[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.

Effects of antibiotic administration delay and inadequacy upon the survival of septic shock patients.

OBJECTIVE: To assess how antibiotic administration delay and inadequacy influence survival in septic shock patients. DESIGN: A prospective, observational cohort study was carried out between September 2005 and September 2010. SCOPE: Patients admitted to the ICU of a third level hospital. PATIENTS: A total of 342 septic shock patients INTERVENTIONS: None VARIABLES OF INTEREST: The time to antibiotic administration (difference between septic shock presentation and first administered dose of antibiotic) and its adequacy (in vitro susceptibility testing of isolated pathogens) were determined. RESULTS: ICU and hospital mortality were 26.4% and 33.5%, respectively. The median delay to administration of the first antibiotic dose was 1.7h. Deceased patients received antibiotics significantly later than survivors (1.3±14.5h vs. 5.8±18.02h; P=.001). Percentage drug inadequacy was 12%. Those patients who received inadequate antibiotics had significantly higher mortality rates (33.8% vs. 51.2%; P=.03). The coexistence of treatment delay and inadequacy was associated to lower survival rates. CONCLUSIONS: Both antibiotic administration delay and inadequacy exert deleterious effects upon the survival of septic shock patients, independently of their characteristics or severity.

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.

[Severe lactic acidosis associated to metformin intoxication]. / Acidosis láctica grave asociada a intoxicación por metformina.

Metformin is a biguanide extensively used in the treatment of type II diabetes mellitus. Between the nocive effects of the metformin emphasizes tha lactic acidosis because of its low frecuency but potential severity. The diagnosis of the poisoning due to metformin is based on the coexistence of lactic acidosis and one or more of the risk factors. The development of lactic acidosis in metformin poisoning is associated to a range of 50-80% of mortality.

[Purulent pericarditis and pleural empyema due to Streptococcus pneumoniae]. / Pericarditis purulenta y empiema pleural por Streptococcus pneumoniae.

We present the case of a 59 year old woman with no previous clinical history of disease who was admitted in our ICU due to respiratory failure and hemodynamic instability. She was found to have purulent pericarditis due to Streptococcus pneumoniae, complicated by massive pericardial effusion and pleural empyema. A pericardial tap was performed unsuccessfully and finally pericardial effusion was evacuated by surgical drainage. Pleural empyema was also evacuated. She received antibiotic treatment and recovered with normalisation of heart function.

[External validation of the Risk Quantification of Early Outcome after Lung Transplantation scale]. / Validación externa de la escala Risk Quantification of Early Outcome After Lung Transplantation.

OBJECTIVE: To validate the "Risk Quantification of Early Outcome After Lung Transplantation" (RQLT) scale in a cohort of lung transplantation patients. DESIGN: The parameters included in the RQLT scale were recorded prospectively. PATIENT: A total of 74 lung transplant patients in the University Hospital Marquis of Valdecilla (Santander) were analyzed between September 2004 and March 2008. MAIN VARIABLES OF INTEREST: This was the association of the score on the RQLT scale with mortality at 30 days and prolonged ICU stay. The dependent variable of mortality at 30 days was adjustment of scale using the logistic regression model. Diagnostic efficacy was evaluated using the ROC curve and calibration of the system on the sample with the Hosmer and Lemeshow goodness of fit test. RESULTS: The 30-day mortality in lung transplant patients increases significantly as the RQLT score increases, with an odds ratio (OR) of 2.20 (1.24-3.93) for each point increase on the RQLT scale. The area under the ROC curve for 30-day mortality was 0.79 (0.68-0.88; P=0.01). The Hosmer and Lemeshow goodness of fit test described a value p=0.58. CONCLUSIONS: The RQLT scale is a useful tool as an indicator of 30-day mortality in transplant patients.

[Evaluation of the pre-operative exercise capacity as survival marker in the lung transplant recipients]. / Valoración de la capacidad preoperatoria al ejercicio como factor predictivo de supervivencia en enfermos sometidos a trasplante pulmonar.

OBJECTIVE: To make an independent evaluation of the capacity for exercise as a predictive factor in lung transplant recipients. DESIGN: Retrospective study. SCOPE: Lung transplant unit of the Intensive Care Unit (ICU) of a university hospital. PATIENTS: We analyzed 132 lung transplants in a total of 130 patients. The patients were monitorized up to June 18, 2005 or their death. VARIABLES OF INTEREST: An evaluation was made of their pre-operative exercise capacity with the 6-minute walking test (6MWT). Long-term survival in relationship with the walking test value was also assessed. The survival curves were estimated using the Kaplan-Meier method. Comparison between curves was made with the Log-Rank methods and the hazard ratios were estimated by Cox regression. RESULTS: The association between mortality and the walking test value showed a hazard ratio of 0.99 (95% CI: 0.99-1.00) per metric unit (meter), (p = 0.282). The patients were classified according to the distance covered in the 4 groups: group 1 (distance covered less than 100 meters), group II (distance covered between 101-200 meters), group III (distance covered between 201 and 300 meters) and group IV (distance greater than 301 meters). No significant differences were found when comparing the survival curves of the four groups (p = 0.709). The multivariant analysis also did not show any statistical significance. CONCLUSIONS: We do not believe that the distance covered in the 6MWT conducted in the study protocol in the lung transplant candidates is useful as a marker to predict long-term mortality in patients undergoing lung transplant.

[Recombinant factor VIIa (rFVIIa). Description of use in a cohort of critical patients and prognostic markers]. / Factor VIIa recombinante (rFVIIa). Descripción de uso en una cohorte de enfermos críticos y marcadores pronósticos.

OBJECTIVE: Describe and identify the factors associated with the survival of the patients who received treatment with rFVIIa in an Intensive Care Unit (ICU). DESIGN: Longitudinal, ambispective, observational, descriptive study in a series of clinical cases performed from July 20, 2004 to July 20, 2006. SCOPE: The study population included 16 hospitalized patients in the Intensive Medicine Department (ICU) of the Hospital Marqués de Valdecilla (Santander). PATIENTS: Inclusion criteria were: Patients who required rFVIIa at some time of their stay in the ICU. RESULTS: Hemodynamic improvement of the patients treated with rFVIIa in an ICU, within the first 3 hours of the infusion (evaluated by an increase of SBP > 20 mmHg and/or increase of DBP > 8 mmHg) was associated to greater survival. CONCLUSIONS: The present series of cases, with the disadvantage of its heterogeneity and the limited number of patients, stresses the role of hemodynamic improvement as a differentiating factor between those patients who survive and those who do not.