Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies ...has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by nasal cannula and non-invasive mechanical ventilation in critically ill intensive care unit (ICU) patients remain unclear.
In this retrospective study, we used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020.
Of the 1093 non-invasively oxygenated patients at ICU admission treated with one of the three stand-alone non-invasive oxygenation strategies, 897 (82%) required endotracheal intubation and 310 (28%) died during the ICU stay. High-flow oxygen therapy by nasal cannula (n = 439) and non-invasive mechanical ventilation (n = 101) were associated with a lower rate of endotracheal intubation (70% and 88%, respectively) than oxygen masks (n = 553 and 91% intubated), p < 0.001. Compared to oxygen masks, high-flow oxygen therapy by nasal cannula was associated with lower ICU mortality (hazard ratio 0.75 95% CI 0.58-0.98), and the hazard ratio for ICU mortality was 1.21 95% CI 0.80-1.83 for non-invasive mechanical ventilation.
In critically ill COVID-19 ICU patients and, in the absence of conclusive data, high-flow oxygen therapy by nasal cannula may be the approach of choice as the primary non-invasive oxygenation support strategy.
Western countries share an interest in evaluating quality of care in the healthcare field. In spite of this, there is a lack of intercultural comparison of the perceptions of professionals. One ...reason for this may be the lack of standardized instruments. The objective of this study was to investigate the psychometric properties and dimensions of the Spanish version of the Quality in Psychiatric Care-Inpatients Staff (QPC-IPS) instrument.
After translation and revision of the instrument by a panel of experts, a questionnaire was obtained in Spanish that was administered to a pilot sample. A total of 163 professionals participated in the study.
After conducting pilot testing and a cognitive interview with 30 professionals, it was determined that the QPC-IPS was adequate and could be self-administered. Confirmatory factor analysis confirmed six factors that explained 60.9% of the variation. In terms of internal consistency, a Cronbach's alpha of 0.92 was obtained for the full instrument. For test re-test reliability, the intraclass correlation coefficient for the overall questionnaire was 0.91. Convergent validity was analyzed using the NTP394 satisfaction instrument, yielding a positive correlation (0.58).
The results demonstrated that the psychometric properties in terms of internal consistency, temporal stability (test-retest), content validity, and construct validity (confirmatory factor analysis) were adequate. These results confirm that the structure of the Spanish version is similar to the original Swedish version of the QPC-IP.
Community-acquired (CA) and healthcare-associated (HCA) infections caused by carbapenemase-producing Enterobacterales (CPE) are not well characterized. The objective was to provide detailed ...information about the clinical and molecular epidemiological features of nosocomial, HCA and CA infections caused by carbapenemase-producing Klebsiella pneumoniae (CP-Kp) and Escherichia coli (CP-Ec).
A prospective cohort study was performed in 59 Spanish hospitals from February to March 2019, including the first 10 consecutive patients from whom CP-Kp or CP-Ec were isolated. Patients were stratified according to acquisition type. A multivariate analysis was performed to identify the impact of acquisition type in 30-day mortality.
Overall, 386 patients were included (363 94% with CP-Kp and 23 6% CP-Ec); in 296 patients (76.3%), the CPE was causing an infection. Acquisition was CA in 31 (8.0%) patients, HCA in 183 (47.4%) and nosocomial in 172 (48.3%). Among patients with a HCA acquisition, 100 (54.6%) had been previously admitted to hospital and 71 (38.8%) were nursing home residents. Urinary tract infections accounted for 19/23 (82.6%), 89/130 (68.5%) and 42/143 (29.4%) of CA, HCA and nosocomial infections, respectively. Overall, 68 infections (23%) were bacteremia (8.7%, 17.7% and 30.1% of CA, HCA and nosocomial, respectively). Mortality in infections was 28% (13%, 14.6% and 42.7% of CA, HCA and nosocomial, respectively). Nosocomial bloodstream infections were associated with increased odds for mortality (adjusted OR, 4.00; 95%CI 1.21-13.19).
HCA and CA infections caused by CPE are frequent and clinically significant. This information may be useful for a better understanding of the epidemiology of CPE.
The aim of the present study was to investigate whether there are specific prognostic factors to predict the development of secondary pancreatic infection (SPI) in severe acute pancreatitis in order ...to perform a computed tomography-fine needle aspiration with bacteriological sampling at the right moment and confirm the diagnosis.
Twenty-five clinical and laboratory parameters were determined sequentially in 150 patients with severe acute pancreatitis (SAP) and univariate, and multivariate regression analyses were done looking for correlation with the development of SPI.
Only APACHE II score and C-reactive protein levels were related to the development of SPI in the multivariate analysis. A regression equation was designed using these two parameters, and empiric cut-off points defined the subgroup of patients at high risk of developing secondary pancreatic infection.
The results showed that it is possible to predict SPI during SAP allowing bacteriological confirmation and early treatment of this severe condition.
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