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Background: To compare the demographic characteristics and prognosis of patients admitted to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) pneumonia during the first wave (March–July) versus those admitted during the second wave (August–December). Methods: Prospective, observational, descriptive cohort-study including patients admitted to the ICU for COVID-19 pneumonia during the first wave (March–July 2020) or the second wave (August–December). The demographic characteristics, comorbidities, treatments, complications, and mortality in both pandemic waves were studied. Results: A total of 72 patients were included: Twenty-six admitted during the first wave and 46 during the second wave. Men were predominant in both waves: 61.5% versus 73.9%. The most frequently associated comorbidities in both periods were: arterial hypertension 65.4% versus 65.2%, diabetes mellitus 46.2% versus 34.8% and overweight, measured as (body mass index), 29.13 ± 3.38 versus 28.98 ± 4.25. More patients received noninvasive mechanical ventilation prior to invasive ventilation during the second wave (P < 0.01); the incidence of atelectasis and bronchial obstruction were lower during the second wave (P < 0.01 and P = 0.055 respectively); no further differences were observed in the occurrence of other complications. Conclusions: No significant differences were observed between the first and the second wave in the demographic characteristics or comorbidities of admitted patients. Blood hypertension, diabetes and overweight were remarkable risk factors. Improving our knowledge of the complications, these patients tend to develop was essential to reduce some of them, such as endotracheal tube obstruction or atelectasis, and to promote the use of noninvasive ventilation therapies. [ABSTRACT FROM AUTHOR]

Objective: To analyze the epidemiological and prognostic differences between critical surgical patients admitted to intensive care unit (ICU) according to length of stay in the ICU. Materials and Methods: Retrospective observational study on patients with surgical pathology admitted to ICU of a tertiary hospital, during 7 years, with a stay ≥ 5 days. The variables analyzed were age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II), duration of stay, hospital and ICU mortality, original service, reason for admission, geographical place of residence, and the use of invasive techniques such as mechanical ventilation (MV), tracheotomy, and techniques of continuous renal replacement (CRR). Two groups were defined; one with intermediate stay, the one that exceeds the average of our population (> 5 days) and another with long stay patients (> 14 days). Readmissions were excluded. Firstly, the analysis of differential characteristics of patients was performed, this was according to the duration of their stay using either a contrast equal averages when the variable contrast between the two groups was quantitative or the Chi-square test when the variable analyzed was qualitative. For both tests, the existence of significant differences between groups was considered when the significance level was less than 5%. And, secondly, a model forecast ICU survival of these patients, regardless of length of stay in ICU, using a binary logistic regression analysis was performed. Results: Among the 540 patients analyzed, no significant differences were observed, depending on the length of stay in the ICU, except the need for invasive techniques such as MV or tracheotomy in those of longer stay (P = 0.000). However, ICU mortality was significantly higher for patients with intermediate stay (30 vs 17: 5%; P = 0.000), without observing differences in hospital mortality. ICU survival was influenced by age, APACHE II levels, admission to the ICU in a coma state, and the application of the three invasive techniques discussed. Conclusion: Surgical patients who survive in the ICU, regardless of the length of their stay in it, have the same odds of hospital survival. Found as predictors of mortality in ICU APACHE II, age, admission in a coma state, and application of invasive techniques. [ABSTRACT FROM AUTHOR]

Objective: To compare outcomes of critically ill patients transferred from another island compared to those patients with direct admission from Emergency Department to intensive care unit (ICU). Patients and Methods: Retrospective study of prospectively collected data during 8 years. The population studied was all critical adult patients transferred from another island to our hospital and those directly admitted from the Emergency Department. Variables were age, sex, clinical diagnosis (coronary, medical, surgical, or trauma), acute physiology and chronic health evaluation (APACHE) II score at admission, ICU days of stay, days of mechanical ventilation and ICU mortality. Results: During the period of study, 3,115 patients coming from Emergency Department (Group 1) were admitted to our ICU and 138 were transferred from another island (Group 2). No significant statistically differences were found between both groups neither age, sex, APACHE II, ICU days, days of mechanical ventilation, and mortality rate (17.5% versus 20.3%, P = 0.43). The multivariate analysis showed that age, APACHE II score, ICU days of stay, type of patient, and days of mechanical ventilation were independent variables associated with mortality. Conclusions: No differences were found in the global prognosis of the admitted patients transferred from another island compared to those who were admitted directly from the Emergency Department. There is no impact on mortality in transferring a patient in our study population. [ABSTRACT FROM AUTHOR]

Decompressive craniectomy (DC) is a useful technique for the treatment of traumatic brain injuries (TBI) with intracranial hypertension (ICHT) resistant to medical treatment, increasing survival, although its role in the functional prognosis of patients is not defined. It is also a technique that is not without complications, and may increase the patient's morbidity and mortality. We report two cases of patients with TBI who required DC and suffered complications from the technique. [ABSTRACT FROM AUTHOR]

The author discusses the stress condition of several patients in emergency medicine. The author recognizes the services and efforts rendered by several emergency departments (ED), particularly in providing preventive care. The author cites that some patients are not satisfied with the care they have received at ED. The author also notes the recommendations developed by Society for Academic Emergency Medicine Public Health and Education Task Force for the improvement of the emergency care.

We report the case of a woman, with severe respiratory impairment as a debut of acute myeloid leukemia who suspecting a pulmonary leukostasis, leukoapheresis was applied. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article related to factors affecting survival rate of patients that were associated with prolonged admission to the intensive care unit (ICU) in the previous issue.

A letter to the editor is presented about necrotizing fasciitis of the perineum and external genital area called Fournier's Gangrene.

The article presents a case study of a 17-year-old male patient that was admitted after being hit by a car and resuscitated for 45 minutes after cardiac arrest. They performed craniotomy and bifrontal lobectomy in the patient's brain. It concludes that patients who undergone a bifrontal craniectomy are at high risk for postcranioplasty complications.

Unilateral dilated pupil in a critical patient under sedation is an important clinical sign that requires prompt evaluation. An exhaustive assessment must be performed, including neurological examination and imaging tests, and pharmacological causes must be ruled out. We describe a case of unilateral fixed dilated pupil secondary to the administration of a nebulized cholinergic antagonist, ipratropium bromide, in an unconscious patient. [ABSTRACT FROM AUTHOR]

The article discusses the use of ultrasound (US) guidance for central venous access in several studies. These studies have assessed US-guided peripheral intravenous (IV) line placement in a group of Emergency Department (ED) patients. It is concluded that in patients with difficult access to be in an extensive care setting or with a high possibility for clinical deterioration, must be responsible to consider setting a central line than attempting US-guided peripheral IV access in the ED.

The article describes a case of cardiac tamponade as a critical cardiac complication following pacemaker implantation in a 72-years old female patient. The patient was implanted with pacemaker prior to valvuplasty procedure by severe aortic stenosis. The patient suffered arterial hypotension, and a pericardial effusion of 20 millimeter (mm) with commitment of diastolic filling was detected on transthoracic echocardiography.

A letter to the editor is presented which discusses the diagnosis and complications of the delayed perforation of the sigmoid colon referring to the condition of a 53-year-old previously healthy man who suffered a closed and compound pelvic fracture after a crush between two motor vehicle.

A letter to the editor is presented which discusses the prognosis of patients with post-traumatic intractable intracranial hypertension based on a retrospective study conducted at the Intensive Care Unit (ICU) of the University Hospital Insular in Gran Canaria, Spain.

A letter to the editor is presented which discusses the significance of supplementing chest radiography with computed tomography (CT) scan to prevent major complications, particularly those that are related to the use of chest tube.

A letter to the editor is presented commenting on subclavian vein catheterization.

The article emphasizes the proper techniques of independent lung ventilation in cases of unilateral pulmonary abnormalities. It presents a case of a 53-year-old man who was admitted to the emergency department after a cardiorespiratory arrest secondary to massive hemoptysis in which selective intubation of the left bronchus with a double-lumen tube was made to achieve adequate oxygenation. The significance of correct placement of double-lumen endobronchial tube to avoid patient's death is cited.

A letter to the editor is presented in response to the article related to erythrocytapheresis in the emergency management of severe falsiparum malaria of a patient in the previous issue.

A letter to the editor is presented in response to the article "Emergency Management of Decompensated Peripartum Cardiomyopathy," by I. Lata and colleagues in the previous issue.