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Laguna G, Suárez-Sipmann F, Tusman G, Ripollés J, Díaz-Cambronero O, Pujol R, Rivas E, Garutti I, Mellado R, Vallverdú J, Jacas A, Fervienza A, Marrero R, Librero J, Villar J, Ferrando C. Rationale and study design for an Individualized PeriopeRative Open lung VEntilatory approach in Emergency Abdominal Laparotomy/scopy: study protocol for a prospective international randomized controlled trial. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00075-1. [PMID: 38636796 DOI: 10.1016/j.redare.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/16/2023] [Indexed: 04/20/2024]
Abstract
BACKGROUND Postoperative pulmonary complications (PPC) are the most frequent postoperative complications, with an estimated prevalence in elective surgery ranging from 20% in observational cohort studies to 40% in randomized clinical trials. However, the prevalence of PPCs in patients undergoing emergency abdominal surgery is not well defined. Lung-protective ventilation aims to minimize ventilator-induced lung injury and reduce PPCs. The open lung approach (OLA), which combines recruitment manoeuvres (RM) and positive end-expiratory pressure (PEEP) titration, aims to minimize areas of atelectasis and the development of PPCs; however, there is no conclusive evidence in the literature that OLA can prevent PPCs. The purpose of this study is to compare an individualized perioperative OLA with conventional standardized lung-protective ventilation in patients undergoing emergency abdominal surgery with clinical signs of intraoperative lung collapse. METHODS Randomized international clinical trial to compare an individualized perioperative OLA (RM plus individualized PEEP and individualized postoperative respiratory support) with conventional lung-protective ventilation (standard PEEP of 5 cmH2O and conventional postoperative oxygen therapy) in patients undergoing emergency abdominal surgery with clinical signs of lung collapse. Patients will be randomised to open-label parallel groups. The primary outcome is any severe PPC during the first 7 postoperative days, including: acute respiratory failure, pneumothorax, weaning failure, acute respiratory distress syndrome, and pulmonary infection. The estimated sample size is 732 patients (366 per group). The final sample size will be readjusted during the interim analysis. DISCUSSION The Individualized Perioperative Open-lung Ventilatory Strategy in emergency abdominal laparotomy (iPROVE-EAL) is the first multicentre, randomized, controlled trial to investigate whether an individualized perioperative approach prevents PPCs in patients undergoing emergency surgery.
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Affiliation(s)
- G Laguna
- Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, España.
| | - F Suárez-Sipmann
- Unidad de Cuidados Intensivos, Hospital Universitario La Princesa, Madrid, España; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - G Tusman
- Departamento de Anestesia, Hospital Privado de Comunidad, Mar de Plata, Argentina
| | - J Ripollés
- Departamento de Anestesia, Hospital Infanta Leonor, Madrid, España
| | | | - R Pujol
- Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, España
| | - E Rivas
- Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, España
| | - I Garutti
- Departamento de Anestesia, Hospital Universitario Gregorio Marañón, Madrid, España
| | - R Mellado
- Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, España
| | - J Vallverdú
- Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, España
| | - A Jacas
- Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, España
| | - A Fervienza
- Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, España
| | - R Marrero
- Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Barcelona, España
| | - J Librero
- Navarrabiomed-Fundación Miguel Servet, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, España
| | - J Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Red Multidisciplinar de Investigación en Evaluación de Disfunción de Órganos, Unidad de Investigación, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, España
| | - C Ferrando
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Departamento de Anestesia y Cuidados Críticos, Hospital Clínic, Institut D'Investigació August Pi i Sunyer, Barcelona, España
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Duque P, Perez-Peña JM, Alarcon-Perez L, Olmedilla L, Varela JA, Pascual C, Rodriguez-Huerta AM, Asencio JM, Lopez-Baena JÁ, Garutti I. The link between high factor VIII to protein C ratio values and poor liver function after major hepatectomy. Blood Coagul Fibrinolysis 2024; 35:82-93. [PMID: 38305104 DOI: 10.1097/mbc.0000000000001277] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Our goal was to assess the coagulation profile in the immediate postoperative time after major liver surgery and its association with the liver function. Our hypothesis is that a decreased synthesis of the coagulation factor levels reflects an impaired liver synthesis following hepatic resection and will be associated with poor outcomes. This is a prospective, observational study recruiting consecutive patients scheduled for major liver resection in a tertiary hospital. Coagulation profile was assessed by conventional assays, viscoelastic assays and coagulation factor levels preoperatively and, on postoperative days 1, 2 and 6. Factor VIII to protein C (FVIII/PC) ratio has been used as a surrogate marker of hemostatic imbalance. Liver function was measured with conventional and indocyanine green (ICG) clearance tests, which were obtained preoperatively and on postoperative days 1 and 2. Sixty patients were recruited and 51 were included in the study. There is a clear increase in FVIII/PC ratio after surgery, which was significantly associated with low liver function, being more pronounced beyond postoperative day 2 and in patients with poorer liver function ( P < 0.001). High FVIII/PC ratio values were significantly associated with higher postoperative morbidity, prolonged ICU and hospital stay and less survival ( P < 0.05). High FVIII/PC ratio on postoperative day 2 was found to be predictor of posthepatectomy liver failure (PHLF; area under the ROC curve = 0.8129). Early postoperative high FVIII/PC ratio values are associated with low liver function, PHLF and poorer outcomes in patients undergoing major hepatic resection.
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Affiliation(s)
- Patricia Duque
- Anesthesiology Department
- Gregorio Marañon Health Research Institute
| | | | | | - Luis Olmedilla
- Anesthesiology Department
- Gregorio Marañon Health Research Institute
| | | | | | | | - José Manuel Asencio
- General Surgery Department, Gregorio Marañon Hospital
- Gregorio Marañon Health Research Institute
- Medical Faculty, Complutense University, Madrid, Spain
| | - Jose Ángel Lopez-Baena
- General Surgery Department, Gregorio Marañon Hospital
- Gregorio Marañon Health Research Institute
| | - Ignacio Garutti
- Anesthesiology Department
- Gregorio Marañon Health Research Institute
- Medical Faculty, Complutense University, Madrid, Spain
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Ferrando C, Carramiñana A, Piñeiro P, Mirabella L, Spadaro S, Librero J, Ramasco F, Scaramuzzo G, Cervantes O, Garutti I, Parera A, Argilaga M, Herranz G, Unzueta C, Vives M, Regi K, Costa-Reverte M, Sonsoles Leal M, Nieves-Alonso J, García E, Rodríguez-Pérez A, Fariña R, Cabrera S, Guerra E, Gallego-Ligorit L, Herrero-Izquierdo A, Vallés-Torres J, Ramos S, López-Herrera D, De La Matta M, Gokhan S, Kucur E, Mugarra A, Soro M, García L, Sastre JA, Aguirre P, Salazar CJ, Ramos MC, Morocho DR, Trespalacios R, Ezequiel-Fernández F, Lamanna A, Pia Cantatore L, Laforgia D, Bellas S, López C, Navarro-Ripoll R, Martínez S, Vallverdú J, Jacas A, Yepes-Temiño MJ, Belda FJ, Tusman G, Suárez-Sipmann F, Villar J. Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicentre, randomised, controlled clinical trial. Lancet Respir Med 2024; 12:195-206. [PMID: 38065200 DOI: 10.1016/s2213-2600(23)00346-6] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND It is uncertain whether individualisation of the perioperative open-lung approach (OLA) to ventilation reduces postoperative pulmonary complications in patients undergoing lung resection. We compared a perioperative individualised OLA (iOLA) ventilation strategy with standard lung-protective ventilation in patients undergoing thoracic surgery with one-lung ventilation. METHODS This multicentre, randomised controlled trial enrolled patients scheduled for open or video-assisted thoracic surgery using one-lung ventilation in 25 participating hospitals in Spain, Italy, Turkey, Egypt, and Ecuador. Eligible adult patients (age ≥18 years) were randomly assigned to receive iOLA or standard lung-protective ventilation. Eligible patients (stratified by centre) were randomly assigned online by local principal investigators, with an allocation ratio of 1:1. Treatment with iOLA included an alveolar recruitment manoeuvre to 40 cm H2O of end-inspiratory pressure followed by individualised positive end-expiratory pressure (PEEP) titrated to best respiratory system compliance, and individualised postoperative respiratory support with high-flow oxygen therapy. Participants allocated to standard lung-protective ventilation received combined intraoperative 4 cm H2O of PEEP and postoperative conventional oxygen therapy. The primary outcome was a composite of severe postoperative pulmonary complications within the first 7 postoperative days, including atelectasis requiring bronchoscopy, severe respiratory failure, contralateral pneumothorax, early extubation failure (rescue with continuous positive airway pressure, non-invasive ventilation, invasive mechanical ventilation, or reintubation), acute respiratory distress syndrome, pulmonary infection, bronchopleural fistula, and pleural empyema. Due to trial setting, data obtained in the operating and postoperative rooms for routine monitoring were not blinded. At 24 h, data were acquired by an investigator blinded to group allocation. All analyses were performed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT03182062, and is complete. FINDINGS Between Sept 11, 2018, and June 14, 2022, we enrolled 1380 patients, of whom 1308 eligible patients (670 [434 male, 233 female, and three with missing data] assigned to iOLA and 638 [395 male, 237 female, and six with missing data] to standard lung-protective ventilation) were included in the final analysis. The proportion of patients with the composite outcome of severe postoperative pulmonary complications within the first 7 postoperative days was lower in the iOLA group compared with the standard lung-protective ventilation group (40 [6%] vs 97 [15%], relative risk 0·39 [95% CI 0·28 to 0·56]), with an absolute risk difference of -9·23 (95% CI -12·55 to -5·92). Recruitment manoeuvre-related adverse events were reported in five patients. INTERPRETATION Among patients subjected to lung resection under one-lung ventilation, iOLA was associated with a reduced risk of severe postoperative pulmonary complications when compared with conventional lung-protective ventilation. FUNDING Instituto de Salud Carlos III and the European Regional Development Funds.
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Affiliation(s)
- Carlos Ferrando
- Institut D'investigació August Pi I Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Albert Carramiñana
- Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Patricia Piñeiro
- Department of Anesthesiology and Critical Care, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Lucia Mirabella
- Department of Medical and Surgical Sciences, Università Degli Studi di Foggia, Foggia, Italy
| | - Savino Spadaro
- Department of Anesthesiology and Critical Care, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Julián Librero
- UPNA, REDISSEC Red de Investigación en Servicios de Salud, Navarrabiomed, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Fernando Ramasco
- Department of Anesthesiology and Critical Care, Hospital Universitario de La Princesa, Madrid, Spain
| | - Gaetano Scaramuzzo
- Department of Anesthesiology and Critical Care, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Oriol Cervantes
- Department of Anesthesiology and Critical Care, Hospital Universitario Germans Trías i Pujol, Barcelona, Spain
| | - Ignacio Garutti
- Department of Anesthesiology and Critical Care, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Parera
- Department of Anesthesiology and Critical Care, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Argilaga
- Department of Anesthesiology and Critical Care, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Gracia Herranz
- Department of Anesthesiology and Critical Care, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Carmen Unzueta
- Department of Anesthesiology and Critical Care, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Marc Vives
- Department of Anesthesiology and Critical Care, Hospital Universitario Josep Trueta, Girona, Spain
| | - Kevin Regi
- Department of Anesthesiology and Critical Care, Hospital Universitario Josep Trueta, Girona, Spain
| | - Marta Costa-Reverte
- Department of Anesthesiology and Critical Care, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Jesús Nieves-Alonso
- Department of Anesthesiology and Critical Care, Hospital Universitario de La Princesa, Madrid, Spain
| | - Esther García
- Department of Anesthesiology and Critical Care, Hospital Universitario de La Princesa, Madrid, Spain
| | - Aurelio Rodríguez-Pérez
- Department of Anesthesiology and Critical Care, Hospital Universitario de Gran Canaria Dr Negrín, Gran Canarias, Spain
| | - Roberto Fariña
- Department of Anesthesiology and Critical Care, Hospital Universitario de Gran Canaria Dr Negrín, Gran Canarias, Spain
| | - Sergio Cabrera
- Department of Anesthesiology and Critical Care, Hospital Universitario de Gran Canaria Dr Negrín, Gran Canarias, Spain
| | - Elisabeth Guerra
- Department of Anesthesiology and Critical Care, Hospital Universitario de Gran Canaria Dr Negrín, Gran Canarias, Spain
| | - Lucia Gallego-Ligorit
- Department of Anesthesiology and Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón IIS Aragón, Zaragoza, Spain
| | - Alba Herrero-Izquierdo
- Department of Anesthesiology and Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón IIS Aragón, Zaragoza, Spain
| | - J Vallés-Torres
- Department of Anesthesiology and Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón IIS Aragón, Zaragoza, Spain
| | - Silvia Ramos
- Department of Anesthesiology and Critical Care, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Daniel López-Herrera
- Department of Anesthesiology and Critical Care, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel De La Matta
- Department of Anesthesiology and Critical Care, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Sertcakacilar Gokhan
- Department of Anesthesiology and Critical Care, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey; Outcomes Research Consortium, Cleveland, OH, USA
| | - Evrim Kucur
- Department of Anesthesiology and Critical Care, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ana Mugarra
- Department of Anesthesiology and Critical Care, Hospital Universitario Clínico de Valencia, Valencia, Spain
| | - Marina Soro
- Department of Anesthesiology and Critical Care, Hospital Universitario Clínico de Valencia, Valencia, Spain
| | - Laura García
- Department of Anesthesiology and Critical Care, Hospital Universitario Clínico de Valencia, Valencia, Spain
| | - José Alfonso Sastre
- Department of Anesthesiology and Critical Care, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Pilar Aguirre
- Department of Anesthesiology and Critical Care, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Claudia Jimena Salazar
- Department of Anesthesiology and Critical Care, Hospital Universitario Ntra Sra de Candelaria, Santa Cruz de Tenerife, Spain
| | - María Carolina Ramos
- Department of Anesthesiology and Critical Care, Hospital Universitario Ntra Sra de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Ramón Trespalacios
- Department of Anesthesiology and Critical Care, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Félix Ezequiel-Fernández
- Department of Anesthesiology and Critical Care, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Angella Lamanna
- Department of Medical and Surgical Sciences, Università Degli Studi di Foggia, Foggia, Italy
| | - Leonarda Pia Cantatore
- Department of Medical and Surgical Sciences, Università Degli Studi di Foggia, Foggia, Italy
| | - Donato Laforgia
- Department of Medical and Surgical Sciences, Università Degli Studi di Foggia, Foggia, Italy
| | - Soledad Bellas
- Department of Anesthesiology and Critical Care, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos López
- Department of Anesthesiology and Critical Care, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Ricard Navarro-Ripoll
- Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Samira Martínez
- Department of Anesthesiology and Critical Care, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Jordi Vallverdú
- Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Adriana Jacas
- Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Barcelona, Spain
| | - María José Yepes-Temiño
- Department of Anesthesiology and Critical Care, Clínica Universidad de Navarra, Pamplona, Spain
| | - Francisco Javier Belda
- Department of Anesthesiology and Critical Care, Hospital Universitario Clínico de Valencia, Valencia, Spain
| | - Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar de Plata, Buenos Aires, Argentina
| | - Fernando Suárez-Sipmann
- CIBER de Enfermedades Respiratorias CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain; Li Ka Shing Knowledge Institute for Medical Science, St Michael's Hospital, Toronto, ON, Canada
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Alonso A, de la Gala F, Vara E, Hortal J, Piñeiro P, Reyes A, Simón C, Garutti I. Lung and blood perioperative metalloproteinases in patients undergoing oncologic lung surgery: Prognostic implications. Thorac Cancer 2024; 15:307-315. [PMID: 38155459 PMCID: PMC10834222 DOI: 10.1111/1759-7714.15190] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Metalloproteinases (MMPs) have been reported to be related to oncologic outcomes. The main goal of the study was to study the relationship between these proteins and the long-term prognosis of patients undergoing oncologic lung resection surgery. METHODS This was a substudy of the phase IV randomized control trial (NCT02168751). We analyzed MMP-2, -3, -7, and -9 in blood samples and bronchoalveolar lavage (LBA) and the relationship between MMPs and long postoperative outcomes (survival and disease-free time of oncologic recurrence). RESULTS Survival was longer in patients who had lower MMP-2 levels than those with higher MMP-2 in blood samples taken 6 h after surgery (6.8 vs. 5.22 years; p = 0.012) and MMP-3 (6.82 vs. 5.35 years; p = 0.03). In contrast, survival was longer when MMP-3 levels were higher in LBA from oncologic lung patients than those with lower MMP-3 (7.96 vs. 6.02 years; p = 0.005). Recurrence-free time was longer in patients who had lower MMP-3 levels in blood samples versus higher (5.97 vs. 4.23 years; p = 0.034) as well as lower MMP-7 (5.96 vs. 4.5 years; p = 0.041) or lower MMP-9 in LBA samples (6.21 vs. 4.18 years; p = 0.012). CONCLUSION MMPs were monitored during the perioperative period of oncologic lung resection surgery. These biomarkers were associated with mortality and recurrence-free time. The role of the different MMPs analyzed during the study do not have the same prognostic implications after this kind of surgery.
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Affiliation(s)
- Angel Alonso
- Department of Anesthesiology, Gregorio Marañon University General Hospital, Madrid, Spain
| | - Francisco de la Gala
- Department of Anesthesiology, Gregorio Marañon University General Hospital, Madrid, Spain
| | - Elena Vara
- Department of Biochemistry and Molecular Biology III, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Javier Hortal
- Department of Anesthesiology, Gregorio Marañon University General Hospital, Madrid, Spain
- Department of Pharmacology, Faculty of Medicine complutense University of Madrid, Madrid, Spain
| | - Patricia Piñeiro
- Department of Anesthesiology, Gregorio Marañon University General Hospital, Madrid, Spain
| | - Almudena Reyes
- Department of Anesthesiology, Gregorio Marañon University General Hospital, Madrid, Spain
| | - Carlos Simón
- Department of Thoracic Surgery, Gregorio Marañon University General Hospital, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Ignacio Garutti
- Department of Anesthesiology, Gregorio Marañon University General Hospital, Madrid, Spain
- Department of Pharmacology, Faculty of Medicine complutense University of Madrid, Madrid, Spain
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5
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Caamano E, Velasco L, Garcia MV, Asencio JM, Piñeiro P, Hortal J, Garutti I. Prognostic factors for deterioration of quality of life one year after admission to ICU for severe SARS-COV2 infection. Qual Life Res 2024; 33:123-132. [PMID: 37615735 DOI: 10.1007/s11136-023-03503-0] [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] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE Patients with COVID-19 present long-term symptoms collectively known as "post-COVID syndrome". Long-term manifestations are more frequent in patients requiring admission to Intensive Care Units (ICU), but the risk factors for their development are still unknown. This study explores the quality of life of patients with severe COVID-19 one year after their discharge from ICU. METHODS Prospective observational study including 106 patients admitted to the ICU of a tertiary care hospital between March and August 2020. We analysed quality of life using the EuroQol-5D index (EQ-5D). We evaluated as possible risk factors associated with a worse value of the EQ-5D index the medical record, the clinical situation at hospital admission, the clinical situation at ICU admission and evolution in the ICU. As a secondary objective, we explored the presence of other frequent symptoms. RESULTS Most patients (55.4%) reported that their quality of life worsened one year after admission. The mean perceived health status, on the EQ-VAS scale (0-100), was 70.4, with a median of 70 (RI 60-90). The median EQ-5D index was 0.91 (RI 0.76-1). The factors independently related to lower quality of life were female sex and duration of mechanical ventilation. Almost all (91%) of the patients had sequelae one year after discharge from the ICU. The most frequent manifestations were neuropsychiatric (71%). CONCLUSIONS Critically ill COVID-19 patients worsen their quality of life more than one year after discharge. Female sex and duration of mechanical ventilation predict a lower quality of life assessed by the EQ-5D index.
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Affiliation(s)
- E Caamano
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain.
| | - L Velasco
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - M V Garcia
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - J M Asencio
- Department of General Surgery, Gregorio Maranon National Hospital, Madrid, Spain
| | - P Piñeiro
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - J Hortal
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - I Garutti
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
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6
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Zaballos M, Fernández I, Rodríguez L, Álvarez-Zaballos S, Duque P, Terradillos E, Piñeiro P, Garutti I, Guerrero JE, Hortal J. Cohort study to assess the prevalence of prolonged QT and arrhythmias in critically ill patients during the early phase of the COVID-19 pandemic. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:561-568. [PMID: 37717632 DOI: 10.1016/j.redare.2023.01.006] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/10/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Patients with SARS-CoV-2 infection may present cardiovascular involvement including myocarditis, arrhythmias and QT interval prolongation. Our objective was to evaluate the impact of COVID-19 and its treatment on ventricular repolarization and development of arrhythmias in critically ill patients. METHODS Retrospective cohort study of critically ill COVID-19 patients during a 3-month period in whom at least one ECG was available. Relevant clinical data and specific treatment administered for COVID-19 were recorded. Prolonged QTc was considered prolonged when it measured ≥ 460 ms in women and ≥450 ms in men. The incidence and type of arrhythmias during the same period were recorded. RESULTS A total of 77 patients with a mean age of 62 ± 13 years, 20 women and 57 men, were evaluated. Sixty percent of the patients were hypertensive, 52% had a BMI > 30, and 70% developed acute renal failure during admission. Some 56% of the patients presented QTc prolongation. Forty-four percent presented some type of arrhythmia during their stay in the ICU, 21% of which were atrial arrhythmias. Overall mortality was 53%, with no differences between patients with or without prolonged QTc. CONCLUSIONS In our series, a high proportion of critical patients with COVID-19 presented prolonged QTc and arrhythmias. The factors involved have been related to the elevation of cardiac biomarkers, the myocardial involvement of the virus and concomitant medication received in the ICU.
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Affiliation(s)
- M Zaballos
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense, Madrid, Spain.
| | - I Fernández
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - L Rodríguez
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - S Álvarez-Zaballos
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Duque
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - E Terradillos
- Oberärztin, Institut für Anästhesiologie und Intensivmedizin, San Galo, Sankt Gallen, Switzerland
| | - P Piñeiro
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - I Garutti
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Farmacología, Universidad Complutense, Madrid, Spain
| | - J E Guerrero
- Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Hortal
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Farmacología, Universidad Complutense, Madrid, Spain
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Díaz-Cambronero Ó, Mazzinari G, Errando CL, Garutti I, Gurumeta AA, Serrano AB, Esteve N, Montañes MV, Neto AS, Hollmann MW, Schultz MJ, Argente Navarro MP. An educational intervention to reduce the incidence of postoperative residual curarisation: a cluster randomised crossover trial in patients undergoing general anaesthesia. Br J Anaesth 2023; 131:482-490. [PMID: 37087332 DOI: 10.1016/j.bja.2023.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/20/2022] [Revised: 02/11/2023] [Accepted: 02/28/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND The incidence of postoperative residual curarisation remains unacceptably high. We assessed whether an educational intervention on perioperative neuromuscular block management can reduce it. METHODS In this multicentre, cluster randomised crossover trial, centres were allocated to receive an educational intervention either in a first or a second period. The educational intervention consisted of a lecture about neuromuscular management key points, including quantitative neuromuscular monitoring and use of reversal agents. The lecture was streamed to allow repetition. Additionally, memory cards were distributed in each operating theatre. The primary outcome was postoperative residual curarisation in the PACU. Secondary outcomes were frequency of quantitative neuromuscular monitoring, use of reversal agents, and incidence of postoperative pulmonary complications during hospital stay. Measurements were performed before randomisation and after the first and the second period. The effect of the educational intervention was estimated using multivariable mixed effects logistic regression models. RESULTS We included 2314 subjects in 34 Spanish centres. Postoperative residual curarisation incidence was not affected by the educational intervention (odds ratio [OR] 0.90 [95% confidence interval {CI}: 0.51-1.58]; P=0.717 and 1.30 [0.73-2.30]; P=0.371] for first and second time-period interaction). The educational intervention increased the quantitative neuromuscular monitor usage (OR 2.04 [95% CI: 1.31-3.19]; P=0.002), the use of reversal agents was unchanged (OR 0.79 [95% CI: 0.50-1.26]; P=0.322), and the incidence of postoperative pulmonary complications decreased (OR 0.19 [95% CI: 0.10-0.35]; P<0.001). CONCLUSIONS An educational intervention on perioperative neuromuscular block management did not reduce the incidence of postoperative residual curarisation nor increase reversal, despite increased quantitative neuromuscular monitoring. Sugammadex reversal was associated with reduced postoperative residual curarisation. The educational intervention was associated with a decrease in postoperative pulmonary complications. CLINICAL TRIAL REGISTRATION NCT03128151.
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Affiliation(s)
- Óscar Díaz-Cambronero
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Perioperative Medicine Research Group, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
| | - Guido Mazzinari
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Perioperative Medicine Research Group, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | | | - Ignacio Garutti
- Department of Anesthesiology, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - Alfredo A Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Ana B Serrano
- Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Neus Esteve
- Department of Anesthesiology, Hospital Son Espases, Palma de Mallorca, Spain
| | - Maria V Montañes
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Perioperative Medicine Research Group, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Ary S Neto
- Australian and New Zealand Intensive Care Research Center, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Maria P Argente Navarro
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Perioperative Medicine Research Group, Hospital Universitario y Politécnico la Fe, Valencia, Spain
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Garcia-Ramos S, Caamaño E, Rodríguez Benítez P, Benito P, Calvo A, Ramos S, Power M, Garutti I, Piñeiro P. Mortality Risk Prediction in Abdominal Septic Shock Treated with Polymyxin-B Hemoperfusion: A Retrospective Cohort Study. J Pers Med 2023; 13:1023. [PMID: 37511635 PMCID: PMC10381630 DOI: 10.3390/jpm13071023] [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: 05/22/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Endotoxin, a component of the cell membrane of gram-negative bacteria, is a trigger for dysregulated inflammatory response in sepsis. Extracorporeal purification of endotoxin, through adsorption with polymyxin B, has been studied as a therapeutic option for sepsis. Previous studies suggest that it could be effective in patients with high endotoxin levels or patients with septic shock of moderate severity. Here, we perform a retrospective, single-centre cohort study of 93 patients suffering from abdominal septic shock treated with polymyxin-B hemoperfusion (PMX-HP) between 2015 and 2020. We compared deceased and surviving patients one month after the intervention using X2 and Mann-Whitney U tests. We assessed the data before and after PMX-HP with a Wilcoxon single-rank test and a multivariate logistic regression analysis. There was a significant reduction of SOFA score in the survivors. The expected mortality using APACHE-II was 59.62%, whereas in our sample, the rate was 40.9%. We found significant differences between expected mortality and real mortality only for the group of patients with an SOFA score between 8 and 13. In conclusion, in patients with abdominal septic shock, the addition of PMX-HP to the standard therapy resulted in lower mortality than expected in the subgroup of patients with intermediate severity of illness.
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Affiliation(s)
- Sergio Garcia-Ramos
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | - Estrela Caamaño
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | | | - Pilar Benito
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | - Alberto Calvo
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | - Silvia Ramos
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | - Mercedes Power
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | - Ignacio Garutti
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
| | - Patricia Piñeiro
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Marañon National Hospital, 28007 Madrid, Spain
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9
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Ramos R, de la Villa S, García-Ramos S, Padilla B, García-Olivares P, Piñero P, Garrido A, Hortal J, Muñoz P, Caamaño E, Benito P, Cedeño J, Garutti I. COVID-19 associated infections in the ICU setting: A retrospective analysis in a tertiary-care hospital. Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:278-283. [PMID: 37142346 PMCID: PMC10151902 DOI: 10.1016/j.eimce.2021.10.013] [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] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/20/2021] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Our work describes the frequency of superinfections in COVID-19 ICU patients and identifies risk factors for its appearance. Second, we evaluated ICU length of stay, in-hospital mortality and analyzed a subgroup of multidrug-resistant microorganisms (MDROs) infections. METHODS Retrospective study conducted between March and June 2020. Superinfections were defined as appeared ≥48h. Bacterial and fungal infections were included, and sources were ventilator-associated lower respiratory tract infection (VA-LRTI), primary bloodstream infection (BSI), secondary BSI, and urinary tract infection (UTI). We performed a univariate analysis and a multivariate analysis of the risk factors. RESULTS Two-hundred thirteen patients were included. We documented 174 episodes in 95 (44.6%) patients: 78 VA-LRTI, 66 primary BSI, 9 secondary BSI and 21 UTI. MDROs caused 29.3% of the episodes. The median time from admission to the first episode was 18 days and was longer in MDROs than in non-MDROs (28 vs. 16 days, p<0.01). In multivariate analysis use of corticosteroids (OR 4.9, 95% CI 1.4-16.9, p 0.01), tocilizumab (OR 2.4, 95% CI 1.1-5.9, p 0.03) and broad-spectrum antibiotics within first 7 days of admission (OR 2.5, 95% CI 1.2-5.1, p<0.01) were associated with superinfections. Patients with superinfections presented respect to controls prolonged ICU stay (35 vs. 12 days, p<0.01) but not higher in-hospital mortality (45.3% vs. 39.7%, p 0.13). CONCLUSIONS Superinfections in ICU patients are frequent in late course of admission. Corticosteroids, tocilizumab, and previous broad-spectrum antibiotics are identified as risk factors for its development.
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Affiliation(s)
- Rafael Ramos
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sofía de la Villa
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Sergio García-Ramos
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Belén Padilla
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo García-Olivares
- Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Piñero
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Garrido
- Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Hortal
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Estrela Caamaño
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Benito
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jamil Cedeño
- Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio Garutti
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Granell-Gil M, Murcia-Anaya M, Sevilla S, Martínez-Plumed R, Biosca-Pérez E, Cózar-Bernal F, Garutti I, Gallart L, Ubierna-Ferreras B, Sukia-Zilbeti I, Gálvez-Muñoz C, Delgado-Roel M, Mínguez L, Bermejo S, Valencia O, Real M, Unzueta C, Ferrando C, Sánchez F, González S, Ruiz-Villén C, Lluch A, Hernández A, Hernández-Beslmeisl J, Vives M, Vicente R. Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy). Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:266-301. [PMID: 35610172 DOI: 10.1016/j.redare.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/19/2021] [Indexed: 06/15/2023]
Abstract
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
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Affiliation(s)
- M Granell-Gil
- Sección en Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Profesor Contratado Doctor en Anestesiología, Universitat de València, Valencia, Spain
| | - M Murcia-Anaya
- Anestesiología, Reanimación y T. Dolor, Unidad de Cuidados Intensivos, Hospital IMED Valencia, Valencia, Spain.
| | - S Sevilla
- Sociedad de Cirugía Torácica, Complejo Hospitalario Universitario de Jaén, Jaén, Spain
| | - R Martínez-Plumed
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - E Biosca-Pérez
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - F Cózar-Bernal
- Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - I Garutti
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - L Gallart
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - I Sukia-Zilbeti
- Fisioterapia, Hospital Universitario Donostia de San Sebastián, Spain
| | - C Gálvez-Muñoz
- Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, Spain
| | - M Delgado-Roel
- Cirugía Torácica, Complejo Hospitalario Universitario La Coruña, La Coruña, Spain
| | - L Mínguez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, Spain
| | - S Bermejo
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O Valencia
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Doce de Octubre de Madrid, Madrid, Spain
| | - M Real
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Doce de Octubre de Madrid, Madrid, Spain
| | - C Unzueta
- Anestesiología, Reanimación y T. Dolor, Hospital Sant Pau de Barcelona, Barcelona, Spain
| | - C Ferrando
- Anestesiología, Reanimación y T. Dolor, Hospital Clínic Universitari de Barcelona, Barcelona, Spain
| | - F Sánchez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario de la Ribera de Alzira, Valencia, Spain
| | - S González
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Donostia de San Sebastián, Spain
| | - C Ruiz-Villén
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - A Lluch
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, Spain
| | - A Hernández
- Anestesiología, Reanimación y T. Dolor, Grupo Policlínica de Ibiza, Ibiza, Spain
| | - J Hernández-Beslmeisl
- Anestesiología, Reanimación y T. Dolor, Complejo Hospitalario Universitario de Canarias, Canarias, Spain
| | - M Vives
- Anestesiología, Reanimación y T. Dolor, Hospital Universitari Dr. Josep Trueta de Girona, Girona, Spain
| | - R Vicente
- Sección de Anestesia Cardiaca, Vascular y Torácica, SEDAR, Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Universitat de València, Valencia, Spain
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Garutti I, Cabañero A, Vicente R, Sánchez D, Granell M, Fraile CA, Real Navacerrada M, Novoa N, Sanchez-Pedrosa G, Congregado M, Gómez A, Miñana E, Piñeiro P, Cruz P, de la Gala F, Quero F, Huerta LJ, Rodríguez M, Jiménez E, Puente-Maestu L, Aragon S, Osorio-Salazar E, Sitges M, Lopez Maldonado MD, Rios FT, Morales JE, Callejas R, Gonzalez-Bardancas S, Botella S, Cortés M, Yepes MJ, Iranzo R, Sayas J. Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:208-241. [PMID: 35585017 DOI: 10.1016/j.redare.2021.02.011] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/04/2021] [Indexed: 06/15/2023]
Abstract
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Affiliation(s)
- I Garutti
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - A Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R Vicente
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - D Sánchez
- Servicio de Cirugía Torácica, Hospital Clínic, Barcelona, Spain
| | - M Granell
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, Spain
| | - C A Fraile
- Servicio de Cirugía Torácica, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Real Navacerrada
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - N Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca (CAUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - G Sanchez-Pedrosa
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Congregado
- Servicio de Cirugía Torácica, Hospital Virgen de la Macarena, Sevilla, Spain
| | - A Gómez
- Unitat de Rehabilitació Cardiorespiratòria, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Miñana
- Servicio de Anestesia y Reanimación, Hospital de la Ribera, Alzira, Valencia, Spain
| | - P Piñeiro
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Cruz
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F de la Gala
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Quero
- Servicio de Cirugía Torácica, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - L J Huerta
- Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Rodríguez
- Servicio de Cirugía Torácica, Clínica Universidad de Navarra, Madrid, Spain
| | - E Jiménez
- Fisioterapia Respiratoria, Hospital Universitario A Coruña, La Coruña, Spain
| | - L Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - S Aragon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, Spain
| | - E Osorio-Salazar
- Servicio de Anestesia y Reanimación, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Sitges
- Bloc Quirúrgic i Esterilització, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - F T Rios
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - J E Morales
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, Spain
| | - R Callejas
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, Spain
| | - S Gonzalez-Bardancas
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - S Botella
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - M Cortés
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M J Yepes
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Navarra, Pamplona, Spain
| | - R Iranzo
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - J Sayas
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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12
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Ramos R, de la Villa S, García-Ramos S, Padilla B, García-Olivares P, Piñero P, Garrido A, Hortal J, Muñoz P, Caamaño E, Benito P, Cedeño J, Garutti I. COVID-19 associated infections in the ICU setting: A retrospective analysis in a tertiary-care hospital. Enferm Infecc Microbiol Clin 2021; 41:278-283. [PMID: 34908639 PMCID: PMC8658403 DOI: 10.1016/j.eimc.2021.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022]
Abstract
Introduction Our work describes the frequency of superinfections in COVID-19 ICU patients and identifies risk factors for its appearance. Second, we evaluated ICU length of stay, in-hospital mortality and analyzed a subgroup of multidrug-resistant microorganisms (MDROs) infections. Methods Retrospective study conducted between March and June 2020. Superinfections were defined as appeared ≥48 h. Bacterial and fungal infections were included, and sources were ventilator-associated lower respiratory tract infection (VA-LRTI), primary bloodstream infection (BSI), secondary BSI, and urinary tract infection (UTI). We performed a univariate analysis and a multivariate analysis of the risk factors. Results Two-hundred thirteen patients were included. We documented 174 episodes in 95 (44.6%) patients: 78 VA-LRTI, 66 primary BSI, 9 secondary BSI and 21 UTI. MDROs caused 29.3% of the episodes. The median time from admission to the first episode was 18 days and was longer in MDROs than in non-MDROs (28 vs. 16 days, p < 0.01). In multivariate analysis use of corticosteroids (OR 4.9, 95% CI 1.4–16.9, p 0.01), tocilizumab (OR 2.4, 95% CI 1.1–5.9, p 0.03) and broad-spectrum antibiotics within first 7 days of admission (OR 2.5, 95% CI 1.2–5.1, p < 0.01) were associated with superinfections. Patients with superinfections presented respect to controls prolonged ICU stay (35 vs. 12 days, p < 0.01) but not higher in-hospital mortality (45.3% vs. 39.7%, p 0.13). Conclusions Superinfections in ICU patients are frequent in late course of admission. Corticosteroids, tocilizumab, and previous broad-spectrum antibiotics are identified as risk factors for its development.
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Affiliation(s)
- Rafael Ramos
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sofía de la Villa
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sergio García-Ramos
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Belén Padilla
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo García-Olivares
- Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Piñero
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Garrido
- Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Hortal
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Estrela Caamaño
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Benito
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jamil Cedeño
- Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio Garutti
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Granell-Gil M, Murcia-Anaya M, Sevilla S, Martínez-Plumed R, Biosca-Pérez E, Cózar-Bernal F, Garutti I, Gallart L, Ubierna-Ferreras B, Sukia-Zilbeti I, Gálvez-Muñoz C, Delgado-Roel M, Mínguez L, Bermejo S, Valencia O, Real M, Unzueta C, Ferrando C, Sánchez F, González S, Ruiz-Villén C, Lluch A, Hernández A, Hernández-Beslmeisl J, Vives M, Vicente R. Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy). Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00129-8. [PMID: 34330548 DOI: 10.1016/j.redar.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/09/2021] [Accepted: 03/19/2021] [Indexed: 10/20/2022]
Abstract
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
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Affiliation(s)
- M Granell-Gil
- Sección en Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Profesor Contratado Doctor en Anestesiología, Universitat de València, Valencia, España
| | - M Murcia-Anaya
- Anestesiología, Reanimación y T. Dolor, Unidad de Cuidados Intensivos, Hospital IMED Valencia, Valencia, España.
| | - S Sevilla
- Sociedad de Cirugía Torácica, Complejo Hospitalario Universitario de Jaén, Jaén, España
| | - R Martínez-Plumed
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - E Biosca-Pérez
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - F Cózar-Bernal
- Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - I Garutti
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Gregorio Marañón, Madrid, España
| | - L Gallart
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - I Sukia-Zilbeti
- Fisioterapia, Hospital Universitario Donostia, San Sebastián, España
| | - C Gálvez-Muñoz
- Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
| | - M Delgado-Roel
- Cirugía Torácica, Complejo Hospitalario Universitario La Coruña, La Coruña, España
| | - L Mínguez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, España
| | - S Bermejo
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - O Valencia
- Anestesiología, Reanimación y T. Dolor. Hospital Universitario Doce de Octubre de Madrid, Madrid, España
| | - M Real
- Anestesiología, Reanimación y T. Dolor. Hospital Universitario Doce de Octubre de Madrid, Madrid, España
| | - C Unzueta
- Anestesiología, Reanimación y T. Dolor. Hospital Sant Pau de Barcelona, Barcelona, España
| | - C Ferrando
- Anestesiología, Reanimación y T. Dolor. Hospital Clínic Universitari de Barcelona, Barcelona, España
| | - F Sánchez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario de la Ribera de Alzira, Valencia, España
| | - S González
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Donostia de San Sebastián, España
| | - C Ruiz-Villén
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Reina Sofía de Córdoba, Córdoba, España
| | - A Lluch
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, España
| | - A Hernández
- Anestesiología, Reanimación y T. Dolor, Grupo Policlínica de Ibiza, Ibiza, España
| | - J Hernández-Beslmeisl
- Anestesiología, Reanimación y T. Dolor, Complejo Hospitalario Universitario de Canarias, Canarias, España
| | - M Vives
- Anestesiología, Reanimación y T. Dolor, Hospital Universitari Dr. Josep Trueta de Girona, Girona, España
| | - R Vicente
- Sección de Anestesia Cardiaca, Vascular y Torácica, SEDAR, Anestesiología, Reanimación y T. Dolor. Hospital Universitario La Fe de Valencia, Universitat de València, Valencia, España
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Garutti I, Cabañero A, Vicente R, Sánchez D, Granell M, Fraile CA, Real Navacerrada M, Novoa N, Sanchez-Pedrosa G, Congregado M, Gómez A, Miñana E, Piñeiro P, Cruz P, de la Gala F, Quero F, Huerta LJ, Rodríguez M, Jiménez E, Puente-Maestu L, Aragon S, Osorio-Salazar E, Sitges M, Lopez Maldonado MD, Rios FT, Morales JE, Callejas R, Gonzalez-Bardancas S, Botella S, Cortés M, Yepes MJ, Iranzo R, Sayas J. Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00102-X. [PMID: 34294445 DOI: 10.1016/j.redar.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyses, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Affiliation(s)
- I Garutti
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España; Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - A Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - R Vicente
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - D Sánchez
- Servicio de Cirugía Torácica, Hospital Clínic, Barcelona, España
| | - M Granell
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, España
| | - C A Fraile
- Servicio de Cirugía Torácica, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M Real Navacerrada
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - N Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca (CAUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - G Sanchez-Pedrosa
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Congregado
- Servicio de Cirugía Torácica, Hospital Virgen de la Macarena, Sevilla, España
| | - A Gómez
- Unitat de Rehabilitació Cardiorespiratòria, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Miñana
- Servicio de Anestesia y Reanimación, Hospital de La Ribera, Alzira, Valencia, España
| | - P Piñeiro
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Cruz
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F de la Gala
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Quero
- Servicio de Cirugía Torácica, Hospital Universitario Virgen de las Nieves, Granada, España
| | - L J Huerta
- Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Rodríguez
- Servicio de Cirugía Torácica, Clínica Universidad de Navarra, Madrid, España
| | - E Jiménez
- Fisioterapia Respiratoria, Hospital Universitario de A Coruña, La Coruña, España
| | - L Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - S Aragon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, España
| | - E Osorio-Salazar
- Servicio de Anestesia y Reanimación, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M Sitges
- Bloc Quirúrgic i Esterilització, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | | | - F T Rios
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - J E Morales
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, España
| | - R Callejas
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, España
| | - S Gonzalez-Bardancas
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - S Botella
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - M Cortés
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - M J Yepes
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Navarra, Pamplona, España
| | - R Iranzo
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J Sayas
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Romero-Cristóbal M, Clemente-Sánchez A, Piñeiro P, Cedeño J, Rayón L, del Río J, Ramos C, Hernández DA, Cova M, Caballero A, Garutti I, García-Olivares P, Hortal J, Guerrero JE, García R, Bañares R, Rincón D. Possible unrecognised liver injury is associated with mortality in critically ill COVID-19 patients. Therap Adv Gastroenterol 2021; 14:17562848211023410. [PMID: 34178116 PMCID: PMC8207265 DOI: 10.1177/17562848211023410] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/02/2020] [Accepted: 05/20/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-threatening condition. A previous diagnosis of chronic liver disease is associated with poorer outcomes. Nevertheless, the impact of silent liver injury has not been investigated. We aimed to explore the association of pre-admission liver fibrosis indices with the prognosis of critically ill COVID-19 patients. METHODS The work presented was an observational study in 214 patients with COVID-19 consecutively admitted to the intensive care unit (ICU). Pre-admission liver fibrosis indices were calculated. In-hospital mortality and predictive factors were explored with Kaplan-Meier and Cox regression analysis. RESULTS The mean age was 59.58 (13.79) years; 16 patients (7.48%) had previously recognised chronic liver disease. Up to 78.84% of patients according to Forns, and 45.76% according to FIB-4, had more than minimal fibrosis. Fibrosis indices were higher in non-survivors [Forns: 6.04 (1.42) versus 4.99 (1.58), p < 0.001; FIB-4: 1.77 (1.17) versus 1.41 (0.91), p = 0.020)], but no differences were found in liver biochemistry parameters. Patients with any degree of fibrosis either by Forns or FIB-4 had a higher mortality, which increased according to the severity of fibrosis (p < 0.05 for both indexes). Both Forns [HR 1.41 (1.11-1.81); p = 0.006] and FIB-4 [HR 1.31 (0.99-1.72); p = 0.051] were independently related to survival after adjusting for the Charlson comorbidity index, APACHE II, and ferritin. CONCLUSION Unrecognised liver fibrosis, assessed by serological tests prior to admission, is independently associated with a higher risk of death in patients with severe COVID-19 admitted to the ICU.
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Affiliation(s)
| | | | - Patricia Piñeiro
- Department of Anesthesiology, H.G.U. Gregorio Marañón, Madrid, Spain
| | - Jamil Cedeño
- Intensive Care Unit, H.G.U. Gregorio Marañón, Madrid, Spain
| | - Laura Rayón
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
| | - Julia del Río
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
| | - Clara Ramos
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
| | | | - Miguel Cova
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
| | - Aranzazu Caballero
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
| | - Ignacio Garutti
- Department of Anesthesiology, H.G.U. Gregorio Marañón, Madrid, Spain
| | | | - Javier Hortal
- Department of Anesthesiology, H.G.U. Gregorio Marañón, Madrid, Spain,CIBERES, Instituto de Salud Carlos III, Madrid, Spain,School of Medicine, Complutense University, Madrid, Spain
| | | | - Rita García
- CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain,Department of Internal Medicine, H.G.U. Gregorio Marañón, Madrid, Spain
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Granell M, Sanchís N, López-Cantero M, Romero CS, Garutti I, Vicente R. Analysis and review of the perioperative management of COVID-19 patients in thoracic surgery. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:369-371. [PMID: 34130935 PMCID: PMC8188385 DOI: 10.1016/j.redare.2020.08.010] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/18/2022]
Affiliation(s)
- M Granell
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain; Universitat de Valencia, Valencia, Spain; Sección de Anestesia Cardiaca, Vascular y Torácica de Sociedad Española de Anestesiología y Reanimación (SEDAR), Spain.
| | - N Sanchís
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | | | - C S Romero
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - I Garutti
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - R Vicente
- Sección de Anestesia Cardiaca, Vascular y Torácica de Sociedad Española de Anestesiología y Reanimación (SEDAR), Spain; Hospital Universitario Politécnico La FE, Valencia, Spain
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Garutti I, Errando CL, Mazzinari G, Bellón JM, Díaz-Cambronero O, Ferrando C. Spontaneous recovery of neuromuscular blockade is an independent risk factor for postoperative pulmonary complications after abdominal surgery: A secondary analysis. Eur J Anaesthesiol 2021; 37:203-211. [PMID: 32028288 DOI: 10.1097/eja.0000000000001128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In intermediate-to-high-risk patients, major abdominal surgery is associated with a high incidence of postoperative complications, mainly pulmonary. Neuromuscular blocking drugs have been suggested as a contributing factor, but this remains unproven. OBJECTIVE To define the relationship of neuromuscular blockade management (reversal) with postoperative pulmonary complications (PPCs). DESIGN The individualised PeRioperative Open-lung approach Versus standard protectivE ventilation in abdominal surgery study was a prospective, multicentre, four-arm, randomised controlled trial. This is a secondary analysis of the data. SETTING Twenty-one teaching hospitals in Spain. The study was conducted between 2 January 2015, and 18 May 2016. PATIENTS Age more than 18 years with an intermediate-to-high risk for PPCs, scheduled for major abdominal surgery lasting more than 2 h. Exclusion criteria included pregnancy or breastfeeding, and moderate-to-severe organ diseases. INTERVENTIONS The mode of reversal of neuromuscular blockade determined two patient groups: pharmacological reversal versus spontaneous recovery. MAIN OUTCOME MEASURES The primary outcome was a composite of PPCs during the first 30 postoperative days. The association between categorical variables and PPCs within 30 days was studied. Univariate and multivariable logistic regression modelling and propensity score analyses were performed. RESULTS From the 923 patients included, 596 (64.6%) presented with PPCs within 30 days after surgery. Patients who developed these complications were older with a higher BMI, a lower pre-operative SpO2, a higher ASA physical status score and a higher incidence of arterial hypertension, diabetes mellitus or chronic obstructive pulmonary disease. Pharmacological neuromuscular blockade reversal was associated with a lower incidence of PPCs (odds ratio 0.62, 95% CI 0.47 to 0.82). CONCLUSION Spontaneous recovery of neuromuscular blockade was an independent risk factor for PPCs in patients with intermediate-to-high risk, undergoing abdominal surgery. We suggest this factor should be included in future studies on PPCs. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT02158923.
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Affiliation(s)
- Ignacio Garutti
- From the Department of Anaesthesiology, Hospital General Universitario Gregorio Marañón, Madrid (IG), Department of Anaesthesiology, Consorcio Hospital General Universitario de Valencia (CLE), Department of Anaesthesiology, Hospital de Manises, Valencia (GM), Department of Biostatistics, Hospital General Universitario Gregorio Marañón, Madrid (JMB), Department of Anaesthesiology, Hospital Universitari i Politécnic La Fe (OD-C), Perioperative Medicine Research Group Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia (GM, OD-C) and Pharmacology and Toxicology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain (IG) the Department of Anaesthesiology and Critical Care, Hospital Clinic i Provincial, Barcelona, Spain (CF), CIBER de Enfermedades Respiratorias. Instituto de Salud Carlos III, Madrid, Spain (CF)
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Puente-Maestú L, López E, Sayas J, Alday E, Planas A, Parise DJ, Martínez-Borja M, Garutti I. The effect of immediate postoperative Boussignac CPAP on adverse pulmonary events after thoracic surgery: A multicentre, randomised controlled trial. Eur J Anaesthesiol 2021; 38:164-170. [PMID: 33186306 DOI: 10.1097/eja.0000000000001369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The effectiveness of prophylactic continuous positive pressure ventilation (CPAP) after thoracic surgery is not clearly established. OBJECTIVE The aim of this study was to assess the effectiveness of CPAP immediately after lung resection either by thoracotomy or thoracoscopy in preventing atelectasis and pneumonia. DESIGN A multicentre, randomised, controlled, open-label trial. SETTINGS Four large University hospitals at Madrid (Spain) from March 2014 to December 2016. PATIENTS Immunocompetent patients scheduled for lung resection, without previous diagnosis of sleep-apnoea syndrome or severe bullous emphysema. Four hundred and sixty-four patients were assessed, 426 were randomised and 422 were finally analysed. INTERVENTION Six hours of continuous CPAP through a Boussignac system versus standard care. MAIN OUTCOME MEASURES Primary outcome: incidence of the composite endpoint 'atelectasis + pneumonia'. Secondary outcome: incidence of the composite endpoint 'persistent air leak + pneumothorax'. RESULTS The primary outcome occurred in 35 patients (17%) of the CPAP group and in 58 (27%) of the control group [adjusted relative risk (ARR) 0.53, 95% CI 0.30 to 0.93]. The secondary outcome occurred in 33 patients (16%) of the CPAP group and in 29 (14%) of the control group [ARR 0.92, 95% CI 0.51 to 1.65]. CONCLUSION Prophylactic CPAP decreased the incidence of the composite endpoint 'postoperative atelectasis + pneumonia' without increasing the incidence of the endpoint 'postoperative persistent air leaks + pneumothorax'.
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Affiliation(s)
- Luis Puente-Maestú
- From the Servicio de Neumología Hospital General Universitario Gregorio Marañón (LP-M), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) (LP-M, IG), Facultad de Medicina Universidad Complutense de Madrid (UCM) (LP-M, EL, JS, IG), Servicio de Anestesia Hospital General Universitario Gregorio Marañón (IG), Servicio de Anestesia Hospital General Universitario 12 de Octubre (EL), Instituto de Investigación Sanitaria 12 de Octubre (I+12) (EL, JS), Servicio de Neumología Hospital General Universitario 12 de Octubre (JS), Servicio de Anestesia Hospital General Universitario La Princesa (EA, AP), Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS La Princea) (EA, AP), Facultad de Medicina Universidad Autónoma de Madrid (UAM) (EA, AP), Servicio de Anestesia Hospital General Universitario Ramón y Cajal (DJP, MM-B), Instituto de Investigación Sanitaria Hospital Ramón y Cajal (IRICYS) (DJP, MM-B), Facultad de Medicina Universidad de Alcalá de Henares (UAH), Madrid, Spain (DJP, MM-B)
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Granell M, Sanchís N, López-Cantero M, Romero CS, Garutti I, Vicente R. [Analysis and review of the perioperative management of COVID-19 patients in thoracic surgery]. ACTA ACUST UNITED AC 2020; 68:369-371. [PMID: 33838906 PMCID: PMC7476441 DOI: 10.1016/j.redar.2020.08.007] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- M Granell
- Consorcio Hospital General Universitario de Valencia, València, España.,Universitat de Valencia València, España.,Sección de Anestesia Cardiaca, Vascular y Torácica de Sociedad Española de Anestesiología y Reanimación (SEDAR), España
| | - N Sanchís
- Consorcio Hospital General Universitario de Valencia, València, España
| | | | - C S Romero
- Consorcio Hospital General Universitario de Valencia, València, España
| | - I Garutti
- Hospital Universitario Gregorio Marañón, Madrid, España
| | - R Vicente
- Sección de Anestesia Cardiaca, Vascular y Torácica de Sociedad Española de Anestesiología y Reanimación (SEDAR), España.,Hospital Universitario Politécnico La FE, València, España
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20
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Thomas S, Borges F, Bhandari M, De Beer J, Urrútia Cuchí G, Adili A, Winemaker M, Avram V, Chan MTV, Lamas C, Cruz P, Aguilera X, Garutti I, Alonso-Coello P, Villar JC, Jacka M, Wang CY, Berwanger O, Chow C, Srinathan S, Pettit S, Heels-Ansdell D, Rubery P, Devereaux PJ. Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery: A Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Substudy. J Bone Joint Surg Am 2020; 102:880-888. [PMID: 32118652 DOI: 10.2106/jbjs.18.01305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Myocardial injury after noncardiac surgery (MINS) is common and of prognostic importance. Little is known about MINS in orthopaedic surgery. The diagnostic criterion for MINS was a level of ≥0.03 ng/mL on a non-high-sensitivity troponin T (TnT) assay due to myocardial ischemia. METHODS We undertook an international, prospective study of 15,103 patients ≥45 years of age who had inpatient noncardiac surgery; 3,092 underwent orthopaedic surgery. Non-high-sensitivity TnT assays were performed on postoperative days 0, 1, 2, and 3. Among orthopaedic patients, we determined (1) the prognostic relevance of the MINS diagnostic criteria, (2) the 30-day mortality rate for those with and without MINS, and (3) the probable proportion of MINS cases that would go undetected without troponin monitoring because of a lack of an ischemic symptom. RESULTS Three hundred and sixty-seven orthopaedic patients (11.9%) had MINS. MINS was associated independently with 30-day mortality including among those who had had orthopaedic surgery. Orthopaedic patients without and with MINS had a 30-day mortality rate of 1.0% and 9.8%, respectively (odds ratio [OR], 11.28; 95% confidence interval [CI], 6.72 to 18.92). The 30-day mortality rate was increased for patients with MINS who had an ischemic feature (i.e., symptoms, or evidence of ischemia on electrocardiography or imaging) (OR, 18.25; 95% CI, 10.06 to 33.10) and for those who did not have an ischemic feature (OR, 7.35; 95% CI, 3.37 to 16.01). The proportion of orthopaedic patients with MINS who were asymptomatic and in whom the myocardial injury would have probably gone undetected without TnT monitoring was 81.3% (95% CI, 76.3% to 85.4%). CONCLUSIONS One in 8 orthopaedic patients in our study had MINS, and MINS was associated with a higher mortality rate regardless of symptoms. Troponin levels should be measured after surgery in at-risk patients because most MINS cases (>80%) are asymptomatic and would go undetected without routine measurements. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sabu Thomas
- University of Rochester, Rochester, New York.,McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | | | | | - Claudia Lamas
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Cruz
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ignacio Garutti
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - C Y Wang
- University of Malaya, Kuala Lumpur, Malaysia
| | | | - Clara Chow
- University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | - Paul Rubery
- University of Rochester, Rochester, New York
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21
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Vilchez-Monge AL, Garutti I, Jimeno C, Zaballos M, Jimenez C, Olmedilla L, Piñeiro P, Duque P, Salcedo M, Asencio JM, Lopez-Baena JA, Maruszewski P, Bañares R, Perez-Peña JM. Intraoperative Troponin Elevation in Liver Transplantation Is Independently Associated With Mortality: A Prospective Observational Study. Liver Transpl 2020; 26:681-692. [PMID: 31944566 DOI: 10.1002/lt.25716] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/09/2020] [Indexed: 01/09/2023]
Abstract
Intraoperative factors implicated in postoperative mortality after liver transplantation (LT) are poorly understood. Because LT is a particularly demanding procedure, we hypothesized that intraoperative myocardial injury may be frequent and independently associated with early postoperative outcomes. We aimed to determine the association between intraoperative high-sensitivity troponin (hsTn) elevation during LT and 30-day postoperative mortality. A total of 203 adult patients undergoing LT were prospectively included in the cohort and followed during 1 year. Advanced hemodynamic parameters and serial high-sensitivity troponin T (hsTnT) measurements were assessed at 6 intraoperative time points. The optimal hsTnT cutoff level for intraoperative troponin elevation (ITE) was identified. Patients were classified into 2 groups according to the presence of ITE. Independent impact of ITE on survival was assessed through survival curves and multivariate Cox regression analysis. Intraoperative cardiac function was compared between groups. Troponin levels increased early during surgery in the ITE group. Troponin values at abdominal closure were associated with 30-day mortality (area under the receiver operating caracteristic curve, [AUROC], 0.73; P = 0.005). Patients with ITE showing values of hsTnT ≥61 ng/L at abdominal closure presented higher 30-day mortality (29.6% versus 3.4%; P < 0.001). ITE was independently associated with 30-day mortality (hazard ratio, 3.8; 95% confidence interval, 1.1-13.8; P = 0.04) and with worse overall intraoperative cardiac function. The hsTnT upper reference limit showed no discriminant capacity during LT. Intraoperative myocardial injury identified by hsTn elevation is frequently observed during LT, and it is associated with myocardial dysfunction and short-term mortality. Determinations of hsTn may serve as a valuable intraoperative monitoring tool during LT.
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Affiliation(s)
- Almudena L Vilchez-Monge
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ignacio Garutti
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria of Hospital General Universitario Gregorio Marañon (IiSGM), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Concepción Jimeno
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Matilde Zaballos
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria of Hospital General Universitario Gregorio Marañon (IiSGM), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Consuelo Jimenez
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Luis Olmedilla
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Patricia Piñeiro
- Postoperative Care Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Patricia Duque
- Postoperative Care Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Magdalena Salcedo
- Hepatology and Liver Transplant Unit, Department of Digestive Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Jose M Asencio
- Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose A Lopez-Baena
- Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Przemyslaw Maruszewski
- Department of Pediatric Surgery and Organ Transplantation, Children´s Memorial Health Institute, Warsaw, Poland
| | - Rafael Bañares
- Hepatology and Liver Transplant Unit, Department of Digestive Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria of Hospital General Universitario Gregorio Marañon (IiSGM), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose M Perez-Peña
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria of Hospital General Universitario Gregorio Marañon (IiSGM), Madrid, Spain
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22
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Spence J, LeManach Y, Chan MTV, Wang CY, Sigamani A, Xavier D, Pearse R, Alonso-Coello P, Garutti I, Srinathan SK, Duceppe E, Walsh M, Borges FK, Malaga G, Abraham V, Faruqui A, Berwanger O, Biccard BM, Villar JC, Sessler DI, Kurz A, Chow CK, Polanczyk CA, Szczeklik W, Ackland G, X GA, Jacka M, Guyatt GH, Sapsford RJ, Williams C, Cortes OL, Coriat P, Patel A, Tiboni M, Belley-Côté EP, Yang S, Heels-Ansdell D, McGillion M, Parlow S, Patel M, Pettit S, Yusuf S, Devereaux PJ. Association between complications and death within 30 days after noncardiac surgery. CMAJ 2020; 191:E830-E837. [PMID: 31358597 DOI: 10.1503/cmaj.190221] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Among adults undergoing contemporary noncardiac surgery, little is known about the frequency and timing of death and the associations between perioperative complications and mortality. We aimed to establish the frequency and timing of death and its association with perioperative complications. METHODS We conducted a prospective cohort study of patients aged 45 years and older who underwent inpatient noncardiac surgery at 28 centres in 14 countries. We monitored patients for complications until 30 days after surgery and determined the relation between these complications and 30-day mortality using a Cox proportional hazards model. RESULTS We included 40 004 patients. Of those, 715 patients (1.8%) died within 30 days of surgery. Five deaths (0.7%) occurred in the operating room, 500 deaths (69.9%) occurred after surgery during the index admission to hospital and 210 deaths (29.4%) occurred after discharge from the hospital. Eight complications were independently associated with 30-day mortality. The 3 complications with the largest attributable fractions (AF; i.e., potential proportion of deaths attributable to these complications) were major bleeding (6238 patients, 15.6%; adjusted hazard ratio [HR] 2.6, 95% confidence interval [CI] 2.2-3.1; AF 17.0%); myocardial injury after noncardiac surgery [MINS] (5191 patients, 13.0%; adjusted HR 2.2, 95% CI 1.9-2.6; AF 15.9%); and sepsis (1783 patients, 4.5%; adjusted HR 5.6, 95% CI 4.6-6.8; AF 12.0%). INTERPRETATION Among adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality. Study registration: ClinicalTrials.gov, no. NCT00512109.
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23
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Ferrando C, Suárez-Sipmann F, Librero J, Pozo N, Soro M, Unzueta C, Brunelli A, Peiró S, Llombart A, Balust J, Aldecoa C, Díaz-Cambronero O, Franco T, Redondo FJ, Garutti I, García JI, Ibáñez M, Granell M, Rodríguez A, Gallego L, de la Matta M, Marcos JM, García J, Mazzinari G, Tusman G, Villar J, Belda J. A noninvasive postoperative clinical score to identify patients at risk for postoperative pulmonary complications: the Air-Test Score. Minerva Anestesiol 2020; 86:404-415. [DOI: 10.23736/s0375-9393.19.13932-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Ferrando C, Aldecoa C, Unzueta C, Belda FJ, Librero J, Tusman G, Suárez-Sipmann F, Peiró S, Pozo N, Brunelli A, Garutti I, Gallego C, Rodríguez A, García JI, Díaz-Cambronero O, Balust J, Redondo FJ, de la Matta M, Gallego-Ligorit L, Hernández J, Martínez P, Pérez A, Leal S, Alday E, Monedero P, González R, Mazzirani G, Aguilar G, López-Baamonde M, Felipe M, Mugarra A, Torrente J, Valencia L, Varón V, Sánchez S, Rodríguez B, Martín A, India I, Azparren G, Molina R, Villar J, Soro M. Effects of oxygen on post-surgical infections during an individualised perioperative open-lung ventilatory strategy: a randomised controlled trial. Br J Anaesth 2019; 124:110-120. [PMID: 31767144 DOI: 10.1016/j.bja.2019.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/07/2019] [Accepted: 10/19/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We aimed to examine whether using a high fraction of inspired oxygen (FIO2) in the context of an individualised intra- and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery. METHODS We performed a multicentre, randomised controlled clinical trial in a network of 21 university hospitals from June 6, 2017 to July 19, 2018. Patients undergoing abdominal surgery were randomly assigned to receive a high (0.80) or conventional (0.3) FIO2 during the intraoperative period and during the first 3 postoperative hours. All patients were mechanically ventilated with an open-lung strategy, which included recruitment manoeuvres and individualised positive end-expiratory pressure for the best respiratory-system compliance, and individualised continuous postoperative airway pressure for adequate peripheral oxyhaemoglobin saturation. The primary outcome was the prevalence of SSI within the first 7 postoperative days. The secondary outcomes were composites of systemic complications, length of intensive care and hospital stay, and 6-month mortality. RESULTS We enrolled 740 subjects: 371 in the high FIO2 group and 369 in the low FIO2 group. Data from 717 subjects were available for final analysis. The rate of SSI during the first postoperative week did not differ between high (8.9%) and low (9.4%) FIO2 groups (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.59-1.50; P=0.90]). Secondary outcomes, such as atelectasis (7.7% vs 9.8%; RR: 0.77; 95% CI: 0.48-1.25; P=0.38) and myocardial ischaemia (0.6% [n=2] vs 0% [n=0]; P=0.47) did not differ between groups. CONCLUSIONS An oxygenation strategy using high FIO2 compared with conventional FIO2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found. CLINICAL TRIAL REGISTRATION NCT02776046.
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Affiliation(s)
- Carlos Ferrando
- Department of Anesthesiology and Critical Care, Hospital Clínic i Provincial, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - César Aldecoa
- Department of Anesthesiology and Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Carmen Unzueta
- Department of Anesthesiology and Critical Care, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - F Javier Belda
- Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Julián Librero
- Navarrabiomed, Complejo Hospitalario de Navarra, UPNA, REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Valencia, Spain
| | - Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Fernando Suárez-Sipmann
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University Hospital, Uppsala, Sweden; Department of Intensive Care, Hospital Universitario La Princesa, Madrid, Spain
| | - Salvador Peiró
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Natividad Pozo
- Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Andrea Brunelli
- Department of Anesthesiology and Critical Care, Hospital Germans Tries i Pujol, Badalona, Spain
| | - Ignacio Garutti
- Department of Anesthesiology and Critical Care, Hospital Universitario General Gregorio Marañón, Madrid, Spain
| | - Clara Gallego
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Aurelio Rodríguez
- Department of Anesthesiology and Critical Care, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - Jose Ignacio García
- Department of Anesthesiology and Critical Care, Hospital Fundación of Alcorcón, Alcorcón, Spain
| | - Oscar Díaz-Cambronero
- Department of Anesthesiology and Critical Care, Hospital Universitario La Fe, Valencia, Spain
| | - Jaume Balust
- Department of Anesthesiology and Critical Care, Hospital Clínic i Provincial, Barcelona, Spain
| | - Francisco J Redondo
- Department of Anesthesiology and Critical Care, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Manuel de la Matta
- Department of Anesthesiology and Critical Care, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Lucía Gallego-Ligorit
- Department of Anesthesiology and Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Javier Hernández
- Department of Anesthesiology and Critical Care, Hospital General, Valencia, Spain
| | - Pascual Martínez
- Department of Anesthesiology and Critical Care, Hospital de Albacete, Albacete, Spain
| | - Ana Pérez
- Department of Anesthesiology and Critical Care, Hospital of Elche, Elche, Spain
| | - Sonsoles Leal
- Department of Anesthesiology and Critical Care, Hospital Povisa, Vigo, Spain
| | - Enrique Alday
- Department of Anesthesiology and Critical Care, Hospital Universitario La Princesa, Madrid, Spain
| | - Pablo Monedero
- Department of Anesthesiology and Critical Care, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Rafael González
- Department of Anesthesiology and Critical Care, Hospital Universitario de León, León, Spain
| | - Guido Mazzirani
- Department of Anesthesiology, Hospital de Manises, Manises, Spain
| | - Gerardo Aguilar
- Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Manuel López-Baamonde
- Department of Anesthesiology and Critical Care, Hospital Clínic i Provincial, Barcelona, Spain
| | - Mar Felipe
- Department of Anesthesiology and Critical Care, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Ana Mugarra
- Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Jara Torrente
- Department of Intensive Care, Hospital Universitario La Princesa, Madrid, Spain
| | - Lucia Valencia
- Department of Anesthesiology and Critical Care, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - Viviana Varón
- Department of Anesthesiology and Critical Care, Hospital Fundación of Alcorcón, Alcorcón, Spain
| | - Sergio Sánchez
- Department of Anesthesiology and Critical Care, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Benigno Rodríguez
- Department of Anesthesiology and Critical Care, Hospital Povisa, Vigo, Spain
| | - Ana Martín
- Department of Anesthesiology and Critical Care, Hospital Universitario de León, León, Spain
| | - Inmaculada India
- Department of Anesthesiology and Critical Care, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Gonzalo Azparren
- Department of Anesthesiology and Critical Care, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Rodrigo Molina
- Department of Anesthesiology and Critical Care, Hospital Fundación of Alcorcón, Alcorcón, Spain
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain; Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St Michael''s Hospital, Toronto, ON, Canada
| | - Marina Soro
- Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain
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- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Navarrabiomed-Fundación Miguel Servet, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain; Department of Anesthesiology, Hospital Privado de Comunidad, Mar de Plata, Argentina; Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University Hospital Uppsala, Sweden; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; Department of Anesthesiology and Critical Care, Hospital de Albacete, Spain; Department of Anesthesiology and Critical Care, Hospital Universitario La Princesa, Madrid, Spain; Department of Anesthesiology, Hospital de Manises, Spain; Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain; Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael''s Hospital, Toronto, ON, Canada
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25
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De la Gala F, Piñeiro P, Reyes A, Simón C, Vara E, Rancan L, Huerta LJ, Gonzalez G, Benito C, Muñoz M, Grande P, Paredes SD, Aznar PT, Perez A, Martinez D, Higuero F, Sanz D, De Miguel JP, Cruz P, Olmedilla L, Lopez Gil E, Duque P, Sanchez-Pedrosa G, Valle M, Garutti I. Effect of intraoperative paravertebral or intravenous lidocaine versus control during lung resection surgery on postoperative complications: A randomized controlled trial. Trials 2019; 20:622. [PMID: 31694684 PMCID: PMC6836654 DOI: 10.1186/s13063-019-3677-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Use of minimally invasive surgical techniques for lung resection surgery (LRS), such as video-assisted thoracoscopy (VATS), has increased in recent years. However, there is little information about the best anesthetic technique in this context. This surgical approach is associated with a lower intensity of postoperative pain, and its use has been proposed in programs for enhanced recovery after surgery (ERAS). This study compares the severity of postoperative complications in patients undergoing LRS who have received lidocaine intraoperatively either intravenously or via paravertebral administration versus saline. METHODS/DESIGN We will conduct a single-center randomized controlled trial involving 153 patients undergoing LRS through a thoracoscopic approach. The patients will be randomly assigned to one of the following study groups: intravenous lidocaine with more paravertebral thoracic (PVT) saline, PVT lidocaine with more intravenous saline, or intravenous remifentanil with more PVT saline. The primary outcome will be the comparison of the postoperative course through Clavien-Dindo classification. Furthermore, we will compare the perioperative pulmonary and systemic inflammatory response by monitoring biomarkers in the bronchoalveolar lavage fluid and blood, as well as postoperative analgesic consumption between the three groups of patients. We will use an ANOVA to compare quantitative variables and a chi-squared test to compare qualitative variables. DISCUSSION The development of less invasive surgical techniques means that anesthesiologists must adapt their perioperative management protocols and look for anesthetic techniques that provide good analgesic quality and allow rapid rehabilitation of the patient, as proposed in the ERAS protocols. The administration of a continuous infusion of intravenous lidocaine has proven to be useful and safe for the management of other types of surgery, as demonstrated in colorectal cancer. We want to know whether the continuous administration of lidocaine by a paravertebral route can be substituted with the intravenous administration of this local anesthetic in a safe and effective way while avoiding the risks inherent in the use of regional anesthetic techniques. In this way, this technique could be used in a safe and effective way in ERAS programs for pulmonary resection. TRIAL REGISTRATION EudraCT, 2016-004271-52; ClinicalTrials.gov, NCT03905837 . Protocol number IGGFGG-2016 version 4.0, 27th April 2017.
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Affiliation(s)
- Francisco De la Gala
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Piñeiro
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Almudena Reyes
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Simón
- Department Thoracic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elena Vara
- Biochemical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Lisa Rancan
- Biochemical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Javier Huerta
- Department Thoracic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Guillermo Gonzalez
- Department Thoracic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carmen Benito
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marta Muñoz
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Grande
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sergio D Paredes
- Biochemical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo Tomas Aznar
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alvaro Perez
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David Martinez
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Fernando Higuero
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David Sanz
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Pedro De Miguel
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Cruz
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Luis Olmedilla
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elena Lopez Gil
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Duque
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Mayte Valle
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio Garutti
- Department Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Carramiñana A, Ferrando C, Unzueta MC, Navarro R, Suárez-Sipmann F, Tusman G, Garutti I, Soro M, Pozo N, Librero J, Gallego L, Ramasco F, Rabanal JM, Rodriguez A, Sastre J, Martinez J, Coves S, García P, Aguirre-Puig P, Yepes J, Lluch A, López-Herrera D, Leal S, Vives M, Bellas S, Socorro T, Trespalacios R, Salazar CJ, Mugarra A, Cinnella G, Spadaro S, Futier E, Ferrer L, Cabrera M, Ribeiro H, Celestino C, Kucur E, Cervantes O, Morocho D, Delphy D, Ramos C, Villar J, Belda J. Rationale and Study Design for an Individualized Perioperative Open Lung Ventilatory Strategy in Patients on One-Lung Ventilation (iPROVE-OLV). J Cardiothorac Vasc Anesth 2019; 33:2492-2502. [DOI: 10.1053/j.jvca.2019.01.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/11/2022]
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Monteserín Matesanz C, de la Gala F, Rancan L, Piñeiro P, Simón C, Tejedor A, Vara E, Gonzalez-Cantero JL, Garutti I. [Predictive value of plasma cytokines for acute kidney injury following lung resection surgery: prospective observational study]. Rev Bras Anestesiol 2019; 69:242-252. [PMID: 31133282 DOI: 10.1016/j.bjan.2018.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients undergoing lung resection surgery are at risk of developing postoperative acute kidney injury. Determination of cytokine levels allows the detection of an early inflammatory response. We investigated any temporal relationship among perioperative inflammatory status and development of acute kidney injury after lung resection surgery. Furthermore, we evaluated the impact of acute kidney injury on outcome and analyzed the feasibility of cytokines to predict acute kidney injury. METHODS We prospectively analyzed 174 patients scheduled for elective lung resection surgery with intra-operative periods of one-lung ventilation. Fiberoptic broncho-alveolar lavage was performed in each lung before and after one-lung ventilation periods for cytokine analysis. As well, cytokine levels were measured from arterial blood samples at five time points. Acute kidney injury was diagnosed within 48h of surgery based estabilished criteria for its diagnosis. We analyzed the association between acute kidney injury and cardiopulmonary complications, length of intensive care unit and hospital stays, intensive care unit re-admission, and short-term and long-term mortality. RESULTS The incidence of acute kidney injury in our study was 6.9% (12/174). Acute kidney injury patients showed higher plasma cytokine levels after surgery, but differences in alveolar cytokines were not detected. Although no patient required renal replacement therapy, acute kidney injury patients had higher incidence of cardiopulmonary complications and increased overall mortality. Plasma interleukin-6 at 6h was the most predictive cytokine of acute kidney injury (cut-off point at 4.89pg.mL-1). CONCLUSIONS Increased postoperative plasma cytokine levels are associated with acute kidney injury after lung resection surgery in our study, which worsens the prognosis. Plasma interleukin-6 may be used as an early indicator for patients at risk of developing acute kidney injury after lung resection surgery.
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Affiliation(s)
| | - Francisco de la Gala
- Gregorio Marañón University General Hospital, Department of Anesthesiology, Madrid, Espanha
| | - Lisa Rancan
- Complutense University of Madrid, Medical Faculty, Department of Biochemistry and Molecular Biology III, Madrid, Espanha
| | - Patricia Piñeiro
- Gregorio Marañón University General Hospital, Department of Anesthesiology, Madrid, Espanha
| | - Carlos Simón
- Gregorio Marañón University General Hospital, Department of Thoracic Surgery, Madrid, Espanha
| | - Alberto Tejedor
- Gregorio Marañón University General Hospital, Department of Nephrology, Madrid, Espanha
| | - Elena Vara
- Complutense University of Madrid, Medical Faculty, Department of Biochemistry and Molecular Biology III, Madrid, Espanha
| | | | - Ignacio Garutti
- Gregorio Marañón University General Hospital, Department of Anesthesiology, Madrid, Espanha
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Monteserín Matesanz C, de la Gala F, Rancan L, Piñeiro P, Simón C, Tejedor A, Vara E, Gonzalez-Cantero JL, Garutti I. Predictive value of plasma cytokines for acute kidney injury following lung resection surgery: prospective observational study. Brazilian Journal of Anesthesiology (English Edition) 2019. [PMID: 31133282 PMCID: PMC9391883 DOI: 10.1016/j.bjane.2019.03.005] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background and objectives Patients undergoing lung resection surgery are at risk of developing postoperative acute kidney injury. Determination of cytokine levels allows the detection of an early inflammatory response. We investigated any temporal relationship among perioperative inflammatory status and development of acute kidney injury after lung resection surgery. Furthermore, we evaluated the impact of acute kidney injury on outcome and analyzed the feasibility of cytokines to predict acute kidney injury. Methods We prospectively analyzed 174 patients scheduled for elective lung resection surgery with intra-operative periods of one-lung ventilation periods. Fiberoptic broncho-alveolar lavage was performed in each lung before and after one-lung ventilation periods for cytokine analysis. As well, cytokine levels were measured from arterial blood samples at five time points. acute kidney injury was diagnosed within 48 h of surgery based on acute kidney injury criteria. We analyzed the association between acute kidney injury and cardiopulmonary complications, length of intensive care unit and hospital stays, intensive care unit re-admission, and short-term and long-term mortality. Results The incidence of acute kidney injury in our study was 6.9% (12/174). Acute kidney injury patients showed higher plasma cytokine levels after surgery but differences in alveolar cytokines were not detected. Although no patient required renal replacement therapy, acute kidney injury patients had higher incidence of cardiopulmonary complications and increased overall mortality. Plasma interleukin-6 at 6 h was the most predictive cytokine of acute kidney injury (cut-off point at 4.89 pg.mL−1). Conclusions Increased postoperative plasma cytokine levels are associated with acute kidney injury after lung resection surgery in our study, which worsens the prognosis. Plasma interleukin-6 may be used as an early indicator for patients at risk of developing acute kidney injury after lung resection surgery.
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Affiliation(s)
| | - Francisco de la Gala
- Gregorio Marañón University General Hospital, Department of Anesthesiology, Madrid, Espanha
| | - Lisa Rancan
- Complutense University of Madrid, Medical Faculty, Department of Biochemistry and Molecular Biology III, Madrid, Espanha
| | - Patricia Piñeiro
- Gregorio Marañón University General Hospital, Department of Anesthesiology, Madrid, Espanha
| | - Carlos Simón
- Gregorio Marañón University General Hospital, Department of Thoracic Surgery, Madrid, Espanha
| | - Alberto Tejedor
- Gregorio Marañón University General Hospital, Department of Nephrology, Madrid, Espanha
| | - Elena Vara
- Complutense University of Madrid, Medical Faculty, Department of Biochemistry and Molecular Biology III, Madrid, Espanha
| | | | - Ignacio Garutti
- Gregorio Marañón University General Hospital, Department of Anesthesiology, Madrid, Espanha
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Garutti I, Gonzalez-Moraga F, Sanchez-Pedrosa G, Casanova J, Martin-Piñeiro B, Rancan L, Simón C, Vara E. The effect of anesthetic preconditioning with sevoflurane on intracellular signal-transduction pathways and apoptosis, in a lung autotransplant experimental model. Brazilian Journal of Anesthesiology (English Edition) 2019. [PMID: 30459087 PMCID: PMC9391783 DOI: 10.1016/j.bjane.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Anesthetic pre-conditioning attenuates inflammatory response during ischemia-reperfusion lung injury. The molecular mechanisms to explain it are not fully understood. The aim of our investigation was to analyze the molecular mechanism that explain the anti-inflammatory effects of anesthetic pre-conditioning with sevoflurane focusing on its effects on MAPKs (mitogen-activated protein kinases), NF-κB (nuclear factor kappa beta) pathways, and apoptosis in an experimental lung autotransplant model. Methods Twenty large white pigs undergoing pneumonectomy plus lung autotransplant were divided into two 10-member groups on the basis of the anesthetic received (propofol or sevoflurane). Anesthetic pre-conditioning group received sevoflurane 3% after anesthesia induction and it stopped when one-lung ventilation get started. Control group did not receive sevoflurane in any moment during the whole study period. Intracellular signal-transduction pathways (MAPK family), transcription factor (NF-κB), and apoptosis (caspases 3 and 9) were analyzed during experiment. Results Pigs that received anesthetic pre-conditioning with sevoflurane have shown significant lower values of MAPK-p38, MAPK-P-p38, JNK (c-Jun N-terminal kinases), NF-κB p50 intranuclear, and caspases (p < 0.05) than pigs anesthetized with intravenous propofol. Conclusions Lung protection of anesthetic pre-conditioning with sevoflurane during experimental lung autotransplant is, at least, partially associated with MAPKs and NF κB pathways attenuation, and antiapoptotic effects.
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Affiliation(s)
- Ignacio Garutti
- Hospital General Universitario Gregorio Marañon, Departamento de Anestesiologia, Madri, Espanha; Universidad Complutense de Madrid, Departamento de Farmacologia, Madri, Espanha.
| | | | | | - Javier Casanova
- Hospital General Universitario Gregorio Marañon, Departamento de Anestesiologia, Madri, Espanha
| | | | - Lisa Rancan
- Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Bioquímica, Madri, Espanha
| | - Carlos Simón
- Hospital General Universitario Gregorio Marañon, Departamento de Cirugía Torácica, Madri, Espanha; Universidad Complutense de Madrid, Departamento de Cirugía, Madri, Espanha
| | - Elena Vara
- Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Bioquímica, Madri, Espanha
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Buse GL, Manns B, Lamy A, Guyatt G, Polanczyk CA, Chan MTV, Wang CY, Villar JC, Sigamani A, Sessler DI, Berwanger O, Biccard BM, Pearse R, Urrútia G, Szczeklik W, Garutti I, Srinathan S, Malaga G, Abraham V, Chow CK, Jacka MJ, Tiboni M, Ackland G, Macneil D, Sapsford R, Leuwer M, Le Manach Y, Devereaux PJ. Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost-consequence analysis. Can J Surg 2018; 61:185-194. [PMID: 29806816 DOI: 10.1503/cjs.010217] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is strongly associated with 30-day mortality; however, it remains mostly undetected without systematic troponin T monitoring. We evaluated the cost and consequences of postoperative troponin T monitoring to detect MINS. METHODS We conducted a model-based cost-consequence analysis to compare the impact of routine troponin T monitoring versus standard care (troponin T measurement triggered by ischemic symptoms) on the incidence of MINS detection. Model inputs were based on Canadian patients enrolled in the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study, which enrolled patients aged 45 years or older undergoing inpatient noncardiac surgery. We conducted probability analyses with 10 000 iterations and extensive sensitivity analyses. RESULTS The data were based on 6021 patients (48% men, mean age 65 [standard deviation 12] yr). The 30-day mortality rate for MINS was 9.6%. We determined the incremental cost to avoid missing a MINS event as $1632 (2015 Canadian dollars). The cost-effectiveness of troponin monitoring was higher in patient subgroups at higher risk for MINS, e.g., those aged 65 years or more, or with a history of atherosclerosis or diabetes ($1309). CONCLUSION The costs associated with a troponin T monitoring program to detect MINS were moderate. Based on the estimated incremental cost per health gain, implementation of postoperative troponin T monitoring seems appealing, particularly in patients at high risk for MINS.
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Affiliation(s)
- Giovanna Lurati Buse
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Braden Manns
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Andre Lamy
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Gordon Guyatt
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Carisi A Polanczyk
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Matthew T V Chan
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Chew Yin Wang
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Juan Carlos Villar
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Alben Sigamani
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Daniel I Sessler
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Otavio Berwanger
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Bruce M Biccard
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Rupert Pearse
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Gerard Urrútia
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Wojciech Szczeklik
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Ignacio Garutti
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Sadeesh Srinathan
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - German Malaga
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Valsa Abraham
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Clara K Chow
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Michael J Jacka
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Maria Tiboni
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Gareth Ackland
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Danielle Macneil
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Robert Sapsford
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Martin Leuwer
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Yannick Le Manach
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
| | - Philip J Devereaux
- From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach)
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Belda J, Ferrando C, Garutti I. The Effects of an Open-Lung Approach During One-Lung Ventilation on Postoperative Pulmonary Complications and Driving Pressure: A Descriptive, Multicenter National Study. J Cardiothorac Vasc Anesth 2018; 32:2665-2672. [DOI: 10.1053/j.jvca.2018.03.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Indexed: 11/11/2022]
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Garutti I, Gonzalez-Moraga F, Sanchez-Pedrosa G, Casanova J, Martin-Piñeiro B, Rancan L, Simón C, Vara E. [The effect of anesthetic preconditioning with sevoflurane on intracellular signal-transduction pathways and apoptosis, in a lung autotransplant experimental model]. Rev Bras Anestesiol 2018; 69:48-57. [PMID: 30459087 DOI: 10.1016/j.bjan.2018.07.002] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 06/29/2018] [Accepted: 07/13/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Anesthetic pre-conditioning attenuates inflammatory response during ischemia-reperfusion lung injury. The molecular mechanisms to explain it are not fully understood. The aim of our investigation was to analyze the molecular mechanism that explain the anti-inflammatory effects of anesthetic pre-conditioning with sevoflurane focusing on its effects on MAPKs (mitogen-activated protein kinases), NF-κB (nuclear factor kappa beta) pathways, and apoptosis in an experimental lung autotransplant model. METHODS Twenty large white pigs undergoing pneumonectomy plus lung autotransplant were divided into two 10-member groups on the basis of the anesthetic received (propofol or sevoflurane). Anesthetic pre-conditioning group received sevoflurane 3% after anesthesia induction and it stopped when one-lung ventilation get started. Control group did not receive sevoflurane in any moment during the whole study period. Intracellular signal-transduction pathways (MAPK family), transcription factor (NF-κB), and apoptosis (caspases 3 and 9) were analyzed during experiment. RESULTS Pigs that received anesthetic pre-conditioning with sevoflurane have shown significant lower values of MAPK-p38, MAPK-P-p38, JNK (c-Jun N-terminal kinases), NF-κB p50 intranuclear, and caspases (p<0.05) than pigs anesthetized with intravenous propofol. CONCLUSIONS Lung protection of anesthetic pre-conditioning with sevoflurane during experimental lung autotransplant is, at least, partially associated with MAPKs and NF κB pathways attenuation, and antiapoptotic effects.
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Affiliation(s)
- Ignacio Garutti
- Hospital General Universitario Gregorio Marañon, Departamento de Anestesiologia, Madri, Espanha; Universidad Complutense de Madrid, Departamento de Farmacologia, Madri, Espanha.
| | | | | | - Javier Casanova
- Hospital General Universitario Gregorio Marañon, Departamento de Anestesiologia, Madri, Espanha
| | | | - Lisa Rancan
- Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Bioquímica, Madri, Espanha
| | - Carlos Simón
- Hospital General Universitario Gregorio Marañon, Departamento de Cirugía Torácica, Madri, Espanha; Universidad Complutense de Madrid, Departamento de Cirugía, Madri, Espanha
| | - Elena Vara
- Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Bioquímica, Madri, Espanha
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Garutti I, Rancan L, Abubakra S, Simón C, Paredes SD, Ortega J, Huerta L, Ramos S, Vara E. Effects of Intraoperative Infusion of Esmolol on Systemic and Pulmonary Inflammation in a Porcine Experimental Model of Lung Resection Surgery. Anesth Analg 2018; 128:168-175. [PMID: 30234542 DOI: 10.1213/ane.0000000000003737] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lung resection surgery (LRS) is associated with systemic and pulmonary inflammation, which can affect postoperative outcomes. Activation of β-adrenergic receptors increases the expression of proinflammatory and anti-inflammatory mediators, and their blockade may attenuate the systemic inflammatory response. The aim of this study was to analyze the effect of a continuous perioperative intravenous perfusion of esmolol on postoperative pulmonary edema in an experimental model of LRS requiring periods of one-lung ventilation (OLV). METHODS Twenty-four large white pigs were randomly assigned to 3 groups: control (CON), esmolol (ESM), and sham. The ESM group received an intravenous esmolol bolus (0.5 mg/kg) and then an esmolol infusion (0.05 mg·kg·minute) throughout the procedure. The CON group received the same volume of 0.9% saline solution as the ESM group plus a continual infusion of saline. The sham group underwent a left thoracotomy without LRS or OLV. At the end of the LRS, the animals were awakened, and after 24 hours, they underwent general anesthesia again. Lung biopsies and plasma samples were obtained to analyze the levels and expression of inflammatory mediators, and the animals also received a bronchoalveolar lavage. RESULTS At 24 hours after the operation, the ESM group had less lung edema and lower expression of the proinflammatory biomarkers tumor necrosis factor (TNF) and interleukin (IL)-1 compared to the CON group for both lung lobes. For the mediastinal lobe biopsies, the mean difference and 95% confidence interval (CI) between the groups for edema, TNF, and IL-1 were 14.3 (95% CI, 5.6-23.1), P = .002; 0.19 (95% CI, 0.07-0.32), P = .002; and 0.13 (95% CI, 0.04-0.22), P = .006, respectively. In the left upper lobe, the mean differences for edema, TNF, and IL-1 were 12.4 (95% CI, 4.2-20.6), P = .003; 0.25 (95% CI, 0.12-0.37), P < .001; and 0.3 (95% CI, 0.08-0.53), P = .009. CONCLUSIONS Our results suggest that esmolol reduces lung edema and inflammatory responses in the intraoperative and postoperative periods in animals that underwent LRS with OLV.
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Affiliation(s)
- Ignacio Garutti
- From the Department of Anesthesiology, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Lisa Rancan
- Department of Biochemistry and Molecular Biology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Selma Abubakra
- From the Department of Anesthesiology, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Carlos Simón
- Department of Thoracic Surgery, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Sergio Damian Paredes
- Department of Physiology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Javier Ortega
- Department of Thoracic Surgery, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Luis Huerta
- Department of Thoracic Surgery, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Silvia Ramos
- From the Department of Anesthesiology, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Elena Vara
- Department of Biochemistry and Molecular Biology, School of Medicine, Complutense University of Madrid, Madrid, Spain
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Rancan L, Simón C, Sánchez Pedrosa G, Aymonnier K, Shahani PM, Casanova J, Muñoz C, Garutti I, Vara E. Glycocalyx Degradation after Pulmonary Transplantation Surgery. Eur Surg Res 2018; 59:115-125. [PMID: 30089286 DOI: 10.1159/000489492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 07/19/2017] [Accepted: 04/23/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Ischaemia-reperfusion injury (IRI) is a main cause of morbidity after pulmonary resection surgery. The degradation of glycocalyx, a dynamic layer of macromolecules at the luminal surface of the endothelium, seems to participate in tissue dysfunction after IRI. Lidocaine has a proven anti-inflammatory activity in several tissues but its modulation of glycocalyx has not been investigated. This work aimed to investigate the potential involvement of glycocalyx in lung IRI in a lung auto-transplantation model and the possible effect of lidocaine in modulating IRI. METHODS Three groups (sham-operated, control, and lidocaine), each consisting of 6 Large White pigs, were subjected to lung auto-transplantation. All groups received the same anaesthesia. In addition, the lidocaine group received a continuous IV administration of lidocaine (1.5 mg/kg/h). Lung tissue and plasma samples were taken before pulmonary artery clamp, before reperfusion, and 30 and 60 min post-reperfusion in order to analyse pulmonary oedema, glycocalyx components, adhesion molecules, and myeloperoxidase level. RESULTS Ischaemia caused pulmonary oedema, which was greater after reperfusion. This effect was accompanied by decreased levels of syndecan-1 and heparan sulphate in the lung samples, together with increased levels of both glycocalyx components in the plasma samples. After reperfusion, neutrophil activation and the expression of adhesion molecules were increased. All these alterations were significantly lower or absent in the lidocaine group. CONCLUSION Lung IRI caused glycocalyx degradation that contributed to neutrophil activation and adhesion. The administration of lidocaine was able to protect the lung from glycocalyx degradation.
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Affiliation(s)
- Lisa Rancan
- Department of Biochemistry & Molecular Biology, Faculty of Medicine, Complutense University of Madrid, Madrid,
| | - Carlos Simón
- Department of Thoracic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Karen Aymonnier
- Department of Biochemistry & Molecular Biology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Priya M Shahani
- Department of Biochemistry & Molecular Biology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Javier Casanova
- Department of Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Celia Muñoz
- Department of Biochemistry & Molecular Biology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Ignacio Garutti
- Department of Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elena Vara
- Department of Biochemistry & Molecular Biology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Lema Tome M, De la Gala FA, Piñeiro P, Olmedilla L, Garutti I. Behavior of stroke volume variation in hemodynamic stable patients during thoracic surgery with one-lung ventilation periods. Brazilian Journal of Anesthesiology (English Edition) 2018. [PMID: 29477233 PMCID: PMC9391809 DOI: 10.1016/j.bjane.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction In last few years, emphasis was placed in goal-directed therapy in order to optimize patient's hemodynamic status and improve their prognosis. Parameters based on the interaction between heart and lungs have been questioned in situations like low tidal volume and open chest surgery. The goal of the study was to analyze the changes that one-lung ventilation can produce over stroke volume variation and to assess the possible impact of airway pressures and lung compliance over stroke volume variation. Methods Prospective observational study, 112 patients undergoing lung resection surgery with one-lung ventilation periods were included. Intravenous fluid therapy with crystalloids was set at 2 mL.g−1. Hypotension episodes were treated with vasoconstrictive drugs. Two-lung Ventilation was implemented with a TV of 8 mL.g−1 and one-lung ventilation was managed with a TV of 6 mL.g−1. Invasive blood pressure was monitored. We recorded the following cardiorespiratory values: heart rate, mean arterial pressure, cardiac index, stroke volume index, airway peak pressure, airway plateau pressure and static lung compliance at 3 different times during surgery: immediately after lung collapse, 30 min after initiating one-lung ventilation and after restoration of two-lung ventilation. Results Stroke volume variation values were influenced by lung collapse (before lung collapse 14.6 (DS) vs. OLV 9.9% (DS), p < 0.0001); or after restoring two-lung ventilation (11.01 (DS), p < 0.0001). During two-lung Ventilation there was a significant correlation between airway pressures and stroke volume variation, however this correlation lacks during one-lung ventilation. Conclusion The decrease of stroke volume variation values during one-lung ventilation with protective ventilatory strategies advices not to use the same threshold values to determine fluid responsiveness.
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Lema Tome M, De la Gala FA, Piñeiro P, Olmedilla L, Garutti I. Comportamento da variação do volume sistólico em pacientes hemodinamicamente estáveis durante cirurgia torácica com períodos de ventilação monopulmonar. Braz J Anesthesiol 2018; 68:225-230. [DOI: 10.1016/j.bjan.2017.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/08/2017] [Indexed: 01/13/2023] Open
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Ferrando C, Soro M, Unzueta C, Suarez-Sipmann F, Canet J, Librero J, Pozo N, Peiró S, Llombart A, León I, India I, Aldecoa C, Díaz-Cambronero O, Pestaña D, Redondo FJ, Garutti I, Balust J, García JI, Ibáñez M, Granell M, Rodríguez A, Gallego L, de la Matta M, Gonzalez R, Brunelli A, García J, Rovira L, Barrios F, Torres V, Hernández S, Gracia E, Giné M, García M, García N, Miguel L, Sánchez S, Piñeiro P, Pujol R, García-Del-Valle S, Valdivia J, Hernández MJ, Padrón O, Colás A, Puig J, Azparren G, Tusman G, Villar J, Belda J. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial. Lancet Respir Med 2018; 6:193-203. [PMID: 29371130 DOI: 10.1016/s2213-2600(18)30024-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. METHODS We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m2. Patients were randomly assigned (1:1:1:1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. FINDINGS Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic complications did not differ for patients in OLA-iCPAP (110 [46%] of 241, relative risk 0·89 [95% CI 0·74-1·07; p=0·25]), OLA-CPAP (111 [47%] of 238, 0·91 [0·76-1·09; p=0·35]), or STD-CPAP groups (118 [48%] of 244, 0·95 [0·80-1·14; p=0·65]) when compared with patients in the STD-O2 group (125 [51%] of 244). Intraoperatively, PEEP was increased in 69 (14%) of patients in the standard perioperative ventilation groups because of hypoxaemia, and no patients from either of the OLA groups required rescue manoeuvres. INTERPRETATION In patients who have major abdominal surgery, the different perioperative open lung approaches tested in this study did not reduce the risk of postoperative complications when compared with standard lung-protective mechanical ventilation. FUNDING Instituto de Salud Carlos III of the Spanish Ministry of Economy and Competitiveness, and Grants Programme of the European Society of Anaesthesiology.
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Affiliation(s)
- Carlos Ferrando
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Marina Soro
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Carmen Unzueta
- Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Fernando Suarez-Sipmann
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Jaume Canet
- Department of Anesthesiology & Critical Care, Hospital Universitario Germans Tries i Pujol, Badalona, Spain
| | - Julián Librero
- Navarrabiomed-Fundación Miguel Servet. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
| | - Natividad Pozo
- INCLIVA Clinical Research Institute, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Salvador Peiró
- Centro Superior de Investigación en Salud Publica (CSISP-FISABIO), REDISSEC, Valencia, Spain
| | - Alicia Llombart
- IISLAFE Clinical Research Institute, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Irene León
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Inmaculada India
- Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Cesar Aldecoa
- Department of Anesthesiology & Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Oscar Díaz-Cambronero
- Department of Anesthesiology & Critical Care, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Pestaña
- Department of Anesthesiology & Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Francisco J Redondo
- Department of Anesthesiology & Critical Care, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Ignacio Garutti
- Department of Anesthesiology & Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jaume Balust
- Department of Anesthesiology & Critical Care, Hospital Clínic i Provincial Universitario, Barcelona, Spain
| | - Jose I García
- Department of Anesthesiology & Critical Care, Hospital Fundación de Alcorcón, Alcorcón, Spain
| | - Maite Ibáñez
- Department of Anesthesiology, Hospital de la Marina Baixa de la Vila Joiosa, Alicante, Spain
| | - Manuel Granell
- Department of Anesthesiology & Critical Care, Hospital General Universitario, Valencia, Spain
| | - Aurelio Rodríguez
- Department of Anesthesiology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Lucía Gallego
- Department of Anesthesiology & Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Manuel de la Matta
- Department of Anesthesiology & Critical Care, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Rafael Gonzalez
- Department of Anesthesiology, Hospital Universitario de León, León, Spain
| | - Andrea Brunelli
- Department of Anesthesiology & Critical Care, Hospital Universitario Germans Tries i Pujol, Badalona, Spain
| | - Javier García
- Department of Anesthesiology & Critical Care, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Lucas Rovira
- Department of Anesthesiology, Hospital de Manises, Valencia, Spain
| | - Francisco Barrios
- Department of Anesthesiology & Critical Care, Hospital Principe de Asturias, Madrid, Spain
| | - Vicente Torres
- Department of Anesthesiology & Critical Care, Hospital Son Espases, Palma de Mallorca, Spain
| | - Samuel Hernández
- Department of Anesthesiology, Hospital NS de Candelaria, Santa Cruz de Tenerife, Spain
| | - Estefanía Gracia
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Marta Giné
- Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain
| | - María García
- Department of Anesthesiology & Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Nuria García
- Department of Anesthesiology & Critical Care, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lisset Miguel
- Department of Anesthesiology & Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Sergio Sánchez
- Department of Anesthesiology & Critical Care, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Patricia Piñeiro
- Department of Anesthesiology & Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Roger Pujol
- Department of Anesthesiology & Critical Care, Hospital Clínic i Provincial Universitario, Barcelona, Spain
| | | | - José Valdivia
- Department of Anesthesiology, Hospital de la Marina Baixa de la Vila Joiosa, Alicante, Spain
| | - María J Hernández
- Department of Anesthesiology & Critical Care, Hospital General Universitario, Valencia, Spain
| | - Oto Padrón
- Department of Anesthesiology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Ana Colás
- Department of Anesthesiology & Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jaume Puig
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Gonzalo Azparren
- Department of Anesthesiology & Critical Care, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad Mar de Plata, Mar de Plata, Argentina
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Multidisciplinary Organ Dysfunction Evaluation Research Network, Hospital Universitario Doctor Negrin, Las Palmas, Spain
| | - Javier Belda
- Department of Anesthesiology & Critical Care, Hospital Clínico Universitario, Valencia, Spain; Department of Surgery, Universidad de Valencia, Valencia, Spain
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de la Gala F, Garutti I. New anesthetic considerations in thoracic surgery. ACTA ACUST UNITED AC 2018; 65:125-128. [PMID: 29331202 DOI: 10.1016/j.redar.2017.12.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/04/2017] [Indexed: 11/28/2022]
Affiliation(s)
- F de la Gala
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - I Garutti
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
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de la Gala F, Piñeiro P, Reyes A, Vara E, Olmedilla L, Cruz P, Garutti I. Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia. Br J Anaesth 2017; 119:655-663. [DOI: 10.1093/bja/aex230] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/14/2022] Open
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Errando CL, Mazzinari G, Díaz-Cambronero O, Garutti I. Residual neuromuscular blockade in the postanesthesia care unit. A secondary analysis of the ReCuSS. Observational cross-sectional study of a multicenter cohort. Rev Esp Anestesiol Reanim 2017; 64:419-422. [PMID: 28341080 DOI: 10.1016/j.redar.2017.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 06/06/2023]
Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - G Mazzinari
- Servicio de Anestesiología, Hospital de Manises, Valencia, España
| | - O Díaz-Cambronero
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Politécnico La Fe, Valencia, España
| | - I Garutti
- Servicio de Anestesiología y Reanimación. Hospital General Universitario Gregorio Marañón, Madrid, España
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Ferrando C, Soro M, Unzueta C, Canet J, Tusman G, Suarez-Sipmann F, Librero J, Peiró S, Pozo N, Delgado C, Ibáñez M, Aldecoa C, Garutti I, Pestaña D, Rodríguez A, García del Valle S, Diaz-Cambronero O, Balust J, Redondo FJ, De La Matta M, Gallego L, Granell M, Martínez P, Pérez A, Leal S, Alday K, García P, Monedero P, Gonzalez R, Mazzinari G, Aguilar G, Villar J, Belda FJ. Rationale and study design for an individualised perioperative open-lung ventilatory strategy with a high versus conventional inspiratory oxygen fraction (iPROVE-O2) and its effects on surgical site infection: study protocol for a randomised controlled trial. BMJ Open 2017; 7:e016765. [PMID: 28760799 PMCID: PMC5642673 DOI: 10.1136/bmjopen-2017-016765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Surgical site infection (SSI) is a serious postoperative complication that increases morbidity and healthcare costs. SSIs tend to increase as the partial pressure of tissue oxygen decreases: previous trials have focused on trying to reduce them by comparing high versus conventional inspiratory oxygen fractions (FIO2) in the perioperative period but did not use a protocolised ventilatory strategy. The open-lung ventilatory approach restores functional lung volume and improves gas exchange, and therefore it may increase the partial pressure of tissue oxygen for a given FIO2. The trial presented here aims to compare the efficacy of high versus conventional FIO2 in reducing the overall incidence of SSIs in patients by implementing a protocolised and individualised global approach to perioperative open-lung ventilation. METHODS AND ANALYSIS This is a comparative, prospective, multicentre, randomised and controlled two-arm trial that will include 756 patients scheduled for abdominal surgery. The patients will be randomised into two groups: (1) a high FIO2 group (80% oxygen; FIO2 of 0.80) and (2) a conventional FIO2 group (30% oxygen; FIO2 of 0.30). Each group will be assessed intra- and postoperatively. The primary outcome is the appearance of postoperative SSI complications. Secondary outcomes are the appearance of systemic and pulmonary complications. ETHICS AND DISSEMINATION The iPROVE-O2 trial has been approved by the Ethics Review Board at the reference centre (the Hospital Clínico Universitario in Valencia). Informed consent will be obtained from all patients before their participation. If the approach using high FIO2 during individualised open-lung ventilation decreases SSIs, use of this method will become standard practice for patients scheduled for future abdominal surgery. Publication of the results is anticipated in early 2019. TRIAL REGISTRATION NUMBER NCT02776046; Pre-results.
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Affiliation(s)
- Carlos Ferrando
- Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Marina Soro
- Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Carmen Unzueta
- Department of Anesthesiology and Critical Care, Hospital de la Santa Creu i Sant Pau, Valencia, Spain
| | - Jaume Canet
- Department of Anesthesiology and Critical Care, Hospital Germans Tries i Pujol, Badalona, Spain
| | - Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar de Plata, Argentina
| | - Fernando Suarez-Sipmann
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University Hospital, Uppsala, Sweden
| | - Julian Librero
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Navarrabiomed Fundación Miguel Servet, Pamplona, Spain
| | - Salvador Peiró
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Centro Superior de Investigación en Salud Pública (CSISP FISABIO), Valencia, Spain
| | - Natividad Pozo
- Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Carlos Delgado
- Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Maite Ibáñez
- Department of Anesthesiology, Hospital de Villajoyosa, Villajoyosa, Spain
| | - César Aldecoa
- Department of Anesthesiology and Critical Care, Hospital de Villajoyosa, Villajoyosa, Spain
| | - Ignacio Garutti
- Department of Anesthesiology and Critical Care, Hospital General Gregorio Marañon, Madrid, Spain
| | - David Pestaña
- Anesthesiology and Critical Care, Hospital Ramón y Cajal, Madrid, Spain
| | - Aurelio Rodríguez
- Anesthesiology and Critical Care, Hospital Dr. Negrín, Gran Canaria, Spain
| | | | | | - Jaume Balust
- Anesthesiology and Critical Care, Hospital Clínic i Provincial, Barcelona, Spain
| | | | - Manuel De La Matta
- Anesthesiology and Critical Care, Hospital Vírgen del Rocio, Seville, Spain
| | - Lucía Gallego
- Anesthesiology and Critical Care, Hospital Miguel Servet, Zaragoza, Spain
| | - Manuel Granell
- Anesthesiology and Critical Care, Hospital General, Valencia, Spain
| | - Pascual Martínez
- Anesthesiology and Critical Care, Hospital de Albacete, Albacete, Spain
| | - Ana Pérez
- Anesthesiology and Critical Care, Hospital of Elche, Elche, Spain
| | - Sonsoles Leal
- Anesthesiology and Critical Care, Hospital Povisa, Vigo, Spain
| | - Kike Alday
- Anesthesiology and Critical Care, Hospital La Princesa, Madrid, Spain
| | - Pablo García
- Anesthesiology and Critical Care, Hospital 12 de Octubre, Madrid, Spain
| | - Pablo Monedero
- Anesthesiology and Critical Care, Clínica Universidad de Navarra, Pamplona, Spain
| | - Rafael Gonzalez
- Anesthesiology and Critical Care, Hospital Universitario de León, León, Spain
| | - Guido Mazzinari
- Anesthesiology and Critical Care, Hospital de Manises, Manises, Spain
| | - Gerardo Aguilar
- Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Gran Canaria, Spain
- Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Francisco Javier Belda
- Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain
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Rancan L, Simón C, Marchal-Duval E, Casanova J, Paredes SD, Calvo A, García C, Rincón D, Turrero A, Garutti I, Vara E. Lidocaine Administration Controls MicroRNAs Alterations Observed After Lung Ischemia-Reperfusion Injury. Anesth Analg 2017; 123:1437-1447. [PMID: 27870736 DOI: 10.1213/ane.0000000000001633] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Ischemia-reperfusion injury (IRI) is associated with morbidity and mortality. MicroRNAs (miRNAs) have emerged as regulators of IRI, and they are involved in the pathogenesis of organ rejection. Lidocaine has proven anti-inflammatory activity in several tissues but its modulation of miRNAs has not been investigated. This work aims to investigate the involvement of miRNAs in lung IRI in a lung auto-transplantation model and to investigate the effect of lidocaine. METHODS Three groups (sham, control, and Lidocaine), each comprising 6 pigs, underwent a lung autotransplantation. All groups received the same anesthesia. In addition, animals of lidocaine group received a continuous intravenous administration of lidocaine (1.5 mg/kg/h) during surgery. Lung biopsies were taken before pulmonary artery clamp, before reperfusion, 30 minutes postreperfusion (Rp-30), and 60 minutes postreperfusion (Rp-60). Samples were analyzed for different miRNAs (miR-122, miR-145, miR-146a, miR-182, miR-107, miR-192, miR-16, miR-21, miR-126, miR-127, miR142-5p, miR152, miR155, miR-223, and let7) via the use of reverse-transcription quantitative polymerase chain reaction. Results were normalized with miR-103. RESULTS The expression of miR-127 and miR-16 did not increase after IRI. Let-7d, miR-21, miR-107, miR-126, miR-145, miR-146a, miR-182, and miR-192 significantly increased at the Rp-60 (control versus sham P < .001). miR-142-5p, miR-152, miR-155, and miR 223 significantly increased at the Rp-30 (control versus sham P < .001) and at the Rp-60 (control versus. sham P < .001). The administration of lidocaine was able to attenuate these alterations in a significant way (control versus Lidocaine P < .001). CONCLUSIONS Lung IRI caused dysregulation miRNA. The administration of lidocaine reduced significantly miRNAs alterations.
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Affiliation(s)
- Lisa Rancan
- From the *Department of Biochemistry and Molecular Biology III, Faculty of Medicine, Complutense University of Madrid, Spain; Departments of †Thoracic Surgery and ‡Anesthesiology, Hospital Gregorio Marañón, Madrid, Spain; and Departments of §Physiology and ‖Biostatistics and Operational Investigation, Faculty of Medicine, Complutense University of Madrid, Spain
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Rancan L, Paredes SD, Huerta L, Casanova J, Guzmán J, Garutti I, González-Aragoneses F, Simón C, Vara E. Chemokine Involvement in Lung Injury Secondary to Ischaemia/Reperfusion. Lung 2017; 195:333-340. [PMID: 28432436 DOI: 10.1007/s00408-017-0001-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/28/2016] [Accepted: 03/27/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION During transplant surgeries, the lung experiences an ischaemia-reperfusion (I/R)-induced damage identified as a significant cause of morbidity and mortality. However, the mechanisms by which I/R induces leucocyte accumulation and subsequent tissue damage in lung surgeries remain unknown. Therefore, the present study aims to assess the role of monocyte chemotactic protein 1 (MCP-1) and macrophage inflammatory protein 2 (MIP-2) in leucocyte chemotaxis related to lung injury secondary to I/R. METHODS Six pigs were subjected to an orthotopic left caudal lobe lung transplantation with a subsequent 60-min graft reperfusion (Transplant group). In addition, six animals underwent to sham surgery (Sham Group). Plasma samples and lung biopsies were collected before the beginning of pneumonectomy, before starting the reperfusion, and 30 min and 60 min after the beginning of the reperfusion. Plasma levels of intercellular adhesion molecule 1 (ICAM-1) and lung expressions of MCP-1, MIP-2, myeloperoxidase (MPO), and lung oedema were measured. RESULTS Lung I/R caused substantial damage observed as pulmonary oedema. The oedema was evident after the ischemic insult and increased after reperfusion. After reperfusion, increased levels of MPO were observed which suggests an activation and infiltration of neutrophils into the lung tissue. After 30 min of reperfusion, MCP-1, MIP-2, and ICAM-1 levels were significantly increased compared to prepneumonectomy levels (p < 0.05) and a further increase was observed after 60 min of reperfusion (p < 0.05). CONCLUSION The present study demonstrates that activated neutrophils, as well as MCP-1, MIP-2, and ICAM-1, are involved in inflammatory response induced by ischaemia-reperfusion-induced lung injury.
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Affiliation(s)
- Lisa Rancan
- Department of Biochemistry and Molecular Biology III, School of Medicine, Complutense University of Madrid, Av.da Complutense s/n, 28040, Madrid, Spain.
| | - Sergio D Paredes
- Department of Physiology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Luis Huerta
- Service of Thoracic Surgery, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Javier Casanova
- Service of Anaesthesiology and Rehabilitation, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Jorge Guzmán
- Department of Biochemistry and Molecular Biology III, School of Medicine, Complutense University of Madrid, Av.da Complutense s/n, 28040, Madrid, Spain
| | - Ignacio Garutti
- Service of Anaesthesiology and Rehabilitation, Gregorio Marañón University General Hospital, Madrid, Spain
| | | | - Carlos Simón
- Service of Thoracic Surgery, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Elena Vara
- Department of Biochemistry and Molecular Biology III, School of Medicine, Complutense University of Madrid, Av.da Complutense s/n, 28040, Madrid, Spain
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Casanova J, Piñeiro P, De La Gala F, Olmedilla L, Cruz P, Duque P, Garutti I. [Deep versus moderate neuromuscular block during one-lung ventilation in lung resection surgery]. Rev Bras Anestesiol 2017; 67:288-293. [PMID: 28256331 DOI: 10.1016/j.bjan.2017.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 10/27/2015] [Accepted: 12/01/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Neuromuscular relaxants are essential during general anesthesia for several procedures. Classical anesthesiology literature indicates that the use of neuromuscular blockade in thoracic surgery may be deleterious in patients in lateral decubitus position in one-lung ventilation. The primary objective of our study was to compare respiratory function according to the degree of patient neuromuscular relaxation. Secondary, we wanted to check that neuromuscular blockade during one-lung ventilation is not deleterious. METHODS A prospective, longitudinal observational study was made in which each patient served as both treated subject and control. 76 consecutive patients programmed for lung resection surgery in Gregorio Marañon Hospital along the year of 2013 who required one-lung ventilation in lateral decubitus were included. Ventilator data, hemodynamic parameters were registered in different moments according to train-of-four response (intense, deep and moderate blockade) during one-lung ventilation. RESULTS Peak, plateau and mean pressures were significantly lower during the intense and deep blockade. Besides, compliance and peripheral oxygen saturation were significantly higher in those moments. Heart rate was significantly higher during deep blockade. No mechanical ventilation parameters were modified during measurements. CONCLUSIONS Deep neuromuscular blockade attenuates the poor lung mechanics observed during one-lung ventilation.
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Errando CL, Garutti I, Mazzinari G, Díaz-Cambronero Ó, Bebawy JF. Residual neuromuscular blockade in the postanesthesia care unit: observational cross-sectional study of a multicenter cohort. Minerva Anestesiol 2016; 82:1267-1277. [PMID: 27232277] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Residual neuromuscular blockade after general anesthesia using nondepolarizing neuromuscular blocking agents has pathophysiological, clinical, and economic consequences. A significant number of patients under muscle relaxation sustain residual curarization. METHODS Observational, prospective, multicenter study of a cohort of patients (Residual Curarization in Spain Study, ReCuSS). Residual blockade was defined as TOFr<0.9. Patients >18 years-old under general anesthesia, including at least one dose of non-depolarizing neuromuscular blocking agents, and transferred extubated and spontaneously ventilating to the postanesthesia care unit were included. Pre- and intraoperative data were recorded, including, patient characteristics, ASA physical status, experience of the anesthesiologist, type of surgery, temperature monitoring, surgery duration, neuromuscular blockade-related parameters, type of anesthesia (halogenated-balanced, intravenous propofol-based, other), and use of neuromuscular monitoring. RESULTS A total of 763 patients from 26 hospitals were included, 190 patients (26.7%) showing residual paralysis. Female patients were more prone to residual neuromuscular blockade. Length of surgery, type of relaxant used (benzylisoquinolines), halogenated anesthesia, absence of intraoperative specific monitoring, avoidance of drug reversal, and neostigmine reversal (vs. sugammadex), were significantly related to residual blockade. In the postanesthesia care unit, patients with residual neuromuscular blockade had an increased incidence of respiratory events and tracheal reintubation. CONCLUSIONS The incidence of residual blockade in Spain is similar to that published in other settings and countries. Female gender, longer duration of surgery, and halogenated drugs for anesthesia maintenance were related to residual paralysis, as were NMBA specific items, such as the use of benzylisoquinoline drugs, and the absence of reversal or reversal with neostigmine.
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Affiliation(s)
- Carlos L Errando
- Unit of Anesthesiology, Resuscitation and Pain Treatment, General University Hospital of Valencia, Valencia, Spain -
| | - Ignacio Garutti
- Unit of Anesthesiology and Resuscitation, General University Hospital Gregorio Marañón, Madrid, Spain
- Department of Pharmacology, Complutense University, Madrid, Spain
| | - Guido Mazzinari
- Unit of Anesthesiology, Hospital de Manises, Valencia, Spain
| | - Óscar Díaz-Cambronero
- Unit of Anesthesiology, Resuscitation and Pain Treatment, University Hospital La Fe, Valencia, Spain
| | - John F Bebawy
- Department of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Casanova J, Simon C, Vara E, Sanchez G, Rancan L, Abubakra S, Calvo A, Gonzalez FJ, Garutti I. Sevoflurane anesthetic preconditioning protects the lung endothelial glycocalyx from ischemia reperfusion injury in an experimental lung autotransplant model. J Anesth 2016; 30:755-62. [DOI: 10.1007/s00540-016-2195-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/24/2016] [Indexed: 12/15/2022]
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Garutti I, Sanz J, Olmedilla L, Tranche I, Vilchez A, Fernandez-Quero L, Bañares R, Perez-Peña JM. Extravascular Lung Water and Pulmonary Vascular Permeability Index Measured at the End of Surgery Are Independent Predictors of Prolonged Mechanical Ventilation in Patients Undergoing Liver Transplantation. Anesth Analg 2015. [DOI: 10.1213/ane.0000000000000875] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ferrando C, Soro M, Canet J, Unzueta MC, Suárez F, Librero J, Peiró S, Llombart A, Delgado C, León I, Rovira L, Ramasco F, Granell M, Aldecoa C, Diaz O, Balust J, Garutti I, de la Matta M, Pensado A, Gonzalez R, Durán ME, Gallego L, Del Valle SG, Redondo FJ, Diaz P, Pestaña D, Rodríguez A, Aguirre J, García JM, García J, Espinosa E, Charco P, Navarro J, Rodríguez C, Tusman G, Belda FJ. Rationale and study design for an individualized perioperative open lung ventilatory strategy (iPROVE): study protocol for a randomized controlled trial. Trials 2015; 16:193. [PMID: 25927183 PMCID: PMC4425893 DOI: 10.1186/s13063-015-0694-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 12/26/2014] [Accepted: 03/30/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Postoperative pulmonary and non-pulmonary complications are common problems that increase morbidity and mortality in surgical patients, even though the incidence has decreased with the increased use of protective lung ventilation strategies. Previous trials have focused on standard strategies in the intraoperative or postoperative period, but without personalizing these strategies to suit the needs of each individual patient and without considering both these periods as a global perioperative lung-protective approach. The trial presented here aims at comparing postoperative complications when using an individualized ventilatory management strategy in the intraoperative and immediate postoperative periods with those when using a standard protective ventilation strategy in patients scheduled for major abdominal surgery. METHODS This is a comparative, prospective, multicenter, randomized, and controlled, four-arm trial that will include 1012 patients with an intermediate or high risk for postoperative pulmonary complications. The patients will be divided into four groups: (1) individualized perioperative group: intra- and postoperative individualized strategy; (2) intraoperative individualized strategy + postoperative continuous positive airway pressure (CPAP); (3) intraoperative standard ventilation + postoperative CPAP; (4) intra- and postoperative standard strategy (conventional strategy). The primary outcome is a composite analysis of postoperative complications. DISCUSSION The Individualized Perioperative Open-lung Ventilatory Strategy (iPROVE) is the first multicenter, randomized, and controlled trial to investigate whether an individualized perioperative approach prevents postoperative pulmonary complications. TRIAL REGISTRATION Registered on 5 June 2014 with identification no. NCT02158923 .
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Affiliation(s)
- Carlos Ferrando
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Marina Soro
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Jaume Canet
- Anesthesiology and Critical Care Department, Hospital Germans Tries i Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain.
| | - Ma Carmen Unzueta
- Anesthesiology and Critical Care Department, Hospital San Pau, Carrer de Sant Quintí, 89, CP: 08026, Barcelona, Spain.
| | - Fernando Suárez
- Intensive Care Department, Uppsala University Hospital, Suecia Akademiska Sjukhuset Uppsala University, CP: 75185, Uppsala, Sweden.
| | - Julián Librero
- FISABIO salud Pública, Av. Cataluña, 21, CP: 46020, Valencia, Spain.
| | - Salvador Peiró
- FISABIO salud Pública, Av. Cataluña, 21, CP: 46020, Valencia, Spain.
| | - Alicia Llombart
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Carlos Delgado
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Irene León
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
| | - Lucas Rovira
- Anesthesiology and Critical Care Department, Hospital de Manises, Av. De la Generalitat Valenciana, Manises, CP: 46940, Spain.
| | - Fernando Ramasco
- Anesthesiology and Critical Care Department, Hospital La Princesa of Madrid, Calle de Diego León, 62, CP: 28006, Madrid, Spain.
| | - Manuel Granell
- Anesthesiology and Critical Care Department, Hospital General of Valencia, Av. De les Tres Creus, 2, Valencia, CP: 46014, Spain.
| | - César Aldecoa
- Anesthesiology and Critical Care Department, Hospital Río Hortega of Valladolid, Calle Dulzaina, 2, Valladolid, CP 47012, Spain.
| | - Oscar Diaz
- Anesthesiology and Critical Care Department, Hospital La Fe of Valencia, Av. De Fernando Abril Martorell, 106, Valencia, CP: 46026, Spain.
| | - Jaume Balust
- Anesthesiology and Critical Care Department, Hospital Clínic i Provincial of Barcelona, Carrer Villarroel 170, Barcelona, CP: 08036, Spain.
| | - Ignacio Garutti
- Anesthesiology and Critical Care Department, Hospital General Gregorio Marañon of Madrid, Calle del Doctor Esquerdo, 46, Madrid, CP: 28007, Spain.
| | - Manuel de la Matta
- Anesthesiology and Critical Care Department, Hospital Vírgen del Rocio of Sevilla, Av. Manuel Siurot s/n, Sevilla, CP: 41013, Spain.
| | - Alberto Pensado
- Anesthesiology and Critical Care Department, Complejo Hospitalario Juan Canalejo of La Coruña, Xubias, 84, La Coruña, CP: 15006, Spain.
| | - Rafael Gonzalez
- Anesthesiology and Critical Care Department, Hospital of León, C/ Altos de Nava s/n, Leon, CP: 24701, Spain.
| | - M Eugenia Durán
- Anesthesiology and Critical Care Department, Hospital Vírgen de la Arraixaca of Murcia, Carretera de Madrid-Cartagena s/n, Madrird, CP: 30120, Spain.
| | - Lucia Gallego
- Anesthesiology and Critical Care Department, Hospital Miguel Servet of Zaragoza, Paseo Isabel la Católica, 1-3, Zaragoza, CP: 50009, Spain.
| | - Santiago García Del Valle
- Anesthesiology and Critical Care Department, Hospital Fundación of Alcorcón, Calle de Valdelaguna, 1, Alcorcón, CP: 28922, Spain.
| | - Francisco J Redondo
- Anesthesiology and Critical Care Department, Hospital General of Ciudad Real, C/ Alisos, 19, Ciudad Real, CP: 13002, Spain.
| | - Pedro Diaz
- Anesthesiology and Critical Care Department, Hospital de Valme of Sevilla, Av. Bellavista s/n, Sevilla, CP: 41014, Spain.
| | - David Pestaña
- Anesthesiology and Critical Care Department, Hospital Ramón y Cajal of Madrid, Carretera de Colmenar Viejo Km 9, Madrid, CP: 28034, Spain.
| | - Aurelio Rodríguez
- Anesthesiology and Critical Care Department, Hospital de Gran Canaria Dr. Negrín, c/ Barranco de la Ballena s/n, Negrin, CP: 35010, Spain.
| | - Javier Aguirre
- Anesthesiology and Critical Care Department, Hospital of Galdakano, Barrio Labeaga s/n, Galdakano, CP: 48960, Spain.
| | - Jose M García
- Anesthesiology and Critical Care Department, Complejo Hospitalario Juan Ramón Jimenez of Huelva, Ronda exterior norte, s/n, Huelva, CP: 21005, Spain.
| | - Javier García
- Anesthesiology and Critical Care Department, Hospital Puerta de Hierro of Majadahonda, C/ Manuel de Falla, 1, Majadahonda, CP: 28222, Spain.
| | - Elena Espinosa
- Anesthesiology and Critical Care Department, Hospital Nuestra Señora de la Candelaria of Santa Cruz de Tenerife, Carretera del Rosario, 145, Santa Cruz de Tenerife, CP: 38010, Spain.
| | - Pedro Charco
- Anesthesiology and Critical Care Department, Hospital Son Espases of Mallorca, Carretera de la Valldemosa, 79, Mallorca, CP: 07120, Spain.
| | - Jose Navarro
- Anesthesiology and Critical Care Department, Hospital General of Alicante, Pintor Baeza, 12, Alicante, CP: 03010, Spain.
| | - Clara Rodríguez
- FISABIO salud Pública, Av. Cataluña, 21, CP: 46020, Valencia, Spain.
| | - Gerardo Tusman
- Anesthesiology Department, Hospital Privado de Comunidad Mar de Plata, Mar de Plata, Argentina.
| | - Francisco Javier Belda
- Anesthesiology and Critical Care Department, Hospital Clínico of Valencia, Av. Blasco Ibañez, 17, Valencia, CP: 46010, Spain.
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Garutti I, Puente-Maestu L. Reply from the authors. Br J Anaesth 2015; 114:524-5. [PMID: 25694560 DOI: 10.1093/bja/aev010] [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: 11/14/2022] Open
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Garutti I, Rancan L, Simón C, Cusati G, Sanchez-Pedrosa G, Moraga F, Olmedilla L, Lopez-Gil MT, Vara E. Intravenous lidocaine decreases tumor necrosis factor alpha expression both locally and systemically in pigs undergoing lung resection surgery. Anesth Analg 2014; 119:815-828. [PMID: 25036372 DOI: 10.1213/ane.0000000000000360] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lung resection surgery is associated with an inflammatory reaction. The use of 1-lung ventilation (OLV) seems to increase the likelihood of this reaction. Different prophylactic and therapeutic measures have been investigated to prevent lung injury secondary to OLV. Lidocaine, a commonly used local anesthetic drug, has antiinflammatory activity. Our main goal in this study was to investigate the effect of IV lidocaine on tumor necrosis factor α (TNF-α) lung expression during lung resection surgery with OLV. METHODS Eighteen pigs underwent left caudal lobectomy. The animals were divided into 3 groups: control, lidocaine, and sham. All animals received general anesthesia. In addition, animals in the lidocaine group received a continuous IV infusion of lidocaine during surgery (1.5 mg/kg/h). Animals in the sham group only underwent thoracotomy. Samples of bronchoalveolar lavage (BAL) fluid and plasma were collected before initiation of OLV, at the end of OLV, at the end of surgery, and 24 hours after surgery. Lung biopsy specimens were collected from the left caudal lobe (baseline) before surgery and from the mediastinal lobe and the left cranial lobe 24 hours after surgery. Samples were flash-frozen and stored to measure levels of the following inflammatory markers: interleukin (IL) 1β, IL-2, IL-10, TNF-α, nuclear factor κB, monocyte chemoattractant protein-1, inducible nitric oxide synthase, and endothelial nitric oxide synthase. Markers of apoptosis (caspase 3, caspase 9, Bad, Bax, and Bcl-2) were also measured. In addition, levels of metalloproteinases and nitric oxide metabolites were determined in BAL fluid and in plasma samples. A nonparametric test was used to examine statistical significance. RESULTS OLV caused lung damage with increased TNF-α expression in BAL, plasma, and lung samples. Other inflammatory (IL-1β, nuclear factor κB, monocyte chemoattractant protein-1) and apoptosis (caspase 3, caspase 9, and BAX) markers were also increased. With the use of IV lidocaine there was a significant decrease in the levels of TNF-α in the same samples compared with the control group. Lidocaine administration also reduced the inflammatory and apoptotic changes observed in the control group. Hemodynamic values, blood gas values, and airway pressure were similar in all groups. CONCLUSIONS Our results suggest that lidocaine can prevent OLV-induced lung injury through reduced expression of proinflammatory cytokines and lung apoptosis. Administration of lidocaine may help to prevent lung injury during lung surgery with OLV.
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Affiliation(s)
- Ignacio Garutti
- From the Anesthesiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Biochemistry and Molecular Biology III, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain; and Thoracic Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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