1
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Nagore D, Candela A, Bürge M, Tamayo E, Murie-Fernández M, Vives M, Monedero P, Álvarez J, Mendez E, Pasqualetto A, Mon T, Pita R, Varela MA, Esteva C, Pereira MA, Sanchez J, Rodriguez MA, Garcia A, Carmona P, López M, Pajares A, Vicente R, Aparicio R, Gragera I, Calderón E, Marcos JM, Gómez L, Rodríguez JM, Matilla A, Medina A, Hernández A, Morales L, Santana L, Garcia E, Montesinos S, Muñoz P, Bravo B, Blanco V. Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00094-5. [PMID: 38704092 DOI: 10.1016/j.redare.2024.04.019] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 05/06/2024]
Abstract
PURPOSE It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI. DESIGN Multicenter prospective international cohort study. SETTING Fourteen university hospitals in Spain and the United Kingdom. PARTICIPANTS We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37). CONCLUSIONS Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.
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Affiliation(s)
- D Nagore
- Departamento de Anestesia y Medicina Perioperatoria, Grupo Quirón - Policlínica Guipúzcoa, San Sebastián, Spain; Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Candela
- Departamento de Anestesia y Medicina Perioperatoria, Grupo Quirón - Policlínica Guipúzcoa, San Sebastián, Spain; Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Bürge
- Departamento de Anestesia y Medicina Perioperatoria, Barts Heart Centre, St Bartholomew's Hospital, Londres, UK
| | - E Tamayo
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - M Vives
- Departamento de Anestesiología & Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain; Departamento de Anestesiología y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain.
| | - P Monedero
- Departamento de Anestesiología & Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain
| | - J Álvarez
- Departamento de Anestesiología y Medicina Perioperatoria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - E Mendez
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Pasqualetto
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - T Mon
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - R Pita
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Alvaro Cunqueiro Vigo, Vigo, Spain
| | - M A Varela
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Alvaro Cunqueiro Vigo, Vigo, Spain
| | - C Esteva
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Alvaro Cunqueiro Vigo, Vigo, Spain
| | - M A Pereira
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Alvaro Cunqueiro Vigo, Vigo, Spain
| | - J Sanchez
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M A Rodriguez
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Garcia
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - P Carmona
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - M López
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - A Pajares
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - R Vicente
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - R Aparicio
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - I Gragera
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Infanta Cristina, Badajoz, Spain
| | - E Calderón
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Puerta de Mar, Cádiz, Spain
| | - J M Marcos
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de León, León, Spain
| | - L Gómez
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - J M Rodríguez
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de Salamanca, Salamanca, Spain
| | - A Matilla
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de Salamanca, Salamanca, Spain
| | - A Medina
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de Málaga, Málaga, Spain
| | - A Hernández
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Policlínica Ibiza, Ibiza, Spain
| | - L Morales
- Servicio de Anestesiología y Medicina Perioperatoria, Hospital Universitario Dr, Negrín, Las Palmas de Gran Canaria, Spain
| | - L Santana
- Servicio de Anestesiología y Medicina Perioperatoria, Hospital Universitario Dr, Negrín, Las Palmas de Gran Canaria, Spain
| | - E Garcia
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - S Montesinos
- Departamento de Anestesiología y Medicina Perioperatoria, Centro Médico Teknon Barcelona, Barcelona, Spain
| | - P Muñoz
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital 12 de octubre, Madrid, Spain
| | - B Bravo
- Servicio de Anestesiología y Medicina Perioperatoria, Hospital de Cruces de Bizkaia, Bilbao, Spain
| | - V Blanco
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
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2
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Ramasco F, Aguilar G, Aldecoa C, Bakker J, Carmona P, Dominguez D, Galiana M, Hernández G, Kattan E, Olea C, Ospina-Tascón G, Pérez A, Ramos K, Ramos S, Tamayo G, Tuero G. Towards the personalization of septic shock resuscitation: the fundamentals of ANDROMEDA-SHOCK-2 trial. Rev Esp Anestesiol Reanim (Engl Ed) 2024; 71:112-124. [PMID: 38244774 DOI: 10.1016/j.redare.2024.01.003] [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] [Received: 05/08/2023] [Accepted: 07/04/2023] [Indexed: 01/22/2024]
Abstract
Septic shock is a highly lethal and prevalent disease. Progressive circulatory dysfunction leads to tissue hypoperfusion and hypoxia, eventually evolving to multiorgan dysfunction and death. Prompt resuscitation may revert these pathogenic mechanisms, restoring oxygen delivery and organ function. High heterogeneity exists among the determinants of circulatory dysfunction in septic shock, and current algorithms provide a stepwise and standardized approach to conduct resuscitation. This review provides the pathophysiological and clinical rationale behind ANDROMEDA-SHOCK-2, an ongoing multicenter randomized controlled trial that aims to compare a personalized resuscitation strategy based on clinical phenotyping and peripheral perfusion assessment, versus standard of care, in early septic shock resuscitation.
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Affiliation(s)
- F Ramasco
- Hospital Universitario de La Princesa, Madrid, Spain.
| | - G Aguilar
- Hospital Clínico Universitario de Valencia, Spain
| | - C Aldecoa
- Hospital Universitario Río Hortega, Valladolid, Spain
| | - J Bakker
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile; The Latin American Intensive Care Network (LIVEN); Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands; Division of Pulmonary Critical Care, and Sleep Medicine, New York University and Columbia University, New York, USA
| | - P Carmona
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - D Dominguez
- Hospital Universitario Ntra. Sra. de Candelaria, Santa Cruz de Tenerife, Spain
| | - M Galiana
- Hospital General Universitario Doctor Balmis, Alicante, Spain
| | - G Hernández
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile; The Latin American Intensive Care Network (LIVEN)
| | - E Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile; The Latin American Intensive Care Network (LIVEN)
| | - C Olea
- Hospital Universitario 12 de Octubre, Madrid. Spain
| | - G Ospina-Tascón
- The Latin American Intensive Care Network (LIVEN); Department of Intensive Care, Fundación Valle del Lili, Cali, Colombia; Translational Research Laboratory in Critical Care Medicine (TransLab-CCM), Universidad Icesi, Cali, Colombia
| | - A Pérez
- Hospital General Universitario de Elche, Spain
| | - K Ramos
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile; The Latin American Intensive Care Network (LIVEN)
| | - S Ramos
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - G Tamayo
- Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain
| | - G Tuero
- Hospital Can Misses, Ibiza, Spain
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3
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García-Hidalgo MC, González J, Benítez ID, Carmona P, Santisteve S, Pérez-Pons M, Moncusí-Moix A, Gort-Paniello C, Rodríguez-Jara F, Molinero M, Belmonte T, Torres G, Labarca G, Nova-Lamperti E, Caballero J, Bermejo-Martin JF, Ceccato A, Fernández-Barat L, Ferrer R, Garcia-Gasulla D, Menéndez R, Motos A, Peñuelas O, Riera J, Torres A, Barbé F, de Gonzalo-Calvo D. Identification of circulating microRNA profiles associated with pulmonary function and radiologic features in survivors of SARS-CoV-2-induced ARDS. Emerg Microbes Infect 2022; 11:1537-1549. [PMID: 35603455 PMCID: PMC9176679 DOI: 10.1080/22221751.2022.2081615] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Indexed: 12/11/2022]
Abstract
There is a limited understanding of the pathophysiology of postacute pulmonary sequelae in severe COVID-19. The aim of current study was to define the circulating microRNA (miRNA) profiles associated with pulmonary function and radiologic features in survivors of SARS-CoV-2-induced ARDS. The study included patients who developed ARDS secondary to SARS-CoV-2 infection (n = 167) and a group of infected patients who did not develop ARDS (n = 33). Patients were evaluated 3 months after hospital discharge. The follow-up included a complete pulmonary evaluation and chest computed tomography. Plasma miRNA profiling was performed using RT-qPCR. Random forest was used to construct miRNA signatures associated with lung diffusing capacity for carbon monoxide (DLCO) and total severity score (TSS). Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment analyses were conducted. DLCO < 80% predicted was observed in 81.8% of the patients. TSS showed a median [P25;P75] of 5 [2;8]. The miRNA model associated with DLCO comprised miR-17-5p, miR-27a-3p, miR-126-3p, miR-146a-5p and miR-495-3p. Concerning radiologic features, a miRNA signature composed by miR-9-5p, miR-21-5p, miR-24-3p and miR-221-3p correlated with TSS values. These associations were not observed in the non-ARDS group. KEGG pathway and GO enrichment analyses provided evidence of molecular mechanisms related not only to profibrotic or anti-inflammatory states but also to cell death, immune response, hypoxia, vascularization, coagulation and viral infection. In conclusion, diffusing capacity and radiological features in survivors from SARS-CoV-2-induced ARDS are associated with specific miRNA profiles. These findings provide novel insights into the possible molecular pathways underlying the pathogenesis of pulmonary sequelae. Trial registration:ClinicalTrials.gov identifier: NCT04457505.. Trial registration:ISRCTN.org identifier: ISRCTN16865246..
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Affiliation(s)
- María C García-Hidalgo
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Jessica González
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Iván D Benítez
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Paola Carmona
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Sally Santisteve
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Manel Pérez-Pons
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Anna Moncusí-Moix
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Clara Gort-Paniello
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Fátima Rodríguez-Jara
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Marta Molinero
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Thalia Belmonte
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Gerard Torres
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Gonzalo Labarca
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepcion, Concepcion, Chile.,Internal Medicine Unit, Complejo Asistencial Dr. Víctor Ríos Ruiz, Los Ángeles, Chile
| | - Estefania Nova-Lamperti
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepcion, Concepcion, Chile
| | - Jesús Caballero
- Grup de Recerca Medicina Intensiva, Intensive Care Department Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Jesús F Bermejo-Martin
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Adrián Ceccato
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Laia Fernández-Barat
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona; IDIBAPS, Barcelona, Spain
| | - Ricard Ferrer
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Intensive Care Department, Vall d'Hebron Hospital Universitari. SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | | - Rosario Menéndez
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Pulmonology Service, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Ana Motos
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona; IDIBAPS, Barcelona, Spain
| | - Oscar Peñuelas
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Hospital Universitario de Getafe, Madrid, Spain
| | - Jordi Riera
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Intensive Care Department, Vall d'Hebron Hospital Universitari. SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Antoni Torres
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Insitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - ICREA, University of Barcelona (UB), Barcelona, Spain
| | - Ferran Barbé
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
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- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
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4
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Targa ADS, Benítez ID, González J, Torres G, Santisteve S, Vaca R, Minguez O, Aguilà M, Carmona P, Moncusí‐Moix A, Gort‐Paniello C, Labarca G, Caballero J, Barberà C, Torres A, de Gonzalo‐Calvo D, Barbé F. Sleep and circadian health 6 months after critical COVID-19 disease. Respirology 2022; 27:1083-1088. [PMID: 36210340 PMCID: PMC9874423 DOI: 10.1111/resp.14390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/19/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Adriano D. S. Targa
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)MadridSpain
| | - Iván D. Benítez
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)MadridSpain
| | - Jessica González
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain
| | - Gerard Torres
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)MadridSpain
| | - Sally Santisteve
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain
| | - Rafaela Vaca
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain
| | - Olga Minguez
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain
| | - Maria Aguilà
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain
| | - Paola Carmona
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain
| | - Anna Moncusí‐Moix
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)MadridSpain
| | - Clara Gort‐Paniello
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)MadridSpain
| | - Gonzalo Labarca
- Department of Clinical Biochemistry and Immunology, Faculty of PharmacyUniversity of ConcepcionConcepcionChile,Division of Sleep and Circadian DisordersBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Jesús Caballero
- Intensive Care DepartmentHospital Universitari Arnau de VilanovaLleidaSpain
| | - Carme Barberà
- Intensive Care DepartmentHospital Universitari Santa MariaLleidaSpain
| | - Antoni Torres
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)MadridSpain,Servei de Pneumologia, Hospital ClinicUniversitat de BarcelonaBarcelonaSpain
| | - David de Gonzalo‐Calvo
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)MadridSpain
| | - Ferran Barbé
- Translational Research in Respiratory MedicineHospital Universitari Arnau de Vilanova‐Santa Maria, Institut de Recerca Biomèdica de Lleida (IRBLleida)LleidaSpain,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)MadridSpain
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5
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Targa A, Benítez I, Moncusí-Moix A, Vaca R, Gort-Paniello C, Minguez O, Santisteve S, Carmona P, Torres G, Labarca G, Caballero J, Barberà C, Torres A, González J, De Gonzalo-Calvo D, Barbé F. Sleep and circadian rest-activity pattern of critical COVID-19 survivors in the long-term: a 6-month follow-up study. Sleep Med 2022. [PMCID: PMC9300256 DOI: 10.1016/j.sleep.2022.05.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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6
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García-Hidalgo MC, Peláez R, González J, Santisteve S, Benítez ID, Molinero M, Perez-Pons M, Belmonte T, Torres G, Moncusí-Moix A, Gort-Paniello C, Aguilà M, Seck F, Carmona P, Caballero J, Barberà C, Ceccato A, Fernández-Barat L, Ferrer R, Garcia-Gasulla D, Lorente-Balanza JÁ, Menéndez R, Motos A, Peñuelas O, Riera J, Bermejo-Martin JF, Torres A, Barbé F, de Gonzalo-Calvo D, Larráyoz IM. Genome-wide transcriptional profiling of pulmonary functional sequelae in ARDS- secondary to SARS-CoV-2 infection. Biomed Pharmacother 2022; 154:113617. [PMID: 36058144 PMCID: PMC9424524 DOI: 10.1016/j.biopha.2022.113617] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/18/2022] [Accepted: 08/27/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Up to 80% of patients surviving acute respiratory distress syndrome (ARDS) secondary to SARS-CoV-2 infection present persistent anomalies in pulmonary function after hospital discharge. There is a limited understanding of the mechanistic pathways linked to post-acute pulmonary sequelae. AIM To identify the molecular underpinnings associated with severe lung diffusion involvement in survivors of SARS-CoV-2-induced ARDS. METHODS Survivors attended to a complete pulmonary evaluation 3 months after hospital discharge. RNA sequencing (RNA-seq) was performed using Illumina technology in whole-blood samples from 50 patients with moderate to severe diffusion impairment (DLCO<60%) and age- and sex-matched individuals with mild-normal lung function (DLCO≥60%). A transcriptomic signature for optimal classification was constructed using random forest. Transcriptomic data were analyzed for biological pathway enrichment, cellular deconvolution, cell/tissue-specific gene expression and candidate drugs. RESULTS RNA-seq identified 1357 differentially expressed transcripts. A model composed of 14 mRNAs allowed the optimal discrimination of survivors with severe diffusion impairment (AUC=0.979). Hallmarks of lung sequelae involved cell death signaling, cytoskeleton reorganization, cell growth and differentiation and the immune response. Resting natural killer (NK) cells were the most important immune cell subtype for the prediction of severe diffusion impairment. Components of the signature correlated with neutrophil, lymphocyte and monocyte counts. A variable expression profile of the transcripts was observed in lung cell subtypes and bodily tissues. One upregulated gene, TUBB4A, constitutes a target for FDA-approved drugs. CONCLUSIONS This work defines the transcriptional programme associated with post-acute pulmonary sequelae and provides novel insights for targeted interventions and biomarker development.
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Affiliation(s)
- María C. García-Hidalgo
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Rafael Peláez
- Biomarkers and Molecular Signaling Group, Neurodegenerative Diseases Area Center for Biomedical Research of La Rioja, CIBIR, Logroño, Spain
| | - Jessica González
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Sally Santisteve
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Iván D. Benítez
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Marta Molinero
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Manel Perez-Pons
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Thalía Belmonte
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Gerard Torres
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Anna Moncusí-Moix
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Clara Gort-Paniello
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Maria Aguilà
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Faty Seck
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Paola Carmona
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Jesús Caballero
- Grup de Recerca Medicina Intensiva, Intensive Care Department Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Carme Barberà
- Intensive Care Department, University Hospital Santa María, IRBLleida, Lleida, Spain
| | - Adrián Ceccato
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Laia Fernández-Barat
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Servei de Pneumologia, Hospital Clinic; Universitat de Barcelona; IDIBAPS, Barcelona, Spain
| | - Ricard Ferrer
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Intensive Care Department, Vall d’Hebron Hospital Universitari. SODIR Research Group, Vall d’Hebron Institut de Recerca (VHIR), Spain
| | | | - Jose Ángel Lorente-Balanza
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Hospital Universitario de Getafe, Madrid, Spain
| | - Rosario Menéndez
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Pulmonology Service, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Ana Motos
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Servei de Pneumologia, Hospital Clinic; Universitat de Barcelona; IDIBAPS, Barcelona, Spain
| | - Oscar Peñuelas
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Hospital Universitario de Getafe, Madrid, Spain
| | - Jordi Riera
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Intensive Care Department, Vall d’Hebron Hospital Universitari. SODIR Research Group, Vall d’Hebron Institut de Recerca (VHIR), Spain
| | - Jesús F. Bermejo-Martin
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Antoni Torres
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Insitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), ICREA, University of Barcelona (UB), Barcelona, Spain
| | - Ferran Barbé
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Correspondence to: Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Avda. Alcalde Rovira Roure 80, Lleida 25198, Spain
| | - Ignacio M. Larráyoz
- Biomarkers and Molecular Signaling Group, Neurodegenerative Diseases Area Center for Biomedical Research of La Rioja, CIBIR, Logroño, Spain,GRUPAC, Department of Nursing, University of La Rioja, Logroño, Spain,Correspondence to: Biomarkers and Molecular Signaling Group, Neurodegenerative Diseases Area, Center for Biomedical Research of La Rioja, CIBIR. C. Piqueras, 98, Logroño 26006, Spain
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Vives M, Hernández A, Carmona P, Villen T, Borrat X, Sánchez E, Nagore D, González AD, Cuesta P, Serna M, Campo R, Bengoetxea U, Mercadal J. Diploma on Basic Echocardiography training and competencies for Intensive Care and Emergency medicine: Consensus document of the Spanish Society of Anesthesiology and Critical Care (SEDAR) and the Spanish Society of Emergency Medicine (SEMES). Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:402-410. [PMID: 35871144 DOI: 10.1016/j.redare.2021.05.015] [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] [Received: 11/08/2020] [Accepted: 05/09/2021] [Indexed: 06/15/2023]
Abstract
Cardiac ultrasound has become an essential tool for diagnosis and hemodynamic monitoring in critically ill patients. Scientific societies need to work toward developing a training program that will allow clinicians to acquire competence in performing cardiac ultrasound and understanding its indications. The Clinical Ultrasound for Intensive Care task force of the Spanish Society of Anesthesiology and Critical Care (SEDAR) and the Spanish Society of Emergency Medicine (SEMES) have drawn up this position statement defining the learning objectives and training required to acquire the competencies recommended for basic ultrasound management in the intensive care and emergency setting in order to obtain a diploma in Basic Ultrasound in Intensive Care and Emergency Medicine. This document defines the training program and the competencies needed for basic skills in ultrasound in Intensive Care and Emergency Medicine-part of the Diploma in Ultrasound for Intensive Care and Emergency Medicine awarded by SEDAR/SEMES. The Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES) have drawn up a position statement determining the competencies and training program for a diploma in ultrasound (lung, abdominal and vascular) in Intensive Care and Emergency Medicine. To obtain the SEDAR/SEMES Diploma in Ultrasound in Intensive Care and Emergency Medicine, clinicians must have completed the SEDAR, SEMI and SEMES Diploma in basic ultrasound and the Diploma in lung, abdominal, and vascular ultrasound.
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Affiliation(s)
- M Vives
- Co-directores del Grupo de trabajo de Ecografía Clínica en Cuidados Intensivos de la SEDAR; Unidad de Reanimación Posquirúrgica, Servicio de Anestesiología y Reanimación. Hospital Universitario de Girona Dr. J Trueta. Institut d'Investigació Biomèdica de Girona (IDIBGI), Universitat de Girona, Girona, Spain. Representante en España de la «European Association of Cardiothoracic Anesthesia and Intensive Care» (EACTAIC).
| | - A Hernández
- Unidad de Reanimación Posquirúrgica, Servicio de Anestesiología y Reanimación, Grupo Policlínica, Ibiza, Spain. Board member del Subcomité de Cuidados Intensivos de la EACTAIC
| | - P Carmona
- Unidad de Reanimación Posquirúrgica, Servicio de Anestesiología y Reanimación, Hospital Universitario La Fe, Valencia, Spain
| | - T Villen
- Director del Grupo de trabajo de Ecografía Clínica en Urgencias y Emergencias de la SEMES; Servicio de Urgencias, Hospital Universitario La Paz, Madrid, Spain
| | - X Borrat
- Unidad de Cuidados Intensivos Postquirúrgica, Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain
| | - E Sánchez
- Unidad de Reanimación Postquirúrgica, Servicio de Anestesiología y Reanimación, Hospital Gregorio Marañón, Madrid, Spain
| | - D Nagore
- Intensive Care Unit, Department of Anaesthesia & Intensive Care, Barts Heart Center, Barts Health NHS Trust, London, UK
| | - A D González
- Unidad de Cuidados Intensivos, Servicio de Anestesiología y Reanimación, Clínica Universidad de Navarra, Pamplona, Spain
| | - P Cuesta
- Unidad de Reanimación Postquirúrgica, Servicio de Anestesiología y Reanimación, Hospital Universitario de Albacete, Spain
| | - M Serna
- Unidad de Reanimación Postquirúrgica, Servicio de Anestesiología y Reanimación, Hospital Universitario de Denia, Spain
| | - R Campo
- Servicio de Urgencias, Hospital Santa Bárbara de Puertollano, Ciudad Real, Spain
| | - U Bengoetxea
- Unidad de Reanimación Postquirúrgica, Servicio de Anestesiología y Reanimación, Hospital de Urduliz, Bilbao, Spain
| | - J Mercadal
- Co-directores del Grupo de trabajo de Ecografía Clínica en Cuidados Intensivos de la SEDAR; Unidad de Cuidados Intensivos Postquirúrgica, Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain; Coordinador de la Sección de Críticos de la Sociedad Catalana de Anestesiología y Reanimación (SCARDT)
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8
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García-Hidalgo MC, González J, Benítez ID, Carmona P, Santisteve S, Moncusí-Moix A, Gort-Paniello C, Rodríguez-Jara F, Molinero M, Perez-Pons M, Torres G, Caballero J, Barberà C, Tedim AP, Almansa R, Ceccato A, Fernández-Barat L, Ferrer R, Garcia-Gasulla D, Menéndez R, Motos A, Peñuelas O, Riera J, Bermejo-Martin JF, Torres A, Barbé F, de Gonzalo-Calvo D. Proteomic profiling of lung diffusion impairment in the recovery stage of SARS-CoV-2-induced ARDS. Clin Transl Med 2022; 12:e838. [PMID: 35538880 PMCID: PMC9091985 DOI: 10.1002/ctm2.838] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 12/19/2022] Open
Affiliation(s)
- María C García-Hidalgo
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Jessica González
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Iván D Benítez
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Paola Carmona
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Sally Santisteve
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Anna Moncusí-Moix
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Clara Gort-Paniello
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Fátima Rodríguez-Jara
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Marta Molinero
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Manel Perez-Pons
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Gerard Torres
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Jesús Caballero
- Intensive Care Department, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Carme Barberà
- Intensive Care Department, University Hospital Santa María, IRBLleida, Lleida, Spain
| | - Ana P Tedim
- Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.,Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Raquel Almansa
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.,Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Adrián Ceccato
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Laia Fernández-Barat
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Ricard Ferrer
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Intensive Care Department, Vall d'Hebron Hospital Universitari, SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Spain
| | | | - Rosario Menéndez
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Pulmonology Service, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Ana Motos
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Oscar Peñuelas
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Hospital Universitario de Getafe, Madrid, Spain
| | - Jordi Riera
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Intensive Care Department, Vall d'Hebron Hospital Universitari, SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Spain
| | - Jesús F Bermejo-Martin
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.,Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Antoni Torres
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Ferran Barbé
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
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9
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González J, Benítez ID, de Gonzalo-Calvo D, Torres G, de Batlle J, Gómez S, Moncusí-Moix A, Carmona P, Santisteve S, Monge A, Gort-Paniello C, Zuil M, Cabo-Gambín R, Manzano Senra C, Vengoechea Aragoncillo JJ, Vaca R, Minguez O, Aguilar M, Ferrer R, Ceccato A, Fernández L, Motos A, Riera J, Menéndez R, Garcia-Gasulla D, Peñuelas O, Labarca G, Caballero J, Barberà C, Torres A, Barbé F. Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study. Crit Care 2022; 26:18. [PMID: 35012662 PMCID: PMC8744383 DOI: 10.1186/s13054-021-03882-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023]
Abstract
Question We evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae.
Materials and methods Prospective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge.
Results We included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29–4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42–4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of − 10.77 (95% CI − 18.40 to − 3.15), with a greater number of affected lobes (+ 1.51 [95% CI 0.89–2.13]) and a greater TSS (+ 4.35 [95% CI 2.41–6.27]) in the chest CT scan. Conclusions Among critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03882-1.
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Affiliation(s)
- Jessica González
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Iván D Benítez
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Gerard Torres
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Jordi de Batlle
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Silvia Gómez
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Anna Moncusí-Moix
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Paola Carmona
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Sally Santisteve
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Aida Monge
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Clara Gort-Paniello
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - María Zuil
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Ramón Cabo-Gambín
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Carlos Manzano Senra
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - José Javier Vengoechea Aragoncillo
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain.,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain.,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Rafaela Vaca
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain
| | - Olga Minguez
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain
| | - María Aguilar
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain
| | - Ricard Ferrer
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Intensive Care Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain.,SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Adrián Ceccato
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Laia Fernández
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Pulmonary Department, Hospital Clinic, Universitat de Barcelona. IDIBAPS. ICREA, Barcelona, Spain
| | - Ana Motos
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Pulmonary Department, Hospital Clinic, Universitat de Barcelona. IDIBAPS. ICREA, Barcelona, Spain
| | - Jordi Riera
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Intensive Care Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain.,SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Rosario Menéndez
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | - Oscar Peñuelas
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Hospital Universitario de Getafe, Madrid, Spain
| | - Gonzalo Labarca
- Faculty of Medicine, University of Concepcion, Concepción, Chile.,Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepción, Chile
| | - Jesús Caballero
- Intensive Care Department, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida, Lleida, Spain
| | - Carme Barberà
- Intensive Care Department, Hospital Universitari Santa Maria de Lleida, Lleida, Spain
| | - Antoni Torres
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.,Pulmonary Department, Hospital Clinic, Universitat de Barcelona. IDIBAPS. ICREA, Barcelona, Spain
| | - Ferran Barbé
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain. .,Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain. .,Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain. .,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.
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10
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González J, Carmona P, Gracia-Lavedan E, Benítez ID, Antón A, Balaña A, Díaz SB, Bernadich Ò, Córdoba A, Embid C, Espallargues M, Luján M, Martí S, Castillo O, Del Pilar M, Tárrega J, Barbé F, Escarrabill J. Cluster analysis of home mechanical ventilation in copd patients: a picture of the real world and its impact on mortality. Arch Bronconeumol 2022; 58:642-648. [DOI: 10.1016/j.arbres.2021.12.015] [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] [Received: 10/20/2021] [Revised: 12/10/2021] [Accepted: 12/30/2021] [Indexed: 11/02/2022]
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11
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Galan J, Mateo E, Carmona P, Gajate L, Mazer CD, Martinez-Zapata MJ. Restrictive or liberal transfusion for cardiac surgery: Spanish results of a randomized multicenter international parallel open-label clinical trial. Med Intensiva 2022; 46:53-57. [PMID: 34991874 DOI: 10.1016/j.medine.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/31/2020] [Indexed: 06/14/2023]
Affiliation(s)
- J Galan
- Department of Anesthesia, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - E Mateo
- Department of Anesthesia, Consorcio Hospital General de Valencia, Valencia, Spain
| | - P Carmona
- Department of Anesthesia, Hospital Universitario y Politécnico La Fe de Valencia, Valencia, Spain
| | - L Gajate
- Department of Anesthesia, Hospital Ramón y Cajal, Madrid, Spain
| | - C D Mazer
- Department of Anesthesia and LKSKI of Saint Michael's Hospital, University of Toronto, Toronto, Canada
| | - M J Martinez-Zapata
- Iberoamerican Cochrane-Centre-Clinical Epidemiology and Health Service.IIB Sant Pau. CIBERESP, Barcelona, Spain.
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12
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Cabo-Gambin R, Benítez ID, Carmona P, Santiesteve S, Mínguez O, Vaca R, Moncusí-Moix A, Gort-Paniello C, García-Hidalgo MC, de Gonzalo-Calvo D, de Batlle J, Torres G, Torres A, Barbé F, González J. Three to Six Months Evolution of Pulmonary Function and Radiological Features in Critical COVID-19 Patients: A Prospective Cohort. Arch Bronconeumol 2021; 58:S0300-2896(21)00208-8. [PMID: 35312604 PMCID: PMC8313896 DOI: 10.1016/j.arbres.2021.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/12/2023]
Key Words
- ards, acute respiratory distress syndrome
- covid-19, coronavirus disease 2019
- ct, computed tomography
- dlco, diffusing capacity for carbon monoxide
- fev1, forced expiratory volume during the first second of the forced breath
- fvc, forced vital capacity
- ggo, ground-glass opacities
- icu, intensive care unit
- imv, invasive mechanical ventilation
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- tlc, total lung capacity
- tss, total severity score
- 6mwt, 6 minutes walking test
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Affiliation(s)
- Ramón Cabo-Gambin
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Iván D Benítez
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Paola Carmona
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Sally Santiesteve
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Olga Mínguez
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Rafaela Vaca
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Anna Moncusí-Moix
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Clara Gort-Paniello
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - María C García-Hidalgo
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Jordi de Batlle
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Gerard Torres
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Antoni Torres
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Pulmonary Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, ICREA, Barcelona, Spain
| | - Ferran Barbé
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Jessica González
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.
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13
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González J, Benítez ID, Carmona P, Santisteve S, Monge A, Moncusí-Moix A, Gort-Paniello C, Pinilla L, Carratalá A, Zuil M, Ferrer R, Ceccato A, Fernández L, Motos A, Riera J, Menéndez R, Garcia-Gasulla D, Peñuelas O, Bermejo-Martin JF, Labarca G, Caballero J, Torres G, de Gonzalo-Calvo D, Torres A, Barbé F. Pulmonary Function and Radiologic Features in Survivors of Critical COVID-19: A 3-Month Prospective Cohort. Chest 2021; 160:187-198. [PMID: 33676998 PMCID: PMC7930807 DOI: 10.1016/j.chest.2021.02.062] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [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: 10/14/2020] [Revised: 02/12/2021] [Accepted: 02/25/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND More than 20% of hospitalized patients with COVID-19 demonstrate ARDS requiring ICU admission. The long-term respiratory sequelae in such patients remain unclear. RESEARCH QUESTION What are the major long-term pulmonary sequelae in critical patients who survive COVID-19? STUDY DESIGN AND METHODS Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-min walking test [6MWT]), and chest CT imaging. RESULTS One hundred twenty-five patients admitted to the ICU with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%) and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median distance in the 6MWT was 400 m (interquartile range, 362-440 m). CT scans showed abnormal results in 70.2% of patients, demonstrating reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT scan showed worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT scan were age and length of invasive mechanical ventilation during the ICU stay. INTERPRETATION Three months after hospital discharge, pulmonary structural abnormalities and functional impairment are highly prevalent in patients with ARDS secondary to COVID-19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.
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Affiliation(s)
- Jessica González
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Iván D Benítez
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Paola Carmona
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Sally Santisteve
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Aida Monge
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Anna Moncusí-Moix
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Clara Gort-Paniello
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Lucía Pinilla
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Amara Carratalá
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - María Zuil
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Ricard Ferrer
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Intensive Care Department, Vall d'Hebron Hospital Universitari. SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Adrián Ceccato
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Laia Fernández
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Pulmonary Department, Hospital Clinic, Universitat de Barcelona, IDIBAPS, ICREA, Barcelona, Spain
| | - Ana Motos
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Pulmonary Department, Hospital Clinic, Universitat de Barcelona, IDIBAPS, ICREA, Barcelona, Spain
| | - Jordi Riera
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Intensive Care Department, Vall d'Hebron Hospital Universitari. SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Rosario Menéndez
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Pulmonary Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | - Oscar Peñuelas
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Hospital Universitario de Getafe, Madrid, Spain
| | - Jesús F Bermejo-Martin
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Gonzalo Labarca
- Faculty of Medicine, Faculty of Pharmacy, University of Concepcion, Concepción, Chile; Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepción, Chile
| | - Jesus Caballero
- Intensive Care Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain
| | - Gerard Torres
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Antoni Torres
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Pulmonary Department, Hospital Clinic, Universitat de Barcelona, IDIBAPS, ICREA, Barcelona, Spain
| | - Ferran Barbé
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain; Translational Research in Respiratory Medicine Group (TRRM), Lleida, Spain; Lleida Biomedical Research Institute (IRBLleida), Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.
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14
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Vives M, Hernández A, González AD, Torres J, Cuesta P, Villen T, Carmona P, Nagore D, Serna M, Bengoetxea U, Borrat X, García de Casasola G, Sánchez E, Campo R, Mercadal J. Diploma on Ultrasound training and competency for Intensive Care and Emergency Medicine: Consensus document of the Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES). Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:143-148. [PMID: 33172655 DOI: 10.1016/j.redar.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
The use of ultrasound as a clinical diagnostic tool and guide of bedside procedures has become an indispensable examination in the acute critically ill patient. The training of professionals in minimum skills of knowledge, management and indications of use of ultrasound required to be defined by the Scientific Societies. The Intensive Care Ultrasound Working Group of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Emergency Medicine (SEMES) has developed this consensus document in which the recommended training program and the minimum competencies to be achieved with regard to the use of Ultrasound in Intensive Care, Anesthesia and Emergency medicine are defined. This document defines the training program and the skills to acquire in order to achieve the diploma in lung, abdominal and vascular ultrasound. This document can serve as a guide to define the skills to be acquired in the training programs of residents (MIRs) of specialists working in intensive care, anesthesia, and emergency medicine.
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Affiliation(s)
- M Vives
- Co-director del grupo de trabajo de Ecografía Clínica en Cuidados Intensivos de la SEDAR; Servicio de Anestesia y Reanimación, Hospital Universitario de Girona Dr. J. Trueta. Universidad de Girona, Girona, España.
| | - A Hernández
- Servicio de Anestesia y Reanimación, Grupo Policlínica, Ibiza, España
| | - A D González
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Pamplona, España
| | - J Torres
- Servicio de Medicina Interna, Hospital Universitario Infanta Cristina Parla, Madrid, España; Co-director del grupo de trabajo de Ecografía Clínica de la SEMI
| | - P Cuesta
- Servicio de Anestesia y Reanimación, Hospital Universitario de Albacete, Albacete, España
| | - T Villen
- Servicio de Urgencias, Hospital Universitario La Paz, Madrid, España; Director del grupo de trabajo de Ecografía Clínica de la SEMES
| | - P Carmona
- Servicio de Anestesia y Reanimación, Hospital Universitario La Fe, Valencia, España
| | - D Nagore
- Department of Anaesthesia & Intensive Care, Barts Heart Center. Barts Health NHS Trust, London, Reino Unido
| | - M Serna
- Servicio de Anestesia y Reanimación, Hospital Universitario de Denia, Denia, Alicante, España
| | - U Bengoetxea
- Servicio de Anestesia y Reanimación, Hospital de Urduliz, Bilbao, España
| | - X Borrat
- Servicio de Anestesia y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - G García de Casasola
- Servicio de Medicina Interna, Hospital Universitario Infanta Cristina. Parla, Madrid, España; Co-director del grupo de trabajo de Ecografía Clínica de la SEMI
| | - E Sánchez
- Servicio de Anestesia y Reanimación, Hospital Gregorio Marañón, Madrid, España
| | - R Campo
- Servicio de Urgencias, Hospital Santa Bárbara de Puertollano, Ciudad Real, España
| | - J Mercadal
- Co-director del grupo de trabajo de Ecografía Clínica en Cuidados Intensivos de la SEDAR; Servicio de Anestesia y Reanimación, Hospital Clinic de Barcelona, Barcelona, España
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15
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González J, Moncusí-Moix A, Benitez ID, Santisteve S, Monge A, Fontiveros MA, Carmona P, Torres G, Barbé F, de Batlle J. Clinical Consequences of COVID-19 Lockdown in Patients With COPD: Results of a Pre-Post Study in Spain. Chest 2021; 160:135-138. [PMID: 33444614 PMCID: PMC7797779 DOI: 10.1016/j.chest.2020.12.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/13/2020] [Accepted: 12/18/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jessica González
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Lleida, Spain
| | - Anna Moncusí-Moix
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Lleida, Spain
| | - Ivan D Benitez
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Lleida, Spain
| | - Sally Santisteve
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Lleida, Spain
| | - Aida Monge
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Lleida, Spain
| | - Maria Angeles Fontiveros
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Lleida, Spain
| | - Paola Carmona
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Lleida, Spain
| | - Gerard Torres
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Lleida, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Lleida, Spain
| | - Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Lleida, Spain.
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16
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Galan J, Mateo E, Carmona P, Gajate L, Mazer CD, Martinez-Zapata MJ. Restrictive or liberal transfusion for cardiac surgery: Spanish results of a randomized multicenter international parallel open-label clinical trial. Med Intensiva 2020; 46:S0210-5691(20)30268-0. [PMID: 33012573 DOI: 10.1016/j.medin.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/12/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Affiliation(s)
- J Galan
- Department of Anesthesia, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - E Mateo
- Department of Anesthesia, Consorcio Hospital General de Valencia, Valencia, Spain
| | - P Carmona
- Department of Anesthesia, Hospital Universitario y Politécnico La Fe de Valencia, Valencia, Spain
| | - L Gajate
- Department of Anesthesia, Hospital Ramón y Cajal, Madrid, Spain
| | - C D Mazer
- Department of Anesthesia and LKSKI of Saint Michael's Hospital, University of Toronto, Toronto, Canada
| | - M J Martinez-Zapata
- Iberoamerican Cochrane-Centre-Clinical Epidemiology and Health Service.IIB Sant Pau. CIBERESP, Barcelona, Spain.
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Gutiérrez-Carrasquilla L, López-Cano C, Sánchez E, Barbé F, Dalmases M, Hernández M, Campos A, Gaeta AM, Carmona P, Hernández C, Simó R, Lecube A. Effect of Glucose Improvement on Nocturnal Sleep Breathing Parameters in Patients with Type 2 Diabetes: The Candy Dreams Study. J Clin Med 2020; 9:jcm9041022. [PMID: 32260419 PMCID: PMC7230160 DOI: 10.3390/jcm9041022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/18/2020] [Revised: 03/24/2020] [Accepted: 04/01/2020] [Indexed: 12/16/2022] Open
Abstract
Type 2 diabetes exerts a negative impact on sleep breathing. It is unknown whether a long-term improvement in glycemic control ameliorates this effect. We conducted an interventional study with 35 patients with type 2 diabetes and obstructive sleep apnea (OSA) to explore this. At home, sleep breathing parameters were assessed at baseline and after a 4-month period in which antidiabetic therapy was intensified. Patients who decreased their body mass index ≥2kg/m2 were excluded. Those with an HbA1c reduction ≥0.5% were considered good responders (n = 24). After the follow-up, good responders exhibited an improvement in the apnea–hypopnea index (AHI: 26-1 (95% IC: 8.6–95.0) vs. 20.0 (4.0–62.4) events/hour, p = 0.002) and in time with oxygen saturation below 90% (CT90: 13.3 (0.4–69.0) vs. 8.1 (0.4–71.2) %, p = 0.002). No changes were observed in the group of non–responders (p = 0.722 and p = 0.138, respectively). The percentage of moderate and severe OSA decreased among good responders (p = 0.040). In the wider population, the change in HbA1c correlated positively to decreases in AHI (r = 0.358, p = 0.035) and negatively to increases in the minimum arterial oxygen saturation (r = −0.386, p = 0.039). Stepwise multivariate regression analysis showed that baseline AHI and the absolute change in HbA1c independently predicted decreased AHI (R2 = 0.496). The improvement of glycemic control exerts beneficial effects on sleep breathing parameters in type 2 diabetes, which cannot be attributed merely to weight loss.
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Affiliation(s)
- Liliana Gutiérrez-Carrasquilla
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain; (L.G.-C.); (C.L.-C.); (E.S.); (M.H.); (A.C.)
| | - Carolina López-Cano
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain; (L.G.-C.); (C.L.-C.); (E.S.); (M.H.); (A.C.)
| | - Enric Sánchez
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain; (L.G.-C.); (C.L.-C.); (E.S.); (M.H.); (A.C.)
| | - Ferran Barbé
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, 25198 Lleida, Spain; (F.B.); (M.D.); (A.M.G.); (P.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Mireia Dalmases
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, 25198 Lleida, Spain; (F.B.); (M.D.); (A.M.G.); (P.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Marta Hernández
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain; (L.G.-C.); (C.L.-C.); (E.S.); (M.H.); (A.C.)
| | - Angela Campos
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain; (L.G.-C.); (C.L.-C.); (E.S.); (M.H.); (A.C.)
| | - Anna Michaela Gaeta
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, 25198 Lleida, Spain; (F.B.); (M.D.); (A.M.G.); (P.C.)
| | - Paola Carmona
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, 25198 Lleida, Spain; (F.B.); (M.D.); (A.M.G.); (P.C.)
| | - Cristina Hernández
- Endocrinology and Nutrition Department, University Hospital Vall d’Hebron, Diabetes and Metabolism Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Autonomous University of Barcelona, 08035 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Rafael Simó
- Endocrinology and Nutrition Department, University Hospital Vall d’Hebron, Diabetes and Metabolism Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Autonomous University of Barcelona, 08035 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: (R.S.); (A.L.)
| | - Albert Lecube
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain; (L.G.-C.); (C.L.-C.); (E.S.); (M.H.); (A.C.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: (R.S.); (A.L.)
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García-Berrocal A, Montalvo C, Carmona P, Blázquez J. The Coriolis mass flow meter as a volume meter for the custody transfer in liquid hydrocarbons logistics. ISA Trans 2019; 90:311-318. [PMID: 30711341 DOI: 10.1016/j.isatra.2019.01.007] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/16/2018] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
In recent years, the Coriolis mass flow meters (CMF), devices based on the Coriolis effect over a vibrating pipe, have developed better metrological performance and they are now a reasonable alternative for the custody transfer measurements. Nowadays, many custody transfer operations require measurement of the net volume (volume measured at a certain reference temperature) and, therefore, it is not feasible to use the CMF as a mass flow meter. However, the actual CMF can be used as net volume meters because they have special equipment to measure density and temperature, and a flow computer. In this work, firstly a mathematical simplification of the physical model is proposed for the CMF. We part from the dimensional analysis of the flow-phase relationship produced by the Coriolis force, the main physical principle behind these devices. A simplified formula is obtained and it permits identifying the magnitudes of influence of the CMF as a mass meter. Secondly, its metrological properties are characterized. For such purpose, a 4" straight tube commercial meter has been calibrated in volume, in the 50 to 165 m3/h range against a standard container and a bidirectional prover, employing gas oil and kerosene (JET-A1). These calibrations have turned out to be compatible with the ones performed by the manufacturer in mass and using water. Then it is verified that the CMF fulfills the requisites of the legal metrology: maximum error allowed, linearity and repeatability. Skewness is observed in the relative error (expressed in %) of the CMF and it has been researched to be due to systematic effects related to constructive parameters of the meter. Lineal correlation is verified between relative error and temperature, and between relative error and flow rate, with negative slopes of -0.03% °C-1 and -0.001% h/m3 respectively.
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Affiliation(s)
- A García-Berrocal
- Universidad Politécnica de Madrid (UPM), CLH Chair in Hydrocarbon Metrology, ETSI Minas y Energía, Ríos Rosas 21, Madrid 28003, Spain
| | - C Montalvo
- Universidad Politécnica de Madrid (UPM), CLH Chair in Hydrocarbon Metrology, ETSI Minas y Energía, Ríos Rosas 21, Madrid 28003, Spain.
| | - P Carmona
- CLH Group, Titán 13, Madrid 28045, Spain
| | - J Blázquez
- CIEMAT, Avenida Complutense 40, Madrid 28040, Spain
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Gutiérrez-Carrasquilla L, Sánchez E, Barbé F, Dalmases M, López-Cano C, Hernández M, Rius F, Carmona P, Hernández C, Simó R, Lecube A. Effect of Glucose Improvement on Spirometric Maneuvers in Patients With Type 2 Diabetes: The Sweet Breath Study. Diabetes Care 2019; 42:617-624. [PMID: 30705064 DOI: 10.2337/dc18-1948] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/08/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes exerts a deleterious effect on lung function. However, it is unknown whether an improvement in glycemic control ameliorates pulmonary function. RESEARCH DESIGN AND METHODS Prospective interventional study with 60 patients with type 2 diabetes and forced expiratory volume in 1 s (FEV1) ≤90% of predicted. Spirometric maneuvers were evaluated at baseline and after a 3-month period in which antidiabetic therapy was intensified. Those with an HbA1c reduction of ≥0.5% were considered to be good responders (n = 35). RESULTS Good responders exhibited a significant improvement in spirometric values between baseline and the end of the study (forced vital capacity [FVC]: 78.5 ± 12.6% vs. 83.3 ± 14.7%, P = 0.029]; FEV1: 75.6 ± 15.3% vs. 80.9 ± 15.4%, P = 0.010; and peak expiratory flow [PEF]: 80.4 ± 21.6% vs. 89.2 ± 21.0%, P = 0.007). However, no changes were observed in the group of nonresponders when the same parameters were evaluated (P = 0.586, P = 0.987, and P = 0.413, respectively). Similarly, the initial percentage of patients with a nonobstructive ventilatory defect and with an abnormal FEV1 decreased significantly only among good responders. In addition, the absolute change in HbA1c inversely correlated to increases in FEV1 (r = -0.370, P = 0.029) and PEF (r = -0.471, P = 0.004) in the responders group. Finally, stepwise multivariate regression analysis showed that the absolute change in HbA1c independently predicted increased FEV1 (R 2 = 0.175) and PEF (R 2 = 0.323). In contrast, the known duration of type 2 diabetes, but not the amelioration of HbA1c, was related to changes in forced expiratory flow between 25% and 75% of the FVC. CONCLUSIONS In type 2 diabetes, spirometric measurements reflecting central airway obstruction and explosive muscle strength exhibit significant amelioration after a short improvement in glycemic control.
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Affiliation(s)
- Liliana Gutiérrez-Carrasquilla
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Institut de Recerca Biomèdica de Lleida (IRBLleida), and Universitat de Lleida, Lleida, Catalonia, Spain
| | - Enric Sánchez
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Institut de Recerca Biomèdica de Lleida (IRBLleida), and Universitat de Lleida, Lleida, Catalonia, Spain
| | - Ferran Barbé
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (IRBLleida), and Universitat de Lleida, Lleida, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mireia Dalmases
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (IRBLleida), and Universitat de Lleida, Lleida, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Carolina López-Cano
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Institut de Recerca Biomèdica de Lleida (IRBLleida), and Universitat de Lleida, Lleida, Catalonia, Spain
| | - Marta Hernández
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Institut de Recerca Biomèdica de Lleida (IRBLleida), and Universitat de Lleida, Lleida, Catalonia, Spain
| | - Ferran Rius
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Institut de Recerca Biomèdica de Lleida (IRBLleida), and Universitat de Lleida, Lleida, Catalonia, Spain
| | - Paola Carmona
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (IRBLleida), and Universitat de Lleida, Lleida, Catalonia, Spain
| | - Cristina Hernández
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), and Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Rafael Simó
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), and Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain .,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Albert Lecube
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Institut de Recerca Biomèdica de Lleida (IRBLleida), and Universitat de Lleida, Lleida, Catalonia, Spain .,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Ripa C, Ercilla M, Ariztia M, Urreta I, Gayán M, Pascual P, Carmona P, Leunda L, Lizardi A, Barral J, Odriozola B, Lombera L, Bachiller M. Early dietary supplementation enriched in Vitamin D and calcium B-hydroxy-B-methylbutirate in hip fracture: does it improve postoperative complications? Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1578] [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: 10/28/2022]
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21
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Ripa C, Ercilla M, Ariztia M, Urreta I, Gayán M, Pascual P, Carmona P, Leunda L, Lizardi A, Barral J, Odriozola B, Lombera L. Early dietary supplementation enriched in Vitamin D and calcium B-hydroxy-B-methylbutirate in hip fracture: Does it improve nutritional status? Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1579] [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: 11/16/2022]
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Herrero A, Ruiz-Capillas C, Pintado T, Carmona P, Jiménez-Colmenero F. Elucidation of lipid structural characteristics of chia oil emulsion gels by Raman spectroscopy and their relationship with technological properties. Food Hydrocoll 2018. [DOI: 10.1016/j.foodhyd.2017.09.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Pintado T, Ruiz-Capillas C, Jiménez-Colmenero F, Carmona P, Herrero AM. Oil-in-water emulsion gels stabilized with chia (Salvia hispanica L.) and cold gelling agents: Technological and infrared spectroscopic characterization. Food Chem 2015; 185:470-8. [PMID: 25952895 DOI: 10.1016/j.foodchem.2015.04.024] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [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: 05/06/2014] [Revised: 03/04/2015] [Accepted: 04/09/2015] [Indexed: 11/16/2022]
Abstract
This paper reports on the development of olive oil-in-water emulsion gels containing chia (Salvia hispanica L.) (flour or seed) and cold gelling agents (transglutaminase, alginate or gelatin). The technological and structural characteristics of these emulsion gels were evaluated. Both structural and technological changes in emulsion gels resulting from chilled storage were also determined. The color and texture of emulsion gels depend on both the cold gelling agents used and chilled storage. Lipid oxidation increased (p < 0.05) during storage in emulsion gels containing transglutaminase or alginate. Analyses of the half-bandwidth of the 2923 cm(-1) band and the area of the 3220 cm(-1) band suggest that the order/disorder of the oil lipid chain related to lipid interactions and droplet size in the emulsion gels could be decisive in determining their textural properties. The half-bandwidth of 2923 cm(-1) band and area of 3220 cm(-1) band did not show significant differences during chilled storage.
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Affiliation(s)
- T Pintado
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), José Antonio Novais, 10, 28040 Madrid, Spain
| | - C Ruiz-Capillas
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), José Antonio Novais, 10, 28040 Madrid, Spain
| | - F Jiménez-Colmenero
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), José Antonio Novais, 10, 28040 Madrid, Spain
| | - P Carmona
- Institute for the Structure of Matter (CSIC), Serrano 121, 28006 Madrid, Spain
| | - A M Herrero
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), José Antonio Novais, 10, 28040 Madrid, Spain.
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Pintado T, Herrero AM, Ruiz-Capillas C, Triki M, Carmona P, Jiménez-Colmenero F. Effects of emulsion gels containing bioactive compounds on sensorial, technological, and structural properties of frankfurters. FOOD SCI TECHNOL INT 2015; 22:132-45. [DOI: 10.1177/1082013215577033] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/27/2015] [Indexed: 11/16/2022]
Abstract
Emulsion gels prepared with olive oil, chia, and cold gelling agents (transglutaminase, alginate, or gelatin) were used as fat replacers in reduced-fat frankfurter formulation. Nutritional advantages, sensory analysis, technological properties, and microbiological populations of frankfurters were evaluated along with their lipid structural characteristics over chilled storage. Frankfurters with emulsion gels showed significant improvements in fat content (lower saturated fatty acid, higher mono- and polyunsaturated fatty acid contents) and had good fat and water-binding properties. The presence of an emulsion gel reduced lightness and redness, but increased yellowness. Textural behavior of samples was significantly affected by the presence of emulsion gels and by storage. Sensory properties were not affected by the incorporation of emulsion gels, and all frankfurters were judged acceptable. Attenuated total reflectance–Fourier transform infrared spectroscopy results showed that samples with emulsion gels involve more lipid–protein interactions. Frankfurters with emulsion gels showed good stability to oxidation during storage and contained lower levels of microorganism than reduced-fat control at 85 days.
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Affiliation(s)
- T Pintado
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), Madrid, Spain
| | - AM Herrero
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), Madrid, Spain
| | - C Ruiz-Capillas
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), Madrid, Spain
| | - M Triki
- LAVASA-ENIS: Laboratory of Food Analysis, Valorization and Security of the School of Engineers of Sfax, Tunisia
| | - P Carmona
- Institute for the Structure of Matter (CSIC), Madrid, Spain
| | - F Jiménez-Colmenero
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), Madrid, Spain
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Lizardi A, Carmona P, Liceaga G, Barral J, Umerez M, Urretavizcaya M, Esnaola E, Gayán MJ, Irastorza MB, Bachiller MP. CP-064 Analysis of oral immunosuppressant use in off-label indications in a hospital pharmacy service. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.60] [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: 11/04/2022] Open
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Carmona P, Agirre I, Lizeaga G, Lizardi A, Bachiller MP, Andueza K, Esnaola E, Aranguren MA, Leunda L, Umerez M. PS-038 Appropriateness of new oral anticoagulant prescriptions: analysis of pharmacist interventions. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.364] [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: 11/03/2022] Open
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27
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Carmona P, Gayán MJ, Lopez G, Lizardi A, Iribarren J, Von Wichmann M, Ercilla M, Ripa C, Lombera L, Bachiller MP. CP-082 Difference in effectiveness and safety of triple therapy-based treatment between Mono and Co-infected hepatitis C patients. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.78] [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: 11/03/2022] Open
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28
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Herrero AM, Ruiz-Capillas C, Jiménez-Colmenero F, Carmona P. Raman spectroscopic study of structural changes upon chilling storage of frankfurters containing olive oil bulking agents as fat replacers. J Agric Food Chem 2014; 62:5963-5971. [PMID: 24910127 DOI: 10.1021/jf501231k] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Technological properties and structural characteristics of proteins and lipids, using Raman spectroscopy, of frankfurters formulated with olive oil bulking agents as animal fat replacers were examined during chilling storage. Frankfurters reformulated with oil bulking agents showed lower (P<0.05) processing loss and higher (P<0.05) hardness and chewiness. Purge loss during chilling storage was relatively low, demonstrating a good water retention in the products. β-Sheet structures were enhanced by the use of olive oil bulking agents, and this effect was more pronounced in samples containing inulin. Reformulated frankfurters contained the least turns (P<0.05). A significant decrease of β-sheets and an increase of turns were observed after 85 days of chilled storage. The lowest (P<0.05) values of IνsCH2/IνasCH2 were recorded in frankfurters reformulated with oil bulking agents, which suggests more lipid acyl chain disorder. Structural characteristics were correlated to processing losses, hardness, and chewiness.
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Affiliation(s)
- A M Herrero
- Institute of Food Science, Technology and Nutrition (ICTAN-CSIC) , José Antonio Novais, 10, 28040 Madrid, Spain
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29
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Cozar F, Carmona P, Congregado M, Lopez-Porras M, Pinos N, Giron JC, Jimenez-Merchan R, Loscertales J. V-048 * STERNAL RECONSTRUCTION. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.48] [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: 11/13/2022] Open
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30
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Herrero A, Carmona P, Jiménez-Colmenero F, Ruiz-Capillas C. Polysaccharide gels as oil bulking agents: Technological and structural properties. Food Hydrocoll 2014. [DOI: 10.1016/j.foodhyd.2013.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Carmona P, Mateo E, Montoro A, Alós L, Coret M, Errando CL, Llagunes J, De Andrés J. [Evaluation of postoperative myocardial injury by heart-type fatty acid-binding protein in off-pump coronary artery bypass grafting surgery]. ACTA ACUST UNITED AC 2014; 62:3-9. [PMID: 24746360 DOI: 10.1016/j.redar.2014.02.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND GOAL OF STUDY Postoperative myocardial infarction is a serious and frequent complication of cardiac surgery. Nonetheless, diagnosis in this context it is occasionally challenging. We sought to evaluate the kinetics and diagnostic accuracy of the new biomarker « heart-type fatty acid-binding protein » (h-FABP) in the early detection of myocardial injury in patients undergoing off-pump coronary artery bypass grafting, compared with classical biomarkers. MATERIALS AND METHODS A prospective study was conducted on 17 consecutive patients who underwent off-pump coronary artery bypass grafting during a 2 month period. Blood samples were drawn for measurement of myocardial ischemic injury biomarkers (h-FABP, troponin, creatine kinase [CK] and CK-MB), at baseline (T1), immediate post-coronary artery bypass grafting (T2), on ICU admission (T3), and after 4 (T4), 8 (T5), 24 (T6) and 48 h (T7). Perioperative ischemic complications, defined according to electrocardiographic, echocardiographic and hemodynamic criteria, were recorded. RESULTS Earlier biomarkers peak plasma values occurred at T4 with troponin (2.9 ± 5.2 ng/mL), and at T5 with h-FABP (37.9 ± 55.5 ng/mL). Maximum values of CK and CK-MB occurred later, both in T6 (741 ± 779 and 37 ± 51 U/L, respectively). The optimized cut-off obtained for h-FABP was 19 ng/mL, providing a sensitivity and specificity of 77 and 75%, respectively, for diagnosis of perioperative ischemic injury, with an area under the ROC curve for h-FABP of 0.83 (95% CI 0.6-1.0) vs. 0.63 (95% CI 0.33-0.83) for troponin. This cut-off value for h-FABP is reached on average at T2 (mean value of h-FABP at T2: 18.9 ± 21.5 ng/mL). CONCLUSION This is the first study evaluating the kinetics of h-FABP biomarker in perioperative off-pump coronary artery bypass grafting, and the cut-off value established could help to extend earlier detection of myocardial ischemia in this context.
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Affiliation(s)
- P Carmona
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - E Mateo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - A Montoro
- Servicio de Análisis Clínicos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Alós
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - M Coret
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J Llagunes
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J De Andrés
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Umerez M, Gayan M, Ercilla M, Ripa C, Carmona P, Barral JOSU, Lizardi A, Aguirre I, Mauleón MD, Lombera L. PS-050 Inhaled sodium colistimethate-associated thrombocytopenia. A case report. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Carmona P, Mateo E, Hornero F, Errando CL, Vázquez A, Llagunes J, De Andrés J. [Hyperlactatemia in surgical ablation of atrial fibrillation and cardiac surgery. Is it a predictive factor of postoperative morbidity?]. ACTA ACUST UNITED AC 2014; 61:311-8. [PMID: 24556510 DOI: 10.1016/j.redar.2014.01.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 12/26/2013] [Accepted: 01/10/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Increased serum lactate in postoperative cardiac surgery is very common and its pathogenesis is due to multiple factors. The elevation of serum lactate is associated with tissue hypoxia (hyperlactatemia type A) and non-hypoxic (hyperlactatemia type B) metabolic disorders. The aim of the study was to assess the evolution of postoperative lactate in surgical atrial fibrillation ablation during cardiac surgery, and to determine whether lactate levels could be predictors of morbimortality. MATERIAL AND METHODS A case-control study was conducted on 32 patients undergoing surgical atrial fibrillation ablation and cardiac surgery (Maze group) and 32 matched patients (Control group), operated on between 2011 and 2012. An analysis was made of the levels of postoperative lactate, perioperative morbimortality and hospital length of stay. A univariate and multivariate study was performed for a composite endpoint of morbimortality, and prolonged length of stay. RESULTS Lactate levels were significantly higher at 6, 12 and 24h in the Maze group. The univariate analysis showed that being in the Maze group (OR 3.88; 95% CI 1.3-11.1; P=.01) and an elevated lactate at 12h (OR 1.33; 95% CI 1.01-1.7; P=.04) were significant predictors of major complications, mortality, and longer hospital stays. In the multivariate analysis, surgical atrial fibrillation ablation (Maze group) was an independent predictor of major complications (OR 4.13; 95% CI 1.312.9; P=.015) for the morbimortality composite endpoint (OR 3.9; 95% CI 1.3-11.6; P=.01), and prolonged length of stay in the Intensive Care Unit (OR 5.7; 95% CI 2.01-15.7; P=.01). CONCLUSIONS The atrial fibrillation surgical ablation may be a not-yet-described cause of type B hyperlactatemia, with serum peak values being reached between 4-24h after cardiac surgery. The predictive value of this elevation, its correlation with morbimortality, its sensitivity and specificity to discriminate the significant thresholds needs to be defined.
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Affiliation(s)
- P Carmona
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
| | - E Mateo
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España.
| | - F Hornero
- Servicio de Cirugía cardiaca, Instituto Cardiovascular, Consorcio Hospital General Universitario, Valencia, España
| | - C L Errando
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
| | - A Vázquez
- Servicio de Cirugía cardiaca, Hospital Politécnico La Fe, Valencia, España
| | - J Llagunes
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
| | - J De Andrés
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
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Ruiz-Capillas C, Carmona P, Jiménez-Colmenero F, Herrero A. Oil bulking agents based on polysaccharide gels in meat batters: A Raman spectroscopic study. Food Chem 2013; 141:3688-94. [DOI: 10.1016/j.foodchem.2013.06.043] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/29/2013] [Accepted: 06/11/2013] [Indexed: 12/01/2022]
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Congregado M, Moreno-Merino S, Jimenez-Merchan R, Cozar F, Porras ML, Carmona P, Gallardo G, Loscertales J. O-071COMPARATIVE STUDY OF THORACOSCOPIC DECORTICATION VERSUS OPEN DECORTICATION IN ADVANCED STAGES EMPYEMA. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.71] [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: 11/13/2022] Open
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Llagunes J, Arastey S, Cobo Del Prado I, Carmona P, Peña JJ, Mínguez C. [Sepsis, cardiomyopathy and human immunodeficiency virus infection: presentation of a case]. ACTA ACUST UNITED AC 2013; 61:214-8. [PMID: 23706936 DOI: 10.1016/j.redar.2013.03.003] [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: 12/18/2012] [Revised: 03/13/2013] [Accepted: 03/19/2013] [Indexed: 11/17/2022]
Abstract
Sepsis in patients with human immunodeficiency virus (HIV) may be associated with the appearance of cardiac dysfunction. This is a challenge, both when making the differential diagnosis and determining the proper treatment, as there are numerous risk factors: Myocarditis due to the HIV itself, the presence or absence of highly active antiretroviral therapy, toxic substances, and cardiomyopathy associated with sepsis. The diagnostic and therapeutic approach to an HIV positive patient with septic shock and cardiac dysfunction is described, as well as a brief review of the different causes of cardiomyopathy which may affect this group of patients is also presented.
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Affiliation(s)
- J Llagunes
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España.
| | - S Arastey
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
| | - I Cobo Del Prado
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
| | - P Carmona
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
| | - J J Peña
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
| | - C Mínguez
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España
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Carmona P, Casanova I, Llagunes J, Mateo E. [Continuous paravertebral block for analgesia in minimally invasive cardiac surgery. Reply of the authors]. Rev Esp Anestesiol Reanim 2013; 60:238. [PMID: 23453237 DOI: 10.1016/j.redar.2012.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 06/01/2023]
Affiliation(s)
- P Carmona
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
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Pascual P, Carmona P, Barral J, Umerez M, Irastorza B, Aranguren A, Lizeaga G, Asensio A, Esnaola E, Andueza K. GRP-166 Safety Evaluation of Rituximab Off-Label Use For Systemic Autoimmune Rheumatic Diseases. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.166] [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: 11/03/2022] Open
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Herrero A, Carmona P, Pintado T, Jiménez-Colmenero F, Ruiz-Capillas C. Lipid and protein structure analysis of frankfurters formulated with olive oil-in-water emulsion as animal fat replacer. Food Chem 2012. [DOI: 10.1016/j.foodchem.2012.04.114] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Escobar R, Carmona P, Rodríguez-Casado A, Molina M. Raman spectroscopic determination of inosine nucleoside in nucleotides. Talanta 2012; 48:773-80. [PMID: 18967520 DOI: 10.1016/s0039-9140(98)00094-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/1997] [Revised: 12/01/1997] [Accepted: 12/02/1997] [Indexed: 10/17/2022]
Abstract
Raman spectroscopy has been applied to the analytical determination of inosine nucleoside in nucleotides. Spectral characteristics of aqueous solutions of lithium, potassium and magnesium salts of inosine 5'-monophosphoric acid are described. Two characteristic bands located at 1553 and 1593 cm(-1) whose frequencies are not sensitive either to the nucleotide concentration or to alkaline cations present in the medium, have been used for this purpose. The concentration ranges over which the method was applicable were 2.5-80 and 11.5-80 mg ml(-1) of inosine using the 1553 and 1593 cm(-1) bands, respectively, with relative standard deviations of 2.5 and 4.0% and detection limits of 0.25 and 1.16% (w/w). As the above bands are not generated by the standard nucleobases, this method can be applied to the quantitative determination of inosine in transfer ribonucleic acids.
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Affiliation(s)
- R Escobar
- Departamento de Quimica Analitica, Facultad de Quimica, Universidad de Sevilla, E-41012 Sevilla, Spain
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Peña JJ, Mateo E, Martín E, Llagunes J, Carmona P, Blasco L. [Haemorrhage and morbidity associated with the use of tranexamic acid in cardiac surgery: a retrospective, multicentre cohort study]. ACTA ACUST UNITED AC 2012; 60:142-8. [PMID: 22795924 DOI: 10.1016/j.redar.2012.05.040] [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: 01/27/2012] [Accepted: 05/22/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Postoperative bleeding is common complication, affecting up to 20% of patients, after cardiac bypass surgery. Fibrinolysis is one of the causes of this excessive bleeding, and for this reason the use of tranexamic acid is recommended. The problem with using this is that there are numerous guidelines and differences in the dose to be administered. Our aim was to evaluate whether there were any differences in postoperative bleeding and morbidity after cardiac surgery with the administering of different tranexamic acid doses in three university hospitals. MATERIAL AND METHODS A retrospective, multicentre cohort study was conducted. A total of 146 patients who were subjected to elective cardiac bypass surgery according to the anaesthetic-surgical protocol of each hospital were included in the study. The clinical histories were reviewed, and they were divided into two groups according to the tranexamic acid dose: Group A (high doses), initial dose of 20mg/kg and continuous infusion of 4 mg/kg/hour until closure of the sternotomy. A further 100mg was added to prime the bypass machine. Group B (low doses), initial dose of 10mg/kg followed by a continuous infusion of 2mg/kg/hour until closure of the sternotomy. A further 50mg was added to prime the bypass machine. Variables, such as age, sex, weight, height, type of surgical procedure (valvular, coronary or mixed), haematocrit, INR, and preoperative platelet count, time and temperature of the bypass machine, and haematocrit on sternum closure, were recorded. Among the post-operative variables collected were: debit due to drainage at 6, 12 and 24 hours after surgery, number and type of blood products transfused in the first 24 hours, need for further surgery due to haemorrhage, CVA, TIA, or a new acute myocardial infarction, convulsions, and mortality. RESULTS The incidence of increased bleeding (patients in the 90 percentile) was higher in Group B at all the study evaluation times (P<.05). The incidence of further surgery due to bleeding, and the need for transfusion of ≥ 3 units of packed red cells was lower in Group A (5.56%) than in Group B (13.89%). There were no significant differences in the requirements for blood products transfusions between the groups. As regards associated morbidity, there was one isolated case of convulsion and a perioperative AMI in another case in Group A, and three cases of perioperative AMI in Group B. CONCLUSIONS Elevated doses of tranexamic acid in cardiac bypass surgery appear to significantly reduce bleeding in the first hours after surgery compared to low doses. However, this decrease did not lead to a reduction in the needs for blood products.
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Affiliation(s)
- J J Peña
- Servicio de Anestesia, Reanimación y Terapia del Dolor, Consorcio Hospital General Universitario de Valencia, España.
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Sasso J, Carmona P, Quiñones L, Ortiz M, Tamayo E, Varela N, Cáceres D, Saavedra I. Bioequivalence of acenocoumarol in chilean volunteers: an open, randomized, double-blind, single-dose, 2-period, and 2-sequence crossover study for 2 oral formulations. Arzneimittelforschung 2012; 62:395-9. [PMID: 22773430 DOI: 10.1055/s-0032-1316290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of this study was to compare the bioavailability of an oral formulation of the coumarin derivative-vitamine K antagonist acenocoumarol (Acebron™ 4 mg, Test) with the reference formulation (Neo-Sintrom™ 4 mg). We performed a single-dose, double-blind, fasting, 2-period, 2-sequence, crossover study design. Plasma concentrations of acenocoumarol were determined using a validated UPLC-MS/MS method. 24 healthy Chilean volunteers (11 male, 13 female) were enrolled and all of them completed the study. Adverse events were monitored throughout the study. The values of the pharmacokinetic parameters were (mean ± SD): AUC0-24 =1 364.38±499.26 ngxh/mL for the test and 1 328.39±429.20 ngxh/mL for the reference; AUC0-∞ =1 786.00±732.85 ngxh/mL for the test and 1 706.71±599.66 ngxh/mL for the reference; Cmax =180.69±35.11 ng/mL with a Tmax of 1.83±0.95 h for the test and 186.97±38.21 ng/mL with a Tmax of 2.19±0.83 h for the reference. Regarding half life measurements, the mean ± SD of t1/2 were 11.84±4.54 h for the test and 11.08±3.28 h for the reference. The 90% confidence intervals for the test/reference ratio using logarithmic transformed data were 97.89-100.87%, 98.62-101.99% and 98.64-102.38% for Cmax, AUC0-t(24) and AUC0-∞. There were no significant differences in pharmacokinetic parameters between groups.The results obtained in this study lead us to conclude, based on FDA criteria, that the test acenocoumarol formulation (Acebron™, 4 mg tablets) is bioequivalent to the reference product (Neo-Sintrom™, 4 mg tablets).
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Affiliation(s)
- J Sasso
- Center of Pharmacological and Toxicological Research (IFT), Molecular and Clinical Pharmacology Program, ICBM, Faculty of Medicine, University of Chile, Santiago, Chile
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Carmona P, Llagunes J, Casanova I, Mateo E, Cánovas S, Martín E, Marqués JI, Peña JJ, de Andrés J. [Continuous paravertebral analgesia versus intravenous analgesia in minimally invasive cardiac surgery by mini-thoracotomy]. ACTA ACUST UNITED AC 2012; 59:476-82. [PMID: 22657350 DOI: 10.1016/j.redar.2012.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 04/11/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Minimal access cardiac surgery via minithoracotomy aims faster recovery and shorter hospital length of stay. Pain control is essential in order to achieve this goal. A study was conducted to assess the quality of post-operative analgesia and complications related to the analgesia techniques after cardiac surgery by minithoracotomy. MATERIAL AND METHODS A descriptive, observational and retrospective study was conducted on the patients subjected to minimal access cardiac surgery in our centre between the years 2009 to 2011. The patients were divided into two groups according to the type of analgesia received: analgesia through a paravertebral catheter, with an infusion of local anaesthetics (PVB group), and intravenous analgesia with opioids (IOA group). The aim of the study was to compare the analgesic quality and the complications associated to the analgesic technique, extubation time, post-surgical complications, and length of hospital stay between both techniques. RESULTS A total of 37 patients underwent to a modified minimally invasive Heart-Port access cardiac surgery. Fifteen patients received analgesia through a paravertebral block and the other 22 IV analgesia with opioids. Data are shown as means and standard deviation (SD). Mean tracheal extubation time less than 4 hours was observed in 60% of the patients in the PVB group, compared to 22% in the IOA group (P<.05). Length of stay in ICU for the PVB group was 1.2 (0.7) days compared to 2.2 (0.7) days in the IOA group (P<.05). Mean hospital stay was 4.8 (1.2) days for the PVB group, and 5.6 (2.8) for the IOA group (P>.05. No complications associated to the continuous paravertebral block were observed. DISCUSSION PVB analgesia is an acceptable safe technique in cardiac surgery via thoracotomy which enables early extubation with optimal pain control when compared with IV analgesia with opioids.
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Affiliation(s)
- P Carmona
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Consorcio Hospital General Universitario de Valencia, España.
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Gonzalez PP, Asensio A, Carmona P, Barral J, Lizeaga G, Fernandez I, Esnaola E, Irastorza B, Valbuena O, Bachiller M. Pharmaceutical intervention for Vitamin D level: CPC105 table 1. Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2012-000074.454] [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: 11/03/2022] Open
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Asensio A, Lizeaga G, Fernandez I, Pascual P, Carmona P, Barral J, Irastorza B, Andueza K, Esnaola E, Valbuena O. Development of a pharmaceutical care programme in a bone marrow transplantation unit. Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2012-000074.110] [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: 11/03/2022] Open
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Ercilla M, Celayeta A, Ripa C, Madueño A, Ayerregaray M, Carmona P, Gayan M, Odriozola B. Compliance with Spanish and international guidelines on intradialytic parenteral nutrition in chronic renal disease: Table 1. Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2012-000074.313] [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: 11/04/2022] Open
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Martín E, Cánovas S, Carmona P, Casanova I, García A, Paredes F, Gil O, Hornero F, García R, Martínez-León J. 69. Estrategias de analgesia en cirugía cardíaca mínimamente invasiva vía toracotomía: Bloqueo paravertebral continuo frente a analgesia endovenosa. Cirugía Cardiovascular 2012. [DOI: 10.1016/s1134-0096(12)70638-1] [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: 10/26/2022] Open
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Carmona P, Ruiz-Capillas C, Jiménez-Colmenero F, Pintado T, Herrero AM. Infrared study of structural characteristics of Frankfurters formulated with olive oil-in-water emulsions stabilized with casein as pork backfat replacer. J Agric Food Chem 2011; 59:12998-13003. [PMID: 22060725 DOI: 10.1021/jf203941b] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article reports an infrared spectroscopic (FT-IR) study on lipids and protein structural characteristics in frankfurters as affected by an emulsified olive oil stabilizing system used as a pork backfat replacer. The oil-in-water emulsions were stabilized with sodium caseinate, without (F/SC) and with microbial transglutaminase (F/SC+MTG). Proximate composition and textural characteristics were also evaluated. Frankfurters F/SC+MTG showed the highest (P < 0.05) hardness and lowest (P < 0.05) adhesiveness. These products also showed the lowest (P < 0.05) half-bandwidth of the 2922 cm(-1) band, which could be related to the fact that the lipid chain was more orderly than that in the frankfurters formulated with animal fat and F/SC. The spectral results revealed modifications in the amide I band profile when the olive oil-in-water emulsion replaced animal fat. This fact is indicative of a greater content of aggregated intermolecular β-sheets. Structural characteristics in both proteins and lipids could be associated with the specific textural properties of frankfurters.
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Affiliation(s)
- P Carmona
- Instituto de Estructura de la Materia, CSIC, Serrano 121, 28006 Madrid, Spain
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Llagunes J, Casanova I, Reina C, Carmona P, Pirola A, de Andrés J. [Late-onset postpartum sepsis with septic shock and heart dysfunction]. Rev Esp Anestesiol Reanim 2011; 58:387-389. [PMID: 21797090 DOI: 10.1016/s0034-9356(11)70089-5] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a case of late-onset postpartum sepsis from endometritis due to group A streptococci (GAS) in a 37-year-old white woman. The patient developed septic shock, with mitral regurgitation and cardiac dysfunction. Early treatment with broad-spectrum antibiotics and hemodynamic support was essential for a favorable outcome. Because of the resurgence of virulent strains of GAS that can cause fatal infections, these pathogens should be included in the differential diagnosis of postpartum infections in the mother. Although cardiac dysfunction is rare in association with GAS infection, it should be ruled out by echocardiography when the condition of a patient with sepsis does not improve.
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Affiliation(s)
- J Llagunes
- Servicio de Anestesiologia, Cuidados Críticos y Medicina del Dolor, Consorcio Hospital General Universitario, Valencia
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Llagunes J, Carmona P, Latorre MD, Casanova I. [Echocardiographic image of a left atrial myxoma causing acute heart failure]. Rev Esp Anestesiol Reanim 2011; 58:331. [PMID: 21688518 DOI: 10.1016/s0034-9356(11)70078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- J Llagunes
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia.
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