1
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Proaños NJ, Reyes LF, Bastidas A, Martín-Loeches I, Díaz E, Suberviola B, Moreno G, Bodí M, Nieto M, Estella A, Sole-Violán J, Curcio D, Papiol E, Guardiola J, Rodríguez A. Prior influenza vaccine is not a risk factor for bacterial coinfection in patients admitted to the ICU due to severe influenza. Med Intensiva 2022; 46:436-445. [PMID: 35868720 DOI: 10.1016/j.medine.2021.05.009] [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: 02/10/2021] [Accepted: 05/22/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine whether the prior usage of the flu vaccine is a risk factor for bacterial co-infection in patients with severe influenza. DESIGN This was a retrospective observational cohort study of subjects admitted to the ICU. A propensity score matching, and logistic regression adjusted for potential confounders were carried out to evaluate the association between prior influenza vaccination and bacterial co-infection. SETTINGS 184 ICUs in Spain due to severe influenza. PATIENTS Patients included in the Spanish prospective flu registry. INTERVENTIONS Flu vaccine prior to the hospital admission. RESULTS A total of 4175 subjects were included in the study. 489 (11.7%) received the flu vaccine prior to develop influenza infection. Prior vaccinated patients were older 71 [61-78], and predominantly male 65.4%, with at least one comorbid condition 88.5%. Prior vaccination was not associated with bacterial co-infection in the logistic regression model (OR: 1.017; 95%CI 0.803-1.288; p=0.885). After matching, the average treatment effect of prior influenza vaccine on bacterial co-infection was not statistically significant when assessed by propensity score matching (p=0.87), nearest neighbor matching (p=0.59) and inverse probability weighting (p=0.99). CONCLUSIONS No association was identified between prior influenza vaccine and bacterial coinfection in patients admitted to the ICU due to severe influenza. Post influenza vaccination studies are necessary to continue evaluating the possible benefits.
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Affiliation(s)
| | - L F Reyes
- Universidad de La Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia.
| | - A Bastidas
- Universidad de La Sabana, Chía, Colombia
| | - I Martín-Loeches
- St James's University Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Department of Anaesthesia and Critica Care, Dublin, Ireland
| | - E Díaz
- ICU Complejo Hospitalario Parc Taulí/UAB, Sabadell, Spain
| | - B Suberviola
- ICU Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - G Moreno
- ICU Hospital Universitario de Tarragona Joan XXIII, Tarragona, Spain
| | - M Bodí
- ICU Hospital Universitario de Tarragona Joan XXIII, Tarragona, Spain; IISPV/URV/CIBERES, Tarragona, Spain
| | - M Nieto
- ICU Hospital Clínico San Carlos, Madrid, Spain
| | - A Estella
- ICU Hospital de Jerez, Jerez de la Frontera, Spain
| | - J Sole-Violán
- ICU Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - D Curcio
- Departamento de Enfermedades Infecciosas, Universidad de Buenos Aires, Argentina
| | - E Papiol
- ICU Hospital Univseritario Vall d'Hebron, Barcelona, Spain
| | - J Guardiola
- University of Louisville and Robley Rex VA Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, Louisville, KY, United States
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Fernández-Galilea A, Estella A, García-Garmendia JL, Loza A, Palacios-García I, Sierra-Camerino R, Seller G, Rodríguez-Delgado M, Rodriguez-Higueras I, Garnacho-Montero J. Clindamycin but not Intravenous Immunoglobulins reduces mortality in a retrospective cohort of critically ill patients with bacteremic Group A Streptococcal infections. Rev Esp Quimioter 2022; 35:475-481. [PMID: 35796693 PMCID: PMC9548074 DOI: 10.37201/req/030.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objectives Mortality of patients requiring Intensive Care Unit (ICU) admission for an invasive group A streptococcal (GAS) infection continues being high. In critically ill patients with bacteremic GAS infection we aimed at determining risk factors for mortality. Patients and methods Retrospective multicentre study carried out in nine ICU in Southern Spain. All adult patients admitted to the participant ICUs from January 2014 to June 2019 with one positive blood culture for S. pyogenes were included in this study. Patient characteristics, infection-related variables, therapeutic interventions, failure of organs, and outcomes were registered. Risk factors independently associated with ICU and in-hospital mortalities were determined by multivariate regression analyses. Results Fifty-seven patients were included: median age was 63 (45-73) years, median SOFA score at admission was 11 (7-13). The most frequent source was skin and soft tissue infection (n=32) followed by unknown origin of bacteremia (n=12). In the multivariate analysis, age (OR 1.079; 95% CI 1.016-1.145), SOFA score (OR 2.129; 95% CI 1.339-3.383) were the risk factors for ICU mortality and the use of clindamycin was identified as a protective factor (OR 0.049; 95% CI 0.003-0.737). Age and SOFA were the independent factors associated with hospital mortality however the use of clindamycin showed a strong trend but without reaching statistical significance (OR 0.085; 95% CI 0.007-1.095). Conclusion In this cohort of critically ill patients the use of intravenous immunoglobulin was not identified as a protective factor for ICU or hospital mortality treatment with clindamycin significantly reduced mortality after controlling for confounders.
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Affiliation(s)
| | - A Estella
- Ángel Estella, Hospital Universitario de Jerez. Departamento de Medicina Universidad de Cádiz, INiBICA, Carretera Nacional IV s/n. Jerez de la Frontera. 11407, Jerez de la Frontera (Cádiz), Spain.
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3
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Escudero-Acha P, Leizaola O, Lázaro N, Cordero M, Cossío AM, Ballesteros D, Recena P, Tizón AI, Palomo M, Del Campo MM, Freita S, Duerto J, Bilbao NM, Vidal B, González-Romero D, Diaz-Dominguez F, Revuelto J, Blasco ML, Domezain M, de la Concepción Pavía-Pesquera M, Rubio O, Estella A, Pobo A, Gomez-Acebo I, González-Castro A. ADENI-UCI study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments. Med Intensiva 2022; 46:192-200. [PMID: 35227639 DOI: 10.1016/j.medine.2022.02.008] [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: 09/07/2020] [Revised: 10/23/2020] [Accepted: 11/07/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN Prospective, multicentrico. SCOPE 62 ICU from Spain between February 2018 and March 2019. PATIENTS Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS None. MAIN INTEREST VARIABLES Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.
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Affiliation(s)
- P Escudero-Acha
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - O Leizaola
- Hospital Universitario Central de Asturias, Asturias, Spain
| | - N Lázaro
- Hospital 12 de Octubre, Madrid, Spain
| | - M Cordero
- Hospital Universitario de Álava, Vitoria, Spain
| | - A M Cossío
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - P Recena
- Hospital Universitario de Cabueñes, Gijón, Spain
| | - A I Tizón
- Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Palomo
- Hospital de Sagunto, Valencia, Spain
| | - M M Del Campo
- Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - S Freita
- Complexo Hospitalario Universitario Alvaro Cunqueiro, Vigo, Spain
| | - J Duerto
- Hospital Clínico San Carlos, Madrid, Spain
| | - N M Bilbao
- Hospital Galdakao-Usansolo, Bizkaia, Spain
| | - B Vidal
- Hospital Universitario de Castellón, Castellón, Spain
| | | | | | - J Revuelto
- Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - M L Blasco
- Hospital Clínico de Valencia, Valencia, Spain
| | - M Domezain
- Hospital Universitario de Cruces, Bilbao, Spain
| | | | - O Rubio
- Fundació Althaia Xarxa Universitaria Assistencial de Manresa, Manresa, Spain
| | | | - A Pobo
- Hospital Joan XXIII de Tarragona, Tarragona, Spain
| | - I Gomez-Acebo
- Departamento de Preventiva y Salud Pública, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
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4
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Mensa J, Barberán J, Ferrer R, Borges M, Rascado P, Maseda E, Oliver A, Marco F, Adalia R, Aguilar G, Estella A, León López R, Robles Marcos MS, González de Molina FJ, Serrano García R, Salavert M, Fernández Gómez J, Poliakova Y, Pasquau J, Azanza JR, Bou Arévalo G, LLinares Mondéjar P, Cardinal-Fernández P, Soriano A. Recommendations for antibiotic selection for severe nosocomial infections. Rev Esp Quimioter 2021; 34:511-524. [PMID: 34693705 PMCID: PMC8638841 DOI: 10.37201/req/126.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Severe infection and its evolution to sepsis are becoming more prevalent every day and are among the leading causes of critical illness and mortality. Proper management is crucial to improve prognosis. This document addresses three essential points that have a significant impact on this objective: a) early recognition of patients with sepsis criteria, b) identification of those patients who suffer from an infection and have a high risk of progressing to sepsis, and c) adequate selection and optimization of the initial antimicrobial treatment.
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Affiliation(s)
| | - J Barberán
- José Barberán, Servicio de Medicina Interna - Enfermedades Infecciosas. Hospital Universitario HM Montepríncipe. Universidad San Pablo CEU. Spain.
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5
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Rubio O, Cabré L, Estella A, Ferrer R. Reply to "Considerations on ICU triage ethics during the COVID-19 pandemic". Med Intensiva 2021; 45:382. [PMID: 34294238 PMCID: PMC8092810 DOI: 10.1016/j.medine.2021.04.011] [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: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 11/17/2022]
Affiliation(s)
- O Rubio
- Hospital Sant Joan de Déu de Manresa, Manresa, Spain.
| | - L Cabré
- Hospital de Barcelona, Barcelona, Spain
| | - A Estella
- Hospital de Jerez de la Frontera, Jerez de la Frontera, Spain
| | - R Ferrer
- Hospital Universitario de Valle Hebrón, Barcelona, Spain
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6
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Proaños NJ, Reyes LF, Bastidas A, Martín-Loeches I, Díaz E, Suberviola B, Moreno G, Bodí M, Nieto M, Estella A, Sole-Violán J, Curcio D, Papiol E, Guardiola J, Rodríguez A. Prior influenza vaccine is not a risk factor for bacterial coinfection in patients admitted to the ICU due to severe influenza. Med Intensiva 2021; 46:S0210-5691(21)00118-2. [PMID: 34175139 DOI: 10.1016/j.medin.2021.05.013] [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: 02/10/2021] [Revised: 05/01/2021] [Accepted: 05/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether the prior usage of the flu vaccine is a risk factor for bacterial co-infection in patients with severe influenza. DESIGN This was a retrospective observational cohort study of subjects admitted to the ICU. A propensity score matching, and logistic regression adjusted for potential confounders were carried out to evaluate the association between prior influenza vaccination and bacterial co-infection. SETTINGS 184 ICUs in Spain due to severe influenza. PATIENTS Patients included in the Spanish prospective flu registry. INTERVENTIONS Flu vaccine prior to the hospital admission. RESULTS A total of 4175 subjects were included in the study. 489 (11.7%) received the flu vaccine prior to develop influenza infection. Prior vaccinated patients were older 71 [61-78], and predominantly male 65.4%, with at least one comorbid condition 88.5%. Prior vaccination was not associated with bacterial co-infection in the logistic regression model (OR: 1.017; 95%CI 0.803-1.288; p=0.885). After matching, the average treatment effect of prior influenza vaccine on bacterial co-infection was not statistically significant when assessed by propensity score matching (p=0.87), nearest neighbor matching (p=0.59) and inverse probability weighting (p=0.99). CONCLUSIONS No association was identified between prior influenza vaccine and bacterial coinfection in patients admitted to the ICU due to severe influenza. Post influenza vaccination studies are necessary to continue evaluating the possible benefits.
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Affiliation(s)
| | - L F Reyes
- Universidad de La Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia.
| | - A Bastidas
- Universidad de La Sabana, Chía, Colombia
| | - I Martín-Loeches
- St James's University Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Department of Anaesthesia and Critica Care, Dublin, Ireland
| | - E Díaz
- ICU Complejo Hospitalario Parc Taulí/UAB, Sabadell, Spain
| | - B Suberviola
- ICU Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - G Moreno
- ICU Hospital Universitario de Tarragona Joan XXIII, Tarragona, Spain
| | - M Bodí
- ICU Hospital Universitario de Tarragona Joan XXIII, Tarragona, Spain; IISPV/URV/CIBERES, Tarragona, Spain
| | - M Nieto
- ICU Hospital Clínico San Carlos, Madrid, Spain
| | - A Estella
- ICU Hospital de Jerez, Jerez de la Frontera, Spain
| | - J Sole-Violán
- ICU Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - D Curcio
- Departamento de Enfermedades Infecciosas, Universidad de Buenos Aires, Argentina
| | - E Papiol
- ICU Hospital Univseritario Vall d'Hebron, Barcelona, Spain
| | - J Guardiola
- University of Louisville and Robley Rex VA Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, Louisville, KY, United States
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Rabal O, San José-Enériz E, Agirre X, Sánchez-Arias JA, de Miguel I, Ordoñez R, Garate L, Miranda E, Sáez E, Vilas-Zornoza A, Pineda-Lucena A, Estella A, Zhang F, Wu W, Xu M, Prosper F, Oyarzabal J. Design and Synthesis of Novel Epigenetic Inhibitors Targeting Histone Deacetylases, DNA Methyltransferase 1, and Lysine Methyltransferase G9a with In Vivo Efficacy in Multiple Myeloma. J Med Chem 2021; 64:3392-3426. [PMID: 33661013 DOI: 10.1021/acs.jmedchem.0c02255] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/07/2023]
Abstract
Concomitant inhibition of key epigenetic pathways involved in silencing tumor suppressor genes has been recognized as a promising strategy for cancer therapy. Herein, we report a first-in-class series of quinoline-based analogues that simultaneously inhibit histone deacetylases (from a low nanomolar range) and DNA methyltransferase-1 (from a mid-nanomolar range, IC50 < 200 nM). Additionally, lysine methyltransferase G9a inhibitory activity is achieved (from a low nanomolar range) by introduction of a key lysine mimic group at the 7-position of the quinoline ring. The corresponding epigenetic functional cellular responses are observed: histone-3 acetylation, DNA hypomethylation, and decreased histone-3 methylation at lysine-9. These chemical probes, multitarget epigenetic inhibitors, were validated against the multiple myeloma cell line MM1.S, demonstrating promising in vitro activity of 12a (CM-444) with GI50 of 32 nM, an adequate therapeutic window (>1 log unit), and a suitable pharmacokinetic profile. In vivo, 12a achieved significant antitumor efficacy in a xenograft mouse model of human multiple myeloma.
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Affiliation(s)
- Obdulia Rabal
- Small Molecule Discovery Platform, Molecular Therapeutics Program, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
| | - Edurne San José-Enériz
- Area de Hemato-Oncología, IDISNA, CIBERONC, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
| | - Xabier Agirre
- Area de Hemato-Oncología, IDISNA, CIBERONC, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
| | - Juan Antonio Sánchez-Arias
- Small Molecule Discovery Platform, Molecular Therapeutics Program, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
| | - Irene de Miguel
- Small Molecule Discovery Platform, Molecular Therapeutics Program, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
| | - Raquel Ordoñez
- Area de Hemato-Oncología, IDISNA, CIBERONC, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
| | - Leire Garate
- Area de Hemato-Oncología, IDISNA, CIBERONC, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
| | - Estíbaliz Miranda
- Area de Hemato-Oncología, IDISNA, CIBERONC, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
| | - Elena Sáez
- Small Molecule Discovery Platform, Molecular Therapeutics Program, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
| | - Amaia Vilas-Zornoza
- Area de Hemato-Oncología, IDISNA, CIBERONC, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
| | - Antonio Pineda-Lucena
- Small Molecule Discovery Platform, Molecular Therapeutics Program, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
| | - Ander Estella
- Small Molecule Discovery Platform, Molecular Therapeutics Program, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
| | - Feifei Zhang
- WuXi Apptec (Tianjin) Company Ltd., TEDA, No. 168 Nanhai Road, 10th Avenue, 300456 Tianjin, PR China
| | - Wei Wu
- WuXi Apptec (Tianjin) Company Ltd., TEDA, No. 168 Nanhai Road, 10th Avenue, 300456 Tianjin, PR China
| | - Musheng Xu
- WuXi Apptec (Tianjin) Company Ltd., TEDA, No. 168 Nanhai Road, 10th Avenue, 300456 Tianjin, PR China
| | - Felipe Prosper
- Area de Hemato-Oncología, IDISNA, CIBERONC, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
- Departmento de Hematología, Clínica Universidad de Navarra, University of Navarra, Avenida Pio XII 36, E-31008 Pamplona, Spain
| | - Julen Oyarzabal
- Small Molecule Discovery Platform, Molecular Therapeutics Program, Center for Applied Medical Research (CIMA), University of Navarra, Avenida Pio XII 55, E-31008 Pamplona, Spain
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8
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Escudero-Acha P, Leizaola O, Lázaro N, Cordero M, Cossío AM, Ballesteros D, Recena P, Tizón AI, Palomo M, Del Campo MM, Freita S, Duerto J, Bilbao NM, Vidal B, González-Romero D, Diaz-Dominguez F, Revuelto J, Blasco ML, Domezain M, de la Concepción Pavía-Pesquera M, Rubio O, Estella A, Pobo A, Gomez-Acebo I, González-Castro A. ADENI-UCI Study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments. Med Intensiva 2020; 46:S0210-5691(20)30342-9. [PMID: 33386143 DOI: 10.1016/j.medin.2020.11.003] [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: 09/07/2020] [Revised: 10/23/2020] [Accepted: 11/07/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN Prospective, multicentrico SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS None. MAIN INTEREST VARIABLES Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.
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Affiliation(s)
- P Escudero-Acha
- Hospital Universitario Marqués de Valdecilla, Santander, España
| | - O Leizaola
- Hospital Universitario Central de Asturias, Asturias, España
| | - N Lázaro
- Hospital 12 de Octubre, Madrid, España
| | - M Cordero
- Hospital Universitario de Álava, Vitoria, España
| | - A M Cossío
- Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - P Recena
- Hospital Universitario de Cabueñes, Gijón, España
| | - A I Tizón
- Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - M Palomo
- Hospital de Sagunto, Valencia, España
| | - M M Del Campo
- Hospital Universitario Germans Trias i Pujol, Badalona, España
| | - S Freita
- Complexo Hospitalario Universitario Alvaro Cunqueiro, Vigo, España
| | - J Duerto
- Hospital Clínico San Carlos, Madrid, España
| | - N M Bilbao
- Hospital Galdakao-Usansolo, Bizkaia, España
| | - B Vidal
- Hospital Universitario de Castellón, Castellón, España
| | | | | | - J Revuelto
- Hospital Universitario Puerta del Mar, Cádiz, España
| | - M L Blasco
- Hospital Clínico de Valencia, Valencia, España
| | - M Domezain
- Hospital Universitario de Cruces, Bilbao, España
| | | | - O Rubio
- Fundació Althaia Xarxa Universitaria Assistencial de Manresa, Manresa, España
| | | | - A Pobo
- Hospital Joan XXIII de Tarragona, Tarragona, España
| | - I Gomez-Acebo
- Departamento de Preventiva y Salud Pública. Facultad de Medicina. Universidad de Cantabria, Santander, España
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9
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Rubio O, Cabré L, Estella A, Ferrer R. [Reply to "Considerations on ICU triage ethics during the COVID-19 pandemic"]. Med Intensiva 2020; 45:382. [PMID: 34629589 PMCID: PMC7368891 DOI: 10.1016/j.medin.2020.07.001] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- O Rubio
- Hospital Sant Joan de Déu de Manresa, Manresa, España.
| | - L Cabré
- Hospital de Barcelona, Barcelona, España
| | - A Estella
- Hospital de Jerez de la Frontera, Jerez de la Frontera, España
| | - R Ferrer
- Hospital Universitario del Valle de Hebrón, Barcelona, España
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10
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Rubio O, Estella A, Cabre L, Saralegui-Reta I, Martin MC, Zapata L, Esquerda M, Ferrer R, Castellanos A, Trenado J, Amblas J. [Ethical recommendations for a difficult decision-making in intensive care units due to the exceptional situation of crisis by the COVID-19 pandemia: A rapid review & consensus of experts]. Med Intensiva 2020; 44:439-445. [PMID: 32402532 PMCID: PMC7158790 DOI: 10.1016/j.medin.2020.04.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [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] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/10/2020] [Indexed: 01/10/2023]
Abstract
Ante la situación excepcional de salud pública provocada por la pandemia por COVID-19, desde el grupo de ética de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) se ha promovido un trabajo de consenso con el objetivo de encontrar algunas respuestas desde la ética a la encrucijada entre el incremento de personas con necesidades de atención intensiva y la disponibilidad efectiva de medios. En un periodo muy corto de tiempo se ha cambiado el marco de ejercicio de la medicina hacia un escenario de «medicina de catástrofe», con el consecuente cambio en los parámetros de toma de decisiones. En este contexto la asignación de recursos o la priorización de tratamiento pasan a ser elementos cruciales, y es importante contar con un marco de referencia ético para poder tomar las decisiones clínicas necesarias. Para ello, se ha realizado un proceso de revisión narrativa de la evidencia, seguida de un consenso de expertos no sistematizado, que ha tenido como resultado tanto la publicación de un documento de posicionamiento y recomendaciones de la propia SEMICYUC, como el consenso entre 18 sociedades científicas y 5 institutos/cátedras de bioética y cuidados paliativos de un documento marco de referencia de recomendaciones éticas generales en este contexto de crisis.
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Affiliation(s)
- O Rubio
- Cuidados Intensivos, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España.
| | - A Estella
- Cuidados Intensivos, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
| | - L Cabre
- Cuidados Intensivos, Comité de Bioética de Cataluña, Catalunya, España
| | - I Saralegui-Reta
- Cuidados Intensivos, Hospital Universitario de Áraba, Osakidetza Araba, Vitoria-Gasteiz, España
| | - M C Martin
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - L Zapata
- Cuidados Intensivos, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Esquerda
- Instituto Borja de Bioética, Esplugues de Llobregat, Barcelona, España
| | - R Ferrer
- Servicio de Medicina Intensiva, Hospital Universitario Vall de Hebron, Barcelona, España
| | - A Castellanos
- Área de Medicina Crítica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J Trenado
- Servicio de Medicina Intensiva, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España
| | - J Amblas
- Geriatría y Cuidados paliativos, Hospital Universitario de la Santa Creu de Vic, Central Catalonia Chronicity Research Group (C3RG), Universitat de Vic-UCC, Vic, Barcelona, España
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Abstract
Research in critical care patients is an ethical obligation. The ethical conflicts of intensive care research arise from patient vulnerability, since during ICU admission these individuals sometimes lose all or part of their decision making capacity and autonomy. We therefore must dedicate effort to ensure that neither treatment (sedation or mechanical ventilation) nor the disease itself can affect the right to individual freedom of the participants in research, improving the conditions under which informed consent must be obtained. Fragility, understood as a decrease in the capacity to tolerate adverse effects derived from research must be taken into account in selecting the participants. Research should be relevant, not possible to carry out in non-critical patients, and a priori should offer potential benefits that outweigh the risks that must be known and assumable, based on principles of responsibility.
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Affiliation(s)
- A Estella
- Unidad de Gestión clínica de Medicina Intensiva, Hospital del SAS de Jerez, Jerez, España.
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Hernández-Tejedor A, Peñuelas O, Sirgo Rodríguez G, Llompart-Pou J, Palencia Herrejón E, Estella A, Fuset Cabanes M, Alcalá-Llorente M, Ramírez Galleymore P, Obón Azuara B, Lorente Balanza J, Vaquerizo Alonso C, Ballesteros Sanz M, García García M, Caballero López J, Socias Mir A, Serrano Lázaro A, Pérez Villares J, Herrera-Gutiérrez M. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.medine.2017.03.008] [Citation(s) in RCA: 2] [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: 12/26/2022]
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ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Buitinck SH, van der Voort PHJ, Oto J, Andoh K, Nakataki E, Tsunano Y, Izawa M, Tane N, Onodera M, Nishimura M, Ghosh S, Gupta A, De Gasperi A, Mazza E, Yamamoto H, Limuti R, Prosperi M, Bissenova N, Yergaliyeva A, Talan L, Yılmaz G, Güven G, Yoruk F, Altıntas ND, Mukherjee DN, Noda E, Agarwal LK, Mandal K, Palomar M, Balsera B, Vallverdu M, Martinez M, Garcia M, Castellana D, Lopez R, Barcenilla F, Hatakeyama J, Kaminsky GE, Carreño R, Escribá A, Fuentes M, Gálvez V, Del Olmo R, Nieto B, Vaquerizo C, Alvarez J, De la Torre MA, Saitou N, Torres E, Bogossian E, Nouer SA, Salgado DR, Brugger SC, Jiménez GJ, Torner MM, Vidal MV, Garrido BB, Casals XN, Okamoto H, Gaite FB, Cabello JT, Martínez MP, Doganci M, Izdes S, Besevli SG, Alkan A, Kayaaslan B, Ramírez CS, Balcázar LC, Kobayashi A, Santana MC, Viera MAH, Escalada SH, Vázquez CFL, Penichet SMM, Campelo FA, López MADLC, Santana PS, Santana SR, Repessé X, Takei T, Artiguenave M, Paktoris-Papine S, Espinasse F, Dinh A, El Sayed F, Charron C, Géri G, Vieillard-Baron A, Marmanidou K, Oikonomou M, Matsukubo S, Nouris C, Dimitroulakis K, Soilemezi E, Matamis D, Ferré A, Guillot M, Teboul JL, Lichtenstein D, Mézière G, Richard C, Rotzel HB, Monnet X, Pham T, Beduneau G, Schortgen F, Piquilloud L, Zogheib E, Jonas M, Grelon F, Runge I, Terzi N, Lázaro AS, Grangé S, Barberet G, Guitard PG, Frat JP, Constan A, Chrétien JM, Mancebo J, Mercat A, Richard JCM, Brochard L, Prada DA, Prīdāne S, Sabeļņikovs O, Mojoli F, Orlando A, Bianchi I, Torriglia F, Bianzina S, Pozzi M, Iotti GA, Braschi A, Gimillo MR, Beduneau G, Pham T, Schortgen F, Piquilloud L, Zogheib E, Jonas M, Grelon F, Runge I, Terzi N, Grangé S, Barinas OD, Barberet G, Guitard PG, Frat JP, Constan A, Chrétien JM, Mancebo J, Mercat A, Richard JCM, Brochard L, Kondili E, Cortes MLB, Psarologakis C, Kokkini S, Amargianitakis V, Babalis D, Chytas A, Chouvarda I, Vaporidi K, Georgopoulos D, Trapp O, Kalenka A, Franco JF, Mojoli F, Orlando A, Bianchi I, Torriglia F, Bianzina S, Pozzi M, Iotti GA, Braschi A, Lozano JAB, Sánchez PC, Roca JMS, Francioni JEB, Ferrón FR, Simón JMS, Spadaro S, Karbing DS, Gioia A, Moro F, Corte FD, Mauri T, Volta CA, Carratalá A, Rees SE, Petrova MV, Mohan R, Butrov AV, Beeharry SD, Vatsik MV, Sakieva FI, Gobert F, Yonis H, Tapponnier R, Gonçalves B, Fernandez R, Labaune MA, Burle JF, Barbier J, Vincent B, Cleyet M, Richard JC, Guérin C, Shinotsuka CR, Creteur J, Turon R, Taccone FS, Törnblom S, Nisula S, Vaara S, Poukkanen M, Andersson S, Pettilä V, Pesonen E, Xie Z, Liao X, Mendes A, Kang Y, Zhang J, Kubota K, Egi M, Mizobuchi S, Hegazy S, El-Keraie A, El Sayed E, El Hamid MA, Rodrigues NJ, Miranda F, Pereira M, Godinho I, Gameiro J, Neves M, Gouveia J, e Silva ZC, Lopes JA, Mckinlay J, Kostalas M, Kooner G, Mata PJ, Dudas G, Horton A, Kerr C, Karanjia N, Creagh-Brown B, Forni L, Yamazaki A, Ganuza MS, Molina JAM, Martinez FH, Cavalcanti D, Freile MTC, Fernandez NG, Travieso PM, Bandert A, Frithiof R, Lipcsey M, Smekal D, Schlaepfer P, Durovray JD, Plouhinec V, Melo N, Chiappa C, Bellomo R, Schneider AG, Mitchell S, Durrant J, Street H, Dunthorne E, Shears J, Caballero CH, Hutchison R, Lacerda P, Schwarze S, Ghabina S, Thompson E, Prowle JR, Kirwan CJ, Gonzalez CA, Pinto JL, Orozco V, Patiño JA, Garcia PK, Kurtz P, Contreras KM, Rodriguez P, Echeverri JE, Righy C, Rosario LEDLC, Lesmes SPG, Romero JCG, Herrera ANG, Pertuz EDD, Sánchez MJG, Sanz ER, Hualde JB, Hernández AA, Irazabal JMG, Spatenkova V, Bradac O, Suchomel P, Urli T, Lazzeri EH, Aspide R, Zanello M, Perez-Borrero L, Garcia-Alvarez JM, Arias-Verdu MD, Aguilar-Alonso E, Rivera-Fernandez R, Mora-Ordoñez J, De La Fuente-Martos C, Castillo-Lorente E, Guerrero-Lopez F, Lesmes SPG, Rosario LEDLC, Pertuz EDD, Hernández AA, Romero JCG, Sánchez MJG, Herrera ANG, Ramírez JR, Sanz ER, Hualde JB, León JPT, Navarro-Guillamón L, Cordovilla-Guardia S, Iglesias-Santiago A, Guerrero-López F, Fernández-Mondéjar E, Vidal A, Perez M, Juez A, Arias N, Colino L, Perez JL, Pérez H, Calpe P, Alcala MA, Robaglia D, Perez C, Lan SK, Cunha MM, Moreira T, Santos F, Lafuente E, Fernandes MJ, Silva JG, Rosario LEDLC, Lesmes SPG, Herrera ANG, Romero JCG, Pertuz EDD, Sánchez MJG, Sanz ER, Echeverría JGA, Hernández AA, Hualde JB, Podlepich V, Sokolova E, Alexandrova E, Lapteva K, Kurtz P, Shuinotsuka C, Rabello L, Vianna G, Reis A, Cairus C, Salluh J, Bozza F, Torres JCB, Araujo NJF, García-Olivares P, Keough E, Dalorzo M, Tang LK, De Sousa I, Díaz M, Marcos-Zambrano LJ, Guerrero JE, Gomez SEZ, Lopez GDH, Cuellar AIV, Nieto ORP, Gonzalez JAC, Bhasin D, Rai S, Singh H, Gupta O, Bhattal MK, Sampley S, Sekhri K, Nandha R, Aliaga FA, Olivares F, Appiani F, Farias P, Alberto F, Hernández A, Pons S, Sonneville R, Bouadma L, Neuville M, Mariotte E, Radjou A, Lebut J, Chemam S, Voiriot G, Dilly MP, Mourvillier B, Dorent R, Nataf P, Wolff M, Timsit JF, Ediboglu O, Ataman S, Ozkarakas H, Kirakli C, Vakalos A, Avramidis V, Obukhova O, Kurmukov IA, Kashiya S, Golovnya E, Baikova VN, Ageeva T, Haritydi T, Kulaga EV, Rios-Toro JJ, Perez-Borrero L, Aguilar-Alonso E, Arias-Verdu MD, Garcia-Alvarez JM, Lopez-Caler C, De La Fuente-Martos C, Rodriguez-Fernandez S, Sanchez-Orézzoli MG, Martin-Gallardo F, Nikhilesh J, Joshi V, Villarreal E, Ruiz J, Gordon M, Quinza A, Gimenez J, Piñol M, Castellanos A, Ramirez P, Jeon YD, Jeong WY, Kim MH, Jeong IY, Ahn MY, Ahn JY, Han SH, Choi JY, Song YG, Kim JM, Ku NS, Shah H, Kellner F, Rezai F, Mistry N, Yodice P, Ovnanian V, Fless K, Handler E, Alejos RM, Romeu JDM, Antón DG, Quinart A, Martí AT, Llaurado-Serra M, Lobo-Civico A, Ventura-Rosado A, Piñol-Tena A, Pi-Guerrero M, Paños-Espinosa C, Peralvo-Bernat M, Marine-Vidal J, Gonzalez-Engroba R, Montesinos-Cerro N, Treso-Geira M, Valeiras-Valero A, Martinez-Reyes L, Sandiumenge A, Jimenez-Herrera MF, Helyar S, Riozzi P, Noon A, Hallows G, Cotton H, Keep J, Hopkins PA, Taggu A, Renuka S, Sampath S, Rood PJT, Frenzel T, Verhage R, Bonn M, Pickkers P, van der Hoeven JG, van den Boogaard M, Corradi F, Melnyk L, Moggia F, Pienovi R, Adriano G, Brusasco C, Mariotti L, Lattuada M, Bloomer MJ, Coombs M, Ranse K, Endacott R, Maertens B, Blot K, Blot S, Amerongen MPVN, van der Heiden ES, Twisk JWR, Girbes ARJ, Spijkstra JJ, Riozzi P, Helyar S, Cotton H, Hallows G, Noon A, Bell C, Peters K, Feehan A, Keep J, Hopkins PA, Churchill K, Hawkins K, Brook R, Paver N, Endacott R, Maistry N, van Wijk A, Rouw N, van Galen T, Evelein-Brugman S, Taggu A, Krishna B, Sampath S, Putzu A, Fang M, Berto MB, Belletti A, Cassina T, Cabrini L, Mistry M, Alhamdi Y, Welters I, Abrams ST, Toh CH, Han HS, Gil EM, Lee DS, Park CM, Winder-Rhodes S, Lotay R, Doyle J, Ke MW, Huang WC, Chiang CH, Hung WT, Cheng CC, Lin KC, Lin SC, Chiou KR, Wann SR, Shu CW, Kang PL, Mar GY, Liu CP, Dubó S, Aquevedo A, Jibaja M, Berrutti D, Labra C, Lagos R, García MF, Ramirez V, Tobar M, Picoita F, Peláez C, Carpio D, Alegría L, Hidalgo C, Godoy K, Bakker J, Hernández G, Sadamoto Y, Katabami K, Wada T, Ono Y, Maekawa K, Hayakawa M, Sawamura A, Gando S, Marin-Mateos H, Perez-Vela JL, Garcia-Gigorro R, Peiretti MAC, Lopez-Gude MJ, Chacon-Alves S, Renes-Carreño E, Montejo-González JC, Parlevliet KL, Touw HRW, Beerepoot M, Boer C, Elbers PWG, Tuinman PR, Abdelmonem SA, Helmy TA, El Sayed I, Ghazal S, Akhlagh SH, Masjedi M, Hozhabri K, Kamali E, Zýková I, Paldusová B, Sedlák P, Morman D, Youn AM, Ohta Y, Sakuma M, Bates D, Morimoto T, Su PL, Chang WY, Lin WC, Chen CW, Facchin F, Zarantonello F, Panciera G, De Cassai A, Venrdramin A, Ballin A, Tonetti T, Persona P, Ori C, Del Sorbo L, Rossi S, Vergani G, Cressoni M, Chiumello D, Chiurazzi C, Brioni M, Algieri I, Tonetti T, Guanziroli M, Colombo A, Tomic I, Colombo A, Crimella F, Carlesso E, Gasparovic V, Gattinoni L, Neto AS, Schmidt M, Pham T, Combes A, de Abreu MG, Pelosi P, Schultz MJ, Katira BH, Engelberts D, Giesinger RE, Ackerley C, Yoshida T, Zabini D, Otulakowski G, Post M, Kuebler WM, McNamara PJ, Kavanagh BP, Pirracchio R, Rigon MR, Carone M, Chevret S, Annane D, Eladawy S, El-Hamamsy M, Bazan N, Elgendy M, De Pascale G, Vallecoccia MS, Cutuli SL, Di Gravio V, Pennisi MA, Conti G, Antonelli M, Andreis DT, Khaliq W, Singer M, Hartmann J, Harm S, Carmona SA, Almudevar PM, Abellán AN, Ramos JV, Pérez LP, Valbuena BL, Sanz NM, Simón IF, Arrigo M, Feliot E, Deye N, Cariou A, Guidet B, Jaber S, Leone M, Resche-Rigon M, Baron AV, Legrand M, Gayat E, Mebazaa A, Balik M, Kolnikova I, Maly M, Waldauf P, Tavazzi G, Kristof J, Herpain A, Su F, Post E, Taccone F, Vincent JL, Creteur J, Lee C, Hatib F, Jian Z, Buddi S, Cannesson M, Fileković S, Turel M, Knafelj R, Gorjup V, Stanić R, Gradišek P, Cerović O, Mirković T, Noč M, Tirkkonen J, Hellevuo H, Olkkola KT, Hoppu S, Lin KC, Hung WT, Chiang CC, Huang WC, Juan WC, Lin SC, Cheng CC, Lin PH, Fong KY, Hou DS, Kang PL, Wann SR, Chen YS, Mar GY, Liu CP, Paul M, Bougouin W, Geri G, Dumas F, Champigneulle B, Legriel S, Charpentier J, Mira JP, Sandroni C, Cariou A, Zimmerman J, Sullivan E, Noursadeghi M, Fox B, Sampson D, McHugh L, Yager T, Cermelli S, Seldon T, Bhide S, Brandon RA, Brandon RB, Zwaag J, Beunders R, Pickkers P, Kox M, Gul F, Arslantas MK, Genc D, Zibandah N, Topcu L, Akkoc T, Cinel I, Greco E, Lauretta MP, Andreis DT, Singer M, Garcia IP, Cordero M, Martin AD, Pallás TA, Montero JG, Rey JR, Malo LR, Montoya AAT, Martinez ADCA, Ayala LYD, Zepeda EM, Granillo JF, Sanchez JA, Alejo GC, Cabrera AR, Montenegro AP, Pham T, Beduneau G, Schortgen F, Piquilloud L, Zogheib E, Jonas M, Grelon F, Runge I, Terzi N, Grangé S, Barberet G, Guitard PG, Frat JP, Constan A, Chrétien JM, Mancebo J, Mercat A, Richard JCM, Brochard L, Soilemezi E, Koco E, Savvidou S, Nouris C, Matamis D, Di Mussi R, Spadaro S, Volta CA, Mariani M, Colaprico A, Antonio C, Bruno F, Grasso S, Rodriguez A, Martín-Loeches I, Díaz E, Masclans JR, Gordo F, Solé-Violán J, Bodí M, Avilés-Jurado FX, Trefler S, Magret M, Reyes LF, Marín-Corral J, Yebenes JC, Esteban A, Anzueto A, Aliberti S, Restrepo MI, Larsson JS, Redfors B, Ricksten SE, Haines R, Powell-Tuck J, Leonard H, Ostermann M, Berthelsen RE, Itenov TS, Perner A, Jensen JU, Ibsen M, Jensen AEK, Bestle MH, Bucknall T, Dixon J, Boa F, MacPhee I, Philips BJ, Doyle J, Saadat F, Samuels T, Huddart S, McCormick B, DeBrunnar R, Preece J, Swart M, Peden C, Richardson S, Forni L, Kalfon P, Baumstarck K, Estagnasie P, Geantot MA, Berric A, Simon G, Floccard B, Signouret T, Boucekine M, Fromentin M, Nyunga M, Sossou A, Venot M, Robert R, Follin A, Renault A, Garrouste M, Collange O, Levrat Q, Villard I, Thévenin D, Pottecher J, Patrigeon RG, Revel N, Vigne C, Mimoz O, Auquier P, Pawar S, Jacques T, Deshpande K, Pusapati R, Wood B, Pulham RA, Wray J, Brown K, Pierce C, Nadel S, Ramnarayan P, Azevedo JR, Montenegro WS, Rodrigues DP, Sousa SC, Araujo VF, Leitao AL, Prazeres PH, Mendonca AV, Paula MP, Das Neves A, Loudet CI, Busico M, Vazquez D, Villalba D, Lischinsky A, Veronesi M, Emmerich M, Descotte E, Juliarena A, Bisso MC, Grando M, Tapia A, Camargo M, Ulla DV, Corzo L, dos Santos HP, Ramos A, Doglia JA, Estenssoro E, Carbonara M, Magnoni S, Donald CLM, Shimony JS, Conte V, Triulzi F, Stretti F, Macrì M, Snyder AZ, Stocchetti N, Brody DL, Podlepich V, Shimanskiy V, Savin I, Lapteva K, Chumaev A, Tjepkema-Cloostermans MC, Hofmeijer J, Beishuizen A, Hom H, Blans MJ, van Putten MJAM, Longhi L, Frigeni B, Curinga M, Mingone D, Beretta S, Patruno A, Gandini L, Vargiolu A, Ferri F, Ceriani R, Rottoli MR, Lorini L, Citerio G, Pifferi S, Battistini M, Cordolcini V, Agarossi A, Di Rosso R, Ortolano F, Stocchetti N, Lourido CM, Cabrera JLS, Santana JDM, Alzola LM, del Rosario CG, Pérez HR, Torrent RL, Eslami S, Dalhuisen A, Fiks T, Schultz MJ, Hanna AA, Spronk PE, Wood M, Maslove D. ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Estella A, Martín MC, Hernández A, Rubio O, Monzón JL, Cabré L. End of life critical patients: A multicenter study in Spanish Intensive Care Units. Med Intensiva 2016; 40:448-50. [PMID: 27033989 DOI: 10.1016/j.medin.2015.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/08/2015] [Accepted: 12/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A Estella
- Unidad de Cuidados Intensivos, Hospital del SAS, Jerez de la Frontera, Cádiz, España.
| | - M C Martín
- Unidad de Cuidados Intensivos, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - A Hernández
- Unidad de Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - O Rubio
- Unidad de Cuidados Intensivos, Hospital Sant Joan de Déu, Manresa, Barcelona, España
| | - J L Monzón
- Unidad de Cuidados Intensivos, Hospital de San Pedro, Logroño, La Rioja, España
| | - L Cabré
- Unidad de Cuidados Intensivos, Hospital de Barcelona SCIAS, Barcelona, España
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Estella A. La donación de órganos: ¿una excepción para consentir medidas de tratamientos fútiles? Med Intensiva 2016; 40:69-70. [DOI: 10.1016/j.medin.2015.08.007] [Citation(s) in RCA: 2] [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] [Received: 08/05/2015] [Accepted: 08/18/2015] [Indexed: 11/28/2022]
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Estella A, Rico Armenteros T, Jaen Franco M, Guijo P, Fernández Ruiz L, Recuerda Nuñez M. INTRACEREBRAL HEMORRHAGE IN CRITICALLY ILL PATIENTS ADMITTED IN A GENERAL ICU OF A HOSPITAL WITHOUT NEUROSURGICAL SERVICE. Intensive Care Med Exp 2015. [PMCID: PMC4797854 DOI: 10.1186/2197-425x-3-s1-a982] [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: 11/17/2022] Open
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Estella A. [Severe community-acquired pneumonia: prognostic scales versus evolutive parameters in ICU admission decisions]. Med Intensiva 2013; 37:305-7. [PMID: 23664007 DOI: 10.1016/j.medin.2013.03.006] [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: 02/20/2013] [Revised: 02/28/2013] [Accepted: 03/08/2013] [Indexed: 10/26/2022]
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Abstract
UNLABELLED Usefulness of CURB-65 and pneumonia severity index for influenza A H1N1v pneumonia. A. Estella. BACKGROUND Different prognostic scales have been documented to assess the severity and indications for hospitalization and ICU admissions of community acquired pneumonia. During the past two years Influenza A H1N1v infections have been commonly attended to in emergency departments. The aim of the study was to analyse the usefulness of the application of the Pneumonia Severity Index (PSI) and CURB-65 prognostic scales in patients with primary viral pneumonia caused by influenza A H1N1v. METHODS A retrospective study was performed at a community hospital with a 17 bed-intensive care unit. Patients admitted in hospital with influenza A H1N1v pneumonia over a two year period were analysed. CURB 65 and PSI scales were applied in the emergency department and outcome and destination of admission were analysed. RESULTS 24 patients were registered, 19 required ICU admission and 5 patients were admitted in medical wards. Most of the patients admitted to the intensive care unit (78.9%) required mechanical ventilation. Mortality was 21.1%. Most patients admitted to the ICU had CURB 65 scale of 1 (60%), 13.3% obtained 0 and 26.7% 2. PSI scale resulted class I in a 20%, class II 40%, 26.7% class IV and 13.3% class V. The scales CURB 65 and PSI showed no differences in scores according to the destination of admission and mortality. CONCLUSIONS Use of CURB-65 and PSI in the emergency department may underestimate the risk of patients with Influenza A H1N1v pneumonia. Based in our results, the ability of these scales to predict ICU admissions for Influenza A H1N1v pneumonia is questioned.
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Affiliation(s)
- A Estella
- Intensive Care Unit, Hospital of Jerez, Jerez de la Frontera (Cácidiz), Spain.
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Estella A. Factores que influyen en la concentración de interleucina-6 en el paciente crítico. Med Intensiva 2013; 37:122-3. [DOI: 10.1016/j.medin.2012.11.006] [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: 11/18/2012] [Accepted: 11/19/2012] [Indexed: 11/27/2022]
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Estella A. [Analysis of 208 flexible bronchoscopies performed in an intensive care unit]. Med Intensiva 2011; 36:396-401. [PMID: 22192316 DOI: 10.1016/j.medin.2011.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/21/2011] [Accepted: 11/04/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the main indications, clinical results and complications associated with fibrobronchoscopy in the Intensive Care Unit (ICU). DESIGN A retrospective, single-center observational study was carried out. Setting. Seventeen beds in a medical/surgical ICU. Patients. Consecutive patients undergoing fibrobronchoscopy during their stay in the ICU over a period of 5 years. INTERVENTIONS Flexible bronchoscopy performed by an intensivist. Main variables of interest. Flexible bronchoscopy indications and complications derived from the procedure. RESULTS A total of 208 flexible bronchoscopies were carried out in 192 patients admitted to the ICU. Most of the procedures (193 [92.8%]) were performed in mechanically ventilated patients. The average patient age was 58 ± 16 years, with an APACHE II score at admission of 19 ± 7. The most frequent indication for flexible bronchoscopy was diagnostic confirmation of initially suspected pneumonia (148 procedures), with positive bronchoalveolar lavage findings in 46%. The most frequent therapeutic indication was the resolution of atelectasis (28 procedures). Other indications were the diagnosis and treatment of pulmonary hemorrhage, the aspiration of secretions, control of percutaneous tracheotomy, and difficult airway management. The complications described during the procedures were supraventricular tachycardia (3.8%), transient hypoxemia (6.7%), and slight bleeding of the bronchial mucosal membrane (2.4%). CONCLUSIONS A microbiological diagnosis of pneumonia and the resolution of atelectasis are the most frequent indications for flexible bronchoscopy in critically ill patients. Flexible bronchoscopy performed by an intensivist in ICU is a safe procedure.
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Affiliation(s)
- A Estella
- Servicio de Medicina Intensiva, Hospital SAS de Jerez, Jerez de la Frontera, Cádiz, España.
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Estella A. [Intrapulmonary inflammatory response in critically ill patients with pneumonia]. Med Intensiva 2010; 34:590-4. [PMID: 20702001 DOI: 10.1016/j.medin.2010.05.008] [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: 02/11/2010] [Revised: 05/24/2010] [Accepted: 05/27/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE to evaluate the relationship between the microbiology result and cytokine expression in bronchoalveolar lavage (BAL). DESIGN An observational, prospective study. SETTING a 17-bed medical and surgical intensive care unit. PATIENTS Mechanically-ventilated patients with suspected pneumonia admitted to the ICU during a 27-month time period were consecutively enrolled. INTERVENTIONS BAL was performed with 150ml sterile isotonic saline solution in three aliquots of 50ml. Local anesthetics were not used during the procedure. A BAL sample was processed for a microbiologic quantitative culture and BAL cytokines IL-6, IL 8, TNFα, granulocyte colony-stimulating factor (G-CSF) and granulocyte-monocyte colony-stimulating factor (GM-CSF) were measured. MAIN VARIABLES OF INTEREST age, APACHE II score within the first 24 hours of admission, time on mechanical ventilation, ICU length of stay, mortality, previous antibiotic therapy, isolated bacteria and cytokines concentration were analyzed. RESULTS fifty-nine consecutive patients were included, and most of the patients (79.7%) had prior antibiotic therapy. Twenty-two patients (37.2%) had a positive BAL. In the group of patients with positive BAL, the TNFα concentration was significantly higher in the group of patients with positive BAL than in the BAL negative group. CONCLUSIONS there is a significant correlation between the microbiology result and the TNFα concentration in the BAL fluid. In mechanically-ventilated patients, TNFα in BAL has been associated with positive cultures despite prior antibiotic therapy.
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Affiliation(s)
- A Estella
- Servicio de Medicina Intensiva, Hospital SAS de Jerez, Jerez de la Frontera, Cádiz, España.
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Estella A, Monge MI, Pérez Fontaiña L, Sainz de Baranda A, Galá MJ, Moreno E. [Bronchoalveolar lavage for diagnosing pneumonia in mechanically ventilated patients]. Med Intensiva 2009; 32:419-23. [PMID: 19080864 DOI: 10.1016/s0210-5691(08)75718-8] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the diagnostic role of bronchoalveolar lavage (BAL) in mechanically ventilated patients with suspected pneumonia and to describe the clinical outcome in the different kinds of pneumonia in critically ill patients. DESIGN Descriptive study. SETTING A 17-bed medical and surgical intensive care unit. PATIENTS Mechanically ventilated patients admitted to the ICU from November 2003 to March 2006 with suspected pneumonia who underwent bronchoscopy with BAL. INTERVENTIONS BAL was performed by fiberoptic bronchoscopy with three aliquots of 50 ml sterile normal saline. Recovered BAL fluid was pro-cessed for microbiologic analysis. MAIN VARIABLES OF INTEREST Age, APACHE II score within the first 24 hours of admission, time on mechanical ventilation, ICU length of stay, mortality, and isolated bacteria were analyzed. RESULTS A total of 96 cases of suspected pneumonia with BAL were recruited, including 4 groups: community associated pneumonia (CAP), 12 cases, early-onset ventilator-associated pneumonia (VAP), 26 cases, late-onset ventilator-associated pneumonia, 43 cases, and immunocompromised patients, 15 cases. BAL was positive (> 10000 ufc/ml) in 40 (41.7%) patients (2, 16, 17 and 5 patients with CAP, early-onset VAP, late-onset VAP and immunocompromised, respectively). Mortality was 33.3%, 26.9%, 25.6% and 73.3% in CAP, early-onset VAP, late-onset VAP and immunocompromised patients respectively. CONCLUSIONS The low incidence of positive BAL in the CAP group supports using BAL only for particularly severe, selected cases. Mortality was very high in the immunocompromised patients. In the light of our personal experience, BAL is most useful in the diagnosis of pneumonia in the group of patients with VAP.
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Affiliation(s)
- A Estella
- Unidad de Cuidados Intensivos. Hospital del SAS de Jerez. Jerez. Cádiz. España
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Abstract
Hemodynamic monitoring is a key element in the care of the critical patients, providing an unquestionable aid in the attendance to diagnosis and the choice of the adequate treatment. Minimally invasive devices have been emerging over the past few years as an effective alternative to classic monitoring tools. The esophageal echoDoppler is among these. It makes it possible to obtain continuous and minimally invasive monitoring of the cardiac output in addition to other useful parameters by measuring the blood flow rate and the diameter of the thoracic descending aorta, which provides a sufficiently extensive view of the hemodynamic state of the patient and facilitates early detection of the changes produced by a sudden clinical derangement. Although several studies have demonstrated the usefulness of the esophageal Doppler in the surgical scene, there is scarce and dispersed evidence in the literature on its benefits in critical patients. Nevertheless, its advantages make it an attractive element to take into account within the diagnostic arsenal in the intensive care. The purpose of the following article is to describe how it works, its degree of validation with other monitoring methods and the role of esophageal echoDoppler as a minimally invasive monitoring tool for measuring cardiac output in the daily clinical practice, contributing with our own experience in the critical patient.
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Affiliation(s)
- M I Monge
- Servicio de Cuidados Críticos y Urgencias, Hospital de Jerez, Cádiz, España.
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Estella A, de Baranda AS, Moreno E, Galan MJ, Leal E, Jareño A. Alteplase for acute ischemic stroke: 2 years in a community hospital without previous experience in stroke thrombolysis. Crit Care 2008. [PMCID: PMC4088498 DOI: 10.1186/cc6348] [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: 11/13/2022] Open
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