[Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. / Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos.

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.

Crystalloids and colloids in critical patient resuscitation.

Fluid resuscitation is essential for the survival of critically ill patients in shock, regardless of the origin of shock. A number of crystalloids and colloids (synthetic and natural) are currently available, and there is strong controversy regarding which type of fluid should be administered and the potential adverse effects associated with the use of these products, especially the development of renal failure requiring renal replacement therapy. Recently, several clinical trials and metaanalyses have suggested the use of hydroxyethyl starch (130/0.4) to be associated with an increased risk of death and kidney failure, and data have been obtained showing clinical benefit with the use of crystalloids that contain a lesser concentration of sodium and chlorine than normal saline. This new information has increased uncertainty among clinicians regarding which type of fluid should be used. We therefore have conducted a review of the literature with a view to developing practical recommendations on the use of fluids in the resuscitation phase in critically ill adults.

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units.

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.

Early mobilisation algorithm for the critical patient. Expert recommendations.

INTRODUCTION: Intensive care unit (ICU)-acquired weakness is developed by 40%-46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term. OBJECTIVE: To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO). METHODOLOGY: Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions. RESULTS: 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each. CONCLUSIONS: The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it.

Management of temperature control in post-cardiac arrest care: an expert report. / Manejo con control de temperatura en los cuidados posparada cardiaca: documento de expertos.

Targeted temperature management (TTM) through induced hypothermia (between 32-36 oC) is currently regarded as a first-line treatment during the management of post-cardiac arrest patients admitted to the Intensive Care Unit (ICU). The aim of TTM is to afford neuroprotection and reduce secondary neurological damage caused by anoxia. Despite the large body of evidence on its benefits, the TTM is still little used in Spain. There are controversial issues referred to its implementation, such as the optimal target body temperature, timing, duration and the rewarming process. The present study reviews the best available scientific evidence and the current recommendations contained in the international guidelines. In addition, the study focuses on the practical implementation of TTM in post-cardiac arrest patients in general and cardiological ICUs, with a discussion of the implementation strategies, protocols, management of complications and assessment of the neurological prognosis.

Consensus Document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on Tracheotomy in Patients with COVID-19 Infection. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

[Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection. / Recomendaciones de consenso respecto al soporte respiratorio no invasivo en el paciente adulto con insuficiencia respiratoria aguda secundaria a infección por SARS-CoV-2.

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.

Optimization of the neurosurgical patient in Intensive Care. / Optimización del manejo del paciente neuroquirúrgico en Medicina Intensiva.

Neurosurgical patients frequently require admission to intensive care units, either for postoperative management or for treating complications. Most neurosurgical diseases require specific monitoring and prophylaxis. The basic principle of neurosurgical patient management is to ensure correct brain tissue perfusion, i.e., maintaining a sufficient blood flow to supply energy and oxygen to the brain parenchyma. In the last few years, several systems have been developed and improved for monitoring variables such as intracranial pressure, cerebral electrical activity (electroencephalography), cerebral blood flow, parenchymal oxygenation (tissue oxygen pressure) or locoregional metabolism (microdialysis). The present study provides an overview of the general management of neurosurgical patients and the main complications that may occur during the postoperative period. An interventional algorithm is also proposed to facilitate physician decisions, with the inclusion of multimodal neuromonitoring.

Application of a mindfulness program among healthcare professionals in an intensive care unit: Effect on burnout, empathy and self-compassion. / Aplicación de un programa de mindfulness en profesionales de un servicio de medicina intensiva. Efecto sobre el burnout, la empatía y la autocompasión.

OBJECTIVE: To evaluate the effect of a mindfulness training program on the levels of burnout, mindfulness, empathy and self-compassion among healthcare professionals in an Intensive Care Unit of a tertiary hospital. DESIGN: A longitudinal study with an intrasubject pre-post intervention design was carried out. SETTING: Intensive Care Unit of a tertiary hospital. PARTICIPANTS: A total of 32 subjects (physicians, nurses and nursing assistants) participated in the study. INTERVENTION: A clinical session/workshop was held on the practice of mindfulness and its usefulness. The possibility of following an 8-week training program with specifically designed short guided practices supported by a virtual community based on a WhatsApp group was offered. A weekly proposal in audio and text format and daily reminders with stimulating messages of practice were sent. MAIN MEASUREMENTS: Various psychometric measures were self-reported: burnout (MBI), mindfulness (FFMQ), empathy (Jefferson) and self-compassion (SCS), before and after the training program. Demographic and workplace variables were also compiled. RESULTS: Among the factors affecting burnout, the level of emotional exhaustion decreased (-3.78 points; P=.012), mindfulness levels measured by the FFMQ were not globally modified, though "observation" and "non-reacting" factors increased. Empathy was not modified, and self-compassion levels increased (3.7 points; P=.001). Satisfaction and program adherence levels were very high. CONCLUSIONS: In the population described, this program showed a decrease in emotional exhaustion and an increase in self-compassion -these being factors that can produce well-being and exert a positive impact upon burnout in this vulnerable group.

[Acute respiratory distress syndrome: incidence and course in a Spanish ICU]. / Síndrome de distrés respiratorio agudo: incidencia y evolución en una UCI española.

We have analyzed the 57 ARDS admitted at the Intensive Care Unit (ICU) of the Hospital General Vall d'Hebron of Barcelona in 1996 (the 5.7% of the ICU and the 0.18% of the hospital admission). We have studied the epidemiological characteristics, as well as their ICU complications and mortality. This year was the first to have nitric oxide (NO) as complementary treatment in the ARDS patients at our hospital. They were 42 males and 15 females, with a mean age of 60 years, APACHE II 21 and a lung injury score 3.1. The 87% of the patients need vasoactive drugs. The 47% need Swan-Ganz catheter to optimize the haemodynamic management. The 77% presented a multiple organ disfunction syndrome (MODS) and the 56% acute renal failure. The total mortality was 70%, basically due to MODS (68%), while due to hypoxemia only in the 22%. The group treated with NO (the 35% of the ARDS patients) were younger, without any other differences the patients who did not received this treatment and with the same stage and mortality. Patients who presented MODS, renal failure or hemodynamic unstableness presented a higher mortality (p < 0.05).