Fatality from COVID-19 does not affect palliative care duration among patients with advanced cancer: a retrospective cohort study.

BACKGROUND: Jomar et al. demonstrated that death due to COVID-19 did not affect the time under exclusive palliative care among patients with advanced cancer, even during the first year of the pandemic caused by a hitherto little-known disease. BACKGROUND: ◼ Fatality due to COVID-19 does not alter the time under oncological palliative care. BACKGROUND: ◼ The retrospective design of this pioneering study allows causal inference. BACKGROUND: ◼ Access to oncological palliative care frequently approaches terminality of life. OBJECTIVE: This study aimed at investigating the extent to which COVID-19-induced fatalities affect the duration of palliative care among patients with advanced cancer. METHODS: A retrospective cohort study was conducted at the Palliative Care Unit of the Brazilian Instituto Nacional de Câncer in Rio de Janeiro, Brazil, on 1,104 advanced cancer patients who died under exclusive palliative care between March 11, 2020, and March 31, 2021. Wilcoxon rank-sum (Mann-Whitney U) and log-rank tests were performed to examine statistical differences between the medians of time, and the Kaplan-Meier estimator was used to graphically illustrate survival over time under exclusive palliative care contingent upon the underlying causes of death of the two experimental groups (cancer versus COVID-19). RESULTS: A total of 133 (12.05%) patients succumbed to COVID-19. In both groups, the median time under exclusive palliative care was less than one month. The exclusive palliative care survival curves did not exhibit any statistically significant difference between the groups. CONCLUSION: Death due to COVID-19 did not modify the duration of exclusive palliative care among patients with advanced cancer.

Efficacy of convalescent plasma in hospitalized COVID-19 patients: findings from a controlled trial.

The COVID-19 pandemic has driven the search for alternative therapies, including convalescent plasma, historically used in infectious diseases. Despite results in other diseases, its effectiveness against COVID-19 remains uncertain with conflicting results in clinical trials. A pragmatic, single-center, prospective, and open randomized controlled trial was carried out in a hospital in Brazil, with the aim of evaluating the impact of convalescent plasma on the clinical improvement of patients hospitalized with COVID-19. The World Health Organization (WHO) ordinal scale was used to measure clinical improvement, focusing on the reduction in disease severity by up to 2 points, while antibody and C-reactive protein levels were monitored over time. After hospital admission, participants were randomized 1:1 to receive convalescent plasma and standard treatment or to be part of the control group with standard treatment. Follow-up was carried out on days 1, 3, 7, 14 and/or at discharge. From January 14 to April 4, 2022, 38 patients were included, but 3 were excluded due to protocol deviations, resulting in a total of 35 patients: 19 in the control group and 16 in the plasma group. There was no significant difference in clinical improvement between the convalescent plasma group and the control group, nor in secondary outcomes. The study had limitations due to the small number of patients and limited representation of COVID-19 cases. Broader investigations are needed to integrate therapies into medical protocols, both for COVID-19 and other diseases. Conducting randomized studies is challenging due to the complexity of medical conditions and the variety of treatments available.

Assistance time and peripheral oxygen saturation in prehospital emergency data as predictors of COVID19 hospital outcomes.

To verify if data obtained in the prehospital evaluation of patients with severe acute respiratory syndrome (SARS) during the initial response to the COVID-19 pandemic is associated with clinical outcomes: mechanical ventilation, hospital discharge, and death. This is a retrospective analysis involving secondary data from the Emergency Medical Service (EMS) records and the Health Surveillance Information System of patients assisted by the EMS in Manaus, from January to June 2020, the period of the first peak of COVID-19 cases. The combination of the two databases yielded a total of 1.190 patients, who received a first EMS response and were later admitted to hospital with SARS and had data on clinical outcomes of interest available. Patients were predominantly male (754, 63.4%), with a median age of 66 (IQR: 54.0-78.0) years. SARS illness before medical assistance was associated to need for invasive mechanical ventilation (IMV, p < 0.001). Lower pre-hospital SpO2 was associated to death (p = 0.025). Death was more common among patients with respiratory support needs, especially in the invasive ventilation group (262/287; 91.3%) (p < 0.001). In addition, IMV was more common among elderly individuals (p < 0.001). Patients admitted to ICU had a greater chance of dying when compared to non-ICU admitted patients (p < 0.001), and closely related to IMV (p < 0.001). Patients in ICU were also older (p = 0.003) and had longer hospital stay (p < 0.001). Mortality was associated with mechanical ventilation (p < 0.001), ICU admission (p < 0.001), and older age (p < 0.001). Patients who died had a shorter length of both ICU and total hospital stay (p < 0.001). Prehospital EMS may provide feasible and early recognition of critical patients with SARS in strained healthcare systems, such as in low-resource settings and pandemics.

Bench assessment of PC-CMVs modes in transport and emergency ventilators under ICU conditions.

Although there has been an increase in bench test evaluation of mechanical ventilators in recent years, a publication gap remains in assessing Pressure Control Continuous Mandatory Ventilation Modes with a set point targeting scheme PC-CMVs. This study evaluates the operational variability in PC-CMVs of eleven transport and emergency ventilators used in ICU units in Brazil during the COVID-19 pandemic. The assessment involved a comprehensive set of test scenarios derived from existing literature and the NBR ISO 80601-2-12:2014 standard. Nine parameters were computed for five consecutive breaths, offering a comprehensive characterization of pressure and flow waveforms. Most ventilators had Inspiratory pressure and PEEP values that fell outside of the tolerance ranges. Notably, three mechanical ventilators failed to reach the target pressures within the specified inspiratory times during test scenarios with a higher time constant (τ). We observed significant differences among emergency and transport ventilators in all assessed parameters, indicating a performance difference in PC-CMVs modes. The current results might help clinicians determine which ventilator models are suitable for specific clinical situations, particularly when unfavorable circumstances compel doctors to use ventilators that may not provide adequate support for patients in intensive care units.

Análisis retrospectivo sobre la eficacia del uso de tocilizumab en pacientes con neumonía grave por SARS-CoV-2 / Efficacy of the use of tocilizumab in severe COVID-19

La infección por SARS-CoV-2 puede generar síndrome de dificultad respiratoria aguda del adulto. El único trata-miento que demostró disminuir la mortalidad es la dexa-metasona. El tocilizumab es prometedor al inhibir la IL-6. La ausencia de evidencia local sobre su eficacia motivó este estudio restrospectivo, analítico y observacional, realizado desde 1/6/21 al 28/2/23 y que tiene como obje-tivos analizar mortalidad, requerimiento de oxígeno, días de internación y complicaciones de pacientes internados con COVID-19 grave que recibieron tocilizumab respec-to a un grupo control que recibió cuidados estándar. Se incluyeron 27 pacientes que recibieron tocilizumab y 69 en el grupo control. El promedio de días de enfermedad al recibir tocilizumab fue de 11,96. Encontramos una ten-dencia no estadísticamente significativa de menor mor-talidad (29 vs. 14,8% p=0,19), días de internación en UTI (13 vs. 19 p=0,6), requerimiento de oxígeno a alto flujo (22 vs. 45 p=0,11), asistencia mecánica respiratoria (5 vs. 21 p=0,23), complicaciones infecciosas (18,5 vs. 27,5% p=0,35) y no infecciosas (11 vs. 21,7% p=0,23) en el grupo que recibió tocilizumab con tendencia al aumento de PAFI y disminución de proteína C reactiva a las 48 horas de su infusión. El uso de tocilizumab podría asociarse a menor mortalidad, días de internación en UTI, necesidad de ARM y de complicaciones durante la internación, en pacientes grave, lo que impresiona estar en relación con una mejo-ría del estado hiperinflamatorio. Debido a que es un estu-dio unicéntrico y con bajo número de pacientes, debería ampliarse para obtener mayor evidencia de dicho efecto.

SARS-CoV-2 infection can lead to adult acute respirato-ry distress syndrome. The only treatment that has been shown to reduce mortality is dexamethasone. Tocilizum-ab shows promise in inhibiting IL-6. The absence of local evidence on its efficacy motivated this retrospective, an-alytical and observational study, from 6/1/21 to 2/28/23, which aims to analyze mortality, oxygen requirement, days of hospitalization and complications of hospitalized patients with COVID19. patients who received tocilizumab compared to a control group who received standard care. Twenty-seven patients who received tocilizumab and 69 in the control group were included. The average number of sick days when receiving tocilizumab was 11.96. We found a non-statistically significant trend of lower mor-tality (29 vs 14.8% p=0.19), days of ICU hospitalization (13 vs 19 p=0.6), high-flow oxygen requirement (22 vs 45 p =0.11), respiratory mechanical assistance (5 vs 21 p=0.23), infectious complications (18.5 vs 27.5% p=0.35) and non-infectious (11 vs 21.7% p=0 ,23), in the group that received tocilizumab with a tendency to increase PAFI and decrease C-reactive protein 48 hours after its infusion. The use of tocilizumab could be associated with lower mortality, days spent in the ICU, need for MRA, and complications during hospitalization, in seriously ill pa-tients, which seems to be related to an improvement in the hyperinflammatory state. Since it is a single-center study with a low number of patients, it should be expand-ed to obtain more evidence of this effect.

Impacto clínico de tocilizumab en pacientes con presentación severa de COVID-19: cohorte retrospectiva / Clinical impact of Tocilizumab in treatment of severe Covid-19 patients: Retrospective cohort study

Introducción: Tocilizumab (TCZ) es un bloqueador del re-ceptor de la interleuquina 6, propuesto como tratamiento de pacientes con COVID-19 grave o crítico. El objetivo es evaluar el impacto clínico de la administración de TCZ en pacientes hospitalizados con COVID-19 grave y describir los eventos adversos e infecciosos más frecuentes.Materiales y métodos: Estudio analítico, observacional de casos y controles emparejado por edad, sexo y co-morbilidades de pacientes adultos con COVID-19 grave, hospitalizados entre diciembre de 2020 y marzo de 2021. Criterios de inclusión: requerimiento de aporte de O2 ma-yor o igual 5 l/min para lograr saturación >93% y uno de los siguientes: ACV, IAM, IMC >30, ERC, edad >60 años, dímero D >1000 ng/ml o proteína C reactiva cuantitativa >75 mg/l. Desenlaces evaluados: muerte por todas las causas, traslado a unidad de cuidados críticos (UCC) y requerimiento de asistencia ventilatoria mecánica (AVM).Resultados: Se incluyeron 320 pacientes, 210 expuestos a corticoterapia (controles) y 110 recibieron además TCZ (casos). La tasa de letalidad fue 44% en el grupo contro-les vs.29% en el grupo casos (p= 0.0081); el traslado a UCC fue del 81% vs.48% (p= 0.0081) respectivamente y el requerimiento de AVM en el grupo casos fue del 56% vs.24% (p= 0.0001) respectivamente. Conclusiones: Los pacientes tratados con TCZ presenta-ron una proporción de uso de UCC, de AVM y de mortali-dad menor en comparación con pacientes con similares características que no lo recibieron. Estos resultados coinciden con la evidencia disponible a la fecha

Introduction: Tocilizumab (TCZ) is an interleukin-6 recep-tor blocker proposed to treat severe or critical COVID-19 patients. This study aims to evaluate the clinical effects of TCZ administration in hospitalized patients with severe COVID-19. Additionally, the study investigates the most common adverse and infectious events associated with the use of TCZ.Materials and Methods: Analytical, observational case-control study matched by age, sex, and comorbidi-ties of adult patients with severe COVID-19, hospitalized between December 2020 and March 2021. Inclusion criteria: requirement for oxygen provision greater than or equal to 5 l/min to achieve saturation >93% and one of the following: stroke, myocardial infarction, BMI >30, chronic kidney disease, age >60 years, D-dimer >1000 ng/ml, or quantitative C-reactive protein >75 mg/l. Outcomes evaluated: all-cause mortality, transfer to critical care unit (CCU), and mechanical ventilatory assistance (MVA) re-quirement.Results: The study included 320 patients, out of which 110 patients received TCZ in addition to corticosteroids (cas-es), while 210 patients were only exposed to corticoste-roids (controls). The mortality rate was 29% in the cases group, compared to 44% in the control group (p=0.0081). Similarly, 48% of the cases were transferred to CCU, while 81% of the control group were transferred (p=0.0081). The requirement for mechanical ventilation (MVA) was 24% in the cases group and 56% in the control group (p=0.0001).Conclusion: Patients treated with TCZ had a lower propor-tion of CCU use, MVA, and mortality compared to similar patients who did not receive it. These results are consis-tent with the current evidence

Qualitative analysis of nurses' performance and experiences in hospital management in the face of COVID-19. / Análise qualitativa sobre a atuação e as experiências dos enfermeiros na gestão hospitalar frente à COVID-19.

This study aimed to analyze the role of nurses in hospital management in the face of COVID-19. The study had a qualitative, descriptive, and exploratory approach. The setting was a hospital that was completely transformed to care for patients with COVID-19. At the time of data collection, ten nurses managed the services, and all participated in the semi-structured interview. After thematic analysis, the data were presented in three categories, representing the elements of Donabedian's triad: structure, process, and result. Category 1 highlighted the hospital structure reconfiguration based on material and people management; category 2 addressed the work process restructuring to achieve goals with safety and quality; and category 3 focused on nurses' experiences in describing the results achieved and expected. The analysis highlighted the importance of teamwork, involvement, and adaptation of managers in the face of the challenges of a new and life-threatening disease, scarce resources, and the complexity of human relationships in the crisis. In transformational leadership, these nurses encouraged behavior change, professional growth, and resilience.

Objetivou-se analisar a atuação dos enfermeiros na gestão hospitalar frente à COVID-19. O estudo teve uma abordagem qualitativa, do tipo descritivo e exploratório. O cenário foi um hospital que se transformou totalmente para atendimento de pacientes com COVID-19. No momento da coleta de dados, dez enfermeiros estavam à frente da gestão dos serviços, e todos participaram da entrevista semiestruturada. Os dados, após análise temática, foram apresentados em três categorias representativas dos elementos da tríade de Donabedian, ou seja, estrutura, processo e resultado. A categoria 1 realçou a reconfiguração da estrutura hospitalar a partir da gestão de materiais e das pessoas; a categoria 2 abordou a reestruturação do processo de trabalho para alcance das metas com segurança e qualidade; e a categoria 3 focou nas experiências dos enfermeiros na descrição dos resultados alcançados e esperados. A análise evidenciou a importância do trabalho em equipe, do envolvimento e da adaptação do gestor diante dos desafios da doença nova e ameaçadora da vida, dos recursos escassos e da complexidade das relações humanas na crise. Na liderança transformacional esses enfermeiros incentivaram a mudança de comportamento, o crescimento profissional, e resiliência.

Antisense therapy to block the Kallikrein-kinin pathway in COVID-19: The ASKCOV randomized controlled trial.

PURPOSE: To assess the effect of antisense therapy to block kallikrein-kinin pathway in COVID-19 patients. MATERIAL AND METHODS: Randomized, placebo-controlled, double blind, controlled trial enrolling hospitalized COVID-19 patients that required supplementary oxygen to sustain peripheral oxygen saturation. Key exclusion criteria included use of mechanical ventilation or vasopressors, and patients with more than 10 days since symptom onset or more than 48 h of oxygen use. Patients were randomized to either one subcutaneous dose of ISIS721744, an antisense that blocks prekallikrein, or placebo. The primary outcome was the number of days alive and free of oxygen support up to 15 days (DAFOR15). Secondary endpoints included organ failure score, need and duration of mechanical ventilation up to 15 days, and all-cause mortality at 30 days. Exploratory endpoints included physiological parameters, biomarkers, and quality of life. RESULTS: From October 10, 2020, to December 09, 2020, 111 patients were randomized at thirteen sites in Brazil (56 to treatment and 55 to control group). Average age was 57.5 years, and most patients were male (68.5%). There were no significant differences in DAFOR15 between groups (5.9 ± 5.2 days for the intervention arm and 7.7 ± 5.1 for the control group; mean difference - 0.65, 95% confidence intervals from -2.95 to 1.36, p = 0.520). CONCLUSION: Antisense therapy designed to block the kallikrein-kinin pathway did not demonstrate clinical benefits in increasing days-alive without respiratory support at 15 days in patients with COVID-19 during the first wave in 2020. GOV IDENTIFIER: NCT04549922.

Predictors of high-flow nasal cannula failure in COVID-19 patients in a northern Peruvian hospital.

OBJECTIVES: To determine predictors of high-flow nasal cannula (HFNC) failure in COVID-19 patients in a hospital in northern Peru. METHODOLOGY: A retrospective cohort study was conducted during the months of March and May 2021. Data collection was based on a follow-up of 156 hospitalized patients with a diagnosis of COVID-19 who were users of HFNC. Epidemiological factors and clinical outcomes of treatment were analyzed from medical records. Epidemiological, analytical, and HFNC use-related characteristics were described using measures of absolute and relative frequencies, measures of central tendency, and dispersion. A multivariate Poisson regression analysis with robust variance and a 95% confidence interval was performed. RESULTS: We found that age, SpO2/FiO2, work of breathing (WOB scale) at admission, degree of involvement, type of infiltrate on CT scan, lymphocytes, c-reactive protein, and D-dimer were significantly associated with failure of HFNC (p < 0.05). In addition, the WOB scale, PaO2/FiO2, SaO2/FiO2, and ROX index were variables that presented statistical significance (p < 0.0001). In the multivariate analysis model, a risk of failure of HFNC was determined with age > = 60 years [RRa 1.39 (1.05-1.85)] and PaO2/FiO2 score less than 100 [Rra 1.65 (0.99-2.76)]. CONCLUSIONS: Predictors to failure of HFNC are age older than 60 years and minimally significantly lower PaO2/FiO2 than 100.

Clinical outcomes in patients with diabetes and stress hyperglycemia that developed SARS-CoV-2 infection / Desenlaces clínicos de los pacientes con diabetes e hiperglucemia de estrés que presentaron infección por SARS-CoV-2

INTRODUCTION: Diabetes and stress hyperglycemia have been related with poorer clinical outcomes in patients infected by SARS-CoV-2 and at risk for severe disease. OBJECTIVE: To evaluate clinical outcomes in three groups of patients (with diabetes, without diabetes and with stress hyperglycemia) with SARS-CoV-2 infection. MATERIALS AND METHODS: A retrospective cohort study was conducted in Cali (Colombia). We included patients 18 years old or older with a diagnosis of SARS-CoV-2 infection, managed in the emergency room, hospitalization, or intensive care unit between March 2020 and December 2021. Immunocompromised patients and pregnant women were excluded. Patients were classified into three groups: without diabetes, with diabetes, and with stress hyperglycemia. A comparison between the groups was performed. RESULTS: A total of 945 patients were included (59.6% without diabetes, 27% with diabetes, and 13.4% with stress hyperglycemia). Fifty-five-point three percent required intensive care unit management, with a higher need in patients with stress hyperglycemia (89.8%) and diabetes (67.1%), with no difference between these groups (p = 0.249). We identified a higher probability of death in the group with stress hyperglycemia versus the one without diabetes (adjusted OR = 8.12; 95% CI: 5.12-12.88; p < 0.01). Frequency of acute respiratory distress syndrome, need for invasive mechanical ventilation, use of vasopressors and inotropes, need for de novo renal replacement therapy, and mortality was higher in patients with metabolic alterations (diabetes and stress hyperglycemia). CONCLUSIONS: Diabetes and stress hyperglycemia were associated with worse clinical outcomes and mortality in patients with COVID-19. These patients should be identified early and considered them high risk at the COVID-19 diagnosis to mitigate adverse outcomes.

Introducción. La diabetes y la hiperglucemia de estrés se han relacionado con peores desenlaces clínicos en pacientes infectados por SARS-CoV-2 y con riesgo de enfermedad grave. Objetivo. Evaluar los resultados clínicos en tres grupos de pacientes (con diabetes, sin diabetes o con hiperglucemia de estrés) con infección por SARS-CoV-2. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de cohorte en Cali (Colombia). Se incluyeron pacientes de 18 años o más, con diagnóstico de infección por SARS-CoV-2 atendidos en urgencias, hospitalización o unidad de cuidados intensivos entre marzo de 2020 y diciembre de 2021. Se excluyeron los pacientes inmunocomprometidos y las mujeres embarazadas. Los pacientes fueron clasificados en tres grupos: sin diabetes, con diabetes y con hiperglucemia de estrés. Se realizó una comparación entre los grupos. Resultados. Se incluyeron 945 pacientes (59,6 % sin diabetes, 27 % con diabetes y 13,4 % con hiperglucemia de estrés). El 55,3 % requirió manejo en la unidad de cuidados intensivos, con mayor necesidad por parte de los pacientes con hiperglucemia de estrés (89,8 %) y diabetes (67,1%), sin diferencia entre estos grupos (p = 0,249). Se observó una mayor probabilidad de muerte en el grupo con hiperglucemia de estrés versus sin diabetes (OR ajustado = 8,12; IC95%: 5,12-12,88; p < 0,01). La frecuencia de síndrome de distrés respiratorio agudo, necesidad de ventilación mecánica invasiva, uso de vasopresores e inotrópicos, necesidad de terapia de reemplazo renal de novo y mortalidad fue mayor en pacientes con alteraciones metabólicas (diabetes e hiperglucemia de estrés). Conclusiones. La diabetes y la hiperglucemia de estrés se asociaron a peores resultados clínicos y mortalidad en pacientes con COVID-19. Estos pacientes deben ser identificados tempranamente y considerados de alto riesgo al momento del diagnóstico de COVID-19 para mitigar los desenlaces adversos.

The respiratory oxygenation index for identifying the risk of orotracheal intubation in COVID-19 patients receiving high-flow nasal cannula oxygen.

OBJECTIVE: To assess whether the respiratory oxygenation index (ROX index) measured after the start of high-flow nasal cannula oxygen therapy can help identify the need for intubation in patients with acute respiratory failure due to coronavirus disease 2019. METHODS: This retrospective, observational, multicenter study was conducted at the intensive care units of six Brazilian hospitals from March to December 2020. The primary outcome was the need for intubation up to 7 days after starting the high-flow nasal cannula. RESULTS: A total of 444 patients were included in the study, and 261 (58.7%) were subjected to intubation. An analysis of the area under the receiver operating characteristic curve (AUROC) showed that the ability to discriminate between successful and failed high-flow nasal cannula oxygen therapy within 7 days was greater for the ROX index measured at 24 hours (AUROC 0.80; 95%CI 0.76 - 0.84). The median interval between high-flow nasal cannula initiation and intubation was 24 hours (24 - 72), and the most accurate predictor of intubation obtained before 24 hours was the ROX index measured at 12 hours (AUROC 0.75; 95%CI 0.70 - 0.79). Kaplan-Meier curves revealed a greater probability of intubation within 7 days in patients with a ROX index ≤ 5.54 at 12 hours (hazard ratio 3.07; 95%CI 2.24 - 4.20) and ≤ 5.96 at 24 hours (hazard ratio 5.15; 95%CI 3.65 - 7.27). CONCLUSION: The ROX index can aid in the early identification of patients with acute respiratory failure due to COVID-19 who will progress to the failure of high-flow nasal cannula supportive therapy and the need for intubation.

Long-term oxygen therapy to reduce length of hospital stay in COVID-19.

OBJECTIVE: The aim of this study was to evaluate the efficacy of long-term oxygen therapy as a strategy to reduce hospitalization time in patients affected by COVID-19. METHODS: Between April and December 2021, COVID-19 patients with stable clinical conditions needing supplementary oxygen therapy during hospitalization were oriented to have hospital discharge with long-term oxygen therapy and reassessment after 15 days. RESULTS: A total of 62 patients were evaluated and, 15 days after discharge, 69% of patients had suspended long-term oxygen therapy, with no difference between the groups admitted to the intensive care unit or the ward (p=0.319). Among the individuals who needed to maintain long-term oxygen therapy, in addition to worse P/F ratio (265±57 vs. 345±51; p<0.001) and lower partial pressure of oxygen (55±12 vs. 72±11 mmHg; p<0.001), were those more obese (37±8 vs. 30±6 kg/m2; p=0.032), needed more time for invasive mechanical ventilation (46±27 vs. 20±16 days; p=0.029), had greater persistence of symptoms (p<0.001), and shorter time between the onset of symptoms and the need for hospitalization (7 [2-9] vs. 10 [6-12] days; p=0.039). CONCLUSION: Long-term oxygen therapy is an effective strategy for reducing hospitalization time in COVID-19 patients, regardless of gravity. Additionally, more obese patients with persistence of respiratory symptoms, faster disease evolution, and more days of invasive mechanical ventilation needed to maintain the long-term oxygen therapy longer.

Influence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19.

OBJECTIVE: To identify the influence of obesity on mortality, time to weaning from mechanical ventilation and mobility at intensive care unit discharge in patients with COVID-19. METHODS: This retrospective cohort study was carried out between March and August 2020. All adult patients admitted to the intensive care unit in need of ventilatory support and confirmed to have COVID-19 were included. The outcomes included mortality, time on mechanical ventilation, and mobility at intensive care unit discharge. RESULTS: Four hundred and twenty-nine patients were included, 36.6% of whom were overweight and 43.8% of whom were obese. Compared with normal body mass index patients, overweight and obese patients had lower mortality (p = 0.002) and longer intensive care unit survival (log-rank p < 0.001). Compared with patients with a normal body mass index, overweight patients had a 36% lower risk of death (p = 0.04), while patients with obesity presented a 23% lower risk (p < 0.001). There was no association between obesity and time on mechanical ventilation. The level of mobility at intensive care unit discharge did not differ between groups and showed a moderate inverse correlation with length of stay in the intensive care unit (r = -0.461; p < 0.001). CONCLUSION: Overweight and obese patients had lower mortality and higher intensive care unit survival rates. The duration of mechanical ventilation and mobility level at intensive care unit discharge did not differ between the groups.

Palliative Care for SARS-CoV-2 Patients in the Intensive Care Unit: A Comprehensive Study.

OBJECTIVE: To comprehend the multiprofessional actions regarding palliative care for patients in the Intensive Care Unit affected by SARS-CoV-2. METHODS: A comprehensive qualitative study conducted with 31 professionals from the Intensive Care Units of a university hospital, based on the Theory of Peaceful End of Life. RESULTS: The analysis of the discourse led to the identification of two categories: "Multidisciplinary actions to promote comfort at the end of life" and "Palliative care during the pandemic period and the promotion of emotional and spiritual comfort." FINAL CONSIDERATIONS: It became evident that local administration needs to invest in measures that reduce barriers to the implementation of palliative care during times of crisis. Understanding the discourse highlighted that non-specialized professionals can provide basic palliative care appropriately, without diminishing the importance and necessity of the presence of palliative care specialists in various hospital areas.

Quality of Care Transition for COVID-19 Patients in a University Hospital in Southern Brazil.

OBJECTIVE: To assess the quality of care transition from hospital to home for COVID-19 patients. METHOD: A cross-sectional study conducted at a University Hospital in Southern Brazil, involving 78 patients discharged after COVID-19 hospitalization. Data collection was performed via telephone using the Brazilian version of the Care Transitions Measure (CTM-15). Data were analyzed using descriptive and analytical statistics. RESULTS: The mean quality of care transition was 70.8 on a scale ranging from zero to 100, indicating moderate quality of care transition. The highest score was attributed to factor 1, "Preparation for self-management," and the lowest to factor 4, "Care Plan." CONCLUSIONS: It is important to enhance communication and support provided to patients during the transition process, especially regarding understanding prescribed medications and the development of clear care plans.

Exploring diaphragmatic response to high-flow nasal cannula in patients with COVID-19 pneumonia using ultrasound: a proof of concept study.

BACKGROUND: Recent studies have highlighted the recognition of diaphragmatic dysfunction as a significant factor contributing to respiratory disturbances in severely ill COVID-19 patients. In the field of noninvasive respiratory support, high-flow nasal cannula (HFNC) has shown effectiveness in relieving diaphragm dysfunction. This study aims to investigate the diaphragmatic response to HFNC in patients with COVID-19 pneumonia by utilizing ultrasound. METHODS: This retrospective study was conducted in a medical-surgical intensive care unit (ICU) at a tertiary care center in Buenos Aires, Argentina (Sanatorio de Los Arcos) over a 16-month period (January 2021-June 2022). The study included patients admitted to the ICU with a diagnosis of COVID-19 pneumonia who were deemed suitable candidates for HFNC therapy by the attending physician. Diaphragm ultrasound was conducted, measuring diaphragmatic excursion (DE) both before and during the utilization of HFNC for these patients. RESULTS: A total of 10 patients were included in the study. A statistically significant decrease in respiratory rate was observed with the use of HFNC (p = 0.02), accompanied by a significant increase in DE (p = 0.04). CONCLUSION: HFNC leads to a reduction in respiratory rate and an increase in DE as observed by ultrasound in patients with COVID-19 pneumonia, indicating promising enhancements in respiratory mechanics. However, further research is required to validate these findings.

NEWS2, S/F-ratio and ROX-index at emergency department for the prediction of adverse outcomes in COVID-19 patients: An external validation study.

BACKGROUND: In the context of the COVID-19 pandemic, the early and accurate identification of patients at risk of deterioration was crucial in overcrowded and resource-limited emergency departments. This study conducts an external validation for the evaluation of the performance of the National Early Warning Score 2 (NEWS2), the S/F ratio, and the ROX index at ED admission in a large cohort of COVID-19 patients from Colombia, South America, assessing the net clinical benefit with decision curve analysis. METHODS: A prospective cohort study was conducted on 6907 adult patients with confirmed COVID-19 admitted to a tertiary care ED in Colombia. The study evaluated the diagnostic performance of NEWS2, S/F ratio, and ROX index scores at ED admission using the area under the receiver operating characteristic curve (AUROC) for discrimination, calibration, and decision curve analysis for the prediction of intensive care unit admission, invasive mechanical ventilation, and in-hospital mortality. RESULTS: We included 6907 patients who presented to the ED with confirmed SARS-CoV-2 infection from March 2020 to November 2021. Mean age was 51 (35-65) years and 50.4% of patients were males. The rate of intensive care unit admission was 28%, and in-hospital death was 9.8%. All three scores have good discriminatory performance for the three outcomes based on the AUROC. S/F ratio showed miscalibration at low predicted probabilities and decision curve analysis indicated that the NEWS2 score provided a greater net benefit compared to other scores across at a 10% threshold to decide ED admission at a high-level of care facility. CONCLUSIONS: The NEWS2, S/F ratio, and ROX index at ED admission have good discriminatory performances in COVID-19 patients for the prediction of adverse outcomes, but the NEWS2 score has a higher net benefit underscoring its clinical utility in optimizing patient management and resource allocation in emergency settings.

Predictive value of invasive mechanical ventilation parameters for mortality in COVID-19 related ARDS: a retrospective cohort study.

The 2019 coronavirus (COVID-19) can generate acute respiratory distress syndrome (ARDS), requiring advanced management within the Intensive Care Unit (ICU) using invasive mechanical ventilation (IMV However, managing this phenomenon has seen learning and improvements through direct experience. Therefore, this study aims were to describe the assessment of the different IMV variables in patients with post-COVID-19 hospitalized in the ICU and their relation with mortality. Observational and retrospective study. The sample was divided into two, the surviving group (SG) and the non-surviving group (NSG). Clinical data were extracted from the electronic clinical file and the respiratory therapist record sheet. The following information was obtained: Patient medical history: gender, age, co-morbidities, arterial gases, days on IMV, and IMV parameters. Out of a total of 101 patients, the total mortality was 32%. There was a significant decrease in respiratory rate (RR) (29.12 ± 4.24-26.78 ± 3.59, p = 0.006), Driving pressure (DP) (11.33 ± 2.39-9.67 ± 1.84, p = 0.002), Ventilatory rate (VR) (2.26 ± 0.66-1.89 ± 0.45, p = 0.001) and a significant rise in Static compliance (Cest) (35.49 ± 8.64-41.45 ± 9.62, p = 0.003) and relation between Arterial oxygen pressure/Inspirated oxygen fraction (PaO2/FiO2) (201.5 ± 53.98- 227.8 ± 52.11, p = 0.008) after 72 h of IMV, within the NSG compared to the SG. Apart from these points, multi-morbidity (HR = 3.208, p = 0.010) and DP (HR = 1.228, p = 0.030) and VR variables (HR = 2.267, p = 0.027) had more death probabilities. The results of this study indicate that there was a significant increase in RR, DP, VR, and CO2 and a significant drop in Cest and PaO2/FiO2 among the NSG compared with the SG. Apart from this, the DP and VR variables, multi-morbidity and being male. have more possibility of death.

Lessons from community engagement to improve COVID-19 diagnosis and treatment in Cochabamba, Bolivia.

BACKGROUND: Community engagement is recognized as a vital component of health-related research and programs, particularly during infectious disease outbreaks and epidemics. Despite the importance of engaging communities in the response to COVID-19, relatively little research has examined how this was (or was not) achieved, and even less in low- and middle-income countries. This article describes the community engagement that accompanied efforts to strengthen COVID-19 diagnosis and treatment as part of the ECO Project in Cochabamba, Bolivia and highlights lessons for future pandemic response. METHODS: Community engagement involved formative assessment, co-creation to develop a health information campaign, ongoing community listening and evaluation. Qualitative data were collected during workshops, project meetings and focus groups. Questionnaire-based surveys were conducted to assess COVID-19-related attitudes, knowledge and practices. RESULTS: The collected data highlighted the value of working closely with well-established community health committees and involving community members with social media skills in the design of COVID-19-related messages to address on- and offline misinformation. Co-creation sessions enabled the adjustment of the information campaign in terms of content and approach based on the needs and preferences of community members and health staff. The continuous listening with community and health personnel facilitated the ongoing adaptation of project activities. CONCLUSION: Through a stepped and multi-pronged approach, incorporating co-creation and community listening, the engagement could respond to emerging local challenges during the pandemic. The project created spaces for dialogue and opportunities for collaboration that strengthened links between the community and the health services.

Main findings Key elements of community engagement to improve COVID-19 diagnosis and treatment in Cochabamba, Bolivia, included working closely with well-established community health committees, involving community members with social media skills in the co-design of COVID-19-related messages, and continuous listening with community and health personnel facilitated the ongoing adaptation of project activities.Added knowledge With little research on community engagement for COVID-19 diagnosis and treatment in Latin America, this study reports the results of mixed methods research on the impact of a comprehensive approach to engagement that highlights lessons for future health emergencies.Global health impact for policy and action Lessons for engagement in health emergencies include the need for a multi-pronged approach, incorporating co-creation and community listening, to respond to emerging local challenges.

Critically Ill Patients with COVID-19 Pneumonia Requiring Continuous Renal Replacement Therapy with oXiris® Membrane in a Third-Level Hospital in Northeast Mexico.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic represented a global public health problem with devastating consequences that have challenged conventional medical treatments. Continuous renal replacement therapy (CRRT), based on a spectrum of modalities and dialysis membranes, can modify cytokine storms, and improve the clearance of inflammatory factors. As severe COVID-19 can lead to acute kidney injury (AKI) requiring RRT, most patients require more than one extracorporeal organ support at this point. This is due to complications that lead to organ dysfunction. The aim of our study was to assess renal recovery and survival while use of the oXiris membrane, as well as a decrease in vasopressors and hemodynamic parameters. METHODS: This was a retrospective, observational study. The population included adult patients (aged >18 years) with a real-time PCR COVID-19 positive test, admitted to the intensive care unit (ICU) with AKI KDIGO 3, which required CRRT, in a hospital in northern Mexico. The primary outcomes were renal recovery and survival, and the secondary outcomes were a decrease in the vasopressor requirements and changes in the hemodynamic parameters. RESULTS: Thirteen patients were included from January 2020 to August 2021, all of whom met the inclusion criteria. oXiris, an AN69-modified membrane, was used for blood purification and cytokine storm control in all the patients. The primary outcome, renal recovery, and survival were observed in 23% of the patients. The secondary outcome was a decrease of 12% in the use of noradrenaline in the first 24 h of CRRT initiation with oXiris, in addition to a decrease in creatinine and C-reactive protein levels in all patients. DISCUSSION: The use of the oXiris membrane in patients with severe COVID-19 improved hemodynamic parameters, with 23% of the patients achieving renal recovery. The decrease on the requirement of vasopressors in the overall patients in the first 24 h of CRRT with oXiris was achieved. The mean decrease was of 12%, accompanied by a decrease in inflammatory markers. There is literature on the benefit of CRRT with a modified AN69 membrane in Mexico; however, studies in this regard are scarce, and our research provides valuable information on our experience in this field.