Utilization of mechanical power and associations with clinical outcomes in brain injured patients. a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

BackgroundThere is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes.MethodsIn this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale <= 12 before intubation) who required mechanical ventilation (MV) >= 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS).ResultsWe included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22).ConclusionsExposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation

Prospective cohort study of patients with COVID-19 hospitalized in the Internal Medicine ward of Hospital Durand: study protocol

Fil: Melendi, Santiago E. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Pérez, María M. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Salas, Cintia E. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Aguirre, Camila. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Baleta, María L. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Balsano, Facundo J. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Caldano, Mariano G. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Colignon, María G. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Oliveira Brasil, Thayana De. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Wolodimeroff, Nicolás de. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Déramo Aquino, Andrea I. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Fernández de Córdova, Ana G. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Fontan, María B. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Galvagno, Florencia I. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Haedo, Mariana F. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Iturrieta Araya, Noelia S. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Mollinedo Cruz,Volga S. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Olivero, Agustín. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Pestalardo, Ignacio. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Ricciardi, María. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Saltos Navarrete, Jandry D. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Vera Rueda, María L. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Villaverde, María C. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Xavier, Franco B. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Lauko, Marcela. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Ujeda, Carlos. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Leis, Rocío. Hospital General de Agudos Carlos G. Durand; Argentina.INTRODUCCIÓN: Conocer los predictores de mala evolución en pacientes con Enfermedad por Coronavirus 2019 (COVID-19) permite identificar de forma temprana a los pacientes con peor pronóstico, aportando mejores herramientas a la hora de tomar decisiones clínicas. Se presenta el protocolo de un estudio de cohorte cuyo objetivo principal es identificar factores de riesgo de infección severa, critica y mortalidad en pacientes con COVID-19 internados en el Servicio de Clínica Médica del Hospital Durand (Buenos Aires, Argentina). MÉTODOS: Estudio de cohorte prospectivo con base en un único centro. Se incluirá a todos los pacientes que ingresen al servicio de Clínica Médica con diagnóstico de COVID-19 durante el periodo de estudio. Se recolectarán las características epidemiológicas, clínicas, de laboratorio, radiológicas y los datos de tratamiento, al ingreso y al momento del alta o muerte hospitalaria. El evento final primario es la muerte en la internación; los eventos secundarios son el desarrollo de enfermedad grave y enfermedad crítica, la internación en unidad cerrada y el requerimiento de asistencia respiratoria mecánica

Prospective cohort study of patients with COVID-19 hospitalized in the Internal Medicine ward of Hospital Durand: study protocol

Fil: Melendi, Santiago E. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Pérez, María M. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Salas, Cintia E. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Aguirre, Camila. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Baleta, María L. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Balsano, Facundo J. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Caldano, Mariano G. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Colignon, María G. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Oliveira Brasil, Thayana De. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Wolodimeroff, Nicolás de. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Déramo Aquino, Andrea I. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Fernández de Córdova, Ana G. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Fontan, María B. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Galvagno, Florencia I. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Haedo, Mariana F. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Iturrieta Araya, Noelia S. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Mollinedo Cruz,Volga S. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Olivero, Agustín. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Pestalardo, Ignacio. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Ricciardi, María. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Saltos Navarrete, Jandry D. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Vera Rueda, María L. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Villaverde, María C. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Xavier, Franco B. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Lauko, Marcela. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Ujeda, Carlos. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Leis, Rocío. Hospital General de Agudos Carlos G. Durand; Argentina.INTRODUCCIÓN: Conocer los predictores de mala evolución en pacientes con Enfermedad por Coronavirus 2019 (COVID-19) permite identificar de forma temprana a los pacientes con peor pronóstico, aportando mejores herramientas a la hora de tomar decisiones clínicas. Se presenta el protocolo de un estudio de cohorte cuyo objetivo principal es identificar factores de riesgo de infección severa, critica y mortalidad en pacientes con COVID-19 internados en el Servicio de Clínica Médica del Hospital Durand (Buenos Aires, Argentina). MÉTODOS: Estudio de cohorte prospectivo con base en un único centro. Se incluirá a todos los pacientes que ingresen al servicio de Clínica Médica con diagnóstico de COVID-19 durante el periodo de estudio. Se recolectarán las características epidemiológicas, clínicas, de laboratorio, radiológicas y los datos de tratamiento, al ingreso y al momento del alta o muerte hospitalaria. El evento final primario es la muerte en la internación; los eventos secundarios son el desarrollo de enfermedad grave y enfermedad crítica, la internación en unidad cerrada y el requerimiento de asistencia respiratoria mecánica

Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation

Hacia un programa de control biológico de la avispa agalladora del eucalipto.

El pasado viernes 22 de febrero se introdujo por primera vez al país la avispa parasitoide Selitrichodes neseri (Hymenoptera: Eulophidae) como agente de control biológico de la avispa agalladora del eucalipto Leptocybe invasa. Esta introducción, que permitirá reducir el impacto de esta plaga sobre nuestras plantaciones forestales, es el resultado de una importante coordinación del sector forestal en materia de plagas y enfermedades

Digital piracy: an update

This note summarizes and updates our previous survey of the economics of digital piracy (Belleflamme and Peitz, 2012)