Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

[Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. / Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Diagnóstico de cuerpo extraño accidental / Diagnosis of accidental foreign body

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Efectos del retraso y la inadecuación del tratamiento antibiótico en la supervivencia de los pacientes en shock séptico / Effects of antibiotic administration delay and inadequacy upon the survival of septic shock patients

OBJETIVO: Evaluar cómo influye el retraso en la administración de la primera dosis de antibiótico y la inadecuación de la pauta seleccionada en la supervivencia de los pacientes en shock séptico. DISEÑO: Estudio prospectivo de cohortes observacional realizado entre septiembre de 2005 y septiembre de 2010. ÁMBITO: Pacientes hospitalizados en la UCI de un hospital de tercer nivel. PACIENTES: Trescientos cuarenta y dos pacientes con cuadro de shock séptico. INTERVENCIONES: Ninguna. Variables de interés principales: Se determinó el tiempo hasta la administración del antibiótico (diferencia entre la presentación del shock séptico y la primera dosis de antibiótico) y la adecuación del mismo (susceptibilidad in vitro de los microorganismos aislados). RESULTADOS: La mortalidad en UCI fue del 26,4% y a nivel hospitalario del 33,5%. La mediana de retraso en la administración de la primera dosis de tratamiento antibiótico fue de 1,7 h. Los pacientes fallecidos recibieron el antibiótico significativamente más tarde (1,3 ± 14,5 h frente a 5,8 ± 18,02; p = 0,001) que los supervivientes. El porcentaje de inadecuación del tratamiento antibiótico fue del 12%. Los pacientes tratados inadecuadamente presentaron cifras de mortalidad hospitalaria significativamente más altas (33,8% frente a 51,2%; p = 0,03) respecto a los que recibieron una pauta antibiótica adecuada. La coexistencia de retraso e inadecuación en el tratamiento antibiótico se asoció a una menor supervivencia de los pacientes. CONCLUSIONES: Tanto el retraso como la inadecuación del tratamiento antibiótico tienen efectos negativos sobre la supervivencia de los pacientes en shock séptico independientemente de las características de estos o de su estado de gravedad

OBJECTIVE: To assess how antibiotic administration delay and inadequacy influence survival in septic shock patients. DESIGN: A prospective, observational cohort study was carried out between September 2005 and September 2010. SCOPE: Patients admitted to the ICU of a third level hospital. PATIENTS: A total of 342 septic shock patients Interventions: None Variables of interest: The time to antibiotic administration (difference between septic shock presentation and first administered dose of antibiotic) and its adequacy (in vitro susceptibility testing of isolated pathogens) were determined. RESULTS: ICU and hospital mortality were 26.4% and 33.5%, respectively. The median delay to administration of the first antibiotic dose was 1.7 h. Deceased patients received antibiotics significantly later than survivors (1.3 ± 14.5 h vs. 5.8 ± 18.02 h; P = .001). Percentage drug inadequacy was 12%. Those patients who received inadequate antibiotics had significantly higher mortality rates (33.8% vs. 51.2%; P = .03). The coexistence of treatment delay and inadequacy was associated to lower survival rates. CONCLUSIONS: Both antibiotic administration delay and inadequacy exert deleterious effects upon the survival of septic shock patients, independently of their characteristics or severity

Effects of antibiotic administration delay and inadequacy upon the survival of septic shock patients.

OBJECTIVE: To assess how antibiotic administration delay and inadequacy influence survival in septic shock patients. DESIGN: A prospective, observational cohort study was carried out between September 2005 and September 2010. SCOPE: Patients admitted to the ICU of a third level hospital. PATIENTS: A total of 342 septic shock patients INTERVENTIONS: None VARIABLES OF INTEREST: The time to antibiotic administration (difference between septic shock presentation and first administered dose of antibiotic) and its adequacy (in vitro susceptibility testing of isolated pathogens) were determined. RESULTS: ICU and hospital mortality were 26.4% and 33.5%, respectively. The median delay to administration of the first antibiotic dose was 1.7h. Deceased patients received antibiotics significantly later than survivors (1.3±14.5h vs. 5.8±18.02h; P=.001). Percentage drug inadequacy was 12%. Those patients who received inadequate antibiotics had significantly higher mortality rates (33.8% vs. 51.2%; P=.03). The coexistence of treatment delay and inadequacy was associated to lower survival rates. CONCLUSIONS: Both antibiotic administration delay and inadequacy exert deleterious effects upon the survival of septic shock patients, independently of their characteristics or severity.

Validación externa de la escala Risk Quantification of Early Outcome After Lung Transplantation / External validation of the Risk Quantification of Early Outcome After Lung Transplantation scale

Objetivo: Validar la escala Risk Quantification of Early Outcome After Lung Transplantation (RQLT) en una cohorte de enfermos trasplantados de pulmón. Diseño: Prospectivamente se recogieron los parámetros incluidos en la escala RQLT. Pacientes: Se analizaron 74 enfermos trasplantados de pulmón en el Hospital Universitario Marqués de Valdecilla (Santander) entre septiembre de 2004 y marzo de 2008. Variables de interés principales: Asociación de la puntuación de la escala RQLT con la mortalidad a 30 días y la estancia en unidad de cuidados intensivos prolongada. Ajuste de la escala mediante modelo de regresión logística teniendo como variable dependiente la mortalidad a 30 días. Valoración de la eficacia diagnóstica mediante curva receiver operating characteristics, y calibración del sistema sobre la muestra mediante el test de bondad del ajuste de Hosmer y Lemeshow. Resultados: La mortalidad a 30 días en los enfermos trasplantados de pulmón es significativamente mayor conforme aumenta el valor del RQLT, y muestra una odds ratio de 2,20 (1,24-3,93) por cada punto de más en la escala. El área bajo la curva receiver operating characteristics, con respecto a la mortalidad a 30 días, fue de 0,79 (0,68-0,88); p=0,01. El test de bondad de ajuste de Hosmer y Lemeshow describió un valor p=0,58. Conclusiones: La escala RQLT es una herramienta útil como indicador de mortalidad a 30 días en los pacientes trasplantados (AU)

Objective: To validate the «Risk Quantification of Early Outcome After Lung Transplantation» (RQLT) scale in a cohort of lung transplantation patients. Design: The parameters included in the RQLT scale were recorded prospectively. Patient: A total of 74 lung transplant patients in the University Hospital Marquis of Valdecilla (Santander) were analyzed between September 2004 and March 2008. Main variables of interest: This was the association of the score on the RQLT scale with mortality at 30 days and prolonged ICU stay. The dependent variable of mortality at 30 days was adjustment of scale using the logistic regression model. Diagnostic efficacy was evaluated using the ROC curve and calibration of the system on the sample with the Hosmer and Lemeshow goodness of fit test. Results: The 30-day mortality in lung transplant patients increases significantly as the RQLT score increases, with an odds ratio (OR) of 2.20 (1.24-3.93) for each point increase on the RQLT scale. The area under the ROC curve for 30-day mortality was 0.79 (0.68-0.88; P=0.01). The Hosmer and Lemeshow goodness of fit test described a value p=0.58. Conclusions: The RQLT scale is a useful tool as an indicator of 30-day mortality in transplant patients (AU)

[External validation of the Risk Quantification of Early Outcome after Lung Transplantation scale]. / Validación externa de la escala Risk Quantification of Early Outcome After Lung Transplantation.

OBJECTIVE: To validate the "Risk Quantification of Early Outcome After Lung Transplantation" (RQLT) scale in a cohort of lung transplantation patients. DESIGN: The parameters included in the RQLT scale were recorded prospectively. PATIENT: A total of 74 lung transplant patients in the University Hospital Marquis of Valdecilla (Santander) were analyzed between September 2004 and March 2008. MAIN VARIABLES OF INTEREST: This was the association of the score on the RQLT scale with mortality at 30 days and prolonged ICU stay. The dependent variable of mortality at 30 days was adjustment of scale using the logistic regression model. Diagnostic efficacy was evaluated using the ROC curve and calibration of the system on the sample with the Hosmer and Lemeshow goodness of fit test. RESULTS: The 30-day mortality in lung transplant patients increases significantly as the RQLT score increases, with an odds ratio (OR) of 2.20 (1.24-3.93) for each point increase on the RQLT scale. The area under the ROC curve for 30-day mortality was 0.79 (0.68-0.88; P=0.01). The Hosmer and Lemeshow goodness of fit test described a value p=0.58. CONCLUSIONS: The RQLT scale is a useful tool as an indicator of 30-day mortality in transplant patients.

Discrepancias entre el diagnóstico clínico y el diagnóstico anatomopatológico en la mortalidad temprana del trasplante pulmonar / Discrepancies between the clinical and pathological diagnosis in lung transplant early mortality

Objetivo: Analizar la frecuencia y el espectro de las enfermedades más relevantes encontradas en las autopsias de los enfermos a los que se les realizó un trasplante pulmonar y en las autopsias de los fallecidos en el primer mes postrasplante. Valorar la concordancia de los diagnósticos pre mórtem y post mórtem, y compararlos mediante la escala de Goldman et al modificada por Battle et al. Material y método: Análisis retrospectivo y longitudinal de las historias clínicas y de los registros de autopsias de los enfermos trasplantados de pulmón en nuestro centro (Hospital Universitario Marqués de Valdecilla) desde 1997 hasta 2007 que fallecieron en el período postoperatorio temprano (primer mes postrasplante). La discordancia entre el diagnóstico clínico y el diagnóstico anatomopatológico se clasificó de acuerdo a la clasificación de Goldman et al (N Engl JMed: 1983) y Battle et al (JAMA: 1987). En la comparación de los grupos se utilizó el test de la t de Student para las variables cuantitativas y la prueba de la Chi cuadrado para las variables cualitativas. Resultados: Los 5 errores de clase I se circunscriben a enfermedades respiratorias: 2 rechazos agudos no diagnosticados, una tromboembolia pulmonar bilateral, una embolia grasa y un infarto hemorrágico del pulmón injertado. Encontramos una diferencia significativa (p=0,05) entre los días de supervivencia de los enfermos del grupo con errores de clase I (6±4,52 días) y los enfermos del grupo sin discrepancia (15,42±8,99). Conclusiones: El breve período de tiempo existente entre el trasplante y el fallecimiento del enfermo hace que se reduzca la posibilidad de llegar a un diagnóstico correcto. Este dato debe hacer extremar las posibilidades diagnósticas en las enfermedades potencialmente mortales en este período, de este modo la tasa de estudios necrópsicos en este período debería ser del 100% (AU)

Objective: To analyze the prevalence and frequency spectrum of the most relevant diseases found in the autopsies of patients who underwent a lung transplant and died in the first month after transplantation. To evaluate the consistency of the pre-and post-mortem diagnoses, comparing them with the Goldman et al. scale modified by Battle et al. Material and methods: Retrospective and longitudinal analysis, comparison of the medical records and records of autopsies of patients who received a lung transplant in our center (University Hospital Marques de Valdecilla) from 1997 to 2007, who died in the early postoperative period (first month post-transplant). The discordance between clinical and pathological diagnosis was classified according to the classification of Goldman et al. and Battle et al. The Student t test for quantitative variables and chi-square for qualitative variables were used for the comparison of the groups. Results: The five class I errors are limited to respiratory diseases: 2 undiagnosed acute rejection, 1 bilateral pulmonary thromboembolism, 1 fat embolism and 1 hemorrhagic infarction of the lung graft. We found a significant difference (p=0.05) between days of survival of patients with group Class I errors (6±4.52 days) and patients from the group with no discrepancy (15.42±8.99). Conclusion: The short time between transplant and death of the patient reduces the possibility of reaching a correct diagnosis. Because of this information, diagnostic possibilities must be maximized in life-threatening diseases during this period. Therefore, the rate of autopsy studies in this period should be 100% (AU)

Utilidad de la procalcitonina en el diagnóstico de la infección del paciente trasplantado pulmonar / Usefulness of procalcitonin in the diagnosis of infection in lung transplant patients

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