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Ioan AM, Gonzalez-Lorenzo O, Kallmeyer Mayor A, Pérez-Calvo C, Santos A. Low hemodynamic impact of moderate ARDS caused by SARS-CoV2. Med Intensiva 2023; 47:348-350. [PMID: 37250856 PMCID: PMC10209604 DOI: 10.1016/j.medin.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Ana-Maria Ioan
- Department of Intensive Care Medicine, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain
| | - Oscar Gonzalez-Lorenzo
- Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain
| | - Andrea Kallmeyer Mayor
- Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain
| | - César Pérez-Calvo
- Department of Intensive Care Medicine, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain
| | - Arnoldo Santos
- Department of Intensive Care Medicine, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain
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2
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Clemente-Moragón A, Martínez-Milla J, Oliver E, Santos A, Flandes J, Fernández I, Rodríguez-González L, Serrano Del Castillo C, Ioan AM, López-Álvarez M, Gómez-Talavera S, Galán-Arriola C, Fuster V, Pérez-Calvo C, Ibáñez B. Metoprolol in Critically Ill Patients With COVID-19. J Am Coll Cardiol 2021; 78:1001-1011. [PMID: 34474731 PMCID: PMC8404624 DOI: 10.1016/j.jacc.2021.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/17/2021] [Accepted: 07/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Severe coronavirus disease-2019 (COVID-19) can progress to an acute respiratory distress syndrome (ARDS), which involves alveolar infiltration by activated neutrophils. The beta-blocker metoprolol has been shown to ameliorate exacerbated inflammation in the myocardial infarction setting. OBJECTIVES The purpose of this study was to evaluate the effects of metoprolol on alveolar inflammation and on respiratory function in patients with COVID-19-associated ARDS. METHODS A total of 20 COVID-19 patients with ARDS on invasive mechanical ventilation were randomized to metoprolol (15 mg daily for 3 days) or control (no treatment). All patients underwent bronchoalveolar lavage (BAL) before and after metoprolol/control. The safety of metoprolol administration was evaluated by invasive hemodynamic and electrocardiogram monitoring and echocardiography. RESULTS Metoprolol administration was without side effects. At baseline, neutrophil content in BAL did not differ between groups. Conversely, patients randomized to metoprolol had significantly fewer neutrophils in BAL on day 4 (median: 14.3 neutrophils/µl [Q1, Q3: 4.63, 265 neutrophils/µl] vs median: 397 neutrophils/µl [Q1, Q3: 222, 1,346 neutrophils/µl] in the metoprolol and control groups, respectively; P = 0.016). Metoprolol also reduced neutrophil extracellular traps content and other markers of lung inflammation. Oxygenation (PaO2:FiO2) significantly improved after 3 days of metoprolol treatment (median: 130 [Q1, Q3: 110, 162] vs median: 267 [Q1, Q3: 199, 298] at baseline and day 4, respectively; P = 0.003), whereas it remained unchanged in control subjects. Metoprolol-treated patients spent fewer days on invasive mechanical ventilation than those in the control group (15.5 ± 7.6 vs 21.9 ± 12.6 days; P = 0.17). CONCLUSIONS In this pilot trial, intravenous metoprolol administration to patients with COVID-19-associated ARDS was safe, reduced exacerbated lung inflammation, and improved oxygenation. Repurposing metoprolol for COVID-19-associated ARDS appears to be a safe and inexpensive strategy that can alleviate the burden of the COVID-19 pandemic.
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Affiliation(s)
| | - Juan Martínez-Milla
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Eduardo Oliver
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Arnoldo Santos
- Intensive Care Unit, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Javier Flandes
- Department of Pulmonary Medicine, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Iker Fernández
- Department of Pulmonary Medicine, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Lorena Rodríguez-González
- Pathology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; Biobank Patform-PT20/00141, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | | | - Ana-María Ioan
- Intensive Care Unit, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - María López-Álvarez
- Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Sandra Gómez-Talavera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Carlos Galán-Arriola
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - César Pérez-Calvo
- Intensive Care Unit, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Madrid, Spain.
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3
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Paez Vargas JJ, Vidal González A, Pérez-Calvo C, Flandes J. COVID-19 in the Critically Ill: Too Risky for High-Dose Anticoagulation? Chest 2021; 160:e249. [PMID: 34366058 PMCID: PMC8339404 DOI: 10.1016/j.chest.2021.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Juan José Paez Vargas
- Intensive Care Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - Anxela Vidal González
- Intensive Care Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - César Pérez-Calvo
- Intensive Care Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Javier Flandes
- Interventional Pulmonology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Franqueza JL, Rosas E, Ioan AM, Durante-López A, Pérez-Calvo C, Santos A. When success means focusing on the oxygen delivery. A case of conventional management of severe hypoxemia in SARS-CoV-2. Med Intensiva 2021; 45:379-380. [PMID: 34629587 PMCID: PMC7298484 DOI: 10.1016/j.medin.2020.06.003] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- J L Franqueza
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - E Rosas
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A-M Ioan
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Durante-López
- Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - C Pérez-Calvo
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Santos
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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5
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Franqueza JL, Rosas E, Ioan AM, Durante-López A, Pérez-Calvo C, Santos A. When success means focusing on the oxygen delivery. A case of conventional management of severe hypoxemia in SARS-CoV-2. Med Intensiva 2021; 45:379-380. [PMID: 34294236 PMCID: PMC8294004 DOI: 10.1016/j.medine.2020.06.013] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/01/2020] [Indexed: 11/12/2022]
Affiliation(s)
- J L Franqueza
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - E Rosas
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A-M Ioan
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Durante-López
- Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - C Pérez-Calvo
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Santos
- Intensive Care Medicine Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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Velasco-Rodríguez D, Alonso-Dominguez JM, Vidal Laso R, Lainez-González D, García-Raso A, Martín-Herrero S, Herrero A, Martínez Alfonzo I, Serrano-López J, Jiménez-Barral E, Nistal S, Pérez Márquez M, Askari E, Castillo Álvarez J, Núñez A, Jiménez Rodríguez Á, Heili-Frades S, Pérez-Calvo C, Górgolas M, Barba R, Llamas-Sillero P. Development and validation of a predictive model of in-hospital mortality in COVID-19 patients. PLoS One 2021; 16:e0247676. [PMID: 33661939 PMCID: PMC7932507 DOI: 10.1371/journal.pone.0247676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/11/2021] [Indexed: 12/23/2022] Open
Abstract
We retrospectively evaluated 2879 hospitalized COVID-19 patients from four hospitals to evaluate the ability of demographic data, medical history, and on-admission laboratory parameters to predict in-hospital mortality. Association of previously published risk factors (age, gender, arterial hypertension, diabetes mellitus, smoking habit, obesity, renal failure, cardiovascular/ pulmonary diseases, serum ferritin, lymphocyte count, APTT, PT, fibrinogen, D-dimer, and platelet count) with death was tested by a multivariate logistic regression, and a predictive model was created, with further validation in an independent sample. A total of 2070 hospitalized COVID-19 patients were finally included in the multivariable analysis. Age 61–70 years (p<0.001; OR: 7.69; 95%CI: 2.93 to 20.14), age 71–80 years (p<0.001; OR: 14.99; 95%CI: 5.88 to 38.22), age >80 years (p<0.001; OR: 36.78; 95%CI: 14.42 to 93.85), male gender (p<0.001; OR: 1.84; 95%CI: 1.31 to 2.58), D-dimer levels >2 ULN (p = 0.003; OR: 1.79; 95%CI: 1.22 to 2.62), and prolonged PT (p<0.001; OR: 2.18; 95%CI: 1.49 to 3.18) were independently associated with increased in-hospital mortality. A predictive model performed with these parameters showed an AUC of 0.81 in the development cohort (n = 1270) [sensitivity of 95.83%, specificity of 41.46%, negative predictive value of 98.01%, and positive predictive value of 24.85%]. These results were then validated in an independent data sample (n = 800). Our predictive model of in-hospital mortality of COVID-19 patients has been developed, calibrated and validated. The model (MRS-COVID) included age, male gender, and on-admission coagulopathy markers as positively correlated factors with fatal outcome.
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Affiliation(s)
- Diego Velasco-Rodríguez
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | | | - Rosa Vidal Laso
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Daniel Lainez-González
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Aránzazu García-Raso
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Sara Martín-Herrero
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Antonio Herrero
- Department of Information Technology, Quironsalud, Madrid, Spain
| | - Inés Martínez Alfonzo
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Juana Serrano-López
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Elena Jiménez-Barral
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Sara Nistal
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Manuel Pérez Márquez
- Intensive Care Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Elham Askari
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Jorge Castillo Álvarez
- Department of Internal Medicine, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Antonio Núñez
- Department of Internal Medicine, Hospital General de Villalba, Collado Villalba, Madrid, Spain
| | | | - Sarah Heili-Frades
- Department of Pneumology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - César Pérez-Calvo
- Intensive Care Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Miguel Górgolas
- Department of Internal Medicine, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Raquel Barba
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Pilar Llamas-Sillero
- Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
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7
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Sánchez-Guijo F, García-Arranz M, López-Parra M, Monedero P, Mata-Martínez C, Santos A, Sagredo V, Álvarez-Avello JM, Guerrero JE, Pérez-Calvo C, Sánchez-Hernández MV, Del-Pozo JL, Andreu EJ, Fernández-Santos ME, Soria-Juan B, Hernández-Blasco LM, Andreu E, Sempere JM, Zapata AG, Moraleda JM, Soria B, Fernández-Avilés F, García-Olmo D, Prósper F. Adipose-derived mesenchymal stromal cells for the treatment of patients with severe SARS-CoV-2 pneumonia requiring mechanical ventilation. A proof of concept study. EClinicalMedicine 2020; 25:100454. [PMID: 32838232 PMCID: PMC7348610 DOI: 10.1016/j.eclinm.2020.100454] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Identification of effective treatments in severe cases of COVID-19 requiring mechanical ventilation represents an unmet medical need. Our aim was to determine whether the administration of adipose-tissue derived mesenchymal stromal cells (AT-MSC) is safe and potentially useful in these patients. METHODS Thirteen COVID-19 adult patients under invasive mechanical ventilation who had received previous antiviral and/or anti-inflammatory treatments (including steroids, lopinavir/ritonavir, hydroxychloroquine and/or tocilizumab, among others) were treated with allogeneic AT-MSC. Ten patients received two doses, with the second dose administered a median of 3 days (interquartile range-IQR- 1 day) after the first one. Two patients received a single dose and another patient received 3 doses. Median number of cells per dose was 0.98 × 106 (IQR 0.50 × 106) AT-MSC/kg of recipient's body weight. Potential adverse effects related to cell infusion and clinical outcome were assessed. Additional parameters analyzed included changes in imaging, analytical and inflammatory parameters. FINDINGS First dose of AT-MSC was administered at a median of 7 days (IQR 12 days) after mechanical ventilation. No adverse events were related to cell therapy. With a median follow-up of 16 days (IQR 9 days) after the first dose, clinical improvement was observed in nine patients (70%). Seven patients were extubated and discharged from ICU while four patients remained intubated (two with an improvement in their ventilatory and radiological parameters and two in stable condition). Two patients died (one due to massive gastrointestinal bleeding unrelated to MSC therapy). Treatment with AT-MSC was followed by a decrease in inflammatory parameters (reduction in C-reactive protein, IL-6, ferritin, LDH and d-dimer) as well as an increase in lymphocytes, particularly in those patients with clinical improvement. INTERPRETATION Treatment with intravenous administration of AT-MSC in 13 severe COVID-19 pneumonia under mechanical ventilation in a small case series did not induce significant adverse events and was followed by clinical and biological improvement in most subjects. FUNDING None.
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Affiliation(s)
- Fermín Sánchez-Guijo
- Cell Therapy Area, Hematology Department, IBSAL-Hospital Universitario de Salamanca, Universidad de Salamanca, Salamanca, Spain
- RETIC TerCel, ISCIII, Madrid, Spain
- Grupo Español de Trasplante y Terapia Celular (GETH), Spain
| | - Mariano García-Arranz
- RETIC TerCel, ISCIII, Madrid, Spain
- New Therapies Unit, Health Research Institute Fundación Jiménez Díaz, Madrid, Spain
- Surgery Department. School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Miriam López-Parra
- Cell Therapy Area, Hematology Department, IBSAL-Hospital Universitario de Salamanca, Universidad de Salamanca, Salamanca, Spain
- RETIC TerCel, ISCIII, Madrid, Spain
- Grupo Español de Trasplante y Terapia Celular (GETH), Spain
| | - Pablo Monedero
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Pamplona, Spain
| | - Carmen Mata-Martínez
- Instituto de Investigación Sanitaria (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Arnoldo Santos
- Intensive Care Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- CIBER de Enfermedades Respiratorias CIBERES, Madrid, Spain
| | - Víctor Sagredo
- Intensive Care Unit, IBSAL- Hospital Universitario de Salamanca, University of Salamanca, Salamanca, Spain
| | | | - José Eugenio Guerrero
- Instituto de Investigación Sanitaria (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - César Pérez-Calvo
- Intensive Care Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - José Luis Del-Pozo
- Infectious Diseases Division, Microbiology Department, Clínica Universidad de Navarra, Spain
| | - Enrique J Andreu
- RETIC TerCel, ISCIII, Madrid, Spain
- Cell Therapy Area and Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - María-Eugenia Fernández-Santos
- RETIC TerCel, ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBER Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Barbara Soria-Juan
- New Therapies Unit, Health Research Institute Fundación Jiménez Díaz, Madrid, Spain
| | - Luis M Hernández-Blasco
- Hospital General Universitario de Alicante (Universidad Miguel Hernandez-ISABIAL), Alicante, Spain
| | - Etelvina Andreu
- Hospital General Universitario de Alicante (Universidad Miguel Hernandez-ISABIAL), Alicante, Spain
| | - José M Sempere
- Hospital General Universitario de Alicante (Departamento de Biotecnología, Universidad de Alicante-ISABIAL), Alicante, Spain
| | - Agustín G Zapata
- RETIC TerCel, ISCIII, Madrid, Spain
- Department of Cell Biology, Universidad Complutense, Madrid, Spain
| | - José M Moraleda
- RETIC TerCel, ISCIII, Madrid, Spain
- Grupo Español de Trasplante y Terapia Celular (GETH), Spain
- Servicio de Hematología, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB, Universidad de Murcia, Murcia, Spain
| | - Bernat Soria
- Hospital General Universitario de Alicante (Universidad Miguel Hernandez-ISABIAL), Alicante, Spain
- Institute of Bioengineering, Universidad Miguel Hernández, Alicante, Spain
| | - Francisco Fernández-Avilés
- RETIC TerCel, ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBER Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Damián García-Olmo
- RETIC TerCel, ISCIII, Madrid, Spain
- New Therapies Unit, Health Research Institute Fundación Jiménez Díaz, Madrid, Spain
- Surgery Department. School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Surgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Felipe Prósper
- RETIC TerCel, ISCIII, Madrid, Spain
- Grupo Español de Trasplante y Terapia Celular (GETH), Spain
- Cell Therapy Area and Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain
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8
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Affiliation(s)
- Ana-Maria Ioan
- Intensive Care Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, España
| | | | | | - César Pérez-Calvo
- Intensive Care Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, España
| | - Arnoldo Santos
- Intensive Care Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, España.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España
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Ioan AM, Durante-López A, Martínez-Milla J, Pérez-Calvo C, Santos A. Pulmonary embolism in COVID-19. When nothing is what it seems. ACTA ACUST UNITED AC 2020; 73:665-667. [PMID: 32376225 PMCID: PMC7184010 DOI: 10.1016/j.rec.2020.04.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/18/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Ana-Maria Ioan
- Intensive Care Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - César Pérez-Calvo
- Intensive Care Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Arnoldo Santos
- Intensive Care Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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10
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Mas-Font S, Ros-Martinez J, Pérez-Calvo C, Villa-Díaz P, Aldunate-Calvo S, Moreno-Clari E. Prevention of acute kidney injury in Intensive Care Units. Med Intensiva 2017; 41:116-126. [PMID: 28190602 DOI: 10.1016/j.medin.2016.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 09/15/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 12/13/2022]
Abstract
Acute kidney injury (AKI) is a growing concern in Intensive Care Units. The advanced age of our patients, with the increase in associated morbidity and the complexity of the treatments provided favor the development of AKI. Since no effective treatment for AKI is available, all efforts are aimed at prevention and early detection of the disorder in order to establish secondary preventive measures to impede AKI progression. In critical patients, the most frequent causes are sepsis and situations that result in renal hypoperfusion; preventive measures are therefore directed at securing hydration and correct hemodynamics through fluid perfusion and the use of inotropic or vasoactive drugs, according to the underlying disease condition. Apart from these circumstances, a number of situations could lead to AKI, related to the administration of nephrotoxic drugs, intra-tubular deposits, the administration of iodinated contrast media, liver failure and major surgery (mainly heart surgery). In these cases, in addition to hydration, there are other specific preventive measures adapted to each condition.
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Affiliation(s)
- S Mas-Font
- Intensive Care Medicine, Hospital General Universitario de Castellón, Spain.
| | - J Ros-Martinez
- Intensive Care Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - C Pérez-Calvo
- Intensive Care Medicine, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - P Villa-Díaz
- Intensive Care Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - S Aldunate-Calvo
- Intensive Care Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Moreno-Clari
- Intensive Care Medicine, Hospital General Universitario de Castellón, Spain
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Seller-Pérez G, Más-Font S, Pérez-Calvo C, Villa-Díaz P, Celaya-López M, Herrera-Gutiérrez ME. Acute kidney injury: Renal disease in the ICU. Med Intensiva 2016; 40:374-82. [PMID: 27388683 DOI: 10.1016/j.medin.2016.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/21/2016] [Accepted: 05/01/2016] [Indexed: 12/26/2022]
Abstract
Acute kidney injury (AKI) in the ICU frequently requires costly supportive therapies, has high morbidity, and its long-term prognosis is not as good as it has been presumed so far. Consequently, AKI generates a significant burden for the healthcare system. The problem is that AKI lacks an effective treatment and the best approach relies on early secondary prevention. Therefore, to facilitate early diagnosis, a broader definition of AKI should be established, and a marker with more sensitivity and early-detection capacity than serum creatinine - the most common marker of AKI - should be identified. Fortunately, new classification systems (RIFLE, AKIN or KDIGO) have been developed to solve these problems, and the discovery of new biomarkers for kidney injury will hopefully change the way we approach renal patients. As a first step, the concept of renal failure has changed from being a "static" disease to being a "dynamic process" that requires continuous evaluation of kidney function adapted to the reality of the ICU patient.
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Affiliation(s)
- G Seller-Pérez
- Intensive Care Medicine, Complejo Hospitalario Universitario Carlos Haya, Málaga, Spain
| | - S Más-Font
- Intensive Care Medicine, Hospital General Universitario de Castellón, Spain
| | - C Pérez-Calvo
- Intensive Care Medicine, HU Fundación Jiménez Díaz, Madrid, Spain
| | - P Villa-Díaz
- Intensive Care Medicine, Hospital Universitario Principe de Asturias, Alcalá de Henares, Madrid, Spain
| | - M Celaya-López
- Intensive Care Medicine, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - M E Herrera-Gutiérrez
- Intensive Care Medicine, Complejo Hospitalario Universitario Carlos Haya, Málaga, Spain.
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