Cognitive behavioural therapy (CBT) is aimed to counteract cognitions and behaviours that are considered as dysfunctional. The aim of the study is to test whether the inclusion of a non-counteractive ...approach (dilemma-focused intervention, DFI) in combination with CBT group therapy will yield better short- and long-term outcomes than an intervention conducted entirely using CBT.
A total of 128 patients with depression and at least one cognitive conflict, of six health community centres in Barcelona, participated from November of 2011 to December of 2014 in seven weekly group CBT sessions and were then randomly allocated to either DFI or CBT (eight individual sessions each) by an independent researcher. Depressive symptoms were assessed with the Beck Depression Inventory-II at baseline, at the end of therapy and three- and twelve-month follow-ups. Therapists did not participate in any of the assessments nor in the randomisation of patients and evaluators were masked to group assignment. Both intention to treat and complete case analyses were performed using linear mixed models with random effects.
According to intention-to-treat analysis (F2, 179 = 0.69) and complete case analysis (F2, 146 = 0.88), both conditions similarly reduced the severity of symptoms across posttreatment assessments. For the 77 participants (CBTgroup +CBTindividual = 40; CBTgroup+DFIindividual = 37) that completed allocated treatment and one-year follow-up assessment, response and remission rates were relative higher for the DFI condition, however no significant differences were found between treatment conditions. The relapse rates were similar between treatment conditions (CBTgroup +CBTindividual = 7/20; CBTgroup+DFIindividual = 8/22).
Although using a counteractive approach across all the treatment sessions is quite effective, it does not seem to be necessary to produce significant improvement. DFI may be considered as an alternative, which could be included in a wider treatment for depression.
ClinicalTrials.gov; ID: NCT01542957.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Dermatological problems are not usually related to intensive medicine because they are considered to have a low impact on the evolution of critical patients. Despite this, dermatological ...manifestations (DMs) are relatively frequent in critically ill patients. In rare cases, DMs will be the main diagnosis and will require intensive treatment due to acute skin failure. In contrast, DMs can be a reflection of underlying systemic diseases, and their identification may be key to their diagnosis. On other occasions, DMs are lesions that appear in the evolution of critical patients and are due to factors derived from the stay or intensive treatment. Lastly, DMs can accompany patients and must be taken into account in the comprehensive pathology management. Several factors must be considered when addressing DMs: on the one hand, the moment of appearance, morphology, location, and associated treatment and, on the other hand, aetiopathogenesis and classification of the cutaneous lesion. DMs can be classified into 4 groups: life-threatening DMs (uncommon but compromise the patient's life); DMs associated with systemic diseases where skin lesions accompany the pathology that requires admission to the intensive care unit (ICU); DMs secondary to the management of the critical patient that considers the cutaneous manifestations that appear in the evolution mainly of infectious or allergic origin; and DMs previously present in the patient and unrelated to the critical process. This review provides a characterization of DMs in ICU patients to establish a better identification and classification and to understand their interrelation with critical illnesses.
The coronavirus disease 2019 (COVID-19) vaccination campaign in Spain began on 27 December 2020 1. To date, more than 36 million people have been fully vaccinated, with most of the population, namely ...25.3 million people (69.1%), receiving BNT 162b2 (Pfizer/BioNTech) 1. With respect to other vaccines and figures, 4.8 million (13.2%) people have received AZD1222 (Oxford/AstraZeneca); 4.5 million (12.3%) mRNA-1273 (Moderna); and 2.0 million (5.4%) JNJ-78436735 (Janssen) 1.
Severe COVID-19 disease requiring ICU admission is possible in the fully vaccinated population, especially in those with immunocompromised status and other comorbidities. Interventions to improve vaccine response might be necessary in this population.
https://bit.ly/3Fw6vCP
Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the ...first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission.
Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes.
Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO
/FiO
increased from 115.6 80.0-171.2 to 180.0 135.4-227.9 mmHg and the ventilatory ratio from 1.73 1.33-2.25 to 1.96 1.61-2.40. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 CI 1.01-1.07, p = 0.030) and creatinine levels (OR 1.05 CI 1.01-1.09, p = 0.005) and a lower increase in platelet counts (OR 0.96 CI 0.93-1.00, p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO
/FiO
variation was observed (OR 0.99 CI 0.95 to 1.02, p = 0.47).
Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO
/FiO
variation.
Purpose
Although the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, ...almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia.
Methods
We carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations.
Results
Between 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis 0.57 (95% confidence interval (CI) 0.51–0.61) and 0.6 (95% CI, 0.55–0.64), respectively, but high negative predictive values (NPV) 97.5% (95% CI 96.5–98.5) and 98.2% (95% CI 97.5–98.9) for PCT and CRP, respectively. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25–3.19;
p
= 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT ≥ 0.12 ng/mL was associated with higher 90 days mortality.
Conclusion
Our study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19.
Purpose
Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their ...potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19.
Methods
Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (≥ 10 days) were also investigated.
Results
Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 0.65–0.92,
p
= 0.003) and in-hospital mortality (SHR 0.70 0.58–0.84,
p
< 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (
p
= 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (
p
= 0.014 interaction term), and mechanical ventilation (
p
= 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged ≥ 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 1.14–1.53,
p
< 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 0.61–0.82,
p
< 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia.
Conclusion
Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful.
Background Cognitive behavioural therapy (CBT) is aimed to counteract cognitions and behaviours that are considered as dysfunctional. The aim of the study is to test whether the inclusion of a ...non-counteractive approach (dilemma-focused intervention, DFI) in combination with CBT group therapy will yield better short- and long-term outcomes than an intervention conducted entirely using CBT. Method A total of 128 patients with depression and at least one cognitive conflict, of six health community centres in Barcelona, participated from November of 2011 to December of 2014 in seven weekly group CBT sessions and were then randomly allocated to either DFI or CBT (eight individual sessions each) by an independent researcher. Depressive symptoms were assessed with the Beck Depression Inventory-II at baseline, at the end of therapy and three- and twelve-month follow-ups. Therapists did not participate in any of the assessments nor in the randomisation of patients and evaluators were masked to group assignment. Both intention to treat and complete case analyses were performed using linear mixed models with random effects. Findings According to intention-to-treat analysis (F2, 179 = 0.69) and complete case analysis (F2, 146 = 0.88), both conditions similarly reduced the severity of symptoms across posttreatment assessments. For the 77 participants (CBTgroup +CBTindividual = 40; CBTgroup+DFIindividual = 37) that completed allocated treatment and one-year follow-up assessment, response and remission rates were relative higher for the DFI condition, however no significant differences were found between treatment conditions. The relapse rates were similar between treatment conditions (CBTgroup +CBTindividual = 7/20; CBTgroup+DFIindividual = 8/22). Interpretation Although using a counteractive approach across all the treatment sessions is quite effective, it does not seem to be necessary to produce significant improvement. DFI may be considered as an alternative, which could be included in a wider treatment for depression.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Funding Financial support was provided by the Instituto de Salud Carlos III de Madrid (COV20/00110, ISCIII), Fondo Europeo de Desarrollo Regional (FEDER), "Una manera de hacer Europa", and by the ...Centro de Investigación Biomedica En Red – Enfermedades Respiratorias (CIBERES). The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients RAW_REF_TEXT Antoni Torres ORCID: orcid.org/0000-0002-5470-29781,2,53 na1, /RAW_REF_TEXT RAW_REF_TEXT Anna Motos1,2 na1, /RAW_REF_TEXT RAW_REF_TEXT Jordi Riera3, /RAW_REF_TEXT RAW_REF_TEXT Laia Fernández-Barat1,2 na1, /RAW_REF_TEXT RAW_REF_TEXT Adrián Ceccato1 na1, /RAW_REF_TEXT RAW_REF_TEXT Raquel Pérez-Arnal4, /RAW_REF_TEXT RAW_REF_TEXT Dario García-Gasulla4, /RAW_REF_TEXT RAW_REF_TEXT Oscar Peñuelas1,5, /RAW_REF_TEXT RAW_REF_TEXT José Angel Lorente1,5, /RAW_REF_TEXT RAW_REF_TEXT Alejandro Rodriguez6, /RAW_REF_TEXT RAW_REF_TEXT David de Gonzalo-Calvo1,7, /RAW_REF_TEXT RAW_REF_TEXT Raquel Almansa8,9, /RAW_REF_TEXT RAW_REF_TEXT Albert Gabarrús2, /RAW_REF_TEXT RAW_REF_TEXT Rosario Menéndez10, /RAW_REF_TEXT RAW_REF_TEXT Jesús F. Bermejo-Martin8,9, /RAW_REF_TEXT RAW_REF_TEXT Ricard Ferrer3, /RAW_REF_TEXT RAW_REF_TEXT Rosario Amaya Villar11, /RAW_REF_TEXT RAW_REF_TEXT José M. Añón1,12, /RAW_REF_TEXT RAW_REF_TEXT Carme Barberà13, /RAW_REF_TEXT RAW_REF_TEXT José Barberán14, /RAW_REF_TEXT RAW_REF_TEXT Aaron Blandino Ortiz15, /RAW_REF_TEXT RAW_REF_TEXT Elena Bustamante-Munguira16, /RAW_REF_TEXT RAW_REF_TEXT Jesús Caballero17, /RAW_REF_TEXT RAW_REF_TEXT Cristina Carbajales18, /RAW_REF_TEXT RAW_REF_TEXT Nieves Carbonell19, /RAW_REF_TEXT RAW_REF_TEXT Mercedes Catalán-González20, /RAW_REF_TEXT RAW_REF_TEXT Cristóbal Galbán21, /RAW_REF_TEXT RAW_REF_TEXT Víctor D. Gumucio-Sanguino22,23, /RAW_REF_TEXT RAW_REF_TEXT Maria del Carmen de la Torre24, /RAW_REF_TEXT RAW_REF_TEXT Emili Díaz25,26, /RAW_REF_TEXT RAW_REF_TEXT Ángel Estella27, /RAW_REF_TEXT RAW_REF_TEXT Elena Gallego28, /RAW_REF_TEXT RAW_REF_TEXT José Luis García Garmendia29, /RAW_REF_TEXT RAW_REF_TEXT José Garnacho-Montero30, /RAW_REF_TEXT RAW_REF_TEXT José M. Gómez31, /RAW_REF_TEXT RAW_REF_TEXT Arturo Huerta32, /RAW_REF_TEXT RAW_REF_TEXT Ruth Noemí Jorge García33, /RAW_REF_TEXT RAW_REF_TEXT Ana Loza-Vázquez34, /RAW_REF_TEXT RAW_REF_TEXT Judith Marin-Corral35, /RAW_REF_TEXT RAW_REF_TEXT Amalia Martínez de la Gándara36, /RAW_REF_TEXT RAW_REF_TEXT Ignacio Martínez Varela37, /RAW_REF_TEXT RAW_REF_TEXT Juan López Messa38, /RAW_REF_TEXT RAW_REF_TEXT Guillermo M. Albaiceta1,39,40, /RAW_REF_TEXT RAW_REF_TEXT Mariana Andrea Novo41, /RAW_REF_TEXT RAW_REF_TEXT Yhivian Peñasco42, /RAW_REF_TEXT RAW_REF_TEXT Juan Carlos Pozo-Laderas43, /RAW_REF_TEXT RAW_REF_TEXT Pilar Ricart44, /RAW_REF_TEXT RAW_REF_TEXT Inmaculada Salvador-Adell45, /RAW_REF_TEXT RAW_REF_TEXT Angel Sánchez-Miralles46, /RAW_REF_TEXT RAW_REF_TEXT Susana Sancho Chinesta47, /RAW_REF_TEXT RAW_REF_TEXT Lorenzo Socias48, /RAW_REF_TEXT RAW_REF_TEXT Jordi Solé-Violan49, /RAW_REF_TEXT RAW_REF_TEXT Fernando Suares Sipmann50, /RAW_REF_TEXT RAW_REF_TEXT Luis Tamayo Lomas51, /RAW_REF_TEXT RAW_REF_TEXT José Trenado52, /RAW_REF_TEXT RAW_REF_TEXT Ferran Barbé1,7 on behalf of /RAW_REF_TEXT RAW_REF_TEXT CIBERESUCICOVID Project (COV20/00110, ISCIII) /RAW_REF_TEXT Critical Care volume 25, Article number: 435 (2021) Cite this article RAW_REF_TEXT 22 Accesses /RAW_REF_TEXT RAW_REF_TEXT Metrics details /RAW_REF_TEXT The Original Article was published on 13 September 2021 Correction Open Access Published:17 December 2021 /RAW_REF_TEXT Correction to: The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients RAW_REF_TEXT Antoni Torres ORCID: orcid.org/0000-0002-5470-29781,2,53 na1, Anna Motos1,2 na1, Jordi Riera3, Laia Fernández-Barat1,2 na1, Adrián Ceccato1 na1, Raquel Pérez-Arnal4, Dario García-Gasulla4, Oscar Peñuelas1,5, José Angel Lorente1,5, Alejandro Rodriguez6, David de Gonzalo-Calvo1,7, Raquel Almansa8,9, Albert Gabarrús2, Rosario Menéndez10, Jesús F. Bermejo-Martin8,9, Ricard Ferrer3, Rosario Amaya Villar11, José M. Añón1,12, Carme Barberà13, José Barberán14, Aaron Blandino Ortiz15, Elena Bustamante-Munguira16, Jesús Caballero17, Cristina Carbajales18, Nieves Carbonell19, Mercedes Catalán-González20, Cristóbal Galbán21, Víctor D. Gumucio-Sanguino22,23, Maria del Carmen de la Torre24, Emili Díaz25,26, Ángel Estella27, Elena Gallego28, José Luis García Garmendia29, José Garnacho-Montero30, José M. Gómez31, Arturo Huerta32, Ruth Noemí Jorge García33, Ana Loza-Vázquez34, Judith Marin-Corral35, Amalia Martínez de la Gándara36, Ignacio Martínez Varela37, Juan López Messa38, Guillermo M. Albaiceta1,39,40, Mariana Andrea Novo41, Yhivian Peñasco42, Juan Carlos Pozo-Laderas43, Pilar Ricart44, Inmaculada Salvador-Adell45, Angel Sánchez-Miralles46, Susana Sancho Chinesta47, Lorenzo Socias48, Jordi Solé-Violan49, Fernando Suares Sipmann50, Luis Tamayo Lomas51, José Trenado52, Ferran Barbé1,7 on behalf of CIBERESUCICOVID Project (COV20/00110, ISCIII) /RAW_REF_TEXT Critical Care volume 25, Article number: 435 (2021) Cite this article RAW_REF_TEXT 22 Accesses Metrics details
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Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a ...follow-up visit in a cohort of critical COVID-19 survivors.
Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit.
The median p25–p75 time from discharge to follow-up was 3.57 2.77–4.92 months. Median age was 60 53–67 years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO<80% and 24% having DLCO<60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO<60% were chronic lung disease (CLD) (OR: 1.86 (1.18–2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37–1.77)), age (OR per-1-SD (95%CI): 1.39 (1.18–1.63)), urea (OR: 1.16 (0.97–1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73–1.06)). Bacterial pneumonia (1.62 (1.11–2.35)) and duration of ventilation (NIMV (1.23 (1.06–1.42), IMV (1.21 (1.01–1.45)) and prone positioning (1.17 (0.98–1.39)) were associated with fibrotic lesions.
Age and CLD, reflecting patients’ baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities.
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