1
|
Alexa EA, Cobo-Díaz JF, Renes E, O Callaghan TF, Kilcawley K, Mannion D, Skibinska I, Ruiz L, Margolles A, Fernández-Gómez P, Alvarez-Molina A, Puente-Gómez P, Crispie F, López M, Prieto M, Cotter PD, Alvarez-Ordóñez A. The detailed analysis of the microbiome and resistome of artisanal blue-veined cheeses provides evidence on sources and patterns of succession linked with quality and safety traits. Microbiome 2024; 12:78. [PMID: 38678226 PMCID: PMC11055350 DOI: 10.1186/s40168-024-01790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/08/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Artisanal cheeses usually contain a highly diverse microbial community which can significantly impact their quality and safety. Here, we describe a detailed longitudinal study assessing the impact of ripening in three natural caves on the microbiome and resistome succession across three different producers of Cabrales blue-veined cheese. RESULTS Both the producer and cave in which cheeses were ripened significantly influenced the cheese microbiome. Lactococcus and the former Lactobacillus genus, among other taxa, showed high abundance in cheeses at initial stages of ripening, either coming from the raw material, starter culture used, and/or the environment of processing plants. Along cheese ripening in caves, these taxa were displaced by other bacteria, such as Tetragenococcus, Corynebacterium, Brevibacterium, Yaniella, and Staphylococcus, predominantly originating from cave environments (mainly food contact surfaces), as demonstrated by source-tracking analysis, strain analysis at read level, and the characterization of 613 metagenome-assembled genomes. The high abundance of Tetragenococcus koreensis and Tetragenococcus halophilus detected in cheese has not been found previously in cheese metagenomes. Furthermore, Tetragenococcus showed a high level of horizontal gene transfer with other members of the cheese microbiome, mainly with Lactococcus and Staphylococcus, involving genes related to carbohydrate metabolism functions. The resistome analysis revealed that raw milk and the associated processing environments are a rich reservoir of antimicrobial resistance determinants, mainly associated with resistance to aminoglycosides, tetracyclines, and β-lactam antibiotics and harbored by aerobic gram-negative bacteria of high relevance from a safety point of view, such as Escherichia coli, Salmonella enterica, Acinetobacter, and Klebsiella pneumoniae, and that the displacement of most raw milk-associated taxa by cave-associated taxa during ripening gave rise to a significant decrease in the load of ARGs and, therefore, to a safer end product. CONCLUSION Overall, the cave environments represented an important source of non-starter microorganisms which may play a relevant role in the quality and safety of the end products. Among them, we have identified novel taxa and taxa not previously regarded as being dominant components of the cheese microbiome (Tetragenococcus spp.), providing very valuable information for the authentication of this protected designation of origin artisanal cheese. Video Abstract.
Collapse
Affiliation(s)
- Elena A Alexa
- Department of Food Hygiene and Technology, Universidad de León, León, Spain
| | - José F Cobo-Díaz
- Department of Food Hygiene and Technology, Universidad de León, León, Spain
| | - Erica Renes
- Department of Food Hygiene and Technology, Universidad de León, León, Spain
| | - Tom F O Callaghan
- School of Food and Nutritional Sciences, University College Cork, Cork, T12 Y337, Ireland
| | | | - David Mannion
- Teagasc Food Research Centre, Fermoy, Co., Cork, Ireland
| | | | - Lorena Ruiz
- Dairy Research Institute, Spanish National Research Council, Instituto de Productos Lácteos de Asturias-CSIC, Villaviciosa, Spain
- Functionality and Ecology of Beneficial Microbes (MicroHealth) Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011, Oviedo, Asturias, Spain
| | - Abelardo Margolles
- Dairy Research Institute, Spanish National Research Council, Instituto de Productos Lácteos de Asturias-CSIC, Villaviciosa, Spain
- Functionality and Ecology of Beneficial Microbes (MicroHealth) Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011, Oviedo, Asturias, Spain
| | | | | | - Paula Puente-Gómez
- Department of Food Hygiene and Technology, Universidad de León, León, Spain
| | - Fiona Crispie
- Teagasc Food Research Centre, Fermoy, Co., Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Mercedes López
- Department of Food Hygiene and Technology, Universidad de León, León, Spain
- Institute of Food Science and Technology, Universidad de León, León, Spain
| | - Miguel Prieto
- Department of Food Hygiene and Technology, Universidad de León, León, Spain
- Institute of Food Science and Technology, Universidad de León, León, Spain
| | - Paul D Cotter
- Teagasc Food Research Centre, Fermoy, Co., Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- VistaMilk, Cork, Ireland
| | - Avelino Alvarez-Ordóñez
- Department of Food Hygiene and Technology, Universidad de León, León, Spain.
- Institute of Food Science and Technology, Universidad de León, León, Spain.
| |
Collapse
|
2
|
Abarquero D, Bodelón R, Flórez AB, Fresno JM, Renes E, Mayo B, Tornadijo ME. Technological and safety assessment of selected lactic acid bacteria for cheese starter cultures design: Enzymatic and antimicrobial activity, antibiotic resistance and biogenic amine production. Lebensm Wiss Technol 2023. [DOI: 10.1016/j.lwt.2023.114709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
|
3
|
Diezhandino I, Fernández D, Combarros‐Fuertes P, Renes E, Fresno JM, Tornadijo ME. Characteristics and proteolysis of a Spanish blue cheese made with raw or pasteurised milk. INT J DAIRY TECHNOL 2022. [DOI: 10.1111/1471-0307.12862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Isabel Diezhandino
- Department of Hygiene and Food Technology University of León León 24071Spain
| | - Domingo Fernández
- Institute of Food Science and Technology (ICTAL) University of León León 24007 Spain
| | | | - Erica Renes
- Department of Hygiene and Food Technology University of León León 24071Spain
| | - José María Fresno
- Department of Hygiene and Food Technology University of León León 24071Spain
| | | |
Collapse
|
4
|
Lolli V, Renes E, Caligiani A, de la Fuente MA, Gómez-Cortés P. Cyclopropane Fatty Acids as Quality Biomarkers of Cheeses from Ewes Fed Hay- and Silage-Based Diets. J Agric Food Chem 2021; 69:9654-9660. [PMID: 34387080 DOI: 10.1021/acs.jafc.1c03312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study aimed to investigate cyclopropane fatty acids (CPFAs) as quality biomarkers of forage feedings in cheese fat obtained from ewe's milk, based on two different dietary treatments (hay and silage). The gas chromatography-mass spectrometry (GC-MS) analysis detected CPFAs in most cheese samples, both from hay and silage-based diets. CPFA levels in cheese fat from hay feeding were positively correlated to the total trans-monounsaturated fatty acids (MUFAs) and n-6 polyunsaturated fatty acids (PUFAs), whereas they were negatively correlated to cis-MUFAs, odd- and branched-chain fatty acids (i.e., C13:0 anteiso, C16:0 iso, and C17:1), and C22:5n-3, which are mainly associated with a low starch intake and grass pasture. Overall, the presence of CPFAs in ovine cheese fat suggests the use of silage, but it can also be an indicator of poor-quality hay forages. This approach confirmed the reliability of CPFAs as biomarkers of forage quality, especially in relation to the use of conserved forages and good livestock practices.
Collapse
Affiliation(s)
- Veronica Lolli
- Department of Food and Drug, University of Parma, 43124 Parma, Italy
| | - Erica Renes
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, 24071 León, Spain
| | - Augusta Caligiani
- Department of Food and Drug, University of Parma, 43124 Parma, Italy
| | - Miguel Angel de la Fuente
- Instituto de Investigación en Ciencias de la Alimentación (CIAL, CSIC-UAM), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Pilar Gómez-Cortés
- Instituto de Investigación en Ciencias de la Alimentación (CIAL, CSIC-UAM), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| |
Collapse
|
5
|
Abarquero D, Renes E, Fresno JM, Tornadijo ME. Study of exopolysaccharides from lactic acid bacteria and their industrial applications: a review. Int J Food Sci Technol 2021. [DOI: 10.1111/ijfs.15227] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Daniel Abarquero
- Department of Food Hygiene and Technology Faculty of Veterinary Science University of León León 24071 Spain
| | - Erica Renes
- Department of Food Hygiene and Technology Faculty of Veterinary Science University of León León 24071 Spain
| | - José María Fresno
- Department of Food Hygiene and Technology Faculty of Veterinary Science University of León León 24071 Spain
| | - María Eugenia Tornadijo
- Department of Food Hygiene and Technology Faculty of Veterinary Science University of León León 24071 Spain
| |
Collapse
|
6
|
Renes E, Fernández D, Abarquero D, Ladero V, Álvarez MA, Tornadijo ME, Fresno JM. Effect of forage type, season, and ripening time on selected quality properties of sheep milk cheese. J Dairy Sci 2021; 104:2539-2552. [PMID: 33455752 DOI: 10.3168/jds.2020-19036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/19/2020] [Indexed: 01/16/2023]
Abstract
The aim of this research was to study changes in the microbial populations, free AA profile, biogenic amine content, and sensory characteristics of ripened cheeses (100 and 180 d) produced in different seasons (summer, autumn, winter, and spring) from pasteurized sheep milk from 8 commercial flocks fed hay or silage diets. Twenty-one individual AA and 6 biogenic amines were determined by ultra-high performance liquid chromatography. Type of conserved forage for sheep feeding did not affect the variables studied, which is of great interest because hay and silage are low-cost ingredients for sheep feeding. Proteolysis led total free AA concentrations ranging between 35,179.26 and 138,063.71 mg/kg of cheese at 180 d of ripening. γ-Aminobutyric acid, which has been associated with beneficial effects on human health, was the second most abundant AA in all cheese samples, accounting for 15% of total free AA. Spring cheeses showed 2-fold higher concentrations of γ-aminobutyric acid than summer and autumn cheeses at the end of ripening. Overall, spring, winter, and autumn cheeses had lower average concentration of biogenic amines (431.99 mg/kg of cheese) than summer cheeses (825.70 mg/kg of cheese) as well as better sensory characteristics. Therefore, this study could provide the dairy industry with useful information for producing cheeses with valuable nutritional and sensory quality for consumers.
Collapse
Affiliation(s)
- E Renes
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, 24071, León, Spain
| | - D Fernández
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, 24071, León, Spain
| | - D Abarquero
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, 24071, León, Spain
| | - V Ladero
- Instituto de Productos Lácteos de Asturias (IPLA-CSIC), 33300, Villaviciosa, Asturias, Spain
| | - M A Álvarez
- Instituto de Productos Lácteos de Asturias (IPLA-CSIC), 33300, Villaviciosa, Asturias, Spain
| | - M E Tornadijo
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, 24071, León, Spain
| | - J M Fresno
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, 24071, León, Spain.
| |
Collapse
|
7
|
Renes E, Fernández A, Fernández D, López M, Álvarez‐Ordoñez A. Effect of high hydrostatic pressure processing of milk on the quality characteristics of kefir. J FOOD PROCESS PRES 2020. [DOI: 10.1111/jfpp.14797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Erica Renes
- Department of Food Hygiene and Technology Faculty of Veterinary Science Universidad de León León Spain
| | - Alejandro Fernández
- Department of Food Hygiene and Technology Faculty of Veterinary Science Universidad de León León Spain
| | - Domingo Fernández
- Department of Food Hygiene and Technology Faculty of Veterinary Science Universidad de León León Spain
| | - Mercedes López
- Department of Food Hygiene and Technology Faculty of Veterinary Science Universidad de León León Spain
- Institute of Food Science and Technology Universidad de León León Spain
| | - Avelino Álvarez‐Ordoñez
- Department of Food Hygiene and Technology Faculty of Veterinary Science Universidad de León León Spain
- Institute of Food Science and Technology Universidad de León León Spain
| |
Collapse
|
8
|
Renes E, Gómez-Cortés P, de la Fuente MA, Fernández D, Tornadijo ME, Fresno JM. Effect of forage type in the ovine diet on the nutritional profile of sheep milk cheese fat. J Dairy Sci 2019; 103:63-71. [PMID: 31629509 DOI: 10.3168/jds.2019-17062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/01/2019] [Indexed: 01/14/2023]
Abstract
The high nutritional value of sheep milk can be advantageous in the manufacture of cheese, and fat plays an important role in sheep cheese properties. The aim of this study was to investigate the effect of feeding common hay or silage diets used in commercial farms on the nutritional value of sheep cheese fat. We also monitored the effect of cheese ripening period on the fatty acid profile. Cheeses were produced from milk of sheep fed hay and silage diets from 8 farms, on 4 separate occasions (February, May, August, and November) over a 1-yr period. Eighty-four individual fatty acids were determined and identified by gas chromatography. Ripening time (100 and 180 d) significantly reduced moisture, acidity, and water activity of cheeses but did not affect the fatty acid content. However, hay feeding, compared with silage feeding, led to cheeses with 1.5- and 1.3-fold higher contents of vaccenic acid and conjugated linoleic acid, without detrimental changes in saturated and n-3 (omega-3) fatty acid composition. Hay forages could be a low-cost alternative for producing cheese with a fatty acid profile suitable for human health, which is an aspect of great interest to the food industry.
Collapse
Affiliation(s)
- E Renes
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, 24071, León, Spain
| | - P Gómez-Cortés
- Instituto de Investigación en Ciencias de la Alimentación (CIAL, CSIC-UAM), Universidad Autónoma de Madrid, Nicolás Cabrera, 9, 28049, Madrid, Spain
| | - M A de la Fuente
- Instituto de Investigación en Ciencias de la Alimentación (CIAL, CSIC-UAM), Universidad Autónoma de Madrid, Nicolás Cabrera, 9, 28049, Madrid, Spain
| | - D Fernández
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, 24071, León, Spain
| | - M E Tornadijo
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, 24071, León, Spain
| | - J M Fresno
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, 24071, León, Spain.
| |
Collapse
|
9
|
Renes E, Gómez-Cortés P, de la Fuente M, Linares D, Tornadijo M, Fresno J. CLA-producing adjunct cultures improve the nutritional value of sheep cheese fat. Food Res Int 2019; 116:819-826. [DOI: 10.1016/j.foodres.2018.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 10/28/2022]
|
10
|
Renes E, Ladero V, Tornadijo ME, Fresno JM. Production of sheep milk cheese with high γ-aminobutyric acid and ornithine concentration and with reduced biogenic amines level using autochthonous lactic acid bacteria strains. Food Microbiol 2018; 78:1-10. [PMID: 30497589 DOI: 10.1016/j.fm.2018.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/22/2018] [Accepted: 09/01/2018] [Indexed: 01/15/2023]
Abstract
Consumer demand for health-promoting foods is generating the need to develop biofunctional dairy products. Lactic acid bacteria are employed in cheese-making and some of them are able to produce beneficial compounds on human health such as γ-aminobutyric acid (GABA) and ornithine but also to synthetize biogenic amines. The aim was to investigate the effect of four selected autochthonous co-cultures on the free amino acid profile, with special emphasis on GABA and ornithine, and on the biogenic amine content of pasteurized sheep milk cheese during ripening. High average concentrations of GABA (1296.75 mg/kg cheese) and ornithine (2355.76 mg/kg cheese) were found in all the cheese batches at 240 days of ripening. Batch 2, manufactured with the co-culture containing autochthonous Lactococcus lactis strains as starter and Lactobacillus plantarum TAUL1588 as adjunct, showed 2.37 fold reduced biogenic amines concentration with respect to the batch 1 made with the starter during the ripening time. The microstructure and microbiological counts of cheeses were affected (P ≤ 0.001) by the ripening time, without appreciating differences (P ≥ 0.05) in the physico-chemical composition between batches. This study could be a good approach to the development of functional sheep milk cheese.
Collapse
Affiliation(s)
- E Renes
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, León, 24071, Spain
| | - V Ladero
- Instituto de Productos Lácteos de Asturias (IPLA-CSIC), Villaviciosa, Asturias, 33300, Spain
| | - M E Tornadijo
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, León, 24071, Spain.
| | - J M Fresno
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of León, León, 24071, Spain
| |
Collapse
|
11
|
Renes E, De la Fuente F, Fernández D, Tornadijo ME, Fresno JM. Effect of feeding regimen on the fatty acid profile of sheep bulk tank milk. INT J DAIRY TECHNOL 2018. [DOI: 10.1111/1471-0307.12553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Erica Renes
- Department of Food Hygiene and Technology; Faculty of Veterinary Science; University of León; 24071 León Spain
| | - Fernando De la Fuente
- Department of Animal Production; Faculty of Veterinary Science; University of León; 24071 León Spain
| | - Domingo Fernández
- Department of Food Hygiene and Technology; Faculty of Veterinary Science; University of León; 24071 León Spain
| | - María Eugenia Tornadijo
- Department of Food Hygiene and Technology; Faculty of Veterinary Science; University of León; 24071 León Spain
| | - José María Fresno
- Department of Food Hygiene and Technology; Faculty of Veterinary Science; University of León; 24071 León Spain
| |
Collapse
|
12
|
Renes E, Linares D, González L, Fresno J, Tornadijo M, Stanton C. Study of the conjugated linoleic acid synthesis by Lactobacillus strains and by different co-cultures designed for this ability. J Funct Foods 2017. [DOI: 10.1016/j.jff.2017.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
|
13
|
Linares DM, Gómez C, Renes E, Fresno JM, Tornadijo ME, Ross RP, Stanton C. Lactic Acid Bacteria and Bifidobacteria with Potential to Design Natural Biofunctional Health-Promoting Dairy Foods. Front Microbiol 2017; 8:846. [PMID: 28572792 PMCID: PMC5435742 DOI: 10.3389/fmicb.2017.00846] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/25/2017] [Indexed: 12/19/2022] Open
Abstract
Consumer interest in healthy lifestyle and health-promoting natural products is a major driving force for the increasing global demand of biofunctional dairy foods. A number of commercial sources sell synthetic formulations of bioactive substances for use as dietary supplements. However, the bioactive-enrichment of health-oriented foods by naturally occurring microorganisms during dairy fermentation is in increased demand. While participating in milk fermentation, lactic acid bacteria can be exploited in situ as microbial sources for naturally enriching dairy products with a broad range of bioactive components that may cover different health aspects. Several of these bioactive metabolites are industrially and economically important, as they are claimed to exert diverse health-promoting activities on the consumer, such as anti-hypertensive, anti-inflammatory, and anti-diabetic, anti-oxidative, immune-modulatory, anti-cholesterolemic, or microbiome modulation. This review aims at discussing the potential of these health-supporting bacteria as starter or adjunct cultures for the elaboration of dairy foods with a broad spectrum of new functional properties and added value.
Collapse
Affiliation(s)
- Daniel M. Linares
- Teagasc Food Research Centre, MooreparkFermoy, Ireland
- APC Microbiome Institute, University College CorkCork, Ireland
| | | | - Erica Renes
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of LeónLeón, Spain
| | - José M. Fresno
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of LeónLeón, Spain
| | - María E. Tornadijo
- Department of Food Hygiene and Technology, Faculty of Veterinary Science, University of LeónLeón, Spain
| | - R. P. Ross
- APC Microbiome Institute, University College CorkCork, Ireland
| | - Catherine Stanton
- Teagasc Food Research Centre, MooreparkFermoy, Ireland
- APC Microbiome Institute, University College CorkCork, Ireland
| |
Collapse
|
14
|
|
15
|
Pérez Vela J, Sánchez P, Rubio M, Renes E, Perales N, Guillén F, Hernández I. Réplica. Med Intensiva 2004. [DOI: 10.1016/s0210-5691(04)70104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
16
|
Carrascal Y, Guerrero AL, Maroto LC, Cortina JM, Rodríguez JE, Renes E, Rufilanchas JJ. Neurological complications after cardiopulmonary bypass: An update. Eur Neurol 2000; 41:128-34. [PMID: 10202243 DOI: 10.1159/000008035] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neurological complications are, at the present time, considered among the most important causes of morbidity and mortality after heart surgery. We evaluated their importance and risk factors. PATIENTS AND METHODS We retrospectively reviewed 2, 528 consecutive patients who underwent cardiopulmonary bypass in a single center. In each one, we attended to previous vascular risk factors, such as surgical and postoperative events. We considered four categories of neurologic outcome: (1) persistent neurological focal deficits, (2) stupor or coma, (3) temporary neurological focal deficits, and (4) seizures. We carried out univariant and multivariant statistical analysis, looking for predictors of adverse neurologic events. RESULTS Neurological complications occurred in 76 patients (3%); 36 of them (47%) had persistent neurological focal deficits, 18 (24%) stupor or coma, 18 (24%) temporary neurological focal deficits, and 27 (36%) seizures. Twenty-two patients with cerebral adverse outcomes died (29%), the overall mortality among the 2,528 cases being 5%. Predictors of risk were aortic aneurysm and aortic valve surgery, advanced age, female sex, and the use of intra-aortic balloon pump. A longer hospitalization time was noticed among patients with neurological side effects. DISCUSSION Neurological complications are common and serious after heart surgery, as we have noticed with this series, the largest up to now, according to our review of the literature. They increase perioperative mortality and hospitalization time. Neurological morbidity and risk factors in our study are similar to those previously published.
Collapse
Affiliation(s)
- Y Carrascal
- Service of Cardiovascular Surgery, Hospital '12 de Octubre', Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
17
|
Lorente JA, Landin L, Cañas P, Delgado MA, Albaya A, Renes E, Jorge P, Liste D. Effects of nitric oxide synthase inhibition on the cardiovascular response to low output shock. Crit Care Med 1996; 24:482-7. [PMID: 8625638 DOI: 10.1097/00003246-199603000-00019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To study the role of nitric oxide in the cardiovascular response to a model of a low output syndrome. DESIGN Prospective animal study. SETTING Animal research laboratory. SUBJECTS Sheep anesthetized with pentobarbital, mechanically ventilated, and monitored with pulmonary arterial and peripheral arterial catheters. INTERVENTIONS A low output state was induced by inflating a balloon-tip catheter placed in the right atrium. Cardiac index was maintained at 1 L/min/m2 throughout the experiment in three groups of sheep: a) control (n=6) b)LNNA group (pretreated with the nitric oxide synthase inhibitor N omega-nitro-L-arginine [LNNA, 100 mg/kg, iv bolus, n=6); and c) dexamethasone group (pretreated with dexamethasone (6 mg/kg, intravenous bolus, n=6). Dexamethasone is an inhibitor of the induction of nitric oxide synthase. LNNA or dexamethasone were administered 15 mins before inducing the low output state. MEASUREMENTS AND MAIN RESULTS Hemodynamic and oxygen transport variables, and plasma lactate and pyruvate concentrations, were measured at baseline and during the next 3 hrs. For a comparable decrease in cardiac index and oxygen delivery in all groups, the LNNA group had less hypotension and a more marked increase in systemic vascular resistance as compared with the control group. Oxygen consumption and oxygen extraction were higher in the LNNA group as compared with the control group at 30 and 60 mins. Plasma lactate concentration increased significantly less in the LNNA group than in the control and the dexamethasone groups during the observation period. CONCLUSIONS Inhibition of nitric oxide synthesis during a severe low output state in sheep is associated with a better hemodynamic response, as evidenced by a greater vasoconstriction, and signs of less marked tissue hypoxia. It is likely that inhibition of nitric oxide synthesis in this model leads to an imbalance between the tonic relaxing action of nitric oxide and the influences of vasoconstrictor agents.
Collapse
|
18
|
Díaz de Tuesta I, Rufilanchas JJ, Cortina J, Renes E, Rodríguez E, Molina L, Pérez de la Sota E, Carrascal Y, Maroto L, Guillén F. [A method for the predictive estimation of the surgical risk in adult cardiac pathology]. Rev Esp Cardiol 1995; 48:732-40. [PMID: 8532942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION In order to test the efficiency of statistical predictive models, we compare the results of a standard method (Parsonnet) with the model created through the data of our population. MATERIAL AND METHODS We used the chi 2 univariate model, lineal and logistic regression with the data of the whole population receiving cardiac surgical procedure from January 1, 1990 to December 31, 1993 (total 1626 patients). The population was divided into a control group (1100 cases, 68%) and a study group (526 cases, 32%). The coefficients of the control group were used to estimate the results in the study group. RESULTS Univariate model p value. Significant (p < 0.001) for emergency, age, pulmonary hypertension, left ventricular failure, preoperative use of intra-aortic balloon pump; p < 0.05 mitral valve disease, aortic aneurysm and reoperation. No significance (p < 0.01) was found for gender, aortic or tricuspid disease, percutaneous transluminal coronary angioplasty, unstable or postinfarction angina, transplant, left main or vessel disease number, and mitral, tricuspid or aortic procedure. MULTIVARIATE MODEL: Emergency, pulmonary hypertension, age, left ventricular dysfunction and aortic aneurysm. We estimated a 5.2%, 5.2% and 11.4% mortality with linear, logistic and Parsonnet method respectively with a real group mortality of 6.5%. The average error of the observed and predicted mortality after risk stratification was 5.7%, 6% and 12%. CONCLUSION A model for risk prediction based on the data of the own institution is more accurate for that population than a model created for comparison between institutions, because the former takes account of the center and population peculiarities.
Collapse
|
19
|
Landín L, Lorente JA, Renes E, Cañas P, Jorge P, Liste D. Inhibition of nitric oxide synthesis improves the vasoconstrictive effect of noradrenaline in sepsis. Chest 1994; 106:250-6. [PMID: 8020279 DOI: 10.1378/chest.106.1.250] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Septic shock is characterized by systemic vasodilation and an impaired reactivity to vasoconstrictor agents. It has been suggested that an excessive release of nitric oxide has a role in this hemodynamic derangement. OBJECTIVE To investigate whether inhibition of nitric oxide synthesis by the administration of N omega-nitro-L-arginine (LNNA), improves the vasoconstrictor effects of catecholamines in sepsis. MATERIAL AND METHODS Mechanically ventilated and pentobarbital-anesthetized sheep received either no treatment (n = 6) or LNNA (100 mg/kg IV bolus, n = 4). Other sheep (septic group) received live Escherichia coli (E coli) (1,5* 10(9) micro-organisms/kg over 30 min) followed 1 hour later by either no treatment (n = 5) or LNNA (100 mg/kg IV bolus, n = 7). After those interventions, all sheep were given noradrenaline in a continuous IV infusion at three different doses (0.5, 1.5, and 4.5 micrograms, kg-1, min-1). Cardiovascular parameters were recorded at maximal blood pressure response achieved with each dose. RESULTS The administration of live E coli to the septic group resulted in systemic hypotension, high cardiac output, and hyperlactatemia. The LNNA caused a significant systemic and pulmonary vasoconstriction in both septic and nonseptic sheep. In nonseptic sheep, noradrenaline induced a significant increase in systemic vascular resistance (from 2,973 +/- 637 to 4,561 +/- 1,287 dyn/s/cm-5/m-2), whereas the increase caused in those that received LNNA was nonsignificant (5,562 +/- 3,489 to 6,693 +/- 2,871 dyn, s, cm-5, m-2). Septic sheep showed a nonsignificant vasoconstriction during the infusion of noradrenaline (from 1,438 +/- 1,132 to 2,244 +/- 1,391 dyn/s/cm-5/m-2). However, treatment with LNNA markedly improved the vasoconstrictor effect of noradrenaline (from 2,804 +/- 2,317 to 4,894 +/- 3,435 dyn/s/cm-5/m-2). The dose-response curve of systemic vascular resistance in these LNNA-pretreated septic sheep became very similar to the corresponding curve obtained in nonseptic animals. CONCLUSIONS Inhibition of nitric oxide synthesis by the administration of LNNA significantly improves the vasoconstrictor effect of noradrenaline in septic sheep, allowing an increase in systemic vasomotor tone similar to that observed in nonseptic sheep. It is concluded that increased synthesis of nitric oxide contributes to the depressed vascular reactivity to vasoconstrictor agents characteristic of sepsis.
Collapse
Affiliation(s)
- L Landín
- Unidad de Cuidados Intensivos, Hospital Ramón y Cajal, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
OBJECTIVE To investigate the role of nitric oxide in the regulation of vascular tone in patients with the sepsis syndrome. DESIGN Prospective, intervention study. SETTING Tertiary care hospital. PATIENTS Fifteen patients admitted to our medical intensive care unit with the diagnosis of sepsis syndrome by defined criteria. INTERVENTIONS Eight patients received N omega-nitro-L-arginine (20 mg/kg, iv bolus) followed by L-arginine (200 mg/kg, iv bolus). Seven patients received L-arginine alone (200 mg/kg). MEASUREMENTS AND MAIN RESULTS In the first group, hemodynamic and oxygen transport variables were recorded at baseline, during 45 mins after the injection of N omega-nitro-L-arginine, and during 45 mins after the administration of L-arginine. In the second group, hemodynamic parameters were recorded at baseline and during 15 mins after the administration of L-arginine. Data are mean +/- SEM. The administration of N omega-nitro-L-arginine was followed by hypertension (mean blood pressure increased from 89 +/- 8 to a maximum of 140 +/- 12 mm Hg) accompanied by a decrease in cardiac index (from 3.51 +/- 0.39 to a minimum of 2.65 +/- 0.21 L/min/m2) and an increase in right atrial and pulmonary artery occlusion pressure. Systemic vascular resistance index increased from 1871.1 +/- 302.3 to 3825.6 +/- 244.4 dyne.sec/cm5.m2, and pulmonary vascular resistance increased from 533.2 +/- 125.8 to 816.0 +/- 117.3 dyne.sec/cm5.m2. These changes induced by N omega-nitro-L-arginine were reversed by the administration of L-arginine. The administration of L-arginine to another group of patients caused transient hypotension (from 103 +/- 6 to 81 +/- 10 mm Hg) and an increase in cardiac index (from 3.57 +/- 0.15 to 4.74 +/- 0.54 L/min/m2). Both systemic and pulmonary vascular resistance indices decreased (from 1987.6 +/- 163.9 to 1251.4 +/- 231.5 dyne.sec/cm5.m2, and from 486.1 +/- 65.2 to 380.5 +/- 70.3 dyne.sec/cm5.m2). Parallel to the increase in oxygen transport due to the increase in cardiac output, oxygen consumption index increased significantly 1 min after L-arginine (from 127.0 +/- 19.0 to 182.5 +/- 37.3 mL/min/m2). All mentioned changes were statistically significant (p < .05). CONCLUSIONS A continuous basal release of nitric oxide plays a role in the regulation of systemic and pulmonary vascular tone in patients with sepsis syndrome. L-arginine has systemic and pulmonary vasodilatory actions.
Collapse
Affiliation(s)
- J A Lorente
- Unidades de Cuidados Intensivos, Hospital Ramón y Cajal, Madrid, Spain
| | | | | | | | | |
Collapse
|
21
|
Abstract
OBJECTIVE To investigate whether increasing oxygen delivery (DO2) by increasing hematocrit results in increases in oxygen uptake (VO2) in septic patients with an abnormal DO2/VO2 relationship. DESIGN Prospective, randomized, interventional crossover study. SETTING Tertiary care hospital. PATIENTS A consecutive sample of 16 patients admitted to the intensive care unit, who were diagnosed as having severe sepsis by defined criteria and who had a hemoglobin concentration of < 10 g/dL. INTERVENTIONS Patients received, in random order, an infusion of dobutamine (10 micrograms/kg/min) and a blood transfusion (800 mL of packed red blood cells in 90 mins). Hemodynamic and oxygen transport variables were determined before and after each treatment, allowing at least 20 mins during the infusion of dobutamine to achieve the steady state. MEASUREMENTS AND MAIN RESULTS Changes in DO2 and VO2 induced by each intervention were measured. Dobutamine significantly increased DO2 (48.5 +/- 6.9%; p = .0001) and VO2 (21.7 +/- 3.3%; p = .0001). Blood transfusion increased DO2 (21.4 +/- 4.3%; p = .005) but VO2 did not change significantly (2.2 +/- 4.1%). Correlation coefficients for the percent changes of DO2 and VO2 (r2 = .67, p = .001 for dobutamine; and r2 = 21, p = .07 for blood transfusion) were significantly different for each treatment (p = .0001). CONCLUSIONS In patients with an abnormal DO2-dependent VO2, as shown by increases in VO2 brought about by an infusion of dobutamine, blood transfusion does not significantly increase VO2, despite significant changes in DO2. The VO2, in some critically ill patients, depends more on blood flow than on global DO2.
Collapse
Affiliation(s)
- J A Lorente
- Unidad de Cuidados Intensivos, Hospital Ramón y Cajal, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
22
|
Lorente JA, García-Frade LJ, Landín L, de Pablo R, Torrado C, Renes E, García-Avello A. Time course of hemostatic abnormalities in sepsis and its relation to outcome. Chest 1993; 103:1536-42. [PMID: 8486040 DOI: 10.1378/chest.103.5.1536] [Citation(s) in RCA: 230] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To investigate the time course and the relation to prognosis of coagulation and fibrinolytic abnormalities in patients with septic shock. PATIENTS AND METHODS Forty-eight consecutive patients admitted to the medical ICU with the diagnosis of septic shock (diagnosed by defined criteria) were studied. Mortality was 25 of 48. Mean age was 57 +/- 7.3 years. Blood samples were obtained on days 1, 4, and 7 after hospital admission to measure tissue-type plasminogen activator antigen (t-PA), urokinase-type plasminogen activator (u-PA), plasminogen activator inhibitor antigen (PAI-1), plasminogen, alpha 2-antiplasmin, fibrinogen, antithrombin III, protein C, protein S, thrombin-antithrombin complexes (TAT), D-dimer, and von Willebrand factor-related antigen (vWF:Ag). RESULTS All patients showed marked abnormalities in both the coagulation and fibrinolytic systems. There were signs of coagulation activation and elevation of both activators and inhibitors of fibrinolysis. Nonsurvivors showed lower levels of protein C and antithrombin III and higher concentration of TAT than survivors. While both t-PA and PAI-1 concentrations were high in survivors and nonsurvivors, only survivors showed a progressive normalization of both parameters during the study period. Low plasminogen levels and plasminogen/alpha 2-antiplasmin ratio were found in both groups, presenting a trend toward normalization only in survivors. The differences reported were not apparent at the time of hospital admission. CONCLUSIONS Septic shock is characterized by coagulation activation and fibrinolysis activation and inhibition. Nonsurvivors present a particular hemostatic profile characterized by a more marked activation of coagulation and a more intense inhibition of fibrinolysis. None of the abnormalities studied was significantly different between survivors and nonsurvivors at the time of hospital admission. In the presence of fibrin formation, nonsurvivors present a maintained imbalance in the fibrinolytic response determined by higher PAI-1 plasma concentration, probably contributing to their poor outcome.
Collapse
Affiliation(s)
- J A Lorente
- Unidad de Cuidados Intensivos, Hospital Ramón y Cajal, Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
OBJECTIVE To study the role of nitric oxide in the hemodynamic changes of sepsis. DESIGN Prospective, randomized, controlled, intervention study. SUBJECTS Twenty-five sheep randomized to four groups: Group A (n = 8, nonseptic sheep) received NG-nitro L-arginine (20 mg/kg i.v.) followed 15 mins later by L-arginine (200 mg/kg i.v.); group B (n = 4, nonseptic sheep) received L-arginine followed 15 mins later by NG-nitro L-arginine; group C (n = 7, septic sheep) received NG-nitro L-arginine (20 mg/kg i.v.) alone; group D (n = 6, septic sheep) received L-arginine (200 mg/kg i.v.) followed by NG-nitro L-arginine (20 mg/kg i.v.). INTERVENTIONS Sheep were anesthetized with pentobarbital, mechanically ventilated and monitored with a pulmonary artery catheter, a peripheral artery catheter, and a Miller catheter in the left ventricle. Sepsis was induced by the intravenous administration of live Escherichia coli (1.5 x 10(9) microorganisms/kg over 30 mins), which resulted in systemic hypotension, pulmonary hypertension, high cardiac output, and hyperlactatemia. Acetylcholine was administered before and after each intervention. MEASUREMENTS AND MAIN RESULTS In nonseptic sheep (groups A and B) NG-nitro L-arginine induced an increase in mean blood pressure (BP), pulmonary arterial pressure, and systemic and pulmonary vascular resistances, accompanied by a decrease in cardiac index and the first derivative of left ventricular pressure. L-arginine administered to normal sheep induced systemic vasodilation. In the sepsis groups (groups C and D), the increases in BP and systemic vascular resistances induced by NG-nitro L-arginine were significant but less marked than in nonseptic sheep. Pretreatment of septic sheep with L-arginine totally abolished the NG-nitro L-arginine induced increases in systemic and pulmonary vascular resistances in this group. The administration of L-arginine in these animals induced both systemic and pulmonary vasodilation. Acetylcholine-mediated vasodilation was severely impaired in sepsis. In this condition, pretreatment with L-arginine improved the response to acetylcholine. CONCLUSIONS These data support the view that nitric oxide plays a significant role in modulating systemic and pulmonary vasomotor tone in normal and septic sheep. L-arginine produced systemic vasodilation in normal sheep, whereas both systemic and pulmonary vasodilation were observed in septic animals. The impaired response to an endothelium-dependent vasodilator in sepsis was improved by the previous administration of L-arginine.
Collapse
Affiliation(s)
- J A Lorente
- Hospital Universitario de Getafe, Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
24
|
Glovannini I, Chiarla C, Boldrini G, Castagneto M, Beards SC, Watt T, Edwards JD, Nightingale P, Boyd O, Mackay J, Lamb G, Grounds RM, Bennett ED, Munerato P, Fracasso A, Fantin D, Bortolussi R, Giaimo F, Santantonio C, Lendinez MJ, Lopez J, Cerdeno V, Monjas A, Arce MA, de Lorenzo AG, de la Casa R, Lind L, Mälstam J, Skoog G, Mathìeu D, Nevìere R, Herengt F, Fleyfel M, Wattel F, Meier-Hellmann A, Hannemann L, Specht M, Schaffartzik W, Heiss-Dunlop W, Hassel H, Reinhart K, Silance PG, Vincent JL, Berlot PG, Berlot G, Silance PG, Zhang H, Smolle KH, Kahn RJ, Riera JASI, López EA, Aznarez SB, Renes E, Martín MJJ, Gándara AMD, Prados J, López PA, Rodriguez JG, Varela JP, Léon A, Raclot P, Cousson J, Biotteau C, Suinat JL, Rendoing J, van der Hoeven JG, Waanders H, Compier EA, Meinders AE, Lindner KH, Schümann W, Pfenninger EG, Ahnefeld FW, Strohmenger H, Brinkmann A, Georgieff M, Verde G, Pallavicini FB, Caramella F, Cassini F, Bichisao G, Ferguson C, Withey F, Coakley J, Crane P, Honovar M, Hinds CJ, von Planta I, Wagner O, Ritz R, Planta MV, Groeneveld ABJ, Thijs LG, de Boer JP, Abbink JJ, Creasey AA, Chang A, Roem D, Eerenberg AJM, Hack CE, Taylor FB, Annane D, Raphaël JC, Gajdos P, Bernardin G, Milhaud D, Pradier C, Matlei M, Donati A, Adrario E, Valente M, Orsetti G, Sambo G, Cola L, Giovannini C, Pietropaoli P, Tran DD, Cuesta MA, Schneider AJ, Wesdorp RIC, D’Orio V, Martinez C, Saad G, Mendes P, Marcelle R, Boulain T, Legras A, Perrotin D, Giniès G, Perrotin D, Geroulanos S, Cakmakci M, Schilling J, Staubach KH, Audibert G, Donner M, Lefèvre JC, Stoltz JF, Laxenaire MC, Russo R, Veschi G, Dellino E, Solca M, Aveni R, Colombo A, Iapichino G, Coronet B, Mercatello A, Bret M, Lefrançois N, Dubernard IM, Moskovtchenko JF. Shock I. Intensive Care Med 1992. [DOI: 10.1007/bf03216352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
25
|
Lorente JA, Landín L, de Pablo R, Renes E. [The effects of prostacyclin on oxygen transport in adult respiratory distress syndrome]. Med Clin (Barc) 1992; 98:641-5. [PMID: 1598007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with the adult respiratory distress syndrome (ARDS) present a deficit of tissue oxygenation which may be unmasked if increases in oxygen uptake (VO2) are observed when increases in oxygen delivery (DO2) are induced. Prostacyclin is a drug to which microvasodilator effects have been attributed and it has been proposed as an efficient agent for increasing histic enhancement of oxygen. METHODS An infusion of prostacyclin was administered to 13 patients diagnosed with ARDS at doses of 10, 20, and 30 ng/kg per minute monitored with a Swan-Gatz catheter. RESULTS The values are expressed as the percentage median of the increase with p less than 0.05 being considered as statistically significant. Prostacyclin significantly increased DO2 (10, 18 and 15% at the different doses). The VO2 rose significantly only following the first dose (13%). There was a correlation between the increase of DO2 and that of VO2 following the administration of the first dose (r = 0.70, p = 0.017. An important systemic vasodilator and pulmonary effect was observed accompanied by increases in the pulmonary (20, 56 and 59%) and reductions of PaO2 (-33.5, -40 and -48%) which may have been due to inhibition of hypoxic vasoconstriction. CONCLUSIONS Prostacyclin is efficient for unmasking a lack of oxygen in patients with adult respiratory distress syndrome. The deleterious effects of this drug on systemic hemodynamics and on gaseous interchange makes not only the monitorization of arterial pressure but also of the parameters of gaseous interchanges necessary in these patients.
Collapse
Affiliation(s)
- J A Lorente
- Unidad de Cuidados Intensivos, Hospital Ramón y Cajal, Madrid
| | | | | | | |
Collapse
|
26
|
Renes E, Lorente JA, Landin L. [Changes in tissue delivery of oxygen in patients with acute respiratory insufficiency]. Med Clin (Barc) 1992; 98:39. [PMID: 1545614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
27
|
Aguinaga MA, Santos P, Renes E, Alvaro PF, Lorente JA, Maudes A, Diaz RR, Landín L, Liste D. Hemodynamic changes during whole bronchoalveolar lavage in two cases of pulmonary alveolar proteinosis. Intensive Care Med 1991; 17:421-3. [PMID: 1774397 DOI: 10.1007/bf01720681] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Five whole bronchoalveolar lavages were performed in 2 patients with pulmonary alveolar proteinosis with continuous monitoring of mixed venous and arterial oxygen saturation. Hemodynamic parameters and gas-exchange status were measured during the different phases of the lavage. In the phase of filled lung, a significant increase of arterial partial pressure (PaO2) and arterial saturation of oxygen were observed, secondary to a decrease in the intrapulmonary shunt. The mean pulmonary arterial pressure, pulmonary vascular resistances and cardiac index were higher during the filling of the lung as compared to the controls. During the empty lung phase, although PaO2 decreased (without reaching statistical significance), due to an increase in the intrapulmonary shunt, the increase in cardiac output during this phase left the oxygen delivery (DO2) unchanged.
Collapse
Affiliation(s)
- M A Aguinaga
- Service of Intensive Care Medicine, Ramon y Cajal Hospital, Madrid, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
OBJECTIVE To investigate whether oxygen consumption (VO2) is dependent on oxygen delivery (DO2) in adult respiratory distress syndrome (ARDS) and non-ARDS acute respiratory failure. DESIGN Intervention study of a consecutive sample of patients admitted to the ICU with the diagnosis of acute respiratory failure. SETTING Tertiary care center. PATIENTS Thirteen consecutive patients with a diagnosis of ARDS and 11 with a diagnosis of respiratory failure not due to ARDS. Patients were monitored with an oximetric pulmonary artery catheter and mechanically ventilated. INTERVENTIONS DO2 was decreased by the application of positive end-expiratory pressure (PEEP) (20 cm H2O), and subsequently increased by an iv infusion of dobutamine (10 micrograms/kg.min). RESULTS After the application of PEEP, DO2 decreased significantly in both groups. However, VO2 decreased significantly (p less than .01) only in the ARDS group. When dobutamine was infused, DO2 increased significantly (p less than .01) in both groups, but VO2 increased only in ARDS patients. DO2 correlated significantly with VO2 both in ARDS (r2 = .81, p less than .01) and in non-ARDS (r2 = .38, p less than .05) patients. The correlation coefficient was significantly higher for ARDS than for non-ARDS patients. Comparing the slopes of the regression lines, a stronger dependency of VO2 on DO2 was found in ARDS than in non-ARDS respiratory failure (p less than .001). The oxygen extraction ratio correlated with DO2 in non-ARDS patients (r2 = .49, p less than .05), but not in ARDS patients. CONCLUSIONS VO2 is dependent on DO2 over a wide range of DO2 values in acute respiratory failure. This dependency phenomenon is much stronger in ARDS than in respiratory failure due to other causes. Due to the abnormal dependency of VO2 on DO2, changes in the oxygenation status may not be reflected by changes in mixed venous oxygen saturation in ARDS.
Collapse
|
29
|
Lorente JA, Martinez J, Renes E, Gomez-Aguinaga MA, Rodriguez-Diaz R, Pallares JM. Occult gastrointestinal carcinoma. Dis Colon Rectum 1990; 33:631-2. [PMID: 2361434 DOI: 10.1007/bf02052224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
30
|
Lorente JA, Renes E, Gómez-Aguinaga MA, Landín L, Escribano L, Liste D. [Pulmonary microvascular cytology in critical patients]. Med Clin (Barc) 1990; 95:25-6. [PMID: 2232946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cytology in blood drawn through a wedged Swan-Ganz catheter appears as a sensitive method for the diagnosis of carcinomatous lymphangitis in patients in whom transbronchial biopsy is considered dangerous or who refuse to undergo the latter procedure. However, its usefulness has not been assessed in critical patients with acute respiratory failure of unknown etiology in whom malignant disease is suspected. We report our experience in two patients admitted to the Intensive Care Unit with acute respiratory failure of unknown etiology: they were a female with breast carcinoma and a male with lymphoma in whom the cytological study of pulmonary capillary blood disclosed malignant cells. The clinical evaluation and the subsequent histological studies confirmed the pulmonary involvement by malignant disease in both cases.
Collapse
Affiliation(s)
- J A Lorente
- Unidad de Cuidados Intensivos, Hospital Ramón y Cajal, Madrid
| | | | | | | | | | | |
Collapse
|
31
|
Lorente JA, Renes E, Fernández-Molina A, Mateos ML. [Guillain-Barre syndrome associated with herpes simplex infection]. Med Clin (Barc) 1989; 93:477-8. [PMID: 2607813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
32
|
Martínez-Moreno E, Llamas A, Avendaño C, Renes E, Reinoso-Suárez F. General plan of the thalamic projections to the prefrontal cortex in the cat. Brain Res 1987; 407:17-26. [PMID: 3580851 DOI: 10.1016/0006-8993(87)91215-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study elucidates the general pattern of the thalamocortical neurons which project to the prefrontal cortex (PfC) in the cat, on the basis of the findings obtained using different retrograde labeling techniques in a large number of animals. The injections of the retrograde tracers covered the whole extent of the PfC, and did not invade gray or white matter outside the intended targets. The labeled neurons formed a vertical paramedian band throughout the rostrocaudal extent of the thalamus. This band was densest at the mediodorsal and ventromedial nuclei regions, encroached upon neurons located more medially and laterally, and largely spared the intralaminar nuclei. There were overlaps between neuron populations projecting to different subdivisions of the PfC, or to the PfC and sectors of the motor, insular, limbic and anterior ectosylvian sulcus cortices. However, these projections to separate cortical subdivisions apparently arise from different neuron clusters, with little collateralization of the axons arising from a single thalamocortical neuron. Only the neurons of the ventromedial nucleus, seem to possess somewhat more widespread terminal axons in the cortex.
Collapse
|