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1.
Med. intensiva (Madr., Ed. impr.) ; 44(6): 371-388, ago.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-187189

RESUMO

El 11 de marzo de 2020 el director general de la Organización Mundial de la Salud (OMS) declaró la enfermedad causada por el SARS-CoV-2 (COVID-19) como una pandemia. La propagación y evolución de la pandemia está poniendo a prueba los sistemas sanitarios de decenas de países y ha dado lugar a una miríada de artículos de opinión, planes de contingencia, series de casos e incipientes ensayos. Abarcar toda esta literatura es complejo. De forma breve y sintética, en la línea de las anteriores recomendaciones de los Grupos de Trabajo, la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) ha elaborado esta serie de recomendaciones básicas para la asistencia a pacientes en el contexto de la pandemia


On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Betacoronavirus , Pneumonia Viral , Pessoal de Saúde/normas , Transferência de Pacientes/normas , Cuidados Críticos/normas , Espanha/epidemiologia , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas , Segurança do Paciente , Pandemias , Cuidados Críticos/organização & administração
4.
Crit Care Med ; 48(10): 1403-1410, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32796181

RESUMO

OBJECTIVES: To describe the importance of critical care clinical research that is not pandemic-focused during pandemic times; outline principles to assist in the prioritization of nonpandemic research during pandemic times; and propose a guiding framework for decisions about whether, when and how to continue nonpandemic research while still honoring the moral and scientific imperative to launch research that is pandemic-focused. DESIGN/DATA SOURCES: Using in-person, email, and videoconference exchanges, we convened an interprofessional clinical research group, conducted a literature review of empirical studies, ethics documents and expert commentaries (2010 to present), and viewed traditional and social media posts (March 2020 to May 2020). Stakeholder consultation involved scientific, ethics, clinical, and administrative leaders. SETTING: Clinical research in the ICU. PATIENTS: Patients with and without coronavirus disease 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: While clinical research should be prioritized to advantage patients with coronavirus disease 2019 in order to care for affected patients, it ideally would not unduly disadvantage patients without coronavirus disease 2019. Thus, timely, rigorous, relevant, and ethical clinical research is needed to improve the care and optimize outcomes for both patients with and without coronavirus disease 2019, acknowledging how many studies that are not exclusively focused on coronavirus disease 2019 remain relevant to patients with coronavirus disease 2019. Considerations to continue nonpandemic-focused research include the status of the pandemic, local jurisdictional guidance, capacity and safety of bedside and research personnel, disposition of patients already enrolled in nonpandemic studies, analyzing characteristics of each nonpandemic-focused study, research oversight, and final reporting requirements. CONCLUSIONS: Deliberation about continuing nonpandemic research should use objective, transparent criteria considering several aspects of the research process such as bedside and research staff safety, infection control, the informed consent model, protocol complexity, data collection, and implementation integrity. Decisions to pause or pursue nonpandemic research should be proportionate, transparent, and revisited as the pandemic abates.


Assuntos
Pesquisa Biomédica/organização & administração , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/normas , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/prevenção & controle , Estado Terminal/mortalidade , Estado Terminal/terapia , Feminino , Saúde Global , Humanos , Controle de Infecções/normas , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Projetos de Pesquisa , Gestão da Segurança
6.
Nutr Clin Pract ; 35(5): 792-799, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32786117

RESUMO

Worldwide, as of July 2020, >13.2 million people have been infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The spectrum of coronavirus disease 2019 (COVID-19) ranges from mild illness to critical illness in 5% of cases. The population infected with SARS-CoV-2 requiring an intensive care unit admission often requires nutrition therapy as part of supportive care. Although the various societal guidelines for critical care nutrition meet most needs for the patient with COVID-19, numerous factors, which impact the application of those guideline recommendations, need to be considered. Since the SARS-CoV-2 virus is highly contagious, several key principles should be considered when caring for all patients with COVID-19 to ensure the safety of all healthcare personnel involved. Management strategies should cluster care, making all attempts to bundle patient care to limit exposure. Healthcare providers should be protected, and the spread of SARS-CoV-2 should be limited by minimizing procedures and other interventions that lead to aerosolization, avoiding droplet exposure through hand hygiene and use of personal protective equipment (PPE). PPE should be preserved by decreasing the number of individuals providing direct patient care and by limiting the number of patient interactions. Enteral nutrition (EN) is tolerated by the majority of patients with COVID-19, but a relatively low threshold for conversion to parenteral nutrition should be maintained if increased exposure to the virus is required to continue EN. This article offers relevant and practical recommendations on how to optimize nutrition therapy in critically ill patients with COVID-19.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Apoio Nutricional/métodos , Pacotes de Assistência ao Paciente/métodos , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Betacoronavirus , Cuidados Críticos/normas , Nutrição Enteral/métodos , Nutrição Enteral/normas , Humanos , Apoio Nutricional/normas , Pandemias
8.
Medicina (B Aires) ; 80 Suppl 3: 45-64, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32658848

RESUMO

Guidelines on resource allocation, ethics, triage processes with admission and discharge criteria from critical care and palliative care units during the pandemia are here presented. The interdisciplinary and multi-society panel that prepared these guidelines represented by bioethicists and specialists linked to the end of life: clinicians, geriatricians, emergentologists, intensivists, and experts in palliative care and cardiopulmonary resuscitation. The available information indicates that approximately 80% of people with COVID-19 will develop mild symptoms and will not require hospital care, while 15% will require intermediate or general room care, and the remaining 5% will require assistance in intensive care units. The need to think about justice and establish ethical criteria for allocation patients arise in conditions of exceeding available resources, such as outbreaks of diseases and pandemics, with transparency being the main criterion for allocation. These guides recommend general criteria for the allocation of resources relies on bioethical considerations, rooted in Human Rights and based on the value of the dignity of the human person and substantial principles such as solidarity, justice and equity. The guides are recommendations of general scope and their usefulness is to accompany and sustain the technical and scientific decisions made by the different specialists in the care of critically ill patients, but given the dynamic nature of the pandemic, a process of permanent revision and adaptation of recommendations must be ensured.


Assuntos
Infecções por Coronavirus , Tomada de Decisões/ética , Serviços Médicos de Emergência/ética , Alocação de Recursos para a Atenção à Saúde/economia , Pandemias , Pneumonia Viral , Triagem/ética , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos/ética , Cuidados Críticos/normas , Humanos , Cuidados Paliativos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Alocação de Recursos , Sociedades Médicas
10.
AACN Adv Crit Care ; 31(3): 268-280, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32668462

RESUMO

When caring for patients with coronavirus disease 2019 (COVID-19), clinicians have noticed some unusual clinical presentations not observed before, such as profound hypoxia and severe hypotension. Scientists are probing the evidence to explain these issues and many other unanswered questions. Severe acute respiratory syndrome associated with coronavirus 2 presents an unchartered acute and critical care dilemma. Some of the theories and proposed interventions that will improve outcomes for these critically ill patients are explored in this article. Various testing procedures for COVID-19 are described so valid results can be obtained. Clinical presentations are discussed but continue to evolve as the pandemic ravages our society. The psychological impact of this devastation is also addressed from multiple perspectives. The health care provider is faced with an unprecedented, harrowing situation that has become an internal war that also must be confronted. Professional dedication has provided a formidable response to this destructive virus.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Cuidados Críticos/normas , Programas de Rastreamento/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle
12.
PLoS One ; 15(7): e0235424, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614874

RESUMO

Progress of machine learning in critical care has been difficult to track, in part due to absence of public benchmarks. Other fields of research (such as computer vision and natural language processing) have established various competitions and public benchmarks. Recent availability of large clinical datasets has enabled the possibility of establishing public benchmarks. Taking advantage of this opportunity, we propose a public benchmark suite to address four areas of critical care, namely mortality prediction, estimation of length of stay, patient phenotyping and risk of decompensation. We define each task and compare the performance of both clinical models as well as baseline and deep learning models using eICU critical care dataset of around 73,000 patients. This is the first public benchmark on a multi-centre critical care dataset, comparing the performance of clinical gold standard with our predictive model. We also investigate the impact of numerical variables as well as handling of categorical variables on each of the defined tasks. The source code, detailing our methods and experiments is publicly available such that anyone can replicate our results and build upon our work.


Assuntos
Benchmarking , Cuidados Críticos/normas , Aprendizado de Máquina , Algoritmos , Regras de Decisão Clínica , Conjuntos de Dados como Assunto , Mortalidade Hospitalar , Humanos , Tempo de Internação , Software
13.
Crit Care Med ; 48(8): 1196-1202, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32697491

RESUMO

OBJECTIVES: Coronavirus disease 2019 patients are currently overwhelming the world's healthcare systems. This article provides practical guidance to front-line physicians forced to make critical rationing decisions. DATA SOURCES: PubMed and Medline search for scientific literature, reviews, and guidance documents related to epidemic ICU triage including from professional bodies. STUDY SELECTION: Clinical studies, reviews, and guidelines were selected and reviewed by all authors and discussed by internet conference and email. DATA EXTRACTION: References and data were based on relevance and author consensus. DATA SYNTHESIS: We review key challenges of resource-driven triage and data from affected ICUs. We recommend that once available resources are maximally extended, triage is justified utilizing a strategy that provides the greatest good for the greatest number of patients. A triage algorithm based on clinical estimations of the incremental survival benefit (saving the most life-years) provided by ICU care is proposed. "First come, first served" is used to choose between individuals with equal priorities and benefits. The algorithm provides practical guidance, is easy to follow, rapidly implementable and flexible. It has four prioritization categories: performance score, ASA score, number of organ failures, and predicted survival. Individual units can readily adapt the algorithm to meet local requirements for the evolving pandemic. Although the algorithm improves consistency and provides practical and psychologic support to those performing triage, the final decision remains a clinical one. Depending on country and operational circumstances, triage decisions may be made by a triage team or individual doctors. However, an experienced critical care specialist physician should be ultimately responsible for the triage decision. Cautious discharge criteria are proposed acknowledging the difficulties to facilitate the admission of queuing patients. CONCLUSIONS: Individual institutions may use this guidance to develop prospective protocols that assist the implementation of triage decisions to ensure fairness, enhance consistency, and decrease provider moral distress.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Alocação de Recursos para a Atenção à Saúde/métodos , Unidades de Terapia Intensiva/organização & administração , Pandemias , Pneumonia Viral/terapia , Triagem/métodos , Adulto , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/normas , Alocação de Recursos para a Atenção à Saúde/normas , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Triagem/normas
14.
J Cardiothorac Vasc Anesth ; 34(10): 2595-2603, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32620487

RESUMO

Cardiopulmonary resuscitation (CPR) in patients with severe acute respiratory syndrome coronavirus-2-associated disease (coronavirus disease 2019) poses a unique challenge to health- care providers due to the risk of viral aerosolization and disease transmission. This has caused some centers to modify existing CPR procedures, limit the duration of CPR, or consider avoiding CPR altogether. In this review, the authors propose a procedure for CPR in the intensive care unit that minimizes the number of personnel in the immediate vicinity of the patient and conserves the use of scarce personal protective equipment. Highlighting the low likelihood of successful resuscitation in high-risk patients may prompt patients to decline CPR. The authors recommend the preemptive placement of central venous lines in high-risk patients with intravenous tubing extensions that allow for medication delivery from outside the patients' rooms. During CPR, this practice can be used to deliver critical medications without delay. The use of a mechanical compression system for CPR further reduces the risk of infectious exposure to health- care providers. Extracorporeal membrane oxygenation should be reserved for patients with few comorbidities and a single failing organ system. Reliable teleconferencing tools are essential to facilitate communication between providers inside and outside the patients' rooms. General principles regarding the ethics and peri-resuscitative management of coronavirus 2019 patients also are discussed.


Assuntos
Betacoronavirus , Reanimação Cardiopulmonar/métodos , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Parada Cardíaca/terapia , Unidades de Terapia Intensiva , Pneumonia Viral/terapia , Reanimação Cardiopulmonar/normas , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/normas , Parada Cardíaca/epidemiologia , Humanos , Unidades de Terapia Intensiva/normas , Pandemias , Pneumonia Viral/epidemiologia , Fluxo de Trabalho
15.
J Am Assoc Nurse Pract ; 32(6): 416-418, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-594928

RESUMO

Our health care landscape is rapidly changing. With the aging population and seemingly increasing outbreak of communicable diseases, it is expected that there will be a continued demand for inpatient/critical care providers. The current COVID-19 pandemic provides a glimpse of a health care system in severe provider shortage. Adult-gerontology acute nurse practitioners (GACNPs) can play a vital part in relieving that shortage. But with the increased role, there is an increased responsibility and need for expansion of AGACNP skill set. This includes the training and utilization of point-of-care ultrasound (POCUS). The case reports and data available from countries that have already combated COVID-19 outbreak show POCUS can play a key part in managing critically ill patients on isolation precautions. This article provides my perspective on POCUS training and competency achievement for AGACNPPs.


Assuntos
Competência Clínica/normas , Enfermagem Geriátrica/normas , Profissionais de Enfermagem/educação , Sistemas Automatizados de Assistência Junto ao Leito/normas , Ultrassonografia/normas , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos/normas , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
16.
J Am Assoc Nurse Pract ; 32(6): 416-418, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32511190

RESUMO

Our health care landscape is rapidly changing. With the aging population and seemingly increasing outbreak of communicable diseases, it is expected that there will be a continued demand for inpatient/critical care providers. The current COVID-19 pandemic provides a glimpse of a health care system in severe provider shortage. Adult-gerontology acute nurse practitioners (GACNPs) can play a vital part in relieving that shortage. But with the increased role, there is an increased responsibility and need for expansion of AGACNP skill set. This includes the training and utilization of point-of-care ultrasound (POCUS). The case reports and data available from countries that have already combated COVID-19 outbreak show POCUS can play a key part in managing critically ill patients on isolation precautions. This article provides my perspective on POCUS training and competency achievement for AGACNPPs.


Assuntos
Competência Clínica/normas , Enfermagem Geriátrica/normas , Profissionais de Enfermagem/educação , Sistemas Automatizados de Assistência Junto ao Leito/normas , Ultrassonografia/normas , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos/normas , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
17.
Rev Assoc Med Bras (1992) ; 66(4): 498-501, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32578785

RESUMO

The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic shows a rapid increase in cases and deaths. The World Health Organization (WHO) has shown that more than 200.000 confirmed cases have been identified in more than 166 countries/territories. Public health authorities in Brasil have reported 532 confirmed cases by March 19. Approximately 5% of the patients will require intensive care unit treatment with oxygen therapy and mechanical ventilation. Limited data are available about rehabilitation protocols for severe illness and intensive care treatment of COVID-19 increase. Thus, we aim to show current information about COVID-19, describing symptoms and the respiratory management for critical patients and preventive care. Physical therapists and all health care professionals need to recognize the challenges they will face in the coming months.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Fisioterapeutas/normas , Modalidades de Fisioterapia/normas , Pneumonia Viral/terapia , Brasil , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos/normas , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/fisiopatologia , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Síndrome do Desconforto Respiratório do Adulto/terapia , Terapia Respiratória/normas
18.
J Epidemiol Glob Health ; 10(2): 115-117, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32538025

RESUMO

Turkey reported its first COVID-19 case on March 10, 2020. We present here the mitigation efforts Turkey has undertaken so far, and also review the lessons learned for future proactive strategies. High number of intensive care unit beds and ventilators, national treatment algorithms, governmental support for free testing and medications, tedious contact-tracing with early detection and isolation of cases together with early shelter-in-place for the elderly and youngsters, and subsequent weekend curfews in selected cities have so far prevented the surge pressure on the health care system. At this phase, Turkey needs to adopt an evidence-based, proactive control system for an effective transition process to normalize the situation. Here, we underline the urgent need for detailed analysis of the national COVID-19 data and propose an epidemiologic investigation framework for better understanding, efficient control, and reliable forecasting of COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos/normas , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Humanos , Turquia/epidemiologia
19.
J Epidemiol Glob Health ; 10(2): 118-123, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32538026

RESUMO

OBJECTIVES: The study aims to analyze the status quo of public health emergency measures taken in China in dealing with the spread of new coronavirus pneumonia (COVID-19), and to put forward policy suggestions for system construction and improvement. METHODS: According to the official data released by the National Health Commission, the epidemic data of infected people from 0:00 on January 24, 2020 to 24:00 on February 23, 2020 were quantitatively analyzed through statistical analysis. We used EXCEL software to draw the overall epidemic trend chart and Statistical Product and Service Solutions (SPSS) to carry out descriptive statistical analysis of mortality and cure rate. We made qualitative analysis on the emergency measures implemented by national administrative departments and provincial governments to work on controlling and monitoring COVID-19 nationwide spread. RESULTS: The number of patients diagnosed showed a linear increasing trend, with the slope increasing first and decreasing later. Suspected and new cases showed an inverted V pattern, with the peak occurring on February 8 and 12, respectively. There was a linear increase in the number of deaths and an exponential increase in the number of cures. Over the 31-day study period, the mortality rate fluctuated between 2.0% and 3.4%. The mean cure rate was 10.03%, the minimum value was 1.33%, and the maximum value was 32.05%. The quantitative and qualitative analysis shows that the public health emergency response system constructed in China plays a significant role in controlling the epidemic in a certain period of time. DISCUSSION: The four-tier emergency management system and the joint prevention mechanism established in China have provided various resources to control the epidemic, but there are still weakness in dealing with the spread of COVID-19. It is suggested to improve and strengthen the emergency management system, public health service system, health legal system, citizen health education, and international exchange and cooperation.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos/normas , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Saúde Pública/normas , China/epidemiologia , Humanos , Guias de Prática Clínica como Assunto
20.
Intensive Care Med ; 46(7): 1303-1325, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32514598

RESUMO

Given the rapidly changing nature of COVID-19, clinicians and policy makers require urgent review and summary of the literature, and synthesis of evidence-based guidelines to inform practice. The WHO advocates for rapid reviews in these circumstances. The purpose of this rapid guideline is to provide recommendations on the organizational management of intensive care units caring for patients with COVID-19 including: planning a crisis surge response; crisis surge response strategies; triage, supporting families, and staff.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Unidades de Terapia Intensiva/organização & administração , Pandemias , Pneumonia Viral/terapia , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/normas , Equipamentos e Provisões Hospitalares , Alocação de Recursos para a Atenção à Saúde/normas , Mão de Obra em Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Unidades de Terapia Intensiva/normas , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Respiração Artificial/instrumentação , Respiração Artificial/normas , Triagem
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