Management of severe ARDS due to SARS-CoV-2 pneumonia using low-flow extracorporeal CO2 extraction.

post-print695 K

Risk factors associated with the development of delirium in general ICU patients. A prospective observational study.

Objective We aimed to analyze risk factors related to the development of delirium, aiming for early intervention in patients with greater risk. Material and methods Observational study, including prospectively collected patients treated in a single general ICU. These were classified into two groups, according to whether they developed delirium or not (screening performed using CAM-ICU tool). Demographics and clinical data were analyzed. Multivariate logistic regression analyses were performed to quantify existing associations. Results 1462 patients were included. 93 developed delirium (incidence: 6.3%). These were older, scored higher on the Clinical Frailty Scale, on the risk scores on admission (SAPS-3 and SOFA), and had a greater number of organ failures (OF). We observed more incidence of delirium in patients who (a) presented more than two OF (20.4%; OR 4.9; CI95%: 2.9–8.2), and (b) were more than 74 years old albeit having <2 OF (8.6%; OR 2.1; CI95%: 1.3–3.5). Patients who developed delirium had longer ICU and hospital length-of-stays and a higher rate of readmission. Conclusions The highest risk observed for developing delirium clustered in patients who presented more than 2 OF and patients over 74 years old. The detection of patients at high risk for developing delirium could imply a change in management and improved quality of care.post-print382 K

Identifying and managing patient–ventilator asynchrony: An international survey.

Objective: To describe the main factors associated with proper recognition and management of patient ventilator asynchronies (PVA). Design: Analytical cross-sectional study. Setting: International study conducted in 20 countries through an online survey. Participants: Physicians, respiratory therapists, nurses and physiotherapists that are currently working at the Intensive Care Unit (ICU). Main variables of interest: Univariate and multivariate logistic regression models were used to establish associations between all variables (profession, training in mechanical ventilation, type of training program, years of experience and ICU characteristics) with the ability of HCPs to correctly identify and manage 6 PVA. Results: A total of 431 HCPs answered a validated survey. The main factors associated with the proper recognition of PVA were: specific training program in mechanical ventilation (MV) (OR 2.27; 95% CI 1.14-4.52; p = 0.019), courses with more than 100 hours completed (OR 2.28; 95% CI 1.29-4.03; p = 0.005) and the number of intensive care unit (ICU) beds (OR 1.037; 95% CI 1.01-1.06; p = 0.005). The main factor that influenced PVA management was recognizing 6 PVA correctly (OR 118.98; 95%CI 35.25-401.58; p < 0.001). Conclusion: Identifying and managing PVA using ventilator waveform analysis is influenced by many factors including specific training programs in MV, number of ICU beds and the recognized number of PVA.pre-print169 K

Delirium en el paciente crítico Análisis de factores de riesgo, pronóstico e influencia en el síndrome de post-UCI.

Doctorado en Biotecnología, Medicina y Ciencias Biosanitaria

Assessment of pulmonary mechanics in mechanical ventilation

post-print255 K

Functional independence, frailty and perceived quality of life in patients who developed delirium during ICU stay: a prospective cohort study

Abstract Background Survivors of critical illness are frequently left with a long-lasting disability. We hypothesised that patients who developed delirium during ICU stay, compared with patients who did not, would have worse health-related quality of life following a critical illness. Methods Prospective longitudinal observational and analytical study assessing functional independence, frailty and perceived quality of life measured with the Barthel Index, the Clinical Frailty Scale, and the SF-36, comparing patients who developed delirium during ICU stay and patients who did not. The questionnaires were used at different times during the follow-up (upon ICU admission, at ICU discharge, at hospital discharge and 2 years after hospital discharge). Results In a cohort of 1462 patients, we matched 93 patients who developed delirium (delirium group) with 93 patients who did not develop delirium (no-delirium group). Of 156 completed questionnaires (84.7%), we observed that (a) in each of the two groups of patients, the scores related to functional independence (Barthel Index) and frailty (Clinical Frailty Scale) tended to improve over time (p < 0.001), being consistently less favourable in the delirium group compared to the no-delirium group (p < 0.001); (b) the patients who developed delirium also presented lower scores on the SF-36 scale, these differences being statistically significant, and therefore evidencing a worse quality of life, with impact on both the psychological and social spheres (p < 0.001). Conclusions Patients who developed delirium had significantly lower scores 2 years after hospital discharge on the three used questionnaires, displaying a clear negative impact on the physical, psychological, and social dimensions. The study's results reinforce the need to support and strengthen the care of ICU survivors

Análisis del valor predictivo de los criterios de aislamiento preventivo en una unidad de cuidados intensivos.

Objetivo: evaluar la precisión diagnóstica de los criterios empleados para detectar el paciente realmente portador de microrganismos multi-resistentes (MMR) Diseño: Estudio prospectivo, observacional de mayo 2014 a mayo 2015 Ámbito: Unidad de Cuidados Intensivos polivalente. Pacientes cohorte de pacientes ingresados de forma consecutiva que cumplían los siguientes criterios de aislamiento preventivo: hospitalización de más de 4 días en los últimos 3 meses (“hospital”); antibioterapia durante una semana en el último mes (“antibiótico”), pacientes institucionalizados o en contacto con cuidados sanitarios (“institución o cuidado”); portador de MMR los últimos 6 meses (“MMR previo”). Variables: edad, sexo, Simplified Acute Physiology Score 3, tipo de paciente (médico vs quirúrgico), estancia en UCI, mortalidad en UCI, mortalidad hospitalaria y tiempo de aislamiento. Se realizó un análisis multivariable con regresión logística múltiple entre cada uno de los factores de riesgo y el que el paciente fuera realmente portador de MMR. Resultados: Durante el periodo de estudio ingresaron 575 pacientes y cumplieron los criterios un 28%. De los 162 pacientes con criterios 51 (31%) eran portadores de MMR y de los que no cumplían criterios 29 (7%) sí que tenían portadores. En el análisis multivariable la única variables asociada de forma independiente con el ser portador fue “MMR previo” con una OR 12.14 (IC 95% 4.24 - 34.77) Conclusiones El único criterio que se asoció de forma independiente con la capacidad de detectar los pacientes con MMR al ingreso en la UCI fue haber presentado un “MMR previo”pre-print229 K