Spanish Health Institute Carlos III

Madrid, Spain

Spanish Health Institute Carlos III

Madrid, Spain
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Urbano J.,Gregorio Maranon University Hospital | Urbano J.,Spanish Health Institute Carlos III | Urbano J.,Institute Investigacion Sanitaria Hospital Gregorio Maranon IiSGM | Gonzalez R.,Gregorio Maranon University Hospital | And 17 more authors.
PLoS ONE | Year: 2015

Introduction: In series of cases and animal models suffering hemorrhagic shock, the use of vasopressors has shown potential benefits regarding hemodynamics and tissue perfusion. Terlipressin is an analogue of vasopressin with a longer half-life that can be administered by bolus injection. We have previously observed that hypertonic albumin improves resuscitation following controlled hemorrhage in piglets. The aim of the present study was to analyze whether the treatment with the combination of terlipressin and hypertonic albumin can produce better hemodynamic and tissular perfusion parameters than normal saline or hypertonic albumin alone at early stages of hemorrhagic shock in an infant animal model. Methods: Experimental, randomized animal study including 39 2-to-3-month-old piglets. Thirty minutes after controlled 30 ml/kg bleed, pigs were randomized to receive either normal saline (NS) 30 ml/kg (n = 13), 5% albumin plus 3% hypertonic saline (AHS) 15 ml/kg (n = 13) or single bolus of terlipressin 15 μg/kg i.v. plus 5% albumin plus 3% hypertonic saline 15 ml/kg (TAHS) (n = 13) over 30 minutes. Global hemodynamic and tissular perfusion parameters were compared. Results: After controlled bleed a significant decrease of blood pressure, cardiac index, central venous saturation, carotid and peripheral blood flow, brain saturation and an increase of heart rate, gastric PCO2 and lactate was observed. After treatment no significant differences in most hemodynamic (cardiac index, mean arterial pressure) and perfusion parameters (lactate, gastric PCO2, brain saturation, cutaneous blood flow) were observed between the three therapeutic groups. AHS and TAHS produced higher increase in stroke volume index and carotid blood flow than NS. Conclusions: In this pediatric animal model of hypovolemic shock, albumin plus hypertonic saline with or without terlipressin achieved similar hemodynamics and perfusion parameters than twice the volume of NS. Addition of terlipressin did not produce better results than AHS. © 2015 Urbano et al.

Alonso-Quintela P.,Complejo Asistencial Universitario Of Leon | Alonso-Quintela P.,University of León | Oulego-Erroz I.,Complejo Asistencial Universitario Of Leon | Oulego-Erroz I.,University of León | And 6 more authors.
Pediatric Critical Care Medicine | Year: 2015

Objective: To compare the use of bedside ultrasound and chest radiography to verify central venous catheter tip positioning. Design: Prospective observational study. Setting: PICU of a university hospital. Patients: Patients aged 0-14 who required a central venous catheter. Intervention: None. Measurements and Main Results: Central venous catheter tip location was confirmed by ultrasound and chest radiography. Central venous catheters were classified as intra-atrial or extra-atrial according to their positions in relation to the cavoatrial junction. Central venous catheters located outside the vena cava were considered malpositioned. The distance between the catheter tip and the cavoatrial junction was measured. The time elapsed from image capture to interpretation was recorded. Fifty-one central venous catheters in 40 patients were analyzed. Chest radiography and ultrasound results agreed 94% of the time (? coefficient, 0.638; p < 0.001) in determining intra-atrial and extra-atrial locations and 92% of the time in determining the diagnosis of central venous catheter malposition (? coefficient, 0.670; p < 0.001). Chest radiography indicated a greater distance between the central venous catheter tip and the cavoatrial junction than measured by ultrasound, with a mean difference of 0.38 cm (95% CI, +0.27, +0.48 cm). Three central venous catheters were classified as extra-atrial by chest radiography but as intra-atrial by ultrasound. To locate the central venous catheter tip, ultrasound required less time than chest radiography (22.96 min [20.43 min] vs 2.23 min [1.06 min]; p < 0.001). Conclusions: Bedside ultrasound showed a good agreement with chest radiography in detecting central venous catheter tip location and revealing incorrect positions. Ultrasound could be a preferable method for routine verification of central venous catheter tip and can contribute to increased patient safety. Copyright © 2015 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

Lopez-Herce J.,Hospital General Universitario Gregorio Maranon | Lopez-Herce J.,Spanish Health Institute Carlos III | Fernandez B.,Hospital General Universitario Gregorio Maranon | Fernandez B.,Spanish Health Institute Carlos III | And 10 more authors.
Intensive Care Medicine | Year: 2011

Purpose: To analyze the evolution of hemodynamic, respiratory, and tissue perfusion parameters in an infant animal model of asphyxial cardiac arrest (CA). Methods: This was a secondary analysis of a prospective observational study conducted at a laboratory research department of a university hospital. Seventy-one, 2-month-old piglets were studied. CA was induced by removal of mechanical ventilation. Cardiopulmonary resuscitation (CPR) was performed by means of manual external chest compressions, mechanical ventilation, epinephrine and/or terlipressin intravenous administration. Results: The evolution of hemodynamic (heart rate, blood pressure, cardiac index), respiratory (end-tidal CO2, blood gas analysis), and tissue perfusion (intramucosal gastric pH, central, cerebral, and renal hemoglobin saturation) parameters was analyzed during three periods: asphyxia, CPR, and after return of spontaneous circulation (ROSC). During asphyxia, a severe arterial and tissue hypoxia with hypercapnia and lactic acidosis quickly developed. Bradycardia, hypotension, and increasing of systemic vascular resistances and pulmonary arterial pressure were also observed. During CPR, arterial, cerebral, and tissue oxygenation were low in spite of ventilation with oxygen 100%. After ROSC a rapid restoration of hemodynamic and respiratory parameters was observed. However, 30 min after ROSC, lactic acidosis and low intramucosal gastric pH persisted. Conclusions: Asphyxia leads to sudden hypoxia and hypercapnia with tissue hypoxia and progressive bradycardia. Standard CPR is not able to maintain an adequate tissue oxygenation during CPR in this animal model. When ROSC is achieved, a rapid restoration of the normal values of general hemodynamic and respiratory parameters is observed, although lactic acidosis and splanchnic hypoperfusion persist in time. © 2010 jointly held by Springer and ESICM.

Santiago M.J.,Hospital General Universitario Gregorio Maranon | Santiago M.J.,Spanish Health Institute Carlos III | Lopez-Herce J.,Hospital General Universitario Gregorio Maranon | Lopez-Herce J.,Spanish Health Institute Carlos III | And 12 more authors.
Intensive Care Medicine | Year: 2010

Objective: To study the clinical course in children requiring continuous renal replacement therapy (CRRT) and to analyse factors associated with mortality. Design: Prospective observational study. Setting: Paediatric intensive care department of a tertiary university hospital. Patients: Critically ill children with CRRT were included in the study. Intervention: Continuous renal replacement therapy. Measurements and results: Univariate and multivariate analyses were performed to analyse the influence of each factor on mortality. The ability of the PRISM, PIM II and PELOD severity of illness scores to predict mortality was tested using receiver-operating characteristic curve statistics. A total of 174 children aged between 1 month and 22 years were treated with CRRT. Mortality was 35.6%, and multiorgan failure and haemodynamic disturbances were the principal causes of death. Mortality was higher in children less than 12 months of age (44.7%; P = 0.037) and in patients with a diagnosis of sepsis (44.1%; P = 0.001). Haemodynamic disturbances at the time of starting CRRT (hypotension or need for adrenaline >0.6 μg/kg/min) and the presence of multiorgan failure were the factors associated with an increased risk of mortality. The PRISM scale was the severity score with the best predictive capacity, although all three scales underestimated the actual mortality. Conclusions: Mortality in children who require CRRT is high. Haemodynamic disturbances and the presence of multiorgan failure at the time of starting the technique are the factors associated with a higher mortality. The clinical severity scores underestimate mortality in children requiring CRRT. © 2010 Copyright jointly held by Springer and ESICM.

Urbano J.,Hospital General Universitario Gregorio Maranon | Urbano J.,Spanish Health Institute Carlos III | Lopez J.,Hospital General Universitario Gregorio Maranon | Lopez J.,Spanish Health Institute Carlos III | And 9 more authors.
Pediatric Cardiology | Year: 2015

We evaluated two pressure-recording analytical method (PRAM) software versions (v.1 and v.2) to measure cardiac index (CI) in hemodynamically stable critically ill children and investigate factors that influence PRAM values. The working hypothesis was that PRAM CI measurements would stay within normal limits in hemodynamically stable patients. Ninety-five CI PRAM measurements were analyzed in 47 patients aged 1–168 months. Mean CI was 4.1 ± 1.4 L/min/m2 (range 2.0–7.0). CI was outside limits defined as normal (3–5 L/min/m2) in 53.7 % of measurements (47.8 % with software v.1 and 69.2 % with software v.2, p = 0.062). Moreover, 14.7 % of measurements were below 2.5 L/min/m2, and 13.6 % were above 6 L/min/m2. CI was significantly lower in patients with a clearly visible dicrotic notch than in those without (3.7 vs. 4.6 L/min/m2, p = 0.004) and in children with a radial arterial catheter (3.5 L/min/m2) than in those with a brachial (4.4 L/min/m2, p = 0.021) or femoral catheter (4.7 L/min/m2, p = 0.005). By contrast, CI was significantly higher in children under 12 months (4.2 vs. 3.6 L/min/m2, p = 0.034) and weighing under 10 kg (4.2 vs. 3.6 L/min/m2, p = 0.026). No significant differences were observed between cardiac surgery patients and the rest of children. A high percentage of CI measurements registered by PRAM were outside normal limits in hemodynamically stable, critically ill children. CI measured by PRAM may be influenced by the age, weight, location of catheter, and presence of a dicrotic notch. © 2014, Springer Science+Business Media New York.

Rodriguez-Nunez A.,Hospital Clinico Universitario Of Santiago Of Compostela | Rodriguez-Nunez A.,University of Santiago de Compostela | Rodriguez-Nunez A.,Institute of Investigation of Santiago IDIS | Rodriguez-Nunez A.,Spanish Health Institute Carlos III | And 8 more authors.
Resuscitation | Year: 2015

Introduction: Immediate bystander cardiopulmonary resuscitation (CPR) is essential for survival after out-of-hospital cardiac arrest. Down syndrome (DS) citizens have improved their active engagement in society. The objective of this pilot trial was to investigate if they are able to perform quality chest compression-only CPR after a brief training. Methods: Nineteen DS young people (15-30 year old) and 20 University level subjects (18-29 year old) were trained by means of a short video and a brief hands-on session on manikins, to perform chest compression-only CPR. All participants were naïve in CPR. Chest compression (CC) quality (percentage of correct CC, CC rate and depth and chest complete release) was measured during a 2. min test. CPR quality goal was according to 2010 European Resuscitation Council guidelines. Results: DS people had similar weight, lower height and a higher BMI than controls. They were able to deliver chest compression-only CPR but with higher mean CC rate (140. ±. 30 vs 123. ±. 12. CC/min, p= 0.03), less mean CC depth (35.4. ±. 10.3 vs 47.2. ±. 9.6. mm, p=. 0.03) and lower % of full correct CC (13 ±. 18 vs 39. ±. 37, p= 0.02) than controls. Differences were maintained when first and second minute of test were compared. Conclusions: After a short instruction based on a brief video and hands-on session DS people were able to deliver CC but with poor quality. © 2015 Elsevier Ireland Ltd.

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