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Herrera-Linares ME, Rico-Pérez B, Yaffy D, Fernández-Parra R, Llanos C, Parra-Martínez C, Herrera-Gutiérrez ME, Sanchis-Mora S. Cadaveric study of the ultrasound-guided erector spinae plane block over the transverse process of the twelfth thoracic vertebra in dogs: Transversal vs longitudinal approach. Vet J 2024; 304:106094. [PMID: 38452849 DOI: 10.1016/j.tvjl.2024.106094] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
This study describes a transversal (TV) ultrasound-guided erector spinae plane (ESP) block technique over the transverse process of T12. And evaluates the distribution of the dye and affected nerves branches compared to a longitudinal (LNG) approach over the transverse process of T12 in canine cadavers. Secondly, it also compares de anatomy and dimensions of the transverse processes of T12 with T9 and T5. For this double-masked, cadaveric experimental study, 12 adult Beagle cadavers were injected with 0.6 mL/kg of dye/contrast. Spread was evaluated by computed tomography (CT) and dissection. Mean bodyweight was 9.76 (±0.59) kg. The TV and LNG approaches stained a median (range) of four (2-6) and three (1-6) medial branches of the dorsal rami of the spinal nerves, three (2-6) and three (2-5) lateral branches, and one (0-3) and one (0-4) ventral branches, respectively. Dye was detected in the epidural space in 55.6% and 66.7% of cases for the TV and LNG approaches, respectively (P=0.63). And in the ventral paravertebral compartment in 22.2% and lymphatics in 88.8% in both approaches. There were no statistical differences for the spread. The dorsolateral edge of the transverse process (TP) was not visible with CT at T12. The mean (±SD) length of the TP was significantly shorter at T12 [3.34 (±0.22)] mm, compared to T9 [6.08 (±0.47)] mm and T5 [5.93 (±0.62)] mm (P <0.001). This study showed similar distribution whether using a TV or LNG approach and differences in the anatomy and length of the T12 TP.
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Affiliation(s)
- M E Herrera-Linares
- Doctoral School, Catholic University of Valencia San Vicente Mártir, San Agustín Square, 3, 46002, Spain; Department of Clinical Science and Services. The Royal Veterinary College, Hawkshead Ln, Hatfield AL9 7TA, United Kingdom.
| | - B Rico-Pérez
- Department of Clinical Science and Services. The Royal Veterinary College, Hawkshead Ln, Hatfield AL9 7TA, United Kingdom
| | - D Yaffy
- Department of Pathobiology and Population Sciences. The Royal Veterinary College, Hawkshead Ln, Hatfield AL9 7TA, United Kingdom
| | - R Fernández-Parra
- Department of Small Animal Medicine and Surgery, Faculty of Veterinary Medicine and experimental Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, C/ de Quevedo, 2, 46001, Spain
| | - C Llanos
- Department of Clinical Science and Services. The Royal Veterinary College, Hawkshead Ln, Hatfield AL9 7TA, United Kingdom
| | - C Parra-Martínez
- Department of Clinical Science and Services. The Royal Veterinary College, Hawkshead Ln, Hatfield AL9 7TA, United Kingdom
| | - M E Herrera-Gutiérrez
- Department of Intensive Care Medicine. Regional University Hospital of Málaga, Av., 84, Málaga 29010, Spain
| | - S Sanchis-Mora
- Department of Small Animal Medicine and Surgery, Faculty of Veterinary Medicine and experimental Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, C/ de Quevedo, 2, 46001, Spain
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González-Fernández M, Quílez-Trasobares N, Barea-Mendoza JA, Molina-Collado Z, Arias-Verdú D, Barrueco-Francioni J, Seller-Pérez G, Herrera-Gutiérrez ME, Sánchez-Izquierdo Riera JA. Evaluation of the registry DIALYREG for the assessment of continuous renal replacement techniques in the critically ill patient. Sci Rep 2023; 13:6479. [PMID: 37081011 PMCID: PMC10117243 DOI: 10.1038/s41598-023-32795-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/03/2023] [Indexed: 04/22/2023] Open
Abstract
Continuous renal replacement techniques (CRRT) can induce complications and monitoring is crucial to ensure patient safety. We designed a prospective multicenter observational and descriptive study using the DIALYREG registry, an online database located on a REDCap web-based platform that allows real-time data analysis. Our main objective was to identify CRRT-related complications in our intensive care units (ICUs) and implement security measures accordingly. From January 2019 to December 2020, we included 323 patients with admission diagnoses of medical illness (54%), sepsis (24%), postoperative care (20%), and trauma (2%). CRRT indications were homeostasis (42%), oliguria (26%), fluid overload (15%), and hemodynamic optimization (13%). The median initial therapy dose was 30 ml/kg/h (IQR 25-40), and dynamic adjustment was performed in 61% of the treatments. Sets were anticoagulated with heparin (40%), citrate (38%) or no anticoagulation (22%). Citrate anticoagulation had several advantages: more frequent dynamic CRRT dose adjustment (77% vs. 58% with heparin and 56% without anticoagulation, p < 0.05), longer duration of set (median of 55 h, IQR 24-72 vs. 23 h, IQR 12-48 with heparin and 12 h, IQR 12-31 without anticoagulation, p < 0.05), less clotting of the set (26% vs. 46.7% with heparin, p < 0.05), and lower incidence of hypophosphatemia (1% citrate vs. 6% with heparin and 5% without anticoagulation). It was also safe and effective in subgroup analysis of patients with liver disease or sepsis. The main global complications were hypothermia (16%), hypophosphatemia (13%) and metabolic acidosis (10%). Weaning of the therapy was achieved through early discontinuation (56%), nocturnal therapy transition (26%) and progressive SLED (18%). 52% of the patients were discharged from the hospital, while 43% died in the ICU and 5% died during hospitalization. We can conclude that the DIALYREG registry is a feasible tool for real-time control of CRRT in our ICU.
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Affiliation(s)
- M González-Fernández
- Department of Intensive Care Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - N Quílez-Trasobares
- Department of Intensive Care Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - J A Barea-Mendoza
- Department of Intensive Care Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Z Molina-Collado
- Department of Intensive Care Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - D Arias-Verdú
- Department of Intensive Care Medicine, Regional University Hospital of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - J Barrueco-Francioni
- Department of Intensive Care Medicine, Regional University Hospital of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - G Seller-Pérez
- Department of Intensive Care Medicine, Regional University Hospital of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - M E Herrera-Gutiérrez
- Department of Intensive Care Medicine, Regional University Hospital of Malaga, Malaga, Spain.
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
- Departamento de Medicina y Dermatología, University of Malaga, Malaga, Spain.
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Mas-Font S, Herrera-Gutiérrez ME, Gómez-González C, Herrera-Rojas D, Montoiro-Allue R, Sánchez-Morán F, García-García MA. Epidemiology of contrast-associated acute kidney injury in critical patients. NEFROCON study. Med Intensiva 2020; 45:S0210-5691(20)30255-2. [PMID: 32859409 DOI: 10.1016/j.medin.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- S Mas-Font
- Servicio de Medicina Intensiva. Hospital Arnau de Vilanova, Valencia, España.
| | - M E Herrera-Gutiérrez
- Servicio de Medicina Intensiva. Hospital Regional Universitario de Málaga, Málaga, España
| | - C Gómez-González
- Servicio de Medicina Intensiva. Hospital Universitario Virgen del Rocío, Sevilla, España
| | - D Herrera-Rojas
- Servicio de Medicina Intensiva. Hospital de Valme, Sevilla, España
| | - R Montoiro-Allue
- Servicio de Medicina Intensiva. Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - F Sánchez-Morán
- Servicio de Medicina Intensiva. Hospital General Universitario de Castellón, Castellón de la Plana, España
| | - M A García-García
- Servicio de Medicina Intensiva. Hospital de Sagunto, Sagunto (Valencia), España
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Seller-Pérez G, Más-Font S, Pérez-Calvo C, Villa-Díaz P, Celaya-López M, Herrera-Gutiérrez ME. Acute kidney injury: Renal disease in the ICU. Med Intensiva 2016; 40:374-82. [PMID: 27388683 DOI: 10.1016/j.medin.2016.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 03/05/2016] [Revised: 04/21/2016] [Accepted: 05/01/2016] [Indexed: 12/26/2022]
Abstract
Acute kidney injury (AKI) in the ICU frequently requires costly supportive therapies, has high morbidity, and its long-term prognosis is not as good as it has been presumed so far. Consequently, AKI generates a significant burden for the healthcare system. The problem is that AKI lacks an effective treatment and the best approach relies on early secondary prevention. Therefore, to facilitate early diagnosis, a broader definition of AKI should be established, and a marker with more sensitivity and early-detection capacity than serum creatinine - the most common marker of AKI - should be identified. Fortunately, new classification systems (RIFLE, AKIN or KDIGO) have been developed to solve these problems, and the discovery of new biomarkers for kidney injury will hopefully change the way we approach renal patients. As a first step, the concept of renal failure has changed from being a "static" disease to being a "dynamic process" that requires continuous evaluation of kidney function adapted to the reality of the ICU patient.
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Affiliation(s)
- G Seller-Pérez
- Intensive Care Medicine, Complejo Hospitalario Universitario Carlos Haya, Málaga, Spain
| | - S Más-Font
- Intensive Care Medicine, Hospital General Universitario de Castellón, Spain
| | - C Pérez-Calvo
- Intensive Care Medicine, HU Fundación Jiménez Díaz, Madrid, Spain
| | - P Villa-Díaz
- Intensive Care Medicine, Hospital Universitario Principe de Asturias, Alcalá de Henares, Madrid, Spain
| | - M Celaya-López
- Intensive Care Medicine, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - M E Herrera-Gutiérrez
- Intensive Care Medicine, Complejo Hospitalario Universitario Carlos Haya, Málaga, Spain.
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Herrera-Gutiérrez ME, Seller-Pérez G, Arias Verdu D, Jironda-Gallegos C, Martín-Velázquez M, Quesada-García G. Dialysis Efficiency of AN69, a Semisynthetic Membrane Not Well Suited for Diffusion. ISRN Nephrol 2013; 2013:185989. [PMID: 24959535 PMCID: PMC4045434 DOI: 10.5402/2013/185989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 11/14/2012] [Indexed: 11/23/2022]
Abstract
AN69 membrane is not suited for diffusion, with an suggested limit at 25 mL/min dialysate flow rate. When prescribing continuous hemodialysis this threshold must be surpassed to achieve. We designed a study aimed to check if a higher dose of dialysis could be delivered efficiently with this membrane. Ten ICU patients under continuous hemodiafiltration with 1.4 m2 AN69 membrane were included and once a day we set the monitor to exclusively 50 mL/min dialysate flow rate and 250 mL/min blood flow rate and after 15 minutes measured dialysate saturation for urea, creatinine, and β2-microglobulin. We detected that urea saturation of dialysate was nearly complete (1.1 ± 0.09) for at least 40 hours, while creatinine saturation showed a large dispersion (0.86 ± 0.22) and did not detect any relation for these variables with time, blood flow, or anticoagulation regime. Saturation of β2-microglobulin was low (0.34 ± 0.1) and decreased discretely with time (r2 = 0.15, P < 0.05) and significantly with TMP increases (r2 = 0.31, P < 0.01). In our experience AN69 membrane shows a better diffusive capability than previously acknowledged, covering efficiently the range of standard dosage for continuous therapies. Creatinine is not a good marker of the membrane diffusive capability.
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Affiliation(s)
| | - G Seller-Pérez
- ICU, Carlos Haya Hospital, Carlos Haya Avenue s/n, 29010 Málaga, Spain
| | - D Arias Verdu
- ICU, Carlos Haya Hospital, Carlos Haya Avenue s/n, 29010 Málaga, Spain
| | | | | | - G Quesada-García
- ICU, Carlos Haya Hospital, Carlos Haya Avenue s/n, 29010 Málaga, Spain
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Seller-Pérez G, Herrera-Gutiérrez ME, Lebrón-Gallardo M, Moreno-Quintana J, Banderas-Bravo E, Quesada-García G. [Liver transplantation: influence of donor-related factors]. Med Intensiva 2008; 32:378-84. [PMID: 19055930 DOI: 10.1016/s0210-5691(08)75708-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To detect donor characteristics related to graft function after orthotopic liver transplantation (OLT). DESIGN Retrospective cohort study. CONTEXT Polyvalent intensive care unit. PATIENTS 145 liver transplant recipients and their respective donors. INTERVENTIONS None. MAIN VARIABLES OF INTEREST In donors: age, hypernatremia, and infection. In recipients: reperfusion syndrome, coagulopathy, infection, ARDS, shock, kidney failure, primary graft dysfunction, and mortality. RESULTS 71.7% of recipients were male. Mean recipient age was 54.5 +/- 9.9 years; 66.2% of patients were classified as Child B and and 19.3% as Child C. The mean model for end-stage liver disease (MELD) score was 14.6 +/- 4.8 and the mean APACHE II score was 17.3 +/- 4.9. A total of 64.1% of the donors were male. Mean donor age was 42.3 +/- 16.3 years, and mean APACHE II score was 22.3 +/- 5.8. Donor age > 65 years was associated to higher recipient aspartate aminotransferase (AST) levels but not to increased complications or mortality. No other donor factors (including age, sex, serum sodium, severity level, transfusions, hemodynamic alterations, renal dysfunction, or infection) were associated to evolution or prognosis. Infection was diagnosed in 18 recipients (12.4%) in the postoperative period; the incidence of infection in recipients that received an organ from infected donors was not different from those that received an organ from an uninfected donor (14.6% versus 11.5%; p > 0.05). CONCLUSIONS We detected no donor characteristics related to graft function or the appearance of complications in recipients during the immediate postoperative period. Donor age > 65 years and documented but appropriately treated bacteremia posed no risk for the viability of the liver after transplantation.
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Affiliation(s)
- G Seller-Pérez
- Servicio de Cuidados Críticos y Urgencias. Complejo Universitario Hospitalario Carlos Haya. Málaga. España.
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Herrera-Gutiérrez ME, Seller-Pérez G, Lebrón-Gallardo M, De La Cruz-Cortés JP, González-Correa JA. [Use of isolated epoprostenol or associated to heparin for the maintenance of the patency of the continuous renal replacement technical circuits]. Med Intensiva 2006; 30:314-21. [PMID: 17067504 DOI: 10.1016/s0210-5691(06)74536-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/21/2022]
Abstract
OBJECTIVE At present, there is no consensus on the best anticoagulant regimen for the maintenance of extrarenal clearance circuits (RRTC). We present our experience with the isolated use of epoprostenol in patients at risk of bleeding or associated to non-fractionated heparin (nFH) in patients with problems of early coagulation of the filters. DESIGN Prospective study of cohorts on all the RRTC filters used in our service since 1994. SCOPE Forty-two-bed polyvalent ICU in a tertiary hospital. INTERVENTIONS Anticoagulation was administered in prefilter perfusion, at doses of 5-7 U/kg/hour for nFH or 4-5 ng/kg/min for epoprostenol. The combined use was done with equal doses of epoprostenol and nFH at 2,5 U/kg/hour. VARIABLES OF MAIN INTEREST: We analyzed the duration of each filter, reason for removing the filter, existence of coagulopathy, platelet count, appearance of bleeding, anticoagulant used and dose. RESULTS We analyzed the use of 2,322 filters (66,957 hours) in 389 patients, 54% of whom had a clot. nFH was used in 74% of the filters for a median of 39 hours (interquartile range: 19-75), epoprostenol in 6% for 32 hours (interquartile range: 17-48) and combined therapy in 4% for 27 hours (interquartile range: 19-41). In the epoprostenol group, we detected a decrease in blood pressure in only two filters that became normal when the dose was decreased. The filters that were initially anticoagulated with nFH had a 14-hour survival as a median versus 27 hours in combined therapy (p < 0.001). In absence of coagulopathy or thrombopenia, we observed mild bleeding in 8%, moderate in 1% and serious in 1% in the 1,170 filters treated with nFH. We only observed mild bleeding in 3% in 66 filters with epoprostenol. CONCLUSIONS Isolated epoprostenol in patients at risk of bleeding provided a similar duration of the filters to nFH, decreasing the risk of bleeding. The use of epoprostenol plus low dose nFH significantly increases their duration in patients with early coagulation.
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Affiliation(s)
- M E Herrera-Gutiérrez
- Servicio de Cuidados Críticos y Urgencias, Complejo Hospitalario Hospital Universitario Carlos Haya, Málaga, España.
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Herrera-Gutiérrez ME, Seller-Pérez G, Maynar-Moliner J, Sánchez-Izquierdo-Riera JA. Epidemiología del fracaso renal agudo en las UCI españolas. Estudio prospectivo multicéntrico FRAMI. Med Intensiva 2006; 30:260-7. [PMID: 16949000 DOI: 10.1016/s0210-5691(06)74522-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [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: 11/21/2022]
Abstract
OBJECTIVE Multicenter study oriented at establishing the incidence and prognosis of acute kidney failure (AKF) in the ICU of our country. MATERIAL AND METHODS Prospective study of adult patients admitted over 8 months in 43 Spanish ICUs to detect AKF defined as creatinine>or=2 mg/dl or diuresis<400 ml/24 hours (in chronic patients 100% increase of creatinine, excluding those with baseline creatinine>or=4 mg/dl). RESULTS 901 episodes of AKF (AKF episodes (incidence 5.7%), 55% of which occurred on admission. A total of 38.4% of the episodes were due to acute tubular necrosis (ATN), 36.6% to prerenal, and 21.2% to mixed. Renal depuration (RC) was required in 38%. Mortality was 42.3% during the AKF episode (34.1% in those who were admitted with AKF versus 50.9% in those who developed it after admission), 80% in patients with Hepatorenal Syndrome, 51.6% in ATN and 29.9% in prerenal. We detect an independent relationship with mortality for age (OR 1.03), background of diabetes (OR 2.06), development of AKF in the ICU (OR 2.51), oliguria (OR 5.76) and RC (OR 2.32). Recovery of the kidney function occurred in 85.6% of the survivors and RC was maintained in only 1.1% on discharge from the ICU. We calculated the area under the curve of APACHE II on admission (0.62), SOFA on onset of AKF (0.68), Liaño index (0.7) and maximum SOFA (0.79). CONCLUSIONS AKF in ICU patients does not show an elevated incidence but does have high mortality, presenting greater seriousness when it appears after admission. However, recovery is elevated in patients who survive. The usual prognostic indexes are not exact in this patient group, the ISA and maximum SOFA being those which shows a closer relationship with mortality.
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Affiliation(s)
- M E Herrera-Gutiérrez
- Cuidados Críticos y Urgencias, Complejo Hospitalario Universitario Carlos Haya, Málaga, España.
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