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1.
Estima (Online) ; 19(1): e0521, jan.-dez. 2021.
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1178332

RESUMEN

Objetivo:relatar o caso de um paciente crítico com COVID-19 e mostrar os principais achados relacionados à lesão considerada Acute skin failure (ASF), bem como realizar seu diagnóstico diferencial com lesão por pressão (LP) evitável. Método: estudo observacional do tipo relato de caso, desenvolvido em um hospital de São Paulo, na unidade de terapia intensiva (UTI) exclusiva a pessoas diagnosticadas com COVID-19. Os dados foram coletados de um único paciente, entre os meses de março e setembro de 2020. Resultados: paciente com complicações da COVID-19 evoluiu com lesão de pele, inicialmente definida como LP e posteriormente reclassificada como ASF. Os seguintes achados corroboraram o diagnóstico: ventilação mecânica invasiva prolongada, insuficiências respiratória, renal e cardíaca e sepse de foco respiratório. Além disso, outros fatores agravantes, como o uso de droga vasoativa, instabilidade hemodinâmica com intolerância ao mínimo reposicionamento, jejum prolongado e coagulopatia intravascular disseminada associada à infecção pelo coronavírus. Conclusão: o relato mostra que existem dificuldades para o diagnóstico diferencial entre ASF e LP na prática clínica. Trata-se de conceito novo, sendo fundamental que o profissional de saúde reconheça os principais fatores associados ao aparecimento da ASF, muitos dos quais também estão relacionados ao desenvolvimento das LP, ressaltando a necessidade de análise individualizada dessas lesões, e garantia da implementação de intervenções adequadas para prevenção e tratamento.


Asunto(s)
Infecciones por Coronavirus , Úlcera por Presión , Unidades de Cuidados Intensivos , Atención de Enfermería
2.
Estima (Online) ; 19(1): e1121, jan.-dez. 2021.
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1280951

RESUMEN

Objetivos:identificar a incidência e caracterizar as lesões por pressão em unidade de terapia intensiva adulta quanto à ocorrência, locais e fatores de risco, e verificar se há associação entre esses e o surgimento das lesões. Método: estudo observacional, coorte, prospectivo, desenvolvido em unidade de terapia intensiva de hospital terciário, de outubro a dezembro de 2019. A população constitui-se de adultos em primeiro dia de internação na unidade, sem lesão por pressão na admissão. Os participantes foram acompanhados durante a internação e variáveis sociodemográficas e clínicas, assim como avaliação do risco de desenvolver lesão por pressão, avaliação da pele e escala de Braden foram coletadas diariamente. Empregaram-se testes de Qui-quadrado de Pearsone teste t de student para avaliar as relações entre variáveis e lesões. Para as análises foi considerado nível de significância (α) de 5%. Resultados: foram incluídos 40 participantes, 20% apresentaram lesão por pressão com predominância dos estágios 1 e 2; os principais locais afetados foram a região sacral seguida pelo calcâneo. O tempo médio de internação foi 23,38 dias para o grupo com lesão e 5,77 dias para o grupo sem lesão; o tempo apresentou relação significativa com o surgimento das lesões (p=0,002). Conclusão: conclui-se que o local mais acometido foi a região sacral e grau 1 o estadiamento mais frequente; o tempo de internação foi a variável que influenciou o surgimento de lesões.


Objectives:identify the incidence and characterize pressure injuries in an adult intensive care unit regarding the occurrence, locations and risk factors, and verify whether there is an association between these and the appearance of the injuries. Method: observational, cohort, prospective study, developed in an intensive care unit of a tertiary hospital, from October to December 2019. The population consists of adults on the first day of admission to the unit, without pressure injury at admission. Participants were monitored during hospitalization, sociodemographic and clinical variables, and risk assessment of developing a pressure injury, skin assessment and Braden scale were collected daily. Pearson's chi-square tests and student's t-test were used to assessing the relationship between variables and injuries. For the analyzes, a significance level (α) of 5% was considered. Results:40 participants were included, 20% had pressure injuries with a predominance of stages 1 and 2; the main affected sites were the sacral region followed by the calcaneus. The average hospital stay was 23.38 days for the injured group and 5.77 days for the non-injured group; time showed a significant relationship with the appearance of lesions (p = 0.002). Conclusion: it was concluded that the most affected site was the sacral region and grade 1 was the most frequent staging; length of stay was the variable that influenced the appearance of injuries.


Asunto(s)
Incidencia , Factores de Riesgo , Enfermería , Úlcera por Presión , Unidades de Cuidados Intensivos
3.
Praxis (Bern 1994) ; 110(9): 512-516, 2021 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-34231381

RESUMEN

COVID-19 in the Intensive Care Unit: Medical, Nursing, and Physical Therapy Challenges Abstract. The treatment of patients with COVID-19 is a big challenge for intensive care units: substantial additional staff and material is needed to treat the surge of patients admitted in short time. Treatment is difficult as many patients present with multiple organ failure, including acute respiratory distress syndrome (ARDS). Mostly, oxygenation is substantially impaired and compliance low, and many patients need prone positioning. This article deals with the difficulties during the first surge of patients with COVID-19. The suffering of the relatives who were not allowed to visit must also be considered.


Asunto(s)
COVID-19 , Síndrome de Dificultad Respiratoria , Humanos , Unidades de Cuidados Intensivos , Modalidades de Fisioterapia , Síndrome de Dificultad Respiratoria/terapia , SARS-CoV-2
4.
Cien Saude Colet ; 26(7): 2899-2910, 2021 Jul.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34231702

RESUMEN

The aim of this study was to analyze and assess the association between functional status (FS) and muscle strength (MS) in young adults, adults and older adults in an intensive care unit (ICU). We conducted a prospective cohort study with 48 patients. FS was assessed using the Functional Status Score for the Intensive Care Unit (FSS-ICU) and MS was measured using the Medical Research Council Sum-Score (MRC-SS) and by testing handgrip strength (HS). The assessments were performed on awakening and ICU discharge. The data were analyzed using the Kruskall-Wallis, chi-squared, Wilcoxon and Spearman's correlation tests. FS and MRC-SS scores were higher on ICU discharge in all groups. Gains were lowest in the older adult group. HS was greater in both hands on ICU discharge in all groups except the adults. FSS-ICU on both awakening and ICU discharge was highest in the adults; HS-R was lowest in the older adults. There was a strong association between FS and MS in the young adults and adults. FS and MS showed progressive improvement during ICU stay. Gains in FS and MS on awakening and ICU discharge were lowest among the older adults. Important associations were found between these variables in all groups except the older adults. This can be explained by the multifactorial nature of illness and incapacity in this group.


Asunto(s)
Estado Funcional , Fuerza de la Mano , Anciano , Humanos , Unidades de Cuidados Intensivos , Fuerza Muscular , Estudios Prospectivos , Adulto Joven
5.
Artículo en Inglés | MEDLINE | ID: mdl-34198849

RESUMEN

The COVID-19 pandemic had a massive impact on the Italian healthcare systems, which became overwhelmed, leading to an increased risk of psychological pressure on ICU workers. The present study aimed to investigate the prevalence of distress (anxiety, depression and insomnia symptoms), burnout syndrome and resilience in healthcare workers during the COVID-19 pandemic and to detect potential factors associated with their psychological response. This cross-sectional, survey-based study enrolled 136 healthcare workers assisting COVID-19 patients in the new COVID-19 ward (Intensive Care Unit), at Milano Fiera, Lombardy. Participants completed an online survey that comprised different validated and standardized questionnaires: Maslach Burnout Inventory (MBI), Resilience Scale for adults (RSA), Hospital Anxiety and Depression scale (HADS) and Insomnia Severity Index (ISI). Socio-demographic and work characteristics were also collected. Out of 136 ICU specialists, there were 84 nurses (62%) and 52 physicians (38%). Over half (60%) met the criteria for burnout, with nearly the same percentages among nurses and physicians. Nurses reported significantly higher scores of anxiety and insomnia levels. Forty-five percent of participants reported symptoms of depression (of whom 13.9% in the clinical range) and most of the staff showed moderate to high levels (82.4%) of resilience. The COVID-19 pandemic can have a significant impact on ICU staff. Effective interventions are needed to maintain healthcare professionals' mental health and relieve burnout. Follow-up and tailored procedures should be provided to alleviate the psychological burden in the frontline staff at highest risk.


Asunto(s)
Agotamiento Profesional , COVID-19 , Adulto , Agotamiento Profesional/epidemiología , Estudios Transversales , Depresión/epidemiología , Humanos , Unidades de Cuidados Intensivos , Italia/epidemiología , Pandemias , SARS-CoV-2
6.
Artículo en Inglés | MEDLINE | ID: mdl-34206179

RESUMEN

In early March 2020, Italy became the epicenter of the Coronavirus Disease 2019 (COVID-19) pandemic in Europe. A different organization of hospital units was required to take care of patients affected by acute respiratory failure caused by COVID-19. This study aimed to evaluate the prevalence of burnout in two sub-intensive care units (SICUs) of the COVID-19 hub center of the Lombardia region in Milan (Italy). All nurses and healthcare assistants working in the SICUs during June 2020 were included in the study. Burnout was assessed via the Maslach Burnout Inventory questionnaire. One hundred and five (84%) SICU staff participated in the study. The prevalence of high burnout for nurses and healthcare assistants was 61.9% for emotional exhaustion, 47.6% for depersonalization and 34.3% for personal accomplishment. Depersonalization was significantly more frequent in younger nurses (p = 0.009). Nurses were 4.5 times more likely to have burnout than healthcare assistants. Burnout was a common condition among healthcare workers operating in SICUs during the pandemic. Urgent actions are needed, especially for nurses, as well as preventive strategies for future pandemic scenarios.


Asunto(s)
Agotamiento Profesional , COVID-19 , Personal de Enfermería en Hospital , Personal de Enfermería , Agotamiento Profesional/epidemiología , Agotamiento Psicológico , Estudios Transversales , Europa (Continente) , Humanos , Unidades de Cuidados Intensivos , Italia/epidemiología , Pandemias , Prevalencia , SARS-CoV-2 , Encuestas y Cuestionarios , Centros de Atención Terciaria
7.
Nutrients ; 13(7)2021 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-34206813

RESUMEN

This study aimed to determine the relationships among hyperglycemia (HG), the presence of type 2 diabetes (T2D), and the outcomes of COVID-19. Demographic data, blood glucose levels (BG) measured on admission, and hospital outcomes of COVID-19 patients hospitalized at Boston University Medical Center from 1 March to 4 August 2020 were extracted from the hospital database. HG was defined as BG > 200 mg/dL. Patients with type 1 diabetes or BG < 70 mg/dL were excluded. A total of 458 patients with T2D and 976 patients without T2D were included in the study. The mean ± SD age was 56 ± 17 years and 642 (45%) were female. HG occurred in 193 (42%) and 42 (4%) of patients with and without T2D, respectively. Overall, the in-hospital mortality rate was 9%. Among patients without T2D, HG was statistically significantly associated with mortality, ICU admission, intubation, acute kidney injury, and severe sepsis/septic shock, after adjusting for potential confounders (p < 0.05). However, only ICU admission and acute kidney injury were associated with HG among patients with T2D (p < 0.05). Among the 235 patients with HG, the presence of T2D was associated with decreased odds of mortality, ICU admission, intubation, and severe sepsis/septic shock, after adjusting for potential confounders, including BG (p < 0.05). In conclusion, HG in the subset of patients without T2D could be a strong indicator of high inflammatory burden, leading to a higher risk of severe COVID-19.


Asunto(s)
COVID-19/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Hospitalización/estadística & datos numéricos , Hiperglucemia/epidemiología , Lesión Renal Aguda/epidemiología , Adulto , Anciano , Glucemia , Boston/epidemiología , COVID-19/mortalidad , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Intubación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SARS-CoV-2 , Sepsis/epidemiología , Índice de Severidad de la Enfermedad , Población Urbana/estadística & datos numéricos
8.
Nutrients ; 13(7)2021 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-34209229

RESUMEN

Background & Aims: SARS-CoV2 infection is associated with an increased risk of malnutrition. Although there are numerous screening and nutritional management protocols for malnutrition, only few studies have reported nutritional evolution after COVID-19. The objectives of this study were to describe the evolution of nutritional parameters between admission and 30 days after hospital discharge, and to determine predictive factors of poor nutritional outcome after recovery in adult COVID-19 patients. Methods: In this observational longitudinal study, we report findings after discharge in 91 out of 114 patients initially admitted for COVID-19 who received early nutritional management. Nutritional status was defined using GLIM criteria and compared between admission and day 30 after discharge. Baseline predictors of nutritional status at day 30 were assessed using logistic regression. Results: Thirty days after discharge, 28.6% of patients hospitalized for COVID-19 were malnourished, compared to 42.3% at admission. Half of malnourished patients (53%) at admission recovered a normal nutritional status after discharge. Weight trajectories were heterogeneous and differed if patients had been transferred to an intensive care unit (ICU) during hospitalization (p = 0.025). High oxygen requirement during hospitalization (invasive ventilation p = 0.016 (OR 8.3 [1.6-61.2]) and/or oxygen therapy over 5 L/min p = 0.021 (OR 3.2 [1.2-8.9]) were strong predictors of malnutrition one month after discharge. Conclusions: With early nutritional management, most patients hospitalized for COVID-19 improved nutritional parameters after discharge. These findings emphasize the importance of nutritional care in COVID-19 patients hospitalized in medicine departments, especially in those transferred from ICU.


Asunto(s)
COVID-19/dietoterapia , Hospitalización , Desnutrición/epidemiología , Estado Nutricional , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Unidades de Cuidados Intensivos , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Evaluación Nutricional , Terapia Nutricional/métodos , Terapia por Inhalación de Oxígeno/estadística & datos numéricos , Alta del Paciente , Factores de Riesgo , SARS-CoV-2 , Índice de Severidad de la Enfermedad
9.
Pol Merkur Lekarski ; 49(291): 176-181, 2021 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-34218234

RESUMEN

The Glasgow Coma Scale (GCS) is a widely adopted clinical scale which fails to assess a verbal component in intensive care units (ICUs) patients who are ventilated mechanically. AIM: The aim of the study was to evaluate the validity of the FOUR scale (Full Outline of UnResponsivness) when applied by staff of an ICU. MATERIALS AND METHODS: This prospective cohort study included 65 consecutive intubated patients treated in the ICU with brain damage. The study design included the simultaneous assessment of the patients' consciousness by two scales - the FOUR scale and the GCS. All assessments were made under strict inclusion and exclusion criteria. The patients were assessed by a randomly selected staff pairs (neurointensivist/ nurse, neurointensivist/resident, neurointensivist/neurointensivists). The assessments made by experienced neurointensivists were regarded as basic examinations and by other members as control examinations. The study design allowed for the assessment of the interrater reliability. RESULTS: In 65 enrolled patients, a total of 763 double assessments were made using the FOUR score and by the GCS. It has been shown that in 751 out of 763 assessments the patients' consciousness was accurately assessed, representing 98.43 % accuracy of the FOUR scale. In contrast, the patients' consciousness was reliably assessed by the GCS in only 88 assessments, representing 11.5 % of accuracy. CONCLUSIONS: The study showed excellent interrater reliability among the groups of examiners for the FOUR scale as well as the GCS. The main advantage of the FOUR scale in intubated patients is excellent accuracy. The FOUR scale is easy to learn. It is functional and it has no limitations typical of verbal scales. It is a valuable and recommended clinical tool for the assessment of consciousness of the ICU patients.


Asunto(s)
Estado de Conciencia , Unidades de Cuidados Intensivos , Humanos , Variaciones Dependientes del Observador , Estudios Prospectivos , Reproducibilidad de los Resultados
10.
Front Endocrinol (Lausanne) ; 12: 644055, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34220703

RESUMEN

Objective: We aimed to measure insulin-like growth factor 1 (IGF1) and growth hormone (GH) in critically and non-critically ill patients with Covid-19 and assess them vis-a-vis clinical and laboratory parameters and prognostic tools. Subjects and Methods: We included patients who were admitted to the wards or the ICU of the largest Covid-19 referral hospital in Greece; patients with non-Covid-19 pneumonia served as controls. Apart from the routine laboratory work-up for Covid-19 we measured GH and IGF1 (and calculated normalized IGF-1 values as standard deviation scores; SDS), after blood sampling upon admission to the wards or the ICU. Results: We studied 209 critically and non-critically ill patients with Covid-19 and 39 control patients. Patients with Covid-19 who were ICU non-survivors were older and presented with a worse hematological/biochemical profile (including white blood cell count, troponin, glucose, aminotransferases and lactate dehydrogenase) compared to ICU survivors or Covid-19 survivors in the wards. Overall, IGF-1 SDS was higher in Covid-19 survivors compared to non-survivors (-0.96 ± 1.89 vs -2.05 ± 2.48, respectively, p=0.030). No significant differences were noted in GH between the groups. Nevertheless, in critically ill patients with Covid-19, the prognostic value of IGF-1 (raw data), IGF-1 (SDS) and GH for survival/non-survival was on a par with that of APACHE II and SOFA (with a marginal difference between GH and SOFA). Conclusion: In conclusion, our findings suggest that there might be an association between low IGF1 (and possibly GH) and poor outcome in patients with Covid-19.


Asunto(s)
COVID-19/metabolismo , COVID-19/patología , Enfermedad Crítica , Hormona de Crecimiento Humana/metabolismo , Factor I del Crecimiento Similar a la Insulina/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/diagnóstico , COVID-19/mortalidad , Estudios de Casos y Controles , Enfermedad Crítica/mortalidad , Femenino , Grecia/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pronóstico , SARS-CoV-2/fisiología , Índice de Severidad de la Enfermedad , Sobrevivientes/estadística & datos numéricos
11.
BMJ Case Rep ; 14(7)2021 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-34226255

RESUMEN

Vascular Ehlers-Danlos syndrome is caused by mutations of COL3A1 gene coding for type III collagen. The main clinical features involve a propensity to arterial tears leading to several life-threatening conditions and intensive care unit admission. We, herein, report the case of a 34-year-old woman presenting with an aneurysmal subarachnoid haemorrhage. Endovascular coil treatment was attempted; however, the procedure was complicated by dissection of the left iliac artery and abdominal aorta. Hospital management was marked by a series of vascular and haemorrhagic complications. These events, together with some distinctive physical features and medical history, raised the suspicion of vascular type of Ehlers-Danlos syndrome. Neurological evolution was not favourable, and the patient evolved to brain death. Genetic testing was available postmortem and identified a mutation in the COL3A1 gene. This case illustrates the importance of medical history and clinical suspicion for diagnosis, which often goes unnoticed until major complications occur.


Asunto(s)
Síndrome de Ehlers-Danlos , Hemorragia Subaracnoidea , Adulto , Colágeno Tipo III/genética , Síndrome de Ehlers-Danlos/complicaciones , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/genética , Femenino , Pruebas Genéticas , Humanos , Unidades de Cuidados Intensivos , Mutación , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/etiología
12.
BMJ Case Rep ; 14(7)2021 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-34226257

RESUMEN

Ventilator-associated pneumonia (VAP) is one of the leading cause of mortality and morbidity in critically ill patients on mechanical ventilation. We report a case of VAP caused by Providencia rettgeri in a postoperative 58-year-old man with prepyloric perforation. The patient's ICU stay was complicated by VAP. As the organism was carbapenem resistant, high-dose extended infusion of meropenem along with cefepime was started. Early identification and treatment helped in successful weaning of the patient from the ventilator. Providencia is an emerging nosocomial pathogen with an increase in resistance pattern. This case highlights the rarity and importance of Providencia as a cause of VAP.


Asunto(s)
Neumonía Asociada al Ventilador , Providencia , Carbapenémicos/uso terapéutico , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Neumonía Asociada al Ventilador/tratamiento farmacológico , Ventiladores Mecánicos
13.
Nutrients ; 13(6)2021 Jun 09.
Artículo en Inglés | MEDLINE | ID: mdl-34207873

RESUMEN

BACKGROUND AND AIMS: Vitamin D inadequacy may be involved in the mechanisms of SARS-CoV-2 infection and in potential risk factors for disease propagation or control of coronavirus disease 2019 (COVID-19). This study assessed a short-term evolution of vitamin D status and its influence upon different clinical parameters in critically ill patients with COVID-19. METHODS: A prospective analytical study in which 37 critically ill volunteers between 41 and 71 years of age with COVID-19 were evaluated at baseline and three days of intensive care unit (ICU) stay. 25-OH-D3 and 25-OH-D2 were analyzed by liquid chromatography-tandem mass spectrometry and total 25-OH-D levels were calculated as the sum of both. RESULTS: All patients presented low 25-OH-D levels at baseline, decreasing total 25-OH-D (p = 0.011) mainly through 25-OH-D2 (p = 0.006) levels during ICU stay. 25-OH-D2 levels decreased a mean of 41.6% ± 89.6% versus 7.0% ± 23.4% for the 25-OH-D3 form during the ICU stay. Patients who did not need invasive mechanical ventilation presented higher levels of 25-OH-D2 at baseline and follow-up. Lower 25-OH-D and 25-OH-D3 levels were associated with higher D-dimer at baseline (p = 0.003; p = 0.001) and at follow up (p = 0.029), higher procalcitonin levels (p = 0.002; p = 0.018) at follow up, and lower percentage lymphocyte counts (p = 0.044; p = 0.040) during ICU stay. CONCLUSIONS: Deficient vitamin D status in critical patients was established at the admission and further worsened after three days of stay. Lower vitamin D levels were related to key altered clinical and biochemical parameters on patients with SARS-CoV-2 infection. Given the different response of the 25-OH-D3 and 25-OH-D2 forms, it would be useful to monitor them on the evolution of the critically ill patient.


Asunto(s)
COVID-19 , Enfermedad Crítica , Hospitalización , Unidades de Cuidados Intensivos , Índice de Severidad de la Enfermedad , Deficiencia de Vitamina D/complicaciones , Vitamina D/sangre , Anciano , COVID-19/sangre , COVID-19/diagnóstico , COVID-19/mortalidad , Cromatografía Liquida , Progresión de la Enfermedad , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Humanos , Masculino , Espectrometría de Masas , Persona de Mediana Edad , Polipéptido alfa Relacionado con Calcitonina/sangre , Pronóstico , Estudios Prospectivos , SARS-CoV-2 , Deficiencia de Vitamina D/sangre
14.
Mayo Clin Proc ; 96(7): 1718-1726, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34218854

RESUMEN

OBJECTIVE: To determine the difference in the rate of thromboembolic complications between hospitalized coronavirus disease 2019 (COVID-19)-positive compared with COVID-19-negative patients. PATIENTS AND METHODS: Adult patients hospitalized from January 1, 2020, through May 8, 2020, who had COVID-19 testing by polymerase chain reaction assay were identified through electronic health records across multiple hospitals in the Mayo Clinic enterprise. Thrombotic outcomes (venous and arterial) were identified from the hospital problem list. RESULTS: We identified 3790 hospitalized patients with COVID-19 testing across 19 hospitals, 102 of whom had positive test results. The median age was lower in the COVID-positive patients (62 vs 67 years; P=.03). The median duration of hospitalization was longer in COVID-positive patients (8.5 vs 4 days; P<.001) and more required intensive care unit care (56.9% [58 of 102] vs 26.8% [987 of 3688]; P<.001). Comorbidities, including atrial fibrillation/flutter, heart failure, chronic kidney disease, and malignancy, were observed less frequently with COVID-positive admissions. Any venous thromboembolism was identified in 2.9% of COVID-positive patients (3 of 102) and 4.6% of COVID-negative patients (168 of 3688). The frequency of venous and arterial events was not different between the groups. The unadjusted odds ratio (OR) for COVID-positive-patients for any venous thromboembolism was 0.63 (95% CI, 0.19 to 2.02). A multivariable logistic regression model evaluated death within 30 days of hospital discharge; neither COVID positivity (adjusted OR, 1.12; 95% CI, 0.54 to 2.34) nor thromboembolism (adjusted OR, 0.90; 95% CI, 0.60 to 1.32) was associated with death. CONCLUSION: Early experience in patients with COVID-19 across multiple academic and regional hospitals representing different US regions demonstrates a lower than previously reported incidence of thrombotic events. This incidence was not higher than a contemporary COVID-negative hospitalized comparator.


Asunto(s)
COVID-19/complicaciones , Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , SARS-CoV-2 , Trombosis/etiología , Anciano , COVID-19/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Trombosis/epidemiología , Estados Unidos/epidemiología
16.
Medicine (Baltimore) ; 100(27): e26494, 2021 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-34232182

RESUMEN

ABSTRACT: This retrospective study aimed to describe the association between the "ß-lactam allergy" labeling (BLAL) and the outcomes of a cohort of intensive care unit (ICU) patients.Retrospective cohort study.Seven ICU of the Aix Marseille University Hospitals from Marseille in France.We collected the uses of the label "ß-lactam allergy" in the electronic medical files of patients aged 18 years or more who required more than 48 hours in the ICU with mechanical ventilation and/or vasopressors admitted to 7 ICUs of a single institution.We retrospectively compared the patients with this labeling (BLAL group) with those without this labeling (control group).The primary outcome was the duration of ICU stay. Among the 7146 patients included in the analysis, 440 and 6706 patients were classified in the BLAL group and the control group, respectively. The prevalence of BLAL was 6.2%. In univariate and multivariate analyses, BLAL was weakly or not associated with the duration of ICU and hospital stays (respectively, 6 [3-14] vs 6 [3-14] days, standardized beta -0.09, P = .046; and 18 [10-29] vs 15 [8-28] days, standardized beta -0.09, P = .344). In multivariate analysis, the ICU and 28-day mortality rates were both lower in the BLAL group than in the control group (aOR 0.79 95% CI [0.64-0.98] P = .032 and 0.79 [0.63-0.99] P = .042). Antibiotic use differed between the 2 groups, but the outcomes were similar in the subgroups of septic patients in the BLAL group and the control group.In our cohort, the labeling of a ß-lactam allergy was not associated with prolonged ICU and hospital stays. An association was found between the labeling of a ß-lactam allergy and lower ICU and 28-day mortality rates.Trial registration: Retrospectively registered.


Asunto(s)
Cuidados Críticos/métodos , Hipersensibilidad/etiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , beta-Lactamas/efectos adversos , Femenino , Estudios de Seguimiento , Francia/epidemiología , Mortalidad Hospitalaria/tendencias , Humanos , Hipersensibilidad/epidemiología , Hipersensibilidad/terapia , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia/tendencias
17.
Artículo en Inglés | MEDLINE | ID: covidwho-1282497

RESUMEN

In early March 2020, Italy became the epicenter of the Coronavirus Disease 2019 (COVID-19) pandemic in Europe. A different organization of hospital units was required to take care of patients affected by acute respiratory failure caused by COVID-19. This study aimed to evaluate the prevalence of burnout in two sub-intensive care units (SICUs) of the COVID-19 hub center of the Lombardia region in Milan (Italy). All nurses and healthcare assistants working in the SICUs during June 2020 were included in the study. Burnout was assessed via the Maslach Burnout Inventory questionnaire. One hundred and five (84%) SICU staff participated in the study. The prevalence of high burnout for nurses and healthcare assistants was 61.9% for emotional exhaustion, 47.6% for depersonalization and 34.3% for personal accomplishment. Depersonalization was significantly more frequent in younger nurses (p = 0.009). Nurses were 4.5 times more likely to have burnout than healthcare assistants. Burnout was a common condition among healthcare workers operating in SICUs during the pandemic. Urgent actions are needed, especially for nurses, as well as preventive strategies for future pandemic scenarios.


Asunto(s)
Agotamiento Profesional , COVID-19 , Personal de Enfermería en Hospital , Personal de Enfermería , Agotamiento Profesional/epidemiología , Agotamiento Psicológico , Estudios Transversales , Europa (Continente) , Humanos , Unidades de Cuidados Intensivos , Italia/epidemiología , Pandemias , Prevalencia , SARS-CoV-2 , Encuestas y Cuestionarios , Centros de Atención Terciaria
18.
Artículo en Inglés | MEDLINE | ID: covidwho-1259491

RESUMEN

The COVID-19 pandemic had a massive impact on the Italian healthcare systems, which became overwhelmed, leading to an increased risk of psychological pressure on ICU workers. The present study aimed to investigate the prevalence of distress (anxiety, depression and insomnia symptoms), burnout syndrome and resilience in healthcare workers during the COVID-19 pandemic and to detect potential factors associated with their psychological response. This cross-sectional, survey-based study enrolled 136 healthcare workers assisting COVID-19 patients in the new COVID-19 ward (Intensive Care Unit), at Milano Fiera, Lombardy. Participants completed an online survey that comprised different validated and standardized questionnaires: Maslach Burnout Inventory (MBI), Resilience Scale for adults (RSA), Hospital Anxiety and Depression scale (HADS) and Insomnia Severity Index (ISI). Socio-demographic and work characteristics were also collected. Out of 136 ICU specialists, there were 84 nurses (62%) and 52 physicians (38%). Over half (60%) met the criteria for burnout, with nearly the same percentages among nurses and physicians. Nurses reported significantly higher scores of anxiety and insomnia levels. Forty-five percent of participants reported symptoms of depression (of whom 13.9% in the clinical range) and most of the staff showed moderate to high levels (82.4%) of resilience. The COVID-19 pandemic can have a significant impact on ICU staff. Effective interventions are needed to maintain healthcare professionals' mental health and relieve burnout. Follow-up and tailored procedures should be provided to alleviate the psychological burden in the frontline staff at highest risk.


Asunto(s)
Agotamiento Profesional , COVID-19 , Adulto , Agotamiento Profesional/epidemiología , Estudios Transversales , Depresión/epidemiología , Humanos , Unidades de Cuidados Intensivos , Italia/epidemiología , Pandemias , SARS-CoV-2
20.
S Afr Fam Pract (2004) ; 63(1): e1-e5, 2021 06 10.
Artículo en Inglés | MEDLINE | ID: mdl-34212748

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a public health crisis that threatens the current health system. The sudden expansion in the need for inpatient and intensive care facilities raised concerns about optimal clinical management and resource allocation. Despite the pressing need for evidence to make context-specific decisions on COVID-19 management, evidence from South Africa remained limited. This study aimed to describe the clinical characteristics and outcomes of COVID-19 hospitalised patients. METHODS: A retrospective cross-sectional study design was used to evaluate the clinical outcomes of hospitalised adult patients (≥ 18 years old) with laboratory-confirmed COVID-19 illness at Mthatha Regional Hospital (MRH), Eastern Cape. RESULTS: Of the 1814 patients tested for COVID-19 between 20 March 2020 and 31 July 2020 at MRH, two-thirds (65.4%) were female. About two-thirds (242) of the 392 patients (21.6%) who tested positive for this disease were hospitalised and one-third (150) were quarantined at home. The mean age of the patients tested for COVID-19 was 42.6 years and there was no difference between males and females. The mean age of hospitalised patients was 55.5 years and the mean age of hospitalised patients who died (61.3 years) was much higher than recovered (49.5 years). Overall, 188 (77.6%) hospitalised patients had clinical comorbidity on admission. Diabetes (36.8%) and hypertension (33.1%) were the most common comorbidities amongst COVID-19 hospitalised patients. CONCLUSION: The majority of the patients who were hospitalised for COVID-19 were elderly and had high baseline comorbidities. Advance age and underlying comorbidities (diabetes, hypertension and HIV) were associated with high mortality in hospitalised COVID-19 patients.


Asunto(s)
COVID-19 , Control de Enfermedades Transmisibles , Diabetes Mellitus/epidemiología , Hospitalización/estadística & datos numéricos , Hipertensión/epidemiología , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/terapia , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Comorbilidad , Estudios Transversales , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Manejo de Atención al Paciente/métodos , SARS-CoV-2/aislamiento & purificación , Sudáfrica/epidemiología
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