24 research outputs found
Transesophageal Echocardiographic Assessment in Patients with Severe Respiratory Distress due to COVID-19 in the Prone Position: A Feasibility Study
No full textBackground and aim: Our aim was to assess the feasibility, safety, and utility of implementing transesophageal echocardiographic screening in patients with coronavirus disease-2019 (COVID-19)-related acute respiratory distress syndrome (ARDS), receiving mechanical ventilation (MV) and in prone position (PP). Methods: Prospective observational study performed in an intensive care unit; patients 18 years, with ARDS, invasive MV, in PP were included. A total of 87 patients were included. Results: There was no need to change ventilator settings, hemodynamic support, or any difficulties with the insertion of the ultrasonographic probe. Mean duration of transesophageal echocardiography (TEE) was 20 minutes. No displacement of the orotracheal tube, vomiting, or gastrointestinal bleeding was observed. Frequent complication was displacement of the nasogastric tube in 41 (47%) patients. Severe right ventricular (RV) dysfunction was detected in 21 (24%) patients and acute cor pulmonale was diagnosed in 36 (41%) patients. Conclusion: Our results show the importance of assessing RV function during the course of severe respiratory distress and the value of TEE for hemodynamic assessment in PP.Fil: Sosa, Ariel Fernando. Hospital Aleman; ArgentinaFil: Wehit, Jeanette. Hospital Aleman; ArgentinaFil: Merlo, Pablo. Hospital Aleman; ArgentinaFil: Matarrese, Agustín. Hospital Aleman; ArgentinaFil: Torti, Bárbara. Hospital Aleman; ArgentinaFil: Roberti, Javier Eugenio. Hospital Alemán; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: César, Germán. Hospital Aleman; ArgentinaFil: Martínez, Juan Ruiz. Hospital Aleman; ArgentinaFil: Osatnik, Javier. Hospital Alemán; ArgentinaFil: Soliman Aboumarie, Hatem. Harefield Hospital; Reino Unid
Identificación de miocarditis asociada a COVID-19 por ecocardiografía transesofágica speckle-tracking en cuidado intensivo
No full textA 68-year-old male presented with flu-like symptoms, fatigue, history of obesity, hypertension, type 2 diabetes and chronic smoking. Chest radiography revealed right basal opacity consisting of infiltrate. With respiratory failure, orotracheal intubation and mechanical ventilation were performed. Patient presented gas exchange alteration. Real-time PCR detected SARS-CoV-2. Treatment with liponavir/ritonavir and hydroxychloroquine was started. Because of poor acoustic window, speckle-tracking transoesophageal echocardiography (TEE) was performed, detecting deterioration in global longitudinal strain. Acute COVID 19 infection led us to suspect myocarditis, with no other signs or symptoms other than elevated troponin and altered strain. On day 15, the patient suffered bacteraemic sepsis at endovascular focus with Serratia marcescens and multiorgan failure. TEE-guided haemodynamic monitoring was repeated showing global longitudinal strain improvement. Acute COVID 19 infection led us to suspect myocarditis, with no other signs or symptoms beyond elevated troponin and altered strain.Un hombre de 68 años presentó síntomas similares a los de la gripe, fatiga, antecedentes de obesidad, hipertensión, diabetes de tipo 2 y tabaquismo crónico. La radiografía de tórax reveló una opacidad basal derecha consistente con infiltración. Se realizó una intubación orotraqueal y ventilación mecánica. El paciente presentó alteración del intercambio gaseoso. La PCR en tiempo real detectó SARS-CoV-2. Se inició el tratamiento con liponavir/ritonavir e hidroxicloroquina. Debido a la deficiente ventana acústica, se realizó una ecocardiografía transoesofágica (ETE) de speckle-tracking, que detectó el deterioro de la tensión longitudinal global. La infección aguda por COVID 19 nos llevó a sospechar de miocarditis, sin más signos o síntomas que la elevación de la troponina y la alteración de la cepa. El día 15, el paciente sufrió una sepsis bacteriana en el foco endovascular con Serratia marcescens y fallo multiorgánico. Se repitió la monitorización hemodinámica guiada por ETE que mostró una mejora en la tensión longitudinal global.Fil: Wehit, Jeanette M.. Hospital Alemán; ArgentinaFil: Sosa, Fernando A.. Hospital Alemán; ArgentinaFil: Merlo, Pablo. Hospital Bernardino Rivadavia; ArgentinaFil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Hospital Alemán; ArgentinaFil: Osatnik, Javier. Hospital Alemán; Argentin
Frailty and clinical outcomes in critically ill patients with cancer: A cohort study
No full textIntroduction: Our aim was to assess impact of frailty on short-term clinical outcomes in critically ill patients with cancer. Materials and methods: We conducted a cohort study at a medical and surgical intensive care unit (ICU) in Argentina. We included 269 consecutive patients, ≥18 years old, with diagnosis of cancer. We recorded demographic and clinical characteristics, Clinical Frailty Scale (CFS, ≥5 defined a patient as frail), and the number and duration of organ support therapies during ICU stay. Primary outcome was ICU and hospital mortality. Results: Median age 69 (range 20–90); 152 (56%) patients were male. Sixty-eight (25.2%) patients presented frailty at admission. Older adults (≥65 years old) made up 62.8% of patients. Frail patients were 69.7 years versus 64.4 years for non-frail, P = 0.007, with higher Acute Physiology and Chronic Health Evaluation II (APACHE II) 14.7 ± 7 versus 10.8 ± 6, P = 0.001 and Simplified Acute Physiology Score (SAPS II) 40.1 ± 17 versus 28.7 ± 14, P = 0.001, respectively. After adjusting by age, severity score, type of admission, and type of cancer, frailty was independently associated with hospital mortality, odds ratio (OR) 4.87 (95% confidence interval [CI], 2.19–11.19, P ≤0.001). Median ICU length of stay was five days (interquartile range [IQR] 3–7) versus six days (IQR 3.8–9), in non-frail versus frail patients, respectively (P = 0.100), and hospital stay was nine days (IQR 6–17) versus 11.5 days (IQR 7–19.5) in non-frail versus frail patients, respectively (P = 0.085). Discussion: Frailty as a medical condition was strongly associated with worse clinical outcomes among oncologic critically ill patients.Fil: Osatnik, Javier. Hospital Aleman; ArgentinaFil: Matarrese, Agustín. Hospital Aleman; ArgentinaFil: Leone, Bruno. Hospital Alemán; ArgentinaFil: Cesar, Germán. Hospital Alemán; ArgentinaFil: Kleinert, Mercedes. Hospital Alemán; ArgentinaFil: Sosa, Fernando. Hospital Alemán; ArgentinaFil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Ivulich, Daniel. Hospital Alemán; Argentin
Lung ultrasound as a predictor of mortality of patients with Covid-19
No full textObjective: To evaluate the performance of lung ultrasound to determine short-term outcomes of patients with COVID-19 admitted to the intensive care unit. Methods: This is a Prospective, observational study. Between July and November 2020, 59 patients were included and underwent at least two LUS assessments using LUS score (range 0-42) on day of admission, day 5th, and 10th of admission. Results: Age was 66.5±15 years, APACHE II was 8.3±3.9, 12 (20%) patients had malignancy, 46 (78%) patients had a non‑invasive ventilation/high-flow nasal cannula and 38 (64%) patients required mechanical ventilation. The median stay in ICU was 12 days (IQR 8.5-20.5 days). ICU or hospital mortality was 54%. On admission, the LUS score was 20.8±6.1; on day 5th and day 10th of admission, scores were 27.6±5.5 and 29.4±5.3, respectively (P=0.007). As clinical condition deteriorated the LUS score increased, with a positive correlation of 0.52, P <0.001. Patients with worse LUS on day 5th versus better score had a mortality of 76% versus 33% (OR 6.29, 95%CI 2.01-19.65, p. 0.003); a similar difference was observed on day 10. LUS score of 5th day of admission had an area under the curve of 0.80, best cut-point of 27, sensitivity and specificity of 0.75 and 0.78 respectively. Conclusion: These findings position LUS as a simple and reproducible method to predict the course of COVID-19 patients.Fil: Sosa, Fernando A.. Hospital Alemán; ArgentinaFil: Matarrese, Agustín. Hospital Aleman; ArgentinaFil: Saavedra, Santiago. Hospital Aleman; ArgentinaFil: Osatnik, Javier. Hospital Alemán; ArgentinaFil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Tort Oribe, Barbara. Hospital Alemán; ArgentinaFil: Ivulich, Daniel. Hospital Aleman; ArgentinaFil: Durán, Ana Laura. Hospital Alemán; ArgentinaFil: Caputo, Celeste. Hospital Aleman; ArgentinaFil: Benay, Cristian Gabriel. Hospital Alemán; Argentin
Impacto de la edad, las comorbilidades y las complicaciones en pacientes con COVID-19 con síndrome de dificultad respiratoria aguda en la ventilación mecánica invasiva. Estudio multicéntrico observacional.
No full textObjetivos: Millones de pacientes con COVID-19 fueron internados en terapia intensiva
en el mundo, la mitad desarrollaron síndrome de dificultad respiratoria aguda (SDRA)
y recibieron ventilación mecánica invasiva (VMI), con una mortalidad del 50%. Analiza -
mos cómo edad, comorbilidades y complicaciones, en pacientes con COVID-19 y SDRA
que recibieron VMI, se asociaron con el riesgo de morir durante su hospitalización.
Métodos: Estudio de cohorte observacional, retrospectivo y multicéntrico realizado en
5 hospitales (tres privados y dos públicos universitarios) de Argentina y Chile, durante
el segundo semestre de 2020.
Se incluyeron pacientes >18 años con infección por SARS-CoV-2 confirmada RT-PCR,
que desarrollaron SDRA y fueron asistidos con VMI durante >48 horas, durante el segundo semestre de 2020. Se analizaron los antecedentes, las comorbilidades más frecuentes (obesidad, diabetes e hipertensión), y las complicaciones shock, insuficiencia
renal aguda (IRA) y neumonía asociada a la ventilación mecánica (NAV), por un lado, y
las alteraciones de parámetros clínicos y de laboratorio registrados.
Resultados: El 69% era varón. La incidencia de comorbilidades difirió para los diferentes
grupos de edad. La mortalidad aumentó significativamente con la edad (p<0,00001).
Las comorbilidades, hipertensión y diabetes, y las complicaciones de IRA y shock se
asociaron significativamente con la mortalidad. En el análisis multivariado, sólo la edad
mayor de 60 años, la IRA y el shock permanecieron asociados con la mortalidad.
Conclusiones: El SDRA en COVID-19 es más común entre los mayores. Solo la edad >60
años, el shock y la IRA se asociaron a la mortalidad en el análisis multivariado.Fil: Arancibia, Francisco E. Instituto Nacional del Tórax. Santiago de Chile; Chile.Fil: Zabert, Gustavo E. Clínica Pasteur. Neuquén; Argentina.Fil: Zabert, Gustavo E. Universidad Nacional del Comahue. Facultad de Ciencias Médicas; Argentina.Fil: Rainieri, Fernando. Hospital de Clínicas. Universidad de Buenos Aires; Argentina.Fil: Osatnik, Javier. Hospital Alemán. Buenos Aires; Argentina.Fil: Esperatti, Mariano. Hospital de la Comunidad. Mar del Plata, Buenos Aires; Argentina.Fil: Sepúlveda, Claudia. Instituto Nacional del Tórax. Santiago de Chile; Chile.Fil: Zabert, Ignacio. Clínica Pasteur. Neuquén; Argentina.Fil: Ivulich, Daniel. Hospital Alemán. Buenos Aires; Argentina.Fil: Luna, Carlos M. Hospital de Clínicas. Universidad de Buenos Aires; Argentina
Avaliação de delirium com uso do modelo PRE-DELIRIC em uma unidade de terapia intensiva na Argentina
No full textRESUMO Objetivo: Descrever a incidência e os fatores de risco para delirium na unidade de terapia intensiva de um hospital terciário de ensino na Argentina, e conduzir o primeiro estudo não europeu para explorar o desempenho do modelo PREdiction of DELIRium in ICu Patients (PRE-DELIRIC). Métodos: Estudo prospectivo observacional em uma unidade de terapia intensiva com 20 leitos localizada em um hospital terciário de ensino em Buenos Aires, Argentina. O modelo PRE-DELIRIC foi aplicado a 178 pacientes consecutivos dentro de 24 horas após sua admissão à unidade de terapia intensiva. Avaliou-se o delirium com uso da ferramenta Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Resultados: A média de idade foi de 64,3 ± 17,9 anos. O tempo mediano de permanência na unidade de terapia intensiva foi de 6 dias (variação entre 2 e 56 dias). Dentre o total de pacientes, 49/178 (27,5%) desenvolveram delirium, definido como avaliação positiva segundo a CAM-ICU, durante a permanência na unidade de terapia intensiva. Os pacientes no grupo com delirium eram significantemente mais velhos e tinham escore Acute Physiological and Chronic Health Evaluation II (APACHE II) significantemente mais elevado. A taxa de mortalidade na unidade de terapia intensiva foi de 14,6%; não se observou diferença significante entre os dois grupos. Os fatores preditivos para desenvolvimento de delirium foram idade mais avançada, tempo prolongado de permanência na unidade e uso de opioides. A área sob a curva para o modelo PRE-DELIRIC foi de 0,83 (IC95%: 0,77 - 0,90). Conclusões: A incidência observada de delirium salienta a importância deste problema no ambiente da unidade de terapia intensiva. Neste primeiro estudo conduzido fora da Europa, o PRE-DELIRIC previu de forma precisa o desenvolvimento de delirium
Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina
No full textABSTRACT Objective: To describe the incidence of and risk factors for delirium in the intensive care unit of a tertiary care teaching hospital in Argentina and to conduct the first non-European study exploring the performance of the PREdiction of DELIRium in ICu patients (PRE-DELIRIC) model. Methods: Prospective observational study in a 20-bed intensive care unit of a tertiary care teaching hospital in Buenos Aires, Argentina. The PRE-DELIRIC model was applied to 178 consecutive patients within 24 hours of admission to the intensive care unit; delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Results: The mean age was 64.3 ± 17.9 years. The median time of stay in the intensive care unit was 6 (range, 2 - 56) days. Of the total number of patients, 49/178 (27.5%) developed delirium, defined as a positive CAM-ICU assessment, during their stay in the intensive care unit. Patients in the delirium group were significantly older and had a significantly higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score. The mortality rate in the intensive care unit was 14.6%; no significant difference was observed between the two groups. Predictive factors for the development of delirium were increased age, prolonged intensive care unit stay, and opioid use. The area under the curve for the PRE-DELIRIC model was 0.83 (95%CI; 0.77 - 0.90). Conclusions: The observed incidence of delirium highlights the importance of this problem in the intensive care unit setting. In this first study conducted outside Europe, PRE-DELIRIC accurately predicted the development of delirium.</p
Rescue policy for discarded liver grafts: a single-centre experience of transplanting livers ‘that nobody wants’
No full textAbstractBackgroundThere is a worldwide need to expand the donor liver pool. We report a consecutive series of elective candidates for liver transplantation (LT) who received ‘livers that nobody wants’ (LNWs) in Argentina.MethodsBetween 2006 and 2009, outcomes for patients who received LNWs were analysed and compared with outcomes for a control group. To be defined as an LNW, an organ is required to fulfil two criteria. Firstly, each liver must be officially offered and refused more than 30 times; secondly, the liver must be refused by at least 50% of the LT programmes in our country before our programme can accept it. Principal endpoints were primary graft non-function (PNF), mortality, and graft and patient survival.ResultsWe transplanted 26 LNWs that had been discarded by a median of 12 centres. A total of 2666 reasons for refusal had been registered. These included poor donor status (n= 1980), followed by LT centre (n= 398) or recipient (n= 288) conditions. Incidences of PNF (3.8% vs. 4.0%), in-hospital mortality (3.8% vs. 8.0%), 1-year patient (84% vs. 84%) and graft (84% vs. 80%) survival were equal in the LNW and control groups.ConclusionsTransplantable livers are unnecessarily discarded by the transplant community. External and internal supervision of the activity of each LT programme is urgently needed to guarantee high standards of excellence
Impact of exposure time in awake prone positioning on clinical outcomes of patients with COVID-19-related acute respiratory failure treated with high-flow nasal oxygen: a multicenter cohort study
No full textBackground: In patients with COVID-19-related acute respiratory failure (ARF), awake prone positioning (AW-PP) reduces the need for intubation in patients treated with high-flow nasal oxygen (HFNO). However, the effects of different exposure times on clinical outcomes remain unclear. We evaluated the effect of AW-PP on the risk of endotracheal intubation and in-hospital mortality in patients with COVID-19-related ARF treated with HFNO and analyzed the effects of different exposure times to AW-PP.
Methods: this multicenter prospective cohort study in six ICUs of 6 centers in Argentine consecutively included patients > 18 years of age with confirmed COVID-19-related ARF requiring HFNO from June 2020 to January 2021. In the primary analysis, the main exposure was awake prone positioning for at least 6 h/day, compared to non-prone positioning (NON-PP). In the sensitivity analysis, exposure was based on the number of hours receiving AW-PP. Inverse probability weighting–propensity score (IPW-PS) was used to adjust the conditional probability of treatment assignment. The primary outcome was endotracheal intubation (ETI); and the secondary outcome was hospital mortality. Results : during the study period, 580 patients were screened and 335 were included; 187 (56%) tolerated AW-PP for [median (p25–75)] 12 (9–16) h/day and 148 (44%) served as controls. The IPW–propensity analysis showed standardized differences < 0.1 in all the variables assessed. After adjusting for other confounders, the OR (95% CI) for ETI in the AW-PP group was 0.36 (0.2–0.7), with a progressive reduction in OR as the exposure to AW-PP increased. The adjusted OR (95% CI) for hospital mortality in the AW-PP group ≥ 6 h/day was 0.47 (0.19–1.31). The exposure to prone positioning ≥ 8 h/d resulted in a further reduction in OR [0.37 (0.17–0.8)].
Conclusion : In the study population, AW-PP for ≥ 6 h/day reduced the risk of endotracheal intubation, and exposure ≥ 8 h/d reduced the risk of hospital mortality
Mechanically Ventilated Patients With Pneumonia During 2009 Influenza A H1N1 Pandemic In Argentina. Epidemiological And Clinical Features. MV Study Of H1N1 In Argentina (Comite De Neumonología Crítica, Sociedad Argentina De Terapia Intensiva)
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