Purpose To determine whether time-to-intubation was associated with higher ICU mortality in patients with COVID-19 on mechanical ventilation due to respiratory insufficiency. Materials and methods We conducted an observational, prospective, single-center study of patients with confirmed SARS-CoV-2 infection hospitalized with moderate to severe ARDS, connected to mechanical ventilation in the ICU between March 17 and July 31, 2020. We examined their general and clinical characteristics. Time-to-intubation was the time from hospital admission to endotracheal intubation. Results We included 183 consecutive patients; 28% were female, and median age was 62 years old. Eighty-eight patients (48%) were intubated before 48 h (early) and ninety-five (52%) after 48 h (late). Patients intubated early had similar admission PaO 2 /FiO 2 ratio (123 vs 99; p = 0.179) but were younger (59 vs 64; p = 0.013) and had higher body mass index (30 vs 28; p = 0.006) compared to patients intubated late. Mortality was higher in patients intubated late (18% versus 43%), with admission PaO 2 /FiO 2 ratio < 100 mmHg (OR 5.2; p = 0.011), of older age (OR 1.1; p = 0.001), and with previous use of ACE inhibitors (OR 4.8; p = 0.026). Conclusions In COVID-19 patients, late intubation, Pafi <100, older age, and previous ACE inhibitors use were associated with increased ICU mortality.

Background To describe respiratory coinfections, predictive factors and outcomes in patients requiring mechanical ventilation (MV) with COVID-19. Methods Cohort study, carried out in a Chilean single tertiary Hospital. All patients with COVID-19 admitted to ICU that required MV were included between 1 June and 31 July 2020. Results 175 patients were admitted to ICU and required MV. Of these, 71 patients developed at least one respiratory coinfection (40.6 %). Early coinfections and late coinfections were diagnosed in 1.7% and 31.4% of all patients admitted to ICU respectively. Within late coinfections, 88% were bacterial, 10% were fungal, and 2% were viral coinfections. One third of isolated bacteria were multidrug-resistant. Multivariate analysis showed that the risk for coinfection was 7.7 times higher for patients with history of corticosteroids (adOR = 7.65, CI 95%: 1.04-56.2, p=0,046) and 2.7 times higher for patients that received dexamethasone during hospitalization (adOR=2.69; CI 95%: 1.14-6.35, p=0,024) than patients that were not exposed. For each additional day in MV, the risk of coinfection increases 1.1 times (adOR=1.06; CI 95%: 1.01-1.11, p=0,025). Conclusions Patients in ICU with COVID-19 that require MV had a high rate of coinfections during their stay, but not at admission. Major predisposing factors are the history of corticosteroids, the use of dexamethasone during hospitalization and days in MV.

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Background Patients with COVID-19 receiving mechanical ventilation may become aggravated with a secondary respiratory infection. The aim of this study was to describe secondary respiratory infections, their predictive factors, and outcomes in patients with COVID-19 requiring mechanical ventilation. Methods A cohort study was carried out in a single tertiary hospital in Santiago, Chile, from 1st June to 31st July 2020. All patients with COVID-19 admitted to the intensive care unit that required mechanical ventilation were included. Results A total of 175 patients were enrolled, of which 71 (40.6%) developed at least one secondary respiratory infection during follow-up. Early and late secondary infections were diagnosed in 1.7% and 31.4% respectively. Within late secondary infections, 88% were bacterial, 10% were fungal, and 2% were of viral origin. One-third of isolated bacteria were multidrug-resistant. Bivariate analysis showed that the history of corticosteroids used before admission and the use of dexamethasone during hospitalization were associated with a higher risk of secondary infections (p = 0.041 and p = 0.019 respectively). Multivariate analysis showed that for each additional day of mechanical ventilation, the risk of secondary infection increases 1.1 times (adOR = 1.07; 95% CI 1.02–1.13, p = 0.008) Conclusions Patients with COVID-19 admitted to the intensive care unit and requiring mechanical ventilation had a high rate of secondary infections during their hospital stay. The number of days on MV was a risk factor for acquiring secondary respiratory infections.

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Background: SARS-CoV-2 infection presents in many cases with pneumonia and respiratory failure. It is not clear whether the time of intubation and connection to mechanical ventilation (MV) in this condition is associated with an increase in mortality or represents the natural course of the disease.We conducted an observational, prospective, single-center study to describe the characteristics and outcomes of acute respiratory distress syndrome (ARDS) patients with confirmed COVID-19 and treated with invasive MV to determine whether the time-to-intubation following hospital admission is associated with worse outcomes.Methods: We prospectively included consecutive patients with SARS-CoV-2 infection and moderate to severe ARDS, admitted to an intensive care unit (ICU) and connected to MV between March 17 and July 31, 2020. We examined their general characteristics, ventilatory management, and clinical outcomes. Time of intubation was defined as the time from hospital admission to endotracheal intubation and was categorized as early (<72 hours) or late (≥72 hours). Mann-Whitney U, Kruskal Wallis, chi-square, and Fisher’s exact, were used when appropriate. Uni and multivariate analyses between main outcome and explanatory variables were performed.Results: A total of 183 consecutive patients were included, 28% (51/183) were female, and their median age was 62 years [54-70]. One hundred (55%) patients were subjected to early and 83 (45%) to late intubation. Patients intubated after 72 hours were older and presented more comorbidities. Mortality was higher in the group of patients with late intubation (41% versus 21%; p= 0.002), a PaO2/FiO2 ratio <100 mmHg at admission (p= 0.029), and that were older than 60 years (p= 0.008).ConclusionsIn acute COVID-19 patients with moderate to severe ARDS, intubation after 72 hours following hospital admission, age >60 years-old and a PaO2/FiO2 ratio <100 at admission may appear to be associated with increased ICU mortality. Further studies are required to confirm our findings and establish the best timing for intubation in COVID-19 patients admitted to the ICU with respiratory failure.

Introducción: La estenosis aórtica es frecuente en países desarrollados, cuando es severa (EAS) y sintomática se recomienda reemplazo valvular. Su diagnóstico ecocardiográfico se realiza con cualquiera de; área valvular aórtica (AVA) <1.0 cm², gradiente medio (GM) >40 mmHg, velocidad máxima >4 m/s. Habitualmente existe concordancia entre estos criterios, pero diversas razones generan discordancia hasta en un 40%, principalmente entre área y gradiente (DAG), causando incertidumbre diagnóstica en presencia de fracción de eyección preservada del ventrículo izquierdo (FEp) (FEVI >50%). Objetivos: Caracterizar pacientes con EAS en la red UC. Establecer prevalencia y factores asociados a DAG en pacientes con EAS y FEp. Métodos: Estudio de corte transversal, incluyó todos los pacientes con AVA<1.0 cm2 durante 17.5 años en la red UC. Se registraron variables biodemográficas y ecocardiográficas. Los pacientes con EAS y FEp se subdividieron en 2 grupos según GM, bajo (≤40 mmHg) y alto (>40mmHg), se utilizó t-student y Chi cuadrado.

Introduction: Catatonia is a serious syndrome characterized by motor abnormalities associated with mental state alteration, with affection and mood imbalances. Frequent symptoms include mutism, radical negativism, weird posturing, echolalia and echopraxia. Hospital prevalence has been estimated up to 1%, being usually underdiagnosed.Case Presentation: A 49 year old male with a record of refractory frontal lobe epilepsy, borderline personality disorder, C6-C7 spinal trauma related tetraparesia. He presented with a two-month history of behavioral derangement, hallucinations and persecutory delusion. He was then started on risperidone 4.5 mg and venlafaxine 75 mg. Two weeks before admission he started presenting oral intake rejection. Later he was taken to the emergency department, after presenting a convulsive episode (featuring guttural sounds, ascending gaze and upper extremity jerks, without loss of consciousness. Electroencephalography (EEG) showed generalized interictal epileptiform activity. Acute crisis was controlled with 6 mg of lorazepam, following restart of previous medication. Brain CT showed diffuse atrophy and signs of left frontal cortical gliosis. On the third day of stay he was evaluated by psychiatry consultants, impressing oppositional behavior. A possible catatonic syndrome is postulated, scoring 11 points on Bush-Francis score with normal EEG. A 4 mg lorazepam trial results positive, attaining spontaneous speech, cooperation on interview and proper oral intake. Discussion: Catatonia is rather usual in general hospital practice. High suspicion must be kept from clinical presentation -particularly in patients with psychiatric comorbidities -given its potentially deleterious consequences. It should be regarded as a psychiatric emergency.