Time filter

Source Type

Las Palmas de Gran Canaria, Spain

Fan E.,University of Toronto | Fan E.,Sinai University | Villar J.,CIBER ISCIII | Villar J.,Hospital Universitario Dr Negrin | And 3 more authors.
BMC Medicine

Despite over 40 years of research, there is no specific lung-directed therapy for the acute respiratory distress syndrome (ARDS). Although much has evolved in our understanding of its pathogenesis and factors affecting patient outcome, supportive care with mechanical ventilation remains the cornerstone of treatment. Perhaps the most important advance in ARDS research has been the recognition that mechanical ventilation, although necessary to preserve life, can itself aggravate or cause lung damage through a variety of mechanisms collectively referred to as ventilator-induced lung injury (VILI). This improved understanding of ARDS and VILI has been important in designing lung-protective ventilatory strategies aimed at attenuating VILI and improving outcomes. Considerable effort has been made to enhance our mechanistic understanding of VILI and to develop new ventilatory strategies and therapeutic interventions to prevent and ameliorate VILI with the goal of improving outcomes in patients with ARDS. In this review, we will review the pathophysiology of VILI, discuss a number of novel physiological approaches for minimizing VILI, therapies to counteract biotrauma, and highlight a number of experimental studies to support these concepts. © 2013 Fan et al.; licensee BioMed Central Ltd. Source

Kacmarek R.M.,Massachusetts General Hospital | Kacmarek R.M.,Harvard University | Villar J.,CIBER ISCIII | Villar J.,Hospital Universitario Dr Negrin | Villar J.,Li Ka Shing Knowledge Institute
Minerva Anestesiologica

Severe hypoxemia is the hallmark of ARDS. However, unmanageable refractory hypoxemia fortunately is a rare occurrence in patients with ARDS and an infrequent cause of death in ARDS. However, in some patients, in spite of the application of lung protective ventilation with moderate to high levels of end-expiratory pressure (PEEP), refractory hypoxemia remains unresolved. When refractory hypoxemia persists, we first recommend the use of lung recruitment maneuvers and a decremental PEEP trial, if this does not resolve the refractory hypoxemia prone positioning should be attempted. The use of aerosolized pulmonary vasodilators can be used to buy time when these approaches fail as the patient is transitioned to extracorporeal membrane oxygenation. We also find that there is now sufficient evidence to recommend against the use of high frequency oscillation in the management of refractory hypoxemia. Source

Rodriguez-Gonzalez R.,University of Santiago de Compostela | Rodriguez-Gonzalez R.,Hospital Universitario Dr Negrin | Blanco M.,University of Santiago de Compostela | Rodriguez-Yanez M.,University of Santiago de Compostela | And 3 more authors.

Objective: Platelet derived growth factor-CC (PDGF-CC) isoform is activated by tissue plasminogen activator (tPA) regulating blood brain barrier permeability after ischemia. We aimed to study the association of PDGF isoforms serum levels with hemorrhagic transformation (HT) and edema after thrombolytic treatment in ischemic stroke. Methods: We studied 129 patients with ischemic stroke treated with tPA within the first 4.5 h (h) from stroke onset. CT was performed on admission and at 24-36 h. On the 2nd CT, HT was classified according to ECASS II criteria, and severe brain edema was diagnosed if extensive swelling causing any shifting of the structures of the midline was detected. PDGF-AA, PDGF-AB, PDGF-BB and PDGF-CC serum levels were analyzed by ELISA on admission (before tPA bolus), at 24 and 72 h. Results: Patients who developed HT showed only higher levels of PDGF-CC isoform on admission and at 24 h (all p < 0.0001). In the multivariate analysis, PDGF-CC levels on admission (OR, 1.02; CI 95%, 1.00-1.04) and at 24 h (OR, 1.05; CI 95%, 1.02-1.08) were independently associated with HT after adjustment by confounding factors. On the other hand, patients with severe edema showed also higher levels of PDGF-CC on admission and at 24 h (p < 0.0001), but this statistical association was lost in the logistic regression analysis. PDGF-CC levels ≥ 175 ng/mL at 24 h predict the development of PH with a sensitivity of 90% and specificity of 88% (area under the curve 0.936; p < 0.0001). Conclusion: Increased PDGF-CC levels after tPA treatment is associated with HT. © 2012 Elsevier Ireland Ltd. Source

Vargas M.,University of Naples Federico II | Servillo G.,University of Naples Federico II | Sutherasan Y.,Mahidol University | Rodriguez-Gonzalez R.,Hospital Universitario Dr Negrin | And 3 more authors.

Objective: We performed this systematic review to evaluate the effectiveness of in-hospital low targeted temperature in adult patients after out of hospital cardiac arrest on survival and neurologic performance. Data source: We systematically searched MEDLINE and PUBMED from inception to April 2014. Study selection: Citations were screened for studies evaluating the effect of in-hospital low targeted temperature in patients following out of hospital cardiac arrest. Data extraction: We analyzed randomized control trials (RCTs) that included adult patients resuscitated from out of hospital cardiac arrest, reporting mortality at hospital discharge and comparing in-hospital low targeted temperature with a control group. Data synthesis: This meta-analysis included 6 RCTs and 1418 adult patients. In-hospital low targeted (low T) temperature was associated to a reduction in mortality at hospital discharge and at 6 months when compared with in-hospital targeted and not targeted temperature while there was no reduction in mortality comparing low and high targeted temperature. In patients with initial ventricular fibrillation/ventricular tachycardia rhythm of out of hospital cardiac arrest, low T was associated with a reduction in short and long-term mortality when compared with no targeted temperature while not when compared to high targeted temperature. Low T was associated with good neurologic performance at hospital discharge compared with in-hospital high or not targeted temperature. Conclusion: In-hospital low targeted temperature (<4. °C) improved short and long-term mortality when compared to no targeted temperature. In contrast, low T did not improve outcome compared with a slightly higher targeted temperature (≈36. °C). © 2015 Elsevier Ireland Ltd. Source

Villar J.,CIBER ISCIII | Villar J.,Hospital Universitario Dr Negrin | Villar J.,Li Ka Shing Knowledge Institute | Sulemanji D.,Massachusetts General Hospital | And 3 more authors.
Current Opinion in Critical Care

PURPOSE OF REVIEW: The purpose of this review is to examine and discuss the incidence and outcome of patients with the acute respiratory distress syndrome (ARDS). This is a challenging task, as there is no specific clinical sign or diagnostic test that accurately identifies and adequately defines this syndrome. RECENT FINDINGS: This review will focus on published epidemiological studies reporting population-based incidence of ARDS, as defined by the American-European Consensus Conference criteria. In addition, the current outcome figures for ARDS patients reported in observational and randomized controlled trials will be reviewed. The focus will be on studies published since 2000, when the ARDSnet study on protective mechanical ventilation was published, although particular emphasis will be on those articles published in the last 24 months. SUMMARY: On the basis of current evidence, and despite the order of magnitude of reported European and USA incidence figures, it seems that the incidence and overall mortality of ARDS has not changed substantially since the original ARDSnet study. The current mortality of adult ARDS is still greater than 40%. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Discover hidden collaborations