Guillermo Domínguez-Cherit

The SARS-COV-2, pandemic generated the need to modify the current clinical educational model with the challenge of promoting safety as well as the continuity of clinical education through the use of virtual platforms. Since clinical training in hospital institutions cannot be substituted, a strategic training plan was developed to guarantee protection, safety, and academic continuity for students upon their return to clinical clerkships. The objective of this project was to develop and evaluate the impact of a hybrid massive training plan as an educative strategy to give the theoretical and practical knowledge required for the safe return of undergraduate students to their respective clinical activities in the context of this pandemic. An academic program was designed through a massive hybrid strategy to train 616 undergraduate students studying clinical cycles by presential, virtual, synchronous, and asynchronous activities. To know the impact of the program, a pre-experimental study with pre-test and post-test was carried out to evaluate the acquisition of the important knowledge and skills of the program. A significant difference was found between the means of the initial and final evaluations (p <0.001), as well as a high impact of the intervention (d 1.6). Significant improvements in the areas of COVID-19 initial management (p <0.001) and personal protective equipment use (p <0.001) were seen in the post-test when comparing to the initial evaluation. A quantitative and qualitative analysis of the satisfaction survey was carried out, finding positive results on the course design, quality of didactic resources, and instructors’ performance massive hybrid training is an effective strategy to facilitate the reintegration of undergraduate students to their face-to-face clinical rotations. Keywords: COVID-19 Hybrid education, Clinical clerkships, Training, Distance learning, Educational model

Introduction: Identification of risk factors for mortality has enabled improving the treatment of critically ill patients with systemic lupus erythematosus. Objective: To describe clinical characteristics and prognoses of critically ill patients with systemic lupus erythematosus admitted to an intensive care unit. Method: Prospective, observational cohort study. A total of 207 patients with systemic lupus erythematosus admitted between January 2011 and January 2016 were included. Results: During the study period, 3,215 critically ill patients were admitted to the intensive care unit, out of which 207 (6.4%) were identified as having systemic lupus erythematosus after being evaluated by an intensivist. The multivariate analysis identified the presence of organ failure (cardiovascular, liver, neurological) and serum lactate levels > 2 mmoL/L at admission or within the first 24 hours of intensive care unit stay as the main factors associated with increased mortality. Conclusions: A relevant observation was that neurological failure and liver failure were associated with higher mortality risk at 28 days, without reports similar to these findings being identified.

The value of spirometry as a routine preoperative test for bariatric surgery is debatable. The aim of this study was to assess the relationship between spirometry results and the frequency of postoperative pulmonary complications in 602 obese patients. Clinical files of patients undergoing bariatric surgery between 2004 and 2013 were reviewed. Demography, risk factors, respiratory symptoms, and spirometry results (forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), FEV₁/FVC) were recorded, and their relationship with postoperative pulmonary complications was evaluated. There were 256 males and 346 females with a mean age of 40.2 ± 11.6 years and a mean BMI of 42.1 ± 6.4 kg/m2. History of smoking was found in 408 patients (68 %). Preoperative respiratory symptoms were present in 328 (54.5 %). Most frequent symptoms were snoring (288), dyspnea (119), bronchospasm [6], and chronic productive cough [6]. In 153 patients, history of respiratory disease was documented. The obstructive sleep apnea syndrome (OSAS) was present in 124, 20 requiring continuous positive airway pressure (CPAP). Asthma was present in 27 and chronic obstructive pulmonary disease (COPD) in 2. Variables associated to a higher risk of pulmonary complications were OSAS (OR 2.3), an abnormal spirometry (OR 2.6), male gender (OR 1.9), and preoperative respiratory symptoms (OR 1.9). Using multivariate logistic regression, an abnormal spirometry was a significant predictor of postoperative pulmonary complications in patients with respiratory symptoms and/or OSAS. However, it lost prognostic significance when both conditions were subtracted. In obese patients undergoing bariatric surgery, abnormal preoperative spirometry predicts postoperative respiratory complications only in patients with OSAS.

Our aims were to describe the prevalence of pulmonary hypertension in patients with acute respiratory distress syndrome (ARDS), to characterize their hemodynamic cardiopulmonary profiles, and to correlate these parameters with outcome. All consecutive patients over 16 years of age who were in the intensive care unit with a diagnosis of ARDS and an in situ pulmonary artery catheter for hemodynamic monitoring were studied. Pulmonary hypertension was diagnosed when the mean pulmonary artery pressure was >25 mmHg at rest with a pulmonary artery occlusion pressure or left atrial pressure 2 was higher in those who died. The level of airway pressure seemed to influence the onset of pulmonary hypertension. Survival was determined by the severity of organ failure at admission to the intensive care unit.