Impact of non-invasive mechanical ventilation (niv) in critical patients with influenza (H1N1) PDM09

The use of non-invasive mechanical ventilation (NIV) in patients with influenza A (H1N1)pdm09 admitted to intensive care units (ICU) has been controversial

Metabolic Signatures Associated with Severity in Hospitalized COVID-19 Patients

The clinical evolution of COVID-19 pneumonia is poorly understood. Identifying the metabolic pathways that are altered early with viral infection and their association with disease severity is crucial to understand COVID-19 pathophysiology, and guide clinical decisions. This study aimed at assessing the critical metabolic pathways altered with disease severity in hospitalized COVID-19 patients. Forty-nine hospitalized patients with COVID-19 pneumonia were enrolled in a prospective, observational, single-center study in Barcelona, Spain. Demographic, clinical, and analytical data at admission were registered. Plasma samples were collected within the first 48 h following hospitalization. Patients were stratified based on the severity of their evolution as moderate (N = 13), severe (N = 10), or critical (N = 26). A panel of 221 biomarkers was measured by targeted metabolomics in order to evaluate metabolic changes associated with subsequent disease severity. Our results show that obesity, respiratory rate, blood pressure, and oxygen saturation, as well as some analytical parameters and radiological findings, were all associated with disease severity. Additionally, ceramide metabolism, tryptophan degradation, and reductions in several metabolic reactions involving nicotinamide adenine nucleotide (NAD) at inclusion were significantly associated with respiratory severity and correlated with inflammation. In summary, assessment of the metabolomic profile of COVID-19 patients could assist in disease severity stratification and even in guiding clinical decisions

La nécropole néolithique de la Feixa del Moro (Juberri, Andorre): Examen et nouvelles données

At the beginning of the 1980s, a series of archaeological interventions carried out by what was previously called the 'Servei d'Investigacions Arqueológiques del Patrimoni Artistic Nacional d'Andorra' in a Pyrenean valley in Andorra allowed the investigation of the Feixa del Moro site. In a high-altitude area below a series of abandoned terraces, several dwellings and burial structures were located, all of them with chronologies ranging between the Early and the Middle Neolithic (from the mid 5th millennium to the early 4th millennium cal. BC). The distinctiveness of this site does not only lie in its geographical location, nor in the kind of structures discovered, but also in the very good state of preservation of the human bone material recovered from the burials, making Feixa del Moro one of the reference sites for the Neolithic in the Pyrenees and, in general, the Western Mediterranean. So far, sites with a similar conservation of both bones and burial structures are really uncommon. Moreover, the concentration in so small an area, and in the same stratigraphic unit, of such a diversity of evidence, including burials, silos and hearths, is yet more unusual. There are no similar sites in Andorra, or even in the entire Pyrenees. The only other burial site of comparable chronology discovered in the area is the Segudet site, and only a few high-altitude Neolithic dwelling sites are known. Even if cist burials are quite common in the northeast of the Iberian Peninsula and in Southern France, Feixa del Moro is the first that has been found at high altitude. The archaeological work undertaken between 1983 and 1985 provided a picture of a farming community belonging to the so-called 'Sepulcros de fosa' Culture, established in the very heart of the Pyrenees and, thus, highlighted the complexity of Neolithic settlement patterns, even in mountainous zones. At the same time, several analyses of the archaeological materials were already carried out, making Feixa del Moro a reference site for archaeological research even now. Nevertheless, three decades later, new methodologies and the technical advances available are allowing archaeologists to refine old interpretations, to reopen old debates and to carry out new analyses that can improve our understanding of the past. In this respect, since 2011, within the research project 'Aproximación a las primeras comunidades neolíticas del NE peninsular a través de sus prácticas funerarias' (HAR2011-23149), funded by the Spanish Ministry for the Economy and Competitiveness, a group of interdisciplinary researchers have begun to study several Neolithic burial contexts in the northeast of the Iberian Peninsula, among which Feixa del Moro. Following this perspective, in this paper, we present the outcome of the new analyses carried out on the burial goods and of the biochemistry and radiocarbon analyses carried out on the human bone material from the three cist burials of Feixa del Moro, with the aim of better understanding the early farming communities who settled in the Pyrenees. Since the last archaeological work carried out in the 1990s, large quantities of data have been lost. This has produced a certain degree of confusion and misunderstanding that has been repeated in other studies undertaken a posteriori on the site by other scholars. Some of these interpretations need to be revised. That it is why, within the current research project, we are not only bringing in new analyses, but also re-examining all the old written and graphic information available, as well as the state of the conserved archaeological material. The data presented in this paper resume all the available information on the Feixa del Moro site, correcting old mistakes and bias, updating the 1980s archaeological registers and presenting new analyses as well. Our aim is to ensure that Feixa del Moro remains a reference site for the Pyrenean and Western Mediterranean Neolithic. At the same time, we wish to encourage other researchers to undertake new analyses and to embrace new perspectives in order to improve our understanding of Neolithic societies

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

Introduction: Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. Methods: Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit. Results: The median [p25–p75] time from discharge to follow-up was 3.57 [2.77–4.92] months. Median age was 60 [53–67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO < 80% and 24% having DLCO < 60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO < 60% were chronic lung disease (CLD) (OR: 1.86 (1.18–2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37–1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18–1.63)), urea (OR: 1.16 (0.97–1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73–1.06)). Bacterial pneumonia (1.62 (1.11–2.35)) and duration of ventilation (NIMV (1.23 (1.06–1.42), IMV (1.21 (1.01–1.45)) and prone positioning (1.17 (0.98–1.39)) were associated with fibrotic lesions. Conclusion: Age and CLD, reflecting patients’ baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities

Cross-cutting principles for planetary health education

Since the 2015 launch of the Rockefeller Foundation Lancet Commission on planetary health,1 an enormous groundswell of interest in planetary health education has emerged across many disciplines, institutions, and geographical regions. Advancing these global efforts in planetary health education will equip the next generation of scholars to address crucial questions in this emerging field and support the development of a community of practice. To provide a foundation for the growing interest and efforts in this field, the Planetary Health Alliance has facilitated the first attempt to create a set of principles for planetary health education that intersect education at all levels, across all scales, and in all regions of the world—ie, a set of cross-cutting principles

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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