de Cuidados Intensivos , Hospitalización , Neoplasias Hematológicas/terapiaRESUMEN
The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.
Asunto(s)
COVID-19 , Enfermedad Crítica/terapia , Humanos , Unidades de Cuidados Intensivos , Pandemias , SARS-CoV-2Asunto(s)
Hipopituitarismo/complicaciones , Choque Cardiogénico/etiología , Adulto , Femenino , HumanosAsunto(s)
COVID-19 , Delirio , COVID-19/complicaciones , Delirio/epidemiología , Delirio/etiología , Humanos , SARS-CoV-2Asunto(s)
Neumocéfalo/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Bradicardia/etiología , Trastornos de la Conciencia/etiología , Descompresión Quirúrgica , Drenaje , Urgencias Médicas , Hematoma Subdural/cirugía , Humanos , Masculino , Neumocéfalo/cirugía , Complicaciones Posoperatorias/cirugíaRESUMEN
Este grupo es producto del acuerdo de colaboración firmado por la Sociedad de Medicina Intensiva de Madrid (SOMIAMA) y la Sociedad de Anestesiología, Reanimación y Terapéutica del Dolor de Madrid (SAR MADRID), por el que las organizaciones acordaron crear grupos de trabajo conjuntos para mejorar la atención al paciente crítico.El dolor, el malestar, la agitación y el delirio causan sufrimiento, retrasan el alta y pueden provocar complicaciones graves en los pacientes ingresados en las unidades de cuidados críticos médicos y quirúrgicos y en las unidades de cuidados postanestésicos. Los principales objetivos en este tipo de unidades incluyen: asegurar el confort de los pacientes que sufren o se recuperan de una enfermedad crítica. Evitar las complicaciones asociadas a las medidas, sobre todo farmacológicas, adoptadas para asegurar ese confort. (AU)
This group is a product of the collaboration agreement signed by Sociedad de Medicina Intensiva de Madrid (SOMIAMA) and Sociedad de Anestesiología, Reanimación y Terapéutica del Dolor de Madrid (SAR MADRID), under which the organisations agreed to create joint working groups to improve critical patient care.Pain, discomfort, agitation, and delirium cause suffering, delay discharge, and can lead to serious complications in patients admitted to medical and surgical critical care units and post-anaesthesia care units. The main objectives in this type of unit include: Ensuring the comfort of patients suffering or recovering from a critical illness. Avoiding complications associated with the measures, particularly pharmacological, taken to ensure that comfort. (AU)
Asunto(s)
Humanos , Manejo del Dolor/métodos , Analgesia/métodos , Sedación Consciente/métodos , Unidades de Cuidados Intensivos , Delirio del Despertar/terapiaAsunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Analgésicos Opioides/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Pandemias , Síndrome Respiratorio Agudo Grave/terapia , Intubación Intratraqueal , Estudios Retrospectivos , Estudios de CohortesRESUMEN
Objectives To analyze clinical fatures associated to mortality in oncological patients with unplanned admission to the Intensive Care Unit (ICU), and to determine whether such risk factors differ between patients with solid tumors and those with hematological malignancies. Design An observational study was carried out. Setting A total of 123 Intensive Care Units across Spain. Patient All cancer patients with unscheduled admission due to acute illness related to the background oncological disease. Interventions None. Main variables Demographic parameters, severity scores and clinical condition were assessed, and mortality was analyzed. Multivariate binary logistic regression analysis was performed. Results A total of 482 patients were included: solid cancer (n=311) and hematological malignancy (n=171). Multivariate regression analysis showed the factors independently associated to ICU mortality to be the APACHE II score (OR 1.102; 95% CI 1.0641.143), medical admission (OR 3.587; 95% CI 1.3279.701), lung cancer (OR 2.98; 95% CI 1.485.99) and mechanical ventilation after the first 24h of ICU stay (OR 2.27; 95% CI 1.094.73), whereas no need for mechanical ventilation was identified as a protective factor (OR 0.15; 95% CI 0.090.28). In solid cancer patients, the APACHE II score, medical admission, antibiotics in the previous 48h and lung cancer were identified as independent mortality indicators, while no need for mechanical ventilation was identified as a protective factor. In the multivariate analysis, the APACHE II score and mechanical ventilation after 24h of ICU stay were independently associated to mortality in hematological cancer patients, while no need for mechanical ventilation was identified as a protective factor. Neutropenia was not identified as an independent mortality predictor in either the total cohort or in the two subgroups (AU)
Objetivos Determinar las características clínicas asociadas con la mortalidad en pacientes oncológicos ingresados de forma no programada en la UCI. También evaluamos si estos factores de riesgos difieren en los pacientes con neoplasias hematológicas o tumores sólidos. Diseño Estudio observacional. Ámbito Ciento veintitrés Unidades de Cuidados Intensivos en España. Pacientes Todos los pacientes con cáncer ingresados de forma no programada debido a una enfermedad aguda asociada con la enfermedad oncológica. Intervenciones Ninguna. Variables principales Las variables analizadas fueron los datos demográficos, escalas pronósticas de gravedad y el estado clínico del paciente. Se analizó la mortalidad y los factores relacionados con ésta. Se aplicó un análisis de regresión logística binaria multivariante. Resultados Se incluyó a un total de 482 pacientes: con tumores sólidos (n=331) y con neoplasias hematológicas (n=171). En el análisis de regresión multivariante, los factores asociados de manera independiente con la mortalidad en la UCI fueron la puntuación APACHE II (OR 1,102; IC del 95% 1,064-1,143), el ingreso médico (OR 3,587; IC del 95% 1,327-9,701), el cáncer de pulmón (OR 2,98, IC del 95% 1,48-5,99) y la ventilación mecánica tras las primeras 24h de ingreso en la UCI (OR 2,27; IC del 95% 1,09-4,73), mientras que la no necesidad de ventilación mecánica fue un factor protector (OR 0,15; IC del 95% 0,09-0,28). En el caso de los tumores sólidos, la puntuación APACHE II, el ingreso médico, la administración de antibióticos en las 48 h previas y el cáncer de pulmón fueron variables independientes relacionadas con la mortalidad, y la no necesidad de ventilación mecánica se identificó como un factor protector. En el análisis multivariante, la puntuación APACHE II y la ventilación mecánica al cabo de 24h desde el ingreso en la UCI se asociaron de manera independiente con mortalidad en pacientes con neoplasias hematológicas (AU)