Pacientes críticos COVID-19 atendidos por anestesiólogos en el Noroeste de España: estudio multicéntrico, prospectivo, observacional / Critically ill COVID-19 patients attended by anesthesiologists in northwestern Spain: a multicenter prospective observational study

Antecedentes y objetivos: Existe poca información sobre la evolución, complicaciones y los tratamientos recibidos por los pacientes críticos con COVID-19 que requieren ingreso en una unidad de cuidados intensivos (UCI). El objetivo de este estudio es describir la evolución clínica, los tratamientos utilizados, las complicaciones y resultados de pacientes críticos COVID-19 ingresados en siete UCI de Anestesiología en la Región de Galicia durante el pico de la pandemia en marzo-abril 2020. Métodos: Entre el 21 de marzo y el 19 de abril de 2020 evaluamos a todos los pacientes críticos COVID-19 ingresados en las UCI de Anestesiología de siete hospitales en Galicia, en el Noroeste de España. Los resultados, complicaciones y los tratamientos administrados se registraron hasta el 6 de mayo de 2020, fecha final del seguimiento. Resultados: Un total de 97 pacientes críticos COVID-19 fueron incluidos. Durante su estancia en UCI, 80 pacientes (82,5%) necesitaron ventilación mecánica, y 22 pacientes (22,7%) traqueotomía. El decúbito prono se usó frecuentemente en pacientes intubados (67,5%) y despiertos (27,8%). Las medicaciones usadas fueron antivirales (92,7%), corticoides (93,8%), tocilizumab (57,7%), y dosis intermedias y altas de anticoagulantes (83,5%). Las complicaciones más frecuentes fueron infecciones adquiridas en UCI (52,6%), eventos trombóticos (16,5%), y reintubaciones (9,3%). Tras un seguimiento medio de 42 (34-45) días, 15 pacientes fallecieron (15,5%), 73 pacientes (75,2%) habían sido dados de alta de UCI y nueve pacientes (9,3%) permanecían todavía en la unidad. Conclusiones: Un alto porcentaje de nuestros pacientes críticos COVID-19 requirieron ventilación mecánica, posición prona, medicaciones antivirales, corticoides y anticoagulantes. Las complicaciones en UCI fueron frecuentes, principalmente infecciones y eventos trombóticos. Tuvimos una mortalidad relativamente baja del 15,5%.(AU)

Background and objectives: There are limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March-April pandemic peak. Methods: Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up. Results: A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34-45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU. Conclusions: A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%.(AU)

Critically ill COVID-19 patients attended by anesthesiologists in northwestern Spain: a multicenter prospective observational study. / Pacientes críticos COVID-19 atendidos por anestesiólogos en el Noroeste de España: estudio multicéntrico, prospectivo, observacional.

BACKGROUND AND OBJECTIVES: There are limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March-April pandemic peak. METHODS: Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up. RESULTS: A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34-45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU. CONCLUSIONS: A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%.

[Sequential percutaneous surgical treatment in a woman with severe aortic stenosis and hypertrophic obstructive cardiomyopathy]. / Abordaje percutáneo secuencial en una paciente diagnosticada de estenosis aórtica severa y miocardiopatia hipertrófica obstructiva.

Quality of life is seriously compromised in both severe aortic stenosis and in hypertrophic obstructive cardiomyopathy. At advanced stages of disease, symptoms become incapacitating. Surgical correction is extremely effective, reducing symptoms and improving functional capacity. Percutaneous surgical techniques facilitate the treatment of patients in high-risk categories for whom conventional surgery is not an option. We report the case of a woman with severe symptomatic aortic stenosis and hypertrophic obstructive cardiomyopathy with associated mitral regurgitation. An aortic valve was implanted percutaneously. Later septal ablation was also performed percutaneously. The postoperative course was slow and the hospital stay was long. Percutaneous procedures provide a useful alternative way to treat severe symptomatic aortic stenosis and hypertrophic obstructive cardiomyopathy with mitral regurgitation, particularly when patients are at high risk for conventional surgery. These procedures are not without risk, however.

Abordaje percutáneo secuencial en una paciente diagnosticada de estenosis aórtica severa y miocardiopatía hipertrófica obstructiva / Sequential percutaneous surgical treatment in a woman with severe aortic stenosis and hypertrophic obstructive cardiomyopathy

Tanto la estenosis aórtica severa como la miocardiopatía hipertrófica obstructiva son enfermedades que condicionan de manera importante la calidad de vida del paciente y sus síntomas son incapacitantes en sus fases más avanzadas. Su corrección anatómica mediante cirugía es extraordinariamente eficaz, reduciendo las manifestaciones clínicas y mejorando la capacidad funcional del enfermo. El desarrollo de las técnicas percutáneas permite tratar a los enfermos con índices de riesgo elevados, que son rechazados para cirugía convencional. Presentamos el caso de una paciente con estenosis aórtica severa sintomática y miocardiopatía hipertrófica obstructiva con insuficiencia mitral asociada, tratada mediante implante valvular aórtico percutáneo y, posteriormente, con ablación septal percutánea. El postoperatorio fue tórpido y la estancia hospitalaria larga. El intervencionismo percutáneo en la estenosis aórtica severa sintomática asociada con miocardiopatía e insuficiencia mitral, es una alternativa útil de tratamiento, especialmente en pacientes de alto riesgo para cirugía convencional, si bien no exenta de complicaciones(AU)

Quality of life is seriously compromised in both severe aortic stenosis and in hypertrophic obstructive cardiomyopathy. At advanced stages of disease, symptoms become incapacitating. Surgical correction is extremely effective, reducing symptoms and improving functional capacity. Percutaneous surgical techniques facilitate the treatment of patients in high-risk categories for whom conventional surgery is not an option. We report the case of a woman with severe symptomatic aortic stenosis and hypertrophic obstructive cardiomyopathy with associated mitral regurgitation. An aortic valve was implanted percutaneously. Later septal ablation was also performed percutaneously. The postoperative course was slow and the hospital stay was long. Percutaneous procedures provide a useful alternative way to treat severe symptomatic aortic stenosis and hypertrophic obstructive cardiomyopathy with mitral regurgitation, particularly when patients are at high risk for conventional surgery. These procedures are not without risk, however(AU)

[Repair of congenital heart disease in an adult with septal defects and pulmonary stenosis: anesthetic management]. / Cardiopatía congénita con estenosis pulmonar y comunicaciones intracardiacas asociadas en adulto: tratamiento anestésico.

A 66-year-old man with complex congenital heart defects (atrial septal defects, with incomplete cor triatriatum, an aneurysmal sac in the membranous septum, ventricular communication and pulmonary valve stenosis) was scheduled for surgery for progressive dyspnea even at rest. During anesthetic induction, effort was made to avoid increased shunting. Surgery consisted of resection of the cor triatriatum membrane, closure of communications with pericardial patches, pulmonary valve replacement, replacement of the root with a porcine root, and pulmonary artery aneurysmorrhaphy. Severely decreased contractility developed while the patient was still in the operating room; inotropic support with adrenaline and dobutamine was required. Extubation was completed in the postoperative recovery unit with no further complications. Echocardiography showed a left-ventricular ejection fraction of 45%. We found few published reports of cases of complex congenital heart disease treated surgically in adulthood. In such cases, cardiac pathophysiology must be carefully considered, and maneuvers that increase systemic resistance or right-ventricular ejection fraction should be avoided. Postoperative pulmonary vascular resistance should be kept as low as possible.

Cardiopatía congénita con estenosis pulmonar y comunicaciones intracardiacas asociadas en adulto: tratamiento anestésico / Repair of congenital heart disease in an adult with septal defects and pulmonary stenosis: anesthetic management

Paciente varón de 66 años con malformaciones cardiacas congénitas complejas consistentes esquemáticamente en comunicación interacuricular con tabicación incompleta tipo cor triatriatum, aneurisma de septo membranoso con comunicación interventricular y estenosis de válvula pulmonar. Se indicó cirugía por disnea progresiva hasta hacerse de reposo. Se procede a inducción de la anestesia intentando no aumentar el cortocircuito. El procedimiento quirúrgico consistió en resecar la membrana de cor triatiatum, cerrar las comunicaciones con parches de pericardio, sustituir la válvula pulmonar y raíz por una raíz porcina y aneurismorrafía de la arteria pulmonar. Presentó depresión severa de la contractilidad en quirófano que precisó apoyo inotrópico con adrenalina y dobutamina. Posteriormente se extubó en reanimación sin más incidencias. Una ecografía de control cuantificó la fracción de eyección del ventrículo izquierdo en 45%. En la bibliografía hallamos pocos casos de pacientes con cardiopatías congénitas complejas no intervenidos hasta la edad adulta. En ellos hay que considerar la fisiopatología cardiaca e intentar evitar elevaciones de las resistencias sistémicas, al igual que las maniobras que aumenten la resistencia a la eyección del ventrículo derecho. Tras la cirugía hay que intentar minimizar las resistencias vasculares pulmonares(AU)

A 66-year-old man with complex congenital heart defects (atrial septal defects, with incomplete cor triatriatum, an aneurysmal sac in the membranous septum, ventricular communication and pulmonary valve stenosis) was scheduled for surgery for progressive dyspnea even at rest. During anesthetic induction, effort was made to avoid increased shunting. Surgery consisted of resection of the cor triatriatum membrane, closure of communications with pericardial patches, pulmonary valve replacement, replacement of the root with a porcine root, and pulmonary artery aneurysmorrhaphy. Severely decreased contractility developed while the patient was still in the operating room; inotropic support with adrenaline and dobutamine was required. Extubation was completed in the postoperative recovery unit with no further complications. Echocardiography showed a left-ventricular ejection fraction of 45%. We found few published reports of cases of complex congenital heart disease treated surgically in adulthood. In such cases, cardiac pathophysiology must be carefully considered, and maneuvers that increase systemic resistance or right-ventricular ejection fraction should be avoided. Postoperative pulmonary vascular resistance should be kept as low as possible(AU)

Electroacupuntura en un caso de neuralgia postherpética con afectación de la rama oftálmica del V par craneal / Electroacupuncture in a case of postherpetic neuralgia with involvement of the ophthalmic branch of the trigeminal nerve

Neuralgia postherpética: cuadro de dolor neuropático crónico que aparece como complicación de una infección por el virus de la varicela zóster. La clínica se caracteriza por un dolor intenso y episódico. El tratamiento de elección es farmacológico, pero en un porcentaje de pacientes no se consigue una adecuada respuesta terapéutica, bien por intolerancia a los fármacos bien por inadecuado control del dolor. Se presenta el caso clínico de una paciente con una neuralgia postherpética que afecta a la rama oftálmica izquierda del V par craneal, en la cual no conseguimos un adecuado manejo del cuadro doloroso tras probar diferentes pautas farmacológicas. Ante esta situación, se inició sesiones de electroacupuntura combinadas con fármacos. Se obtuvo una mejoría progresiva de las crisis dolorosas en intensidad y frecuencia, lo que permitió la supresión del tratamiento farmacológico. Alternativa terapéutica a pacientes que no toleran los tratamientos farmacológicos para su dolor neuropático o cuando éstos son ineficaces (AU)

Postherpetic neuralgia consists of chronic neuropathic pain that appears as a complication of varicella-zoster virus infection and is characterized by intense and episodic pain. The treatment of choice is pharmacological but adequate therapeutic response is not always achieved, either due to drug intolerance or to inadequate pain control. Were port the case of a woman with postherpetic neuralgia affecting the left ophthalmic branch of the trigeminal nerve, in whom distinct drug treatments failed to achieve adequate pain control. Given this situation, electro-acupuncture sessions were started, combined with pharmacological therapy. The frequency and intensity of the pain exacerbations progressively diminished, allowing drug treatment to be discontinued. Electroacupuncture can constitute a therapeutic alternative in patients with drug intolerance or inadequate control of neuropathic pain with pharmacological treatment (AU)