Efficacy of the "Start to move" protocol on functionality, ICU-acquired weakness and delirium: A randomized clinical trial.

OBJECTIVE: To evaluate the efficacy of the Start to move protocol compared to conventional treatment in subjects over 15 years of age hospitalized in the ICU on an improvement in functionality, decrease in ICU-acquired weakness (DAUCI), incidence of delirium, days of mechanical ventilation (MV), length of stay in ICU and mortality at 28 days. DESIGN: randomized controlled clinical trial. SETTING: Intensive Care Unit. PARTICIPANTS: Includes adults older than 15 years with invasive mechanical ventilation more than 48h, randomized allocation. INTERVENTIONS: Start to move protocol and conventional treatment. MAIN VARIABLES OF INTEREST: Functionality, incidence of ICU-acquired weakness, incidence of delirium, days on mechanical ventilation, ICU stay and mortality-28 days, ClinicalTrials.gov number, NCT05053724. RESULTS: 69 subjects were admitted to the study, 33 to the Start to move group and 36 to conventional treatment, clinically and sociodemographic comparable. In the "Start to move" group, the incidence of IUCD at ICU discharge was 35.7% vs. 80.7% in the "conventional treatment" group (p=0.001). Functionality (FSS-ICU) at ICU discharge corresponds to 26 vs. 17 points in favor of the "Start to move" group (p=0.001). The difference in Barthel at ICU discharge was 20% in favor of the "Start to move" group (p=0.006). There were no significant differences in the incidence of delirium, days of mechanical ventilation, ICU stay and 28-day mortality. The study did not report adverse events or protocol suspension. CONCLUSIONS: The application of the "Start to move" protocol in ICU showed a reduction in the incidence of IUAD, an increase in functionality and a smaller decrease in Barthel score at discharge.

Loxoscelismo: revisión de la literatura a propósito de un caso / Loxoscelism: Literary review about a case

La mordedura de la araña de rincón es un motivo de consulta frecuente en los servicios de urgencia de Chile, que puede producir un cua-dro severo con manifestaciones cutáneas y sistémicas. En Chile, Loxocelles laeta se ubica principalmente desde la I a la VIII región, aunque se han reportado casos de loxocelismo en todo el país. El veneno de esta araña tiene efecto cutáneo-necrosante, hemolítico, vasculítico y coagulante. Podemos identificar 3 tipos de loxocelismo: cutáneo necrótico (80% de los casos), cutáneo edematoso (5%) y cutáneo visceral (10-15%). Este último tiene una letalidad entre 1 y 3% del total de casos de loxocelismo, la cual depende en gran parte de la precocidad de su diagnóstico y manejo oportuno. Se debe controlar cualquier tipo de loxocelismo durante las primeras 24 a 48 horas y vigilar la aparición de síntomas y signos sugerentes del cuadro visceral. No existe ningún examen de laboratorio que confirme el diagnóstico, los cuales sólo se alteran de modo marcado en los casos viscerales. El manejo de las lesiones cutáneas es con hielo local, antiinflamatorios, antihistamínicos y curaciones seriadas. En caso del loxocelismo visceral, el tratamiento principal es de soporte. La dapsona fue una indicación frecuente en el pasado y se asocia a efectos adversos graves, siendo el principal la exacerbación de la hemólisis, por lo que actualmente su uso no está recomendado. El suero anti-loxoceles no tiene evidencia que avale menor severidad ni mortalidad del cuadro.

The bite of the corner spider is a frequent reason for consultation in the emergency services of Chile, which can produce a severe reaction with cutaneous and systemic manifestations. In Chile, Loxocelles laeta is located mainly in the first to the eighth region, but cases of loxoscelism are reported throughout the country. The venom of this spider has cutaneous-necrotizing, hemolytic, vasculitic, and coagulant effects. Three types of loxoscelism can be identified, necrotic cutaneous (80% of cases), edematous cutaneous (5%), and visceral cutaneous (10-15%). The latter has a lethality between 1 and 3% of all cases of loxoscelism, which largely depends on the early diagnosis and timely management. Any loxoscelism should be controlled during the first 24 to 48 hours, and be alert to the appearance of symptoms and signs suggestive of visceral manifestations. There isn ́t any laboratory test to confirm the diagnosis. Laboratory tests are only markedly altered in visceral cases. The management of skin lesions is with local ice, NSAIDs, antihistamine and serial dressings. In the case of visceral loxoscelism, treatment begins with suspicion and early diagnosis. For these patients, the principal treatment is supportive care. Although it was recommended in the past, Dapsone is associated with severe adverse effects, like exacerbation of he-molysis, so its use is not currently recommended. The anti-loxocelles serum has no evidence to support less severity or mortality reduction.