Frailty in severe COVID-19 survivors after ICU admission. A prospective and multicenter study in Mexico.

OBJECTIVE: To analyze the presence of frailty in survivors of severe COVID-19 admitted in the Intensive Care Unit (ICU) and followed six months after discharge. DESIGN: An observational, prospective and multicenter, nation-wide study. SETTING: Eight adult ICU across eight academic acute care hospitals in Mexico. PATIENTS: All consecutive adult COVID-19 patients admitted in the ICU with acute respiratory failure between March 8, 2020 to February 28, 2021 were included. Frailty was defined according to the FRAIL scale, and was obtained at ICU admission and 6-month after hospital discharge. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: The primary endpoint was the frailty status 6-months after discharge. A regression model was used to evaluate the predictors during ICU stay associated with frailty. RESULTS: 196 ICU survivors were evaluated for basal frailty at ICU admission and were included in this analysis. After 6-months from discharge, 164 patients were evaluated for frailty: 40 patients (20.4%) were classified as non-frail, 67 patients (34.2%) as pre-frail and 57 patients (29.1%) as frail. After adjustment, the need of invasive mechanical ventilation was the only factor independently associated with frailty at 6 month follow-up (Odds Ratio [OR] 3.70, 95% confidence interval 1.40-9.81, P = .008). CONCLUSIONS: Deterioration of frailty was reported frequently among ICU survivors with severe COVID-19 at 6-months. The need of invasive mechanical ventilation in ICU survivors was the only predictor independently associated with frailty.

Uso de bloqueadores neuromusculares en la paciente obstétrica crítica / Use of neuromuscular blockade in the crical obstetric patient

The use of neuromuscular blockers has spread over the last decade, reaching different scenarios such is the case of the obstetric patient, in whom their use both in the operating room and in the intensive care unit is considered one of the main challenges for the treating physician. As there is no recent bibliography on their correct use or their penetration through the placental barrier and the effect that these could have on the binomial. The analysis of the clinical situation, the choice and the correct use of these drugs is of vital importance to ensure maternal and fetal well-being. Therefore, an attempt will be made to answer the most frequent questions that could rise in these critical scenarios.

El uso de los bloqueadores neuromusculares se ha extendido durante la última década alcanzando distintos escenarios como es el caso de la paciente obstétrica, en quien su uso tanto en el quirófano como en la unidad de cuidados intensivos se considera uno de los principales retos para el médico tratante, al no contar con bibliografía reciente sobre el uso correcto de los mismos o su penetración a través de la barrera placentaria y el efecto que estos podrían tener sobre el binomio. El análisis de la situación clínica, la elección y el correcto uso de estos fármacos es de vital importancia para asegurar el bienestar materno y fetal. Por lo que, se intentara dar respuesta a las incógnitas más frecuentes que se podrían tener en estos escenarios críticos.

Acute symptomatic hyponatremia in a flight attendant.

Acute symptomatic hyponatremia after thiazide diuretic initiation is a medical emergency. Here we describe the case of a flight attendant who developed acute hyponatremia during a flight and the potential risk factors for developing this condition. A 57-year-old flight attendant with history of essential hypertension was recently started on a thiazide diuretic. As she did routinely when working, she increased her water intake during a flight from London to Mexico City. She complained of nausea and headache during the flight. Upon arrival, she developed severe disorientation and presented to the hospital emergency room (ER) with a Glasgow scale of 12, hypoxia, and a generalized tonic clonic seizure. Her laboratory results on arrival were consistent with severe hyponatremia (serum Na 116 mEql/L) and severe cerebral edema by CT scan. She was treated with hypertonic saline, with complete resolution of the neurologic symptoms. We describe high water intake and hypoxia related to decreased partial pressure of oxygen in the cabin as the two main risk factors for thiazide-induced acute hyponatremia in this case.