Highlights Most of the patients with critical COVID-19 admitted to the 10 ICUs in Mexico were men over 57 years of age with hypertension and diabetes, and 6% were health-care workers. Patients with hypertension and diabetes had significantly decreased survival, but neither of these comorbidities were an independent factor associated with mortality Patients with critical COVID-19 who died in the hospital exhibit significantly higher C-reactive protein concentrations than survivors in our study

Full author information is available at the end of the article who died outside of hospitals or who died before intubation.

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.

Objetivo: Describir las características clínicas y el manejo de pacientes graves con COVID-19. Método: Estudio observacional, descriptivo, longitudinal y restrospectivo. Resultados: Ingresaron 56 pacientes, el 80.3% (n = 45) de sexo masculino, con un promedio de edad de 58 años. Las principales condiciones de comorbilidad fueron obesidad, hipertensión y diabetes. El tiempo de inicio de los síntomas al ingreso fue de 9 [7][8][9][10][11][12][13][14] días, siendo los más frecuentes disnea, fiebre y tos seca. Los datos de laboratorio fueron linfopenia y elevación de deshidrogenasa láctica, fibrinógeno, dímero D, ferritina y proteína C reactiva. El 100% de los pacientes requirieron ventilación mecánica, con una mediana de tiempo de ventilación de 12 [6][7][8][9][10][11][12][13][14][15][16][17] días, y el 66% (n = 37) requirieron posición en prono. El tratamiento farmacólogico fue a base de azitromicina, hidroxicloroquina, tocilizumab y esteroides, principalmente. Las complicaciones más frecuentes fueron lesión renal aguda, enfermedad tromboembólica venosa e infarto agudo al miocardio. La tasa de mortalidad fue del 17.8% (n = 10). Conclusión: Los pacientes graves en nuestro hospital fueron en su mayoría personas de la tercera edad y con obesidad, siendo las variables de mayor puntaje SOFA y lesión renal aguda las asociadas con mayor mortalidad.

The evaluation of the diaphragm in critically ill patients is simple and noninvasive and has shown good repeatability. The aim of the study was to generate a predictive index for successful weaning (ULDIMex) from invasive mechanical ventilation (IMV) based on an ultrasonographic diaphragmatic assessment before performing a spontaneous breathing test. We recruited patients who required IMV and who were candidates for weaning from ventilation. The measurement of diaphragmatic excursion and time during inspiration and expiration was obtained with a 3- to 5-MHz probe in the M mode. Using the formula (a + b)c/2, the value for the ULDIMex was obtained to evaluate its impact on predicting the successful weaning of IMV, where a is the time during the inspiratory phase, b is the time during expiration, and c is the diaphragmatic excursion during the inspiratory phase, which corresponds to the highest point of the curve from the baseline. We recruited 114 patients, of whom 86 (76%) were successfully weaned from IMV. The patients who were successfully weaned from the IMV had a cutoff value greater than 4.06 cm/s for the ULDIMex index, with a sensitivity of 92.8% (95% confidence interval, 76.5–99.1), specificity of 63.9% (95% confidence interval, 52.9–74.0), positive predictive value of 45.6%, and negative predictive value of 96.5%. The ULDIMex index demonstrated a good level of discrimination for successful weaning prediction. Considering the excellent negative likelihood ratio of the ULDIMex index of greater than 4.06, this index may be considered before performing an spontaneous breathing test to identify critically ill adult patients who will extubate successfully.