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Chamorro-Jambrina C.,Servicio de Medicina Intensiva | Munoz-Ramirez M.R.,Servicio de Medicina Critica | Martinez-Melgar J.L.,Complexo Hospitalario Universitario Of Pontevedra | Perez-Cornejo M.S.,Hospital General Del Estado Dr Ernesto Ramos Bours
Medicina Intensiva | Year: 2017

Despite major advances in our understanding of the physiopathology of brain death (BD), there are important controversies as to which protocol is the most appropriate for organ donor management. Many recent reviews on this subject offer recommendations that are sometimes contradictory and in some cases are not applied to other critically ill patients. This article offers a review of the publications (many of them recent) with an impact upon these controversial measures and which can help to confirm, refute or open new areas of research into the most appropriate measures for the management of organ donors in BD, and which should contribute to discard certain established recommendations based on preconceived ideas, that lead to actions lacking a physiopathological basis. Aspects such as catecholamine storm management, use of vasoactive drugs, hemodynamic objectives and monitoring, assessment of the heart for donation, and general care of the donor in BD are reviewed. © 2017 Elsevier España, S.L.U. y SEMICYUC.


PubMed | Hospital Universitario Virgen Of Las Nieves, Hospital Universitario 12 Of Octubre, Hospital Universitario Marques Of Valdecilla, Complejo Hospitalario Of Torrecardenas and 8 more.
Type: | Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society | Year: 2016

We evaluated the predictive ability of mechanism, Glasgow coma scale, age and arterial pressure (MGAP), Glasgow coma scale, age and systolic blood pressure (GAP), and triage-revised trauma Score (T-RTS) scores in patients from the Spanish trauma ICU registry using the trauma and injury severity score (TRISS) as a reference standard.Patients admitted for traumatic disease in the participating ICU were included. Quantitative data were reported as median [interquartile range (IQR), categorical data as number (percentage)]. Comparisons between groups with quantitative variables and categorical variables were performed using Students T Test and Chi Square Test, respectively. We performed receiving operating curves (ROC) and evaluated the area under the curve (AUC) with its 95% confidence interval (CI). Sensitivity, specificity, positive predictive and negative predictive values and accuracy were evaluated in all the scores. A value of p<0.05 was considered significant.The final sample included 1361 trauma ICU patients. Median age was 45 (30-61) years. 1092 patients (80.3%) were male. Median ISS was 18 (13-26) and median T-RTS was 11 (10-12). Median GAP was 20 (15-22) and median MGAP 24 (20-27). Observed mortality was 17.7% whilst predicted mortality using TRISS was 16.9%. The AUC in the scores evaluated was: TRISS 0.897 (95% CI 0.876-0.918), MGAP 0.860 (95% CI 0.835-0.886), GAP 0.849 (95% CI 0.823-0.876) and T-RTS 0.796 (95% CI 0.762-0.830).Both MGAP and GAP scores performed better than the T-RTS in the prediction of hospital mortality in Spanish trauma ICU patients. Since these are easy-to-perform scores, they should be incorporated in clinical practice as a triaging tool.


Gil Cano A.,Hospital del SAS Jerez | Monge Garcia M.I.,Hospital del SAS Jerez | Baigorri Gonzalez F.,Servicio de Medicina Intensiva
Medicina Intensiva | Year: 2012

Hemodynamic monitoring is a tool of great value for the assessment of critically ill patients. It can not only detect and determine the source of hemodynamic instability, but also guide the choice of appropriate treatment and further evaluate its effectiveness. However, monitoring per se is not a therapeutic tool and its use in the absence of a well-defined objective, need not affect patient outcome. To improve outcome, hemodynamic monitoring necessarily must be coupled to a treatment protocol that has effectively been shown to improve outcome. Accordingly, the usefulness of monitoring systems should be evaluated not only on the basis of the accuracy and reliability of their measurements, but also on the ability to positively affect patient outcome. In this regard, many of the arguments against the use of hemodynamic monitoring are a consequence of non-protocolized use and of application not directed towards specific hemodynamic objectives of proven benefit for the patient. © 2012 Elsevier España, S.L. and SEMICYUC.


Ayuela Azcarate J.M.,Hospital General Yague | Clau Terre F.,Hospital Of Vall Dhebron | Ochagavia A.,Servicio de Medicina Intensiva | Vicho Pereira R.,Servicio de Medicina Intensiva Clinica USP Palmaplanas
Medicina Intensiva | Year: 2012

The use of echocardiography in intensive care units in shock patients allows us to measure various hemodynamic variables in an accurate and a non-invasive manner.By using echocardiography not only as a diagnostic technique but also as a tool for continuous hemodynamic monitorization, the intensivist can evaluate various aspects of shock states, such as cardiac output and fluid responsiveness, myocardial contractility, intracavitary pressures, heart-lung interaction and biventricular interdependence.However, to date there has been little guidance orienting echocardiographic hemodynamic parameters in the intensive care unit, and intensivists are usually not familiar with this tool.In this review, we describe some of the most important hemodynamic parameters that can be obtained at the patient bedside with transthoracic echocardiography in critically ill patients. © 2011 Elsevier España, S.L. and SEMICYUC.


Munoz-Ortego J.,Autonomous University of Barcelona | Blanco Lopez L.,Servicio de Medicina Intensiva | Carbonell Abello J.,Autonomous University of Barcelona | Monfort Faure J.,Autonomous University of Barcelona
Joint Bone Spine | Year: 2011

Thromboembolic events tend to arise during the natural lifetime of tumors. However, multiple thromboemboli mimicking catastrophic antiphospholipid syndrome is quite rare as a first manifestation of a tumor. Herein we describe the case of a 51-year old woman that presented with multiple thromboemboli affecting her brain, lung and kidneys. Despite bolus administration of corticosteroids, anticoagulant therapy and immunoglobulin infusion treatment, the patient died. She had suffered from two occult tumors, which could not be identified premortem: a lung adenocarcinoma and an intrahepatic cholangiocarcinoma. This case underscores the importance of determining the underlying etiology behind multiple thromboemboli. The most important prognostic factor is rapid initiation of treatment of the multiple thromboemboli, emphasizing treatment of their etiology. © 2010 Société française de rhumatologie.


Zaragoza R.,Hospital Universitario Dr Peset | Ramirez P.,Polytechnic University of Valencia | Lopez-Pueyo M.J.,Servicio de Medicina Intensiva
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2014

Nosocomial infections (NI) still have a high incidence in intensive care units (ICUs), and are becoming one of the most important problems in these units. It is well known that these infections are a major cause of morbidity and mortality in critically ill patients, and are associated with increases in the length of stay and excessive hospital costs. Based on the data from the ENVIN-UCI study, the rates and aetiology of the main nosocomial infections have been described, and include ventilator-associated pneumonia, urinary tract infection, and both primary and catheter related bloodstream infections, as well as the incidence of multidrug-resistant bacteria. A literature review on the impact of different nosocomial infections in critically ill patients is also presented. Infection control programs such as zero bacteraemia and pneumonia have been also analysed, and show a significant decrease in NI rates in ICUs. © 2013 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica.Todos los derechos reservados.


Lopez-Pueyo M.J.,Servicio de Medicina Intensiva | Barcenilla-Gaite F.,Hospital Universitario Arnau Of Vilanova | Amaya-Villar R.,Hospital Universitario Virgen del Rocio | Garnacho-Montero J.,Hospital Universitario Virgen del Rocio
Medicina Intensiva | Year: 2011

The presence of microorganisms with acquired resistance to multiple antibiotics complicates the management and outcome of critically ill patients. The intensivist, in his/her daily activity, is responsible for the prevention and control of the multiresistance and the challenge of prescribing the appropriate treatment in case of an infection by these microorganisms. We have reviewed the literature regarding the definition, important concepts related to transmission, recommendations on general measures of control in the units and treatment options. We also present data on the situation in our country known primarily through the ENVIN-UCI register. Addressing the multiresistance not only requires training but also teamwork with other specialists and adaptation to the local environment. © 2010 Elsevier España, S.L. y SEMICYUC.


PubMed | Rovira i Virgili University, Hospital Clinico, Autonomous University of Barcelona, Servicio de Medicina Intensiva and 2 more.
Type: Journal Article | Journal: Medicina intensiva | Year: 2015

To determine the degree of antiviral treatment recommendations adherence and its impact to critical ill patients affected by influenza A(H1N1)pdm09 mortality.Secondary analysis of prospective study.Intensive care (UCI).Patients with influenza A(H1N1)pdm09 in the 2009 pandemic and 2010-11 post-Pandemic periods.Adherence to recommendations was classified as: Total (AT); partial in doses (PD); partial in time (PT), and non-adherence (NA). Viral pneumonia, obesity and mechanical ventilation were considered severity criteria for the administration of high antiviral dose. The analysis was performed using t-test or chi square. Survival analysis was performed and adjusted by Cox regression analysis.A total of 1,058 patients, 661 (62.5%) included in the pandemic and 397 (37.5%) in post-pandemic period respectively. Global adherence was achieved in 41.6% (43.9% and 38.0%; P=.07 respectively). Severity criteria were similar in both periods (68.5% vs. 62.8%; P=.06). The AT was 54.7% in pandemic and 36.4% in post-pandemic period respectively (P<.01). The NA (19.7% vs. 11.3%; P<.05) and PT (20.8% vs. 9.9%, P<.01) was more frequent in the post-pandemic period. The mortality rate was higher in the post-pandemic period (30% vs. 21.8%, P<.001). APACHE II (HR=1.09) and hematologic disease (HR=2.2) were associated with a higher mortality and adherence (HR=0.47) was a protective factor.A low degree of adherence to the antiviral treatment was observed in both periods. Adherence to antiviral treatment recommendations was associated with lower mortality rates and should be recommended in critically ill patients with suspected influenza A(H1N1)pdm09.


PubMed | Hospital Son Llatzer and Servicio de Medicina Intensiva
Type: | Journal: Enfermedades infecciosas y microbiologia clinica | Year: 2017

New strategies need to be developed for the early recognition and rapid response for the management of sepsis. To achieve this purpose, the Multidisciplinary Sepsis Team (MST) developed the Computerised Sepsis Protocol Management (PIMIS). The aim of this study was to evaluate the convenience of using PIMIS, as well as the activity of the MST.An analysis was performed on the data collected from solicited MST consultations (direct activation of PIMIS by attending physician or telephone request) and unsolicited ones (by referral from the microbiology laboratory or an automatic referral via the hospital vital signs recording software [SIDCV]), as well as the hospital department, source of infection, treatment recommendation, and acceptance of this.Of the 1,581 first consultations, 65.1% were solicited consultations (84.1% activation of PIMIS and 15.9% by telephone). The majority of unsolicited consultations were generated by the microbiology laboratory (95.2%), and 4.8% from the SIDCV. Referral from solicited consultations were generated sooner (5.63days vs 8.47days; P<.001) and came from clinical specialties rather than from the surgical ward (73.0% vs 39.1%; P<.001). A recommendation was made for antimicrobial prescription change in 32% of first consultations. The treating physician accepted 78.1% of recommendations.The high rate of solicited consultations and acceptance of recommended prescription changes suggest that a MST is seen as a helpful resource, and that PIMIS software is perceived to be useful and convenient to use, as it is the main source of referral.


PubMed | Servicio de Medicina Intensiva, Hospital Morales Meseguer, Hospital Clinico Universitario Of Valencia and Hospital Virgen Of Los Lirios
Type: Journal Article | Journal: Revista espanola de anestesiologia y reanimacion | Year: 2015

Non-invasive mechanical ventilation is a method of ventilatory assistance aimed at increasing alveolar ventilation, thus achieving, in selected subjects, the avoidance of endotracheal intubation and invasive mechanical ventilation, with the consequent improvement in survival. There has been a systematic review and study of the technical, clinical experiences, and recommendations concerning the application of non-invasive mechanical ventilation in the pre- and intraoperative period. The use of prophylactic non-invasive mechanical ventilation before surgery that involves significant alterations in the ventilatory function may decrease the incidence of postoperative respiratory complications. Its intraoperative use will mainly depend on the type of surgery, type of anaesthetic technique, and the clinical status of the patient. Its use allows greater anaesthetic depth without deterioration of oxygenation and ventilation of patients.

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