[Post-intensive care syndrome one month after hospital discharge of critical patients surviving COVID 19.] / Síndrome post-cuidados intensivos al mes del alta hospitalaria de pacientes críticos supervivientes a COVID 19.

OBJECTIVES: incidence of post-intensive care syndrome at one month after hospital discharge in surviving critically ill COVID 19 patients and to identify associated factors. DESIGN: prospective cohort study. SETTING: two multipurpose critical care units of the Araba University Hospital.Patients admitted to critical care units for severe acute respiratory failure secondary to COVID 19. INTERVENTION: none. VARIABLES OF INTEREST: demographic variables, length of stay, Charlson index, APACHE II, SOFA, days of mechanical ventilation, tracheotomy, delirium, tetraparesis of the critical patient, EuroQol 5D5L, Minimental Test. RESULTS: a deterioration in the EuroQol health index (HI) from 90.9 ± 16.9 to 70.9 ± 24.7 (p < 0.001) was observed. The impairment of the five EuroQol domains is: mobility (46.1%), usual activities (44.7%), discomfort/pain (30.7%), psychological domain (27.3%) and self-care (20.3%). The 61.5% suffer a significant decrease in their health index. Multivariate analysis by logistic regression shows us that delirium (OR= 3.01; 95%CI: 1.01-8.9; p= 0.047) and tracheostomy (OR= 2.37; 95%CI: 1.09-5.14; p= 0.029) show association with drop in EuroQoL 5D5L SI. The area under the ROC curve of the model is 67.3%, with a confidence interval between 58% and 76%. The model is calibrated using the Hosmer-Lemeshow test:(χ2=0.468; p=0.792). Only 1.2% of patients showed a score ≤ 24, clearly pathological, on the Folstein's Minimental Test. CONCLUSIONS: delirium and need for tracheostomy are associated with post-intensive care syndrome assessed by EuroQol 5D5L.

Post-intensive care syndrome one month after discharge in surviving critically ill COVID-19 patients.

OBJECTIVES: Incidence of post-intensive care syndrome at one month after hospital discharge in surviving critically ill COVID 19 patients and to identify associated factors. DESIGN: Prospective cohort study. SETTING: Two multipurpose critical care units of the Araba University Hospital. Patients admitted to critical care units for severe acute respiratory failure secondary to COVID 19. INTERVENTION: None. VARIABLES OF INTEREST: Demographic variables, length of stay, Charlson index, APACHE II, SOFA, days of mechanical ventilation, tracheotomy, delirium, tetraparesis of the critical patient, EuroQol 5D5L, Minimental Test. RESULTS: A deterioration in the EuroQol health index (HI) from 90.9±16.9 to 70.9±24.7 (p<0.001) was observed. The impairment of the five EuroQol domains is: mobility (46.1%), usual activities (44.7%), discomfort/pain (30.7%), psychological domain (27.3%) and self-care (20.3%). The 61.5% suffer a significant decrease in their health index. Multivariate analysis by logistic regression shows us that delirium (OR=3.01; 95%CI: 1.01-8.9; p=0.047) and tracheostomy (OR=2.37; 95%CI: 1.09-5.14; p=0.029) show association with drop in EuroQoL 5D5L SI. The area under the ROC curve of the model is 67.3%, with a confidence interval between 58% and 76%. The model is calibrated using the Hosmer-Lemeshow test (χ2=0.468; p=0.792). Only 1.2% of patients showed a score ≤ 24, clearly pathological, on the Folstein's Minimental Test. CONCLUSIONS: Delirium and need for tracheostomy are associated with post-intensive care syndrome assessed by EuroQol 5D5L.

[Variations in health-related quality of life in critical patients]. / Variaciones en la calidad de vida relacionada con la salud en los pacientes críticos.

OBJECTIVE: To determine the changes in the health-related quality of life (hRQOL) six months after discharge from the ICU and the conditions associated to them. DESIGN: A prospective cohort study. SETTING: 14 beds medical-surgical intensive care unit (ICU). PATIENTS: A total of 247 patients admitted to our ICU for more than 24 hours with a follow-up of 6 months were study. Those admitted with acute coronary syndrome or for monitoring purposes were excluded. INTERVENTION: A quality of life survey was conducted using the score developed by the PAEEC group (project of the epidemiological analysis of critical illness) to assess hRQOL before ICU admission and 6 months after discharge. RESULTS: The hRQOL deteriorated, going from a median value of 3 to 6 (p < 0.001). The multivariate analysis showed less deterioration of hRQOL in patients with chronic health conditions registered on the APAChE-II score (regression coefficient [RC] = -1.4; 95% CI, -2.5 to -0.2; p < 0.02) and in those with a hRQOL > or = 10 points (RC = -4,4; 95% CI, -5.9 to -2.8; p < 0.001). There was more deterioration in polytraumatized patients (RC = 1.9; 95% CI, 0.6-3.3; p = 0.01) or with renal failure (RC = 3.9; 95% CI, 1.9-5.9; p < 0.001) or in those with a stay duration longer than 10 days (RC = 1.9; 95% CI, 0.6-3.2; p < 0.001). CONCLUSIONS: Most patients experience deterioration of hRQOL. Patients with chronic diseases or with worst previous hRQOL who survive 6 months experience less deterioration of hRQOL than those who are polytraumatized or have renal failure or a longer ICU stay.

[Limitation of therapeutic effort after ICU admission. Analysis of related factors]. / Limitación del esfuerzo terapéutico tras el ingreso en una Unidad de Medicina Intensiva. Análisis de factores asociados.

OBJECTIVE: To analyze the limitation of therapeutic effort (LTE) in our Intensive Care Unit (ICU) and the variables associated with that decision. DESIGN: Prospective cohort study with a follow up of one year after discharge. SETTING: ICU of a second level hospital. PATIENTS: Four hundred and nine patients admitted during a two-year period. MAIN VARIABLES: APACHE II, NEMS, SOFA, quality of life (PAEEC) and mortality. RESULTS: LTE was performed in 49 (12%) patients. This decision was made by general agreement among the care team in 88% of cases and with the family in 73.5%. It was made on day 8 (4-20) with a SOFA score of 9 (4-13). Mortality in the LTE group was 69.4% in ICU, 92% in hospital, and 96% at 6 and 12 months. A logistic regression model showed that the variables associated with LTE were the following: NEMS score >or=30.7 (OR 12; 95% CI 3.7-39, p < 0.001), NEMS 26.6-30.6 (OR 8; 95% CI 2.5-25.6, p = 0.001), APACHE II > 30 (OR 7.6; 95% CI 2-29, p = 0.003), quality of life >or= 7 (OR 4.2; 95% CI 1.1-15, p = 0.03), age >or= 80 (OR 3.7, 95% CI 1.4-9.5, p = 0.007) and medical patient condition (OR 3.5; 95% CI 1.5-8, p = 0.003). CONCLUSIONS: LTE is a common practice and is usually performed among the care team and the patient's surrogates. The main variables associated with LSC are those related to the severity of illness, previous quality of life, medical disease and patient's age.

[Comparison of two electrode positions in electrical cardioversion of atrial fibrillation]. / Comparación de dos posiciones de electrodos en la cardioversión eléctrica de la fibrilación auricular.

OBJECTIVE: This study aims to compare effectiveness of electrical cardioversion (ECV) in patients with chronic atrial fibrillation (AF) according to the electrode positions: anteroapical (A-A) or anteroposterior (A-P). That which restores the sinus rhythm (SR) using the least energy is considered superior. DESIGN: Observational study comparing two consecutive series of patients. SCOPE. Intensive Care Unit (ICU) of second level hospital. PATIENTS AND METHODS: Out-patients in AF referred to the ICU for biphasic ECV. The first series began with position A-A and the second one with A-P, administering up to 3 shocks (150-200-200J), changing to the alternative position if SR was not achieved and administering 2 more shocks of 200J. Age, gender, weight, baseline heart disease, ejection fraction, left atrial size, AF time, baseline vital signs, antiarrhythmic medication, reversion to SR, number of shocks, energy used and side effects were analyzed and compared between both series. RESULTS. A total of 50 patients were treated in each group. The baseline characteristics were similar except for a greater percentage of women in group A-A. The anteroapical electrode position achieved SR with significantly fewer numbers of shocks and less energy, more frequently achieving reversion on the first shock. CONCLUSIONS: We found greater effectiveness in the electrical cardioversion of the AF with the electrodes in the anteroapical position, that we recommend as first choice. If it is not effective, the A-P position should be attempted.