Clinical characteristics, systemic complications, and in-hospital outcomes for patients with COVID-19 in Latin America. LIVEN-Covid-19 study: A prospective, multicenter, multinational, cohort study.

PURPOSE: The COVID-19 pandemic has spread worldwide, and almost 396 million people have been infected around the globe. Latin American countries have been deeply affected, and there is a lack of data in this regard. This study aims to identify the clinical characteristics, in-hospital outcomes, and factors associated with ICU admission due to COVID-19. Furthermore, to describe the functional status of patients at hospital discharge after the acute episode of COVID-19. MATERIAL AND METHODS: This was a prospective, multicenter, multinational observational cohort study of subjects admitted to 22 hospitals within Latin America. Data were collected prospectively. Descriptive statistics were used to characterize patients, and multivariate regression was carried out to identify factors associated with severe COVID-19. RESULTS: A total of 3008 patients were included in the study. A total of 64.3% of patients had severe COVID-19 and were admitted to the ICU. Patients admitted to the ICU had a higher mean (SD) 4C score (10 [3] vs. 7 [3)], p<0.001). The risk factors independently associated with progression to ICU admission were age, shortness of breath, and obesity. In-hospital mortality was 24.1%, whereas the ICU mortality rate was 35.1%. Most patients had equal self-care ability at discharge 43.8%; however, ICU patients had worse self-care ability at hospital discharge (25.7% [497/1934] vs. 3.7% [40/1074], p<0.001). CONCLUSIONS: This study confirms that patients with SARS CoV-2 in the Latin American population had a lower mortality rate than previously reported. Systemic complications are frequent in patients admitted to the ICU due to COVID-19, as previously described in high-income countries.

Early rise in central venous pressure during a spontaneous breathing trial: A promising test to identify patients at high risk of weaning failure?

BACKGROUND: The spontaneous breathing trial (SBT) assesses the risk of weaning failure by evaluating some physiological responses to the massive venous return increase imposed by discontinuing positive pressure ventilation. This trial can be very demanding for some critically ill patients, inducing excessive physical and cardiovascular stress, including muscle fatigue, heart ischemia and eventually cardiac dysfunction. Extubation failure with emergency reintubation is a serious adverse consequence of a failed weaning process. Some data suggest that as many as 50% of patients that fail weaning do so because of cardiac dysfunction. Unfortunately, monitoring cardiovascular function at the time of the SBT is complex. The aim of our study was to explore if central venous pressure (CVP) changes were related to weaning failure after starting an SBT. We hypothesized that an early rise on CVP could signal a cardiac failure when handling a massive increase on venous return following a discontinuation of positive pressure ventilation. This CVP rise could identify a subset of patients at high risk for extubation failure. METHODS: Two-hundred and four mechanically ventilated patients in whom an SBT was decided were subjected to a monitoring protocol that included blinded assessment of CVP at baseline, and at 2 minutes after starting the trial (CVP-test). Weaning failure was defined as reintubation within 48-hours following extubation. Comparisons between two parametric or non-parametric variables were performed with student T test or Mann Whitney U test, respectively. A logistic multivariate regression was performed to determine the predictive value on extubation failure of usual clinical variables and CVP at 2-min after starting the SBT. RESULTS: One-hundred and sixty-five patients were extubated after the SBT, 11 of whom were reintubated within 48h. Absolute CVP values at 2-minutes, and the change from baseline (dCVP) were significantly higher in patients with extubation failure as compared to those successfully weaned. dCVP was an early predictor for reintubation (OR: 1.70 [1.31,2.19], p<0.001). CONCLUSIONS: An early rise in CVP after starting an SBT was associated with an increased risk of extubation failure. This might represent a warning signal not captured by usual SBT monitoring and could have relevant clinical implications.

Síndrome de sepsis post esplenectomía

RESUMEN El síndrome de sepsis post esplenectomía define a todo cuadro de sepsis, sepsis grave, neumonía grave y meningitis secundaria a bacterias encapsuladas, virus, parásitos, protozoos, en pacientes con antecedentes de asplenia o hipoesplenismo. Se presenta el caso de un paciente masculino de 55 años con antecedente de esplenectomía hace 30 años sin inmunización posterior quien acude a una institución privada de la ciudad de Quito, Ecuador por atención tras presentar desde hace varios meses a nivel de piel petequias sin causa aparente. De manera súbita y tras la ingesta alimentaria presentó y desarrollo un síndrome gastrointestinal importante que motivó su ingreso a Emergencia y posteriormente a la Unidad de cuidados intensivos. Tras su estudio se encasilla al paciente bajo el cuadro de síndrome de sepsis post esplenectomía. La esplenectomía es un procedimiento quirúrgico frecuente en el país y es dado por varias causas entre ellas traumatismos abomínales severos. El caso que se presenta y desarrolla en esta oportunidad es un claro reflejo de la desinformación y falta de apego al seguimiento que todo paciente con asplenia e hipoesplenia debería tener. Esta patología tiene un índice de mortalidad elevado en las primeras horas y pude causar severa morbilidad o discapacidad si no se brinda el soporte necesario.

ABSTRACT Post-splenectomy sepsis syndrome defines all symptoms of sepsis, severe sepsis, severe pneumonia, and meningitis secondary to encapsulated bacteria, viruses, parasites, protozoa, in patients with a history of asplenia or hyposplenia. The case of a 55-year-old male patient, with a history of splenectomy performed 30 years ago without subsequent immunization, is presented. The patient attends a private institution in the city of Quito, Ecuador for care after presenting petechiae for several months at the skin level without apparent cause. Suddenly and after food intake, he presented and developed a major gastrointestinal syndrome that led to his admission into the Emergency Department and later to the Intensive Care Unit. After his study, the patient is classified under the picture of post-splenectomy sepsis syndrome. Splenectomy is a frequent surgical procedure in the country and is caused by various causes, including severe abdominal trauma. The case presented and developed on this occasion is a clear reflection of the misinformation and lack of adherence to follow-up that all patients with asplenia and hyposplenia should have. This pathology has a high mortality rate in the first hours and can cause severe morbidity or disability if the necessary support is not provided.