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The awake prone position (AP) strategy for patients with acute respiratory distress syndrome (ARDS) is a safe, simple, and cost-effective technique used to improve hypoxemia. We aimed to evaluate intubation and mortality risk in patients with coronavirus disease (COVID-19) who underwent AP during hospitalisation.In this retrospective, multicentre observational study conducted between May 1 and June 12, 2020 in 27 hospitals in Mexico and Ecuador, non-intubated patients with COVID-19 managed with AP or supine positioning were included to evaluate intubation and mortality risk through logistic regression models; multivariable and centre adjustment, propensity score analyses, and E-values were calculated to limit confounding. This study was registered at https://clinicaltrials.gov/ct2/show/NCT04407468827 non-intubated patients with COVID-19 in the AP (n=505) and supine (n=322) groups were included for analysis. Less patients in the AP group required endotracheal intubation (23.6% versus 40.4%) or died (20% versus 37.9%). AP was a protective factor for intubation even after multivariable adjustment (OR=0.39, 95%CI: 0.28–0.56, p<0.0001, E-value=2.01), which prevailed after propensity score analysis (OR=0.32, 95%CI: 0.21–0.49, p<0.0001, E-value=2.21), and mortality (adjusted OR=0.38, 95%CI: 0.25–0.57, p<0.0001, E-value=1.98). The main variables associated with intubation amongst AP patients were increasing age, lower baseline SpO2/FiO2, and management with a non-rebreather mask.AP in hospitalised non-intubated patients with COVID-19 is associated with a lower risk of intubation and mortality.

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp . (20.3%), Escherichia coli (15.8%), and Pseudomonas spp . (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06944-2.

Introduction: The weakness acquired in the UCI is a condition that appears often in the critical patient, causing deficiencies in their physical and functional state. The early mobilization has proved to be safe and feasible demonstrating an improvement in the muscular strength and functionality of the patient during his stay in the ICU. Objectives: To describe the benefit of early mobilization in relation to muscle strength and functionality of critical patients upon discharge from the ICU. Material and methods: A retrospective, observational and descriptive study was conducted in the period from June to December of 2017, with a convenience sample of patients admitted to the ICU who were under mechanical ventilation and sedation, registration was obtained in the clinical files of muscle strength, functionality and mobility after the withdrawal of sedation and previous discharge of the patient, and the changes found were recorded. Results: A sample of 8 patients was obtained, of which 25% of the patients met the criterion of weakness acquired in the ICU, in the IB it was observed that 100% of the patients obtained a severe dependency with a score between 21 -60 points and the IMS showed that 100% of the patients performed mobilization out of bed with or without assistance. A statistically significant difference was obtained with the Wilcoxon test: MRC (p = 0.012) and IB (p = 0.012). Conclusion: An early mobilization intervention favors the partial recovery of the complications of the stay in the ICU.

The practice of administering intravenous (IV) fluids originated from the cholera pandemic in 1831, when doctors realized the impact of intravascular volume and electrolyte depletion in significantly dehydrated patients suffering from severe diarrhea [1].Robert Lewis initiated the first IV infusion in a cholera patient whose condition improved as a re-