Atypical presentation of rhabdomyolysis due to hypokalaemia induced by diuretics abuse: Case report from Sierra Leone.

Rhabdomyolysis results from acute necrosis of skeletal muscle fibres and consequent leakage of muscle constituents into the circulation. Its association with anything different than trauma in the Emergency Room is not that frequent. We present the case of a 47-year-old male, hypertensive, that developed weakness and incapability to walk without help, finding on the blood biochemistry that he had developed a rhabdomyolysis due to hipokalemia after abusing of diuretics.</p

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Opinión de los usuarios del Hospital de Burruyacu acerca del derecho de los profesionales de la salud a la huelga

La huelga es un derecho constitucional. Ámbitos laborales, como ser la asistencia sanitaria, son considerados servicios esenciales. Esto restringe la huelga, no solo por la legislación vigente, sino por interrogantes relacionados a la ética profesional. Objetivo: Conocer la opinión de los usuarios del Hospital de Burruyacu (Tucumán) acerca de la huelga de los profesionales de la salud como modalidad de protesta. Material y Métodos: Se recolectó mediante entrevista individual y abierta con cuestionario orientativo, las opiniones de 20 usuarios del Hospital de Burruyacu. Se realizó el análisis cualitativo de la variable en estudio mediante codificación y posterior análisis de temas. Resultados:  A) Concepción del término ¨Huelga¨: es un derecho que poseen los trabajadores. B) Huelga en servicios esenciales: Limitado jurídica y éticamente. C) Guardias mínimas no garantizan la atención de la población. D) Acceso a la salud con hospitales cerrados: Pensar en un paro total no es una opción

Design a simulating lung in 36h or less

International audienceDuring the COVID health crisis, intensive care units were quickly overwhelmed and had to call for help. The only solution was to call for this help among nurses, nursing auxiliaries, and physicians that were normally not working in the ICU units (consultations, operating room, medical units). These people needed mechanical ventilation courses before beginning their job in the ICU unit. Simulation appeared to be the best solution because of its safety and educational effectiveness. Approach: We developed an artificial lung during the 36 hours innovation marathon Crunch Maker Camp 2021. It included three main settings which were lung compliance, airways resistances, and diaphragmatic inspiratory trigger. These parameters seemed to be essential for us in order to simulate the mechanical ventilation characteristics of a COVID lung. The simulator was entirely made of physical components. Evaluation: The team composed of engineers and intensive care medical instructors developed the first proof of concept of the artificial lung. The different controllable modules were able to adjust compliance, and resistance on the respirator, and an inspiratory trigger was efficient. They reflected correctly a normal or a COVID lung, simulating a patient on a ventilator. The simulator was presented to the jury and after deliberation, the teams’ work was rewarded with the first innovation prize. Reflection: We designed a controlled simulation for COVID respiratory issues; the artificial lung was rewarded during this innovation marathon Crunch Maker Camp 2021. This allowed us to improve the simulator and we plan to start using this tool during training sessions soon. We will then measure Pedagogic impact, focusing on long-term memorization.Durant la crise sanitaire du COVID, les services de réanimation ont été rapidement débordés et ont dû appeler à l'aide. La seule solution était de faire appel à cette aide auprès des infirmiers, des aides-soignants et des médecins qui ne travaillaient normalement pas dans les unités de réanimation (consultations, bloc opératoire, unités médicales). Ces personnes avaient besoin de cours de ventilation mécanique avant de commencer leur travail dans l'unité de soins intensifs. La simulation est apparue comme la meilleure solution en raison de sa sécurité et de son efficacité pédagogique. Nous avons développé un simulation du comportement de poumon au cours du marathon d'innovation de 36 heures Crunch Maker Camp 2021. Il comprenait trois paramètres principaux : la compliance pulmonaire, les résistances des voies respiratoires et le déclenchement inspiratoire diaphragmatique. Ces paramètres nous ont semblé essentiels afin de simuler les caractéristiques de ventilation mécanique d’un poumon COVID. Le simulateur était entièrement constitué de composants physiques. L'équipe composée d'ingénieurs et d'instructeurs médicaux en soins intensifs a développé la première preuve de concept du poumon artificiel. Les différents modules contrôlables étaient capables d'ajuster la conformité et la résistance du respirateur, et un déclencheur inspiratoire était efficace. Ils reflétaient correctement un poumon normal ou COVID, simulant un patient sous respirateur. Le simulateur a été présenté au jury et après délibération, le travail des équipes a été récompensé par le premier prix de l’innovation. Réflexion : Nous avons conçu une simulation contrôlée pour les problèmes respiratoires liés au COVID ; le poumon artificiel a été récompensé lors de ce marathon d'innovation Crunch Maker Camp 2021. Cela nous a permis d'améliorer le simulateur et nous prévoyons de commencer à utiliser cet outil prochainement lors des séances d'entraînement. Nous mesurerons ensuite l'impact pédagogique, en nous concentrant sur la mémorisation à long terme

Incidence, clinical characteristics, and outcome after unexpected cardiac arrest among critically ill adults with COVID-19: insight from the multicenter prospective ACICOVID-19 registry

International audienceAbstract Background Initial reports have described the poor outcome of unexpected cardiac arrest (CA) in intensive care unit (ICU) among COVID-19 patients in China and the USA. However, there are scarce data on characteristics and outcomes of such CA patients in Europe. Methods Prospective registry in 35 French ICUs, including all in-ICU CA in COVID-19 adult patients with cardiopulmonary resuscitation (CPR) attempt. Favorable outcome was defined as modified Rankin scale ranging from 0 to 3 at day 90 after CA. Results Among the 2425 COVID-19 patients admitted to ICU from March to June 2020, 186 (8%) experienced in-ICU CA, of whom 146/186 (78%) received CPR. Among these 146 patients, 117 (80%) had sustained return of spontaneous circulation, 102 (70%) died in the ICU, including 48 dying within the first day after CA occurrence and 21 after withdrawal of life-sustaining therapy. Most of CA were non-shockable rhythm (90%). At CA occurrence, 132 patients (90%) were mechanically ventilated, 83 (57%) received vasopressors and 75 (51%) had almost three organ failures. Thirty patients (21%) had a favorable outcome. Sepsis-related organ failure assessment score > 9 before CA occurrence was the single parameter constantly associated with unfavorable outcome in multivariate analysis. Conclusions In-ICU CA incidence remains high among a large multicenter cohort of French critically ill adults with COVID-19. However, 21% of patients with CPR attempt remained alive at 3 months with good functional status. This contrasts with other recent reports showing poor outcome in such patients. Trial registration : This study was retrospectively registered in ClinicalTrials.gov (NTC04373759) in April 2020 ( https://www.clinicaltrials.gov/ct2/show/NCT04373759?term=acicovid&draw=2&rank=1 )

Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3)

International audienc

Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients.Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method.Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO.Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids