Mortality in patients with acquired human immunodeficiency virus infection hospitalized in an intensive care unit during the period 2017-2019.

Identify risk factors associated with mortality in HIV patients admitted to an ICU in the city of Bogotá. Retrospective cohort study of patients treated in an ICU during the years 2017-2019. The analysis included descriptive statistics, association tests, and a logistic regression model. A predictive model of mortality at the time of admission to the ICU was developed. 110 HIV patients were identified. Association was found between a Charlson index ≥ 6 and mortality (OR = 2.3, 95% CI 1.0-5.1) and an increase in mortality in the first 21 days of ICU stay (OR = 2.2, 95% CI 1.0-4.9). In the logistic regression analysis, the absence of highly active antiretroviral therapy (HAART) upon admission to the ICU (OR = 2.5 95% CI 1.0-6.1) and the first 21 days of ICU stay (OR = 2.3 95% CI 1.0-5.4) were associated with an increase in mortality. The predictive mortality model established that mortality was higher in patients admitted to the ICU without having previously received HAART than in those who did receive therapy at the time of admission to the ICU. In patients with HIV admitted to the ICU, the absence of HAART will negatively impact mortality during their hospital stay.

Impacto de la dispensación automatizada de medicamentos en la seguridad del paciente. Evidencia de una Unidad de Cuidado Crítico en Colombia

Objetivo: Determinar el impacto de la dispensación automatizada en la seguridad del paciente en una unidad de cuidado crítico y medir el tiempo de dispensación para conocer los efectos en la atención del paciente y los trabajadores de la salud. Metodología: Estudio retrospectivo observacional. La técnica fue documentar la dispensación tomando las bases de datos en el sistema tradicional y automatizado procesados en Microsoft Excel y medición del tiempo. Resultados: Con el sistema automatizado el uso de controles para el acceso en la dispensación de los medicamentos e insumos fue del 100 %. Y, el porcentaje de casos de problemas con el uso de medicamentos en el sistema tradicional fue de 0,38 y en el automatizado descendió a 0,007. Discusión: Pasar de manual a automatizado en la dispensación representa reducción del tiempo de un día a 22 segundos, el uso del 100 % de las alertas tecnológicas y la eficiencia en los procesos de dispensación reflejado por el 15,2 % de transacciones en el cargue de los dispositivos médicos y medicamentos. Conclusiones: La dispensación automatizada impacta en el paciente acortando el tiempo para que el medicamento sea administrado oportunamente, en los trabajadores este tiempo es una ventaja para invertir en los cuidados, el equipo de sistema automatizado adiciona controles que ayudan al doble chequeo en el alistamiento y cargue y la reducción de eventos adversos. Y, en la organización disminuye los eventos relacionados con roturas de envases, daño de empaques por la menor manipulación y disposición de medicamentos en gabinetes cerrados.

SUMMARY Objective: To determine the impact of automated dispensing on patient safety in a Critical Care Unit and measure the dispensing time to know the effects on patient care and health workers. Methodology: Retrospective observational study. The technique was to document the dispensing taking the databases in the traditional and automated system processed in Microsoft Excel and measuring time. Results: With the automated system, the use of controls for access in the dispensing of medicines and supplies was 100 %. And, the percentage of cases of problems with the use of medicines in the traditional system was 0.38 and in the automated system it fell to 0.007. Discussion: Going from manual to automated in the dispensing represents a reduction in time from one day to 22 seconds, the use of 100 % of technological alerts and the efficiency in the dispensing processes reflected by 15.2 % of transactions in the load of medical devices and drugs. Conclusions: Automated dispensing impacts on the patient by shortening the time for the medication to be administered in a timely manner, in workers this time is an advantage to invest in care, the automated system equipment adds controls that help the double check in the readiness and burden and reducing adverse events. And, in the organization it reduces the events related to container breakage, packaging damage due to less manipulation and disposal of medicines in closed cabinets.

Objetivo: Determinar o impacto da dispensação automatizada na segurança do paciente em um unidade de terapia intensiva e medir o tempo de dispensação para conhecer os efeitos no paciente cuidadores e trabalhadores da saúde. Metodologia: Estudo observacional retrospectivo. O técnica foi documentar a dispensação tomando os bancos de dados na forma tradicional e sistema automatizado processado em Microsoft Excel e medição de tempo. Resultados: Com o sistema automatizado, o uso de controles para acesso na dispensação de medicamentos e suprimentos foi de 100%. E, a porcentagem de casos de problemas com o uso de medicamentos no sistema tradicional foi de 0,38 e no sistema automatizado caiu para 0,007. Discussão : Passar de manual para automatizado na dispensação representa redução do tempo de um dia para 22 segundos, o uso de 100% de tecnologia alertas e a eficiência nos processos de dispensação refletida em 15,2% das transações na carga de dispositivos médicos e medicamentos. Conclusões: dispensação automatizada impactos no paciente, diminuindo o tempo para a medicação ser administrada em tempo hábil, nos trabalhadores este tempo é uma vantagem para investir no atendimento, a automatização equipamentos do sistema adicionam controles que auxiliam na dupla verificação da prontidão e sobrecarga e redução de eventos adversos. E, na organização, reduz o eventos relacionados à quebra de contêineres, danos à embalagem devido à menor manipulação e descarte de medicamentos em armários fechados.

Effect of High-Flow Oxygen Therapy vs Conventional Oxygen Therapy on Invasive Mechanical Ventilation and Clinical Recovery in Patients With Severe COVID-19: A Randomized Clinical Trial.

IMPORTANCE: The effect of high-flow oxygen therapy vs conventional oxygen therapy has not been established in the setting of severe COVID-19. OBJECTIVE: To determine the effect of high-flow oxygen therapy through a nasal cannula compared with conventional oxygen therapy on need for endotracheal intubation and clinical recovery in severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label clinical trial conducted in emergency and intensive care units in 3 hospitals in Colombia. A total of 220 adults with respiratory distress and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of less than 200 due to COVID-19 were randomized from August 2020 to January 2021, with last follow-up on February 10, 2021. INTERVENTIONS: Patients were randomly assigned to receive high-flow oxygen through a nasal cannula (n = 109) or conventional oxygen therapy (n = 111). MAIN OUTCOMES AND MEASURES: The co-primary outcomes were need for intubation and time to clinical recovery until day 28 as assessed by a 7-category ordinal scale (range, 1-7, with higher scores indicating a worse condition). Effects of treatments were calculated with a Cox proportional hazards model adjusted for hypoxemia severity, age, and comorbidities. RESULTS: Among 220 randomized patients, 199 were included in the analysis (median age, 60 years; n = 65 women [32.7%]). Intubation occurred in 34 (34.3%) randomized to high-flow oxygen therapy and in 51 (51.0%) randomized to conventional oxygen therapy (hazard ratio, 0.62; 95% CI, 0.39-0.96; P = .03). The median time to clinical recovery within 28 days was 11 (IQR, 9-14) days in patients randomized to high-flow oxygen therapy vs 14 (IQR, 11-19) days in those randomized to conventional oxygen therapy (hazard ratio, 1.39; 95% CI, 1.00-1.92; P = .047). Suspected bacterial pneumonia occurred in 13 patients (13.1%) randomized to high-flow oxygen and in 17 (17.0%) of those randomized to conventional oxygen therapy, while bacteremia was detected in 7 (7.1%) vs 11 (11.0%), respectively. CONCLUSIONS AND RELEVANCE: Among patients with severe COVID-19, use of high-flow oxygen through a nasal cannula significantly decreased need for mechanical ventilation support and time to clinical recovery compared with conventional low-flow oxygen therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04609462.