1
|
Roldán R, Barriga F, Villamonte R, Romaní F, Tucci M, Gonzales A, Wong P, Zagaceta J, Brochard L. The Use of the Oxygenation Stretch Index to Predict Outcomes in Mechanically Ventilated Patients With COVID-19 ARDS. Respir Care 2023; 68:1683-1692. [PMID: 37402585 PMCID: PMC10676243 DOI: 10.4187/respcare.10903] [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] [Indexed: 07/06/2023]
Abstract
BACKGROUND In ARDS caused by COVID-19 pneumonia, appropriate adjustment of physiologic parameters based on lung stretch or oxygenation may optimize the ventilatory strategy. This study aims to describe the prognostic performance on 60-d mortality of single and composite respiratory variables in subjects with COVID-19 ARDS who are on mechanical ventilation with a lung-protective strategy, including the oxygenation stretch index combining oxygenation and driving pressure (ΔP). METHODS This single-center observational cohort study enrolled 166 subjects on mechanical ventilation and diagnosed with COVID-19 ARDS. We evaluated their clinical and physiologic characteristics. The primary study outcome was 60-d mortality. Prognostic factors were evaluated through receiver operating characteristic analysis, Cox proportional hazards regression model, and Kaplan-Meier survival curves. RESULTS Mortality at day 60 was 18.1%, and hospital mortality was 22.9%. Oxygenation, ΔP, and composite variables were tested: oxygenation stretch index ([Formula: see text]/[Formula: see text] divided by ΔP) and ΔP × 4 + breathing frequency (f) (ΔP × 4 + f). At both day 1 and day 2 after inclusion, the oxygenation stretch index had the best area under the receiver operating characteristic curve (oxygenation stretch index on day 1 0.76 (95% CI 0.67-0.84) and on day 2 0.83 (95% CI 0.76-0.91) to predict 60-d mortality, although without significant difference from other indexes. In multivariable Cox regression, ΔP, [Formula: see text]/[Formula: see text], ΔP × 4 + f, and oxygenation stretch index were all associated with 60-d mortality. When dichotomizing the variables, ΔP ≥ 14, [Formula: see text]/[Formula: see text] ≤ 152 mm Hg, ΔP × 4 + f ≥ 80, and oxygenation stretch index < 7.7 showed lower 60-d survival probability. At day 2, after optimization of ventilatory settings, the subjects who persisted with the worse cutoff values for the oxygenation stretch index showed a lower probability of survival at 60 d compared with day 1; this was not the case for other parameters. CONCLUSIONS The oxygenation stretch index, which combines [Formula: see text]/[Formula: see text] and ΔP, is associated with mortality and may be useful to predict clinical outcomes in COVID-19 ARDS.
Collapse
Affiliation(s)
- Rollin Roldán
- Facultad de Medicina Humana, Universidad de Piura, Lima, Perú. Drs Roldán, Barriga, and Villamonte are affiliated with the Intensive Care Unit, Hospital Rebagliati, Lima, Perú.
| | - Fernando Barriga
- Facultad de Medicina Humana, Universidad de Piura, Lima, Perú. Drs Roldán, Barriga, and Villamonte are affiliated with the Intensive Care Unit, Hospital Rebagliati, Lima, Perú
| | - Renán Villamonte
- Facultad de Medicina Humana, Universidad de Piura, Lima, Perú. Drs Roldán, Barriga, and Villamonte are affiliated with the Intensive Care Unit, Hospital Rebagliati, Lima, Perú
| | - Franco Romaní
- Facultad de Medicina Humana, Universidad de Piura, Lima, Perú. Drs Roldán, Barriga, and Villamonte are affiliated with the Intensive Care Unit, Hospital Rebagliati, Lima, Perú
| | - Mauro Tucci
- UTI Respiratoria, Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Arturo Gonzales
- Facultad de Medicina Humana, Universidad de Piura, Lima, Perú. Drs Roldán, Barriga, and Villamonte are affiliated with the Intensive Care Unit, Hospital Rebagliati, Lima, Perú
| | - Paolo Wong
- Facultad de Medicina Humana, Universidad de Piura, Lima, Perú. Drs Roldán, Barriga, and Villamonte are affiliated with the Intensive Care Unit, Hospital Rebagliati, Lima, Perú
| | - Jorge Zagaceta
- Facultad de Medicina Humana, Universidad de Piura, Lima, Perú. Drs Roldán, Barriga, and Villamonte are affiliated with the Intensive Care Unit, Hospital Rebagliati, Lima, Perú
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Canada. Dr Brochard is affiliated with the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
2
|
Roldán R, Rodriguez S, Barriga F, Tucci M, Victor M, Alcala G, Villamonte R, Suárez-Sipmann F, Amato M, Brochard L, Tusman G. Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients. Ann Intensive Care 2022; 12:13. [PMID: 35150355 PMCID: PMC8840950 DOI: 10.1186/s13613-022-00988-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/17/2021] [Accepted: 01/21/2022] [Indexed: 12/16/2022] Open
Abstract
Background A sequential change in body position from supine-to-both lateral positions under constant ventilatory settings could be used as a postural recruitment maneuver in case of acute respiratory distress syndrome (ARDS), provided that sufficient positive end-expiratory pressure (PEEP) prevents derecruitment. This study aims to evaluate the feasibility and physiological effects of a sequential postural recruitment maneuver in early mechanically ventilated COVID-19 ARDS patients. Methods A cohort of 15 patients receiving lung-protective mechanical ventilation in volume-controlled with PEEP based on recruitability were prospectively enrolled and evaluated in five sequentially applied positions for 30 min each: Supine-baseline; Lateral-1st side; 2nd Supine; Lateral-2nd side; Supine-final. PEEP level was selected using the recruitment-to-inflation ratio (R/I ratio) based on which patients received PEEP 12 cmH2O for R/I ratio ≤ 0.5 or PEEP 15 cmH2O for R/I ratio > 0.5. At the end of each period, we measured respiratory mechanics, arterial blood gases, lung ultrasound aeration, end-expiratory lung impedance (EELI), and regional distribution of ventilation and perfusion using electric impedance tomography (EIT). Results Comparing supine baseline and final, respiratory compliance (29 ± 9 vs 32 ± 8 mL/cmH2O; p < 0.01) and PaO2/FIO2 ratio (138 ± 36 vs 164 ± 46 mmHg; p < 0.01) increased, while driving pressure (13 ± 2 vs 11 ± 2 cmH2O; p < 0.01) and lung ultrasound consolidation score decreased [5 (4–5) vs 2 (1–4); p < 0.01]. EELI decreased ventrally (218 ± 205 mL; p < 0.01) and increased dorsally (192 ± 475 mL; p = 0.02), while regional compliance increased in both ventral (11.5 ± 0.7 vs 12.9 ± 0.8 mL/cmH2O; p < 0.01) and dorsal regions (17.1 ± 1.8 vs 18.8 ± 1.8 mL/cmH2O; p < 0.01). Dorsal distribution of perfusion increased (64.8 ± 7.3% vs 66.3 ± 7.2%; p = 0.01). Conclusions Without increasing airway pressure, a sequential postural recruitment maneuver improves global and regional respiratory mechanics and gas exchange along with a redistribution of EELI from ventral to dorsal lung areas and less consolidation. Trial registration ClinicalTrials.gov, NCT04475068. Registered 17 July 2020, https://clinicaltrials.gov/ct2/show/NCT04475068 Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-00988-9.
Collapse
Affiliation(s)
- Rollin Roldán
- Laboratorio de Fisiología Experimental, Facultad de Medicina Humana, Universidad de Piura, Lima, Peru.,Intensive Care Unit, Hospital Rebagliati, Lima, Peru.,Laboratório de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Shalim Rodriguez
- Laboratorio de Fisiología Experimental, Facultad de Medicina Humana, Universidad de Piura, Lima, Peru.,Intensive Care Unit, Hospital Rebagliati, Lima, Peru
| | - Fernando Barriga
- Laboratorio de Fisiología Experimental, Facultad de Medicina Humana, Universidad de Piura, Lima, Peru.,Intensive Care Unit, Hospital Rebagliati, Lima, Peru
| | - Mauro Tucci
- Laboratório de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcus Victor
- Laboratório de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Electronics Engineering, Aeronautics Institute of Technology, São Paulo, Brazil
| | - Glasiele Alcala
- Laboratório de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Renán Villamonte
- Laboratorio de Fisiología Experimental, Facultad de Medicina Humana, Universidad de Piura, Lima, Peru.,Intensive Care Unit, Hospital Rebagliati, Lima, Peru
| | - Fernando Suárez-Sipmann
- Intensive Care Unit, Hospital Universitario de La Princesa, Madrid, Spain.,Hedenstierna Laboratory, Surgical Sciences, Uppsala University, Uppsala, Sweden.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Marcelo Amato
- Laboratório de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, Room 4-08, Toronto, ON, M5B 1T8, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
| | - Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| |
Collapse
|
3
|
Victor M, Melo J, Roldán R, Nakamura M, Tucci M, Costa E, Amato M, Yoneyama T, Tanaka H. Modelling approach to obtain regional respiratory mechanics using electrical impedance tomography and volume-dependent elastance model. Physiol Meas 2019; 40:045001. [PMID: 30921784 DOI: 10.1088/1361-6579/ab144a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This paper presents a method for breath-by-breath estimation of regional respiratory mechanics without the need for special manoeuvres (such as inspiratory pause or low-flow inflation) using electrical impedance tomography (EIT) associated with pressure/airflow waveforms. APPROACH We developed a method to estimate regional parameters using the regional impedance fraction, by multiplying it by global flow and volume waveforms. A volume-dependent elastance model was used to obtain compliance, resistance, volume-independent (E 1), and volume-dependent (E 2) components. Three swine under invasive mechanical ventilation were used to assess internal consistency and illustrate potential applications of our method. One animal (case 1) was ventilated with a broad range of tidal volumes to compare the consistency between regional and global resistances and compliances. Two other animals (cases 2 and 3) had respiratory compliance decreased, respectively, by overdistension and collapse as quantified by x-ray computed tomography. MAIN RESULTS In case 1, derived global estimates obtained from the independent regional estimates were strongly associated with direct measurements of global mechanics (correlation coefficients of 0.9976 and 0.9981 for compliances and resistances, respectively), suggesting consistency of our modelling. In cases 2 and 3, the development of lung overdistension and collapse over time was captured by regional estimates. CONCLUSIONS Using EIT and pressure/airflow waveforms, regional respiratory parameters can be obtained cycle-by-cycle, refining lung function monitoring. SIGNIFICANCE The method allows real-time monitoring of regional parameters and their trends over time, which might be helpful to differentiate deterioration in lung compliance due to overdistension or collapse.
Collapse
Affiliation(s)
- M Victor
- Electronics Engineering Department, Aeronautics Institute of Technology, São Paulo, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Anguita P, Castillo F, Gámez P, Carrasco F, Roldán R, Jurado B, Castillo J, Martín E, Anguita M. Conducta de los profesionales sanitarios ante las recomendaciones de profilaxis de endocarditis infecciosa en nuestro medio: ¿se siguen las guías? Rev Clin Esp 2017; 217:79-86. [DOI: 10.1016/j.rce.2016.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/07/2016] [Accepted: 10/11/2016] [Indexed: 01/22/2023]
|
5
|
Anguita P, Castillo F, Gámez P, Carrasco F, Roldán R, Jurado B, Castillo J, Martín E, Anguita M. Behavior of health professionals concerning the recommendations for prophylaxis for infectious endocarditis in our setting: Are the guidelines followed? Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2016.12.004] [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: 10/20/2022]
|
6
|
Sifuentes Giraldo WA, Guillén Astete CA, Gámir Gámir ML, Arnal Guimerá C, Clemente Garulo D, Calvo I, Rotes I, Sampedro Álvarez J, García Consuegra J, Medrano M, Collado P, Roldán R, Bustabad S. PReS-FINAL-2115: Differences in musculoskeletal clinical expression between Spanish and Mexican patients with juvenile spondyloarthritis: data from the Mexespa project. Pediatr Rheumatol Online J 2013. [PMCID: PMC4043466 DOI: 10.1186/1546-0096-11-s2-p127] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
7
|
Picazo A, Gómez-Aguado F, Corcuera M., Roldán R, Muñoz E, Curiel I, Muñoz-Torres E, Alonso MJ. In Situ Hybridization Techniques for Electron Microscopy Detection of Human Papillomavirus Gene Sequences. J Histotechnol 2013. [DOI: 10.1179/his.1997.20.4.337] [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: 10/31/2022]
|
8
|
Sifuentes Giraldo WA, Guillén Astete CA, Gámir Gámir ML, Arnal Guimeral C, Clemente Garulo D, Calvo I, Rotes I, Sampedro Alvarez J, García Consuegra J, Medrano M, Collado P, Roldán R, Bustabad S. AB0701 Difference in musculoskeletal clinical expression among spanish and mexican patients with juvenile spondyloarthritis: data from the mexespa project. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3023] [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]
|
9
|
Vilar-Compte D, Roldán R, Sandoval S, Corominas R, De La Rosa M, Gordillo P, Volkow P. Surgical site infections in ambulatory surgery: a 5-year experience. Am J Infect Control 2001; 29:99-103. [PMID: 11287877 DOI: 10.1067/mic.2001.112241] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the ambulatory surgical site infection rate and risk factors associated with surgical site infection. METHODS We conducted a case-control analysis of all ambulatory surgeries between January 1, 1993, and December 31, 1997. The frequency of surgical site infection per 100 surgeries was calculated. The odds ratio (OR) was estimated by using logistic regression analysis. SETTING A 140-bed tertiary-care teaching hospital for adult patients with cancer. RESULTS The study followed 1350 outpatient surgeries. Thirty-eight patients had a surgical site infection (rate per 100 surgeries: 2.8). The risk factors statistically associated with surgical site infection were postoperative antibiotics (OR = 7.5; 95% CI, 2.5-23.0), and surgical time >35 minutes (OR = 2.4; 95% CI, 1.1-5.5). CONCLUSIONS The surgical site infection rate for same-day surgery at our hospital is within the limits reported in the literature and below the rates reported previously for inpatient surgeries at our hospital. Full review of medical records and microbiology reports at day 30 allowed us to identify infections that otherwise would have been missed. Postoperative antibiotics may increase the risk of infection.
Collapse
Affiliation(s)
- D Vilar-Compte
- Departamento de Infectología, Instituto Nacional de Cancerología, and the Facultad de Medicina, Universidad Nacional Autónoma de México
| | | | | | | | | | | | | |
Collapse
|
10
|
Sandoval P, Henríquez J, Fuentes R, Cabezas G, Roldán R. [Cervical curvature. A cephalometric study in position of clinical rest]. Rev Med Chil 1999; 127:547-55. [PMID: 10451624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Alterations in the head position and in cervical curvature are associated with mandibular dysfunction, an increased vertical occlusal dimension, upper airways obstruction and bad postural behaviors at work among other conditions. AIM To perform a cephalometric analysis in young adults. SUBJECTS AND METHODS Lateral cervical X-ray examinations were performed in 46 university students (26 female) aged 19 years old as a mean, Cephalometric landmarks and planes reported by Sollow & Tallgren, determined by investigators, were used for radiographic analysis. RESULTS The combined error of the method did not exceed 0.9 degree for any studied variable. Mean craniocervical angulations were 102 degrees for OPT-SNL, 109 degrees for CVT-SNL, 94.8 degrees for cranium-C2 and 105 for SN-vertical. There were significant sex differences in craniocervical angulations and these were abnormal in two thirds of subjects studies. The Forward Head Position is characterized by a cervical compensation with head inclination. This abnormal postural position showed a dolichofacial growth and an alteration of hyoid angle. CONCLUSIONS The craniocervical position appeared to be related to a vertical craniofacial growth pattern.
Collapse
|
11
|
González-Dominguez J, Roldán R, Villanueva JL, Kindelán JM, Jurado R, Torre-Cisneros J. Isospora belli reactive arthritis in a patient with AIDS. Ann Rheum Dis 1994; 53:618-9. [PMID: 7979603 PMCID: PMC1005417 DOI: 10.1136/ard.53.9.618-b] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
12
|
López-Cano A, Martín L, Cabello I, Díaz F, Roldán R. [Puncture aspiration with fine needle under echographic control. Initial study]. Rev Esp Enferm Apar Dig 1987; 71:117-20. [PMID: 3031779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
13
|
Martín L, Mendoza J, López A, Roldán R, Díaz F. [Primary sclerosing cholangitis associated with ulcerative colitis. Apropos of a new case]. Rev Esp Enferm Apar Dig 1985; 68:539-44. [PMID: 4095356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
14
|
Hernández Padilla P, Roldán R. [Primary malignant tumors of the ovary. Clinical evaluation of the therapeutic effect of 2,3,5-tris-ethyleneimino-1,4-benzoquinone]. CIR CIR 1966; 34:213-45. [PMID: 5987128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
15
|
Gutiérrez N, Vallés A, Benito A, Roldán R. [Lobar agenesis simulating a mediastinal process]. Rev Esp Tuberc 1965; 34:257-61. [PMID: 5854646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|