[Burnout-related symptoms among Italian ICU's staff during the COVID-19 emergency. A multicentric survey study]. / Sintomi Burnout-correlati tra il personale sanitario italiano di Terapia Intensiva durante l'emergenza COVID-19. Indagine conoscitiva multicentrica.

AIM: to analyze the prevalence of Burnout defined by the MBI-GS among Italian Intensive Care (ICU) staff during the COVID-19 outbreak. METHOD: a multicentric study was conducted. A sample of 197 ICU health professionals (135 nurses and 62 physicians) participated in the study. Between 25 March and 15 May 2020, the Maslach Burnout Inventory-General Survey (MBI-GS) questionnaire was made available online by using the Google Forms platform in order to detect and measure the severity ofBurnout Syndrome (BOS). RESULTS: BOS-related symptoms (medium or high score) for individual MBI-GS domains have been identified in at least 69% of ICU healthcare professionals. Ninety-eight healthcare professionals (49.7%) had a moderate-high risk of emotional exhaustion, 108 (54.8%) ofdepersonalization, and 102 (51.8%) of reduced professional accomplishment. A high risk of emotional exhaustion, a moderate risk of depersonalization(56.3% vs 32.2%) and a moderate risk for reduced professional accomplishment (60.7% vs 24.2%) were observed among nursing staff. A strong association between increase in age and increase of the Burnout risk in ICU's staff was observed. CONCLUSIONS: the results suggest that ICU staff during the coronavirus pandemic, had high levels of work-related suffering and were at risk of physical and emotional exhaustion. However, further research should be undertaken to establish causal relationships between BOS and personal and environmental risk factors among healthcare professionals in relation to the COVID-19 outbreak.

Prevalence of Post Traumatic Stress Disorder, Anxiety and Depression among COVID-19 survivors 1 year after Intensive Care discharge.

BACKGROUND: Survivors of Intensive Care are known to be at increased risk of developing longer-term psychopathology issues. AIM: The aim of this study was to determine the prevalence of posttraumatic stress disorder, anxiety and depression among COVID-19 survivors 1 year after discharge from an Italian Intensive Care Unit (ICU). METHODS: We conducted a cross-sectional study between April and August 2021 among 86 adults COVID-19 survivors in Lecco (Italy). The PTSD was measured using the PTSD-checklist (PCL), HADS scale was used to measure anxiety and depression. Chi-square test or Fisher exact two-tailed tests were used to test for associations and the multiple logistic regressions model to determine factors that were independently associated with the outcome variables. RESULTS: The mean PTSD, anxiety and depression scores were (38.6 6.3), (5.1 3.8), (6.9 3.7) respectively. Based on cut-off scores, the prevalence of PTSD (PCL ≥ 45), anxiety (HADs score ≥ 8) and depression (HADs score ≥ 8) were (n = 20, 23.2%) (n = 22, 25.6%) and (n = 38, 44.2%) respectively. COVID-19 survivors who experienced a decreased level of exercise post-ICU discharge were more likely to show symptoms of depression (AOR = 2.57; 95%CI: 1.31-6.85, p = 0.027) and anxiety (AOR = 3.19; 95%CI: 1.29-8.32, p = 0.021) compared to those whose exercise remained the same post-ICU discharge. In addition Older COVID survivors were more likely to show symptoms of depression (AOR = 8.2, 95% CI: 1.97-24.45, p = 0.001) and anxiety (AOR = 3.26; 95%CI: 1.12-8.1, p = 0.022) compared to younger ones. CONCLUSIONS: Our findings show that PTSD, anxiety and depression are common among the COVID-19 survivors in Lecco. NURSING IMPLICATIONS: Nurses play a key role in the public health response to such crises, delivering direct patient care and reducing the risk of exposure to the infectious disease.

Co-infections in critically ill adults with severe acute respiratory syndrome coronavirus 2 infection: an Italian multi-center prospective study.

BACKGROUND: To date, few studies have described Hospital-acquired infections (HAIs) during COVID-19 outbreak. To examine the incidence of HAIs in critically ill adult patients with SARS-CoV-2 infection and to observe risk factors, and the impact on outcome of HAI. METHODS: A prospective multicenter study was conducted that included adult patients with SARS-CoV-2 infection admitted to 18 Italian Intensive Care Units from September 2020 to November 2021. RESULTS: A total of 589 patients were included. A total of 233 patients were diagnosed with at least one HAI (39.6%). The co-infection/co-colonization rate >48 hours after admission was 31.0 per 1000 person-days (95% CI 18.8-34.8). Age, length of ICU stay >7 days, obesity, type 2 diabetes mellitus, cardiovascular disease, inserted central venous catheter, intubation, APACHE II score >25, mechanical ventilation (MV) >48 hours, obesity and inserted urinary catheter are associated outcomes for infection acquisition. The overall mortality rate of patients was found to be significantly higher in patients who had acquired a HAI (RR=4.37; 95% CI 3.30-5.78; P<0.001). CONCLUSIONS: Associated factors for HAI acquisition and mortality in ICU patients were identified and cause for revision of existing infection control policies.

Potential benefits of using an energy-dense, high-protein formula enriched with ß-hydroxy-ß-methylbutyrate, fructo-oligosaccharide, and vitamin D for enteral feeding in the ICU: A pilot case-control study in COVID-19 patients.

OBJECTIVES: The aim of this study was to investigate the potential benefits of using an energy-dense, high-protein (HP) formula enriched with ß-hydroxy-ß-methylbutyrate (HMB), fructo-oligosaccharide (FOS), and vitamin D (VitD) for enteral feeding in the intensive care unit (ICU). METHODS: This was a nested case-control multicenter study. Mechanically ventilated patients with COVID-19 in whom enteral nutrition was not contraindicated and receiving an energy-dense, HP-HMB-FOS-VitD formula (1.5 kcal/mL; 21.5% of calories from protein; n = 53) were matched (1:1) by age (±1 y), sex, body mass index (±1 kg/m2) and Sequential Organ Failure Assessment score (±1 point) and compared with patients fed with a standard HP, fiber-free formula (1.25-1.3 kcal/mL; 20% of calories from protein; n = 53). The primary end point was daily protein intake (g/kg) on day 4. Protein-calorie intake on day 7, gastrointestinal intolerance, and clinical outcomes were addressed as secondary end points. RESULTS: The use of a HP-HMB-FOS-VitD formula resulted in higher protein intake on days 4 and 7 (P = 0.006 and P = 0.013, respectively), with similar energy intake but higher provision of calories from enteral nutrition at both times (P <0 .001 and P = 0.017, respectively). Gastrointestinal tolerance was superior, with fewer patients fed with a HP-HMB-FOS-VitD formula reporting at least one symptom of intolerance (55 versus 74%; odds ratio [OR], 0.43; 95% confidence interval [CI], 0.18-0.99; P = 0.046) and constipation (38 versus 66%; OR, 0.27; 95% CI, 0.12-0.61; P = 0.002). A lower rate of ICU-acquired infections was also observed (42 versus 72%; OR, 0.29; 95% CI, 0.13-0.65; P = 0.003), although no difference was found in mortality, ICU length of stay, and ventilation-free survival. CONCLUSIONS: An energy-dense, HP-HMB-FOS-VitD formula provided a more satisfactory protein intake and a higher provision of caloric intake from enteral nutrition than a standard HP formula in mechanically ventilated patients with COVID-19. Lower rates of gastrointestinal intolerance and ICU-acquired infections were also observed.

[Nosocomial infections during the COVID-19 outbreak. Observational study in an Italian ICU]. / Infezioni nosocomiali durante l'epidemia di COVID-19. Studio osservazionale in una Terapia Intensiva Italiana.

. Nosocomial infections during the COVID-19 outbreak. Observational study in an Italian ICU. INTRODUCTION: Infections are common among ICU patients. AIM: The purpose of this study is to examine the incidence of nosocomial infections among patients admitted to the ICU with SARS-CoV-2 infection. METHODS: A prospective observational study in adults with confirmed SARS-CoV-2 infection requiring intensive care unit (ICU) admission was performed. From May 2020 to October 2021, a total of 109 admitted patients were included. RESULTS: The incidence rate of new infections was 39.4%. The main infections observed were multidrug-resistant germs infections (39.5%), catheter-related blood infections(24.4%), pneumonia (VAP)(18.6%), and urinary tract infections (17.4%). The overall mortality rate was 32.1% (n= 35) and was significantly higher in patients who had a new infection during hospitalization (n= 26/43, 60.4%) than in patients who did not have a new infection (n= 9/66, 13.6%) (RR = 4.43; 95% CI = 2.31-8.52; p <.001). CONCLUSIONS: Our data suggest that secondary infections are associated with a longer duration of mechanical ventilation and hospital stay and may negatively impact patient survival. However, larger studies are needed.