COVID-19 crítico, análisis del impacto clínico y en la organización de las Unidades de Cuidados Intensivos

Abstract

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has caused more tan 767 million infections and nearly 7 million deaths and has destabilized even the most advanced healthcare systems. Intensive Care Units (ICU) had to face a new disease, with no known treatment, and a number of patients much higher than their usual capacity. The objectives of this thesis were: i) Analyze the effect of a short course of low-dose corticosteroids on the inflammatory and gas exchange parameters of patients with COVID- 19 on mechanical ventilation; ii) Describe the incidence, microbiology and impact on the prognosis of bacterial coinfection upon admission to the ICU; iii) Describe how the ICUs in Spain adapted to respond during the first year of the pandemic. A retrospective observational study was carried out on adult patients admitted to the ICU of the Complexo Hospitalario Universitario de Ourense between March 2020 and December 2021. In turn, a survey was carried out among the members of the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias who provided assistance during the first year of the pandemic. The findings show that a short course of corticosteroids improved, at least temporarily, the inflammatory parameters and gas exchange of COVID patients admitted to the ICU. Subsequently, a clinical trial demonstrated the benefit of this treatment. On the other hand, the incidence of bacterial coinfection upon admission to the ICU was high and, in addition, it negatively affects the prognosis of the patients, which is why antibiotic treatment is proposed for all patients upon admission to the ICU followed by early withdrawal if the clinical, analytical and microbiological evolution of the patient in the following 24-48 hours allows us to rule out bacterial coinfection. The survey carried out confirmed that the first waves of the pandemic exceeded the capacity of the country's ICUs. It was possible to remedy the material deficiencies, but not the human resource deficiencies. The ICU staff suffered strong emotional stress and it was necessary to create psychological support teams for workers. The pandemic was a brake on non-care activities, as well as a boost for online training and networking and large research groups.