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De Rosa S, Battaglini D, Llompart-Pou JA, Godoy DA. Ten good reasons to consider gastrointestinal function after acute brain injury. J Clin Monit Comput 2024; 38:355-362. [PMID: 37418061 DOI: 10.1007/s10877-023-01050-0] [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] [Received: 04/21/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
The brain-gut axis represents a bidirectional communication linking brain function with the gastrointestinal (GI) system. This interaction comprises a top-down communication from the brain to the gut, and a bottom-up communication from the gut to the brain, including neural, endocrine, immune, and humoral signaling. Acute brain injury (ABI) can lead to systemic complications including GI dysfunction. Techniques for monitoring GI function are currently few, neglected, and many under investigation. The use of ultrasound could provide a measure of gastric emptying, bowel peristalsis, bowel diameter, bowel wall thickness and tissue perfusion. Despite novel biomarkers represent a limitation in clinical practice, intra-abdominal pressure (IAP) is easy-to-use and measurable at bedside. Increased IAP can be both cause and consequence of GI dysfunction, and it can influence cerebral perfusion pressure and intracranial pressure via physiological mechanisms. Here, we address ten good reasons to consider GI function in patients with ABI, highlighting the importance of its assessment in neurocritical care.
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Affiliation(s)
- Silvia De Rosa
- Centre for Medical Sciences - CISMed, University of Trento, Via S. Maria Maddalena 1, 38122, Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, Trento, Italy
| | - Denise Battaglini
- UO Clinica Anestesiologica e Terapia Intensiva, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain
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Llompart-Pou JA, Galarza L, Amaya-Villar R, Godoy DA. Transcranial sonography in the critical patient. Med Intensiva 2024; 48:165-173. [PMID: 38431382 DOI: 10.1016/j.medine.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/09/2023] [Indexed: 03/05/2024]
Abstract
Transcranial ultrasonography is a non-invasive, bedside technique that has become a widely implemented tool in the evaluation and management of neurocritically ill patients. It constitutes a technique in continuous growth whose fundamentals (and limitations) must be known by the intensivist. This review provides a practical approach for the intensivist, including the different sonographic windows and planes of insonation and its role in different conditions of the neurocritical patients and in critical care patients of other etiologies.
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Affiliation(s)
- Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain.
| | - Laura Galarza
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Rosario Amaya-Villar
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Daniel Agustín Godoy
- Unidad de Cuidados Neurointensivos, Sanatorio Pasteur, San Fernando del Valle de Catamarca, Argentina
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Llompart-Pou JA, Pérez-Bárcena J, Lagares A, Godoy DA. Twelve controversial questions in aneurysmal subarachnoid hemorrhage. Med Intensiva 2024; 48:92-102. [PMID: 37951804 DOI: 10.1016/j.medine.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/28/2023] [Indexed: 11/14/2023]
Abstract
Critical care management of aneurysmal subarachnoid hemorrhage (aSAH) remains a major challenge. Despite the recent publication of guidelines from the American Heart Association/American Stroke Association and the Neurocritical Care Society, there are many controversial questions in the intensive care unit (ICU) management of this population. The authors provide an analysis of common issues in the ICU and provide guidance on the daily management of this specific population of neurocritical care patients.
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Affiliation(s)
- Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva. Hospital Universitari Son Espases. Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain.
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva. Hospital Universitari Son Espases. Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain
| | - Alfonso Lagares
- Servicio de Neurocirugía. Hospital Universitario 12 de Octubre. Madrid. Spain
| | - Daniel Agustín Godoy
- Unidad de Cuidados Neurointensivos, Sanatorio Pasteur, San Fernando del Valle de Catamarca, Argentina
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Barea-Mendoza JA, Chico-Fernández M, Serviá-Goixart L, Quintana-Díaz M, García-Sáez I, Ballesteros-Sanz MÁ, Iglesias-Santiago A, Molina-Díaz I, González-Robledo J, Fernández-Cuervo A, Pérez-Bárcena J, Llompart-Pou JA. Associated Risk Factors and Impact in Clinical Outcomes of Multiorgan Failure in Patients with TBI. Neurocrit Care 2023; 39:411-418. [PMID: 36869209 DOI: 10.1007/s12028-023-01698-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/10/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Individual extracerebral organ dysfunction is common after severe traumatic brain injury (TBI) and impacts outcomes. However, multiorgan failure (MOF) has received less attention in patients with isolated TBI. Our objective was to analyze the risk factors associated with the development of MOF and its impact in clinical outcomes in patients with TBI. METHODS This was an observational, prospective, multicenter study using data from a nationwide registry that currently includes 52 intensive care units (ICUs) in Spain (RETRAUCI). Isolated significant TBI was defined as Abbreviated Injury Scale (AIS) ≥ 3 in the head area with no AIS ≥ 3 in any other anatomical area. Multiorgan failure was defined using the Sequential-related Organ Failure Assessment as the alteration of two or more organs with a score of ≥ 3. We analyzed the contribution of MOF to crude and adjusted mortality (age and AIS head) by using logistic regression analysis. A multiple logistic regression analysis was performed to analyze the risk factors associated with the development of MOF in patients with isolated TBI. RESULTS A total of 9790 patients with trauma were admitted to the participating ICUs. Of them, 2964 (30.2%) had AIS head ≥ 3 and no AIS ≥ 3 in any other anatomical area, and these patients constituted the study cohort. Mean age was 54.7 (19.5) years, 76% of patients were men, and ground-level falls were the main mechanism of injury (49.1%). In-hospital mortality was 22.2%. Up to 185 patients with TBI (6.2%) developed MOF during their ICU stay. Crude and adjusted (age and AIS head) mortality was higher in patients who developed MOF (odds ratio 6.28 [95% confidence interval 4.58-8.60] and odds ratio 5.20 [95% confidence interval 3.53-7.45]), respectively. The logistic regression analysis showed that age, hemodynamic instability, the need of packed red blood cells concentrates in the initial 24 h, the severity of brain injury, and the need for invasive neuromonitoring were significantly associated with MOF development. CONCLUSIONS MOF occurred in 6.2% of patients with TBI admitted to the ICU and was associated with increased mortality. MOF was associated with age, hemodynamic instability, the need of packed red blood cells concentrates in the initial 24 h, the severity of brain injury, and the need for invasive neuromonitoring.
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Affiliation(s)
| | - Mario Chico-Fernández
- UCI Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lluís Serviá-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Lleida, Spain
| | | | - Iker García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, Donostia, Spain
| | | | - Alberto Iglesias-Santiago
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria, Granada, Spain
| | - Ismael Molina-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Javier González-Robledo
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Ana Fernández-Cuervo
- Servicio de Medicina Intensiva, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears, Carretera Valldemossa, 79, 07120, Palma, Spain
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears, Carretera Valldemossa, 79, 07120, Palma, Spain.
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Llompart-Pou JA, Figueras-Castilla A, Guardiola MB, Pérez-Bárcena J. Meningoencephalitis requiring intensive care and neuromonitorization. Intensive Care Med 2023; 49:882-883. [PMID: 37227463 DOI: 10.1007/s00134-023-07080-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa, 79, 07120, Palma, Spain.
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain.
| | - Albert Figueras-Castilla
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa, 79, 07120, Palma, Spain
| | - María Begoña Guardiola
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa, 79, 07120, Palma, Spain
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa, 79, 07120, Palma, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain
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Barea-Mendoza JA, Llompart-Pou JA, Pérez-Bárcena J, Quintana-Díaz M, Serviá-Goixart L, Guerrero-López F, González-Robledo J, Molina-Díaz I, Sánchez Arguiano J, Chico-Fernández M. External validation of the Glasgow Coma Scale-Pupils in patients with severe head injury. Emergencias 2023; 35:39-43. [PMID: 36756915] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To compare the ability of the Glasgow Coma Scale (GCS) score, the GCS Pupils (GCS-P) score, and the Pupil Reactivity Score (PRS) to predict mortality in patients with severe head injury. MATERIAL AND METHODS Retrospective analysis of all patients with severe head injury and initial GCS scores of 8 or lower on initial evaluation for whom records included pupil dilation information and clinical course after admission to intensive care units of participating hospitals. We assessed the ability of each of the 3 scores (GCS, GCS-P, and PRS) to predict mortality using discrimination analysis. Discrimination was estimated by calculating the areas under the receiver operating characteristic curves (AUC) and 95% CIs. RESULTS A total of 1551 patients with severe head injury and pupil dilation records were studied. The mean age was 50 years, 1190 (76.7%) were males, and 592 (38.2%) died. No pupil dilation was observed in 905 patients (58.3%), 362 (23.3%) had unilateral mydriasis, and 284 (18.3%) had bilateral mydriasis. The GCS-P score was significantly better at predicting mortality, with an AUC of 0.77 (95% CI, 0.74-0.79), versus 0.69 (95% CI, 0.67-0.72) for the GCS, and 0.75 (95% CI, 0.72-0.77) for the PRS. As the GCS-P score decreased, mortality increased. CONCLUSION The GCS-P was more useful than the GCS for predicting death after severe head injury.
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Affiliation(s)
- Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, España
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, España
| | | | - Lluís Serviá-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida. IRBLleida. Lleida, España
| | - Francisco Guerrero-López
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs. Granada, Granada, España
| | - Javier González-Robledo
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - Ismael Molina-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Juncal Sánchez Arguiano
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
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Barea-Mendoza JA, Chico-Fernández M, Quintana-Díaz M, Serviá-Goixart L, Fernández-Cuervo A, Bringas-Bollada M, Ballesteros-Sanz MÁ, García-Sáez Í, Pérez-Bárcena J, Llompart-Pou JA. Traumatic Brain Injury and Acute Kidney Injury-Outcomes and Associated Risk Factors. J Clin Med 2022; 11:jcm11237216. [PMID: 36498789 PMCID: PMC9739137 DOI: 10.3390/jcm11237216] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Our objective was to analyze the contribution of acute kidney injury (AKI) to the mortality of isolated TBI patients and its associated risk factors. Observational, prospective and multicenter registry (RETRAUCI) methods were used, from March 2015 to December 2019. Isolated TBI was defined as abbreviated injury scale (AIS) ≥ 3 head with no additional score ≥ 3. A comparison of groups was conducted using the Wilcoxon test, chi-square test or Fisher's exact test, as appropriate. A multiple logistic regression analysis was conducted to analyze associated risk factors in the development of AKI. For the result, overall, 2964 (30.2%) had AIS head ≥ 3 with no other area with AIS ≥ 3. The mean age was 54.7 (SD 19.5) years, 76% were men, and the ground-level falls was 49.1%. The mean ISS was 18.4 (SD 8). The in-hospital mortality was 22.2%. Up to 310 patients (10.6%) developed AKI, which was associated with increased mortality (39% vs. 17%, adjusted OR 2.2). Associated risk factors (odds ratio (OR) (95% confidence interval)) were age (OR 1.02 (1.01-1.02)), hemodynamic instability (OR 2.87 to OR 5.83 (1.79-13.1)), rhabdomyolysis (OR 2.94 (1.69-5.11)), trauma-associated coagulopathy (OR 1.67 (1.05-2.66)) and transfusion of packed red-blood-cell concentrates (OR 1.76 (1.12-2.76)). In conclusion, AKI occurred in 10.6% of isolated TBI patients and was associated with increased mortality.
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Affiliation(s)
- Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, 28029 Madrid, Spain
| | - Lluís Serviá-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, 25198 Lleida, Spain
| | - Ana Fernández-Cuervo
- Servicio de Medicina Intensiva, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
| | - María Bringas-Bollada
- Servicio de Medicina Intensiva, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | | | - Íker García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, 20014 Donostia, Spain
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
- Correspondence:
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Johnson NH, Hadad R, Taylor RR, Rodríguez Pilar J, Salazar O, Llompart-Pou JA, Dietrich WD, Keane RW, Pérez-Bárcena J, de Rivero Vaccari JP. Inflammatory Biomarkers of Traumatic Brain Injury. Pharmaceuticals (Basel) 2022; 15:ph15060660. [PMID: 35745576 PMCID: PMC9227014 DOI: 10.3390/ph15060660] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 12/26/2022] Open
Abstract
Traumatic brain injury (TBI) has a complex pathology in which the initial injury releases damage associated proteins that exacerbate the neuroinflammatory response during the chronic secondary injury period. One of the major pathological players in the inflammatory response after TBI is the inflammasome. Increased levels of inflammasome proteins during the acute phase after TBI are associated with worse functional outcomes. Previous studies reveal that the level of inflammasome proteins in biological fluids may be used as promising new biomarkers for the determination of TBI functional outcomes. In this study, we provide further evidence that inflammatory cytokines and inflammasome proteins in serum may be used to determine injury severity and predict pathological outcomes. In this study, we analyzed blood serum from TBI patients and respective controls utilizing Simple Plex inflammasome and V-PLEX inflammatory cytokine assays. We performed statistical analyses to determine which proteins were significantly elevated in TBI individuals. The receiver operating characteristics (ROC) were determined to obtain the area under the curve (AUC) to establish the potential fit as a biomarker. Potential biomarkers were then compared to documented patient Glasgow coma scale scores via a correlation matrix and a multivariate linear regression to determine how respective biomarkers are related to the injury severity and pathological outcome. Inflammasome proteins and inflammatory cytokines were elevated after TBI, and the apoptosis-associated speck like protein containing a caspase recruitment domain (ASC), interleukin (IL)-18, tumor necrosis factor (TNF)-α, IL-4 and IL-6 were the most reliable biomarkers. Additionally, levels of these proteins were correlated with known clinical indicators of pathological outcome, such as the Glasgow coma scale (GCS). Our results show that inflammatory cytokines and inflammasome proteins are promising biomarkers for determining pathological outcomes after TBI. Additionally, levels of biomarkers could potentially be utilized to determine a patient’s injury severity and subsequent pathological outcome. These findings show that inflammation-associated proteins in the blood are reliable biomarkers of injury severity that can also be used to assess the functional outcomes of TBI patients.
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Affiliation(s)
- Nathan H. Johnson
- Department of Physiology and Biophysics, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (N.H.J.); (R.H.); (R.W.K.)
| | - Roey Hadad
- Department of Physiology and Biophysics, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (N.H.J.); (R.H.); (R.W.K.)
| | - Ruby Rose Taylor
- Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (R.R.T.); (W.D.D.)
| | - Javier Rodríguez Pilar
- Intensive Care Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain; (J.R.P.); (O.S.); (J.A.L.-P.); (J.P.-B.)
| | - Osman Salazar
- Intensive Care Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain; (J.R.P.); (O.S.); (J.A.L.-P.); (J.P.-B.)
| | - Juan Antonio Llompart-Pou
- Intensive Care Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain; (J.R.P.); (O.S.); (J.A.L.-P.); (J.P.-B.)
| | - W. Dalton Dietrich
- Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (R.R.T.); (W.D.D.)
| | - Robert W. Keane
- Department of Physiology and Biophysics, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (N.H.J.); (R.H.); (R.W.K.)
- Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (R.R.T.); (W.D.D.)
| | - Jon Pérez-Bárcena
- Intensive Care Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain; (J.R.P.); (O.S.); (J.A.L.-P.); (J.P.-B.)
| | - Juan Pablo de Rivero Vaccari
- Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (R.R.T.); (W.D.D.)
- Correspondence:
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Llompart-Pou JA, Chico-Fernández M. Traumatic critical hemorrhage. Future challenges. Med Intensiva 2022; 46:217-220. [PMID: 35210173 DOI: 10.1016/j.medine.2022.02.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 06/14/2023]
Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain.
| | - M Chico-Fernández
- Unidad de Cuidados Intensivos de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
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10
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Barea-Mendoza JA, Chico-Fernández M, Quintana-Díaz M, Pérez-Bárcena J, Serviá-Goixart L, Molina-Díaz I, Bringas-Bollada M, Ruiz-Aguilar AL, Ballesteros-Sanz MÁ, Llompart-Pou JA. Risk Factors Associated with Mortality in Severe Chest Trauma Patients Admitted to the ICU. J Clin Med 2022; 11:jcm11010266. [PMID: 35012008 PMCID: PMC8745825 DOI: 10.3390/jcm11010266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Our objective was to determine outcomes of severe chest trauma admitted to the ICU and the risk factors associated with mortality. An observational, prospective, and multicenter registry of trauma patients admitted to the participating ICUs (March 2015-December 2019) was utilized to collect the patient data that were analyzed. Severe chest trauma was defined as an Abbreviated Injury Scale (AIS) value of ≥3 in the thoracic area. Logistic regression analysis was used to evaluate the contribution of severe chest trauma to crude and adjusted ORs for mortality and to analyze the risk factors associated with mortality. Overall, 3821 patients (39%) presented severe chest trauma. The sample's characteristics were as follows: a mean age of 49.88 (19.21) years, male (77.6%), blunt trauma (93.9%), a mean ISS of 19.9 (11.6). Crude and adjusted (for age and ISS) ORs for mortality in severe chest trauma were 0.78 (0.68-0.89) and 0.43 (0.37-0.50) (p < 0.001), respectively. In-hospital mortality in the severe chest trauma patients without significant traumatic brain injury (TBI) was 5.63% and was 25.71% with associated significant TBI (p < 0.001). Age, the severity of injury (NISS and AIS-head), hemodynamic instability, prehospital intubation, acute kidney injury, and multiorgan failure were risk factors associated with mortality. The contribution of severe chest injury to the mortality of trauma patients admitted to the ICU was very low. Risk factors associated with mortality were identified.
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Affiliation(s)
- Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (J.A.B.-M.); (M.C.-F.)
| | - Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (J.A.B.-M.); (M.C.-F.)
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain;
| | - Luís Serviá-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, 25198 Lleida, Spain;
| | - Ismael Molina-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | - María Bringas-Bollada
- Servicio de Medicina Intensiva, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain;
| | | | | | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain;
- Correspondence: ; Tel.: +34-871205974
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11
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Vidal-Cortés P, Díaz Santos E, Aguilar Alonso E, Amezaga Menéndez R, Ballesteros MÁ, Bodí MA, Bordejé Laguna ML, Garnacho Montero J, García Sánchez M, López Sánchez M, Martín-Loeches I, Ochagavía Calvo A, Ramírez Galleymore P, Alcántara Carmona S, Andaluz Ojeda D, Badallo Arébalo O, Barrasa González H, Borges Sa M, Castellanos-Ortega Á, Estella Á, Ferrer Roca R, Fraile Gutiérrez V, Fuset Cabanes M, Giménez-Esparza Vich C, González Iglesias C, Hernández-Tejedor A, Igeño Cano JC, Iglesias Posadilla D, Jiménez Rivera JJ, Llanos Jorge C, Llompart-Pou JA, López Camps V, Lorencio Cárdenas C, Marcos Neira P, Martín Delgado MC, Martín-Macho González M, Martín Villén L, Nuvials Casals X, Ortiz Suñer A, Quintana Díaz M, Rascado Sedes P, Recuerda Núñez M, Del Río Carbajo L, Rodríguez Aguirregabiria M, Rodríguez Oviedo A, Seijas Betolaza I, Soriano Cuesta C, Suberviola Cañas B, Vera Ching C, Vidal González Á, Zapata Fenor L, Zaragoza Crespo R. Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units. Med Intensiva 2021; 46:81-89. [PMID: 34903475 PMCID: PMC8664080 DOI: 10.1016/j.medine.2021.11.019] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.
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Affiliation(s)
- P Vidal-Cortés
- Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
| | - E Díaz Santos
- Medicina Intensiva, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain; Departament de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - E Aguilar Alonso
- Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - R Amezaga Menéndez
- Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - M Á Ballesteros
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - M A Bodí
- Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain; Universitat Rovira i Virgili, Tarragona, Spain
| | - M L Bordejé Laguna
- Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | | | | | - M López Sánchez
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - I Martín-Loeches
- Intensive Care Medicine, St James's Hospital, Dublin, Ireland; Trinity College Dublin, School of Medicine, Dublin, Ireland
| | - A Ochagavía Calvo
- Medicina Intensiva, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | | | - S Alcántara Carmona
- Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - D Andaluz Ojeda
- Medicina Intensiva, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - O Badallo Arébalo
- Medicina Intensiva, Hospital Universitario de Cruces, Bizkaia, Spain
| | | | - M Borges Sa
- Medicina Intensiva, Hospital Universitario Son Llátzer, Palma de Mallorca, Spain
| | | | - Á Estella
- Medicina Intensiva, Hospital Universitario de Jerez, Jerez, Spain; Departamento de Medicina, INIBICA, Universidad de Cádiz, Cádiz, Spain
| | - R Ferrer Roca
- Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - V Fraile Gutiérrez
- Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, Spain
| | - M Fuset Cabanes
- Medicina Intensiva, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - J C Igeño Cano
- Medicina Intensiva, Hospital San Juan de Dios, Córdoba, Spain
| | | | - J J Jiménez Rivera
- Medicina Intensiva, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - C Llanos Jorge
- Medicina Intensiva, Hospital QuirónSalud Tenerife, Tenerife, Spain
| | - J A Llompart-Pou
- Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - V López Camps
- Medicina Intensiva, Hospital de Sagunto, Sagunto, Spain
| | - C Lorencio Cárdenas
- Medicina Intensiva, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | - P Marcos Neira
- Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - M C Martín Delgado
- Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain; Universidad Francisco de Vitoria, Madrid, Spain
| | | | - L Martín Villén
- Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - X Nuvials Casals
- Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - A Ortiz Suñer
- Medicina Intensiva, Hospital Arnau de Vilanova, Valencia, Spain; Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia, Valencia, Spain
| | - M Quintana Díaz
- Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Departamento de Medicina Universidad Autónoma de Madrid, Madrid, Spain
| | - P Rascado Sedes
- Medicina Intensiva, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - M Recuerda Núñez
- Medicina Intensiva, Hospital Universitario Puerto Real, Cádiz, Spain
| | - L Del Río Carbajo
- Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | | | - I Seijas Betolaza
- Medicina Intensiva, Hospital Universitario de Cruces, Bizkaia, Spain
| | - C Soriano Cuesta
- Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - B Suberviola Cañas
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - C Vera Ching
- Medicina Intensiva, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | | | - L Zapata Fenor
- Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Zaragoza Crespo
- Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, Spain
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12
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Serviá L, Llompart-Pou JA, Chico-Fernández M, Montserrat N, Badia M, Barea-Mendoza JA, Ballesteros-Sanz MÁ, Trujillano J. Development of a new score for early mortality prediction in trauma ICU patients: RETRASCORE. Crit Care 2021; 25:420. [PMID: 34876199 PMCID: PMC8650319 DOI: 10.1186/s13054-021-03845-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/20/2021] [Accepted: 11/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background Severity scores are commonly used for outcome adjustment and benchmarking of trauma care provided. No specific models performed only with critically ill patients are available. Our objective was to develop a new score for early mortality prediction in trauma ICU patients. Methods This is a retrospective study using the Spanish Trauma ICU registry (RETRAUCI) 2015–2019. Patients were divided and analysed into the derivation (2015–2017) and validation sets (2018–2019). We used as candidate variables to be associated with mortality those available in RETRAUCI that could be collected in the first 24 h after ICU admission. Using logistic regression methodology, a simple score (RETRASCORE) was created with points assigned to each selected variable. The performance of the model was carried out according to global measures, discrimination and calibration. Results The analysis included 9465 patients: derivation set 5976 and validation set 3489. Thirty-day mortality was 12.2%. The predicted probability of 30-day mortality was determined by the following equation: 1/(1 + exp (− y)), where y = 0.598 (Age 50–65) + 1.239 (Age 66–75) + 2.198 (Age > 75) + 0.349 (PRECOAG) + 0.336 (Pre-hospital intubation) + 0.662 (High-risk mechanism) + 0.950 (unilateral mydriasis) + 3.217 (bilateral mydriasis) + 0.841 (Glasgow ≤ 8) + 0.495 (MAIS-Head) − 0.271 (MAIS-Thorax) + 1.148 (Haemodynamic failure) + 0.708 (Respiratory failure) + 0.567 (Coagulopathy) + 0.580 (Mechanical ventilation) + 0.452 (Massive haemorrhage) − 5.432. The AUROC was 0.913 (0.903–0.923) in the derivation set and 0.929 (0.918–0.940) in the validation set. Conclusions The newly developed RETRASCORE is an early, easy-to-calculate and specific score to predict in-hospital mortality in trauma ICU patients. Although it has achieved adequate internal validation, it must be externally validated. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03845-6.
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Affiliation(s)
- Luis Serviá
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Neus Montserrat
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain
| | - Mariona Badia
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain
| | - Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Javier Trujillano
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain. .,Intensive Care Unit, Hospital Universitario Arnau de Vilanova, Avda Rovira Roure 80, 25198, Lleida, Spain.
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13
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Ballesteros Vizoso MA, Castilla AF, Barceló A, Raurich JM, Argente del Castillo P, Morell-García D, Velasco J, Pérez-Bárcena J, Llompart-Pou JA. Thyroid Disfunction in Critically Ill COVID-19 Patients. Relationship with In-Hospital Mortality. J Clin Med 2021; 10:jcm10215057. [PMID: 34768580 PMCID: PMC8584356 DOI: 10.3390/jcm10215057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/26/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 01/23/2023] Open
Abstract
The incidence of thyroid disfunction has not been analyzed in critically ill COVID-19 patients. Our objective was to analyze the relationship of the thyroid profile and in-hospital mortality in critically ill COVID-19 patients. This was a prospective single-center study involving critically ill COVID-19 patients admitted to the ICU of a tertiary University Hospital. Thyroid hormones were measured through drawing blood samples from a central venous catheter at ICU admission and on the fifth day. A multiple logistic regression analysis was performed to analyze the variables associated with mortality. The ability of the different thyroid hormones to predict in-hospital mortality was evaluated by calculating the receiver operating characteristics (ROCs) and the area under the curve (AUC). A total of 78 patients were included in the study at ICU admission; 72 had their thyroid profile measured at day 5. In-hospital mortality reached 29.5%. Multiple logistic regression analysis showed that variables associated with mortality were age and prior beta-blocker therapy at ICU admission and age fT4 at day 5. The AUC for in-hospital mortality predictions of fT4 at day 5 was 0.69. Thyroid responses are commonly observed in critically ill COVID-19 patients. fT4 at day 5 after ICU admission was associated with mortality.
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Affiliation(s)
| | - Albert Figueras Castilla
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, 07120 Palma, Spain; (A.F.C.); (J.M.R.); (J.V.); (J.P.-B.)
| | - Antonia Barceló
- Servei d’Anàlisi Clíniques, Hospital Universitari Son Espases, 07120 Palma, Spain; (M.A.B.V.); (A.B.); (P.A.d.C.); (D.M.-G.)
- Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
| | - Joan Maria Raurich
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, 07120 Palma, Spain; (A.F.C.); (J.M.R.); (J.V.); (J.P.-B.)
| | - Paula Argente del Castillo
- Servei d’Anàlisi Clíniques, Hospital Universitari Son Espases, 07120 Palma, Spain; (M.A.B.V.); (A.B.); (P.A.d.C.); (D.M.-G.)
| | - Daniel Morell-García
- Servei d’Anàlisi Clíniques, Hospital Universitari Son Espases, 07120 Palma, Spain; (M.A.B.V.); (A.B.); (P.A.d.C.); (D.M.-G.)
- Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
| | - Julio Velasco
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, 07120 Palma, Spain; (A.F.C.); (J.M.R.); (J.V.); (J.P.-B.)
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, 07120 Palma, Spain; (A.F.C.); (J.M.R.); (J.V.); (J.P.-B.)
- Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, 07120 Palma, Spain; (A.F.C.); (J.M.R.); (J.V.); (J.P.-B.)
- Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
- Correspondence:
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14
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Chico-Fernández M, Abelardo Barea-Mendoza J, Servià-Goixart L, Ormazabal-Zabala T, Quintana-Díaz M, González-Robledo J, Iglesias-Santiago A, Sánchez-Arguiano MJ, Pérez-Bárcena J, Llompart-Pou JA. Factors associated with death due to trauma in patients with a Glasgow Coma Scale score of 3 and bilateral fixed dilated pupils. Emergencias 2021; 33:121-127. [PMID: 33750053] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To compare patients with a Glasgow Coma Scale (GCS) score of 3 stratified according to pupillary reaction and to explore factors associated with in-hospital death in those with bilateral fixed dilated pupils. MATERIAL AND METHODS Prospective, observational, multicenter study. We included all patients with trauma and GCS scores of 3 admitted to the intensive care unit from March 2015 to December 2019. Factors associated with in-hospital mortality in the patients with bilateral dilated pupils were explored using multiple regression analysis. RESULTS Of the 933 patients included, 454 (48.7%) had responsive pupils, 201 (21.5%) had a single fixed dilated pupil, and 278 (29.8%) had bilateral dilation. Hospital mortality was high in all 3 groups: 32.5% in those with normal responsive pupils, 54.6% in those with a single unreactive pupil, and 91.0% in those with bilateral dilation. Factors significantly associated with in-hospital death were age, a score of 3 or more on the Abbreviated Injury Scale for the head, and shock or refractory shock. Types I or II diffuse lesions and evacuated mass lesions were protective in patients with GCS scores of 3 and bilateral dilated pupils. Twelve of the 26 patients (46.1%) with bilateral dilated pupils and GCS scores of 3 had GCS scores of 14 or 15 on discharge from the hospital. CONCLUSION The in-hospital mortality was 91% in this study of trauma patients with GCS scores of 3 and bilateral dilated pupils. Factors significantly associated with in-hospital death were age, a score of 3 or more on the Abbreviated Injury Scale for the head, and shock or refractory shock. Types I or II diffuse lesions and evacuated mass lesions were protective in patients with GCS scores of 3 and bilateral dilated pupils.
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Affiliation(s)
- Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - Luis Servià-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, España
| | | | | | - Javier González-Robledo
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | | | | | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, España
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, España
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15
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Vidal-Cortés P, Santos ED, Alonso EA, Menéndez RA, Ballesteros MÁ, Bodí MA, Laguna MLB, Garnacho Montero J, Sánchez MG, Sánchez ML, Martín-Loeches I, Calvo AO, Galleymore PR, Carmona SA, Ojeda DA, Arébalo OB, González HB, Sa MB, Castellanos-Ortega Á, Estella Á, Roca RF, Gutiérrez VF, Cabanes MF, Vich CGE, Iglesias CG, Hernández-Tejedor A, Carlos Igeño Cano J, Posadilla DI, Rivera JJJ, Jorge CL, Llompart-Pou JA, Camps VL, Cárdenas CL, Neira PM, Delgado MCM, González MMM, Villén LM, Casals XN, Suñer AO, Díaz MQ, Sedes PR, Núñez MR, Carbajo LDR, Aguirregabiria MR, Oviedo AR, Betolaza IS, Cuesta CS, Cañas BS, Ching CV, González ÁV, Fenor LZ, Crespo RZ. [Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. Med Intensiva 2021; 46:81-89. [PMID: 34545260 PMCID: PMC8443328 DOI: 10.1016/j.medin.2021.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022]
Abstract
La pandemia por COVID-19 ha provocado el ingreso de un elevado número de pacientes en UCI, generalmente por insuficiencia respiratoria severa. Desde la aparición de los primeros casos de infección por SARS-CoV-2, a finales de 2019, en China, se ha publicado una cantidad ingente de recomendaciones de tratamiento de esta entidad, no siempre respaldadas por evidencia científica suficiente ni con el rigor metodológico necesario. Gracias al esfuerzo de distintos grupos de investigadores, actualmente disponemos de resultados de ensayos clínicos, y otro tipo de estudios, de mayor calidad. Consideramos necesario realizar un documento que incluya recomendaciones que recojan estas evidencias en cuanto al diagnóstico y tratamiento de la COVID-19, pero también aspectos que otras guías no han contemplado y que consideramos fundamentales en el manejo del paciente crítico con COVID-19. Para ello se ha creado un comité redactor, conformado por miembros de los Grupos de Trabajo de SEMICYUC más directamente relacionados con diferentes aspectos específicos del manejo de estos pacientes.
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Affiliation(s)
- Pablo Vidal-Cortés
- Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Emili Díaz Santos
- Medicina Intensiva, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain.,Departament de Medicina, Univ Autonoma de Barcelona, Spain
| | | | | | - María Ángeles Ballesteros
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - María A Bodí
- Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain.,Universitat Rovira i Virgili, Tarragona, Spain
| | | | | | | | - Marta López Sánchez
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ignacio Martín-Loeches
- Intensive Care Medicine, St James´s Hospital, Dublin, Spain.,Trinity College Dublin, School of Medicine, Dublin, Spain
| | - Ana Ochagavía Calvo
- Medicina Intensiva, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | | | | | | | | | | | - Marcio Borges Sa
- Medicina Intensiva, Hospital Universitario Son Llátzer, Palma de Mallorca, Spain
| | | | - Ángel Estella
- Medicina Intensiva, Hospital Universitario de Jerez, Jerez, Spain.,Departamento de Medicina, INIBICA, Universidad de Cádiz, Cádiz, Spain
| | - Ricard Ferrer Roca
- Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - MariPaz Fuset Cabanes
- Medicina Intensiva, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | - Juan Antonio Llompart-Pou
- Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain.,Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | | | | | - Pilar Marcos Neira
- Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - María Cruz Martín Delgado
- Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain.,Universidad Francisco de Vitoria, Spain
| | | | - Luis Martín Villén
- Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Andrea Ortiz Suñer
- Medicina Intensiva, Hospital Arnau de Vilanova, Valencia, Spain.,Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia, Valencia, Spain
| | - Manuel Quintana Díaz
- Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain.,Departamento de Medicina Universidad Autónoma de Madrid, Madrid, Spain
| | - Pedro Rascado Sedes
- Medicina Intensiva, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | | | | | | | - Claudia Vera Ching
- Medicina Intensiva, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | | | - Lluis Zapata Fenor
- Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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16
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Pérez-Bárcena J, Rodríguez Pilar J, Salazar O, Crespí C, Frontera G, Novo MA, Guardiola MB, Llompart-Pou JA, Ibáñez J, de Rivero Vaccari JP. Serum Caspase-1 as an Independent Prognostic Factor in Traumatic Brain Injured Patients. Neurocrit Care 2021; 36:527-535. [PMID: 34498205 DOI: 10.1007/s12028-021-01340-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/23/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND The objectives of this study were to assess the association between serum caspase 1 levels and known clinical and radiological prognostic factors and determine whether caspase 1was a more powerful predictor of outcome after traumatic brain injury (TBI) than clinical indices alone, to determine the association between the serum levels of caspase 1 and the 6-month outcome, and to evaluate if there is any association between caspase 1 with clinical and radiological variables. METHODS This prospective and observational study was conducted in a university hospital and included patients with TBI who required hospital admission. Serum samples were collected at hospital admission and 24 h after TBI. Caspase 1 levels were determined by enzyme-linked immunosorbent assay. Receiver operating characteristic curves were obtained to test the potential of caspase 1 to predict mortality (Glasgow Outcome Scale Extended score of 1) and unfavorable outcome (Glasgow Outcome Scale Extended scores of 1-4). Multivariate logistic regression was used to assess the effect of serum caspase 1 levels, adjusted by known clinical and radiological prognostic indices, on the outcome. RESULTS One hundred thirty-two patients and 33 healthy controls were included. We obtained 6-month outcome in 118 patients. On admission, the mean serum levels of caspase 1 were higher in patients with TBI compared with controls (157.9 vs. 108.5 pg/mL; p < 0.05) but not at 24 h after TBI. Serum caspase 1 levels on admission were higher in patients with unfavorable outcomes (189.5 vs. 144.1 pg/mL; p = 0.009). Similarly, serum caspase 1 levels on admission were higher in patients who died vs. patients who survived (213.6 vs. 146.8 pg/mL; p = 0.03). A logistic regression model showed that the serum caspase 1 level on admission was an independent predictor of 6-month unfavorable outcomes (odds ratio 1.05; 95% confidence interval 1-1.11; p = 0.05). Caspase 1 levels were higher in patients with severe TBI compared with those with moderate TBI, those with mild TBI, and healthy controls (p < 0.001). We did not find any correlation between caspase 1 and the radiological variables studied. CONCLUSIONS In this cohort of patients with TBI, we show that serum caspase 1 protein levels on admission are an independent prognostic factor after TBI. Serum caspase 1 levels on admission are higher in patients who will present unfavorable outcomes 6 months after TBI. Caspase 1 levels on admission are associated with the injury severity determined by the Glasgow Coma Scale.
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Affiliation(s)
- Jon Pérez-Bárcena
- Intensive Care Department, Son Espases University Hospital, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Islas Baleares, Spain.
| | - Javier Rodríguez Pilar
- Intensive Care Department, Son Espases University Hospital, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Islas Baleares, Spain
| | - Osman Salazar
- Department of Neurological Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Catalina Crespí
- Fundación Instituto de Investigación Sanitaria Islas Baleares (IdISBa), Son Espases University Hospital, Palma de Mallorca, Spain
| | - Guillem Frontera
- Fundación Instituto de Investigación Sanitaria Islas Baleares (IdISBa), Son Espases University Hospital, Palma de Mallorca, Spain
| | - Mariana Andrea Novo
- Intensive Care Department, Son Espases University Hospital, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Islas Baleares, Spain
| | - María Begoña Guardiola
- Intensive Care Department, Son Espases University Hospital, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Islas Baleares, Spain
| | - Juan Antonio Llompart-Pou
- Intensive Care Department, Son Espases University Hospital, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Islas Baleares, Spain
| | - Javier Ibáñez
- Department of Neurological Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Juan Pablo de Rivero Vaccari
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
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Llompart-Pou JA, Barea-Mendoza JA, Pérez-Bárcena J, Sánchez-Casado M, Ballesteros-Sanz MÁ, Chico-Fernández M. Survey of neurocritical patient care in Spain. Part 2: Cerebrovascular disease. Med Intensiva 2021; 45:e1-e3. [PMID: 34217639 DOI: 10.1016/j.medine.2021.06.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/11/2019] [Indexed: 11/18/2022]
Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain.
| | - J A Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | - M Á Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
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Llompart-Pou JA, Chico-Fernández M. Traumatic critical hemorrhage. Future challenges. Med Intensiva 2021; 46:S0210-5691(21)00080-2. [PMID: 34074566 DOI: 10.1016/j.medin.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Baleares, España.
| | - M Chico-Fernández
- Unidad de Cuidados Intensivos de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
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Pérez-Bárcena J, Castaño-León AM, Lagares Gómez-Abascal A, Barea-Mendoza JA, Navarro Maín B, Pomar Pons J, Periañez Párraga LDM, Ibáñez Domínguez J, Chico-Fernández M, Llompart-Pou JA, Frontera Juan G. Dexamethasone for the treatment of traumatic brain injured patients with brain contusions and pericontusional edema: Study protocol for a prospective, randomized and double blind trial. Medicine (Baltimore) 2021; 100:e24206. [PMID: 33546038 PMCID: PMC7837989 DOI: 10.1097/md.0000000000024206] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) constitutes a leading cause of death and disability. Patients with TBI and cerebral contusions developing pericontusional edema are occasionally given dexamethasone on the belief that this edema is similar to that of tumors, in which the beneficial effect of dexamethasone has been demonstrated. METHODS The DEXCON TBI trial is a multicenter, pragmatic, randomized, triple-blind, placebo controlled trial to quantify the effects of dexamethasone on the prognosis of TBI patients with brain contusions and pericontusional edema. Adult patients who fulfill the elegibility criteria will be randomized to dexamethasone/placebo in a short and descending course: 4 mg/6 h (2 days); 4 mg/8 hours (2 days); 2 mg/6 hours (2 days); 2 mg/8 hours (2 days); 1 mg/8 hours (2 days); 1 mg/12 hours (2 days). The primary outcome is the Glasgow Scale Outcome Extended (GOSE) performed 1 month and 6 months after TBI. Secondary outcomes are: number of episodes of neurological deterioration; symptoms associated with TBI; adverse events; volume of pericontusional edema before and after 12 days of treatment; results of the neuropsychological tests one month and 6 months after TBI. The main analysis will be on an "intention-to-treat" basis. Logistic regression will estimate the effect of dexamethasone/placebo on GOSE at one month and at 6 months, dichotomized in unfavorable outcome (GOSE 1-6) and favorable outcome (GOSE 7-8). Efficacy will also be analyzed using the 'sliding dichotomy'. An interim and safety analysis will be performed including patients recruited during the first year to calculate the conditional power. A study with 600 patients would have 80% power (2 sided alpha = 5%) to detect a 12% absolute increase (from 50% to 62%) in good recovery. DISCUSSION This is a confirmative trial to elucidate the therapeutic efficacy of dexamethasone in a very specific group of TBI patients: patients with brain contusions and pericontusional edema. This trial could become an important milestone for TBI patients as nowadays there is no effective treatment in this type of patients. TRIAL REGISTRATION eudraCT: 2019-004038-41; Clinical Trials.gov: NCT04303065.
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Affiliation(s)
- Jon Pérez-Bárcena
- Intensive Care Unit, Hospital Universitari Son Espases, Palma de Mallorca
| | - Ana María Castaño-León
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid
| | - Alfonso Lagares Gómez-Abascal
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid
| | | | - Blanca Navarro Maín
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid
| | - Jaume Pomar Pons
- Neuropsychology and Cognition Research Group, Research Institute on Health IDISBA & IUNICS-UIB, Palma de Mallorca
| | | | | | | | | | - Guillem Frontera Juan
- Research Institute on Health IDISBA, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca
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Llompart-Pou JA, Pérez-Bárcena J, Barea-Mendoza JA, Chico-Fernández M. Trauma risk adjustment in geriatric trauma. Eur J Trauma Emerg Surg 2020; 46:1471-1472. [DOI: 10.1007/s00068-020-01301-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
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Llompart-Pou JA, Pérez-Bárcena J, Barea-Mendoza JA, Chico-Fernández M. [Head trauma in the new millennium: elderly patients]. Neurologia 2020; 35:673-674. [PMID: 31899018 DOI: 10.1016/j.nrl.2019.10.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/19/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut de Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, España.
| | - J Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut de Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, España
| | - J A Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
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Serviá L, Montserrat N, Badia M, Llompart-Pou JA, Barea-Mendoza JA, Chico-Fernández M, Sánchez-Casado M, Jiménez JM, Mayor DM, Trujillano J. Machine learning techniques for mortality prediction in critical traumatic patients: anatomic and physiologic variables from the RETRAUCI study. BMC Med Res Methodol 2020; 20:262. [PMID: 33081694 PMCID: PMC7576744 DOI: 10.1186/s12874-020-01151-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 06/27/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
Background Interest in models for calculating the risk of death in traumatic patients admitted to ICUs remains high. These models use variables derived from the deviation of physiological parameters and/or the severity of anatomical lesions with respect to the affected body areas. Our objective is to create different predictive models of the mortality of critically traumatic patients using machine learning techniques. Methods We used 9625 records from the RETRAUCI database (National Trauma Registry of 52 Spanish ICUs in the period of 2015–2019). Hospital mortality was 12.6%. Data on demographic variables, affected anatomical areas and physiological repercussions were used. The Weka Platform was used, along with a ten-fold cross-validation for the construction of nine supervised algorithms: logistic regression binary (LR), neural network (NN), sequential minimal optimization (SMO), classification rules (JRip), classification trees (CT), Bayesian networks (BN), adaptive boosting (ADABOOST), bootstrap aggregating (BAGGING) and random forest (RFOREST). The performance of the models was evaluated by accuracy, specificity, precision, recall, F-measure, and AUC. Results In all algorithms, the most important factors are those associated with traumatic brain injury (TBI) and organic failures. The LR finds thorax and limb injuries as independent protective factors of mortality. The CT generates 24 decision rules and uses those related to TBI as the first variables (range 2.0–81.6%). The JRip detects the eight rules with the highest risk of mortality (65.0–94.1%). The NN model uses a hidden layer of ten nodes, which requires 200 weights for its interpretation. The BN find the relationships between the different factors that identify different patient profiles. Models with the ensemble methodology (ADABOOST, BAGGING and RandomForest) do not have greater performance. All models obtain high values in accuracy, specificity, and AUC, but obtain lower values in recall. The greatest precision is achieved by the SMO model, and the BN obtains the best recall, F-measure, and AUC. Conclusion Machine learning techniques are useful for creating mortality classification models in critically traumatic patients. With clinical interpretation, the algorithms establish different patient profiles according to the relationship between the variables used, determine groups of patients with different evolutions, and alert clinicians to the presence of rules that indicate the greatest severity.
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Affiliation(s)
- Luis Serviá
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Avda Rovira Roure 80, 25198, Lleida, Spain
| | - Neus Montserrat
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Avda Rovira Roure 80, 25198, Lleida, Spain
| | - Mariona Badia
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Avda Rovira Roure 80, 25198, Lleida, Spain
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut de Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
| | - Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - José Manuel Jiménez
- Servicio de Medicina Intensiva, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Dolores María Mayor
- Servicio de Medicina Intensiva, Complejo hospitalario de Torrecárdenas, Almería, Spain
| | - Javier Trujillano
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Avda Rovira Roure 80, 25198, Lleida, Spain.
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Chico-Fernández M, Barea-Mendoza JA, Ormazabal-Zabala T, Moreno-Muñoz G, Pastor-Marcos D, Bueno-González A, Iglesias-Santiago A, Ballesteros-Sanz MÁ, Pérez-Bárcena J, Llompart-Pou JA. Associated risk factors and outcomes of acute kidney injury in severe trauma: Results from the Spanish trauma ICU registry (RETRAUCI). Anaesth Crit Care Pain Med 2020; 39:503-506. [DOI: 10.1016/j.accpm.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/21/2019] [Accepted: 11/16/2019] [Indexed: 12/20/2022]
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Lara M, Moll A, Mas A, Picado MJ, Gassent C, Pomar J, Llompart-Pou JA, Brell M, Ibáñez J, Pérez-Bárcena J. Use of diffusion tensor imaging to assess the vasogenic edema in traumatic pericontusional tissue. Neurocirugia (Astur) 2020; 32:S1130-1473(20)30080-4. [PMID: 32709492 DOI: 10.1016/j.neucir.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/05/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Cerebral edema is a frequent and serious complication of traumatic brain injury (TBI). Diffusion tensor imaging (DTI) is considered a useful technique to assess white matter integrity after TBI. The objective of this prospective, observational study was to assess the characteristics of the vasogenic edema in the traumatic pericontusional tissue and compare it to the vasogenic edema found in brain tumors. We also included a control group. METHODS Using DTI, the Apparent diffusion coefficient (ADC) and Fractional anisotropy (FA) were measured in the area of vasogenic edema in both TBI and tumor patients. The measurements in the control group were done in the gray and white matter. We included 15 TBI patients, 18 tumor patients and 15 controls. RESULTS ADC and FA showed no differences between TBI and tumor patients (p=0.27 for AF; p=0.79 for ADC). Compared to healthy controls, TBI and tumor patients presented higher ADC values and lower FA values. The differences between TBI and controls were statistically significant (p<0.05). CONCLUSIONS In this prospective observational study using DTI-MRI in a selected group of mild and moderate TBI patients with vasogenic pericontusional edema we have shown that there were no significant differences of the ADC and FA values compared to brain tumor patients. Furthermore, healthy controls showed significant lower ADC values and higher FA values compared to TBI and tumor patients. Future studies, using DTI-MRI, should address whether any therapy has a favorable impact on the vasogenic edema of TBI patients with brain contusions.
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Affiliation(s)
- Mónica Lara
- Neurosurgical Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Apolonia Moll
- Radiology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Antonio Mas
- Radiology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - María José Picado
- Radiology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Carmen Gassent
- Radiology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Jaume Pomar
- Neuropsychology and Cognition Research Group, Research Institute on Health IDISBA & IUNICS-UIB, Palma de Mallorca, Spain
| | | | - Marta Brell
- Neurosurgical Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Javier Ibáñez
- Neurosurgical Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Jon Pérez-Bárcena
- Intensive Care Department, Son Espases University Hospital, Palma de Mallorca, Spain.
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Barea-Mendoza JA, Chico-Fernández M, Martínez-Luengo B, Regidor-Sanz E, González-Robledo J, Llompart-Pou JA. Tracheostomy after Severe Trauma: Associated Risk Factors in the Spanish Trauma ICU Registry (RETRAUCI). Am Surg 2020. [DOI: 10.1177/000313481908501219] [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: 11/16/2022]
Affiliation(s)
| | - Mario Chico-Fernández
- UCI de Trauma y Emergencias Servicio de Medicina Intensiva Hospital Universitario 12 de Octubre Madrid, Spain
| | | | - Eva Regidor-Sanz
- Servicio de Medicina Intensiva Complejo Hospitalario de Navarra Navarra, Spain
| | - Javier González-Robledo
- Servicio de Medicina Intensiva Complejo Asistencial Universitario de Salamanca Salamanca, Spain
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva Hospital Universitari Son Espases Institut d'Investigació Sanitària Illes Balears (IdISBa) Palma, Spain On Behalf of the Neurointensive Care and Trauma Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC)
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Pérez-Bárcena J, Crespí C, Frontera G, Llompart-Pou JA, Salazar O, Goliney V, Ibáñez J, Bullock MR, de Rivero Vaccari JP. Levels of caspase-1 in cerebrospinal fluid of patients with traumatic brain injury: correlation with intracranial pressure and outcome. J Neurosurg 2020; 134:1644-1649. [PMID: 32357337 DOI: 10.3171/2020.2.jns193079] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objectives of this study were to evaluate levels of inflammasome-signaling proteins in serum and CSF of patients with traumatic brain injury (TBI), and to correlate these protein levels with intracranial pressure (ICP) and clinical outcomes at 6 months after injury. METHODS This is a prospective and observational study in patients with moderate and severe TBI who required an external ventricular drain as part of their treatment. Serum and CSF samples were collected 3 times a day for the first 5 days after TBI. The authors have determined the protein concentration of caspase-1 in the CSF and serum of patients with TBI by using commercially available enzyme-linked immunosorbent assays. The ICP value was recorded hourly. The 6-month outcome was assessed using the Glasgow Outcome Scale-Extended. RESULTS A total of 21 patients were included in this study, and a total of 234 paired serum-CSF samples were analyzed. The area under the curve (AUC) value of caspase-1 in CSF during the 5-day period was 2452.9 pg/mL·hr in the group of patients with high ICP vs 617.6 pg/mL·hr in the patients with low ICP. The differences were mainly on day 2 (19.7 pg/mL vs 1.8 pg/mL; p = 0.06) and day 3 (13.9 pg/mL vs 1 pg/mL; p = 0.05). The AUC value of caspase in CSF during the 5-day period was 1918.9 pg/mL·hr in the group of patients with poor outcome versus 924.5 pg/mL·hr in the patients with good outcome. The protein levels of caspase-1 in CSF were higher in patients with unfavorable outcomes during the first 96 hours after TBI. CONCLUSIONS In this cohort of patients with TBI who were admitted to the neurosurgical ICU, the inflammasome protein caspase-1 is increased in the CSF of patients with high ICP, especially on days 2 and 3 after TBI. Also the protein levels of caspase-1 in CSF were higher in patients with poor outcome during the first 96 hours after TBI. Moreover, not only the absolute value of caspase-1 in CSF but also its trend is associated with poor outcomes.
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Affiliation(s)
| | - Catalina Crespí
- 2Fundación Instituto de Investigación Sanitaria Islas Baleares (IdISBa), and
| | - Guillem Frontera
- 2Fundación Instituto de Investigación Sanitaria Islas Baleares (IdISBa), and
| | | | - Osman Salazar
- 3Department of Neurological Surgery, Son Espases University Hospital, Palma de Mallorca, Spain; and
| | - Victor Goliney
- 3Department of Neurological Surgery, Son Espases University Hospital, Palma de Mallorca, Spain; and
| | - Javier Ibáñez
- 3Department of Neurological Surgery, Son Espases University Hospital, Palma de Mallorca, Spain; and
| | - M Ross Bullock
- 4The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan Pablo de Rivero Vaccari
- 4The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Llompart-Pou JA, Barea-Mendoza JA, Sánchez-Casado M, González-Robledo J, Mayor-García DM, Montserrat-Ortiz N, Enríquez-Giraudo P, Cordero-Lorenzana ML, Chico-Fernández M. Neuromonitorización en el traumatismo craneoencefálico grave. Datos del Registro español de Trauma en UCI (RETRAUCI). Neurocirugia (Astur) 2020; 31:1-6. [DOI: 10.1016/j.neucir.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/01/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
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Barea-Mendoza JA, Chico-Fernández M, Martínez-Luengo B, Regidor-Sanz E, González-Robledo J, Llompart-Pou JA. Tracheostomy after Severe Trauma: Associated Risk Factors in the Spanish Trauma ICU Registry (RETRAUCI). Am Surg 2019; 85:e623-e624. [PMID: 31908249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Llompart-Pou JA, Barea-Mendoza JA, Pérez-Bárcena J, Sánchez-Casado M, Ballesteros-Sanz MA, Chico-Fernández M. [Survey of the neurocritical patient care in Spain. Part 1: Trauma of the central nervous system]. Med Intensiva 2019; 45:250-252. [PMID: 31611011 DOI: 10.1016/j.medin.2019.09.001] [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: 07/02/2019] [Revised: 08/13/2019] [Accepted: 09/01/2019] [Indexed: 11/24/2022]
Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, España.
| | - J A Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, España
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
| | - M A Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
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Chico-Fernández M, Sánchez-Casado M, Barea-Mendoza JA, García-Sáez I, Ballesteros-Sanz MÁ, Guerrero-López F, Quintana-Díaz M, Molina-Díaz I, Martín-Iglesias L, Toboso-Casado JM, Pérez-Bárcena J, Llompart-Pou JA. Outcomes of very elderly trauma ICU patients. Results from the Spanish trauma ICU registry. Med Intensiva 2019; 44:210-215. [PMID: 30799042 DOI: 10.1016/j.medin.2019.01.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/05/2018] [Accepted: 01/11/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To analyze outcomes and factors related to mortality among very elderly trauma patients admitted to intensive care units (ICUs) participating in the Spanish trauma ICU registry. DESIGN A multicenter nationwide registry. Retrospective analysis. November 2012-May 2017. SETTING Participating ICUs. PATIENTS Trauma patients aged ≥80 years. INTERVENTIONS None. MAIN VARIABLES OF INTEREST The outcomes and influence of limitation of life sustaining therapy (LLST) were analyzed. Comparisons were established using the Wilcoxon test, Chi-squared test or Fisher's exact test as appropriate. Multiple logistic regression analysis was performed to analyze variables related to mortality. A p-value <0.05 was considered statistically significant. RESULTS The mean patient age was 83.4±3.3 years; 281 males (60.4%). Low-energy falls were the mechanisms of injury in 256 patients (55.1%). The mean ISS was 20.5±11.1, with a mean ICU stay of 7.45±9.9 days. The probability of survival based on the TRISS methodology was 69.8±29.7%. The ICU mortality rate was 15.5%, with an in-hospital mortality rate of 19.2%. The main cause of mortality was intracranial hypertension (42.7%). The ISS, the need for first- and second-tier measures to control intracranial pressure, and being admitted to the ICU for organ donation were independent mortality predictors. LLST was applied in 128 patients (27.9%). Patients who received LLST were older, with more severe trauma, and with more severe brain injury. CONCLUSIONS Very elderly trauma ICU patients presented mortality rates lower than predicted on the basis of the severity of injury.
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Affiliation(s)
- M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | - J A Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - I García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, Donostia, Spain
| | - M Á Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - F Guerrero-López
- Servicio de Medicina Intensiva, UCI Neurotraumatológica, Hospital Virgen de las Nieves, Granada, Spain
| | - M Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain
| | - I Molina-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - L Martín-Iglesias
- Servicio de Medicina Intensiva, Hospital Universitario Central De Asturias, Asturias, Spain
| | - J M Toboso-Casado
- Servei de Medicina Intensiva, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
| | - J Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain
| | - J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain.
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Ballesteros MÁ, Llompart-Pou JA, Egea-Guerrero JJ. Temporary inferior vena cava filters in major trauma. Med Intensiva 2018; 43:500-502. [PMID: 30385089 DOI: 10.1016/j.medin.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- M Á Ballesteros
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - J J Egea-Guerrero
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
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Barea-Mendoza JA, Chico-Fernández M, Sánchez-Casado M, Molina-Díaz I, Quintana-Díaz M, Jiménez-Moragas JM, Pérez-Bárcena J, Llompart-Pou JA. Predicción de la supervivencia en pacientes traumáticos ancianos: comparación entre la metodología TRISS y el Geriatric Trauma Outcome Score. Cir Esp 2018; 96:357-362. [DOI: 10.1016/j.ciresp.2018.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/01/2018] [Accepted: 02/11/2018] [Indexed: 10/17/2022]
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Llompart-Pou JA, Pérez-Bárcena J. Geriatric traumatic brain injury: An old challenge. Med Intensiva 2018; 43:44-46. [PMID: 29661567 DOI: 10.1016/j.medin.2018.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/14/2018] [Accepted: 02/18/2018] [Indexed: 10/17/2022]
Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut de Investigació Sanitària Illes Balears (IdISBa), Palma, Spain.
| | - J Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut de Investigació Sanitària Illes Balears (IdISBa), Palma, Spain
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Ferreruela M, Raurich JM, Ayestarán I, Llompart-Pou JA. Hyperlactatemia in ICU patients: Incidence, causes and associated mortality. J Crit Care 2017; 42:200-205. [PMID: 28772222 DOI: 10.1016/j.jcrc.2017.07.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 05/06/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE To describe the incidence, causes and associated mortality of hyperlactatemia in critically ill patients and to evaluate the association between lactate clearance and in-hospital survival. METHODS Retrospective cohort study of patients with hyperlactatemia admitted to the ICU. Hyperlactatemia was defined as a blood lactate concentration ≥5mmol/L and high-grade hyperlactatemia a lactate level ≥10mmol/L. Lactate clearance was calculated as the percentage of decrease in lactate concentration from the peak value. RESULTS Of 10,123 patients, 1373 (13.6%) had lactate concentration ≥5mmol/L, and 434(31.6%) of them had ≥10mmol/L. The most common causes of hyperlactatemia were sepsis/septic shock and post-cardiac surgery. An association was found between lactate concentration and in-hospital mortality (p<0.001). The area under the receiver-operating-characteristics (ROC) of lactate concentration and the optimal cut off to predict mortality were 0.72 (0.70-0.75) and 8.6mmol/L, respectively. ROC analysis for lactate clearance to predict in-hospital survival showed that the best area under the curve was obtained at 12h: 0.67 (95% confidence interval 0.59-0.75). CONCLUSIONS Hyperlactatemia was common and associated with a high mortality in critically ill patients. Lactate clearance had limited utility for predicting in-hospital survival.
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Affiliation(s)
- Mireia Ferreruela
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears, Spain.
| | - Joan Maria Raurich
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears, Spain.
| | - Ignacio Ayestarán
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears, Spain.
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears, Spain.
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Chico-Fernández M, Llompart-Pou JA, Sánchez-Casado M, Ballesteros-Sanz MÁ. Severe traumatic disease register in Spain. Med Intensiva 2017; 41:324-325. [PMID: 28465072 DOI: 10.1016/j.medin.2017.02.011] [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: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
Affiliation(s)
- M Chico-Fernández
- UCI de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Islas Baleares, España
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
| | - M Á Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
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Llompart-Pou JA, Pérez-Bárcena J, Chico-Fernández M, Sánchez-Casado M, Raurich JM. Severe trauma in the geriatric population. World J Crit Care Med 2017; 6:99-106. [PMID: 28529911 PMCID: PMC5415855 DOI: 10.5492/wjccm.v6.i2.99] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/03/2017] [Accepted: 03/17/2017] [Indexed: 02/06/2023] Open
Abstract
Geriatric trauma constitutes an increasingly recognized problem. Aging results in a progressive decline in cellular function which leads to a loose of their capacity to respond to injury. Some medications commonly used in this population can mask or blunt the response to injury. Falls constitute the most common cause of trauma and the leading cause of trauma-related deaths in this population. Falls are complicated by the widespread use of antiplatelets and anticoagulants, especially in patients with brain injury. Under-triage is common in this population. Evaluation of frailty could be helpful to solve this issue. Appropriate triaging and early aggressive management with correction of coagulopathy can improve outcome. Limitation of care and palliative measures must be considered in cases with a clear likelihood of poor prognosis.
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Ferreruela M, Raurich JM, Llompart-Pou JA, Colomar A, Ayestarán I. Effect of FiO 2 in the measurement of VO 2 and VCO 2 using the E-COXV metabolic monitor. Med Intensiva 2017; 41:461-467. [PMID: 28283325 DOI: 10.1016/j.medin.2016.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/02/2016] [Accepted: 12/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We evaluated the effect of changes in FiO2 on the bias and accuracy of the determination of oxygen consumption (V˙O2) and carbon dioxide production (V˙CO2) using the E-COVX monitor in patients with mechanical ventilation. DESIGN Descriptive of concordance. SETTING Intensive Care Unit. PATIENTS OR PARTICIPANTS Patients with mechanical ventilation. INTERVENTIONS We measured V˙O2 and V˙CO2 using the E-COVX monitor. Values recorded were the average in 5min. Two groups of 30 patients. We analyzed: 1) the reproducibility in the measurement of V˙O2 and V˙CO2 at FiO2 0.4, and 2) the effect of the changes in FiO2 on the measurement of V˙O2 and V˙CO2. Statistical analysis was performed using Bland and Altman test. VARIABLES OF MAIN INTEREST Bias and accuracy. RESULTS 1) FiO2 0.4 reproducibility: The bias in the measurement of V˙O2 and V˙CO2 was 1.6 and 2.1mL/min, respectively, and accuracy was 9.7 to -8.3% and 7.2 to -5.2%, respectively, and 2) effect of FiO2 on V˙O2: The bias of V˙O2 measured at FiO2 0.4 and 0.6 was -4.0mL/min and FiO2 0.4 and 0.8 was 5.2mL/min. Accuracy between FiO2 0.4 and 0.6 was 11.9 to -14.1%, and between FiO2 0.4 and 0.8 was 43.9 to -39.7%. CONCLUSIONS The E-COVX monitor evaluates V˙O2 and V˙CO2 in critical patients with mechanical ventilation with a clinically acceptable accuracy until FiO2 0.6.
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Affiliation(s)
- M Ferreruela
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - J M Raurich
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España.
| | - J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - A Colomar
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - I Ayestarán
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
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Llompart-Pou JA, Pérez-Bárcena J, Novo M, Raurich JM. Effect of single-dose of tolvaptan in neurocritical patients with hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion. Med Intensiva 2017; 41:501-503. [PMID: 28087091 DOI: 10.1016/j.medin.2016.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/14/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain.
| | - J Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain
| | - M Novo
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - J M Raurich
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Llompart-Pou JA, Pérez-Bárcena J, Homar J, Abadal JM. Holistic ultrasound in trauma. Injury 2016; 47:2381. [PMID: 27575373 DOI: 10.1016/j.injury.2016.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 08/24/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa, 79 07010, Spain.
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa, 79 07010, Spain
| | - Javier Homar
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa, 79 07010, Spain
| | - Josep Maria Abadal
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa, 79 07010, Spain
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Llompart-Pou JA, Chico-Fernández M, Sánchez-Casado M, Salaberria-Udabe R, Carbayo-Górriz C, Guerrero-López F, González-Robledo J, Ballesteros-Sanz MÁ, Herrán-Monge R, Servià-Goixart L, León-López R, Val-Jordán E. Scoring severity in trauma: comparison of prehospital scoring systems in trauma ICU patients. Eur J Trauma Emerg Surg 2016; 43:351-357. [PMID: 27089878 DOI: 10.1007/s00068-016-0671-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/26/2016] [Accepted: 04/02/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE We evaluated the predictive ability of mechanism, Glasgow coma scale, age and arterial pressure (MGAP), Glasgow coma scale, age and systolic blood pressure (GAP), and triage-revised trauma Score (T-RTS) scores in patients from the Spanish trauma ICU registry using the trauma and injury severity score (TRISS) as a reference standard. METHODS Patients admitted for traumatic disease in the participating ICU were included. Quantitative data were reported as median [interquartile range (IQR), categorical data as number (percentage)]. Comparisons between groups with quantitative variables and categorical variables were performed using Student's T Test and Chi Square Test, respectively. We performed receiving operating curves (ROC) and evaluated the area under the curve (AUC) with its 95 % confidence interval (CI). Sensitivity, specificity, positive predictive and negative predictive values and accuracy were evaluated in all the scores. A value of p < 0.05 was considered significant. RESULTS The final sample included 1361 trauma ICU patients. Median age was 45 (30-61) years. 1092 patients (80.3 %) were male. Median ISS was 18 (13-26) and median T-RTS was 11 (10-12). Median GAP was 20 (15-22) and median MGAP 24 (20-27). Observed mortality was 17.7 % whilst predicted mortality using TRISS was 16.9 %. The AUC in the scores evaluated was: TRISS 0.897 (95 % CI 0.876-0.918), MGAP 0.860 (95 % CI 0.835-0.886), GAP 0.849 (95 % CI 0.823-0.876) and T-RTS 0.796 (95 % CI 0.762-0.830). CONCLUSIONS Both MGAP and GAP scores performed better than the T-RTS in the prediction of hospital mortality in Spanish trauma ICU patients. Since these are easy-to-perform scores, they should be incorporated in clinical practice as a triaging tool.
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Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa, 79, 07010, Palma de Mallorca, Spain.
| | - M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | - R Salaberria-Udabe
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, San Sebastián, Spain
| | - C Carbayo-Górriz
- Servicio de Medicina Intensiva, Complejo Hospitalario de Torrecárdenas, Almería, Spain
| | - F Guerrero-López
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J González-Robledo
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - M Á Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - R Herrán-Monge
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, Spain
| | - L Servià-Goixart
- Servicio de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - R León-López
- Servicio de Medicina Intensiva, Ciudad Sanitaria Reina Sofia, Córdoba, Spain
| | - E Val-Jordán
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
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41
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Chico-Fernández M, Llompart-Pou JA, Sánchez-Casado M, Alberdi-Odriozola F, Guerrero-López F, Mayor-García MD, Egea-Guerrero JJ, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Alvarez E, Pino-Sánchez FI, Homar-Ramírez J. Mortality prediction using TRISS methodology in the Spanish ICU Trauma Registry (RETRAUCI). Med Intensiva 2016; 40:395-402. [PMID: 27068001 DOI: 10.1016/j.medin.2015.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/09/2015] [Accepted: 11/20/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To validate Trauma and Injury Severity Score (TRISS) methodology as an auditing tool in the Spanish ICU Trauma Registry (RETRAUCI). DESIGN A prospective, multicenter registry evaluation was carried out. SETTING Thirteen Spanish Intensive Care Units (ICUs). PATIENTS Individuals with traumatic disease and available data admitted to the participating ICUs. INTERVENTIONS Predicted mortality using TRISS methodology was compared with that observed in the pilot phase of the RETRAUCI from November 2012 to January 2015. Discrimination was evaluated using receiver operating characteristic (ROC) curves and the corresponding areas under the curves (AUCs) (95% CI), with calibration using the Hosmer-Lemeshow (HL) goodness-of-fit test. A value of p<0.05 was considered significant. MAIN VARIABLES OF INTEREST Predicted and observed mortality. RESULTS A total of 1405 patients were analyzed. The observed mortality rate was 18% (253 patients), while the predicted mortality rate was 16.9%. The area under the ROC curve was 0.889 (95% CI: 0.867-0.911). Patients with blunt trauma (n=1305) had an area under the ROC curve of 0.887 (95% CI: 0.864-0.910), and those with penetrating trauma (n=100) presented an area under the curve of 0.919 (95% CI: 0.859-0.979). In the global sample, the HL test yielded a value of 25.38 (p=0.001): 27.35 (p<0.0001) in blunt trauma and 5.91 (p=0.658) in penetrating trauma. TRISS methodology underestimated mortality in patients with low predicted mortality and overestimated mortality in patients with high predicted mortality. CONCLUSIONS TRISS methodology in the evaluation of severe trauma in Spanish ICUs showed good discrimination, with inadequate calibration - particularly in blunt trauma.
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Affiliation(s)
- M Chico-Fernández
- Trauma and Emergencies ICU, Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Llompart-Pou
- Department of Intensive Care Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
| | - M Sánchez-Casado
- Department of Intensive Care Medicine, Hospital Virgen de la Salud, Toledo, Spain
| | - F Alberdi-Odriozola
- Department of Intensive Care Medicine, Hospital Universitario de Donostia, San Sebastián, Spain
| | - F Guerrero-López
- Department of Intensive Care Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M D Mayor-García
- Department of Intensive Care Medicine, Complejo Hospitalario de Torrecárdenas, Almería, Spain
| | - J J Egea-Guerrero
- Department of Intensive Care Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J F Fernández-Ortega
- Department of Intensive Care Medicine, Hospital Universitario Carlos Haya, Málaga, Spain
| | - A Bueno-González
- Department of Intensive Care Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - J González-Robledo
- Department of Intensive Care Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - L Servià-Goixart
- Department of Intensive Care Medicine, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Roldán-Ramírez
- Department of Intensive Care Medicine, Complejo Hospitalario de Pamplona, Navarra, Spain
| | - M Á Ballesteros-Sanz
- Department of Intensive Care Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - E Tejerina-Alvarez
- Department of Intensive Care Medicine, Hospital Universitario de Getafe, Madrid, Spain
| | - F I Pino-Sánchez
- Department of Intensive Care Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J Homar-Ramírez
- Department of Intensive Care Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Llompart-Pou JA, Pericàs-Pulido P, Pérez-Bárcena J, Raurich JM. Use of enteral salbutamol in spinal shock. Med Intensiva 2016; 40:315-6. [PMID: 26748957 DOI: 10.1016/j.medin.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 09/25/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España.
| | - P Pericàs-Pulido
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España
| | - J Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España
| | - J M Raurich
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España
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Chico-Fernández M, Llompart-Pou JA, Alberdi-Odriozolo F, Guerrero-López F, Sánchez-Casado M, Mayor-García MD, Egea-Guerrero J, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Álvarez E. Spanish trauma icu registry (RETRAUCI). final results of the pilot phase. Intensive Care Med Exp 2015. [PMCID: PMC4798319 DOI: 10.1186/2197-425x-3-s1-a377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chico-Fernández M, Sánchez-Casado M, Alberdi-Odriozola F, Guerrero-López F, Mayor-García MD, Egea-Guerrero J, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Álvarez E, Llompart-Pou JA. Validation of the probability of survival using the triss methodology in the Spanish Trauma ICU registry (RETRAUCI). Intensive Care Med Exp 2015. [PMCID: PMC4798491 DOI: 10.1186/2197-425x-3-s1-a856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Chico-Fernández M, Llompart-Pou JA, Guerrero-López F, Sánchez-Casado M, García-Sáez I, Mayor-García MD, Egea-Guerrero J, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Alvarez E, García-Fuentes C, Alberdi-Odriozola F. Epidemiology of severe trauma in Spain. Registry of trauma in the ICU (RETRAUCI). Pilot phase. Med Intensiva 2015; 40:327-47. [PMID: 26440993 DOI: 10.1016/j.medin.2015.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 04/11/2015] [Revised: 07/20/2015] [Accepted: 07/25/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe the characteristics and management of severe trauma disease in Spanish Intensive Care Units (ICUs). Registry of trauma in the ICU (RETRAUCI). Pilot phase. DESIGN A prospective, multicenter registry. SETTING Thirteen Spanish ICUs. PATIENTS Patients with trauma disease admitted to the ICU. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Epidemiology, out-of-hospital attention, registry of injuries, resources utilization, complications and outcome were evaluated. RESULTS Patients, n=2242. Mean age 47.1±19.02 years. Males 79%. Blunt trauma 93.9%. Injury Severity Score 22.2±12.1, Revised Trauma Score 6.7±1.6. Non-intentional in 84.4% of the cases. The most common causes of trauma were traffic accidents followed by pedestrian and high-energy falls. Up to 12.4% were taking antiplatelet medication or anticoagulants. Almost 28% had a suspected or confirmed toxic influence in trauma. Up to 31.5% required an out-of-hospital artificial airway. The time from trauma to ICU admission was 4.7±5.3hours. At ICU admission, 68.5% were hemodynamically stable. Brain and chest injuries predominated. A large number of complications were documented. Mechanical ventilation was used in 69.5% of the patients (mean 8.2±9.9 days), of which 24.9% finally required a tracheostomy. The median duration of stay in the ICU and in hospital was 5 (range 3-13) and 9 (5-19) days, respectively. The ICU mortality rate was 12.3%, while the in-hospital mortality rate was 16.0%. CONCLUSIONS The pilot phase of the RETRAUCI offers a first impression of the epidemiology and management of trauma disease in Spanish ICUs.
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Affiliation(s)
- M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - F Guerrero-López
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
| | - I García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, San Sebastián, España
| | - M D Mayor-García
- Servicio de Medicina Intensiva, Complejo Hospitalario de Torrecárdenas, Almería, España
| | - J Egea-Guerrero
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J F Fernández-Ortega
- Servicio de Medicina Intensiva, Hospital Universitario Carlos Haya, Málaga, España
| | - A Bueno-González
- Servicio de Medicina Intensiva, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - J González-Robledo
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - L Servià-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Lérida, España
| | | | - M Á Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - E Tejerina-Alvarez
- Servicio de Medicina Intensiva, Hospital Universitario de Getafe, Getafe (Madrid), España
| | - C García-Fuentes
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Alberdi-Odriozola
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, San Sebastián, España
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Raurich JM, Llompart-Pou JA, Ferreruela M, Riera M, Homar J, Marsé P, Colomar A, Ayestarán I. A SIMPLIFIED EQUATION FOR TOTAL ENERGY EXPENDITURE IN MECHANICALLY VENTILATED CRITICALLY ILL PATIENTS. NUTR HOSP 2015; 32:1273-80. [PMID: 26319850 DOI: 10.3305/nh.2015.32.3.9359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION "tight calorie control" concept arose to avoid over- and under-feeding of patients. OBJECTIVE to describe and validate a simplified predictive equation of total energy expenditure (TEE) in mechanically ventilated critically ill patients. METHODS this was a secondary analysis of measurements of TEE by indirect calorimetry in critically ill patients. Patients were allocated in a 2:1 form by a computer package to develop the new predictive equation TEE (prediction cohort) and the validation cohort. Indirect calorimetry was performed with three different calorimeters: the Douglas-bag, a metabolic computer and the CalorimetR. We developed a new TEE predictive equation using measured TEE (in kcal/kg/d) as dependent variable and as independent variables different factors known to influence energy expenditure: age, gender, body mass index (BMI) and type of injury. RESULTS prediction cohort: 179 patients. Validation cohort: 91 patients. The equation was: TEEPE (kcal/Kg/d) = 33 - (3 x A) - (3 x BMI) - (1 x G). Where: A (age in years): ≤ 50 = 0; > 50 = 1. BMI (Kg/m2): 18.5 - 24.9 = 0; 25 - 29.9 = 1; 30 - 34.9 = 2; 35 - 39.9 = 3. G (gender): male = 0; female = 1. The bias (95% CI) was -0.1 (-1.0 - 0.7) kcal/kg/d and the limits of agreement (} 2SD) were -8.0 to 7.8 kcal/kg/d. Predicted TEE was accurate (within 85% to 115%) in 73.6% of patients. CONCLUSION the new predictive equation was acceptable to predict TEE in clinical practice for most mechanically ventilated critically ill patients.
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Affiliation(s)
- Joan Maria Raurich
- Servei de Medicina Intensiva. Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears (Spain)..
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva. Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears (Spain)..
| | - Mireia Ferreruela
- Servei de Medicina Intensiva. Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears (Spain)..
| | - Maria Riera
- Servei de Medicina Intensiva. Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears (Spain)..
| | - Javier Homar
- Servei de Medicina Intensiva. Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears (Spain)..
| | - Pere Marsé
- Servei de Medicina Intensiva. Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears (Spain)..
| | - Asunción Colomar
- Servei de Medicina Intensiva. Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears (Spain)..
| | - Ignacio Ayestarán
- Servei de Medicina Intensiva. Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears (Spain)..
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Pérez-Bárcena J, Romay E, Llompart-Pou JA, Ibáñez J, Brell M, Llinás P, González E, Merenda A, Ince C, Bullock R. Direct observation during surgery shows preservation of cerebral microcirculation in patients with traumatic brain injury. J Neurol Sci 2015; 353:38-43. [DOI: 10.1016/j.jns.2015.03.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/22/2015] [Accepted: 03/27/2015] [Indexed: 11/25/2022]
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Perez-Barcena J, Llompart-Pou JA, O'Phelan KH. Intracranial Pressure Monitoring and Management of Intracranial Hypertension. Crit Care Clin 2014; 30:735-50. [DOI: 10.1016/j.ccc.2014.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Pérez-Bárcena J, Marsé P, Zabalegui-Pérez A, Corral E, Herrán-Monge R, Gero-Escapa M, Cervera M, Llompart-Pou JA, Ayestarán I, Raurich JM, Oliver A, Buño A, García de Lorenzo A, Frontera G. A randomized trial of intravenous glutamine supplementation in trauma ICU patients. Intensive Care Med 2014; 40:539-47. [DOI: 10.1007/s00134-014-3230-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/24/2014] [Indexed: 12/21/2022]
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Llompart-Pou JA, Abadal JM, Güenther A, Rayo L, Martín-del Rincón JP, Homar J, Pérez-Bárcena J. Transcranial Sonography and Cerebral Circulatory Arrest in Adults: A Comprehensive Review. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/167468] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The diagnosis of brain death remains a clinical challenge for intensive care unit physicians. Worldwide regulations in its diagnosis may differ, and the need of ancillary tests after a clinical examination is not uniform. Transcranial sonography is a noninvasive, bedside, and widely available technique that can be used in the diagnosis of the cerebral circulatory arrest that preceeds brain death. In this paper we review the general concepts, the technical requisites, the patterns of Doppler signal confirming cerebral circulatory arrest, the vessels to insonate, and the options in cases with poor acoustic window. Future research perspectives in the field of transcranial sonography are discussed as well.
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Affiliation(s)
- Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa 79, 07010 Palma, Spain
| | - Josep Maria Abadal
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa 79, 07010 Palma, Spain
| | - Albrecht Güenther
- Hans Berger Clinic for Neurology, University Hospital Jena, 07743 Jena, Germany
| | - Luis Rayo
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa 79, 07010 Palma, Spain
| | | | - Javier Homar
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa 79, 07010 Palma, Spain
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa 79, 07010 Palma, Spain
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