"Acute kidney injury in critically ill patients with COVID-19 : The AKICOV multicenter study in Catalonia"

This study describes the incidence, evolution and prognosis of acute kidney injury (AKI) in critical COVID-19 during the first pandemic wave. We performed a prospective, observational, multicenter study of confirmed COVID-19 patients admitted to 19 intensive care units (ICUs) in Catalonia (Spain). Data regarding demographics, comorbidities, drug and medical treatment, physiological and laboratory results, AKI development, need for renal replacement therapy (RRT) and clinical outcomes were collected. Descriptive statistics and logistic regression analysis for AKI development and mortality were used. A total of 1,642 patients were enrolled (mean age 63 (15.95) years, 67.5% male). Mechanical ventilation (MV) was required for 80.8% and 64.4% of these patients, who were in prone position, while 67.7% received vasopressors. AKI at ICU admission was 28.4% and increased to 40.1% during ICU stay. A total of 172 (10.9%) patients required RRT, which represents 27.8% of the patients who developed AKI. AKI was more frequent in severe acute respiratory distress syndrome (ARDS) ARDS patients (68% vs 53.6%, p<0.001) and in MV patients (91.9% vs 77.7%, p<0.001), who required the prone position more frequently (74.8 vs 61%, p<0.001) and developed more infections. ICU and hospital mortality were increased in AKI patients (48.2% vs 17.7% and 51.1% vs 19%, p <0.001) respectively). AKI was an independent factor associated with mortality (IC 1.587-3.190). Mortality was higher in AKI patients who required RRT (55.8% vs 48.2%, p <0.04). Conclusions There is a high incidence of AKI in critically ill patients with COVID-19 disease and it is associated with higher mortality, increased organ failure, nosocomial infections and prolonged ICU stay

“Acute kidney injury in critically ill patients with COVID–19: The AKICOV multicenter study in Catalonia”

This study describes the incidence, evolution and prognosis of acute kidney injury (AKI) in critical COVID-19 during the first pandemic wave. We performed a prospective, observational, multicenter study of confirmed COVID-19 patients admitted to 19 intensive care units (ICUs) in Catalonia (Spain). Data regarding demographics, comorbidities, drug and medical treatment, physiological and laboratory results, AKI development, need for renal replacement therapy (RRT) and clinical outcomes were collected. Descriptive statistics and logistic regression analysis for AKI development and mortality were used. A total of 1,642 patients were enrolled (mean age 63 (15.95) years, 67.5% male). Mechanical ventilation (MV) was required for 80.8% and 64.4% of these patients, who were in prone position, while 67.7% received vasopressors. AKI at ICU admission was 28.4% and increased to 40.1% during ICU stay. A total of 172 (10.9%) patients required RRT, which represents 27.8% of the patients who developed AKI. AKI was more frequent in severe acute respiratory distress syndrome (ARDS) ARDS patients (68% vs 53.6%, p<0.001) and in MV patients (91.9% vs 77.7%, p<0.001), who required the prone position more frequently (74.8 vs 61%, p<0.001) and developed more infections. ICU and hospital mortality were increased in AKI patients (48.2% vs 17.7% and 51.1% vs 19%, p <0.001) respectively). AKI was an independent factor associated with mortality (IC 1.587-3.190). Mortality was higher in AKI patients who required RRT (55.8% vs 48.2%, p <0.04). Conclusions There is a high incidence of AKI in critically ill patients with COVID-19 disease and it is associated with higher mortality, increased organ failure, nosocomial infections and prolonged ICU stay

Impacto de los traslados intrahospitalarios en la seguridad del paciente crítico

Introducción: El traslado intrahospitalario (TIH) del paciente crítico es un procedimiento necesario para su manejo en la Unidad de Cuidados Intensivos (UCI) pero implica un riesgo elevado de incidentes relacionados con la seguridad del paciente (IRSP). Objetivos: Analizar los IRSP durante los TIH del paciente crítico tras la aplicación de un protocolo, establecer los factores de riesgo, evaluar la seguridad mediante indicadores de calidad. Evaluar el impacto en la seguridad y en la mortalidad de los TIH de pacientes más graves bajo ventilación mecánica (VM) y / o drogas vasoactivas (DVA). Metodología: Primera etapa: estudio observacional, prospectivo en la UCI del Hospital Universitari de Vic, de los TIH de UCI a pruebas diagnósticas o a quirófano, tras la aplicación de un protocolo, entre marzo del 2011 y marzo del 2017. Se recogieron variables demográficas, gravedad del paciente, prioridad, motivo y equipo del TIH. Se aplicó el protocolo que incluye un listado de comprobación y se registraron los IRSP que se detectaron. Segunda etapa: estudio prospectivo, observacional de un subgrupo de pacientes más graves portadores de DVA y / o VM entre enero-2018 y junio-2019 monitorizándolos mediante capnografía y presión arterial invasiva. Resultados: Primera etapa: se incluyeron 805 TIH y en 112 traslados (13,9%) se detectó algún tipo de IRSP, 54% relacionado con el equipamiento y 30% con el equipo y la organización. En 19 (2,4%) traslados se produjeron eventos adversos (EA), en 47% alteraciones hemodinámicas seguidas de 33 % respiratorias. En el análisis multivariante los factores de riesgo fueron la VM y el equipo que realiza el traslado. La evolución de los indicadores relacionados con los TIH fue significativamente favorable. Segunda etapa: se incluyeron 110 TIH, un 85% bajo VM, y un 60% con DVA. Se registraron 66 (45,5%) IRSP y 28 EA. En 94(85,5%) TIH se objetivaron 212 alteraciones de las constantes vitales. En las gasometrías arteriales, realizadas 5 minutos antes y 5 después de los TIH, se objetivó hipoventilación e hiperoxigenación. Los factores de riesgo de mortalidad en el análisis multivariante fueron la edad, la gravedad, la urgencia del TIH, las DVA, el descenso de la PaO2 / FiO2 < 200 y la elevación del EtCO2 en la capnografía. Conclusiones: Tras la aplicación de un protocolo de TIH, los IRSP son bajos y el principal factor de riesgo es la VM. La experiencia del equipo que realiza el TIH influye en la detección de un mayor número de incidentes. Los pacientes críticos sometidos a VM y / o DVA experimentan mayor número de IRSP y los factores de riesgo de mortalidad son la urgencia del TIH, la inestabilidad hemodinámica, el deterioro en la relación PaO2 / FIO2 y el incremento del EtCO2 al finalizar el TIH. Es imprescindible una correcta valoración del riesgo / beneficio antes de los TIH del paciente crítico ya que la movilización implica un riesgo elevado de alteraciones hemodinámicas, de la oxigenación y de la ventilación que pueden influir en la aparición de EA a incrementar el riesgo de muerte.Introduction: In-hospital transfer (IHT) of critical patients is a necessary procedure for their management in the Intensive Care Unit (ICU) but involves a high risk of incidents related to patient safety (IRPS). Objectives: Analyze the IRPS during the IHT of the critically ill patient after the application of a protocol, establish risk factors, evaluate safety through quality indicators. To evaluate the impact on safety and mortality of IHT of more severe patients under mechanical ventilation (MV) and/or vasoactive drugs (VAD). Methodology: First stage: observational, prospective study in the ICU of the Hospital Universitari de Vic, of IHT from ICU to diagnostic tests or surgery, after the application of a protocol, between March 2011 and March 2017. Demographic variables, patient severity, priority, reason and IHT team were collected. The protocol that includes a checklist was applied and the IRPS detected were recorded. Second stage: prospective, observational study of a subgroup of more severe patients carrying VAD and/or MV between January 2018 and June 2019, monitoring them using capnography and invasive blood pressure. Results: First stage: 805 TIH were included and in 112 transfers (13,9%) some type of IRPS was detected, 54% related to equipment and 30% to team and organization. In 19 (2,4%) transfers, adverse events (AE) occurred, with 47 % hemodynamic alterations followed by 33% respiratory alterations. In the multivariate analysis, the risk factors were MV and the team performing the transfer. The evolution of the indicators related to the IHT was significantly favorable. Second stage: 110 IHT were included, 85% under MV, and 60% with VAD. 66 (45,5%) IRPS and 28 AE were recorded. In 94 (85,5%) IHT, 212 alterations of vital signs were observed. Arterial blood gases analysis, performed 5 minutes before and 5 minutes after the IHT, showed hypoventilation and hyperoxia. Multivariate analysis identified age, severity, IHT urgency, VAD, PaO2 / FiO2 ratio < 200 and EtCO2 elevation in capnography as mortality risk factors. Conclusions: After applying a IHT protocol, IRPS are low, and the main risk factor is MV. The experience of the team performing IHT influences the detection of a greater number of incidents. Critically ill patients undergoing MV and/or VAD experience a greater number of IRPS, and mortality risk factors are IHT urgency, hemodynamic instability, deterioration in the PaO2 / FiO2 ratio and increased EtCO2 at the end of IHT. A correct risk/benefit assessment is essential before IHT in critically ill patients as mobilization involves a high risk of hemodynamic, oxygenation and ventilation alterations that can influence the appearance of AE and increase the risk of death.Cures integrals i Serveis de Salu

Impacto de los traslados intrahospitalarios en la seguridad del paciente crítico

Programa de Doctorat: Cures Integrals i Serveis de SalutIntroducción: El traslado intrahospitalario (TIH) del paciente crítico es un procedimiento necesario para su manejo en la Unidad de Cuidados Intensivos (UCI) pero implica un riesgo elevado de incidentes relacionados con la seguridad del paciente (IRSP). Objetivos: Analizar los IRSP durante los TIH del paciente crítico tras la aplicación de un protocolo, establecer los factores de riesgo, evaluar la seguridad mediante indicadores de calidad. Evaluar el impacto en la seguridad y en la mortalidad de los TIH de pacientes más graves bajo ventilación mecánica (VM) y / o drogas vasoactivas (DVA). Metodología: Primera etapa: estudio observacional, prospectivo en la UCI del Hospital Universitari de Vic, de los TIH de UCI a pruebas diagnósticas o a quirófano, tras la aplicación de un protocolo, entre marzo del 2011 y marzo del 2017. Se recogieron variables demográficas, gravedad del paciente, prioridad, motivo y equipo del TIH. Se aplicó el protocolo que incluye un listado de comprobación y se registraron los IRSP que se detectaron. Segunda etapa: estudio prospectivo, observacional de un subgrupo de pacientes más graves portadores de DVA y / o VM entre enero-2018 y junio-2019 monitorizándolos mediante capnografía y presión arterial invasiva. Resultados: Primera etapa: se incluyeron 805 TIH y en 112 traslados (13,9%) se detectó algún tipo de IRSP, 54% relacionado con el equipamiento y 30% con el equipo y la organización. En 19 (2,4%) traslados se produjeron eventos adversos (EA), en 47% alteraciones hemodinámicas seguidas de 33 % respiratorias. En el análisis multivariante los factores de riesgo fueron la VM y el equipo que realiza el traslado. La evolución de los indicadores relacionados con los TIH fue significativamente favorable. Segunda etapa: se incluyeron 110 TIH, un 85% bajo VM, y un 60% con DVA. Se registraron 66 (45,5%) IRSP y 28 EA. En 94(85,5%) TIH se objetivaron 212 alteraciones de las constantes vitales. En las gasometrías arteriales, realizadas 5 minutos antes y 5 después de los TIH, se objetivó hipoventilación e hiperoxigenación. Los factores de riesgo de mortalidad en el análisis multivariante fueron la edad, la gravedad, la urgencia del TIH, las DVA, el descenso de la PaO2 / FiO2 < 200 y la elevación del EtCO2 en la capnografía. Conclusiones: Tras la aplicación de un protocolo de TIH, los IRSP son bajos y el principal factor de riesgo es la VM. La experiencia del equipo que realiza el TIH influye en la detección de un mayor número de incidentes. Los pacientes críticos sometidos a VM y / o DVA experimentan mayor número de IRSP y los factores de riesgo de mortalidad son la urgencia del TIH, la inestabilidad hemodinámica, el deterioro en la relación PaO2 / FIO2 y el incremento del EtCO2 al finalizar el TIH. Es imprescindible una correcta valoración del riesgo / beneficio antes de los TIH del paciente crítico ya que la movilización implica un riesgo elevado de alteraciones hemodinámicas, de la oxigenación y de la ventilación que pueden influir en la aparición de EA a incrementar el riesgo de muerte.Introduction: In-hospital transfer (IHT) of critical patients is a necessary procedure for their management in the Intensive Care Unit (ICU) but involves a high risk of incidents related to patient safety (IRPS). Objectives: Analyze the IRPS during the IHT of the critically ill patient after the application of a protocol, establish risk factors, evaluate safety through quality indicators. To evaluate the impact on safety and mortality of IHT of more severe patients under mechanical ventilation (MV) and/or vasoactive drugs (VAD). Methodology: First stage: observational, prospective study in the ICU of the Hospital Universitari de Vic, of IHT from ICU to diagnostic tests or surgery, after the application of a protocol, between March 2011 and March 2017. Demographic variables, patient severity, priority, reason and IHT team were collected. The protocol that includes a checklist was applied and the IRPS detected were recorded. Second stage: prospective, observational study of a subgroup of more severe patients carrying VAD and/or MV between January 2018 and June 2019, monitoring them using capnography and invasive blood pressure. Results: First stage: 805 TIH were included and in 112 transfers (13,9%) some type of IRPS was detected, 54% related to equipment and 30% to team and organization. In 19 (2,4%) transfers, adverse events (AE) occurred, with 47 % hemodynamic alterations followed by 33% respiratory alterations. In the multivariate analysis, the risk factors were MV and the team performing the transfer. The evolution of the indicators related to the IHT was significantly favorable. Second stage: 110 IHT were included, 85% under MV, and 60% with VAD. 66 (45,5%) IRPS and 28 AE were recorded. In 94 (85,5%) IHT, 212 alterations of vital signs were observed. Arterial blood gases analysis, performed 5 minutes before and 5 minutes after the IHT, showed hypoventilation and hyperoxia. Multivariate analysis identified age, severity, IHT urgency, VAD, PaO2 / FiO2 ratio < 200 and EtCO2 elevation in capnography as mortality risk factors. Conclusions: After applying a IHT protocol, IRPS are low, and the main risk factor is MV. The experience of the team performing IHT influences the detection of a greater number of incidents. Critically ill patients undergoing MV and/or VAD experience a greater number of IRPS, and mortality risk factors are IHT urgency, hemodynamic instability, deterioration in the PaO2 / FiO2 ratio and increased EtCO2 at the end of IHT. A correct risk/benefit assessment is essential before IHT in critically ill patients as mobilization involves a high risk of hemodynamic, oxygenation and ventilation alterations that can influence the appearance of AE and increase the risk of death

Correction: "Acute kidney injury in critically ill patients with COVID-19: The AKICOV multicenter study in Catalonia".

[This corrects the article DOI: 10.1371/journal.pone.0284248.]

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective