The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Pandemia por Coronavirus en Illes Balears, primera onda epidémica

The appearance and spread of the new COVID-19 disease are described from the epidemiological surveillance aspect. The SARS-CoV-2 virus has produced a global pandemic in which we are still immersed. The appearance of the new virus has represented a challenge of colossal dimensions in all aspects: virology, knowledge of transmission, therapeutic approaches, protection of the most vulnerable population, vaccines, etc. The epidemiological surveillance services of Spain have faced the need to control the disease and record its evolution. Initial attempts to control possible outbreaks such as in 2003 with the SARS epidemic were unsuccessful, the new disease has proven to be much more contagious and difficult to isolate. The characteristics of the first epidemic wave in the Balearic Islands are described from the onset of the disease to the end of the period of de-confinement and the state of alarm on June 21, 2020.Se describe la aparición y difusión de la nueva enfermedad COVID-19 desde el aspecto de la vigilancia epidemiológica. El virus SARS-CoV-2 ha producido una pandemia global en la que estamos inmersos todavía. La aparición del nuevo virus ha representa-do un desafío de dimensiones colosales en todos los aspectos: virología, conocimiento de la transmisión, enfoques terapéuticos, protección de población más vulnerable, vacunas, etc. Los servicios de vigilancia epidemiológica de España se han enfrentado a la necesidad de controlar la enfermedad y registrar su evolución. Los intentos iniciales de controlar posibles brotes como en 2003 con la epidemia del SARS fueron inútiles, la nueva enfermedad ha mostrado ser mucho más contagiosa y difícil de aislar. Se describen las características de la primera onda epidémica en las Islas Baleares desde el inicio de la enfermedad hasta el final del periodo de desconfinamiento y del estado de alarma el 21 de junio de 2020

Medidas de prevención y control de infecciones: el caso del SARS-CoV-2

COVID-19 disease is an emerging infectious disease caused by a new coronavirus, SARS-CoV-2. In the absence of an effective and safe vaccine to protect people from acquiring and developing COVID-19, the implementation of general and specific infection prevention and control measures are the most effective public health interventions against SARS-CoV-2. In most situations, multiple infection prevention and control measures must be implemented simultaneously to maximize their effectiveness. Among the general preventive measures, we must highlight: physical distance, respiratory hygiene and hand hygiene, cleanliness of the environment, isolation of cases, quarantine of close contacts and care for vulnerable populations including residents in long-stay centers. In health care, apply precautions for contact and droplet transmission, in addition to precautions by air when performing techniques that generate aerosols. There are more than 100 vaccines under investigation, of which more than 50 vaccines are being tested in humans. To contain this virus and other new viruses, there is no option for error or relaxation of the highest standards of all components of infection surveillance, prevention and control.La enfermedad COVID-19 es una enfermedad infecciosa emergente causada por un nuevo coronavirus, el SARS-CoV-2. En ausencia de una vacuna eficaz y segura para proteger a las personas de adquirir y desarrollar la COVID-19, la implementación de medidas, generales y específicas, de prevención y control de infecciones son las intervenciones de salud pública más eficaces contra el SARS-CoV-2. En la mayoría de las situaciones, se deben implementar varias medidas de prevención y control de infecciones simultáneamente para maximizar la efectividad de las mismas. Entre las medidas preventivas generales hay que destacar: distancia física, higiene respiratoria e higiene de manos, limpieza del medio ambiente, aislamiento de casos, cuarentena de contactos estrechos y atención a poblaciones vulnerables incluyendo residentes en centros de larga estancia. En los cuidados sanitarios aplicar las precauciones para trasmisión de contacto y por gotas, además de precauciones por aire cuando se realicen técnicas que generen aerosoles. Hay más de 100 vacunas en investigación, de ellas más de 50 vacunas se están ensayando en humanos. Para contener este virus y otros virus nuevos, no hay opción para el error o la relajación de los más altos estándares de todos los componentes de la vigilancia, prevención y control de infecciones

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present