Síndrome post-cuidados intensivos al mes del alta hospitalaria de pacientes críticos supervivientes a COVID-19 / Post-intensive care syndrome at one month after hospital discharge in critically ill patients surviving COVID-19

Objetivos: Incidencia del síndrome post-cuidados intensivos al mes del alta hospitalaria en pacientes críticos supervivientes de COVID-19 e identificar factores asociados. Diseño: Estudio de cohortes prospectivo. Ámbito: Dos unidades de críticos polivalentes del Hospital Universitario Araba. Pacientes ingresados en unidades de críticos por insuficiencia respiratoria aguda grave secundaria a COVID-19. Intervención: Ninguna. Variables de interés: Variables demográficas, estancias, índice de Charlson, APACHEII, SOFA, días de ventilación mecánica, traqueotomía, delirio, tetraparesia del paciente crítico, EuroQol 5D5L, Minimental Test. Resultados: Se objetiva un deterioro en el índice de salud (IS) del EuroQol, que pasa de 90,9 ±16,9 a 70,9 ±24,7 (p<0,001). La afectación de los cinco dominios del EuroQol es de: movilidad (46,1%), actividades habituales (44,7%), malestar/dolor (30,7%), dominio psicológico (27,3%) y autocuidado (20,3%). El 61,5% sufren un descenso significativo de su índice de salud. El análisis multivariante mediante regresión logística nos muestra que el delirio (OR=3,01; IC95%: 1,01-8,9; p=0,047) y la traqueotomía (OR=2,37; IC95%: 1,09-5,14; p=0,029) muestran asociación con la caída en el IS del EuroQol 5D5L. El área bajo la curva ROC del modelo es del 67,3%, con un intervalo de confianza entre el 58% y el 76%. Se calibra el modelo mediante el test de Hosmer-Lemeshow:(χ2=0,468; p=0,792). Solamente el 1,2% de los pacientes mostraban una puntuación ≤24, claramente patológica, en el Minimental Test de Folstein. Conclusiones: El delirio y la necesidad de traqueostomía se asocian a síndrome post-cuidados intensivos evaluado mediante EuroQol 5D5L. (AU)

Objectives: Incidence of post-intensive care syndrome at one month after hospital discharge in surviving critically ill COVID-19 patients and to identify associated factors. Design: Prospective cohort study. Setting: Two multipurpose critical care units of the Araba University Hospital. Patients admitted to critical care units for severe acute respiratory failure secondary to COVID-19. Intervention: None. Variables of interest: Demographic variables, length of stay, Charlson index, APACHEII, SOFA, days of mechanical ventilation, tracheotomy, delirium, tetraparesis of the critical patient, EuroQol 5D5L, Minimental Test. Results: A deterioration in the EuroQol health index (HI) from 90.9 ±16.9 to 70.9 ±24.7 (P<.001) was observed. The impairment of the five EuroQol domains is: mobility (46.1%), usual activities (44.7%), discomfort/pain (30.7%), psychological domain (27.3%) and self-care (20.3%). The 61.5% suffer a significant decrease in their health index. Multivariate analysis by logistic regression shows us that delirium (OR=3.01; 95%CI: 1.01-8.9; P=.047) and tracheostomy (OR=2.37; 95%CI: 1.09-5.14; P=.029) show association with drop in EuroQol 5D5L SI. The area under the ROC curve of the model is 67.3%, with a confidence interval between 58% and 76%. The model is calibrated using the Hosmer-Lemeshow test (χ2=0.468; P=.792). Only 1.2% of patients showed a score ≤24, clearly pathological, on the Folstein's Minimental Test. Conclusions: Delirium and need for tracheostomy are associated with post-intensive care syndrome assessed by EuroQol 5D5L. (AU)

Trombectomía mecánica más allá de 6 horas en ictus isquémico agudo con oclusión de gran vaso en territorio carotídeo: experiencia en un hospital terciario / Mechanical thrombectomy beyond 6 hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: Experience at a tertiary hospital

Introducción: La eficacia de la trombectomía mecánica en territorio carotídeo en las primeras 24 horas se ha probado con trabajos publicados recientemente. Métodos: Revisión retrospectiva a partir de un registro prospectivo en nuestro centro de referencia de ictus para valorar la eficacia y seguridad del tratamiento endovascular realizado más allá de las 6 horas de evolución de los síntomas en pacientes con ictus isquémico agudo y oclusión de gran vaso en territorio carotídeo, entre noviembre de 2016 y abril de 2019. Resultados: Se recopilaron datos de 59 pacientes (55,9% mujeres, mediana de edad 71 años). Treinta y tres pacientes fueron detectados al despertar. El 57,6% de los casos fueron traslados secundarios. La mediana de NIHSS basal fue 16. La mediana del ASPECTS fue 8 y el 94,9% de los pacientes presentó > 50% de tejido salvable. El 88,1% de los pacientes logró una recanalización satisfactoria, en 5 pacientes después de 24 horas de evolución. El 67,8% de los casos logró la independencia funcional a los 90 días de seguimiento. Los pacientes que no lograron la independencia funcional presentaban mayor edad, mayor proporción de fibrilación auricular, mayor tiempo punción-recanalización y mayor puntuación NIHSS, tanto basal como al alta. Conclusión: En nuestra experiencia la trombectomía mecánica después de las 6 horas se asoció con buenos resultados de funcionalidad a los 90 días. La edad, la puntuación NIHSS, el tiempo punción-recanalización y la prevalencia de fibrilación auricular fueron factores determinantes en el pronóstico funcional. La eficacia de este tratamiento por encima de las 24 horas merece ser estudiada.(AU)

Introduction: Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. Methods: We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. Results: Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. Conclusion: In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study.(AU)

Spontaneous pulmonary hematoma in patients with COVID-19.

The disease caused by Sars-Cov-2 (Covid-19) has become a worldwide pandemic and consequently a public health problem. Multiple complications associated with Covid-19 have been described, including coagulation abnormalities. Although the infection is known to induce a prothrombotic state, hemorrhagic complications have also been reported in patients with Covid-19, especially in anticoagulated patients. We present two cases of spontaneous pulmonary hematoma in patients with Covid-19 undergoing anticoagulant treatment. We aim to describe this complication, which although uncommon, should be taken into account in anticoagulated patients with Covid-19.

Hematoma pulmonar espontáneo en pacientes con COVID-19 / Spontaneous pulmonary hematoma in patients with COVID-19

La enfermedad causada por SARS-CoV-2 (Covid-19) se ha convertido en una pandemia mundial y en consecuencia en un problema de salud pública. Se han descrito múltiples complicaciones asociadas a la COVID-19, entre ellas alteraciones de la coagulación. Si bien es conocido que la infección induce un estado protrombótico, también se han descrito complicaciones hemorrágicas en estos pacientes, sobre todo en pacientes anticoagulados. Presentamos dos casos de hematoma pulmonar espontáneo en pacientes con neumonía COVID-19 y terapia anticoagulante. Nuestro objetivo es describir esta complicación, que, aunque poco frecuente, conviene tener en cuenta en pacientes anticoagulados y con COVID-19 concomitante (AU)

The disease caused by Sars-Cov-2 (Covid-19) has become a worldwide pandemic and consequently a public health problem. Multiple complications associated with Covid-19 have been described, including coagulation abnormalities. Although the infection is known to induce a prothrombotic state, hemorrhagic complications have also been reported in patients with Covid-19, especially in anticoagulated patients. We present two cases of spontaneous pulmonary hematoma in patients with Covid-19 undergoing anticoagulant treatment. We aim to describe this complication, which although uncommon, should be taken into account in anticoagulated patients with Covid-19 (AU)

[Spontaneous pulmonary hematoma in patients with COVID-19]. / Hematoma pulmonar espontáneo en pacientes con COVID-19.

The disease caused by Sars-Cov-2 (Covid-19) has become a worldwide pandemic and consequently a public health problem. Multiple complications associated with Covid-19 have been described, including coagulation abnormalities. Although the infection is known to induce a prothrombotic state, hemorrhagic complications have also been reported in patients with Covid-19, especially in anticoagulated patients. We present two cases of spontaneous pulmonary hematoma in patients with Covid-19 undergoing anticoagulant treatment. We aim to describe this complication, which although uncommon, should be taken into account in anticoagulated patients with Covid-19.

Mechanical thrombectomy beyond 6 hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: experience at a tertiary hospital.

INTRODUCTION: Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. METHODS: We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. RESULTS: Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. CONCLUSION: In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study.

Post-intensive care syndrome one month after discharge in surviving critically ill COVID-19 patients.

OBJECTIVES: Incidence of post-intensive care syndrome at one month after hospital discharge in surviving critically ill COVID 19 patients and to identify associated factors. DESIGN: Prospective cohort study. SETTING: Two multipurpose critical care units of the Araba University Hospital. Patients admitted to critical care units for severe acute respiratory failure secondary to COVID 19. INTERVENTION: None. VARIABLES OF INTEREST: Demographic variables, length of stay, Charlson index, APACHE II, SOFA, days of mechanical ventilation, tracheotomy, delirium, tetraparesis of the critical patient, EuroQol 5D5L, Minimental Test. RESULTS: A deterioration in the EuroQol health index (HI) from 90.9±16.9 to 70.9±24.7 (p<0.001) was observed. The impairment of the five EuroQol domains is: mobility (46.1%), usual activities (44.7%), discomfort/pain (30.7%), psychological domain (27.3%) and self-care (20.3%). The 61.5% suffer a significant decrease in their health index. Multivariate analysis by logistic regression shows us that delirium (OR=3.01; 95%CI: 1.01-8.9; p=0.047) and tracheostomy (OR=2.37; 95%CI: 1.09-5.14; p=0.029) show association with drop in EuroQoL 5D5L SI. The area under the ROC curve of the model is 67.3%, with a confidence interval between 58% and 76%. The model is calibrated using the Hosmer-Lemeshow test (χ2=0.468; p=0.792). Only 1.2% of patients showed a score ≤ 24, clearly pathological, on the Folstein's Minimental Test. CONCLUSIONS: Delirium and need for tracheostomy are associated with post-intensive care syndrome assessed by EuroQol 5D5L.