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To validate the unsupervised cluster model (USCM) developed during the first pandemic wave in a cohort of critically ill patients from the second and third pandemic waves.

To evaluate the impact of obesity on ICU mortality.

Describir las características clínicas y respiratorias de una cohorte de 43 pacientes con COVID-19 tras 28 días de evolución.

The introduction of clinical information systems (CIS) in Intensive Care Units (ICUs) offers the possibility of storing a huge amount of machine-ready clinical data that can be used to improve patient outcomes and the allocation of resources, as well as suggest topics for randomized clinical trials. Clinicians, however, usually lack the necessary training for the analysis of large databases. In addition, there are issues referred to patient privacy and consent, and data quality. Multidisciplinary collaboration among clinicians, data engineers, machine-learning experts, statisticians, epidemiologists and other information scientists may overcome these problems.

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The classic concept of massive hemoptysis has been replaced by the newer one of life-threatening hemoptysis (LTH), which means any bleeding from the lower respiratory tract that may cause the death of the patient. Although asphyxia is the usual mechanism of death, hypovolemic shock also plays a role in certain cases. The amount of expectorated blood does not always correlate with the actual volume of bleeding. The underlying state of health, especially basal respiratory function, plays a crucial role when the real consequences of bleeding are considered. The following factors have to be evaluated when a temporary or definitive treatment is chosen setting of the hemoptysis, presumptive etiology, degree of clinical instability, equipment resources, and personal expertise in different techniques. The most important role of bronchoscopy is its rapid availability when hemoptysis is severe and the patient is not sufficiently stable to be immediately taken to the angiography department. In that situation, orotracheal intubation and bronchoscopy may be lifesaving. Rigid bronchoscopy, in skilled hands, has proven to be superior to flexible bronchoscopy in massive hemoptysis. Fiberoptic bronchoscopy (FOB) is also helpful as an extreme emergency measure to properly place an orotracheal tube contralateral to the bleeding side. Endoscopic local measures may sometimes help to transitorily stop bleeding. If the cause of hemoptysis is itself susceptible to primary surgical treatment and the condition of the patient is sufficiently good in terms of pulmonary reserve, life expectancy, and hemodynamic stability, then surgery is indicated. If the condition of the patient is not good enough, a temporary method to stop hemorrhage and stabilize the patient is then warranted. Although bronchoscopy and bronchial artery embolization (BAE) should be ideally complementary, recent data suggest that BAE may be a more effective temporary measure to stop bleeding.

We present a two year study of the evolution of SL9 impact aerosol debris we observed between 0.4 and 0.9 micrometers with continuous high temporal coverage from July 1994 through September 1996 and at 1.7 and 2.3 micrometers during three observing runs in July 1994 and March and August 1995. Temporal cylindrical map projections at red continuum wavelengths in the region covered by the impact debris show the contributions of different mechanisms in producing the complicated morphological evolution of the sites during the first month. Long-term horizontal aerosol transport was mainly due to the zonal jets in the upper troposphere with extreme measured velocities of −10 and 20 m s−1. A comparison of the zonal drift of the core sites in the red continuum and in the 890-nm methane band (sensitive to higher levels) during the first month do not show significant velocity differences between these filters, indicating a low vertical wind shear in the upper troposphere. The spread of the aerosols resulted from the meridional and vertical shears of the zonal winds. Rapid initial outward expansions (speeds of ∼30 to 60 m s−1) and interactions with nearby vortices (speeds of ∼10 to 25 m s−1) also contributed to the dispersion of particulates. Using methane band images we have measured a steady poleward and equatorward meridional transport of the particulates with velocities of ∼−6 and 40 cm s−1, respectively. Particulates were detected up to ∼−20° by August 1995. Limb brightening in the 890-nm methane band was observed up to ∼−30° during the last observation (September 1996) reported here, indicating that a small population of aerosols was still present two years after impact. Photometric observations in the 890-nm band, together with a radiative transfer model, allowed us to calculate the evolution of the aerosol optical depth in the main impact core areas and in the subsequent SL9 band. We found a rapid decrease in optical depth in the largest impacts during July and August 1994 (from ≈3.2 to 2.1), followed by a gradual decrease during the next two years to ≈0.3 (June 1996). This behavior can be explained by simple models of debris horizontal dispersion by the wind shear and by sedimentation. Calculations of the characteristic times related to the microphysical processes in the aerosols (sedimentation, coagulation, and coalescence) together with their observed residence times (≥2 years) indicates that this persistent population of particles had sizes ≤0.1 micrometers during 1995 and 1996.