Caso Clínico: Complicación en la canalización de vena yugular izquierda

Presentamos el caso de una paciente de 77 años y 35 kg de peso con antecedentes personales, entre otros de insuficiencia renal crónica terminal, en programa de diálisis peritoneal, anemia secundaria e hidronefrosis bilateral. Acude a urgencias por cuadro de dolor abdominal de cinco días de evolución, acompañado de astenia, anorexia y sensación distérmica. Ingresa a cargo del servicio de Nefrología, diagnosticándose de peritonitis bacteriana secundaria a infección de catéter de diálisis. En espera de la retirada del catéter de diálisis peritoneal se indica la colocación de catéter venoso central para iniciar hemodiálisis motivo por el cual se traslada a nuestra unidad de Reanimación. Se monitoriza a la paciente con pulsioximetría (muestra Sat O2 del 92%) PANI (muestra TAS de 108 y TAD de 63) y frecuencia cardiaca (muestra 102 lpm). Colocamos gafas nasales a 3 l y procedemos a canalizar la vena yugular interna izquierda guiada ecográficamente. Se comprueba reflujo de sangre a través de aguja, la guía metálica en "J" progresa sin dificultades, se introduce unos 15 cm y se inserta el catéter venoso central de dos luces a través de la misma sin incidencias. Al aspirar a través de ambas luces refluye un líquido claro, similar a suero. Ante la duda sobre la posible ubicación de la punta de catéter se envía a laboratorio muestra del líquido obtenido y se realiza radiografía de tórax portátil. El análisis de laboratorio puso de manifiesto colesterol <50 mg/dl, proteínas totales<2 g/dl, LDH 163 U/L, pH 7,52 y glucosa 122 g/dl

Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trialResearch in context

Summary: Background: Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. Methods: We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. Findings: 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, −3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; −9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. Interpretation: Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. Funding: Grifols