1
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Parisi J, Martínez de Lagran I, Serra-Prat M, Roca Fontbona M, Merino R, de la Torre MªC, Campins L, Yébenes JC. Validation of the nutritrauma concept for the detection of potential harmful effects of medical nutritional treatment in critically ill patients in real life. NUTR HOSP 2024; 41:743-751. [PMID: 38804970 DOI: 10.20960/nh.04993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Introduction Introduction: medical nutritional treatment (MNT) can be complex and may be associated with potential metabolic complications, which has been recently described as nutritrauma. Objective: the aim of our work is to describe whether the application of the nutritrauma concept in real life is feasible and useful to detect the metabolic complications associated with the prescription of MNT. Material and methods: in this descriptive, prospective study at a single center we enrolled 30 consecutive critically ill patients in a 14-bed medical-surgical intensive care unit. The nutritrauma strategy implementation was based in four "M" steps: Metabolic screening, MNT prescription, biochemical Monitoring, and nutritional Management. Results: we analyzed 28 patients (mean age, 69.7 ± 11.3 years; APACHE II, 18.1 ± 8.1; SOFA, 7.5 ± 3.7; Nutric Score, modified, 4.3 ± 2.01, and mean BMI, 27.2 ± 3.8). The main cause of admission was sepsis (46.4 %). Length of ICU stay was 20.6 ± 15.1 days; 39.3 % of subjects died during their ICU stay. Enteral nutrition (82.1 %) was more frequent than parenteral nutrition (17.9 %). During nutritional monitoring, 54 specific laboratory determinations were made. Hyperglycemia was the most frequent metabolic alteration (83.3 % of measurements). Electrolyte disturbances included hypocalcemia (50 %), hypophosphatemia (29.6 %) and hypokalemia (27.8 %). The most frequent lipid profile abnormalities were hypocholesterolemia (64.8 %) and hypertriglyceridemia (27.8 %). Furthermore, nutritional prescription was modified for 53.6 % of patients: increased protein dosage (25 %), increased calorie dosage (21.4 %) and change to organ-specific diet (17.8 %). Conclusions: in conclusion, the application of the nutritrauma approach facilitates detection of metabolic complications and an evaluation of the appropriate prescription of MNT.
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Affiliation(s)
- Jordi Parisi
- Department of Intensive Medicine. Hospital de Mataró
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2
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Yébenes JC, Bordeje-Laguna ML, Lopez-Delgado JC, Lorencio-Cardenas C, Martinez De Lagran Zurbano I, Navas-Moya E, Servia-Goixart L. Smartfeeding: A Dynamic Strategy to Increase Nutritional Efficiency in Critically Ill Patients-Positioning Document of the Metabolism and Nutrition Working Group and the Early Mobilization Working Group of the Catalan Society of Intensive and Critical Care Medicine (SOCMiC). Nutrients 2024; 16:1157. [PMID: 38674847 PMCID: PMC11054493 DOI: 10.3390/nu16081157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Adequate medical nutrition therapy for critically ill patients has an impact on their prognoses. However, it requires an individualized approach that takes into account the activity (phases of metabolic stress) and particularity of these patients. We propose a comprehensive strategy considering the patients' nutritional status and the set of modifiable circumstances in these patients, in order to optimize/support nutritional efficiency: (1) A detailed anamnesis and an adequate initial nutritional assessment must be performed in order to implement medical nutrition therapy that is in line with the needs and characteristics of each patient. Furthermore, risks associated with refeeding syndrome, nutritrauma or gastrointestinal dysfunction must be considered and prevented. (2) A safe transition between nutrition therapy routes and between health care units will greatly contribute to recovery. The main objective is to preserve lean mass in critically ill patients, considering metabolic factors, adequate protein intake and muscle stimulation. (3) Continuous monitoring is required for the successful implementation of any health strategy. We lack precise tools for calculating nutritional efficiency in critically ill patients, therefore thorough monitoring of the process is essential. (4) The medical nutrition approach in critically ill patients is multidisciplinary and requires the participation of the entire team involved. A comprehensive strategy such as this can make a significant difference in the functional recovery of critically ill patients, but leaders must be identified to promote training, evaluation, analysis and feedback as essential components of its implementation, and to coordinate this process with the recognition of hospital management.
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Affiliation(s)
- Juan Carlos Yébenes
- Institut d’Assistència Sanitària (IAS)—Hospital Santa Caterina, 17007 Girona, Spain
| | | | - Juan Carlos Lopez-Delgado
- Hospital Clinic, Medical ICU, Clinical Institute of Internal Medicine & Dermatology (ICMiD), 08036 Barcelona, Spain;
| | | | | | | | - Lluis Servia-Goixart
- Intensive Care Department, Hospital Universitari Arnau de Vilanova, LLeida, 25198 Lleida, Spain;
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3
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Alós Zaragozá L, Cobo Del Prado Ciurlizza I, Solis Albamonte P, Gandía Llopis J, Rosselló Chornet M, Romero García CS. The clinical impact of implementation of a nutritional treatment protocol in critically ill adults with SARS-CoV-2 infection. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:387-394. [PMID: 37553014 DOI: 10.1016/j.redare.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 11/27/2022] [Indexed: 08/10/2023]
Abstract
INTRODUCTION The critical patient affected by SARS-CoV-2 is at risk of malnutrition. The need to avoid volume overload and manoeuvres that delay reaching nutritional requirements such as pronation make the nutritional approach to these patients complex. To ensure adequate treatment, a nutritional support protocol was developed as a clinical practice guideline adapted to the COVID-19 patient. OBJECTIVE To describe and analyse the results of introducing a nutritional support protocol aimed at SARS-CoV-2 patients admitted to the intensive care unit (ICU) of the Consorcio Hospital General Universitario de Valencia (CHGUV) from March to May 2020. MATERIAL AND METHODS Observational, descriptive, retrospective and longitudinal design to evaluate compliance with a nutritional support protocol. RESULTS Thirty-one consecutive patients were included but nutritional follow-up could not be performed in eight. Of the remaining 23 patients, only eight reached 80% of caloric requirements before the tenth day after starting treatment (good compliance group) and 15 after the eleventh day (poor compliance group). In the group with «good compliance» 75% (n=6) were discharged and 25% died (n=2), compared to the group with «bad compliance» where 53% (n=8) were discharged and 47% (n=7) died (Chi square test, p-value=0.019). Those patients who reached 80% of caloric needs during ICU stay had a shorter length of stay compared to those who did not (median days of admission=14, IQR=10-16 and median days of admission=22, IQR=13-39, p-value=0.025). CONCLUSIONS Introducing a nutritional protocol during the first weeks of the SARS-CoV-2 pandemic could improve clinical outcomes by promoting healing and reducing associated complications.
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Affiliation(s)
- L Alós Zaragozá
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - I Cobo Del Prado Ciurlizza
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - P Solis Albamonte
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J Gandía Llopis
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - M Rosselló Chornet
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - C S Romero García
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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4
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Alós Zaragozá L, Cobo Del Prado Ciurlizza I, Solis Albamonte P, Gandía Llopis J, Rosselló Chornet M, Romero García CS. [The clinical impact of implementation of a nutritional treatment protocol in critically ill adults with SARS-CoV-2 infection]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023:S0034-9356(23)00108-1. [PMID: 37363692 PMCID: PMC10208262 DOI: 10.1016/j.redar.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 11/27/2022] [Indexed: 06/28/2023]
Abstract
Introduction The critical patient affected by SARS-CoV-2 is at risk of malnutrition. The need to avoid volume overload and manoeuvres that delay reaching nutritional requirements such as pronation make the nutritional approach to these patients complex. To ensure adequate treatment, a nutritional support protocol was developed as a clinical practice guideline adapted to the COVID-19 patient. Objective To describe and analyse the results of introducing a nutritional support protocol aimed at SARS-CoV-2 patients admitted to the intensive care unit (ICU) of the Consorcio Hospital General Universitario de Valencia (CHGUV) from March to May 2020. Material and methods Observational, descriptive, retrospective and longitudinal design to evaluate compliance with a nutritional support protocol. Results Thirty-one consecutive patients were included but nutritional follow-up could not be performed in eight. Of the remaining 23 patients, only eight reached 80% of caloric requirements before the tenth day after starting treatment (good compliance group) and 15 after the eleventh day (poor compliance group). In the group with «good compliance» 75% (n = 6) were discharged and 25% died (n = 2), compared to the group with «bad compliance» where 53% (n = 8) were discharged and 47% (n = 7) died (Chi square test, p-value = 0.019). Those patients who reached 80% of caloric needs during ICU stay had a shorter length of stay compared to those who did not (median days of admission = 14, IQR = 10-16 and median days of admission = 22, IQR = 13-39, p-value = 0.025). Conclusions Introducing a nutritional protocol during the first weeks of the SARS-CoV-2 pandemic could improve clinical outcomes by promoting healing and reducing associated complications.
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Affiliation(s)
- L Alós Zaragozá
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - I Cobo Del Prado Ciurlizza
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - P Solis Albamonte
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J Gandía Llopis
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - M Rosselló Chornet
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - C S Romero García
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
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5
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Pérez-Cordón L, Yébenes JC, Martínez de Lagrán I, Campins L. Transition from total parenteral nutrition to enteral nutrition in critically ill patients in Spain: A national survey. Med Intensiva 2022; 46:475-477. [PMID: 35760732 DOI: 10.1016/j.medine.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/20/2021] [Accepted: 08/29/2021] [Indexed: 06/15/2023]
Affiliation(s)
- L Pérez-Cordón
- Servicio de Farmacia, Hospital de Mataró, Mataró, Barcelona, Spain.
| | - J C Yébenes
- Servicio de Medicina Intensiva, Hospital de Mataró, Mataró, Barcelona, Spain
| | | | - L Campins
- Servicio de Farmacia, Hospital de Mataró, Mataró, Barcelona, Spain
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6
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Dusapin CJ, Pantet O, Voirol P, Charrière M, Thomann P, Berger MM. Computer customization errors compromised the optimization of trace element repletion dose after major burns. Clin Nutr 2022; 41:2207-2210. [DOI: 10.1016/j.clnu.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 11/29/2022]
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7
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Zhang C, Meng S, Li C, Yang Z, Wang G, Wang X, Ma Y. Primary Broiler Hepatocytes for Establishment of a Steatosis Model. Vet Sci 2022; 9:vetsci9070316. [PMID: 35878333 PMCID: PMC9319065 DOI: 10.3390/vetsci9070316] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
Fatty liver hemorrhage syndrome (FLHS) in chickens is characterized by steatosis and bleeding in the liver, which has caused huge losses to the poultry industry. This study aimed to use primary cultured broiler hepatocytes to establish a steatosis model to explore the optimal conditions for inducing steatosis by incubating the cells with a fat emulsion. Primary hepatocytes were isolated from an AA broiler by a modified two-step in situ perfusion method. Hepatocytes were divided into an untreated control group and a fat emulsion group that was incubated with 2.5, 5, 10, or 20% fat emulsion for different times to determine the optimal conditions for inducing steatosis of primary hepatocytes. Incubation of the cells with 10% fat emulsion resulted in cell viability at 48 h of 67%, which was higher than the control group and met the requirements of the model. In the second experiment, steatosis was induced by incubating hepatocytes with 10% fat emulsion for 48 h. In consequence, the apoptosis rate decreased (p > 0.05) and the concentration of ALT (p < 0.001), AST (p < 0.01), and TG (p < 0.05) increased significantly; the expression level of SREBP-1c (p < 0.05) increased, and the expression levels of PPARα (p < 0.001), CPT1 (p < 0.001), and CPT2 (p < 0.05) were lower in the fat emulsion group than in the control group. In conclusion, the induction condition was selected as 10% fat emulsion incubation for 48 h, and we successfully established a fatty liver degeneration model for broilers.
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8
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Pérez-Cordón L, Yébenes J, Martínez de Lagrán I, Campins L. Encuesta sobre la transición de nutrición parenteral total a nutrición enteral en pacientes críticos en los hospitales de España. Med Intensiva 2021. [DOI: 10.1016/j.medin.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Fadeur M, Preiser JC, Verbrugge AM, Misset B, Rousseau AF. Oral Nutrition during and after Critical Illness: SPICES for Quality of Care! Nutrients 2020; 12:nu12113509. [PMID: 33202634 PMCID: PMC7696881 DOI: 10.3390/nu12113509] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022] Open
Abstract
Malnutrition is associated to poor outcomes in critically ill patients. Oral nutrition is the route of feeding in less than half of the patients during the intensive care unit (ICU) stay and in the majority of ICU survivors. There are growing data indicating that insufficient and/or inadequate intakes in macronutrients and micronutrients are prevalent within these populations. The present narrative review focuses on barriers to food intakes and considers the different points that should be addressed in order to optimize oral intakes, both during and after ICU stay. They are gathered in the SPICES concept, which should help ICU teams improve the quality of nutrition care following 5 themes: swallowing disorders screening and management, patient global status overview, involvement of dieticians and nutritionists, clinical evaluation of nutritional intakes and outcomes, and finally, supplementation in macro-or micronutrients.
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Affiliation(s)
- Marjorie Fadeur
- Department of Diabetes, Nutrition and Metabolic Diseases, University Hospital, University of Liège, Sart-Tilman, 4000 Liège, Belgium;
- Multidisciplinary Nutrition Team, University Hospital, University of Liège, Sart-Tilman, 4000 Liège, Belgium;
| | - Jean-Charles Preiser
- Erasme University Hospital, Medical Direction, Université Libre de Bruxelles, 1070 Brussels, Belgium;
| | - Anne-Marie Verbrugge
- Multidisciplinary Nutrition Team, University Hospital, University of Liège, Sart-Tilman, 4000 Liège, Belgium;
| | - Benoit Misset
- Department of Intensive Care and Burn Center, University Hospital, University of Liège, Sart-Tilman, 4000 Liège, Belgium;
| | - Anne-Françoise Rousseau
- Multidisciplinary Nutrition Team, University Hospital, University of Liège, Sart-Tilman, 4000 Liège, Belgium;
- Department of Intensive Care and Burn Center, University Hospital, University of Liège, Sart-Tilman, 4000 Liège, Belgium;
- Correspondence: ; Tel.: +32-4-3667495
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10
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Ballesteros Sanz MÁ, Hernández-Tejedor A, Estella Á, Jiménez Rivera JJ, González de Molina Ortiz FJ, Sandiumenge Camps A, Vidal Cortés P, de Haro C, Aguilar Alonso E, Bordejé Laguna L, García Sáez I, Bodí M, García Sánchez M, Párraga Ramírez MJ, Alcaraz Peñarrocha RM, Amézaga Menéndez R, Burgueño Laguía P. [Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)]. Med Intensiva 2020; 44:371-388. [PMID: 32360034 PMCID: PMC7142677 DOI: 10.1016/j.medin.2020.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]
Abstract
On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.
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Affiliation(s)
- M Á Ballesteros Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | | | - Á Estella
- Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
| | - J J Jiménez Rivera
- Servicio de Medicina Intensiva, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España
| | | | - A Sandiumenge Camps
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - P Vidal Cortés
- Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - C de Haro
- Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Medicina Intensiva, CIBERES Enfermedades Respiratorias, Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - E Aguilar Alonso
- Servicio de Medicina Intensiva, Hospital Infanta Margarita, Cabra, Córdoba, España
| | - L Bordejé Laguna
- Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - I García Sáez
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, España
| | - M Bodí
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
| | - M García Sánchez
- Servicio de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M J Párraga Ramírez
- Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | | | - R Amézaga Menéndez
- Servicio de Medicina Intensiva, Hospital Universitari Son Espases, Palma, Islas Baleares, España
| | - P Burgueño Laguía
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
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11
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Ballesteros Sanz M, Hernández-Tejedor A, Estella Á, Jiménez Rivera J, González de Molina Ortiz F, Sandiumenge Camps A, Vidal Cortés P, de Haro C, Aguilar Alonso E, Bordejé Laguna L, García Sáez I, Bodí M, García Sánchez M, Párraga Ramírez M, Alcaraz Peñarrocha R, Amézaga Menéndez R, Burgueño Laguía P. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19). MEDICINA INTENSIVA (ENGLISH EDITION) 2020. [PMCID: PMC7340388 DOI: 10.1016/j.medine.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.
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