Teamwork enables high level of early mobilization in critically ill patients

Additional file 2. Physiological responses of physiotherapy session. Values expressed as mean ± standard deviation; IB = In bed, IC = In chair, * different from baseline, ≈ different from 0 min

The Intensive Care Global Study on Severe Acute Respiratory Infection (IC-GLOSSARI): a Multicenter, Multinational, 14-Day Inception Cohort Study

PURPOSE: In this prospective, multicenter, 14-day inception cohort study, we investigated the epidemiology, patterns of infections, and outcome in patients admitted to the intensive care unit (ICU) as a result of severe acute respiratory infections (SARIs). METHODS: All patients admitted to one of 206 participating ICUs during two study weeks, one in November 2013 and the other in January 2014, were screened. SARI was defined as possible, probable, or microbiologically confirmed respiratory tract infection with recent onset dyspnea and/or fever. The primary outcome parameter was in-hospital mortality within 60 days of admission to the ICU. RESULTS: Among the 5550 patients admitted during the study periods, 663 (11.9 %) had SARI. On admission to the ICU, Gram-positive and Gram-negative bacteria were found in 29.6 and 26.2 % of SARI patients but rarely atypical bacteria (1.0 %); viruses were present in 7.7 % of patients. Organ failure occurred in 74.7 % of patients in the ICU, mostly respiratory (53.8 %), cardiovascular (44.5 %), and renal (44.6 %). ICU and in-hospital mortality rates in patients with SARI were 20.2 and 27.2 %, respectively. In multivariable analysis, older age, greater severity scores at ICU admission, and hematologic malignancy or liver disease were independently associated with an increased risk of in-hospital death, whereas influenza vaccination prior to ICU admission and adequate antibiotic administration on ICU admission were associated with a lower risk. CONCLUSIONS: Admission to the ICU for SARI is common and associated with high morbidity and mortality rates. We identified several risk factors for in-hospital death that may be useful for risk stratification in these patients

INTENSIFIED HOME-MANAGEMENT FOR WORRISOME COVID-19 ADULT PATIENTS

In many countries facing the COronaVIrus Disease 2019 (COVID-19) outbreak, the healthcare system was progressively stretched to capacity, emergency departments were overwhelmed and a lack of hospitalbeds threatened to occur.[1, 2] Belgium was no exception and the hospital admissions due to COVID-19 peaked a first time in early April 2020, followed by a second even higher peak in early November 2020. During this second wave of the COVID-19 epidemic, the overstretched capacity of the Intensive Care Units (ICU) was a matter of concern. Patients from some overburdened hospitals had to be transferred to other hospitals within Belgium and even abroad. In order to relieve hospital overloading and save intensive care beds for the most severe cases, the option to treat highly selected patients at home with intensified monitoring and therapy emerged. A decision-aid tool for the home-based management of COVID-19 adult patients was elaborated by the Outbreak Support Team in Liège (OST-Liège) (see Figure 1, version as of 01/11/2020). It aims at helping the General Practitioners (GPs) with a number of crucial considerations to decide which patient with a (confirmed or highly suspected) COVID-19, is eligible for intensified home-based care (monitoring and treatment) in the context of hospital saturation. Such an approach is in line with the WHO interim guidance on home care[3] which recommends that: • COVID-19 care pathways be established at local, regional and national levels. COVID-19 care pathways are for persons with suspected or confirmed COVID-19. • Hospitals and health systems at local, regional, national and global level plan and be ready to surge clinical care capacity (staff, structure, supplies and systems) in order to be able to provide appropriate care of all COVID-19 patients and maintain essential health services. • Each institution should establish a plan for what to do in situations of resource scarcity to cover the allocation or access to critical medical interventions (such as oxygen, intensive care beds and/or ventilators). Such a plan should establish a clear overall aim. The OST-Liège decision-aid tool was inspired by other existing algorithms/tools and was discussed with emergency teams and hospital physicians in four hospitals in Liège. A first diffusion towards the French-speaking GPs was performed in November 2020 in a webinara. At the end of October 2020, the Collège de Médecine Générale (CMG) and the Cellule d’Appui Scientifique Universitaire (CASU) asked KCE to validate the various components of this decision-aid tool

Long COVID : Pathophysiology – epidemiology and patient needs – Supplement

281 p.ill.

Connection between cardiac vascular permeability, myocardial oedema and inflammation during sepsis : role of AMP-activated kinase

Sepsis is the main cause of mortality in non-coronary intensive care units. Its severity arises from the presence of organ dysfunction. Induced capillary leakage contributes to organ dysfunction during sepsis. However, the contribution of cardiac oedema to sepsis-induced left ventricular dysfunction remains to be clarified. In addition, signalling pathways controlling the sepsis-induced myocardial oedema has not been identified. Since AMP-activated protein kinase (AMPK) has been shown to control endothelial cytoskeleton and to display anti-inflammatory effects, we postulated that APMK-activation influenced vascular permeability and inflammation during sepsis even in the heart and could modulate heart function during severe sepsis. In our model, sepsis was mimicked with lipopolysaccharide (LPS) injection in vivo in a murine model and in vitro on cultured-endothelial monolayer. The major findings of this work is that the alpha-1 isoform of AMPK controls myocardial vascular permeability and is involved during sepsis. α1AMPK-/- animals exhibited a dramatic increased in the LPS-induced vascular hyperpermeability within the heart. In addition, survival after lipopolysaccharide injection was lower in α1AMPK-/- animals. We observed by echocardiography and magnetic resonance imaging an increase in LV mass 24 h after LPS injection in α1AMPK-/- animals. Despite the more pronounced wall oedema in α1AMPK-/- animals, no difference in systolic function could be detected after LPS. However, inverse relationship between left ventricular end-diastolic volume and LV mass highly suggest a more important diastolic function. These phenomena occurred independentlty from the inflammatory response. The observed mechanism was a disruption of interendothelial junctions and more particularly Zonula occludens-1 in the tight junctions. Treatment with the AMPK activator, AICAriboside, reduced the LPS-induced vascular hyperpermeability and restored interendothelial junctions in vivo and in vitro. AMPK could consequently represent a new pharmacological target because it mediates endothelial dysfunction and hyperpermeability.(MED - Sciences médicales) -- UCL, 201

Long COVID : Pathophysiology – epidemiology and patient needs

281 p.ill.

Behoeften en opvolging van patiënten met langdurige COVID : Synthese

38 p.ill.,Langdurige COVID treft zowel mensen die een ernstige vorm van COVID-19 hebben doorgemaakt, als mensen die een milde vorm hebben gehad. Alle leeftijdsgroepen kunnen worden getroffen, maar het komt het vaakst voor in de leeftijdsgroep 35-69 jaar. Zes maanden na een besmetting met het coronavirus heeft ten minste één op de zeven mensen nog steeds symptomen. Deze symptomen zijn zeer uiteenlopend en houden waarschijnlijk verband met een combinatie van verschillende mechanismen, die momenteel voornamelijk nog een hypothetisch karakter hebben. Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) heeft een uitgebreide online-enquête gehouden bij 1 320 mensen met langdurige COVID. Deze studie bevestigt dat langdurige COVID leidt tot een duidelijke vermindering van de levenskwaliteit, en vaak moeilijkheden oplevert bij de terugkeer naar het werk. De psychologische gevolgen zijn ernstig. Patiënten melden dat zij zich vaak verloren voelen in ons gezondheidszorgsysteem en dat er een gebrek is aan een globale aanpak van hun problemen. Het KCE stelt voor dat een globaal functioneel assessment (‘bilan’) van patiënten mogelijk gemaakt wordt, zodat zij kunnen worden doorverwezen naar de gepaste zorg op maat, die op een gecoördineerde wijze wordt georganiseerd. Dit "bilan" zou in gespecialiseerde centra plaatsvinden, maar de voorgeschreven behandeling en opvolging zou zoveel als mogelijk binnen de eerste lijn moeten plaatsvinden

Besoins et suivi des patients atteints de COVID long : Synthèse

38 p.ill.,Le COVID long touche aussi bien les personnes qui ont fait une forme grave du COVID-19 que celles qui n’ont présenté qu’une atteinte légère. Toutes les catégories d’âge sont concernées, mais avec une fréquence plus élevée pour les 35-69 ans. Six mois après une infection par le coronavirus, au moins une personne sur 7 en garde encore l’un ou l’autre symptôme. Ceux-ci sont très variés et correspondent probablement à une combinaison de différents mécanismes, encore hypothétiques. Le Centre fédéral d’Expertise des Soins de santé (KCE) a réalisé une vaste enquête en ligne auprès de 1320 personnes atteintes de COVID long. Cette étude confirme que le COVID long entraîne une dégradation manifeste de la qualité de vie et de fréquentes difficultés à reprendre le travail. L’impact psychologique est lourd. Les patients disent s’être souvent sentis perdus dans notre système de soins et déplorent l’absence de prise en charge globale de leurs problèmes. Le KCE propose de prévoir pour ces patients une évaluation fonctionnelle afin de pouvoir les orienter vers une prise en charge sur mesure, adéquate et coordonnée. Ce ‘bilan’ se ferait dans des centres spécialisés, mais les traitements prescrits devraient être dispensés autant que possible en première ligne