Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos

Abstract

La pandemia por COVID-19 ha provocado el ingreso de un elevado número de pacientes en UCI, generalmente por insuficiencia respiratoria severa. Desde la aparición de los primeros casos de infección por SARS-CoV-2, a finales de 2019, en China, se ha publicado una cantidad ingente de recomendaciones de tratamiento de esta entidad, no siempre respaldadas por evidencia científica suficiente ni con el rigor metodológico necesario. Gracias al esfuerzo de distintos grupos de investigadores, actualmente disponemos de resultados de ensayos clínicos, y otro tipo de estudios, de mayor calidad. Consideramos necesario realizar un documento que incluya recomendaciones que recojan estas evidencias en cuanto al diagnóstico y el tratamiento de COVID-19, pero también aspectos que otras guías no han contemplado y que consideramos fundamentales en el manejo del paciente crítico con COVID-19. Para ello se ha creado un comité redactor, conformado por miembros de los Grupos de Trabajo de SEMICYUC más directamente relacionados con diferentes aspectos específicos del manejo de estos pacientes.

Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19

“…The current literature also describes the risk of developing PUs in relation to nutritional status. 22 , 23 The recommendations of scientific societies for the management of critically ill patients diagnosed with COVID-19 include early initiation of nutrition within the first 24 h–48 h of admission 10 , 24 , 25 ; in all the hospitals nutrition was initiated within the recommended time period. In intubated, sedated, and relaxed patients the enteral route is considered the treatment of first choice, and in this study early enteral nutrition was initiated in all the ICUs.…”

“…PUs are frequent complications of prone positioning (PP), with an incidence of 25.7%, and are described as possible factors related to time in this position and nutritional intake. 8 During the first wave of the pandemic, an increase in pressure injuries was detected, especially in patients requiring PP, 10 with an incidence of 38%–57%. 8 , 11 Malnutrition and hydration deficits are factors related to the incidence and severity of PUs, especially low protein intake.…”

“…From the recommendations of the ZERO Projects during the SARS-CoV-2 pandemic, the SEMYCIUC proposes focussing on the training of new professionals, implementing protocols for prone positioning, and a standardised nursing care plan in intensive care units. 10 …”

Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

“…The appearance of this new infection and the exponential increase in the number of patients requiring admission to the Intensive Care Unit (ICU) due to severe hypoxemia secondary to bilateral pneumonia not only collapsed the ICUs 1 but also multiplied the number of patients with more-or-less disabling sequelae caused by prolonged ICU stay, respiratory distress, aggressive treatment (including maneuvering in prone decubitus) 2 and the virus itself. To date, a dozen studies have evaluated aspects such as cognitive impairment, 3 motor sequelae with an impact upon patient quality of life 4 (pain or malaise, anxiety or depression, personal care and routine activities), perceived fatigue, 5 intolerance of exercise, dyspnea in response to moderate physical exertion, limitations referred to physical capacity, and effects upon psychological health 6 , 7 – making it necessary to adopt a multidisciplinary approach to these cases in view of their complexity.…”

Características sociodemográficas, sintomas persistentes e qualidade de vida de pacientes após hospitalização pela COVID-19

“…Pacientes hospitalizados por COVID-19 e que evoluem para forma crítica da doença, adentram a Unidade de Terapia Intensiva (UTI) e são expostos a uma rotina de cuidados e procedimentos invasivos que incluem suporte respiratório, nutrição enteral, uso de bloqueadores neuromusculares, como também uso amplo de medicamentos como por exemplo antibióticos e corticoides (Vidal-Cortés et al, 2022).…”