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Jiménez-Guerra E, Revuelto-Rey J, Rocchetti NS, Egea-Guerrero JJ. Possible adverse effects of the blood donation from brain-dead patients. Med Intensiva 2022; 46:539-540. [PMID: 35753973 DOI: 10.1016/j.medine.2022.06.009] [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: 12/30/2021] [Accepted: 01/09/2022] [Indexed: 06/15/2023]
Affiliation(s)
- E Jiménez-Guerra
- Servicio de Medicina Intensiva, Hospital Universitario Puerta del Mar, Cádiz, Spain.
| | - J Revuelto-Rey
- Servicio de Medicina Intensiva, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - N S Rocchetti
- Unidad de Cuidados Intensivos, Hospital Eva Perón, Granadero Balgorria, Sante Fe, Argentina; Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
| | - J J Egea-Guerrero
- Unidad de Neurocríticos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Egea-Guerrero JJ, Revuelto-Rey J. Social media and intensive care medicine: To be or not to be. Med Intensiva 2022; 46:289-290. [PMID: 35248507 DOI: 10.1016/j.medine.2022.02.014] [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: 02/20/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 06/14/2023]
Affiliation(s)
- J J Egea-Guerrero
- Facultativo Especialista del Área de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - J Revuelto-Rey
- Facultativo Especialista del Área de Medicina Intensiva, Hospital Universitario Puerta del Mar, Cádiz, Spain
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Law ZK, Appleton JP, Scutt P, Roberts I, Al-Shahi Salman R, England TJ, Werring DJ, Robinson T, Krishnan K, Dineen RA, Laska AC, Lyrer PA, Egea-Guerrero JJ, Karlinski M, Christensen H, Roffe C, Bereczki D, Ozturk S, Thanabalan J, Collins R, Beridze M, Ciccone A, Duley L, Shone A, Bath PM, Sprigg N. Brief Consent Methods Enable Rapid Enrollment in Acute Stroke Trial: Results From the TICH-2 Randomized Controlled Trial. Stroke 2022; 53:1141-1148. [PMID: 34847710 PMCID: PMC7612544 DOI: 10.1161/strokeaha.121.035191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/26/2021] [Accepted: 10/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Seeking consent rapidly in acute stroke trials is crucial as interventions are time sensitive. We explored the association between consent pathways and time to enrollment in the TICH-2 (Tranexamic Acid in Intracerebral Haemorrhage-2) randomized controlled trial. METHODS Consent was provided by patients or by a relative or an independent doctor in incapacitated patients, using a 1-stage (full written consent) or 2-stage (initial brief consent followed by full written consent post-randomization) approach. The computed tomography-to-randomization time according to consent pathways was compared using the Kruskal-Wallis test. Multivariable logistic regression was performed to identify variables associated with onset-to-randomization time of ≤3 hours. RESULTS Of 2325 patients, 817 (35%) gave self-consent using 1-stage (557; 68%) or 2-stage consent (260; 32%). For 1507 (65%), consent was provided by a relative (1 stage, 996 [66%]; 2 stage, 323 [21%]) or a doctor (all 2-stage, 188 [12%]). One patient did not record prerandomization consent, with written consent obtained subsequently. The median (interquartile range) computed tomography-to-randomization time was 55 (38-93) minutes for doctor consent, 55 (37-95) minutes for 2-stage patient, 69 (43-110) minutes for 2-stage relative, 75 (48-124) minutes for 1-stage patient, and 90 (56-155) minutes for 1-stage relative consents (P<0.001). Two-stage consent was associated with onset-to-randomization time of ≤3 hours compared with 1-stage consent (adjusted odds ratio, 1.9 [95% CI, 1.5-2.4]). Doctor consent increased the odds (adjusted odds ratio, 2.3 [1.5-3.5]) while relative consent reduced the odds of randomization ≤3 hours (adjusted odds ratio, 0.10 [0.03-0.34]) compared with patient consent. Only 2 of 771 patients (0.3%) in the 2-stage pathways withdrew consent when full consent was sought later. Two-stage consent process did not result in higher withdrawal rates or loss to follow-up. CONCLUSIONS The use of initial brief consent was associated with shorter times to enrollment, while maintaining good participant retention. Seeking written consent from relatives was associated with significant delays. REGISTRATION URL: https://www.isrctn.com; Unique identifier: ISRCTN93732214.
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Affiliation(s)
- Zhe Kang Law
- Stroke Trials Unit (Z.K.L., J.P.A., P.S., P.M.B., N.S.), University of Nottingham, United Kingdom
- Department of Medicine (Z.K.L.), National University of Malaysia
| | - Jason P. Appleton
- Stroke Trials Unit (Z.K.L., J.P.A., P.S., P.M.B., N.S.), University of Nottingham, United Kingdom
- Stroke, University Hospitals Birmingham NHS Foundation Trust, United Kingdom (J.P.A.)
| | - Polly Scutt
- Stroke Trials Unit (Z.K.L., J.P.A., P.S., P.M.B., N.S.), University of Nottingham, United Kingdom
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, United Kingdom (I.R.)
| | | | - Timothy J. England
- Vascular Medicine, Division of Medical Sciences and GEM, Royal Derby Hospital Centre (T.J.E.), University of Nottingham, United Kingdom
| | - David J. Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W.)
| | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, United Kingdom (T.R.)
| | - Kailash Krishnan
- Stroke, Nottingham University Hospitals NHS Trust, United Kingdom (K.K., P.M.B., N.S.)
| | - Robert A. Dineen
- Radiological Sciences (R.A.D.), University of Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, United Kingdom (R.A.D.)
| | - Ann Charlotte Laska
- Department of Clinical Sciences, Karolinska Institute Danderyd Hospital, Sweden (A.C.L.)
| | - Philippe A. Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (P.A.L.)
| | | | | | - Hanne Christensen
- Department of Neurology, Bispebjerg Hospital and University of Copenhagen, Denmark (H.C.)
| | - Christine Roffe
- Stroke Research, School of Medicine, Keele University, Newcastle-Under-Lyme, United Kingdom (C.R.)
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary (D.B.)
| | - Serefnur Ozturk
- Selcuk University Faculty of Medicine, Department of Neurology, Konya, Turkey (S.O.)
| | - Jegan Thanabalan
- Department of Surgery, Division of Neurosurgery (J.T.), National University of Malaysia
| | - Ronan Collins
- Age Related Health Care/Stroke-Service, Tallaght University Hospital, Dublin, Republic of Ireland (R.C.)
| | - Maia Beridze
- The First University Clinic of Tbilisi State Medical University, GA (M.B.)
| | - Alfonso Ciccone
- Neurology and Stroke Unit, Poma Hospital, ASST di Mantova, Mantua, Italy (A.C.)
| | - Lelia Duley
- Nottingham Clinical Trials Unit (L.D.), University of Nottingham, United Kingdom
| | - Angela Shone
- Research and Innovation (A.S.), University of Nottingham, United Kingdom
| | - Philip M. Bath
- Stroke Trials Unit (Z.K.L., J.P.A., P.S., P.M.B., N.S.), University of Nottingham, United Kingdom
- Stroke, Nottingham University Hospitals NHS Trust, United Kingdom (K.K., P.M.B., N.S.)
| | - Nikola Sprigg
- Stroke Trials Unit (Z.K.L., J.P.A., P.S., P.M.B., N.S.), University of Nottingham, United Kingdom
- Stroke, Nottingham University Hospitals NHS Trust, United Kingdom (K.K., P.M.B., N.S.)
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Mesa Galán LA, Henríquez Recine MA, Robles Caballero A, Yus Teruel S, García Martínez JR, Egea-Guerrero JJ, Quintana-Diaz M. Ultrasound diagnosis of Terson syndrome as an indicator of extreme severity in neurocritical care patients. Neurologia 2022; 38:181-187. [PMID: 35305963 DOI: 10.1016/j.nrleng.2020.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/25/2020] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Terson syndrome (TS) is defined as any intraocular haemorrhage identified in patients with acute intracranial pathology. TS appears to be associated with clinical severity in patients with subarachnoid haemorrhage (SAH), but the association is yet to be defined in patients with traumatic brain injury (TBI) and intracerebral haemorrhage (ICH). This study aimed to evaluate the diagnostic performance of ocular ultrasound (OU) and its usefulness in clinical practice. MATERIAL AND METHODS We performed an observational, prospective, single-centre study of neurocritical care patients. We analysed cases and controls, defined according to indirect ophthalmoscopy (IO) and OU findings. We determined the diagnostic characteristics of OU. A multivariate analysis was performed to identify clinically relevant associations. RESULTS The sample included 91 patients diagnosed with ICH (41.76%), SAH (29.67%), and TBI (28.57%). TS was identified by OU in 8 patients (8.79%) and by IO in 24 (24.37%). The adjusted mortality rate in patients with TS showed an odds ratio (OR) of 4.15 (95% confidence interval [CI], 1.52-11.33). All patients with TS detected by OU presented Glasgow Coma Scale scores < 9, with an elevated risk of needing decompressive craniectomy (OR: 9.84; 95% CI, 1.64-59). OU presented an overall sensitivity of 30.43%, specificity of 98.53%, and diagnostic accuracy of 81.32%. For the detection of vitreous haemorrhage, sensitivity and specificity were 87.5% and 98.5%, respectively. CONCLUSIONS OU diagnosis of TS identifies extremely critical patients, who may require the highest level of care; TS is an independent risk factor for in-hospital mortality.
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Affiliation(s)
- L A Mesa Galán
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain.
| | | | - A Robles Caballero
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain
| | - S Yus Teruel
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain
| | | | - J J Egea-Guerrero
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M Quintana-Diaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain
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5
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Egea-Guerrero JJ, García-Sáez I, Quintana-Díaz M. Trigger transfusion in severe traumatic brain injury. Med Intensiva 2021; 46:157-160. [PMID: 34952791 DOI: 10.1016/j.medine.2021.12.003] [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: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- J J Egea-Guerrero
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, IBIS/CSIC/Universidad de Sevilla, Sevilla, Spain.
| | - I García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, San Sebastián, Guipúzcoa, Spain
| | - M Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario de La Paz, Idipaz, Madrid, Spain
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6
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Martin-Villen L, Egea-Guerrero JJ, Mendoza-Prieto M, de Azua-López ZR, Ruiz-Matas JH, Vilches-Arenas A. Effectiveness Factors of Organ Donation in Andalusia. Transplant Proc 2021; 54:4-6. [PMID: 34895898 DOI: 10.1016/j.transproceed.2021.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Donation effectiveness is one of the most important factors for the sustainability of the donation transplant process. The aim of this study was to characterize and identify hypothetical factors associated with effective donation (at least one organ transplanted) in the Andalusian population. METHOD Cross-sectional descriptive observational study of a sample of 4144 potential organ donors registered in the Andalusian Information System of Transplant from January 2006 to December 2018. Donors were categorized according to the result of the donation and analyzed depending their effectiveness. RESULTS The Andalusian donors were mainly men (60%) and were between 55 and 75 years of age (47.6%). The majority died of brain death (87.45%) caused by a cerebrovascular accident (63.5%). They had cardiovascular risk factors such as hypertension (38.3%), diabetes mellitus (14.8%), dyslipidemia (11.1%), smoking (20.4%), and overweight with a median body mass index of 27.1 kg/m2 (IQR, 24.6-29.4). Effective donor rate was 84.5%. Increasing age, diabetes mellitus, increasing body mass index, and the presence of antibodies against hepatitis C virus were hypothetical predictors of an ineffective donation. CONCLUSIONS In view of our results, we can say that the Andalusian donor population has a high effectiveness rate, presenting hypothetical factors that could allow one to predict the outcome of an effective donation.
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Affiliation(s)
- Luis Martin-Villen
- Intensive and Critical Care Service, Virgen del Rocio University Hospital, Seville, Spain.
| | | | - Maria Mendoza-Prieto
- Intensive and Critical Care Service, Virgen del Rocio University Hospital, Seville, Spain
| | | | | | - Angel Vilches-Arenas
- Public Health and Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Seville, Spain
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Egea-Guerrero JJ, García-Sáez I, Quintana-Díaz M. Trigger transfusion in severe traumatic brain injury. Med Intensiva 2021; 46:S0210-5691(21)00071-1. [PMID: 33962806 DOI: 10.1016/j.medin.2021.03.012] [Citation(s) in RCA: 2] [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: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 11/17/2022]
Affiliation(s)
- J J Egea-Guerrero
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla. IBIS/CSIC/Universidad de Sevilla, Sevilla, España.
| | - I García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, San Sebastián, Guipúzcoa, España
| | - M Quintana-Díaz
- Servicio deMedicina Intensiva, Hospital Universitario de La Paz. Idipaz, Madrid, España
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Egea-Guerrero JJ, Revuelto-Rey J. Social media and intensive care medicine: To be or not to be. Med Intensiva 2021; 46:S0210-5691(21)00040-1. [PMID: 33875311 DOI: 10.1016/j.medin.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/24/2022]
Affiliation(s)
- J J Egea-Guerrero
- Facultativo Especialista del Área de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - J Revuelto-Rey
- Facultativo Especialista del Área de Medicina Intensiva, Hospital Universitario Puerta del Mar, Cádiz, España
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9
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Law ZK, Desborough M, Roberts I, Al-Shahi Salman R, England TJ, Werring DJ, Robinson T, Krishnan K, Dineen R, Laska AC, Peters N, Egea-Guerrero JJ, Karlinski M, Christensen H, Roffe C, Bereczki D, Ozturk S, Thanabalan J, Collins R, Beridze M, Bath PM, Sprigg N. Outcomes in Antiplatelet-Associated Intracerebral Hemorrhage in the TICH-2 Randomized Controlled Trial. J Am Heart Assoc 2021; 10:e019130. [PMID: 33586453 PMCID: PMC8174262 DOI: 10.1161/jaha.120.019130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Antiplatelet therapy increases the risk of hematoma expansion in intracerebral hemorrhage (ICH) while the effect on functional outcome is uncertain. Methods and Results This is an exploratory analysis of the TICH‐2 (Tranexamic Acid in Intracerebral Hemorrhage‐2) double‐blind, randomized, placebo‐controlled trial, which studied the efficacy of tranexamic acid in patients with spontaneous ICH within 8 hours of onset. Multivariable logistic regression and ordinal regression were performed to explore the relationship between pre‐ICH antiplatelet therapy, and 24‐hour hematoma expansion and day 90 modified Rankin Scale score, as well as the effect of tranexamic acid. Of 2325 patients, 611 (26.3%) had pre‐ICH antiplatelet therapy. They were older (mean age, 75.7 versus 66.5 years), more likely to have ischemic heart disease (25.4% versus 2.7%), ischemic stroke (36.2% versus 6.3%), intraventricular hemorrhage (40.2% versus 27.5%), and larger baseline hematoma volume (mean, 28.1 versus 22.6 mL) than the no‐antiplatelet group. Pre‐ICH antiplatelet therapy was associated with a significantly increased risk of hematoma expansion (adjusted odds ratio [OR], 1.28; 95% CI, 1.01–1.63), a shift toward unfavorable outcome in modified Rankin Scale (adjusted common OR, 1.58; 95% CI, 1.32–1.91) and a higher risk of death at day 90 (adjusted OR, 1.63; 95% CI, 1.25–2.11). Tranexamic acid reduced the risk of hematoma expansion in the overall patients with ICH (adjusted OR, 0.76; 95% CI, 0.62–0.93) and antiplatelet subgroup (adjusted OR, 0.61; 95% CI, 0.41–0.91) with no significant interaction between pre‐ICH antiplatelet therapy and tranexamic acid (P interaction=0.248). Conclusions Antiplatelet therapy is independently associated with hematoma expansion and unfavorable functional outcome. Tranexamic acid reduced hematoma expansion regardless of prior antiplatelet therapy use. Registration URL: https://www.isrctn.com; Unique identifier: ISRCTN93732214.
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Affiliation(s)
- Zhe Kang Law
- Stroke Trials Unit Division of Clinical Neuroscience University of Nottingham United Kingdom.,Department of Medicine National University of Malaysia Kuala Lumpur Malaysia
| | - Michael Desborough
- Haemophilia and Thrombosis Centre Guy's and St Thomas' NHS Foundation Trust London United Kingdom
| | - Ian Roberts
- Clinical Trials Unit London School of Hygiene & Tropical Medicine London United Kingdom
| | | | - Timothy J England
- Vascular Medicine Division of Medical Sciences & GEM Royal Derby Hospital CentreUniversity of Nottingham United Kingdom
| | - David J Werring
- Stroke Research Centre UCL Queen Square Institute of Neurology London United Kingdom
| | - Thompson Robinson
- Department of Cardiovascular Sciences and National Institute for Health Research Biomedical Research Centre University of Leicester United Kingdom
| | - Kailash Krishnan
- Nottingham University Hospitals NHS Trust Nottingham United Kingdom
| | - Robert Dineen
- Radiological Sciences University of Nottingham United Kingdom.,National Institute for Health Research Nottingham Biomedical Research Centre Nottingham United Kingdom
| | - Ann Charlotte Laska
- Department of Clinical Sciences Karolinska InstitutetDanderyd Hospital Sweden
| | - Nils Peters
- Neurology and Stroke Center Klinik Hirslanden Zürich Switzerland.,Neurology and Neurorehabilitation Unit University Center for Medicine of Aging Felix Platter-Hospital Basel Switzerland.,Department of Neurology and Stroke Center University Hospital Basel and University of Basel Switzerland
| | | | | | - Hanne Christensen
- Department of Neurology Bispebjerg Hospital and University of Copenhagen Denmark
| | - Christine Roffe
- Stroke Research Faculty of Medicine and Health Sciences Keele University Stoke-on-Trent United Kingdom
| | - Daniel Bereczki
- Department of Neurology Semmelweis University Budapest Hungary
| | - Serefnur Ozturk
- Department of Neurology Selcuk University Faculty of Medicine Konya Turkey
| | - Jegan Thanabalan
- Division of Neurosurgery Department of Surgery National University of Malaysia Kuala Lumpur Malaysia
| | - Rónán Collins
- Tallaght University Hospital Dublin Republic of Ireland
| | - Maia Beridze
- The First University Clinic of Tbilisi State Medical University Tbilisi Georgia
| | - Philip M Bath
- Stroke Trials Unit Division of Clinical Neuroscience University of Nottingham United Kingdom.,Nottingham University Hospitals NHS Trust Nottingham United Kingdom
| | - Nikola Sprigg
- Stroke Trials Unit Division of Clinical Neuroscience University of Nottingham United Kingdom.,Nottingham University Hospitals NHS Trust Nottingham United Kingdom
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Martín-Villen L, Ruiz de Azúa-López Z, Revuelto-Rey J, Aldabó-Pallás T, Alonso-Gil M, Egea-Guerrero JJ. Public-private collaboration in Seville as a strategy to expand organ and tissue donors: Think there is no box. Med Intensiva 2021; 46:S0210-5691(20)30398-3. [PMID: 33509645 DOI: 10.1016/j.medin.2020.12.002] [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: 12/07/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/24/2022]
Affiliation(s)
- L Martín-Villen
- Medicina Intensiva, HU Virgen del Rocío, Sevilla, España; Coordinación Sectorial Trasplantes de Sevilla y Huelva, España
| | - Z Ruiz de Azúa-López
- Medicina Intensiva, HU Virgen del Rocío, Sevilla, España; Coordinación Sectorial Trasplantes de Sevilla y Huelva, España
| | - J Revuelto-Rey
- Coordinación Sectorial Trasplantes de Sevilla y Huelva, España; Medicina Intensiva, HU Puerta del Mar, Cádiz, España
| | - T Aldabó-Pallás
- Coordinación Sectorial Trasplantes de Sevilla y Huelva, España; Medicina Intensiva, HU Puerta del Mar, Cádiz, España
| | - M Alonso-Gil
- Coordinación Autonómica de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J J Egea-Guerrero
- Medicina Intensiva, HU Virgen del Rocío, Sevilla, España; Coordinación Autonómica de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España; IBiS/CSIC Universidad de Sevilla, Sevilla, España.
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11
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Mesa Galán LA, Henríquez Recine MA, Robles Caballero A, Yus Teruel S, García Martínez JR, Egea-Guerrero JJ, Quintana-Diaz M. Ultrasound diagnosis of Terson syndrome as an indicator of extreme severity in neurocritical care patients. Neurologia 2020; 38:S0213-4853(20)30219-X. [PMID: 32912744 DOI: 10.1016/j.nrl.2020.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/18/2020] [Accepted: 04/25/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Terson syndrome (TS) is defined as any intraocular haemorrhage identified in patients with acute intracranial pathology. TS appears to be associated with clinical severity in patients with subarachnoid haemorrhage (SAH), but the association is yet to be defined in patients with traumatic brain injury (TBI) and intracerebral haemorrhage (ICH). This study aimed to evaluate the diagnostic performance of ocular ultrasound (OU) and its usefulness in clinical practice. MATERIAL AND METHODS We performed an observational, prospective, single-centre study of neurocritical care patients. We analysed cases and controls, defined according to indirect ophthalmoscopy (IO) and OU findings. We determined the diagnostic characteristics of OU. A multivariate analysis was performed to identify clinically relevant associations. RESULTS The sample included 91 patients diagnosed with ICH (41.76%), SAH (29.67%), and TBI (28.57%). TS was identified by OU in 8 patients (8.79%) and by IO in 24 (24.37%). The adjusted mortality rate in patients with TS showed an odds ratio (OR) of 4.15 (95% confidence interval [CI], 1.52-11.33). All patients with TS detected by OU presented Glasgow Coma Scale scores < 9, with an elevated risk of needing decompressive craniectomy (OR: 9.84; 95% CI, 1.64-59). OU presented an overall sensitivity of 30.43%, specificity of 98.53%, and diagnostic accuracy of 81.32%. For the detection of vitreous haemorrhage, sensitivity and specificity were 87.5% and 98.5%, respectively. CONCLUSIONS OU diagnosis of TS identifies extremely critical patients, who may require the highest level of care; TS is an independent risk factor for in-hospital mortality.
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Affiliation(s)
- L A Mesa Galán
- Servicio de Medicina Intensiva. Hospital Universitario La Paz, Madrid, España.
| | | | - A Robles Caballero
- Servicio de Medicina Intensiva. Hospital Universitario La Paz, Madrid, España
| | - S Yus Teruel
- Servicio de Medicina Intensiva. Hospital Universitario La Paz, Madrid, España
| | | | - J J Egea-Guerrero
- Servicio de Medicina Intensiva. Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Quintana-Diaz
- Servicio de Medicina Intensiva. Hospital Universitario La Paz, Madrid, España
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12
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Martin-Villen L, Cabeza-Cabeza F, Egea-Guerrero JJ. Intensivist or transplant coordinator: It makes no difference. Med Intensiva 2019; 44:62-63. [PMID: 31668750 DOI: 10.1016/j.medin.2019.07.016] [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: 04/13/2019] [Revised: 07/20/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- L Martin-Villen
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España; Coordinación Sectorial de Trasplantes de Sevilla-Huelva, Consejería de Salud y Familias.
| | - F Cabeza-Cabeza
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Juan Ramón Jiménez, Huelva, España; Coordinación Sectorial de Trasplantes de Sevilla-Huelva, Consejería de Salud y Familias
| | - J J Egea-Guerrero
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España; Coordinación Autonómica de Trasplantes de Andalucía, Consejería de Salud y Familias
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Egea-Guerrero JJ, Carmona G, Correa E, Mata R, Arias-Santiago S, Alaminos M, Gacto P, Cuende N. Transplant of Tissue-Engineered Artificial Autologous Human Skin in Andalusia: An Example of Coordination and Institutional Collaboration. Transplant Proc 2019; 51:3047-3050. [PMID: 31627920 DOI: 10.1016/j.transproceed.2019.08.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A new model of tissue-engineered artificial autologous human skin developed in Andalusia is currently being transplanted into patients suffering from large burns within the Andalusian Public Healthcare System. This product is considered an advanced therapy medicinal product (ATMP) in Europe, and its clinical use implies meeting transplant and medicinal product legal requirements, being the Guidelines of Good Manufacturing Practice for ATMPs of particular importance. The preclinical research and clinical translation of the product have represented a technical, regulatory, and organizational challenge, which has taken 10 years since the first preclinical experiments were designed. Twelve patients with large burns, including 3 pediatric patients, have hitherto received artificial autologous skin grafts with an overall survival rate of 75% and positive clinical, homeostatic, and histologic results. Achieving such a milestone within our Healthcare System was possible through a multidisciplinary approach and the joint efforts of multiple publicly funded institutions and units under the coordination of the Andalusian Initiative for Advanced Therapies. In this article, we present the organizational model set up to facilitate collaboration and logistics among the professionals involved, totaling more than 80 people. The similarities between the tissue-engineered artificial autologous human skin transplant and other organ and tissue transplants, in terms of logistic requirements, reveal how regional and hospital transplant coordination have played a crucial role.
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Affiliation(s)
| | - Gloria Carmona
- Andalusian Initiative for Advanced Therapies (AIAT), Junta de Andalucía, Seville, Spain; PhD Program in Biomedicine, Escuela de Posgrado, University of Granada, Granada, Spain
| | - Elena Correa
- Hospital Transplant Coordination, University Hospital Virgen del Rocío, Seville, Spain
| | - Rosario Mata
- Andalusian Initiative for Advanced Therapies (AIAT), Junta de Andalucía, Seville, Spain
| | - Salvador Arias-Santiago
- Cell Production and Tissue Engineering Unit, AIAT's GMP Network, University Hospital Virgen de las Nieves, Granada, Spain; Dermatology Department, University Hospital Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
| | - Miguel Alaminos
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain; Tissue Engineering Group, Histology Department, University of Granada, Spain
| | | | - Natividad Cuende
- Andalusian Transplant Coordination, Servicio Andaluz de Salud, Seville, Spain; Andalusian Initiative for Advanced Therapies (AIAT), Junta de Andalucía, Seville, Spain.
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14
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Daga-Ruiz D, Perez-Villares JM, Martín-Villén L, Egea-Guerrero JJ. The right to become an organ and tissue donor at the end of life of critically ill patient. Med Intensiva 2019; 44:59-60. [PMID: 30665688 DOI: 10.1016/j.medin.2018.11.005] [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: 11/10/2018] [Accepted: 11/13/2018] [Indexed: 11/19/2022]
Affiliation(s)
- D Daga-Ruiz
- Coordinación Autonómica de Trasplantes de Andalucía, Servicio Andaluz de Salud, Hospitales Universitarios: Regional de Málaga, Virgen de las Nieves de Granada y Virgen del Rocío de Sevilla, Málaga, España.
| | - J M Perez-Villares
- Coordinación Autonómica de Trasplantes de Andalucía, Servicio Andaluz de Salud, Hospitales Universitarios: Regional de Málaga, Virgen de las Nieves de Granada y Virgen del Rocío de Sevilla, Málaga, España
| | - L Martín-Villén
- Coordinación Autonómica de Trasplantes de Andalucía, Servicio Andaluz de Salud, Hospitales Universitarios: Regional de Málaga, Virgen de las Nieves de Granada y Virgen del Rocío de Sevilla, Málaga, España
| | - J J Egea-Guerrero
- Coordinación Autonómica de Trasplantes de Andalucía, Servicio Andaluz de Salud, Hospitales Universitarios: Regional de Málaga, Virgen de las Nieves de Granada y Virgen del Rocío de Sevilla, Málaga, España
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15
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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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16
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Naranjo-Izurieta JR, Ruiz de Azúa-López Z, Lameirao J, Martín-Villén L, Roldán-Reina A, Porras-López M, Rodríguez-Rodríguez A, Egea-Guerrero JJ. Orthotopic Liver Transplantation: Preliminary Analysis of Complications With Grafts From Elderly Donors. Transplant Proc 2018; 50:644-645. [PMID: 29579876 DOI: 10.1016/j.transproceed.2017.12.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aims to determine if donor grafts of patients older than 65 years develop more post-transplantation complications than those of younger patients. DESIGN This is a retrospective, observational study of liver transplant recipients during 12 months in Virgen del Rocio University Hospital. We compare incidence rates of reperfusion syndrome, acute kidney injury, and need for intra- and postoperative red blood cell transfusions in two donor age groups in which group A is <65 years old and group B is ≥65 years old. RESULTS Sixty cases were included. Reperfusion syndrome, acute kidney injury, and both intra- and postoperative red blood cell transfusion were more frequent in group A than group B (11.4% vs. 4%, P = .390; 44% vs. 32%, P = .423; 68.8% vs. 48%, P = .120; and 70.6% vs. 64%, P = .779, respectively). Six recipients (17.1%) died at 12 months from group A whereas there were no deaths register in group B during that time (P = .036). CONCLUSION Our results showed that including elderly donors does not aggravate incidence of complications, emphasizing that advanced age should not be an exclusion criteria for liver transplantation.
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Affiliation(s)
- J R Naranjo-Izurieta
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain.
| | - Z Ruiz de Azúa-López
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain; Intrahospital Transplant Coordination, University Hospital Virgen del Rocío, Seville, Spain
| | - J Lameirao
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain
| | - L Martín-Villén
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain; Intrahospital Transplant Coordination, University Hospital Virgen del Rocío, Seville, Spain
| | - A Roldán-Reina
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain
| | - M Porras-López
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain
| | - A Rodríguez-Rodríguez
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain
| | - J J Egea-Guerrero
- Management Unit of Critical Care, University Hospital Virgen del Rocío, Seville, Spain; Sectorial Coordination of Transplants, Sevilla-Huelva, Sevilla, Spain
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17
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Rocchetti NS, Egea-Guerrero JJ, Ruiz de Azua-Lopez Z, Martin-Villen L, Rodriguez-Rodriguez A, Vilches-Arenas A, Correa-Chamorro E, Settecase CJ, Bagilet DH. [APACHE II and SAPS II as predictors of brain death development in neurocritical care patients]. Rev Neurol 2018; 67:121-128. [PMID: 30039839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To assess the prognostic value of APACHE II and SAPS II scales to predict brain death evolution of neurocritical care patients. PATIENTS AND METHODS Retrospective observational study performed in a tertiary hospital. Include 508 patients over 16 years old, hospitalized in ICU for at least 24 hours. The variables of interest were: demographic data, risk factors, APACHE II, SAPS II and outcome. RESULTS Median age: 41 years old (IR: 25-57). Males: 76.2%. Most frequent reason for admission: trauma (55.3%). Medians: Glasgow Coma Scale (GCS), 10 points; APACHE II, 13 points; SAPS II, 31 points; and ICU stay, 5 days. Mortality in the ICU was 28.5% (n = 145) of whom 44 (8.7%) evolved to brain death. Univariate logistic regression analysis showed that GCS, APACHE II and SAPS II scores, as well as ICU stay days behaved as predictors of brain death evolution. However, the multivariate analysis performed including APACHE II and SAPS II scores showed that only APACHE II maintained statistical significance, despite the good discrimination of both scores. CONCLUSION Transplant coordinators might use the APACHE II score as a tool to detect patients at risk of progression to brain death, minimizing the loss of potential donors.
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Affiliation(s)
| | - J J Egea-Guerrero
- Universidad de Sevilla, Sevilla, Espana
- Hospital Universitario Virgen del Rocio, Sevilla, Espana
| | | | | | | | | | | | | | - D H Bagilet
- Hospital Eva Peron, Granadero Baigorria, Argentina
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18
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Sprigg N, Flaherty K, Appleton JP, Al-Shahi Salman R, Bereczki D, Beridze M, Christensen H, Ciccone A, Collins R, Czlonkowska A, Dineen RA, Duley L, Egea-Guerrero JJ, England TJ, Krishnan K, Laska AC, Law ZK, Ozturk S, Pocock SJ, Roberts I, Robinson TG, Roffe C, Seiffge D, Scutt P, Thanabalan J, Werring D, Whynes D, Bath PM. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet 2018; 391:2107-2115. [PMID: 29778325 PMCID: PMC5976950 DOI: 10.1016/s0140-6736(18)31033-x] [Citation(s) in RCA: 252] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/19/2018] [Accepted: 04/30/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tranexamic acid can prevent death due to bleeding after trauma and post-partum haemorrhage. We aimed to assess whether tranexamic acid reduces haematoma expansion and improves outcome in adults with stroke due to intracerebral haemorrhage. METHODS We did an international, randomised placebo-controlled trial in adults with intracerebral haemorrhage from acute stroke units at 124 hospital sites in 12 countries. Participants were randomly assigned (1:1) to receive 1 g intravenous tranexamic acid bolus followed by an 8 h infusion of 1 g tranexamic acid or a matching placebo, within 8 h of symptom onset. Randomisation was done centrally in real time via a secure website, with stratification by country and minimisation on key prognostic factors. Treatment allocation was concealed from patients, outcome assessors, and all other health-care workers involved in the trial. The primary outcome was functional status at day 90, measured by shift in the modified Rankin Scale, using ordinal logistic regression with adjustment for stratification and minimisation criteria. All analyses were done on an intention-to-treat basis. This trial is registered with the ISRCTN registry, number ISRCTN93732214. FINDINGS We recruited 2325 participants between March 1, 2013, and Sept 30, 2017. 1161 patients received tranexamic acid and 1164 received placebo; the treatment groups were well balanced at baseline. The primary outcome was assessed for 2307 (99%) participants. The primary outcome, functional status at day 90, did not differ significantly between the groups (adjusted odds ratio [aOR] 0·88, 95% CI 0·76-1·03, p=0·11). Although there were fewer deaths by day 7 in the tranexamic acid group (101 [9%] deaths in the tranexamic acid group vs 123 [11%] deaths in the placebo group; aOR 0·73, 0·53-0·99, p=0·0406), there was no difference in case fatality at 90 days (250 [22%] vs 249 [21%]; adjusted hazard ratio 0·92, 95% CI 0·77-1·10, p=0·37). Fewer patients had serious adverse events after tranexamic acid than after placebo by days 2 (379 [33%] patients vs 417 [36%] patients), 7 (456 [39%] vs 497 [43%]), and 90 (521 [45%] vs 556 [48%]). INTERPRETATION Functional status 90 days after intracerebral haemorrhage did not differ significantly between patients who received tranexamic acid and those who received placebo, despite a reduction in early deaths and serious adverse events. Larger randomised trials are needed to confirm or refute a clinically significant treatment effect. FUNDING National Institute of Health Research Health Technology Assessment Programme and Swiss Heart Foundation.
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Affiliation(s)
- Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham, UK; Stroke, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK.
| | - Katie Flaherty
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Jason P Appleton
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham, UK
| | | | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Maia Beridze
- The First University Clinic of Tbilisi State Medical University, Tbilisi, Georgia
| | - Hanne Christensen
- Department of Neurology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alfonso Ciccone
- Neurology Unit, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Ronan Collins
- Stroke Service, Adelaide and Meath Hospital, Tallaght, Ireland
| | - Anna Czlonkowska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Robert A Dineen
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queens Medical Centre Campus, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Juan Jose Egea-Guerrero
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Consejo Superior de Investigaciones Científicas, Universidad de Sevilla, Seville, Spain
| | - Timothy J England
- Vascular Medicine, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - Kailash Krishnan
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham, UK; Stroke, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - Ann Charlotte Laska
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Zhe Kang Law
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham, UK; Stroke, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK; Department of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Serefnur Ozturk
- Department of Neurology, Selcuk University Medical Faculty, Konya, Turkey
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Christine Roffe
- Stroke Research, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - David Seiffge
- Stroke Center, Neurology and Department of Clinical Research, University Hospital, University Basel, Basel, Switzerland
| | - Polly Scutt
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Jegan Thanabalan
- Division of Neurosurgery, Department of Surgery, National University of Malaysia, Kuala Lumpur, Malaysia
| | - David Werring
- Stroke Research Centre, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - David Whynes
- School of Economics, University of Nottingham, University Park, Nottingham, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham, UK; Stroke, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
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Gil-Salazar T, Egea-Guerrero JJ, Martin-Villen L, Ruiz de Azua-López Z. Organ donor management: Common recommendations that deserve evidence. Med Intensiva 2018; 42:513. [PMID: 29622462 DOI: 10.1016/j.medin.2018.02.011] [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: 02/15/2018] [Accepted: 02/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- T Gil-Salazar
- Unidad de Trasplantes, Fundación Valle Del Lili, Cali, Valle del Cauca, Colombia
| | - J J Egea-Guerrero
- Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, España.
| | - L Martin-Villen
- Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, España
| | - Z Ruiz de Azua-López
- Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, España
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20
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Toapanta Gaibor NG, González-Roncero FM, Cintra Cabrera M, Suñer Poblet M, Bernal Blanco G, Suarez Benjumea A, Pérez-Valdivia MA, Egea-Guerrero JJ, Rocha Castilla JL, Gentil Govantes MA. Survival and Evolution of Renal Function in Kidney Transplant Recipients From Type II Asystolic Donations: A Single-center Experience. Transplant Proc 2018; 50:565-568. [PMID: 29579853 DOI: 10.1016/j.transproceed.2017.11.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/19/2017] [Accepted: 11/11/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND In recent years, stagnation in the number of kidneys from after brain-dead donors (DBD) has stimulated the use of non-heart beating donors (NHBDs). Herein we present our 5-year experience with type II Maastricht NHBDs in renal transplantation. METHODS All patients (n = 50) in this study received type II Maastricht NHBD kidneys (March 2012 to February 2017), with a median follow-up of 33 months. RESULTS Mean donor age was 39 ± 12 years, mean creatinine 1.24 ± 0.2 mg/dL, and the most frequently observed blood group (donors and recipients) was type A (64%). Recipients were slightly younger (51 ± 11 years old), with mean time on dialysis of 30 ± 24 months. Almost all were primary transplants. Pre-transplant panel-reactive antibodies (PRA) were <25%; initial immunosuppression was thymoglobulin, corticosteroids, mycophenolate mofetil, and delayed introduction of tacrolimus. Six percent were nonfunctioning kidneys; 79.6% presented with delayed renal function (mean duration 14 ± 9 days). Acute rejection was seen in 6% of patients. Mean creatinine at month 3 was 1.7 ± 0.8 mg/dL, and 1.5 ± 0.8 mg/dL in the first year. The last available mean creatinine was 1.54 ± 0.7 mg/dL. Proteinuria in the third month, first year, and third year was 0.70, 0.41, and 0.26 g/d, respectively. Recipient survival at the first, third, and fifth year was 100%, 100%, and 86%, and when graft-censored for death was 94%, 91%, and 91%, respectively. The incidence of acute rejection during first year was 6%, and 2% in the second year. Exitus incidence was 4% and cytomegalovirus infection was 21.3%. BK viremia between 1000 and 10,000 copies/mL was seen in 4.3%, and reached >10,000 copies/mL in 2.1%. CONCLUSIONS Type II NHBD has shown limited frequency of nonfunctioning kidney and high functional delay. The results in survival and renal function are very acceptable, comparable with levels seen in donation after brain death.
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Affiliation(s)
- N G Toapanta Gaibor
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain.
| | | | - M Cintra Cabrera
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - M Suñer Poblet
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - G Bernal Blanco
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - A Suarez Benjumea
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - M A Pérez-Valdivia
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - J J Egea-Guerrero
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - J L Rocha Castilla
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - M A Gentil Govantes
- Department of Nephrology, Virgen del Rocío University Hospital, Seville, Spain
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21
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Egea-Guerrero JJ, Martín-Villén L, Ruiz de Azúa-López Zaida Z, Bonilla-Quintero Francisco F, Pérez-López Enrique E, Marín-Andrés R, Correa-Chamorro E, Vilches-Arenas Á. Short-term Results From a Training Program to Improve Organ Donation in Uncontrolled Donation After Circulatory Death. Transplant Proc 2018; 50:530-532. [PMID: 29579843 DOI: 10.1016/j.transproceed.2017.09.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/21/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In all organ transplantation programs, election of the proper protocol relies primarily on the professionals involved in the detection of potential donors. The objective of our study was to assess the impact of a series of prehospital training sessions, as well as to develop several positive feedback strategies within the uncontrolled organ donation after circulatory death (uDCD) program in our city. METHODS A before-after intervention study was carried out in 3 steps. First, professionals enrolled in the Emergency Health Services Agency-061 (EPES-061) program underwent specific training to identify potential donors. Second, a specific logotype was designed to alert emergency health care professionals that in cases where cardiopulmonary resuscitation was ineffective and after treatment of all potentially reversible causes, the "chain of survival" should be considered a "chain of opportunities." Third, a positive feedback strategy was put in place, whereby each time a donation was procured, the EPES-061 personnel that had identified the potential donor were notified by phone and in a personal letter. RESULTS The mean age for donors was 50.5 years of age (interquartile range 37-52.5), and 89.5% of all donations came from male subjects. Positive feedback letters and phone calls, including information on final outcome, were provided to the appropriate personnel in 100% of the cases. Postintervention information showed an increase in both eligible and utilized donors. CONCLUSIONS Interventions outside the hospital setting that facilitate optimal implementation of the uDCD program are an essential part of this strategy to increase the donor pool and make the wait shorter for transplant patients.
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Affiliation(s)
- J J Egea-Guerrero
- Donation and Transplantation Programs Department, H.U. Virgen del Rocío, Seville, Spain; Instituto de Biomedicina (IBiS)/CSIC/University of Seville, Seville, Spain.
| | - L Martín-Villén
- Donation and Transplantation Programs Department, H.U. Virgen del Rocío, Seville, Spain
| | - Z Ruiz de Azúa-López Zaida
- Donation and Transplantation Programs Department, H.U. Virgen del Rocío, Seville, Spain; Instituto de Biomedicina (IBiS)/CSIC/University of Seville, Seville, Spain
| | | | | | | | - E Correa-Chamorro
- Donation and Transplantation Programs Department, H.U. Virgen del Rocío, Seville, Spain
| | - Á Vilches-Arenas
- Instituto de Biomedicina (IBiS)/CSIC/University of Seville, Seville, Spain; Department of Public Health and Preventive Medicine, University of Seville, Seville, Spain
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22
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Roldán-Reina AJ, Martín-Villén L, Palomo-López N, Hannon V, Cuenca-Apolo DX, Adriaensens-Pérez M, Porras-López M, Ruiz de Azúa-López Z, Corcia-Palomo Y, Egea-Guerrero JJ. Living Donor in Renal Transplantation: Minimizing Risks. Transplant Proc 2018; 50:543-545. [PMID: 29579847 DOI: 10.1016/j.transproceed.2017.11.049] [Citation(s) in RCA: 4] [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] [Received: 07/15/2017] [Revised: 10/21/2017] [Accepted: 11/11/2017] [Indexed: 11/29/2022]
Abstract
In recent years, the broadening of indications for renal transplantation, together with the progressive reduction of donations following brain stem death, has led to living donation being considered in increasing numbers of cases for renal transplantation. To investigate this further, it is necessary to assess the impact it has on the postoperative outcomes in the intensive care unit (ICU). Our group conducted a retrospective, observational, single-center study from 2013 to 2016 to evaluate differences in outcomes between living and cadaveric kidney donation both during ICU admission and total hospitalization. We compared differences in characteristics between living and deceased graft recipients including demographics, comorbidities, analytical data, radioisotope imaging test results, complications, ICU and hospital ward length of stay, and mortality. In all, 387 patients were eligible for analysis, and 13% received living donor grafts. Our results demonstrate that this group had significantly fewer complications, shorter length of hospital stay, and reduced mortality in comparison with recipients of cadaveric donor grafts. The better postoperative outcomes from living donor grafts could result from careful selection of the donor and less inflammatory injury, minimizing risk in the postoperative period.
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Affiliation(s)
- A J Roldán-Reina
- Intensive Care Unit, Virgen del Rocío University Hospital, Seville, Spain.
| | | | - N Palomo-López
- Intensive Care Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - V Hannon
- Intensive Care Unit, The Royal Free Hospital, London, UK
| | - D X Cuenca-Apolo
- Intensive Care Unit, Virgen del Rocío University Hospital, Seville, Spain
| | | | - M Porras-López
- Intensive Care Unit, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Y Corcia-Palomo
- Intensive Care Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - J J Egea-Guerrero
- Coordination of Transplants: Seville-Huelva Sector, Instituto de Biomedicina de Sevilla (IBiS), Consejo Superior de Investigaciones Científicas (CSIC), Seville University, Spain
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23
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Palomo-López N, Martín-Villén L, Roldán-Reina ÁJ, Ruiz de Azúa-López Z, Cuenca-Apolo DX, Adriaensens-Pérez M, Corcia-Palomo Y, Egea-Guerrero JJ. Results of Controlled Donation After Circulatory Death in a Third-Level Hospital. Transplant Proc 2018; 50:536-538. [PMID: 29579845 DOI: 10.1016/j.transproceed.2017.11.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/09/2017] [Accepted: 11/11/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the characteristics and evolution of controlled donation after circulatory death (DCD) type III. MATERIALS AND METHODS Observational and retrospective study of controlled DCD type III of donors conducted from 2014 to 2016. Clinical data, intensive care unit (ICU) stay, cause of death, warm ischemia time, and total time were collected. Delayed graft function (DGF) and survival of renal transplant were also registered. Qualitative variables are described as frequencies and absolute values and quantitative variables as medians and interquartile ranges. RESULTS A total of 21 donors were collected; 71% (15) were males, median age was 55 years (interquartile range [IR] 48-72), and median ICU stay was 7 days (IR 4-12). The main cause of death was anoxic encephalopathy (57%, 12), followed by intracerebral hemorrhage (28%, 6). In 48%, withdrawal of life support occurred in the operating room, and 98% of donors were preserved by abdominal super-rapid cannulation technique. Average warm ischemia time was 20 minutes (IR 16-24), and total ischemia time was 26 minutes (IR 23-34). Of the donations, 57% were livers and 90% were kidneys. Out of 42 kidneys donated, 54% (23) of them were valid. Median renal transplant hospital stay was 18 days (IR 6-24), and 46% develop DGF. Survival at discharge was 100%. CONCLUSION DCD type III ensures a source of organs. The main cause of death was anoxic encephalopathy. Most donors were able to donate some solid organ.
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Affiliation(s)
- N Palomo-López
- Intensive Care Unit, University Hospital Virgen del Rocío, Sevilla, Spain.
| | - L Martín-Villén
- Transplant Coordinator Huelva-Sevilla, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Á J Roldán-Reina
- Intensive Care Unit, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Z Ruiz de Azúa-López
- Transplant Coordinator Huelva-Sevilla, University Hospital Virgen del Rocío, Sevilla, Spain
| | - D X Cuenca-Apolo
- Intensive Care Unit, University Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Y Corcia-Palomo
- Intensive Care Unit, University Hospital Virgen del Rocío, Sevilla, Spain
| | - J J Egea-Guerrero
- Transplant Coordinator Huelva-Sevilla, University Hospital Virgen del Rocío, Sevilla, Spain
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24
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Fernandez-Maza L, Egea-Guerrero JJ, Balcerzyk M, Civantos-Jubera G, Gordillo-Escobar E, Vilches-Arenas A, Fernandez-Gomez I, Parrado-Gallego A, Murillo-Cabezas F. Rapid and simplified synthesis of [ 18 F]Fluoromisonidazole and its use in PET imaging in an experimental model of subarachnoid hemorrhage. Appl Radiat Isot 2018; 132:79-84. [DOI: 10.1016/j.apradiso.2017.09.035] [Citation(s) in RCA: 5] [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: 03/13/2017] [Revised: 08/28/2017] [Accepted: 09/22/2017] [Indexed: 01/08/2023]
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25
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Roldán-Reina AJ, Egea-Guerrero JJ, Palomo-López N, Cuenca-Apolo DX, Adriaensens-Pérez M, Martín-Villén L. Kidney transplantation in the Intensive Care Unit: Graft evaluation using imaging tests. Med Intensiva 2017; 43:384-386. [PMID: 29110916 DOI: 10.1016/j.medin.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/20/2017] [Accepted: 09/04/2017] [Indexed: 11/19/2022]
Affiliation(s)
- A J Roldán-Reina
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - J J Egea-Guerrero
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España; Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España; IBiS-CSIC-Universidad de Sevilla, Sevilla, España
| | - N Palomo-López
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - D X Cuenca-Apolo
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Adriaensens-Pérez
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - L Martín-Villén
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España; Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
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26
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Affiliation(s)
- Z Ruiz de Azúa-López
- Coordinación Intrahospitalaria de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - L Martín-Villén
- Coordinación Intrahospitalaria de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J J Egea-Guerrero
- Coordinación Intrahospitalaria de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España; Coordinación Sectorial de Trasplantes Sevilla-Huelva, España
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27
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de-Bonilla-Damiá Á, Fernández-López R, Capote-Huelva FJ, de la Cruz-Vicente F, Egea-Guerrero JJ, Borrego-Dorado I. Role of 18F-FDG PET/CT in primary brain lymphoma. Rev Esp Med Nucl Imagen Mol 2017; 36:298-303. [PMID: 28438519 DOI: 10.1016/j.remn.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/02/2017] [Accepted: 03/15/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To study the usefulness of 18F-FDG PET/CT in the initial evaluation and in the response assessment in primary brain lymphoma. MATERIAL AND METHODS A retrospective analysis was carried out on 18 patients diagnosed with primary brain lymphoma, a histological subtype of diffuse large B-cell lymphoma, on whom an initial 18F-FDG PET/CT and MRI was performed, with 7 of the cases being analysed after the completion of treatment in order to assess response and clinical follow up. RESULTS Initial 18F-FDG PET/CT showed 26 hypermetabolic foci, whereas 46 lesions were detected by MRI. The average SUV maximum of the lesions was 17.56 with T/N 3.55. The concordance of both tests for identifying the same number of lesions was moderate, obtaining a kappa index of 0.395 (P<.001). In the evaluation of treatment, MRI identified 16 lesions compared to 7 pathological accumulations observed by 18F-FDG PET/CT. The concordance of both tests to assess type of response to treatment was moderate (kappa index 0.41) (P=.04). In both the initial evaluation and the assessment of the response to treatment, PET/CT led to a change strategy in 22% of patients who had lesions outside the cerebral parenchyma. CONCLUSIONS MRI appears to be the method of choice for detecting brain disease in patients with primary brain lymphoma, whereas 18F-FDG PET/CT seems to play a relevant role in the assessment of extra-cerebral disease.
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Affiliation(s)
- Á de-Bonilla-Damiá
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - R Fernández-López
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F J Capote-Huelva
- Unidad de Gestión Clínica de Hematología y Hemoterapia, Hospital Universitario Puerta del Mar, Cádiz, España
| | - F de la Cruz-Vicente
- Unidad de Gestión Clínica de Hematología y Hemoterapia, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J J Egea-Guerrero
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, IBiS, CSIC, Universidad de Sevilla, Sevilla, España
| | - I Borrego-Dorado
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
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28
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Muñoz-Sánchez MÁ, Rodríguez-Rodríguez A, Egea-Guerrero JJ, Gordillo-Escobar E, Vilches-Arenas Á, Carrillo-Vico A, Guerrero JM, Murillo-Cabezas F. Urotensinergic system genes in experimental subarachnoid hemorrhage. Med Intensiva 2017; 41:468-474. [PMID: 28081921 DOI: 10.1016/j.medin.2016.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/14/2016] [Accepted: 10/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cerebral vasospasm, one of the main complications of subarachnoid hemorrhage (SAH), is characterized by arterial constriction and mainly occurs from day 4 until the second week after the event. Urotensin-II (U-II) has been described as the most potent vasoconstrictor peptide in mammals. An analysis is made of the serum U-II concentrations and mRNA expression levels of U-II, urotensin related peptide (URP) and urotensin receptor (UT) genes in an experimental murine model of SAH. DESIGN An experimental study was carried out. SETTING Experimental operating room of the Biomedicine Institute of Seville (IBiS), Virgen del Rocío University Hospital (Seville, Spain). PARTICIPANTS 96 Wistar rats: 74 SAH and 22 sham intervention animals. INTERVENTIONS Day 1: blood sampling, followed by the percutaneous injection of 100μl saline (sham) or blood (SAH) into the subarachnoid space. Day 5: blood sampling, followed by sacrifice of the animals. MAIN VARIABLES OF INTEREST Weight, early mortality, serum U-II levels, mRNA values for U-II, URP and UT. RESULTS Serum U-II levels increased in the SAH group from day 1 (0.62pg/mL [IQR 0.36-1.08]) to day 5 (0.74pg/mL [IQR 0.39-1.43]) (p<0.05), though not in the sham group (0.56pg/mL [IQR 0.06-0.83] day 1; 0.37pg/mL [IQR 0.23-0.62] day 5; p=0.959). Between-group differences were found on day 5 (p<0.05). The ROC analysis showed that the day 5 serum U-II levels (AUC=0.691), URP mRNA (AUC=0.706) and UT mRNA (AUC=0.713) could discriminate between sham and SAH rats. The normal serum U-II concentration range in rats was 0.56pg/mL (IQR 0.06-0.83). CONCLUSION The urotensinergic system is upregulated on day 5 in an experimental model of SAH.
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MESH Headings
- Animals
- Biomarkers
- Disease Models, Animal
- Gene Expression Regulation
- Peptide Hormones/biosynthesis
- Peptide Hormones/blood
- Peptide Hormones/genetics
- RNA, Messenger/biosynthesis
- RNA, Messenger/blood
- RNA, Messenger/genetics
- ROC Curve
- Rats
- Rats, Wistar
- Real-Time Polymerase Chain Reaction
- Receptors, G-Protein-Coupled/biosynthesis
- Receptors, G-Protein-Coupled/blood
- Receptors, G-Protein-Coupled/genetics
- Sensitivity and Specificity
- Subarachnoid Hemorrhage/complications
- Subarachnoid Hemorrhage/genetics
- Urotensins/biosynthesis
- Urotensins/blood
- Urotensins/genetics
- Vasoconstriction/genetics
- Vasospasm, Intracranial/etiology
- Vasospasm, Intracranial/genetics
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Affiliation(s)
- M Á Muñoz-Sánchez
- Servicio de Urgencias, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Spain
| | - A Rodríguez-Rodríguez
- Cuidados Críticos, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Spain.
| | - J J Egea-Guerrero
- Cuidados Críticos, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Spain
| | - E Gordillo-Escobar
- Cuidados Críticos, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Spain
| | - Á Vilches-Arenas
- Servicio de Medicina Preventiva y Salud Pública, Hospital Virgen Macarena, Universidad de Sevilla, Spain
| | - A Carrillo-Vico
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Departamento de Bioquimica Médica, Biología molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, Spain
| | - J M Guerrero
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Departamento de Bioquimica Médica, Biología molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, Spain
| | - F Murillo-Cabezas
- Cuidados Críticos, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Spain
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29
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Sprigg N, Robson K, Bath P, Dineen R, Roberts I, Robinson T, Roffe C, Werring D, Al-Shahi Salman R, Pocock S, Duley L, England T, Whynes D, Ciccone A, Laska AC, Christensen H, Ozturk S, Collins R, Bereczki D, Egea-Guerrero JJ, Law ZK, Czlonkowska A, Seiffge D, Beredzie M. Intravenous tranexamic acid for hyperacute primary intracerebral hemorrhage: Protocol for a randomized, placebo-controlled trial. Int J Stroke 2016; 11:683-94. [PMID: 27048694 DOI: 10.1177/1747493016641960] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/14/2016] [Indexed: 11/15/2022]
Abstract
RATIONALE Outcome after intracerebral hemorrhage remains poor. Tranexamic acid is easy to administer, readily available, inexpensive, and effective in other hemorrhagic conditions. AIM This randomized trial aims to test the hypothesis that intravenous tranexamic acid given within 8 h of spontaneous intracerebral hemorrhage reduces death or dependency. DESIGN Phase III prospective double-blind randomized placebo-controlled trial. Participants within 8 h of spontaneous intracerebral hemorrhage are randomized to receive either intravenous tranexamic acid 1 g 10 min bolus followed by 1 g 8 h infusion, or placebo. SAMPLE SIZE ESTIMATES A trial of 2000 participants (300 from start-up phase and 1700 from main phase) will have 90% power to detect an ordinal shift of the modified Rankin Scale with odds ratio 0.79. STUDY OUTCOMES The primary outcome is death or dependency measured by ordinal shift analysis of the 7 level mRS at day 90. Secondary outcomes are neurological impairment at day 7 and disability, quality of life, cognition, and mood at day 90. Safety outcomes are death, serious adverse events, thromboembolic events, and seizures. Cost outcomes are length of stay in hospital, readmission, and institutionalization. DISCUSSION This pragmatic trial is assessing efficacy of tranexamic acid after spontaneous intracerebral hemorrhage. Recruitment started in 2013; as of 15th January 2016 1355 participants have been enrolled, from 95 centers in seven countries. Recruitment is due to end in 2017. TICH-2 Trial is registered as ISRCTN93732214.
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Affiliation(s)
- Nikola Sprigg
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | - Katie Robson
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | - Philip Bath
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | - Robert Dineen
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | - Ian Roberts
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | - Tom Robinson
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | | | - David Werring
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | | | - Stuart Pocock
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | - Lelia Duley
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | - Tim England
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | - David Whynes
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | | | | | | | | | - Ronan Collins
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | | | | | - Zhe Kang Law
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | | | - David Seiffge
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
| | - Maia Beredzie
- Stroke, Division of Clinical Neuroscience, Nottingham, UK
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30
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Egea-Guerrero JJ, Rodríguez-Rodríguez A. Sepsis biomarkers in severe burn patients: Cut-off point or time profile? Med Intensiva 2016; 40:595-596. [PMID: 27267774 DOI: 10.1016/j.medin.2016.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/04/2016] [Indexed: 11/17/2022]
Affiliation(s)
- J J Egea-Guerrero
- U.G.C. Cuidados Críticos y Urgencias, H.U. Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, Spain.
| | - A Rodríguez-Rodríguez
- U.G.C. Cuidados Críticos y Urgencias, H.U. Virgen del Rocío, IBiS/CSIC/Universidad de Sevilla, Sevilla, Spain
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31
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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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32
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Freire-Aragón MD, Martínez-Roldán A, Egea-Guerrero JJ, Rivera-Fernandez V. Fogging effect. Do we have in mind in early cerebral infarction following aneurysmal subarachnoid hemorrhage? Med Intensiva 2016; 40:590-592. [PMID: 27015788 DOI: 10.1016/j.medin.2016.01.009] [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: 11/03/2015] [Revised: 01/15/2016] [Accepted: 01/18/2016] [Indexed: 11/17/2022]
Affiliation(s)
- M D Freire-Aragón
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España
| | - A Martínez-Roldán
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España
| | - J J Egea-Guerrero
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España.
| | - V Rivera-Fernandez
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España
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33
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Revuelto-Rey J, Rosich-Andreu S, Egea-Guerrero JJ. Intracranial pressure and hypercapnia during the apnoea test for the diagnosis of brain death. Eur J Neurol 2016; 22:e84. [PMID: 26538271 DOI: 10.1111/ene.12786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 06/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J Revuelto-Rey
- Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
| | - S Rosich-Andreu
- Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
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34
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Rivera-Rubiales G, Garcia-Delgado H, Egea-Guerrero JJ. [Acute orolingual angioedema associated to recombinant human tissue plasminogen activator treatment]. Med Intensiva 2015; 39:585-6. [PMID: 26391737 DOI: 10.1016/j.medin.2015.07.012] [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: 07/02/2015] [Revised: 07/10/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Affiliation(s)
- G Rivera-Rubiales
- Unidad de Cuidados Neurocríticos, Hospital de Rehabilitación y Traumatología, Hospitales Universitarios Virgen del Rocío, Sevilla, España.
| | - H Garcia-Delgado
- Unidad de Cuidados Neurocríticos, Hospital de Rehabilitación y Traumatología, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - J J Egea-Guerrero
- Unidad de Cuidados Neurocríticos, Hospital de Rehabilitación y Traumatología, Hospitales Universitarios Virgen del Rocío, Sevilla, España
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Revuelto-Rey J, Aldabó-Pallás T, Correa-Chamorro EA, Gallego-Corpa AI, Martín-Villén L, Egea-Guerrero JJ. Intensive care medicine and organ donation. Beyond our usual frontiers. Med Intensiva 2015; 40:321. [PMID: 26054786 DOI: 10.1016/j.medin.2015.04.003] [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: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 11/24/2022]
Affiliation(s)
- J Revuelto-Rey
- Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, España.
| | - T Aldabó-Pallás
- Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - E A Correa-Chamorro
- Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A I Gallego-Corpa
- Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - L Martín-Villén
- Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J J Egea-Guerrero
- Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
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Fernández-Delgado E, Egea-Guerrero JJ, Freire-Aragón MD, Rivera-Fernández V, Durán-Martínez P. [Severe respiratory failure and neuromuscular blockade after administration of colimycin]. Med Intensiva 2015; 39:448-9. [PMID: 25583045 DOI: 10.1016/j.medin.2014.10.003] [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: 09/29/2014] [Revised: 10/22/2014] [Accepted: 10/29/2014] [Indexed: 11/16/2022]
Affiliation(s)
- E Fernández-Delgado
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - J J Egea-Guerrero
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M D Freire-Aragón
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - V Rivera-Fernández
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - P Durán-Martínez
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
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Bohórquez-López A, Gordillo-Escobar E, Egea-Guerrero JJ. [Acute spinal cord injury after severe electrical trauma]. Med Intensiva 2014; 39:383-4. [PMID: 25499905 DOI: 10.1016/j.medin.2014.09.005] [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: 09/03/2014] [Revised: 09/08/2014] [Accepted: 09/17/2014] [Indexed: 11/24/2022]
Affiliation(s)
- A Bohórquez-López
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - E Gordillo-Escobar
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España; IBIS/CSIC, Universidad de Sevilla, Sevilla, España
| | - J J Egea-Guerrero
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España; IBIS/CSIC, Universidad de Sevilla, Sevilla, España.
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Egea-Guerrero JJ, Quintana Díaz M. New oral anticoagulants in severe trauma patients: enemy at the gates? Med Intensiva 2014; 39:167-71. [PMID: 25510394 DOI: 10.1016/j.medin.2014.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 08/19/2014] [Accepted: 09/10/2014] [Indexed: 12/22/2022]
Abstract
The high incidence of trauma, especially in elderly people anticoagulated with new oral anticoagulants (NOAs), has become a major challenge, particularly in critical situations with life-threatening bleeding. Under these circumstances, urgent NOA reversion becomes mandatory. Prothrombin complex has become a frequent indication in critical situations in which rapid reversal of anticoagulation is needed and where the use of fresh frozen plasma is limited. This study offers our point of view regarding the usefulness of NOAs, not only in the prevention of cardioembolic events but also as regards their emergent reversion in cases of severe bleeding associated to trauma.
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Affiliation(s)
- J J Egea-Guerrero
- Unidad de Neurocríticos. Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Sevilla, España.
| | - M Quintana Díaz
- Departamento de Urgencias, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Unidad de Cuidados Intensivos, Hospital Universitario La Paz, IdiPAZ, Madrid, España
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39
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Ferrete-Araujo AM, Egea-Guerrero JJ, Vilches-Arenas Á, Godoy DA, Murillo-Cabezas F. Predictors of mortality and poor functional outcome in severe spontaneous intracerebral hemorrhage: a prospective observational study. Med Intensiva 2014; 39:422-32. [PMID: 25499725 DOI: 10.1016/j.medin.2014.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To analyze mortality and functional outcome in patients with severe spontaneous intracerebral hemorrhage (ICH), and identify the clinical characteristics, radiological findings and therapeutic procedures predictive of mortality in the Intensive Care Unit (ICU) and during hospitalization, as well as of poor functional results at 6 months. DESIGN A prospective, observational study was carried out. SETTING Neurocritical Care Unit of a university hospital. PATIENTS Patients diagnosed with ICH were included over a period of 23 months. VARIABLES OF INTEREST Demographic characteristics, cardiovascular risk factors, regular medication, laboratory test parameters, cranial CT findings, therapeutic procedures and outcome data. INTERVENTION None. RESULTS A total of 186 patients with ICH met the inclusion criteria. Surgery to evacuate ICH was performed in 25.8% of the patients. The mortality rate was 46.7%. The modified Rankin score at 6 months was 5 (RI: 4.6). Multivariate Cox regression analysis showed the presence of diabetes, prior anticoagulation, as well as APACHE II severity and the type of bleeding on the cranial CT scan to be predictors of mortality and poor functional outcomes. On the other hand, neurosurgical procedures and intracranial pressure (ICP) monitoring were associated with better outcomes. CONCLUSION The presence of comorbidities such as diabetes, or previous anticoagulation, as well as the CT findings were associated to poorer outcomes. In contrast, ICP monitoring and early neurosurgery were predictive of longer survival and better functional outcomes.
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Affiliation(s)
| | - J J Egea-Guerrero
- Unidad de Neurocríticos, H.U. Virgen del Rocío, Sevilla, España; Instituto de Biomedicina, IBiS/CSIC, Universidad de Sevilla, Sevilla, España.
| | - Á Vilches-Arenas
- Instituto de Biomedicina, IBiS/CSIC, Universidad de Sevilla, Sevilla, España; Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España
| | - D A Godoy
- Unidad de Cuidados Neurointensivos, Sanatorio Pasteur. Unidad de Terapia Intensiva, Hospital Interzonal de Agudos «San Juan Bautista», Catamarca, Argentina
| | - F Murillo-Cabezas
- Unidad de Neurocríticos, H.U. Virgen del Rocío, Sevilla, España; Instituto de Biomedicina, IBiS/CSIC, Universidad de Sevilla, Sevilla, España
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Egea-Guerrero JJ, Freire-Aragón MD, Serrano-Lázaro A, Quintana-Díaz M. Resuscitative goals and new strategies in severe trauma patient resuscitation. Med Intensiva 2014; 38:502-12. [PMID: 25241268 DOI: 10.1016/j.medin.2014.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 04/16/2014] [Revised: 06/03/2014] [Accepted: 06/16/2014] [Indexed: 11/17/2022]
Abstract
Traumatic injuries represent a major health problem all over the world. In recent years we have witnessed profound changes in the paradigm of severe trauma patient resuscitation, new concepts regarding acute coagulopathy in trauma have been proposed, and there has been an expansion of specific commercial products related to hemostasis, among other aspects. New strategies in severe trauma management include the early identification of those injuries that are life threatening and require surgical hemostasis, tolerance of moderate hypotension, rational intravascular volume replacement, prevention of hypothermia, correction of acidosis, optimization of oxygen carriers, and identification of those factors required by the patient (fresh frozen plasma, platelets, tranexamic acid, fibrinogen, cryoprecipitates and prothrombin complex). However, despite such advances, further evidence is required to improve survival rates in severe trauma patients.
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Affiliation(s)
- J J Egea-Guerrero
- Unidad de Neurocríticos. Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina (IBiS)/CSIC Universidad de Sevilla, Sevilla, España.
| | - M D Freire-Aragón
- Unidad de Neurocríticos. Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Serrano-Lázaro
- Unidad de Cuidados Intensivos, Hospital Clínico Universitario de Valencia, Valencia, España
| | - M Quintana-Díaz
- Unidad de Cuidados Intensivos, Hospital Universitario de La Paz, Madrid, España
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Egea-Guerrero JJ, Revuelto-Rey J, Gordillo-Escobar E, Rodríguez-Rodríguez A, Enamorado-Enamorado J, Ruiz de Azúa López Z, Aldabó-Pallás T, León-Justel A, Murillo-Cabezas F, Vilches-Arenas A. Serologic behavior of S100B protein in patients who are brain dead: preliminary results. Transplant Proc 2014; 45:3569-72. [PMID: 24314961 DOI: 10.1016/j.transproceed.2013.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this study is to assess the S100B protein serum concentrations from brain dead (BD) donors to understand whether its level could provide clinical information during BD diagnosis as a potential confirmatory test. METHODS During 12 months, 26 patients declared BD were prospectively included in this study. Once the diagnosis of BD was achieved, serum S100B protein levels were measured using an electrochemiluminescence assay. For analytical purposes, we selected the maximum S100B serum value reached during the first 5 days of evolution from a historical cohort of 124 survived patients after a severe brain injury (SBI), as well as from 18 healthy donors (HD) and a subgroup of patients who had severe traumatic brain injuries (TBIs) without extracranial injuries. RESULTS Mean age was 53.48 years (SD, 18.91 years). The BD group had significantly higher S100B serum levels (1.44 μg/L; interquartile ratio [IR], 0.63-3.68) than the SBI (0.34 μg/L; IR, 0.21-0.60) and HD groups (0.06 μg/L; IR, 0.03-0.07; P < .001). Analysis of S100B levels depending on the main cause responsible for BD development showed significant differences between subgroups (P = .012). S100B serum levels were higher in the isolated TBI BD group (P = .004). The S100B value showed an odds ratio for BD diagnosis of 8.38 (95% confidence interval [CI], 1.16-60.45; P = .035). Reciever operating characteristic analysis revealed an area under the curve of 0.92 (95% CI, 0.79-1.00; P = .007). We set a cut-off value of 2 μg/L in S100B serum concentrations. At this level, the diagnostic properties of S100B would reach 100% of specificity and positive predictive value (PPV), and sensitivity and negative predictive value (NPV) of 60% and 86.7%, respectively. CONCLUSION This preliminary analysis shows for the very first time that BD is associated with higher S100B serum levels, compared with other neurocritical care patients. We also found that the cause of BD development must be considered. Specifically, S100B serum levels in severe isolated TBI patients-with clinical exploration compatible with BD-could be used in a future as confirmatory test.
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Affiliation(s)
- J J Egea-Guerrero
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Spain.
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Egea-Guerrero JJ, Murillo-Cabezas F, Rodríguez-Rodríguez A, Gordillo-Escobar E, Revuelto-Rey J, Muñoz-Sánchez MA, León-Justel A, Vilches-Arenas A. [An experimental model of mass-type brain damage in the rat: expression of brain damage based on neurospecific enolase and protein S100B]. Med Intensiva 2013; 38:218-25. [PMID: 23786666 DOI: 10.1016/j.medin.2013.03.015] [Citation(s) in RCA: 9] [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: 01/14/2013] [Revised: 03/14/2013] [Accepted: 03/31/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine whether a model of transient mass-type brain damage (MTBD) in the rat produces early release of neurospecific enolase (NSE) and protein S100B in peripheral blood, as an expression of the induced brain injury. DESIGN An experimental study with a control group. SETTING Experimental operating room of the Institute of Biomedicine (IBiS) of Virgen del Rocío University Hospital (Seville, Spain). PARTICIPANTS Fourteen adult Wistar rats. INTERVENTIONS Blood was sampled at baseline, followed by: MTBD group, a trephine perforation was used to insert and inflate the balloon of a catheter at a rate of 500 μl/20 sec, followed by 4 blood extractions every 20 min. Control group, the same procedure as before was carried out, though without trephine perforation. PRIMARY STUDY VARIABLES Weight, early mortality, serum NSE and S100B concentration. RESULTS Differences in NSE and S100B concentration were observed over time within the MTBD group (P<.001), though not so in the control group. With the exception of the baseline determination, differences were observed between the two groups in terms of the mean NSE and S100B values. Following MTBD, NSE and S100B progressively increased at all measurement timepoints, with r=0.765; P=.001 and r=0.628; P=.001, respectively. In contrast, the control group showed no such correlation for either biomarker. CONCLUSIONS Serum NSE and S100B concentrations offer an early indication of brain injury affecting the gray and white matter in an experimental model of mass-type MTBD in the rat.
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Affiliation(s)
- J J Egea-Guerrero
- Unidad de Neurocríticos, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España.
| | - F Murillo-Cabezas
- Unidad de Neurocríticos, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España
| | - A Rodríguez-Rodríguez
- Departamento de Bioquímica Clínica, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España
| | - E Gordillo-Escobar
- Unidad de Neurocríticos, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España
| | - J Revuelto-Rey
- Unidad de Neurocríticos, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España
| | - M A Muñoz-Sánchez
- Unidad de Neurocríticos, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España
| | - A León-Justel
- Departamento de Bioquímica Clínica, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España
| | - A Vilches-Arenas
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, IBiS/CSIC Universidad de Sevilla, Sevilla, España
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Egea-Guerrero JJ, Gordillo-Escobar E, Revuelto-Rey J, Enamorado-Enamorado J, Vilches-Arenas A, Pacheco-Sánchez M, Domínguez-Roldán JM, Murillo-Cabezas F. Clinical variables and neuromonitoring information (intracranial pressure and brain tissue oxygenation) as predictors of brain-death development after severe traumatic brain injury. Transplant Proc 2013; 44:2050-2. [PMID: 22974906 DOI: 10.1016/j.transproceed.2012.07.070] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to ascertain the role of clinical variables and neuromonitoring data as predictors of brain death (BD) after severe traumatic brain injury (TBI). PATIENTS AND METHODS This prospective observational study involved severe TBI patients admitted to the intensive care unit between October 2009 and May 2011. The following variables were recorded: gender, age, reference Glasgow Coma Scale after resuscitation, pupillary reactivity, prehospital hypotension and desaturation, injury severity score, computed tomography (CT) findings, intracranial hypertension, and low brain tissue oxygenation (Pti02) levels (<16 mm Hg), as well as the final result of BD. RESULTS Among 61 patients (86.9% males) who met the inclusion criteria, the average age was 37.69 ± 16.44 years. Traffic accidents were the main cause of TBI (62.3%). The patients at risk of progressing to BD (14.8% of the entire cohort) were those with a mass lesion on CT (odds ratio [OR] 33.6; 95% confidence interval [CI]: 3.75-300.30; P = .002), altered pupillary reaction at admission (OR 25.5; 95% CI: 2.27-285.65; P = .009), as well low Pti02 levels on admission (OR 20.41; 95% CI: 3.52-118.33; P < .001) and during the first 24 hours of neuromonitoring (OR 20; 95% CI: 2.90-137.83; P < .001). Multivariate logistic regression showed that a low Pti02 level on admission was the best independent predictor for BD (OR 20.41; 95% CI: 3.53-118.33; P = .001). CONCLUSIONS Clinical variables and neuromonitoring information may identify TBI patients at risk of deterioration to BD.
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Affiliation(s)
- J J Egea-Guerrero
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, Seville, Spain.
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Gordillo-Escobar E, Egea-Guerrero JJ, Revuelto-Rey J, Martín-Bermúdez R. [May-Thurner syndrome: an infrequent cause of spontaneous left iliac vein rupture]. Med Intensiva 2012; 36:239-40. [PMID: 22305199 DOI: 10.1016/j.medin.2011.05.021] [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: 05/24/2011] [Accepted: 05/25/2011] [Indexed: 10/14/2022]
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Egea-Guerrero JJ, Revuelto-Rey J, Gordillo-Escobar E. [Cerebral death is not a synonym of whole brain death]. Neurologia 2011; 27:377-8. [PMID: 22018824 DOI: 10.1016/j.nrl.2011.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 07/20/2011] [Indexed: 10/16/2022] Open
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Revuelto-Rey J, Egea-Guerrero JJ, Muñoz-Sánchez MA, Murillo-Cabezas F. [Cerebral microdialysis in the current clinical setting]. Med Intensiva 2011; 36:213-9. [PMID: 21999949 DOI: 10.1016/j.medin.2011.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 08/15/2011] [Accepted: 08/29/2011] [Indexed: 12/27/2022]
Abstract
Cerebral microdialysis, introduced in experimental studies 40 years ago, has been used clinically since 1992 for the neurochemical monitoring of patients in intensive care. The principles underlying this technique are closely related to brain metabolism. The study of the metabolites detected at brain interstitial tissue level, through the semipermeable membrane of the device, allows us to assess different physiological pathways in the brain, analyzing the changes that occur when they become less efficient in terms of energy, and also detecting waste products secondary to tissue damage. Despite its current limitations, this technique provides relevant information for research and the clinical management of critical neurological patients.
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Affiliation(s)
- J Revuelto-Rey
- Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España.
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Egea-Guerrero JJ, Revuelto-Rey J. Second brain death examination may negatively affect organ donation. Neurology 2011; 77:1314-1316. [PMID: 22039612] [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: 05/31/2023] Open
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48
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Egea-Guerrero JJ, Revuelto-Rey J, Martín-Bermúdez R, Dominguez-Roldan JM. Elevated serum pancreatic enzyme levels after hemorrhagic shock, every variable under control? J Trauma 2010; 68:1016. [PMID: 20386294 DOI: 10.1097/ta.0b013e3181cda6c6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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49
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Egea-Guerrero JJ, Revuelto-Rey J, Hinojosa-Perez R. [Right paracardiac mediastinal mass in the context of acute coronary syndrome]. Med Intensiva 2009; 34:575. [PMID: 19864044 DOI: 10.1016/j.medin.2009.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 09/03/2009] [Accepted: 09/10/2009] [Indexed: 11/29/2022]
Affiliation(s)
- J J Egea-Guerrero
- U.G.C. Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España.
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Egea-Guerrero JJ, Martín-Bermúdez R, Miralles-Aguiar F, Revuelto-Rey J. [Use of methylene blue in the treatment of vasoplegic syndrome after heart surgery: other perspectives on the case]. Med Intensiva 2007; 31:528; author reply 529. [PMID: 18039456 DOI: 10.1016/s0210-5691(07)74863-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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