Experience with extracorporeal membrane oxygenation support in Latin America between 2016 and 2020.

Objective: To document the experience with ECMO therapy in healthcare institutions across Latin America between 2016 and 2020.

Design: Cross-sectional study.

Setting: Private and public health institutions from 7 countries.

Complications during extracorporeal membrane oxygenation transfer in Argentina: A multicenter observational study.

Background: There is a lack of documented cases regarding complications during ECMO transfer in middle-income countries. Using portable ECMO devices facilitates patient transport but entails significantly higher costs, necessitating evidence of their practical utility. This study aims to describe complications during ECMO transfer in Argentina and to compare complication rates between the integrated portable ECMO and non-portable ECMO systems.

[ROX index, high-flow oxygen therapy and COVID-19 pneumonia].

Introduction: The objective was to evaluate the predictive value of the ROX index and describe the evolution of a population of patients admitted to intensive care for COVID-19 pneumonia who required high-flow oxygen therapy.

Methods: Retrospective cohort study in patients older than 18 years with a positive nasopharyngeal swab for SARS-COV-2 who were admitted to intensive care unit with acute respiratory failure and required high-flow oxygen therapy for > 2 hours.

Results: Of a total of 97 patients, 42 (43.

Evaluation of the discrimination and calibration of predictive scores of mortality in ECMO for patients with COVID-19.

Background: The criteria for the selection of COVID-19 patients that could benefit most from ECMO organ support are yet to be defined. In this study, we evaluated the predictive performance of ECMO mortality predictive models in patients with COVID-19. We also performed a cost-benefit analysis depending on the mortality predicted probability.

High- Versus Low-Dose Dexamethasone for the Treatment of COVID-19-Related Acute Respiratory Distress Syndrome: A Multicenter, Randomized Open-Label Clinical Trial.

Objective: To determine whether high-dose dexamethasone increases the number of ventilator-free days (VFD) among patients with acute respiratory distress syndrome (ARDS) caused by COVID-19.

Design: Multicenter, randomized, open-label, clinical trial.

Participants: Consecutive patients with confirmed COVID-19-related ARDS were enrolled from June 17, 2020, to March 27, 2021, in four intensive care units (ICUs) in Argentina.

Improving sepsis screening and care in a developing nation health setting: A description of implementation.

Evidence on sepsis screening and care in developing nations is insufficient to inform implementation practices in hospital wards. The aim of this multi-method study was to describe and evaluate the implementation of a three-step intervention (sepsis screening, alert activation, care) in five wards in Argentina in 2017. The implementation involved three stages: (1) context assessment, (2) development/participation in implementation strategies, and (3) evaluation of intervention adherence.

Sensitivity and specificity of a quick sequential [Sepsis-Related] organ failure assessment sepsis screening tool.

Aim: There is limited evidence on the diagnostic accuracy of a quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) sepsis screening (SS) tool in developing nation health settings. The aim of this study was to test the diagnostic accuracy of a qSOFA-based SS tool, and the predictive validity of the qSOFA score in hospital ward patients from Argentina.

Methods: Prospective observational study.

High dose dexamethasone treatment for Acute Respiratory Distress Syndrome secondary to COVID-19: a structured summary of a study protocol for a randomised controlled trial.

Objectives: The aim of this study is to explore the effectiveness and safety of high dose dexamethasone treatment for Acute Respiratory Distress Syndrome secondary to SARS-Cov-2 pneumonia.

Trial Design: Multicentre, randomized clinical trial, controlled, open label, parallel group, to evaluate the effectiveness and safety of high dose dexamethasone in adult patients with confirmed COVID-19, with Acute Respiratory Distress Syndrome.

Participants: We will include patients with SARS-Cov-2 pneumonia who develop acute respiratory distress syndrome, in several intensive care units (ICU) in Buenos Aires, Argentina (CEMIC, Clinica Bazterrica, Sanatorio Sagrado Corazon) Inclusion criteria: Men and women, age ≥ 18 years old.

Implementing a quick Sequential (Sepsis-Related) Organ Failure Assessment sepsis screening tool: an interrupted times series study.

Objective: The aim of this study was to evaluate the outcomes of implementing a sepsis screening (SS) tool based on the quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) and the presence of confirmed/suspected infection. The implementation of the 6-h bundle was also evaluated.

Design: Interrupted times series with prospective data collection.

Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina.

Background: Resuscitation of septic patients regarding goals, monitoring aspects and therapy is highly variable. Our aim was to characterize cardiovascular and fluid management of sepsis in Argentina, a low and middle-income country (LMIC). Furthermore, we sought to test whether the utilization of dynamic tests of fluid responsiveness, as a guide for fluid therapy after initial resuscitation in patients with persistent or recurrent hypoperfusion, was associated with decreased mortality.

Health inequities in the diagnosis and outcome of sepsis in Argentina: a prospective cohort study.

Background: Socioeconomic variables impact health outcomes but have rarely been evaluated in critical illness. Low- and middle-income countries bear the highest burden of sepsis and also have significant health inequities. In Argentina, public hospitals serve the poorest segment of the population, while private institutions serve patients with health coverage.

Predictive Validity of Sepsis-3 Definitions and Sepsis Outcomes in Critically Ill Patients: A Cohort Study in 49 ICUs in Argentina.

Objectives: The new Sepsis-3 definitions have been scarcely assessed in low- and middle-income countries; besides, regional information of sepsis outcomes is sparse. Our objective was to evaluate Sepsis-3 definition performance in Argentina.

Design: Cohort study of 3-month duration beginning on July 1, 2016.

Use of a dual lumen cannula for venovenous extra corporeal membrane oxygenation in a patient with acute respiratory distress syndrome and a previously inserted inferior vena cava filter: a case report.

Extracorporeal membrane oxygenation is used in refractory hypoxemia in many clinical settings. Thoracic trauma patients usually develop acute respiratory distress syndrome. Due to high risk of bleeding, thrombotic complications present in this context are particularly difficult to manage and usually require insertion of an inferior vena cava filter to prevent embolism from the distal veins to the pulmonary circulation.

[Building a private high-volume center for pancreatic resection].

Introduction: There is considerable evidence on the direct relationship between higher volume and lower mortality in the pancreatoduodenectomy (DPC). However, there is little evidence of morbidity and mortality in the process of building a high-volume pancreatic surgery center. Objective.

Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients.

Introduction: Optimal management of sedation, analgesia and delirium offers comfort and security for the critical care patient, allows support measures to be applied more easily and enables an integral approach of medical care, at the same time that lowers the incidence of complications, wich translates in better patient outcomes.

Objective: To update the Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo published in Medicina Intensiva in 2007, and give recommendations for the management of sedation, analgesia, and delirium.

Methodology: A group of 21 intensivists from 9 countries of the Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 of them also specialists in clinical epidemiology and methodology, gathered for the development of guidelines.

Comparison of 6% hydroxyethyl starch 130/0.4 and saline solution for resuscitation of the microcirculation during the early goal-directed therapy of septic patients.

Purpose: The aim of this study was to show that 6% hydroxyethyl starch (HES) 130/0.4 achieves a better resuscitation of the microcirculation than normal saline solution (SS), during early goal-directed therapy (EGDT) in septic patients.

Materials And Methods: Patients with severe sepsis were randomized for EGDT with 6% HES 130/0.

Increasing arterial blood pressure with norepinephrine does not improve microcirculatory blood flow: a prospective study.

Introduction: Our goal was to assess the effects of titration of a norepinephrine infusion to increasing levels of mean arterial pressure (MAP) on sublingual microcirculation.

Methods: Twenty septic shock patients were prospectively studied in two teaching intensive care units. The patients were mechanically ventilated and required norepinephrine to maintain a mean arterial pressure (MAP) of 65 mmHg.

Gastric tonometry versus cardiac index as resuscitation goals in septic shock: a multicenter, randomized, controlled trial.

Introduction: Resuscitation goals for septic shock remain controversial. Despite the normalization of systemic hemodynamic variables, tissue hypoperfusion can still persist. Indeed, lactate or oxygen venous saturation may be difficult to interpret.

Improving quality in the intensive care unit setting.

Summarizing the mission of the ICU, the institution directive board and the unit director must generate a structure, proceedings criteria, management, and analysis of results capable of providing satisfactory care. Furthermore, they must take into account each organizational aspect that is necessary to offer an appropriate service for the patient. Medicine in general and intensive care in particular require that precautions be taken to avoid the patient and family feeling uncertain and fearful about the quality of the attention and care they receive.

[Prognosis for acute exacerbation of chronic obstructive pulmonary disease in mechanically ventilated patients].

Objective: To determine the variables associated with prognosis for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in mechanically ventilated patients.

Design: Prospective cohort study with retrospective analysis.

Location: 361 Intensive Care Units (ICU) in 20 countries.

Incidence, risk factors, and outcome of ventilator-associated pneumonia.

Objective: The purpose of this study is to determine the incidence, risk factors, and outcome of ventilator-associated pneumonia (VAP).

Design: Prospective cohort.

Setting: Three hundred sixty-one intensive care units (ICUs) from 20 countries.

Prognosis factors and outcome of community-acquired pneumonia needing mechanical ventilation.

Purpose: To evaluate the variables associated with mortality of patients with community-acquired pneumonia who require mechanical ventilation and to determine the attributable morbidity and intensive care unit (ICU) mortality of community-acquired pneumonia.

Material And Methods: Retrospective cohort study carried out in 361 ICUs from 20 countries including 124 patients who required mechanical ventilation on the first day of admission to the hospital due to acute respiratory failure secondary to severe community-acquired pneumonia. To assess the factors associated with outcome, a forward stepwise logistic regression analysis was performed, and to determine the attributable mortality of community-acquired pneumonia, a matched study design was used.