[Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study]. / Pacientes críticos COVID-19. ¿Han variado el manejo y los resultados en la UCI tras un año de pandemia? Estudio multicéntrico, prospectivo, observacional.

Objective: To compare the clinical characteristics, treatments, and evolution of critical patients with COVID-19 pneumonia treated in intensive care units (ICU) after one year of pandemic. Methodology: Multicenter, prospective study, which included critical COVID-19 patients in 9 ICUs in northwestern Spain. The clinical characteristics, treatments, and evolution of patients admitted to the ICU during the months of March-April 2020 (period 1) were compared with patients admitted in January-February 2021 (period 2). Results: 337 patients were included (98 in period 1 and 239 in period 2). In period 2, fewer patients required invasive mechanical ventilation (IMV) (65% vs. 84%, P < .001), using high-flow nasal cannulas (CNAF) more frequently (70% vs. 7%, P < .001), ventilation non-invasive mechanical (NIMV) (40% vs. 14%, P < .001), corticosteroids (100% vs. 96%, P = .007) and prone position in both awake (42% vs. 28%, P = .012), and intubated patients (67% vs. 54%, P = .034). The days of IMV, ICU stay and hospital stay were lower in period 2. Mortality was similar in the two periods studied (16% vs. 17%). Conclusions: After one year of pandemic, we observed that in patients admitted to the ICU, CNAF, NIMV, use of the prone position, and corticosteroids have been used more frequently, reducing the number of patients in IMV, and the length of stay in the ICU and hospital stay. Mortality was similar in the two study periods.

Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study.

OBJECTIVE: To compare the clinical characteristics, treatments, and evolution of critical patients with COVID-19 pneumonia treated in Intensive Care Units (ICU) after one year of pandemic. METHODOLOGY: Multicenter, prospective study, which included critical COVID-19 patients in 9 ICUs in northwestern Spain. The clinical characteristics, treatments, and evolution of patients admitted to the ICU during the months of March-April 2020 (period 1) were compared with patients admitted in January-February 2021 (period 2). RESULTS: 337 patients were included (98 in period 1 and 239 in period 2). In period 2, fewer patients required invasive mechanical ventilation (IMV) (65% vs 84%, p < 0.001), using high-flow nasal cannulas (CNAF) more frequently (70% vs 7%, p < 0.001), ventilation non-invasive mechanical (NIMV) (40% vs 14%, p < 0.001), corticosteroids (100% vs 96%, p = 0.007) and prone position in both awake (42% vs 28%, p = 0.012), and intubated patients (67% vs 54%, p = 0.034). The days of IMV, ICU stay and hospital stay were lower in period 2. Mortality was similar in the two periods studied (16% vs 17%). CONCLUSIONS: After 1 year of pandemic, we observed that in patients admitted to the ICU, CNAF, NIMV, use of the prone position, and corticosteroids have been used more frequently, reducing the number of patients in IMV, and the length of stay in the ICU and hospital stay. Mortality was similar in the two study periods.

Long-term Outcomes After Tracheostomy for COVID-19 / Resultados a largo plazo después de la traqueotomía en pacientes con COVID-19

No disponible

Après-coup: ¿lo que el viento se llevó? / Après-coup: what's gen with the wind?

El artículo pretende mostrar la pertinencia y vigencia actual del concepto de après-coup (Nachträglichkeit), concepto presente a lo largo de toda la teoría freudiana, y por tanto inherente a la comprensión de la clínica psicoanalítica y su aplicación técnica. Revisando la literatura contemporánea referente al tema, se considera su importancia en la formación del síntoma, así como en la práctica clínica se analiza su repercusión en la escucha y en el trabajo de perlaboración. Aunque dicho concepto tiene una especial trascendencia en la conceptualización de la temporalidad y la causalidad en psicoanálisis, resultaría reductor reducirlo a una dimensión temporal. En ese "entre dos" tiempos, se produce toda una reorganización para dar sentido, cuestión de importancia capital en la aplicación clínica, no solamente en los casos en los que impera la represión, sino también en aquellos en los cuales los mecanismos defensivos más radicales y arcaicos, como la renegación y la escisión han dificultado la creación de mecanismos de represión. La cura permitirá, en estos casos, ir creando los dos tiempos necesarios para la organización de ésta (AU)

The author shows the pertinence and present validity of the concept of après-coup (Nachträglichkeit), a concept present throughout Freudian theory and hence inherent to understanding of psychoanalytic clinical work and its technical application. Reviewing contemporary literature in reference to this theme, the author discusses its importance in symptom formation as well as its repercussion on listening and the task of working through in clinical practice. Although this concept is particularly transcendent for the conceptualization of temporality and causality in psychoanalysis, it would be reductionist to restrict it to a temporal dimension. In this "time between two times", a major reorganization gives meaning, a matter of capital importance in clinical applications, not only in cases with predominant repression, but also in those where the most radical and archaic defence mechanisms such as disavowal and splitting have hindered the creation of mechanisms of repression. The cure, in these cases, enables the gradual creation of the two times necessary for its organization (AU)