Hypercapnia from Physiology to Practice.

Acute hypercapnic ventilatory failure is becoming more frequent in critically ill patients. Hypercapnia is the elevation in the partial pressure of carbon dioxide (PaCO2) above 45 mmHg in the bloodstream. The pathophysiological mechanisms of hypercapnia include the decrease in minute volume, an increase in dead space, or an increase in carbon dioxide (CO2) production per sec. They generate a compromise at the cardiovascular, cerebral, metabolic, and respiratory levels with a high burden of morbidity and mortality. It is essential to know the triggers to provide therapy directed at the primary cause and avoid possible complications.

When to Use Antibiotics in COVID-19: A Proposal Based on Questions.

The COVID-19 pandemic has affected millions of people, including hundreds of deaths. The search for adequate treatments and interventions that influence poor prognostic factors and reduce mortality has led to excessive use of antibiotics based on the possible existence of bacterial co-infection. However, there is no evidence to justify the systematic use of antimicrobials in COVID-19. The recommendations seek to provide knowledge regarding treatment; standardizing a management algorithm requires validation in clinical trials and studies of greater methodological rigor.

Neuromuscular blocking agents in the intensive care unit.

Neuromuscular blocking agents (NMBA) are a controversial therapeutic option in the approach to the critically ill patient. They are not innocuous, and the available evidence does not support their routine use in the intensive care unit. If necessary, monitoring protocols should be established to avoid residual relaxation, adverse effects, and associated complications. This narrative review discusses the current indications for the use of NMBA and the different tools for monitoring blockade in the intensive care unit. However, expanding the use of NMBA in critical settings merits the development of prospective studies.

Effectiveness of CoronaVac and BNT162b2 COVID-19 mass vaccination in Colombia: A population-based cohort study.

Background: In February 2021, Colombia began mass vaccination against COVID-19 using mainly BNT162b2 and CoronaVac vaccines. We aimed to estimate vaccine effectiveness (VE) to prevent COVID-19 symptomatic cases, hospitalization, critical care admission, and deaths in a cohort of 796,072 insured subjects older than 40 years in northern Colombia, a setting with a high SARS-CoV-2 transmission. Methods: We identified individuals vaccinated between March 1st of 2021 and August 15th of 2021. We included symptomatic cases, hospitalizations, critical care admissions, and deaths in patients with confirmed COVID-19 as main outcomes. We calculated VE for each outcome from the hazard ratio in Cox proportionally hazards regressions (adjusted by age, sex, place of residence, diabetes, human immunodeficiency virus, cancer, hypertension, tuberculosis, neurological diseases, and chronic renal disease), with 95% confidence intervals (CI). Findings: A total of 719,735 insured participants of 40 and more years were followed. We found 21,545 laboratory-confirmed symptomatic COVID-19 among unvaccinated population, along with 2874 hospitalizations, 1061 critical care admissions, and 1329 deaths, for a rate of 207.2 per million person-days, 27.1 per million person-days, 10.0 per million person-days, and 12.5 per million person-days, respectively. We found CoronaVac was not effective for any outcome in subjects above 80 years old; but for people 40-79 years of age, we found two doses of CoronaVac reduced hospitalization (33.1%; 95% CI, 14.5-47.7), critical care admission (47.2%; 95% CI, 18.5-65.8), and death (55.7%; 95% CI, 32.5-70.0). We found BNT162b2 was effective for all outcomes in the entire population of subjects above 40 years of age, significantly declining for subjects ≥80 years. Interpretation: Two doses of either CoronaVac in population between 40 and 79 years of age, or BNT162b2 among vaccinated above 40 years old significantly reduced deaths of confirmed COVID-19 in a cohort of individuals from Colombia. Vaccine effectiveness for CoronaVac and BNT162b2 declined with increasing age. Funding: UK National Institute for Health Research, the European Union's Horizon 2020 research and innovation programme, and the Bill & Melinda Gates Foundation.

Intensive Care Unit Acquired Weakness Associated With Acute Severe Asthma.

Context: Neuromuscular complications in the intensive care unit (ICU) are frequent, multifactorial, and clinically difficult to recognize during their acute phase. The physical examination is the starting point for identification. Case Report: We present a patient with a history of poorly controlled asthma who was admitted to the ICU with status asthmaticus. After 4 days of being under ventilatory support, he developed muscle weakness. The diagnostic approach made it possible to establish myopathic and neurological compromise through electrophysiology studies. Conclusions: ICU-acquired weakness (ICUAW) can bring long-term consequences, early identification, and management, as well as preventive measures, are essential to minimize chronic disability and morbidity.

[Encephalitis as neurological complication due dengue]. / Encefalitis como complicación neurológica por dengue.

We present the case of a 32-year-old male, previously healthy, with a 5-day history of fever, frontal-occipital headache, retro-ocular pain, rash, petechiae, myalgia, arthralgia, and abdominal pain. Blood tests with leukopenia, severe thrombocytopenia, transaminitis, long clotting times. Severe dengue with associated coagulopathy was diagnosed, indicating transfer to ICU. Presents torpid evolution, altered state of consciousness, psychomotor agitation, and aggressiveness. Structural, ischemic-hemorrhagic alterations, bacterial and fungal infections were ruled out. Finally diagnosing dengue encephalitis, confirmed by DENV PCR in CSF. Support measures are provided with favorable evolution. Encephalitis is the most serious neurological complication after dengue virus infection.

Superdiseminadores durante la pandemia del SARS-CoV-2 en Cartagena, Colombia / Super-spreaders during SARS-CoV-2 pandemic in Cartagena, Colombia

Resumen Introducción: la diseminación de agentes infecciosos en una población puede ocurrir de forma homogénea o heterogénea. El SARS-CoV-2 tiene transmisión heterogénea por los superdiseminadores (SD, individuos con ciertas características que transmiten la infección a un 80% de la población expuesta). Objetivos: describir las características de los SD en los primeros casos de la COVID-19 en Cartagena, Colombia. Metodología: estudio de vigilancia epidemiológica realizado entre el 25 de febrero y el 20 de abril del 2020 por el Comité de infecciones de la clínica Gestión Salud y el Departamento Administrativo Distrital de Salud, a casos sospechosos, confirmados por RT-PCR para SARS-CoV-2 y contactos estrechos de casos confirmados de COVID-19. Resultados: en 30 días se confirmaron dos pacientes SD, 21 casos secundarios (10 y 11, cada uno) y dos terciarios. El 1er SD inició síntomas 48 horas después de la exposición, fue hospitalizado al séptimo día de iniciado los síntomas y falleció a las 72 horas de hospitalización. El 2do SD hospitalizado por cetoacidosis diabética, con posterior hallazgo de anosmia y disgeusia, permaneció en UCI un mes. De los casos secundarios, el 9,5% (2/21) fue hospitalizado en UCI, 47% (10/21) en sala general y 42% (9/21) estuvo en cuarentena. El 61% (14/23) de los contagiados fue personal de la salud. Conclusiones: los SD son importantes en la dinámica de transmisión de infecciones. El no reconocimiento o el diagnóstico errado en un paciente con infección por SARS-CoV-2, junto con la transferencia interhospitalaria, son las principales causas de la generación de un número desproporcionado de casos secundarios.

Summary Introduction: The dissemination of infectious agents in a population can occur both in a homogeneous or heterogeneous way. SARS-CoV-2 has heterogeneous transmission by superspreaders (SS) (people with certain characteristics that transmit the infection to 80% of the exposed population). Objective: To describe the characteristics of SS in the first cases of COVID-19 in Cartagena, Colombia. Methodology: Epidemiological surveillance study carried out in Cartagena from February 25 to April 20, 2020, by the infection committee of Clínica Gestión Salud and the administrative department of health, on suspected cases, confirmed by RT-PCR for SARS-CoV-2, and close contacts of those confirmed cases for coronavirus infection. Results: In 30 days, two SS patients were confirmed, 21 secondary cases (10 and 11, each one), and two tertiary cases. The 1st SS began symptoms 48 hours after exposure, he was hospitalized on the 7th day after symptoms began and died 72 hours after hospitalization. The 2nd SS hospitalized for diabetic ketoacidosis, with subsequent finding of anosmia and dysgeusia, remained in the ICU one month. Of the secondary cases, 9.5% (2/21) were hospitalized in the ICU, 47% (10/21) in the general ward and 42% (9/21) were quarantined. Sixty one percent (14/23) of those infected were from health personnel Conclusions: SS are important in the dynamics of transmission infectious diseases. Failure to identify or misdiagnosis a patient with COVID-19, together with hospital transfer, are the main causes of the generation of a disproportionate number of secondary cases.

Dynamics of dengue and SARS-COV-2 co-infection in an endemic area of Colombia.

Since the COVID-19 outbreak, millions of people have been infected with SARS-CoV-2 around the world. An area of epidemiological relevance is Latin America, tropical regions, due to the distribution of endemic diseases such as chikungunya, dengue (DENV), malaria, Zika virus, where febrile disease abounds. The early signs and symptoms of DENV and COVID-19 could be similar, making it a risk that patients may be wrongly diagnosed early during the disease. The problem increases since COVID-19 infection can lead to false positives in DENV screening tests. We present two cases of acute undifferentiated febrile syndrome that were diagnosed with SARS-CoV-2 and DENV co-infection, confirmed by ELISA and RT-PCR for both viral pathogens. The occurrence of simultaneous or overlapped infections can alter the usual clinical course, severity, or outcome of each infection. Therefore, epidemiological surveillance and intensified preparation for those scenarios must be considered, as well as further studies should be done to address cases of co-infection promptly to avoid major complications and fatal outcomes during the current pandemic. Other endemic tropical diseases should not be neglected.

Trombosis de seno venoso asociada con infección por SARS-CoV-2 / Cerebral venous thrombosis associated with SARS-Cov-2 infection

RESUMEN INTRODUCCION: La trombosis del seno venoso se considera una de las causas más infrecuentes de enfermedad cerebrovascular (ECV), prevalente en la edad joven. Suele tener un inicio insidioso, lo cual dificulta su diagnóstico y el inicio oportuno del tratamiento, y se encuentra asociada con múltiples factores de riesgo, incluyendo estados de hipercoagulabilidad, como en aquellos pacientes que cursan con infección por SARS-CoV-2. REPORTE DE CASO: Se presentan dos casos clínicos de pacientes con alteraciones neurológicas, diplopia y estatus epiléptico, en quienes se documentó por medio de la sintomatologia y de estudios imagenológicos, trombosis venosas extensas de localización infrecuente, se descartaron las principales etiologías asociadas, y el único nexo asociado fue la infección por SARS-CoV-2. Ambos pacientes recibieron tratamiento con anticoagulación parenteral, al que respondieron de forma exitosa, por lo cual se logró el alta posteriormente con anticoagulación oral. DISCUSIÓN: Es imprescindible el conocimiento de esta enfermedad, asociada con una alta sospecha diagnóstica, dadas sus manifestaciones clínicas variadas y su asociación cada vez más frecuente con infección por covid-19.

ABSTRACT INTRODUCTION: Venous sinus thrombosis is considered one of the most infrequent causes of cerebrovascular disease (CVD), prevalent in young people. It usually has an insidious onset which difficult its diagnosis and timely initiation of treatment and is associated with multiple risk factors including hypercoagulable states, as in those patients with SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection. CASE REPORT: The following are 2 clinical cases of patients with neurological alterations, diplopia, and status epilepticus, in whom extensive venous thrombosis of infrequent location was documented through symptomatology and imaging studies, ruling out the main associated etiologies, with the only associated nexus: SARS-CoV-2 infection. Both patients received treatment with parenteral anticoagulation, responding successfully and were subsequently discharged with oral anticoagulation. DISCUSSION: It is essential to be aware of this disease associated with a high diagnostic suspicion given its varied clinical manifestations and its increasingly frequent association with COVID-19 infection.

Encefalitis como complicación neurológica por dengue / Encephalitis as neurological complication due dengue

Resumen Se presenta el caso de un varón de 32 años, previamente sano, que consultó por fiebre de cinco días, cefalea, dolor retro-ocular, rash, petequias, mialgias, artralgias y dolor abdominal. Presentaba leucopenia, trombocitopenia intensa, transaminitis y tiempo de coagulación prolongado. Se diagnosticó un dengue grave con coagulopatía que requirió manejo en Unidad de Cuidados Intensivos. Evolucionó con alteración del estado de conciencia, agitación psicomotora y agresividad. Se descartaron alteraciones estructurales, isquémicohemorrágicas, infecciones bacterianas y micóticas. Se confirmó finalmente una encefalitis por dengue por una RPC para virus dengue positiva en LCR. Se brindaron medidas de soporte con una evolución favorable. La encefalitis es la complicación neurológica más grave tras la infección por virus del dengue.

Abstract We present the case of a 32-year-old male, previously healthy, with a 5-day history of fever, frontal-occipital headache, retro-ocular pain, rash, petechiae, myalgia, arthralgia, and abdominal pain. Blood tests with leukopenia, severe thrombocytopenia, transaminitis, long clotting times. Severe dengue with associated coagulopathy was diagnosed, indicating transfer to ICU. Presents torpid evolution, altered state of consciousness, psychomotor agitation, and aggressiveness. Structural, ischemic-hemorrhagic alterations, bacterial and fungal infections were ruled out. Finally diagnosing dengue encephalitis, confirmed by DENV PCR in CSF. Support measures are provided with favorable evolution. Encephalitis is the most serious neurological complication after dengue virus infection.

Alternativas para la sedación, analgesia, relajación y delirium en pacientes COVID-19. Revisión narrativa / Alternatives for sedation, analgesia, neuromuscular blockade and delirium in patients with COVID-19. A narrative review / Alternativas para sedação, analgesia, relaxamento e delírio em pacientes com COVID-19. Revisão narrativa

Resumen: En los últimos años, el mundo entero se vio enfrentado al manejo de pacientes con una patología totalmente nueva y desafiante en términos de su entendimiento fisiopatológico y estrategias de manejo, mientras que su tasa de contagio se incrementaba de manera importante. Se trata de la enfermedad COVID-19, originada por el virus SARS-CoV-2 y que puso en alerta a toda la humanidad. Por lo tanto, se presentaron grandes problemas de salud pública, incluyendo el desabastecimiento de medicamentos y recursos de primera línea para el control de la enfermedad, y en los pacientes críticos se afectó el manejo de soporte óptimo a medida que se superaba la compleja respuesta inmunológica, que terminaba afectando en sus primeros estadios el parénquima pulmonar, y según el estado fisiológico, mórbido y genético del huésped, generando una disfunción orgánica múltiple. En el presente documento se establecen las mejores alternativas para enfrentar un desabastecimiento de medicamentos asociados al abordaje integral de la analgosedación, prevención y manejo de delirium y abstinencia, así como la necesidad de relajación neuromuscular en cada una de las fases por las que atraviesa el paciente crítico hospitalizado en Unidades de Cuidado Intensivo con soporte respiratorio invasivo o no invasivo.

Abstract: In recent years, the entire world has been faced with the management of patients with a totally new and challenging pathology in terms of its pathophysiological understanding and management strategies, while its rate of infection was increased significantly. It is the COVID-19 disease, caused by the SARS-CoV-2 virus, and that put all of humanity on alert. Therefore, major public health problems arose, including shortages of medicines and first-line resources for disease control, and in critical patients, optimal support management was affected as the complex immune response was overcome, which ended up affecting the lung parenchymal in its early stages, and depending on the physiological, morbid and genetic state of the host, generating multiple organ dysfunction. This document establishes the best alternatives to face a shortage of medications associated with the comprehensive approach to analgesia and sedation, prevention and management of delirium and withdrawal, and the need for neuromuscular relaxation in each of the phases that critically hospitalized patients go through in Intensive Care Units with invasive or non-invasive respiratory support.

Resumo: Nos últimos anos, o mundo inteiro se deparou com o manejo de pacientes com uma patologia totalmente nova e desafiadora em termos de compreensão fisiopatológica e estratégias de manejo, enquanto sua taxa de contágio aumentava significativamente. Trata-se da doença COVID-19, causada pelo vírus SARS-CoV-2 que colocou toda a humanidade em alerta. Surgiram, assim, grandes problemas de saúde pública, incluindo a escassez de medicamentos e recursos de primeira linha para o controle da doença, em pacientes em estado crítico afetou-se o manejo do suporte ideal à medida que superavase a complexa resposta imune, que terminava afetando o parênquima pulmonar em seu estágio inicial, e dependendo do estado fisiológico, mórbido e genético do hospedeiro, gerando múltiplas disfunções orgânicas. Este documento estabelece as melhores alternativas para enfrentar a escassez de medicamentos associada à abordagem integral da analgesedação, prevenção e manejo do delirium e abstinência, e a necessidade de relaxamento muscular em cada uma das fases que atravessa o paciente em estado crítico internado na UTI com suporte respiratório invasivo ou não invasivo.

Pneumomediastinum and Pneumothorax Following Non-invasive Respiratory Support in Patients With Severe COVID-19 Disease.

The coronavirus disease-2019 (COVID-19) pandemic led to an increased number of patients with pneumothorax and pneumomediastinum owing to complications attributed to viral pneumonia regardless of the use of mechanical invasive ventilation and the elapsed time of infection. The pathophysiology remains unknown. However, the Macklin effect is shown as the most plausible mechanism along with possible barotrauma secondary to a high-flow nasal cannula and noninvasive mechanical ventilation. We present two cases of patients who developed pneumomediastinum and tension pneumothorax. One of the patients was studied during infection and the other after recovery. Both received appropriate and timely treatments with successful outcomes. It is important to be aware of these potentially fatal complications as early management can reduce the associated morbidity and mortality.

Changes in Oxygenation and Clinical Outcomes with Awake Prone Positioning in Patients with Suspected COVID-19 In Low-Resource Settings: A Retrospective Cohort Study.

INTRODUCTION: This study aimed to describe the use of awake prone positioning (APP) and conventional oxygen therapy (COT) in patients with suspected coronavirus disease (COVID-19) and respiratory failure in a limited-resource setting. METHODS: This was a retrospective cohort study of hospitalized patients aged ≥18 years old who were placed in an awake prone position due to hypoxemic respiratory failure and suspected COVID-19. The patients were selected from a tertiary center in Cartagena, Colombia, between March 1, 2020, and August 31, 2020. Demographic, clinical, and laboratory variables were collated, and all the variables were compared between the groups. RESULTS: The median age of the participants was 63 (IQR, 48.8-73) years (survivors: 59 [IQR, 43.568] years vs. non-survivors: 70 [IQR, 63-78] years, P ≤ .001). Of the 1470 patients admitted for respiratory symptoms, 732 (49.8%) were hospitalized for more than 24 h, and 212 patients developed respiratory failure and required COT and APP (overall hospital mortality, 34% [73/212]). The mean rank difference in PaO2/FiO2 before and after APP was higher in the survivors than in the non-survivors (201.1-252.6, mean rank difference = 51.5, P = .001 vs. 134.1-172.4, mean rank difference = 38.28, P = .24, respectively). CONCLUSION: While using COT in conjunction with APP can improve respiratory failure in patients with suspected COVID-19 in low-resource settings, persistent hypoxemia after APP can identify patients with higher mortality risk. More evidence is needed to establish the role of this strategy.

Lazarus Phenomenon: Return of Spontaneous Circulation After Cessation of Prolonged Cardiopulmonary Resuscitation in a Patient With COVID-19.

The pandemic caused by the SARS-CoV-2 or COVID-19 infection has had an unimaginable impact on health systems worldwide. Cardiorespiratory arrest remains a potentially reversible medical emergency that requires the performance of a set of maneuvers designed to replace and restore spontaneous breathing and circulation. Suspending cardiopulmonary resuscitation (CPR) usually corresponds to an ethical-clinical dilemma that the health professional in charge must assume. The "Lazarus phenomenon" is an unusual syndrome with a difficult pathophysiological explanation, defined as the spontaneous return of circulation in the absence of any life support technique or after the cessation of failed CPR maneuvers. We present the case of a 79-year-old patient hospitalized in the intensive care unit for septic shock of pulmonary origin associated with COVID-19 infection who presented cardiorespiratory arrest that required unsuccessful resuscitation maneuvers for 40 minutes, declared deceased. After 20 minutes of death, he presented a return to spontaneous circulation. The pathophysiological changes of the Lazarus phenomenon remind us of the limitations we have in determining when to end cardiopulmonary resuscitation and that its interruption must be approached with more caution, especially in the context of the COVID-19 pandemic.

New obstetric systemic inflammatory response syndrome criteria for early identification of high-risk of sepsis in obstetric patients.

OBJECTIVES: We aimed to establish new cut-off values for SIRS (Systemic Inflammatory Response Syndrome) variables in the obstetric population. METHODS: A prospective cohort study in pregnant and postpartum women admitted with systemic infections between December 2017 and January 2019. Patients were divided into three cohorts: Group A, patients with infection but without severe maternal outcomes (SMO); Group B, patients with infection and SMO or admission to the intensive care unit (ICU); and Group C, a control group. Outcome measures were ICU admission and SMO. The relationship between SIRS criteria and SMO was expressed as the area under the receiver operating characteristics curve (AUROC), selecting the best cut-off for each SIRS criterion. RESULTS: A total of 541 obstetric patients were enrolled, including 341 with infections and 200 enrolled as the reference group (Group C). The patients with infections included 313 (91.7%) in Group A and 28 (8.2%) in Group B. There were significant differences for all SIRS variables in Group B, compared with Groups A and C, but there were no significant differences between Groups A and C. The best cut-off values were the following: temperature 38.2 °C, OR 4.1 (1.8-9.0); heart rate 120 bpm, OR 2.9 (1.2-7.4); respiratory rate 22 bpm, OR 4.1 (1.6-10.1); and leukocyte count 16,100 per mcl, OR 3.5 (1.6-7.6). CONCLUSIONS: The cut-off values for SIRS variables did not differ between healthy and infected obstetric patients. However, a higher cut-off may help predict the population with a higher risk of severe maternal outcomes.

Determinantes de estancia prolongada de neonatos en una unidad de cuidados intensivos / Determinants of Prolonged Stay of Neonates in Intensive Care Unit / Determinantes de estadia prolongada de neonatos em uma unidade de cuidados intensivos

Resumen Objetivo : determinar los factores asociados con estancias prolongadas en uci neonatal. Materiales y métodos : estudio de tipo retrospectivo, de corte transversal, descriptivo y analítico a partir de los Registros Individuales de Prestación de Servicios (RIPS) y la facturación de una Empresa Prestadora de Servicios de Salud (EPS) de Colombia. Se estimó un modelo logístico binomial tomando como variable dependiente estancias prolongadas. Resultados : la mediana de la duración en estancia en uci de los 947 neonatos incluidos en el análisis fue de 3 días y una estancia promedio de 4.8 días (amplitud intercuartílica de 1-5 días). Respecto a los determinantes, la edad gestacional, el peso al nacer y la edad de la madre mantienen una relación inversa con la probabilidad de generar días estancias, residir en zonas urbanas y contar con un buen control prenatal se convierten en factores protectores. Conclusión : el control prenatal es una intervención eficiente y efectiva para la gestión del riesgo de la salud, así como disminuir los embarazos en las mujeres jóvenes (<18 años) y mayores (>35 años) cumplirían un papel fundamental en la reducción de estancias prolongadas en uci neonatal.

Abstract Objective : To determine the factors associated with prolonged stays in neonatal icu. Materials and Methods : This is a retrospective, cross-sectional, descriptive and analytical study based on the Individual Service Delivery Registries (RIPS) and the billing of a Health Services Provider Company (EPS) of Colombia. A binomial logistic model was estimated using prolonged stays as a dependent variable. Results : The median length of stay in the icu of the 947 neonates included in the analysis was three days with an average sojourn of 4.8 days (interquartile range of 1-5 days). Regarding the determinants: gestational age, birth weight and age of the mother, they have an inverse relationship with the probability of ge nerating stays, while living in urban areas and having accurate prenatal control become protective factors. Conclusion : Prenatal control is an efficient and effective intervention for managing health risk, also reducing pregnancies in young (<18 years) and older women (> 35 years) would play a key role in decreasing prolonged stays in neonatal icu.

Resumo Objetivo : determinar os fatores associados a estadias prolongadas na uci neonatal. Materiais e métodos : estudo de tipo retrospectivo, de corte transversal, descritivo e analítico a partir dos Registros Individuais de prestação de serviços (RIPS) e a faturação de uma Empresa Prestadora de Serviços de Saúde (EPS) da Colômbia. Se estimou um modelo logístico binomial tomando como variável dependente estadias pro longadas. Resultados : a mediana da duração em estadias na uci dos 947 neonatos incluídos na análise foi de 3 dias e uma estadia média de 4.8 dias (amplitude interquartílica de 1-5 dias). Respeito aos deter minantes, a idade gestacional, o peso ao nascer e a idade da mãe mantêm uma relação inversa com a probabilidade de gerar dias estadias, residir em zonas urbanas e contar com um bom controle pré-natal tornam-se em fatores protetores. Conclusão : o controle pré-natal é uma intervenção eficiente e efetiva para a gestão do risco da saúde, assim como diminuir as gravidezes nas mulheres jovens (<18 anos) e maiores (>35 anos) teriam um papel fundamental na redução de estadias prolongadas na uci neonatal.

Zika virus-induced neurological critical illness in Latin America: Severe Guillain-Barre Syndrome and encephalitis.

Zika virus (ZIKAV) is classically described as causing minor symptoms in adult patients, however neurologic complications have been recognized. The recent outbreak in Central and South America has resulted in serious illness in some adult patients. We report adult patients in Latin America diagnosed with ZIKAV infection admitted to Intensive Care Units (ICUs). METHODS: Multicenter, prospective case series of adult patients with laboratory diagnosis of ZIKAV in 16 ICUs in 8 countries. RESULTS: Between December 1st 2015 and April 2nd 2016, 16 ICUs in 8 countries enrolled 49 critically ill patients with diagnosis of ZIKAV infection. We included 10 critically ill patients with ZIKAV infection, as diagnosed with RT-PCR, admitted to the ICU. Neurologic manifestations concordant with Guillain-Barre Syndrome (GBS) were present in all patients, although 2 evolved into an encephalitis-like picture. 2 cases died, one due to encephalitis, the other septic shock. CONCLUSIONS: Differing from what was usually reported, ZIKAV infection can result in life-threatening neurologic illness in adults, including GBS and encephalitis. Collaborative reporting to identify severe illness from an emerging pathogen can provide valuable insights into disease epidemiology and clinical presentation, and inform public health authorities about acute care priorities.

Secuencia rápida de intubación en cuidados intensivos / Rapid sequence intubation in the intensive care unit

Introducción: El médico que trabaja en cuidados intensivos debe tener la habilidad para enfrentarse con éxito a los pacientes que necesitan aislamiento de la vía aérea debido a su pobre condición ventilatoria. El objetivo del presente artículo es revisar el estado actual del conocimiento en torno a la intubación de secuencia rápida en pacientes de la unidad de cuidados intensivos (UCI) y resumir lo que se debe hacer para reducir al máximo los riesgos durante la intubación de un paciente crítico. Métodos Revisión temática: Se realizó una búsqueda electrónica en las bases de datos PubMed, ScienceDirect, EBSCOhost, OvidSP y Scielo, sin limitar la búsqueda por fecha en inglés y español. Se incluyeron ensayos clínicos, metaanálisis, guías para la práctica, ensayos controlados aleatorizados, revisiones, reportes de casos, artículos clásicos, estudios comparativos, conferencias de consenso y clases magistrales. Se incluyeron artículos publicados sobre intubación, intubación de secuencia rápida e intubación en UCI cuyo tema central fuese el abordaje de la vía aérea con tubo orotraqueal del paciente crítico, y las estrategias para optimizar la maniobra. Resultados: La búsqueda arrojó 1.144 estudios. Se revisaron los resúmenes y se seleccionaron los que trataban sobre los criterios centrales de la revisión: protocolos de intubación para los pacientes de la UCI. Cincuenta monografías cumplieron los criterios de selección. Se hace una presentación resumida de los resultados y se propone una versión de intubación de secuencia rápida modificada a partir de la revisión hecha.

Introduction: The Intensive Care Unit (ICU) physician should have the skill to successfully manage patients requiring airway insulation on account of their poor ventilatory condition. The purpose of this article is to review the current knowledge regarding rapid sequence intubation in the ICU patients and to summarize the procedure to maximally reduce the risks of intubating a critical patient. Methods: Theme review. An e-search of databases was performed, including PubMed, ScienceDirect, EBSCOhost, OvidSP and Scielo, without limiting the search by date, in English and Spanish. Clinical trials, meta-analysis, practicing guidelines, randomized controlled trials, reviews, case reports, classical articles, comparative studies, consensus conferences, and keynote speeches. Published articles on intubation, rapid sequence intubation and ICU intubation were included, all focusing on orotracheal intubation of the critical patient and strategies for optimization of the maneuver. Results: The search yielded 1,144 studies. The abstracts were reviewed and those referring to the key review criteria were chosen: intubation protocols for ICU patients. Fifty monographs met the selection criteria. A summarized presentation of the results is made and an approach to a modified rapid sequence intubation is suggested, based on the review accomplished.