Publication: Características sociodemográficas, clínicas y evolutivas de los pacientes críticos con bronconeumonía COVID-19 según las diferentes olas de la pandemia
Authors
Baño Aledo, María Dolores del
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Escuela Internacional de Doctorado
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Aguayo Albasini, José Luis ; Carrillo Alcaraz, Andrés
Publisher
Universidad de Murca
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DOI
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info:eu-repo/semantics/doctoralThesis
Description
Abstract
HIPOTESIS
La hipótesis de este trabajo es que existen diferencias sociodemográficas, clínicas y evolutivas de los pacientes críticos ingresados en UCI por bronconeumonía COVID-19 según las diferentes olas de la pandemia
OBJETIVOS
Describir las características sociodemográficas y clínicas de los pacientes con insuficiencia respiratoria aguda secundaria a infección respiratoria por SARS-CoV-2 ingresados en una Unidad de Cuidados Intensivos según la ola de la pandemia COVID-19
CONCLUSIONES
• Los pacientes COVID-19 ingresados en UCI eran preferentemente hombres y en la edad media de la vida. Los antecedentes personales eran frecuentes, pero no así las comorbilidades relevantes, lo que condicionó que la mediana del índice de Comorbilidad de Charlson fuera 0. Los síntomas más frecuentes fueron fiebre, disnea y tos. Ninguna de estas variables difirió entre las seis olas de la pandemia.
• En esta serie de casos de COVID-19 el soporte respiratorio se realizó fundamentalmente con dispositivos respiratorios no invasivos, OAFCN y VNI. El uso de OAFCN como tratamiento de primera línea fue frecuente en la primera ola y anecdótico en el resto de la pandemia, de forma similar al uso de VMI usada inicialmente. El OAFCN fue utilizado en la mayoría de los pacientes como complemento de la VNI durante las seis olas de la pandemia. En nuestro trabajo, una de las terapias de rescate ante un paciente con IRA grave, el prono despierto no ha sido prácticamente utilizado.
• La mayoría de los dispositivos invasivos y terapias especiales fueron utilizadas sobre todo en la primera ola, con una disminución en su uso en las consiguientes olas, aunque desde el punto de vista estadístico la reducción más importante haya sido en el uso de catéter arterial.
• Las complicaciones infecciosas desarrolladas durante la estancia en UCI afectan a uno de cada tres pacientes. Mientras que la bacteriemia relacionada con el catéter era más frecuente en la primera ola, la NAVM predominaba en las últimas olas.
• Las complicaciones no infecciosas fueron muy frecuentes, afectando a la mayoría de los órganos y sistemas, destacando el desarrollo de SDRA que fue más frecuente en las últimas olas de la pandemia. Aunque predominaba la forma grave, no hubo diferencias en su presentación a lo largo de la pandemia.
• Las frecuencias de los desenlaces de interés más importantes, el fracaso de la CPAP/VNI, mortalidad en UCI y hospital fueron relativamente bajas. Pese a existir variabilidad a lo largo de las diferentes olas ninguno de estos desenlaces difiere entre las seis olas analizadas.
• Aunque la mortalidad hospitalaria fue más elevada en los pacientes de la última ola, ni la mortalidad cruda ni la ajustada difiere de forma significativa con el resto de los pacientes.
• La presencia de síndrome post-cuidados intensivos a los tres meses del alta fue frecuente en los pacientes dados de alta vivos del hospital. Este síndrome fue más frecuente, de forma significativa, en las tres primeras olas de la pandemia.
• La capacidad discriminatoria de los diferentes índices utilizados para predecir el fracaso de la VNI muestra una gran variabilidad. Los mejores resultados los muestran el normograma ideado por Liu y la escala HACOR modificada a la hora de iniciada la VNI. En general, los índices discriminaban mejor el desenlace en las primeras olas que en las últimas.
HYPOTHESIS The hypothesis of this study is that there are sociodemographic, clinical and evolutionary differences, in critical patients admitted to the ICU for COVID-19 bronchopneumonia according to the different waves of the pandemic OBJECTIVES To describe the sociodemographic and clinical characteristics of patients with acute respiratory failure secondary to SARS-CoV-2 respiratory infection, admitted to an Intensive Care Unit according to the wave of the COVID-19 pandemic. CONCLUSIONS - COVID-19 patients admitted to the ICU were mostly male and in the middle age. Personal history was frequent, but relevant comorbidities were not, which meant that the median Charlson Comorbidity index was 0. The most frequent symptoms were fever, dyspnea and cough. None of these variables differed between the six waves of the pandemic. - In this series of COVID-19 cases, respiratory support was primarily with noninvasive respiratory devices, NCBO and NIV. The use of NCBO as first-line treatment was frequent in the first wave and anecdotal in the rest of the pandemic, similar to the initial use of IMV. NCBO was used in most patients as a complement to NIV during all six waves of the pandemic. In our work, one of the rescue therapies for a patient with severe ARF, awake prone, has not been practically used. - The most important findings in relation to the drugs administered were the use of parenteral corticosteroids in practically all patients from the beginning of the pandemic, even without scientific evidence for their use. Similarly, the use of opioids was universal in all waves of the pandemic to control the respiratory rate and to facilitate patient adaptation to noninvasive devices and achieve their comfort. There has been evidence of a decrease in the use of antibiotics at admission in recent waves given the low rate of concomitant infections. However, the use of antibiotics due to suspected or confirmed nosocomial infection has remained stable throughout the pandemic. Regarding the treatments used against SARS-CoV-2 infection, these have been evolving, depending on the evidence provided by the different trials throughout the pandemic. - Most invasive devices and special therapies were used mainly in the first wave, with a decrease in their use in the subsequent waves, although from a statistical point of view the most important reduction has been in the use of arterial catheters. - Infectious complications developed during ICU stay affect one of every three patients. While catheter-related bacteremia was more frequent in the first wave, VAPM predominated in the later waves. - Non-infectious complications were very frequent, affecting most organs and systems, highlighting the development of ARDS being more frequent in the last waves of the pandemic. Although the severe form predominated, there were no differences in its presentation throughout the pandemic. - The frequencies of the most important outcomes of interest, CPAP/NIV failure, ICU and hospital mortality were relatively low. Although there was variability across waves, none of these outcomes differed between the six waves analyzed. - Although in-hospital mortality was higher in patients in the last wave, neither crude nor adjusted mortality differed significantly from the rest of the patients. - The presence of post-intensive care syndrome three months after discharge was frequent in patients discharged alive from the hospital. This syndrome was significantly more frequent in the first three waves of the pandemic. - The discriminatory capacity of the different indices used to predict NIV failure shows great variability. The best results are shown by the normogram devised by Liu and the modified HACOR scale at the time of NIV initiation. In general, the indices were better at discriminating outcome in the first waves than in the last waves.
HYPOTHESIS The hypothesis of this study is that there are sociodemographic, clinical and evolutionary differences, in critical patients admitted to the ICU for COVID-19 bronchopneumonia according to the different waves of the pandemic OBJECTIVES To describe the sociodemographic and clinical characteristics of patients with acute respiratory failure secondary to SARS-CoV-2 respiratory infection, admitted to an Intensive Care Unit according to the wave of the COVID-19 pandemic. CONCLUSIONS - COVID-19 patients admitted to the ICU were mostly male and in the middle age. Personal history was frequent, but relevant comorbidities were not, which meant that the median Charlson Comorbidity index was 0. The most frequent symptoms were fever, dyspnea and cough. None of these variables differed between the six waves of the pandemic. - In this series of COVID-19 cases, respiratory support was primarily with noninvasive respiratory devices, NCBO and NIV. The use of NCBO as first-line treatment was frequent in the first wave and anecdotal in the rest of the pandemic, similar to the initial use of IMV. NCBO was used in most patients as a complement to NIV during all six waves of the pandemic. In our work, one of the rescue therapies for a patient with severe ARF, awake prone, has not been practically used. - The most important findings in relation to the drugs administered were the use of parenteral corticosteroids in practically all patients from the beginning of the pandemic, even without scientific evidence for their use. Similarly, the use of opioids was universal in all waves of the pandemic to control the respiratory rate and to facilitate patient adaptation to noninvasive devices and achieve their comfort. There has been evidence of a decrease in the use of antibiotics at admission in recent waves given the low rate of concomitant infections. However, the use of antibiotics due to suspected or confirmed nosocomial infection has remained stable throughout the pandemic. Regarding the treatments used against SARS-CoV-2 infection, these have been evolving, depending on the evidence provided by the different trials throughout the pandemic. - Most invasive devices and special therapies were used mainly in the first wave, with a decrease in their use in the subsequent waves, although from a statistical point of view the most important reduction has been in the use of arterial catheters. - Infectious complications developed during ICU stay affect one of every three patients. While catheter-related bacteremia was more frequent in the first wave, VAPM predominated in the later waves. - Non-infectious complications were very frequent, affecting most organs and systems, highlighting the development of ARDS being more frequent in the last waves of the pandemic. Although the severe form predominated, there were no differences in its presentation throughout the pandemic. - The frequencies of the most important outcomes of interest, CPAP/NIV failure, ICU and hospital mortality were relatively low. Although there was variability across waves, none of these outcomes differed between the six waves analyzed. - Although in-hospital mortality was higher in patients in the last wave, neither crude nor adjusted mortality differed significantly from the rest of the patients. - The presence of post-intensive care syndrome three months after discharge was frequent in patients discharged alive from the hospital. This syndrome was significantly more frequent in the first three waves of the pandemic. - The discriminatory capacity of the different indices used to predict NIV failure shows great variability. The best results are shown by the normogram devised by Liu and the modified HACOR scale at the time of NIV initiation. In general, the indices were better at discriminating outcome in the first waves than in the last waves.
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