1
|
Olaechea Astigarraga PM, Álvarez Lerma F, Beato Zambrano C, Gimeno Costa R, Gordo Vidal F, Durá Navarro R, Ruano Suarez C, Aldabó Pallás T, Garnacho Montero J. Epidemiology and prognosis of patients with a history of cancer admitted to intensive care. A multicenter observational study. Med Intensiva 2021; 45:332-346. [PMID: 34127405 DOI: 10.1016/j.medine.2021.05.003] [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: 09/27/2019] [Accepted: 01/26/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the epidemiology and outcome at discharge of cancer patients requiring admission to the Intensive Care Unit (ICU). DESIGN A descriptive observational study was made of data from the ENVIN-HELICS registry, combined with specifically compiled variables. Comparisons were made between patients with and without neoplastic disease, and groups of cancer patients with a poorer outcome were identified. SETTING Intensive Care Units participating in ENVIN-HELICS 2018, with voluntary participation in the oncological registry. PATIENTS Subjects admitted during over 24 h and diagnosed with cancer in the last 5 years. PRIMARY ENDPOINTS The general epidemiological endpoints of the ENVIN-HELICS registry and cancer-related variables. RESULTS Of the 92 ICUs with full data, a total of 11,796 patients were selected, of which 1786 (15.1%) were cancer patients. The proportion of cancer patients per Unit proved highly variable (1%-48%). In-ICU mortality was higher among the cancer patients than in the non-oncological subjects (12.3% versus 8.9%; p < .001). Elective postoperative (46.7%) or emergency admission (15.3%) predominated in the cancer patients. Patients with medical disease were in more serious condition, with longer stay and greater mortality (27.5%). The patients admitted to the ICU due to nonsurgical disease related to cancer exhibited the highest mortality rate (31.4%). CONCLUSIONS Great variability was recorded in the percentage of cancer patients in the different ICUs. A total of 46.7% of the patients were admitted after undergoing scheduled surgery. The highest mortality rate corresponded to patients with medical disease (27.5%), and to those admitted due to cancer-related complications (31.4%).
Collapse
Affiliation(s)
- P M Olaechea Astigarraga
- Servicio de Medicina Intensiva, Hospital Universitario Galdakao-Usansolo, Biocruces Bizkaia Health Research Institute, Galdácano, Vizcaya, Spain.
| | - F Álvarez Lerma
- Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - C Beato Zambrano
- Servicio de Oncología Médica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - R Gimeno Costa
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - R Durá Navarro
- Servicio Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - C Ruano Suarez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Cruces, Baracaldo, Vizcaya, Spain
| | - T Aldabó Pallás
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J Garnacho Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | |
Collapse
|
2
|
Picazo L, Gracia Arnillas MP, Muñoz-Bermúdez R, Durán X, Álvarez Lerma F, Masclans JR. Active humidification in mechanical ventilation is not associated to an increase in respiratory infectious complications in a quasi-experimental pre-post intervention study. Med Intensiva 2020; 45:354-361. [PMID: 34294233 DOI: 10.1016/j.medine.2019.11.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is controversy regarding the influence of humidification systems upon the incidence of respiratory infections associated to invasive mechanical ventilation (IMV). An evaluation was made of the differences in the incidence of pneumonia and tracheobronchitis associated to mechanical ventilation (VAP and VAT, respectively) with passive and active humidification. DESIGN A retrospective pre-post quasi-experimental study was carried out. SETTING A polyvalent ICU with 14 beds. PATIENTS All patients connected to IMV for >48h during 2014 and 2016 were included. INTERVENTIONS During 2014, passive humidification with an hygroscopic heat and moisture exchanger (HME) was used, while during 2016 active humidification with a heated humidifier (HH) and an inspiratory heated wire was used. Identical measures for the prevention of VAP were established (Zero Pneumonia Project). MAIN OUTCOME MEASURES The incidence of VAP and VAT was estimated for 1000 days of IMV in both groups, and statistically significant differences were assessed using Poisson regression analysis. RESULTS A total of 287 patients were included (116 with HME and 171 with HH). The incidence density of VAP per 1000 days of IMV was 5.68 in the HME group and 5.80 in the HH group (p=ns). The incidence density of VAT was 3.41 and 3.26 cases per 1000 days of VMI with HME and HH respectively (p=ns). The duration of IMV was identified as a risk factor for VAP. CONCLUSIONS In our population, active humidification in patients ventilated for >48h was not associated to an increase in respiratory infectious complications.
Collapse
Affiliation(s)
- L Picazo
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - M P Gracia Arnillas
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - R Muñoz-Bermúdez
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - X Durán
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - F Álvarez Lerma
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - J R Masclans
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| |
Collapse
|
3
|
Picazo L, Gracia Arnillas MP, Muñoz-Bermúdez R, Durán X, Álvarez Lerma F, Masclans JR. Active humidification in mechanical ventilation is not associated to an increase in respiratory infectious complications in a quasi-experimental pre-post intervention study. Med Intensiva 2020. [PMID: 31924444 DOI: 10.1016/j.medin.2019.11.006] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is controversy regarding the influence of humidification systems upon the incidence of respiratory infections associated to invasive mechanical ventilation (IMV). An evaluation was made of the differences in the incidence of pneumonia and tracheobronchitis associated to mechanical ventilation (VAP and VAT, respectively) with passive and active humidification. DESIGN A retrospective pre-post quasi-experimental study was carried out. SETTING A polyvalent ICU with 14 beds. PATIENTS All patients connected to IMV for>48hours during 2014 and 2016 were included. INTERVENTIONS During 2014, passive humidification with an hygroscopic heat and moisture exchanger (HME) was used, while during 2016 active humidification with a heated humidifier (HH) and an inspiratory heated wire was used. Identical measures for the prevention of VAP were established (Zero Pneumonia Project). MAIN OUTCOME MEASURES The incidence of VAP and VAT was estimated for 1000 days of IMV in both groups, and statistically significant differences were assessed using Poisson regression analysis. RESULTS A total of 287 patients were included (116 with HME and 171 with HH). The incidence density of VAP per 1000 days of IMV was 5.68 in the HME group and 5.80 in the HH group (p=ns). The incidence density of VAT was 3.41 and 3.26 cases per 1000 days of VMI with HME and HH respectively (p=ns). The duration of IMV was identified as a risk factor for VAP. CONCLUSIONS In our population, active humidification in patients ventilated for>48hours was not associated to an increase in respiratory infectious complications.
Collapse
Affiliation(s)
- L Picazo
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - M P Gracia Arnillas
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - R Muñoz-Bermúdez
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - X Durán
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - F Álvarez Lerma
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - J R Masclans
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Universitat Autònoma de Barcelona (UAB), Barcelona, España.
| |
Collapse
|
4
|
Álvarez Lerma F, Muñoz Bermudez R, Grau S, Gracia Arnillas MP, Sorli L, Recasens L, Mico García M. Ceftolozane-tazobactam for the treatment of ventilator-associated infections by colistin-resistant Pseudomonas aeruginosa. Rev Esp Quimioter 2017; 30:224-228. [PMID: 28361526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The use of colistin for the treatment of multiresistant bacteria has led to the emergence of colistin-resistant strains of Gram-negative bacilli. Treatment of infections caused by these pan-drug-resistant bacteria is difficult owing to the paucity of effective antibiotics. We report two cases of ventilator-associated respiratory infection caused by pan-drug-resistant, colistin-resistant Pseudomonas aeruginosa that were successfully treated with ceftolozane-tazobactam.
Collapse
Affiliation(s)
- F Álvarez Lerma
- Francisco Álvarez Lerma, Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain.
| | | | | | | | | | | | | |
Collapse
|
5
|
Grau S, Luque S, Echeverría-Esnal D, Sorlí L, Campillo N, Montero M, Álvarez Lerma F, Plasencia V, Horcajada JP. Urinary micafungin levels are sufficient to treat urinary tract infections caused by Candida spp. Int J Antimicrob Agents 2016; 48:212-4. [PMID: 27424599 DOI: 10.1016/j.ijantimicag.2016.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 03/15/2016] [Revised: 05/06/2016] [Accepted: 05/07/2016] [Indexed: 01/05/2023]
Abstract
Six cases of patients diagnosed with urinary tract infection (UTI) successfully treated with micafungin are reported. Four were infected with fluconazole-resistant Candida spp. and two (with hepatic injury) were infected with fluconazole-sensitive Candida spp. Traditionally, echinocandins have not been considered for the treatment of UTIs. However, despite its low urinary excretion rate, therapeutic drug monitoring of micafungin urinary levels could be helpful in order to achieve optimal pharmacokinetic/pharmacodynamic (PK/PD) indices for treating UTIs caused by Candida spp. resistant to fluconazole.
Collapse
Affiliation(s)
- S Grau
- Pharmacy Service, Hospital del Mar, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
| | - S Luque
- Pharmacy Service, Hospital del Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - D Echeverría-Esnal
- Pharmacy Service, Hospital del Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - L Sorlí
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Infectious Diseases Service, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Barcelona, Spain
| | - N Campillo
- Pharmacy Service, Hospital del Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - M Montero
- Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Infectious Diseases Service, Hospital del Mar, Barcelona, Spain
| | - F Álvarez Lerma
- Universitat Autònoma de Barcelona, Barcelona, Spain; Intensive Care Unit, Hospital del Mar, Barcelona, Spain
| | - V Plasencia
- Laboratori de Referència de Catalunya, Prat de Llobregat, Barcelona, Spain
| | - J P Horcajada
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Infectious Diseases Service, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Spain
| |
Collapse
|
6
|
Álvarez Lerma F, Olaechea Astigarraga P, Palomar Martínez M, Rodríguez Carvajal M, Machado Casas JF, Jiménez Quintana MM, Esteve Urbano F, Ballesteros Herráez JC, Zavala Zegarra E. [Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to the intensive care units]. Med Intensiva 2014; 39:149-59. [PMID: 24713089 DOI: 10.1016/j.medin.2014.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 12/22/2013] [Revised: 02/03/2014] [Accepted: 02/11/2014] [Indexed: 11/18/2022]
Abstract
UNLABELLED The presence of respiratory fungal infection in the critically ill patient is associated with high morbidity and mortality. OBJECTIVES To assess the incidence of respiratory infection caused by Aspergillus spp. independently of the origin of infection in patients admitted to Spanish ICUs, as well as to describe the rates, characteristics, outcomes and prognostic factors in patients with this type of infection. MATERIAL AND METHODS An observational, retrospective, open-label and multicenter study was carried out in a cohort of patients with respiratory infection caused by Aspergillus spp. admitted to Spanish ICUs between 2006 and 2012 (months of April, May and June), and included in the ENVIN-HELICS registry (108,244 patients and 825,797 days of ICU stay). Variables independently related to in-hospital mortality were identified by multiple logistic regression analysis. RESULTS A total of 267 patients from 79 of the 198 participating ICUs were included (2.46 cases per 1000 ICU patients and 3.23 episodes per 10,000 days of ICU stay). From a clinical point of view, infections were classified as ventilator-associated pneumonia in 93 cases (34.8%), pneumonia unrelated to mechanical ventilation in 120 cases (44.9%), and tracheobronchitis in 54 cases (20.2%). The study population included older patients (mean 64.8±17.1 years), with a high severity level (APACHE II score 22.03±7.7), clinical diseases (64.8%) and prolonged hospital stay before the identification of Aspergillus spp. (median 11 days), transferred to the ICU mainly from hospital wards (58.1%) and with high ICU (57.3%) and hospital (59.6%) mortality rates, exhibiting important differences depending on the type of infection involved. Independent mortality risk factors were previous admission to a hospital ward (OR=7.08, 95%CI: 3.18-15.76), a history of immunosuppression (OR=2.52, 95%CI: 1.24-5.13) and severe sepsis or septic shock (OR=8.91, 95%CI: 4.24-18.76). CONCLUSIONS Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to the ICU in Spain are infrequent, and affect a very selected group of patients, characterized by high mortality and conditioned by non-modifiable risk factors.
Collapse
Affiliation(s)
- F Álvarez Lerma
- Servicio de Medicina Intensiva, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
| | | | - M Palomar Martínez
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova, Lleida, España
| | - M Rodríguez Carvajal
- Servicio de Medicina Intensiva, Hospital General de Huelva Juan Ramón Jiménez, Huelva, España
| | - J F Machado Casas
- Servicio de Medicina Intensiva, Complejo Hospitalario de Jaén, Jaén, España
| | - M M Jiménez Quintana
- Unidad de Cuidados Intensivos, Hospital Médico-Quirúrgico Virgen de las Nieves, Granada, España
| | - F Esteve Urbano
- Servicio de Medicina Intensiva, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | | | - E Zavala Zegarra
- Unidad de Cuidados Intensivos Quirúrgica, Hospital Clinic i Provincial, IDIBAPS, Barcelona, España
| |
Collapse
|
7
|
Álvarez Lerma F, Sánchez García M, Lorente L, Gordo F, Añón JM, Álvarez J, Palomar M, García R, Arias S, Vázquez-Calatayud M, Jam R. Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish "Zero-VAP" bundle. Med Intensiva 2014; 38:226-36. [PMID: 24594437 DOI: 10.1016/j.medin.2013.12.007] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [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: 11/11/2013] [Revised: 11/30/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND "Zero-VAP" is a proposal for the implementation of a simultaneous multimodal intervention in Spanish intensive care units (ICU) consisting of a bundle of ventilator-associated pneumonia (VAP) prevention measures. METHODS/DESIGN An initiative of the Spanish Societies of Intensive Care Medicine and of Intensive Care Nurses, the project is supported by the Spanish Ministry of Health, and participation is voluntary. In addition to guidelines for VAP prevention, the "Zero-VAP" Project incorporates an integral patient safety program and continuous online validation of the application of the bundle. For the latter, VAP episodes and participation indices are entered into the web-based Spanish ICU Infection Surveillance Program "ENVIN-HELICS" database, which provides continuous information about local, regional and national VAP incidence rates. Implementation of the guidelines aims at the reduction of VAP to less than 9 episodes per 1000 days of mechanical ventilation. A total of 35 preventive measures were initially selected. A task force of experts used the Grading of Recommendations, Assessment, Development and Evaluation Working Group methodology to generate a list of 7 basic "mandatory" recommendations (education and training in airway management, strict hand hygiene for airway management, cuff pressure control, oral hygiene with chlorhexidine, semi-recumbent positioning, promoting measures that safely avoid or reduce time on ventilator, and discouraging scheduled changes of ventilator circuits, humidifiers and endotracheal tubes) and 3 additional "highly recommended" measures (selective decontamination of the digestive tract, aspiration of subglottic secretions, and a short course of iv antibiotic). DISCUSSION We present the Spanish VAP prevention guidelines and describe the methodology used for the selection and implementation of the recommendations and the organizational structure of the project. Compared to conventional guideline documents, the associated safety assurance program, the online data recording and compliance control systems, as well as the existence of a pre-defined objective are the distinct features of "Zero VAP".
Collapse
Affiliation(s)
- F Álvarez Lerma
- Servicio de Medicina Intensiva, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - M Sánchez García
- Servicio de Medicina Intensiva, Hospital Clínico San Carlos, Madrid, Spain.
| | - L Lorente
- Servicio de Medicina Intensiva, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - F Gordo
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - J M Añón
- Servicio de Medicina Intensiva, Hospital Virgen de la Luz, Cuenca, Spain
| | - J Álvarez
- Servicio de Cuidados Intensivos, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - M Palomar
- Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova, Lérida, Spain
| | - R García
- Servicio de Anestesia y Reanimación, Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain
| | - S Arias
- Servicio de Medicina Intensiva, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - M Vázquez-Calatayud
- Servicio de Medicina Intensiva, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - R Jam
- Servicio de Medicina Intensiva, Centro Hospitalario Parc Taulí, Sabadell, Barcelona, Spain
| | | | | |
Collapse
|
8
|
Rodriguez Colomo O, Álvarez Lerma F, González Pérez MI, Sirvent JM, García Simón M. Impact of administration of vancomycin or linezolid to critically ill patients with impaired renal function. Eur J Clin Microbiol Infect Dis 2011; 30:635-43. [PMID: 21225305 DOI: 10.1007/s10096-010-1133-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 12/17/2010] [Indexed: 11/28/2022]
Abstract
The aim of this study was to assess the impact of vancomycin (VAN) versus linezolid (LZD) on renal function in patients with renal failure (RF) admitted to intensive care units. This was a multicenter, retrospective, comparative cohort study. Renal failure patients were treated with VAN or LZD for proven or suspected infections by multiresistant Gram-positive cocci. Changes in plasma creatinine levels and creatinine clearance at the start and end of treatment were used as endpoints. A total of 147 patients were treated with VAN (group A, n = 68) or LZD (group B, n = 79). Group B included more patients with diabetes mellitus [9 (13.2%) vs. 25 (31.6%); p = 0.007], septic shock [39 (57.4%) vs. 60 (75.9%); p = 0.013] and greater RF (mean ClCr 42.24 ml/min vs. 37.57 ml/min; p = 0.04). Renal function improved in patients from both groups who did not require renal replacement therapy. A greater improvement was seen in group B [percent decrease in Cr (27.94 vs. 9.48; p = 0.02) and percent increase in ClCr (95.96 vs. 55.06; p = 0.05)]. In group A, nine patients (13.2%) experienced an antibiotic-related increase in RF, and antibiotic was discontinued in five patients due to adverse effects. It is reasonable to avoid use of VAN in critically ill patients with acute renal failure.
Collapse
Affiliation(s)
- O Rodriguez Colomo
- Department of Intensive Medicine, Hospital Clínico Universitario, Valencia, Spain.
| | | | | | | | | | | |
Collapse
|
9
|
Palomar Martínez M, Álvarez Lerma F, Riera Badía M, León Gil C, López Pueyo M, Díaz Tobajas C, Sierra Camerino R, Benítez Ruiz L, Agra Varela Y. Prevención de la bacteriemia relacionada con catéteres en UCI mediante una intervención multifactorial. Informe del estudio piloto. Med Intensiva 2010; 34:581-9. [DOI: 10.1016/j.medin.2010.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 07/04/2010] [Accepted: 07/24/2010] [Indexed: 10/18/2022]
|
10
|
Álvarez Lerma F. Desescalada terapéutica en pacientes críticos: una nueva formulación de dos viejas estrategias. Med Intensiva 2005. [DOI: 10.1016/s0210-5691(05)74278-9] [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: 11/25/2022]
|
11
|
Maraví Poma E, Jiménez Urra I, Gener Raxarch J, Zubia Olascoaga F, Pérez Mateo M, Casas Curto J, Montejo González J, García de Lorenzo A, López Camps V, Fernández Mondéjar E, Álvarez Lerma F, Vallés Daunis J, Olaechea Astigarraga P, Domínguez Muñoz E, Tellado Rodríguez J, Landa García I, Lafuente Martínez J, Villalba Martín C, Sesma Sánchez J. Recomendaciones de la 7ª Conferencia de Consenso de la SEMICYUC. Pancreatitis aguda grave en Medicina Intensiva. Med Intensiva 2005. [DOI: 10.1016/s0210-5691(05)74245-5] [Citation(s) in RCA: 7] [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] [Indexed: 12/11/2022]
|
12
|
Álvarez Lerma F, Palomar Martínez M, Olaechea Astigarraga P, Insausti Ordeñana J, Bermejo Fraile B, Cerdá Cerdá E. Estudio nacional de vigilancia de infección nosocomial en Unidades de Cuidados Intensivos. Informe del año 2002. Med Intensiva 2005. [DOI: 10.1016/s0210-5691(05)74197-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
13
|
Jordà Marcos R, Torres Martí A, Ariza Cardenal F, Álvarez Lerma F, Barcenilla Gaite F. Recommendations for the Treatment of Severe Nosocomial Pneumonia. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s1579-2129(06)60367-4] [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: 01/15/2023]
|
14
|
Jordà Marcos R, Torres Martí A, Ariza Cardenal FJ, Álvarez Lerma F, Barcenilla Gaite F. Recomendaciones para el tratamiento de la neumonía intrahospitalaria grave. Arch Bronconeumol 2004. [DOI: 10.1157/13067573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
15
|
Jordà R, Jordàe; Marcos R, Torres Martí A, Ariza Cardenal F, Álvarez Lerma F, Barcenilla Gaite F, del Grupo de CDE. Recomendaciones para el tratamiento de la neumonía intrahospitalaria grave. Enferm Infecc Microbiol Clin 2004. [DOI: 10.1016/s0213-005x(04)73143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
16
|
Valencia Arango M, Torres Martí A, Insausti Ordeñana J, Álvarez Lerma F, Carrasco Joaquinet N, Herranz Casado M, Tirapu León JP. Valor diagnóstico del cultivo cuantitativo del aspirado endotraqueal en la neumonía adquirida durante la ventilación mecánica. Estudio multicéntrico. Arch Bronconeumol 2003. [DOI: 10.1157/13050628] [Citation(s) in RCA: 8] [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] [Indexed: 11/21/2022]
|
17
|
|