1
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Martin-Villen L, Martin-Bermudez R, Perez-Chomon H, Fuset Cabanes MP. Role of ultrasound in the critical ill patient with ECMO. Med Intensiva 2024; 48:46-55. [PMID: 38171717 DOI: 10.1016/j.medine.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/12/2023] [Indexed: 01/05/2024]
Abstract
Ultrasound is an essential diagnostic tool in critically ill patients with extracorporeal membrane oxygenation (ECMO). With it, we can make an anatomical and functional (cardiac, pulmonary and vascular) evaluation which allows us to execute an adequate configuration, guides implantation, helps clinical monitorization and detects complications, facilitates withdrawal and complete post-implant evaluation. In patients with ECMO as respiratory support (veno-venous), thoracic ultrasound allows monitoring pulmonary illness evolution and echocardiography the evaluation of biventricular function, especially right ventricle function, and cardiac output to optimize oxygen transport. In ECMO as circulatory support (veno-arterial), echocardiography is the guide of hemodynamic monitoring, allows detecting the most frequent complications and helps the weaning. In ECMO teams, for a proper management of these patients, there must be trained intensivists with advanced knowledge on this technique.
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Affiliation(s)
- Luis Martin-Villen
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Rafael Martin-Bermudez
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Helena Perez-Chomon
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Mari Paz Fuset Cabanes
- Servicio de Medicina Intensiva, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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2
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Martínez-Solano J, Sousa-Casasnovas I, Santa-Teresa P, García-López JJ, Maestu LP, Martínez-Sellés M. Veno-venal extracorporeal membrane oxygenation to support whole-lung lavage in a severe case of pulmonary alveolar proteinosis. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023:S2341-1929(23)00202-0. [PMID: 38142894 DOI: 10.1016/j.redare.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/29/2023] [Indexed: 12/26/2023]
Abstract
We present the case of a 71-year-old woman with severe bilateral primary alveolar proteinosis admitted for bilateral whole lung lavage (WLL) with a double-lumen endotracheal tube. She had a cardiac arrest of respiratory origin during the procedure and recovered after one minute of advanced resuscitation. A second LLP was scheduled under respiratory support with veno-venous extracorporeal membrane oxygenation (VV-ECMO). During this second WLL the patient was completely VV-ECMO-dependent, and the procedure was successfully completed. She was gradually weaned over the next 48 h. The patient was finally discharged after clinical improvement and home oxygen therapy was discontinued. WLL is the treatment of choice for severe cases of alveolar proteinosis. In rare cases the intervention may be poorly tolerated due to the degree of lung involvement. This case illustrates how VV-ECMO support is an option that may benefit this subgroup of at-risk patients.
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Affiliation(s)
- J Martínez-Solano
- Servicio de Cardiología, Instituto de Investigación Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.
| | - I Sousa-Casasnovas
- Servicio de Cardiología, Instituto de Investigación Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - P Santa-Teresa
- Servicio e Medicina Intensiva, Instituto de Investigación Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J J García-López
- Servicio de Neumología, Instituto de Investigación Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - L P Maestu
- Servicio de Neumología, Instituto de Investigación Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - M Martínez-Sellés
- Servicio de Cardiología, Instituto de Investigación Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain; Universidad Complutense, Madrid, Spain; Universidad Europea, Madrid, Spain
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3
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Lucas JH, Olivencia ML, Pablo RD, Ortíz AB. Early routine use of V-A ECMO in patients with myocardial infarction and cardiogenic shock, is it a poor choice? Med Intensiva 2023; 47:739-740. [PMID: 38035919 DOI: 10.1016/j.medine.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 12/02/2023]
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4
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Lozano-Espinosa M, Antolín-Amérigo D, Riera Del Brío J, Gordo Vidal F, Quirce S, Álvarez Rodríguez J. Extracorporeal membrane oxygenation (ECMO) and beyond in near fatal asthma: A comprehensive review. Respir Med 2023:107246. [PMID: 37245648 DOI: 10.1016/j.rmed.2023.107246] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 05/30/2023]
Abstract
The treatment of choice in severe asthma exacerbations with respiratory failure includes ventilatory support, both invasive and/or non-invasive, along with different kinds of asthma medication. Of note, the rate of mortality of patients with asthma has decreased substantially in recent years mainly due to significant advances in pharmacological treatment and other management strategies. However, the risk of death in patients with severe asthma who require invasive mechanical ventilation has been estimated between 6.5% and 10.3%. When conventional measures fail, rescue strategies, such as extracorporeal membrane oxygenation (ECMO) or extracorporeal CO2 removal (ECCO2R) may need to be implemented. While ECMO does not constitute a definitive treatment per se, it can minimize further ventilator associated lung injury (VALI) and can enable diagnostic-therapeutic maneuvers that cannot be performed without ECMO such as bronchoscopy and transfer for diagnostic imaging. Asthma is one of the diseases that is associated with excellent outcomes for patients with refractory respiratory failure requiring ECMO support, as shown by the Extracorporeal Life Support Organization (ELSO) registry. Moreover, in such situations, the use of ECCO2R for rescue has been described and utilized in both children and adults and is more widely spread in different hospitals than ECMO. In this article, we aim to review the evidence for the usefulness of extracorporeal respiratory support measures in the management of severe asthma exacerbations that lead to respiratory failure.
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Affiliation(s)
- María Lozano-Espinosa
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Darío Antolín-Amérigo
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) Madrid, Spain.
| | - Jordi Riera Del Brío
- Servicio de Medicina Intensiva, Hospital Universitari Vall d'Hebron, SODIR, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Federico Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica. Universidad Francisco de Vitoria. Pozuelo de Alarcón, Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
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5
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Argudo E, Hernández-Tejedor A, Belda Hofheinz S, Fuset MP, Sanchez Galindo A, Burgueño P, Ballcels J, Duerto J, Morales Martínez A, Martínez-Martínez M, Morteruel Arizcuren E, Pérez F, Díaz Vico A, Rubio Mateo-Sidrón JA. Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) and the Spanish Society of Pediatric Intensive Care (SECIP) consensus recommendations for ECMO transport. Med Intensiva 2022; 46:446-454. [PMID: 35752606 DOI: 10.1016/j.medine.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 06/03/2023]
Abstract
The evolution of extracorporeal membrane oxygenation treatment and the transport of patients receiving this treatment has changed dramatically in the last decade unevenly in different regions. The creation of specialized referral centers has been shown to improve outcomes. For all these reasons, it has been necessary to create networks of specialized teams and the number of secondary transports of patients with this treatment is increasing. In order to improve the quality of treatment and offer a guide to the services involved in these transports, the critical transport working groups of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) and the Spanish Society of Pediatric Intensive Care (SECIP) have carried out a joint effort to prepare these recommendations, focused on the following aspects: indications, reference center systems, means of transport, characteristics and equipment, human teams, training and clinical safety.
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Affiliation(s)
- E Argudo
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | | | - S Belda Hofheinz
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M P Fuset
- Servicio de Medicina Intensiva, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - A Sanchez Galindo
- Servicio de Medicina Intensiva Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Burgueño
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Ballcels
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J Duerto
- Servicio de Medicina Intensiva, Hospital Clínico San Carlos, Madrid, Spain
| | - A Morales Martínez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - M Martínez-Martínez
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - E Morteruel Arizcuren
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario de Cruces, Barakaldo, Spain
| | - F Pérez
- Servicio de Medicina Intensiva, Hospital Universitario La Fe, Valencia, Spain
| | - A Díaz Vico
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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6
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Argudo E, Hernández-Tejedor A, Belda Hofheinz S, Fuset M, Sanchez Galindo A, Burgueño P, Ballcels J, Duerto J, Morales Martínez A, Martínez-Martínez M, Morteruel Arizcuren E, Pérez F, Díaz Vico A, Rubio Mateo-Sidrón J. Recomendaciones de consenso sobre el transporte de pacientes en ECMO de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) y la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP). Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Rubio Muñoz JJ, Dominguez-Gil González B, Miñambres García E, Del Río Gallegos F, Pérez-Villares JM. Role of normothermic perfusion with ECMO in donation after controlled cardiac death in Spain. Med Intensiva 2021; 46:31-41. [PMID: 34794913 DOI: 10.1016/j.medine.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 02/07/2023]
Abstract
Spain has become one of the most active countries in donation after controlled cardiac death, using normothermic abdominal perfusion with ECMO in more than 50% of all donors - a situation contributed to by the creation of mobile teams to support hospitals lacking this technology. The donation process must be respectful of the wishes and values of the patients and their relatives, especially if there is pre mortem manipulation, and the absence of cerebral perfusion should be guaranteed. The liver is the most benefited organ by reducing biliary complications as well as the loss of grafts. In renal transplantation, the technique could contribute to reduce the incidence of delayed graft function. In addition, the procedure is compatible with surgical rapid recovery in hypothermia when there is also lung donation. The future lies in the consolidation of cardiac donation by extending normothermic perfusion to the thoracic cavity.
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Affiliation(s)
- J J Rubio Muñoz
- Servicio de Medicina Intensiva, Unidad de Coordinación de Trasplantes, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | | | - E Miñambres García
- Coordinación Regional de Trasplantes de la Comunidad de Cantabria, Servicio de Medicina Intensiva del Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - F Del Río Gallegos
- Coordinación Regional de Trasplantes de la Comunidad de Madrid, Servicio de Medicina Intensiva del Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - J M Pérez-Villares
- Coordinador Regional de Trasplantes de la Comunidad de Andalucía, Servicio de Medicina Intensiva del Hospital Universitario Virgen de las Nieves, Granada, Spain
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8
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Li Y, Cao C, Huang L, Xiong H, Mao H, Yin Q, Luo X. "Awake" Extracorporeal Membrane Oxygenation Combined With Continuous Renal Replacement Therapy For the Treatment of Severe Chemical Gas Inhalation Lung Injury. J Burn Care Res 2021; 41:908-912. [PMID: 32193543 DOI: 10.1093/jbcr/iraa043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung injury caused by chemical gas inhalation is a common clinically severe disease that very easily progresses to acute respiratory distress syndrome (ARDS). Traditional respiratory support consists mainly of mechanical ventilation, but the prognosis of this condition is still poor. "Awake" extracorporeal membrane oxygenation (ECMO) maintains oxygenation, improves ventilation, adequately allows the injured lungs to rest, and avoids complications associated with sedation, intubation, and mechanical ventilation. Continuous renal replacement therapy (CRRT) can provide better fluid management and reduce pulmonary edema. Herein, we describe the case of a patient with severe chemical gas inhalation lung injury who failed to respond to traditional mechanical ventilation and was subsequently treated with awake ECMO combined with CRRT.
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Affiliation(s)
- Yang Li
- Department of Emergency Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - ChunShui Cao
- Department of Emergency Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Liang Huang
- Department of Emergency Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - HuaWei Xiong
- Department of Emergency Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - HongTao Mao
- Department of Emergency Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Qin Yin
- Department of Emergency Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - XiaoLong Luo
- Department of Emergency Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
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9
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Chico-Carballas JI, Touceda-Bravo A, Freita-Ramos S, Mosquera-Rodriguez D, Gómez-Casal V, Piñon-Esteban M. The first year of experience with an extracorporeal resuscitation program for refractory in-hospital cardiac arrest. Med Intensiva 2021; 45:e7-e10. [PMID: 34563346 DOI: 10.1016/j.medine.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/26/2020] [Indexed: 10/20/2022]
Affiliation(s)
- J I Chico-Carballas
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain.
| | - A Touceda-Bravo
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - S Freita-Ramos
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - D Mosquera-Rodriguez
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - V Gómez-Casal
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - M Piñon-Esteban
- Hospital Álvaro Cunqueiro, Cardiothoracic Surgery Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
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10
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González-Castro A, Escudero Acha P, Rodríguez Borregán JC, Peñasco Y, Blanco Huelga C, Cuenca Fito E. Combination of airway pressure release ventilation with inverted inspiration-exhalation ratio and low-flow CO 2 removal devices with renal replacement therapy in refractory hypoxemia. Med Intensiva 2021; 45:376-379. [PMID: 34053911 PMCID: PMC8160289 DOI: 10.1016/j.medine.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 11/27/2019] [Indexed: 11/03/2022]
Affiliation(s)
- A González-Castro
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - P Escudero Acha
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J C Rodríguez Borregán
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Y Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - C Blanco Huelga
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - E Cuenca Fito
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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11
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Gotor-Pérez CA, López-Gude MJ, Benito-Arnaiz V, Pérez de la Sota E, Centeno-Rodríguez JE, Eixerés-Esteve A, Aguilar-Blanco EM, Barajas-Díaz C, Velázquez-Martín MT, Pérez-Núñez M, Pérez-Vela JL, Escribano-Subías P, Cortina-Romero JM. Tromboendarterectomía pulmonar en pacientes con hipertensión pulmonar tromboembólica crónica y afectación distal. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Martínez-Solano J, Sousa-Casasnovas I, Juárez Fernández M, Devesa-Cordero C, Fernández-Avilés F, Martínez-Sellés M. Emergent Bedside and Anticoagulation-free Veno-venal Extracorporeal Oxygenation Membrane Cannulation in a Patient with Massive Hemoptysis and Unresponsive Shock. Arch Bronconeumol 2020; 57:71-73. [PMID: 32863041 DOI: 10.1016/j.arbres.2020.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Jorge Martínez-Solano
- Servicio de Cardiología, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; CIBERCV, Instituto de Salud Carlos III, Madrid, España
| | - Iago Sousa-Casasnovas
- Servicio de Cardiología, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; CIBERCV, Instituto de Salud Carlos III, Madrid, España
| | - Miriam Juárez Fernández
- Servicio de Cardiología, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; CIBERCV, Instituto de Salud Carlos III, Madrid, España
| | - Carolina Devesa-Cordero
- Servicio de Cardiología, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; CIBERCV, Instituto de Salud Carlos III, Madrid, España
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; CIBERCV, Instituto de Salud Carlos III, Madrid, España; Universidad Complutense, Madrid, España
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, España; CIBERCV, Instituto de Salud Carlos III, Madrid, España; Universidad Complutense, Madrid, España; Universidad Europea, Madrid, España.
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13
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Ballesteros Sanz MÁ, Hernández-Tejedor A, Estella Á, Jiménez Rivera JJ, González de Molina Ortiz FJ, Sandiumenge Camps A, Vidal Cortés P, de Haro C, Aguilar Alonso E, Bordejé Laguna L, García Sáez I, Bodí M, García Sánchez M, Párraga Ramírez MJ, Alcaraz Peñarrocha RM, Amézaga Menéndez R, Burgueño Laguía P. [Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)]. Med Intensiva 2020; 44:371-388. [PMID: 32360034 PMCID: PMC7142677 DOI: 10.1016/j.medin.2020.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]
Abstract
On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.
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Affiliation(s)
- M Á Ballesteros Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | | | - Á Estella
- Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
| | - J J Jiménez Rivera
- Servicio de Medicina Intensiva, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España
| | | | - A Sandiumenge Camps
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - P Vidal Cortés
- Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - C de Haro
- Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Medicina Intensiva, CIBERES Enfermedades Respiratorias, Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - E Aguilar Alonso
- Servicio de Medicina Intensiva, Hospital Infanta Margarita, Cabra, Córdoba, España
| | - L Bordejé Laguna
- Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - I García Sáez
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, España
| | - M Bodí
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
| | - M García Sánchez
- Servicio de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M J Párraga Ramírez
- Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | | | - R Amézaga Menéndez
- Servicio de Medicina Intensiva, Hospital Universitari Son Espases, Palma, Islas Baleares, España
| | - P Burgueño Laguía
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
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14
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Ballesteros Sanz M, Hernández-Tejedor A, Estella Á, Jiménez Rivera J, González de Molina Ortiz F, Sandiumenge Camps A, Vidal Cortés P, de Haro C, Aguilar Alonso E, Bordejé Laguna L, García Sáez I, Bodí M, García Sánchez M, Párraga Ramírez M, Alcaraz Peñarrocha R, Amézaga Menéndez R, Burgueño Laguía P. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19). MEDICINA INTENSIVA (ENGLISH EDITION) 2020. [PMCID: PMC7340388 DOI: 10.1016/j.medine.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.
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15
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Rubio Muñoz JJ, Dominguez-Gil González B, Miñambres García E, Del Río Gallegos F, Pérez-Villares JM. Role of normothermic perfusión with ECMO in donation after controlled cardiac death in Spain. Med Intensiva 2020; 46:S0210-5691(20)30066-8. [PMID: 32564985 DOI: 10.1016/j.medin.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 02/07/2023]
Abstract
Spain has become one of the most active countries in donation after controlled cardiac death, using normothermic abdominal perfusion with ECMO in more than 50% of all donors - a situation contributed to by the creation of mobile teams to support hospitals lacking this technology. The donation process must be respectful of the wishes and values of the patients and their relatives, especially if there is pre mortem manipulation, and the absence of cerebral perfusion should be guaranteed. The liver is the most benefited organ by reducing biliary complications as well as the loss of grafts. In renal transplantation, the technique could contribute to reduce the incidence of delayed graft function. In addition, the procedure is compatible with surgical rapid recovery in hypothermia when there is also lung donation. The future lies in the consolidation of cardiac donation by extending normothermic perfusion to the thoracic cavity.
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Affiliation(s)
- J J Rubio Muñoz
- Servicio de Medicina Intensiva, Unidad de Coordinación de Trasplantes, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España.
| | | | - E Miñambres García
- Coordinación Regional de Trasplantes de la Comunidad de Cantabria, Servicio de Medicina Intensiva del Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, España
| | - F Del Río Gallegos
- Coordinación Regional de Trasplantes de la Comunidad de Madrid, Servicio de Medicina Intensiva del Hospital Universitario Clínico San Carlos, Madrid, España
| | - J M Pérez-Villares
- Coordinador Regional de Trasplantes de la Comunidad de Andalucía, Servicio de Medicina Intensiva del Hospital Universitario Virgen de las Nieves, Granada, España
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16
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Chico-Carballas JI, Touceda-Bravo A, Freita-Ramos S, Mosquera-Rodriguez D, Gómez-Casal V, Piñon-Esteban M. The first year of experience with an extracorporeal resuscitation program for refractory in-hospital cardiac arrest. Med Intensiva 2020. [PMID: 32402529 DOI: 10.1016/j.medin.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J I Chico-Carballas
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain.
| | - A Touceda-Bravo
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - S Freita-Ramos
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - D Mosquera-Rodriguez
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - V Gómez-Casal
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - M Piñon-Esteban
- Hospital Álvaro Cunqueiro, Cardiothoracic Surgery Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
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17
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López-Sánchez M, Rubio-López MI. Extracorporeal carbon dioxide removal with continuous renal replacement therapy. Case description and literature review. Rev Bras Ter Intensiva 2020; 32:143-148. [PMID: 32401973 PMCID: PMC7206950 DOI: 10.5935/0103-507x.20200020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/11/2019] [Indexed: 11/20/2022] Open
Abstract
In recent years and due, in part, to technological advances, the use of extracorporeal carbon dioxide removal systems paired with the use of extracorporeal membrane oxygenation has resurfaced. However, studies are lacking that establish its indications and evidence to support its use. These systems efficiently eliminate carbon dioxide in patients with hypercapnic respiratory failure using small-bore cannula, usually double-lumen cannula with a small membrane lung surface area. Currently, we have several systems with different types of membranes and sizes. Pump-driven veno-venous systems generate fewer complications than do arteriovenous systems. Both require systemic anticoagulation. The “lung-kidney” support system, by combining a removal system with hemofiltration, simultaneously eliminates carbon dioxide and performs continuous extrarenal replacement. We describe our initial experience with a combined system for extracorporeal carbon dioxide removal-continuous extrarenal replacement in a lung transplant patients with hypercapnic respiratory failure, barotrauma and associated acute renal failure. The most important technical aspects, the effectiveness of the system for the elimination of carbon dioxide and a review of the literature are described.
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18
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González-Castro A, Escudero Acha P, Rodríguez Borregán JC, Peñasco Y, Blanco Huelga C, Cuenca Fito E. Combination of airway pressure release ventilation with inverted inspiration-exhalation ratio and low-flow CO 2 removal devices with renal replacement therapy in refractory hypoxemia. Med Intensiva 2020. [PMID: 31948837 DOI: 10.1016/j.medin.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A González-Castro
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - P Escudero Acha
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J C Rodríguez Borregán
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Y Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - C Blanco Huelga
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - E Cuenca Fito
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
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19
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Naharro-Abellán A, Abella-Álvarez A. ECMO: Comentario del ensayo EOLIA sobre el uso de la membrana de oxigenación extracorpórea en el síndrome de distrés respiratorio agudo. ENFERMERÍA INTENSIVA 2020. [DOI: 10.1016/j.enfi.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Leal-Noval SR, Fernández-Pacheco J, Casado-Méndez M, Cancela P, Narros JL, Arellano-Orden V, Dusseck R, Díaz-Martín A, Muñoz-Gómez M. A prospective study on the correlation between thromboelastometry and standard laboratory tests - influence of type of surgery and perioperative sampling times. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 80:179-184. [PMID: 31846350 DOI: 10.1080/00365513.2019.1704051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This prospective study aimed at investigating the influence of surgery type and perioperative sampling times on the correlations between rotational thromboelastometry (ROTEM) parameters and standard laboratory coagulation tests assessing comparable coagulation phases. Patients undergoing glioblastoma multiforme resection (GBR group, n = 60) or laparoscopic colon cancer resection (CCR group, n = 40) were prospectively included. Blood samples for ROTEM and laboratory assessments were consecutively drawn within 24-hours prior to surgery (baseline), and at 2, 24 and 48-hours after surgery. Correlations between perioperative ExTEM clotting-time (CT-exTEM) and prothrombin time (PT), and between FibTEM maximum clot firmness (MCF-fibTEM) with and plasma fibrinogen (pFB) concentration (Clauss method), were evaluated using the Spearman's rho test. The efficiency of recommended cut-offs of CT-exTEM (>75 s) and MCF-fibTEM (<10 mm) for predicting a prolonged PT (>15 s) or a low pFB (<2 g/L), respectively, was assessed using Receiver-Operator Characteristic curves. Correlations between CT-exTEM and PT were weak in GBR (rho = 0.25 [0.12-0.38], p < .01), and very weak in CCR (rho = 0.06 [-0.12-0.27]). Those between MCF-fibTEM and pFB, were strong in both GBR (rho = 0.69 [0.61-0.76], p < .01) and CCR (rho = 0.70 [0.60-0.78], p < .01). These correlations remained largely unchanged over the studied perioperative period in both groups. Recommended CT-exTEM and MCF-fibTEM cut-offs had poor sensitivity for predicting a prolonged PT (17% [8-31]) or a low pFB (46% [32-62]), without group-related differences. Neither the type of surgery nor the perioperative sampling times had a significant influence on the correlations between ROTEM parameters and standard laboratory tests. ClinicalTrials.gov ID: NCT02652897.
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Affiliation(s)
- Santiago R Leal-Noval
- Neuro Critical Care Department, University Hospital "Virgen del Rocío" and Institute of Biomedicine "IBIS", Seville, Spain
| | - José Fernández-Pacheco
- Pharmacy and Statistics and Design, University Hospital "Virgen del Rocío" and Institute of Biomedicine "IBIS", Seville, Spain
| | - Manuel Casado-Méndez
- Neuro Critical Care Department, University Hospital "Virgen del Rocío" and Institute of Biomedicine "IBIS", Seville, Spain
| | - Paloma Cancela
- Neurosurgery Department, University Hospital "Virgen del Rocío" and Institute of Biomedicine "IBIS", Seville, Spain
| | - José L Narros
- Neurosurgery Department, University Hospital "Virgen del Rocío" and Institute of Biomedicine "IBIS", Seville, Spain
| | - Victoria Arellano-Orden
- Neuro Critical Care Department, University Hospital "Virgen del Rocío" and Institute of Biomedicine "IBIS", Seville, Spain
| | - Reginald Dusseck
- Neuro Critical Care Department, University Hospital "Virgen del Rocío" and Institute of Biomedicine "IBIS", Seville, Spain
| | - Ana Díaz-Martín
- Neuro Critical Care Department, University Hospital "Virgen del Rocío" and Institute of Biomedicine "IBIS", Seville, Spain
| | - Manuel Muñoz-Gómez
- Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
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