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Introduction: Heart failure is an extremely prevalent disease in the elderly population of the world. Most patients present signs and symptoms of decompensation of the disease due to worsening congestion. This congestion has been clinically assessed through clinical signs and symptoms and complementary imaging tests, such as chest radiography. Recently, pulmonary and inferior vena cava ultrasound has been shown to be useful in assessing congestion but its prognostic significance in elderly patients has been less well evaluated. Objectives: This study aims to compare the clinical and radiological characteristics and predictive values for mortality in patients admitted for heart failure through the determination of B lines by lung ultrasound and the degree of collapsibility of the inferior vena cava (IVC). Secondarily, the study aims to assess the prediction of 30-day mortality based on the diameter of the IVC by means of the ROC curve. Methods: This is an observational cohort study based on data collected in the PROFUND-IC study, a nationwide multicentric registry of patients admitted with decompensated heart failure. Data were collected from these patients between October 2020 and April 2022. Results: A total of 482 patients were entered into the PROFUND-IC registry between October 2020 and April 2022. Bedside clinical ultrasound was performed during admission in 301 patients (64.3%). The number of patients with more than 6 B-lines on lung ultrasound amounted to 194 (66%). Statistically significant differences in 30-day mortality (22.1% vs. 9.2%; p = 0.01) were found in these patients. The sum of patients with IVC collapsibility of less than 50% amounted to 195 (67%). Regarding prognostic value, collapsibility data were significant for the number of admissions in the last year (12.5% vs. 5.5%; p = 0.04), in-hospital mortality (10.1% vs. 3.3%, p = 0.04) and 30-day mortality (22.6% vs. 8.1%; p < 0.01), but not for readmissions. Regarding the prognostic value of IVC diameter for 30-day mortality, the area under the ROC curve (AUC) was 0.73, with a p < 0.01. The curve cut-off point with the highest sensitivity (70%) and specificity (70.3%) was for an IVC value of 22.5 mm. In the logistic regression analysis, we observed that the variable most associated with patient survival at 30 days was the presence of a collapsible inferior vena cava, with more than 50% OR 0.359 (CI 0.139−0.926; p = 0.034). Conclusions: The subgroups of patients analyzed with more than six B lines per field and IVC collapsibility less than or equal to 50%, as measured by clinical ultrasound, had higher 30-day mortality rates than patients who did not fall into these subgroups. IVC diameter may be a good independent predictor of 30-day mortality in patients with decompensated heart failure. Comparing both ultrasound variables, it seems that in our population, the assessment of the inferior vena cava may be more associated with short-term prognosis than the pulmonary congestion variables assessed by B lines.
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The value of serial lung ultrasound (LUS) in patients with COVID-19 is not well defined. In this multicenter prospective observational study, we aimed to assess the prognostic accuracy of serial LUS in patients admitted to hospital due to COVID-19. The serial LUS protocol included two examinations (0-48 h and 72-96 h after admission) using a 10-zones sequence, and a 0 to 5 severity score. Primary combined endpoint was death or the need for invasive mechanical ventilation. Calibration (Hosmer-Lemeshow test and calibration curves), and discrimination power (area under the ROC curve) of both ultrasound exams (SCORE1 and 2), and their difference (DIFFERENTIAL-SCORE) were performed. A total of 469 patients (54.2% women, median age 60 years) were included. The primary endpoint occurred in 51 patients (10.9%). Probability risk tertiles of SCORE1 and SCORE2 (0-11 points, 12-24 points, and ≥25 points) obtained a high calibration. SCORE-2 showed a higher discrimination power than SCORE-1 (AUC 0.72 (0.58-0.85) vs. 0.61 (0.52-0.7)). The DIFFERENTIAL-SCORE showed a higher discrimination power than SCORE-1 and SCORE-2 (AUC 0.78 (0.66-0.9)). An algorithm for clinical decision-making is proposed. Serial lung ultrasound performing two examinations during the first days of hospitalization is an accurate strategy for predicting clinical deterioration of patients with COVID-19.
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El modelo de atención de los cuidados paliativos ha demostrado evidencia prometedora de efectividad en la salud pública. El enfoque responde a la necesidad de equidad de atención independientemente de la edad, los antecedentes, el diagnóstico o la causa de muerte. El aumento de la población que requiere atención paliativa ha generado en el mundo nuevos desafíos para responder a las múltiples necesidades actuales. En esta nueva realidad surge una propuesta basada en la integración sin fisuras de cuatro componentes que interactúen en forma coordinada: cuidado paliativo especializado, cuidado paliativo generalista, comunidades compasivas y el enfoque cívico de la atención al final de la vida. En este marco Pallium Latinoamérica en convenio con la Fundación New Health desarrolla el programa "Buenos Aires, Ciudad Compasiva, Todos con vos". Somos una ONG conformada por un grupo interdisciplinario de la salud, que con la dirección del Dr. Gustavo De Simone ha inaugurado el primer pabellón compasivo de los hospitales del Gobierno de la Ciudad de Buenos Aires, ubicado en el Pabellón C, del Hospital de Gastroenterología "Dr. Carlos Bonorino Udaondo". Se ha adherido a la carta orgánica de propósitos de las Comunidades Compasivas con la "Declaración de principios de Ciudades que cuidan con compasión". Ha creado una Comisión de referentes expertos de la comunidad y diversas actividades que dan respuesta a las necesidades de su organización local y comunitaria. Entre otras: el Espacio Vital, dispositivo complementario de los tratamientos médicos, ¿y otros talleres como "Le dieron el alta y ahora qué?", y "Reciclo con amor" con la inclusión de alumnos de primer grado de un establecimiento educativo de la comunidad, actividades que se reseñan a continuación
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Humanos , Cuidados Paliativos , Organización Comunitaria , Empatía , Hospitales para Enfermos TerminalesRESUMEN
Documento producido por la Comisión de Trabajo Social de la Asociación Latinoamericana de Cuidados Paliativos, con el objetivo de sumar algunos conceptos y herramientas prácticas que surgen de la experiencia de los trabajadores sociales y de la bibliografía consultada, para brindar apoyo a quienes asisten a personas enfermas durante la enfermedad, la muerte y el duelo en contexto de Aislamiento, debido a la pandemia por COVID19. Se describe la situación social de cada país o ciudad de actuación, y se incluye material de interés para el seguimiento familiar en distintos escenarios de la pandemia.
