Anticipating and avoiding preventable intrahospital cardiac arrest and clinical deterioration are important priorities for international healthcare systems and institutions. One of the ...internationally followed strategies to improve this matter is the introduction of the Rapid Response Systems (RRS). Although there is vast evidence from the international community, the evidence reported in a Spanish context is scarce.
A nationwide cross-sectional research consisting of a voluntary 31-question online survey was performed. The Spanish Society of Intensive, Critical and Coronary Care Medicine (SEMICYUC) supported the research.
We received 62 fully completed surveys distributed within 13 of the 17 regions and two autonomous cities of Spain. Thirty-two of the participants had an established Rapid Response Team (RRT). Common frequency on measuring vital signs was at least once per shift but other frequencies were contemplated (48.4%), usually based on professional criteria (69.4%), as only 12 (19.4%) centers used Early Warning Scores (EWS) or automated alarms on abnormal parameters. In the sample, doctors, nurses (55%), and other healthcare professionals (39%) could activate the RRT via telephone, but only 11.3% of the sample enacted this at early signs of deterioration. The responders on the RRT are the Intensive Care Unit (ICU), doctors, and nurses, who are available 24/7 most of the time. Concerning the education and training of general ward staff and RRT members, this varies from basic to advanced and specific-specialized level, simulating a growing educational methodology among participants. A great number of participants have emergency resuscitation equipment (drugs, airway adjuncts, and defibrillators) in their general wards. In terms of quality improvement, only half of the sample registered RRT activity indicators. In terms of the use of communication and teamwork techniques, the most used is clinical debriefing in 29 centers.
In terms of the concept of RRS, we found in our context that we are in the early stages of the establishment process, as it is not yet a generalized concept in most of our hospitals. The centers that have it are in still in the process of maturing the system and adapting themselves to our context.
There are no specific generally accepted therapies for the coronavirus disease 2019 (COVID-19). The full spectrum of COVID-19 ranges from asymptomatic disease to mild respiratory tract illness to ...severe pneumonia, acute respiratory distress syndrome (ARDS), multisystem organ failure, and death. The efficacy of corticosteroids in viral ARDS remains unknown. We postulated that adjunctive treatment of established ARDS caused by COVID-19 with intravenous dexamethasone might change the pulmonary and systemic inflammatory response and thereby reduce morbidity, leading to a decrease in duration of mechanical ventilation and in mortality.
This is a multicenter, randomized, controlled, parallel, open-label, superiority trial testing dexamethasone in 200 mechanically ventilated adult patients with established moderate-to-severe ARDS caused by confirmed SARS-CoV-2 infection. Established ARDS is defined as maintaining a PaO
/FiO
≤ 200 mmHg on PEEP ≥ 10 cmH
O and FiO
≥ 0.5 after 12 ± 3 h of routine intensive care. Eligible patients will be randomly assigned to receive either dexamethasone plus standard intensive care or standard intensive care alone. Patients in the dexamethasone group will receive an intravenous dose of 20 mg once daily from day 1 to day 5, followed by 10 mg once daily from day 6 to day 10. The primary outcome is 60-day mortality. The secondary outcome is the number of ventilator-free days, defined as days alive and free from mechanical ventilation at day 28 after randomization. All analyses will be done according to the intention-to-treat principle.
This study will assess the role of dexamethasone in patients with established moderate-to-severe ARDS caused by SARS-CoV-2.
ClinicalTrials.gov NCT04325061 . Registered on 25 March 2020 as DEXA-COVID19.
Purpose
To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special ...emphasis on antimicrobial therapy and source control.
Methods
Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra‐abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into ‘emergency’ (< 2 h), ‘urgent’ (2–6 h), and ‘delayed’ (> 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI).
Results
The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%,
p
= 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value ≤ 4–55.4% for a value > 12,
p
< 0.001). The highest odds of death were associated with septic shock (OR 3.08 1.42–7.00), late-onset hospital-acquired peritonitis (OR 1.71 1.16–2.52) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 3.99–8.18). Compared with ‘emergency’ source control intervention (< 2 h of diagnosis), ‘urgent’ source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 0.34–0.73).
Conclusion
‘Urgent’ and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome.
Purpose
Unlike in the outpatient setting, delivery of aerosols to critically ill patients may be considered complex, particularly in ventilated patients, and benefits remain to be proven. Many ...factors influence aerosol delivery and recommendations exist, but little is known about knowledge translation into clinical practice.
Methods
Two-week cross-sectional study to assess the prevalence of aerosol therapy in 81 intensive and intermediate care units in 22 countries. All aerosols delivered to patients breathing spontaneously, ventilated invasively or noninvasively (NIV) were recorded, and drugs, devices, ventilator settings, circuit set-up, humidification and side effects were noted.
Results
A total of 9714 aerosols were administered to 678 of the 2808 admitted patients (24 %, CI
95
22–26 %), whereas only 271 patients (10 %) were taking inhaled medication before admission. There were large variations among centers, from 0 to 57 %. Among intubated patients 22 % (
n
= 262) received aerosols, and 50 % (
n
= 149) of patients undergoing NIV, predominantly (75 %) inbetween NIV sessions. Bronchodilators (
n
= 7960) and corticosteroids (
n
= 1233) were the most frequently delivered drugs (88 % overall), predominantly but not exclusively (49 %) administered to patients with chronic airway disease. An anti-infectious drug was aerosolized 509 times (5 % of all aerosols) for nosocomial infections. Jet-nebulizers were the most frequently used device (56 %), followed by metered dose inhalers (23 %). Only 106 (<1 %) mild side effects were observed, despite frequent suboptimal set-ups such as an external gas supply of jet nebulizers for intubated patients.
Conclusions
Aerosol therapy concerns every fourth critically ill patient and one-fifth of ventilated patients.
Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier ...disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of
Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis
and
Enterococcus faecium
in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in
E. coli, K. pneumoniae
and
P. aeruginosa
is problematic, as is carbapenem-resistance in the latter pathogen. For
E. coli
and
K. pneumoniae
, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in
P. aeruginosa
is additionally problematic in Western Europe. Vancomycin-resistance in
E. faecalis
is of lesser concern but requires vigilance in
E. faecium
in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.
Summary Objectives To analyse how rescuers tolerate the effort derived of giving uninterrupted chest compressions during 2 min. Materials and methods Twenty-three healthy volunteers, nurses and ...doctors of the Intensive Care Unit (ICU), members of the hospital cardiac arrest team, were enrolled in the study. Using a training manikin, participants were asked to perform chest compressions during 2 min at a rate of 100 min−1 . The oxygen saturation and cardiac rate of the subjects were monitored using pulse oximetry before and after one and 2 min performing chest compressions. The percentage of the maximal heart rate of the rescuer over the theoretical maximum allowed in a conventional stress test was calculated, taking into account age and body mass index (BMI) of the subjects. Fatigue was measured using a visual analogical scale (VAS). Results The means (±S.D.) of chest compressions in the first and second minutes were 103 ± 12, and 104 ± 11, respectively. The mean percent of the maximum heart rate observed was 61 ± 8%. None of the subjects had difficulties to complete the test. All subjects recovered their basal values in less than 2 min, and the mean value recorded in the VAS was 3 ± 2. Conclusions The practice of uninterrupted chest compressions during 2 min by the same rescuer is well tolerated by health professionals trained in cardiopulmonary resuscitation (CPR).
Background
The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are ...frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival.
Results
This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) 53.8% male, median age 83 (81–86) years were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7,
p
< 0.0001), required more vasoactive drugs 82.2% vs. 55.1%,
p
< 0.0001 and renal replacement therapies 17.4% vs. 9.9%;
p
< 0.0001, and had more life-sustaining treatment limitations 37.3% vs. 32.1%;
p
= 0.02. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival HR 0.99 (95% CI 0.86–1.15),
p
= 0.917. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients HR: 1.00 (95% CI 0.87–1.17),
p
= 0.95. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups 57.2% (95% CI 52.7–60.7) vs. 57.1% (95% CI 53.7–60.1),
p
= 0.85.
Conclusions
After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.
To analyse how rescuers tolerate the effort derived of giving uninterrupted chest compressions during 2min.
Twenty-three healthy volunteers, nurses and doctors of the Intensive Care Unit (ICU), ...members of the hospital cardiac arrest team, were enrolled in the study. Using a training manikin, participants were asked to perform chest compressions during 2min at a rate of 100min(-1). The oxygen saturation and cardiac rate of the subjects were monitored using pulse oximetry before and after one and 2min performing chest compressions. The percentage of the maximal heart rate of the rescuer over the theoretical maximum allowed in a conventional stress test was calculated, taking into account age and body mass index (BMI) of the subjects. Fatigue was measured using a visual analogical scale (VAS).
The means (+/-S.D.) of chest compressions in the first and second minutes were 103+/-12, and 104+/-11, respectively. The mean percent of the maximum heart rate observed was 61+/-8%. None of the subjects had difficulties to complete the test. All subjects recovered their basal values in less than 2min, and the mean value recorded in the VAS was 3+/-2.
The practice of uninterrupted chest compressions during 2min by the same rescuer is well tolerated by health professionals trained in cardiopulmonary resuscitation (CPR).
In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to ...Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC, have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.
In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to ...Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organisation (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC, have decided to draw up this Contingency Plan to guide the response of the intensive care services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.
En enero de 2020 China identificó un nuevo virus de la familia de los Coronaviridae como causante de varios casos de neumonía de origen desconocido. Inicialmente confinado a la ciudad de Wuhan, se extendió posteriormente fuera de las fronteras chinas. En España, el primer caso se declaró el 31 de enero de 2020. El 11 de marzo, la Organización Mundial de la Salud declaró el brote de coronavirus como pandemia. El 16 de marzo había 139 países afectados. Ante esta situación, las Sociedades Científicas SEMICYUC y SEEIUC han decidido la elaboración de este plan de contingencia para dar respuesta a las necesidades que conllevará esta nueva enfermedad. Se pretende estimar la magnitud del problema e identificar las necesidades asistenciales, de recursos humanos y materiales, de manera que los servicios de medicina intensiva del país tengan una herramienta que les permita una planificación óptima y realista con que responder a la pandemia.
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