Fregenal de la Sierra, Spain
Fregenal de la Sierra, Spain

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Villar J.,Hospital Universitario Dr Negrin | for the Spanish Initiative for Epidemiology,A+ Network
Critical Care Medicine | Year: 2017

OBJECTIVES:: The driving pressure (plateau pressure minus positive end-expiratory pressure) has been suggested as the major determinant for the beneficial effects of lung-protective ventilation. We tested whether driving pressure was superior to the variables that define it in predicting outcome in patients with acute respiratory distress syndrome. DESIGN:: A secondary analysis of existing data from previously reported observational studies. SETTING:: A network of ICUs. PATIENTS:: We studied 778 patients with moderate to severe acute respiratory distress syndrome. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: We assessed the risk of hospital death based on quantiles of tidal volume, positive end-expiratory pressure, plateau pressure, and driving pressure evaluated at 24 hours after acute respiratory distress syndrome diagnosis while ventilated with standardized lung-protective ventilation. We derived our model using individual data from 478 acute respiratory distress syndrome patients and assessed its replicability in a separate cohort of 300 acute respiratory distress syndrome patients. Tidal volume and positive end-expiratory pressure had no impact on mortality. We identified a plateau pressure cut-off value of 29 cm H2O, above which an ordinal increment was accompanied by an increment of risk of death. We identified a driving pressure cut-off value of 19 cm H2O where an ordinal increment was accompanied by an increment of risk of death. When we cross tabulated patients with plateau pressure less than 30 and plateau pressure greater than or equal to 30 with those with driving pressure less than 19 and driving pressure greater than or equal to 19, plateau pressure provided a slightly better prediction of outcome than driving pressure in both the derivation and validation cohorts (p < 0.0000001). CONCLUSIONS:: Plateau pressure was slightly better than driving pressure in predicting hospital death in patients managed with lung-protective ventilation evaluated on standardized ventilator settings 24 hours after acute respiratory distress syndrome onset. Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.


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 | Year: 2013

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.


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 | Year: 2013

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.


Villar J.,CIBER ISCIII | Villar J.,Hospital Universitario Dr Negrin | Villar J.,Li Ka Shing Knowledge Institute | Blanco J.,CIBER ISCIII | And 3 more authors.
Current Opinion in Critical Care | Year: 2016

Purpose of review This article discusses recently published articles reporting the incidence and outcome of patients with the acute respiratory distress syndrome (ARDS). This is a difficult task since there is a marked variability regarding the methodology of the few, large epidemiological, and observational studies on ARDS. Recent findings The review will mainly focus on publications from the past 18 months. We have reviewed new epidemiological studies reporting population-based incidence of ARDS. Also, we have reviewed the data on survival reported in observational and randomized controlled trials, discussed how the current ARDS definition modifies the true incidence of ARDS, and briefly mentioned recent approaches that appear to improve ARDS outcome. Summary On the basis of current evidence, it seems that the incidence and overall hospital mortality of ARDS has not changed substantially in the last decade. Independent of the definition used for identification of ARDS patients, reported population-based incidence of ARDS is an order of magnitude lower in Europe than in the USA. Current hospital mortality of combined moderate and severe ARDS reported in observational studies is greater than 40%. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


De Torres J.P.,University of Navarra | Casanova C.,Hospital Ntra Sra Of Candelaria | Marin J.M.,Hospital Universitario Miguel Servet | Pinto-Plata V.,Hospital Universitario Dr Negrin | And 9 more authors.
Thorax | Year: 2014

Background The Global Obstructive Lung Disease (GOLD) 2011 revision recommends the multidimensional assessment of COPD including comorbidities and has developed a disease categories system (ABCD) attempting to implement this strategy. The added value provided by quantifying comorbidities and integrating them to multidimensional indices has not been explored. Objective Compare the prognostic value of the GOLD ABCD categories versus the BMI, Obstruction, Dyspnea, Exercise (BODE) index, and explore the added prognostic value of comorbidities evaluation to this multidimensional assessment. Methods From the patients who have been enrolled in the BODE study, we selected the most recent ones who had the available information needed to classify them by the ABCD GOLD categories. Cox proportional hazards ratios for all-cause mortality were performed for GOLD categories and BODE index. The added value of the comorbidity Copd cO-morbidity TEst (COTE) index was also explored using receiver operating curves (ROC) values. Results 707 patients were followed for 5030 months including all degrees of airway limitation and BODE index severity. ABCD GOLD predicted global mortality (HR: 1.47; 95% CI 1.28 to 1.70) as did the BODE index (HR: 2.02; 95% CI 1.76 to 2.31). Area under the curve (AUC) of ROC for ABCD GOLD was 0.68; (95% CI 0.64 to 0.73) while for the BODE index was 0.71 (95% CI 0.67 to 0.76). The C statistics value was significantly higher for the observed difference. Adding the COTE index to the BODE index improved its AUC to 0.81 (95% CI 0.77 to 0.85), (2=40.28, p<0.001). Conclusions In this population of COPD patients, the BODE index had a better survival prediction than the ABCD GOLD categories. Adding the COTE to the BODE index was complimentary and significantly improved outcome prediction.


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 | Year: 2014

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.


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.
Resuscitation | Year: 2015

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.


Martinez-Martin F.J.,Hospital Universitario Dr Negrin | Rodriguez-Rosas H.,Hospital Universitario Dr Negrin | Peiro-Martinez I.,Hospital Universitari Of Bellvitge | Soriano-Perera P.,Hospital Universitario Of Canarias Carretera Cuesta Taco | And 2 more authors.
Journal of Human Hypertension | Year: 2011

We studied the effects of treatment with olmesartan/amlodipine and olmesartan/hydrochlorothiazide on inflammatory and metabolic parameters (including new-onset diabetes as a secondary endpoint) in non-diabetic hypertensive patients with metabolic syndrome (MetS). A total of 120 patients with MetS and stage I and II hypertension were randomized to olmesartan 20 mg/amlodipine 5 mg or olmesartan 20 mg/hydrochlorothiazide 12.5 mg. If target systolic blood pressure (<140 mm Hg) was not reached, doses were doubled after 13 weeks; doxazosin 4 mg was added after 26 weeks, and doubled after 39 weeks; follow-up ended at 78 weeks. At each visit, blood pressure (BP), fasting plasma glucose, insulin, adiponectin, tumour necrosis factor-α, C-reactive protein (CRP), intercellular adhesion molecule-1, vascular cell adhesion molecule-1, interleukins-1Β, -6 and -8, and albuminuria were measured; BP was similarly reduced in both groups; 80% of patients reached target BP. Reductions in albuminuria were also similar (50%). Only olmesartan/amlodipine reduced the insulin resistance index (24%, P<0.01), increased plasma adiponectin (16%, P<0.05) and significantly reduced all of the inflammation markers studied, except CRP, which showed a similar reduction in each group. The risk of new-onset diabetes was significantly lower with olmesartan/amlodipine (P=0.02). Both olmesartan-based combinations were effective, but the amlodipine combination resulted in metabolic and anti-inflammatory effects that may have advantages over the hydrochlorothiazide combination. © 2011 Macmillan Publishers Limited All rights reserved.


Restrepo M.I.,University of Texas at San Antonio | Sole-Violan J.,Hospital Universitario Dr Negrin | Martin-Loeches I.,St James's Hospital
Current Opinion in Infectious Diseases | Year: 2016

Purpose of review: An update and literature review assessing the implications for use of macrolide therapy for patients with pneumonia is very relevant. Multiple studies have focused on assessing the efficacy, clinical effectiveness and clinical risks associated with the use of macrolides. Recent findings: The scope of this review is on recently published literature regarding the use of macrolides in patients with pneumonia. Recent evidence suggests that macrolides may benefit several populations of patients with pneumonia that includes ambulatory care, hospitalized patients with nonsevere pneumonia and severe pneumonia patients requiring ICU admission. In addition, there is benefit among patients with pneumococcal pneumonia, particularly those patients hospitalized with severe disease. The contradictory results that emerged from recent randomized controlled trials testing the efficacy of macrolide are discussed. Important remarks are made to the risks of cardiovascular events related to the use of macrolides and the clinical implications for care. Summary: A careful decision on the use of macrolides in patients with pneumonia will need to balance the possible beneficial effects and the risks linked to their use. © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Rodriguez Sosa J.T.,Hospital Universitario Dr Negrin | Acosta Ojeda M.,Hospital Universitario Dr Negrin | Rodriguez Del Rosario L.,Hospital Universitario Dr Negrin
Revista de Psiquiatria y Salud Mental | Year: 2011

Social cognition can be understood as "the mental operations underlying social interactions, which include the human ability to perceive the intentions and dispositions of others" (Brothers, 1990). Theory of mind, atributtional style, social perception are involved in social cognition. It is wellknown that social cognition is impaired in individuals with schizophrenia. Recent investigations for social cognition in schizophrenia has showed that there is a relationship among social cognition, neurocognition and psychosocial functioning. The purpose of this article is to provide a review of social cognition in schizophrenia focusing on the deficit in Theory of mind described by Frith and recent neuroimaging studies. In fact neuroimaging research has demonstrated specific brain regions consistently engaged during theory of mind tasks.We also present some of the instruments avalaible to evaluate social cognition and to review and improve the main intervention programs. Social cognition may be an important target for pharmacological and psychosocial treatments in the future. © 2010 SEP y SEPB. Publicado por Elsevier España, S.L. Todos los derechos reservados.

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