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Ramirez-Cervantes KL, Campillo-Morales S, García-Poza P, Quintana-Díaz M, Huerta-Álvarez C. Antithrombotic Use Patterns in COVID-19 Patients from Spain: A Real-World Data Study. J Clin Med 2024; 13:2403. [PMID: 38673678 PMCID: PMC11051525 DOI: 10.3390/jcm13082403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Antithrombotics have been widely used to treat and prevent COVID-19-related thrombosis; however, studies on their use at population levels are limited. We aimed to describe antithrombotic use patterns during the pandemic in Spanish primary care and hospital-admitted patients with COVID-19. Methods: A real-world data study was performed. Data were obtained from BIFAP's electronic health records. We investigated the antithrombotic prescriptions made within ±14 days after diagnosis between March 2020 and February 2022, divided their use into prior and new/naive groups, and reported their post-discharge use. Results: We included 882,540 individuals (53.4% women), of whom 78,499 were hospitalized. The median age was 44.7 (IQR 39-59). Antithrombotics were prescribed in 37,183 (4.6%) primary care subjects and 42,041 (53.6%) hospital-admitted patients, of whom 7505 (20.2%) and 20,300 (48.3%), respectively, were naive users. Prior users were older and had more comorbidities than new users. Enoxaparin was the most prescribed antithrombotic in hospitals, with higher prescription rates in new than prior users (2348.2, IQR 2390-3123.1 vs. 1378, IQR 1162-1751.6 prescriptions per 10,000 cases, p = 0.002). In primary care, acetylsalicylic acid was the most used antithrombotic, with higher use rates in prior than in naïve users. Post-discharge use occurred in 6686 (15.9%) subjects (median use = 10 days, IQR 9-30). Conclusions: Our study identified a consensus on prescribing antithrombotics in COVID-19 patients, but with low use rates in hospitals.
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Affiliation(s)
| | - Salvador Campillo-Morales
- Patient Blood Management Research Group, Hospital La Paz Institute for Health Research, 28040 Madrid, Spain;
| | - Patricia García-Poza
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices (AEMPS), C/Campezo n° 1, Edificio 8, 28022 Madrid, Spain;
| | - Manuel Quintana-Díaz
- Intensive Care Unit, Patient Blood Management Research Group, Research Institute of La Paz University Hospital, La Paz University Hospital, 28040 Madrid, Spain
| | - Consuelo Huerta-Álvarez
- Department of Public Health and Maternity Childcare, Faculty of Medicine, Complutense University of Madrid, Pl. de Ramón y Cajal, s/n, 28040 Madrid, Spain;
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Barea-Mendoza JA, Chico-Fernández M, Serviá-Goixart L, Quintana-Díaz M, García-Sáez I, Ballesteros-Sanz MÁ, Iglesias-Santiago A, Molina-Díaz I, González-Robledo J, Fernández-Cuervo A, Pérez-Bárcena J, Llompart-Pou JA. Associated Risk Factors and Impact in Clinical Outcomes of Multiorgan Failure in Patients with TBI. Neurocrit Care 2023; 39:411-418. [PMID: 36869209 DOI: 10.1007/s12028-023-01698-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/10/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Individual extracerebral organ dysfunction is common after severe traumatic brain injury (TBI) and impacts outcomes. However, multiorgan failure (MOF) has received less attention in patients with isolated TBI. Our objective was to analyze the risk factors associated with the development of MOF and its impact in clinical outcomes in patients with TBI. METHODS This was an observational, prospective, multicenter study using data from a nationwide registry that currently includes 52 intensive care units (ICUs) in Spain (RETRAUCI). Isolated significant TBI was defined as Abbreviated Injury Scale (AIS) ≥ 3 in the head area with no AIS ≥ 3 in any other anatomical area. Multiorgan failure was defined using the Sequential-related Organ Failure Assessment as the alteration of two or more organs with a score of ≥ 3. We analyzed the contribution of MOF to crude and adjusted mortality (age and AIS head) by using logistic regression analysis. A multiple logistic regression analysis was performed to analyze the risk factors associated with the development of MOF in patients with isolated TBI. RESULTS A total of 9790 patients with trauma were admitted to the participating ICUs. Of them, 2964 (30.2%) had AIS head ≥ 3 and no AIS ≥ 3 in any other anatomical area, and these patients constituted the study cohort. Mean age was 54.7 (19.5) years, 76% of patients were men, and ground-level falls were the main mechanism of injury (49.1%). In-hospital mortality was 22.2%. Up to 185 patients with TBI (6.2%) developed MOF during their ICU stay. Crude and adjusted (age and AIS head) mortality was higher in patients who developed MOF (odds ratio 6.28 [95% confidence interval 4.58-8.60] and odds ratio 5.20 [95% confidence interval 3.53-7.45]), respectively. The logistic regression analysis showed that age, hemodynamic instability, the need of packed red blood cells concentrates in the initial 24 h, the severity of brain injury, and the need for invasive neuromonitoring were significantly associated with MOF development. CONCLUSIONS MOF occurred in 6.2% of patients with TBI admitted to the ICU and was associated with increased mortality. MOF was associated with age, hemodynamic instability, the need of packed red blood cells concentrates in the initial 24 h, the severity of brain injury, and the need for invasive neuromonitoring.
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Affiliation(s)
| | - Mario Chico-Fernández
- UCI Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lluís Serviá-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Lleida, Spain
| | | | - Iker García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, Donostia, Spain
| | | | - Alberto Iglesias-Santiago
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria, Granada, Spain
| | - Ismael Molina-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Javier González-Robledo
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Ana Fernández-Cuervo
- Servicio de Medicina Intensiva, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears, Carretera Valldemossa, 79, 07120, Palma, Spain
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears, Carretera Valldemossa, 79, 07120, Palma, Spain.
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Larraga-García B, Monforte-Escobar F, Quintero Mínguez R, Quintana-Díaz M, Gutiérrez Á. Modified Needleman-Wunsch algorithm for trauma management performance evaluation. Int J Med Inform 2023; 177:105153. [PMID: 37490831 DOI: 10.1016/j.ijmedinf.2023.105153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/28/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Trauma injuries are one of the leading causes of death in the world, representing approximately 8 % of all deaths. Therefore, trauma management training is of great importance and new training courses have arisen during the last decades. However, actual training courses do not typically analyze compliance with the protocols and guidelines available in the literature. Considering general trauma management guidelines such as the Advanced Trauma Life Support (ATLS) manual and the expertise of trauma specialists, a trauma management automated evaluation system has been designed in this paper. METHODS A modification to the Needleman-Wunsch (NW) algorithm is developed, including all relevant aspects of trauma management to automatically evaluate how a trauma intervention has been implemented according to trauma protocols. This allows to consider more information with respect to the order of the actions taken and the type of actions performed than current evaluation methods, such as checklists or videos recorded in simulation. A web-based trauma simulator is used so that it can be used at any setting with internet connection. Final-year medical students and first- and second-year residents performed an experimental test, where a trauma score is obtained with the modified NW algorithm. This automatic score relates to how similar the actions are to trauma protocols. RESULTS The results show the best combination of the scores used for the modified NW variables. This combination has an error, for the different case scenarios created, below 0.07 which verifies the values obtained. Additionally, trauma experts verified the results obtained showing a median difference of 0 between the protocol adherence evaluation using the algorithm and the one provided by the trauma experts. CONCLUSIONS The best set of score values to apply to the modified NW algorithm show that the modified NW algorithm provides a successful objective measurement with respect to the protocol compliance.
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Affiliation(s)
- Blanca Larraga-García
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Avenida Complutense, 30, 28040 Madrid, Spain.
| | | | | | - Manuel Quintana-Díaz
- Hospital La Paz Institute for Health Research, IdiPAZ, C. de Pedro Rico, 6, 28029 Madrid, Spain
| | - Álvaro Gutiérrez
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Avenida Complutense, 30, 28040 Madrid, Spain
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Jaramillo-Castell F, Lorenzo SM, Derqui DC, Murphy M, Aguilar CF, Nanwani K, Quintana-Díaz M, Martín-Martín JJ. Design, validation and piloting of clinical vignettes to analyze critical care clinical decision processes during the COVID-19 pandemic in three different countries (Spain, Chile and United States). Res Sq 2023:rs.3.rs-3208463. [PMID: 37609191 PMCID: PMC10441453 DOI: 10.21203/rs.3.rs-3208463/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background The use of heuristics in clinical decision-making processes increases in contexts of high uncertainty, such as those in Intensive Care Units (ICU. Given the impossibility of empirically studying their impact on real-world conditions, clinical vignettes were developed with the goal of identifying the use of heuristics in the care of critically ill patients during the COVID-19 pandemic in different clinical contexts. Methodology Vignettes were designed by critical care physicians in Spain to assess the use of representativeness, availability, and status quo heuristics in the care of critically ill patients during the COVID-19 pandemic. The construct, internal and external validity of the vignettes designed in Spain, the United States and Chile were evaluated. A questionnaire was piloted with the vignettes being validated in the three aforementioned countries through a computer application built for this purpose. Results 16 study vignettes grouped into 5 models were created: each model included between 2 and 4 vignettes. The vignettes designed were closed-response vignettes with 2-3 possible alternatives. The vignettes, initially developed in Spain in Spanish, were translated to English and adapted to the Spanish used in Chile. The clinical content of the vignettes was not modified during the translation process. Conclusions The vignettes allow for the study of the use of heuristics in critical care clinical decision making in the context of the COVID-19 pandemic. The piloting and validation process used can serve as a model for similar multinational studies exploring clinical decision making.
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Affiliation(s)
| | | | | | - Matthew Murphy
- Brown University Public Health Program: Brown University School of Public Health
| | | | - Kapil Nanwani
- La Paz University Hospital: Hospital Universitario La Paz
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Larraga-García B, Castañeda López L, Monforte-Escobar F, Quintero Mínguez R, Quintana-Díaz M, Gutiérrez Á. Design and Development of an Objective Evaluation System for a Web-Based Simulator for Trauma Management. Appl Clin Inform 2023; 14:714-724. [PMID: 37673097 PMCID: PMC10482499 DOI: 10.1055/s-0043-1771396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/15/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Trauma injuries are one of the main leading causes of death in the world. Training with guidelines and protocols is adequate to provide a fast and efficient treatment to patients that suffer a trauma injury. OBJECTIVES This study aimed to evaluate deviations from a set protocol, a new set of metrics has been proposed and tested in a pilot study. METHODS The participants were final-year students from the Universidad Autónoma de Madrid and first-year medical residents from the Hospital Universitario La Paz. They were asked to train four trauma scenarios with a web-based simulator for 2 weeks. A test was performed pre-training and another one post-training to evaluate the evolution of the treatment to those four trauma scenarios considering a predefined trauma protocol and based on the new set of metrics. The scenarios were pelvic and lower limb traumas in a hospital and in a prehospital setting, which allow them to learn and assess different trauma protocols. RESULTS The results show that, in general, there is an improvement of the new metrics after training with the simulator. CONCLUSION These new metrics provide comprehensive information for both trainers and trainees. For trainers, the evaluation of the simulation is automated and contains all relevant information to assess the performance of the trainee. And for trainees, it provides valuable real-time information that could support the trauma management learning process.
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Affiliation(s)
- Blanca Larraga-García
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Luis Castañeda López
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | | | | | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Álvaro Gutiérrez
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
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Rojas-García A, Moreno-Blanco D, Otero-Arteseros M, Rubio-Bolívar FJ, Peinado H, Elorza-Fernández D, Gómez EJ, Quintana-Díaz M, Sánchez-Gonzalez P. SIMUNEO: Control and Monitoring System for Lung Ultrasound Examination and Treatment of Neonatal Pneumothorax and Thoracic Effusion. Sensors (Basel) 2023; 23:5966. [PMID: 37447813 DOI: 10.3390/s23135966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/07/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Training with real patients is a critical aspect of the learning and growth of doctors in training. However, this essential step in the educational process for clinicians can potentially compromise patient safety, as they may not be adequately prepared to handle real-life situations independently. Clinical simulators help to solve this problem by providing real-world scenarios in which the physicians can train and gain confidence by safely and repeatedly practicing different techniques. In addition, obtaining objective feedback allows subsequent debriefing by analysing the situation experienced and learning from other people's mistakes. This article presents SIMUNEO, a neonatal simulator in which professionals are able to learn by practicing the management of lung ultrasound and the resolution of pneumothorax and thoracic effusions. The article also discusses in detail the hardware and software, the main components that compose the system, and the communication and implementation of these. The system was validated through both usability questionnaires filled out by neonatology residents as well as through follow-up sessions, improvement, and control of the system with specialists of the department. Results suggest that the environment is easy to use and could be used in clinical practice to improve the learning and training of students as well as the safety of patients.
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Affiliation(s)
- Adriana Rojas-García
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Diego Moreno-Blanco
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Martin Otero-Arteseros
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Helena Peinado
- Servicio de Neonatología, Hospital Universitario La Paz de Madrid, 28046 Madrid, Spain
| | | | - Enrique J Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Manuel Quintana-Díaz
- CEASEC-Fundación para la Investigación Biomédica del Hospital Universitario La Paz de Madrid, 28046 Madrid, Spain
- Servicio de Medicina Intensiva, Hospital Universitario La Paz de Madrid, 28046 Madrid, Spain
| | - Patricia Sánchez-Gonzalez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
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7
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Barea-Mendoza JA, Llompart-Pou JA, Pérez-Bárcena J, Quintana-Díaz M, Serviá-Goixart L, Guerrero-López F, González-Robledo J, Molina-Díaz I, Sánchez Arguiano J, Chico-Fernández M. External validation of the Glasgow Coma Scale-Pupils in patients with severe head injury. Emergencias 2023; 35:39-43. [PMID: 36756915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To compare the ability of the Glasgow Coma Scale (GCS) score, the GCS Pupils (GCS-P) score, and the Pupil Reactivity Score (PRS) to predict mortality in patients with severe head injury. MATERIAL AND METHODS Retrospective analysis of all patients with severe head injury and initial GCS scores of 8 or lower on initial evaluation for whom records included pupil dilation information and clinical course after admission to intensive care units of participating hospitals. We assessed the ability of each of the 3 scores (GCS, GCS-P, and PRS) to predict mortality using discrimination analysis. Discrimination was estimated by calculating the areas under the receiver operating characteristic curves (AUC) and 95% CIs. RESULTS A total of 1551 patients with severe head injury and pupil dilation records were studied. The mean age was 50 years, 1190 (76.7%) were males, and 592 (38.2%) died. No pupil dilation was observed in 905 patients (58.3%), 362 (23.3%) had unilateral mydriasis, and 284 (18.3%) had bilateral mydriasis. The GCS-P score was significantly better at predicting mortality, with an AUC of 0.77 (95% CI, 0.74-0.79), versus 0.69 (95% CI, 0.67-0.72) for the GCS, and 0.75 (95% CI, 0.72-0.77) for the PRS. As the GCS-P score decreased, mortality increased. CONCLUSION The GCS-P was more useful than the GCS for predicting death after severe head injury.
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Affiliation(s)
- Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, España
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, España
| | | | - Lluís Serviá-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida. IRBLleida. Lleida, España
| | - Francisco Guerrero-López
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs. Granada, Granada, España
| | - Javier González-Robledo
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - Ismael Molina-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Juncal Sánchez Arguiano
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
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Castro-Olmo F, Morales-Fernández P, Alcaide-Martín M, Fernández-Puntero B, Quintana-Díaz M, Aceña-Gil V. Minimizar el volumen de descarte para la extracción de muestras sanguíneas en los pacientes críticos: ¿es factible? Enfermería Intensiva 2023. [DOI: 10.1016/j.enfi.2022.06.004] [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: 01/30/2023]
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9
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Castro-Olmo FJ, Morales-Fernández P, Alcaide-Martín MJ, Fernández-Puntero B, Quintana-Díaz M, Aceña-Gil V. Is minimising waste volume for drawing blood samples in critically ill patients feasible? Enferm Intensiva (Engl Ed) 2023; 34:19-26. [PMID: 36774248 DOI: 10.1016/j.enfie.2022.06.002] [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: 10/27/2021] [Accepted: 06/07/2022] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Drawing blood samples through a central venous catheter (CVC) is a customary practice in Intensive Care Units (ICUs). It is indicated to discard a volume of waste blood to avoid interference in the results. AIM To determine whether a lower discard volume for obtaining blood samples from temporary CVCs placed into the internal jugular, femoral or subclavian vein offers valid results. METHOD A quasi-experimental prospective cross-sectional study for which sixty-five patients of over 18 years of age in ICUs, who had been fitted with a triple lumen central venous catheter, were recruited over a period of eight months. Two consecutive blood samples were extracted with tubes for biochemistry, coagulation and hemogram from each patient from the distal lumen. The first sample was obtained with a discarded waste of 1.5 ml from a total extracted volume of 10.2 ml, similar to the usual waste in our ambit (10 ml). Subsequently the second sample was obtained. The paired t-test was used to analyse the data. The Bland-Altman plot and intraclass correlation coefficient (ICC) were used to measure the agreement between methods. The reference change value (RCV) was established as the admissible limit of variation between the pairs of samples. RESULTS A total of 65 sample pairs were drawn (intervention-control). The paired t-test found statistically significant differences with a significance level of α = .05 for chlorine (-.536; .012); prothrombin time (-.092; .019) and prothrombin activity (.284; 1.375).The ICC was greater than .9 in all the variables and the limit determined for the RCV was not surpassed by any value. CONCLUSIONS The results show the reliability of the blood samples drawn with a discard volume of 1.5 ml.
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Affiliation(s)
- F J Castro-Olmo
- Unidad de Cirugía Plástica, Reparadora y Quemados, Hospital Universitario La Paz, Madrid, Spain.
| | - P Morales-Fernández
- Unidad de Cirugía Plástica, Reparadora y Quemados, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - M Quintana-Díaz
- Unidad de Quemados Críticos, Hospital Universitario La Paz, Madrid, Spain
| | - V Aceña-Gil
- Data Science Laboratory (DSLAB), Universidad Rey Juan Carlos, Móstoles, Madrid, Spain
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10
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Barea-Mendoza JA, Chico-Fernández M, Quintana-Díaz M, Serviá-Goixart L, Fernández-Cuervo A, Bringas-Bollada M, Ballesteros-Sanz MÁ, García-Sáez Í, Pérez-Bárcena J, Llompart-Pou JA. Traumatic Brain Injury and Acute Kidney Injury-Outcomes and Associated Risk Factors. J Clin Med 2022; 11:jcm11237216. [PMID: 36498789 PMCID: PMC9739137 DOI: 10.3390/jcm11237216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Our objective was to analyze the contribution of acute kidney injury (AKI) to the mortality of isolated TBI patients and its associated risk factors. Observational, prospective and multicenter registry (RETRAUCI) methods were used, from March 2015 to December 2019. Isolated TBI was defined as abbreviated injury scale (AIS) ≥ 3 head with no additional score ≥ 3. A comparison of groups was conducted using the Wilcoxon test, chi-square test or Fisher's exact test, as appropriate. A multiple logistic regression analysis was conducted to analyze associated risk factors in the development of AKI. For the result, overall, 2964 (30.2%) had AIS head ≥ 3 with no other area with AIS ≥ 3. The mean age was 54.7 (SD 19.5) years, 76% were men, and the ground-level falls was 49.1%. The mean ISS was 18.4 (SD 8). The in-hospital mortality was 22.2%. Up to 310 patients (10.6%) developed AKI, which was associated with increased mortality (39% vs. 17%, adjusted OR 2.2). Associated risk factors (odds ratio (OR) (95% confidence interval)) were age (OR 1.02 (1.01-1.02)), hemodynamic instability (OR 2.87 to OR 5.83 (1.79-13.1)), rhabdomyolysis (OR 2.94 (1.69-5.11)), trauma-associated coagulopathy (OR 1.67 (1.05-2.66)) and transfusion of packed red-blood-cell concentrates (OR 1.76 (1.12-2.76)). In conclusion, AKI occurred in 10.6% of isolated TBI patients and was associated with increased mortality.
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Affiliation(s)
- Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, 28029 Madrid, Spain
| | - Lluís Serviá-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, 25198 Lleida, Spain
| | - Ana Fernández-Cuervo
- Servicio de Medicina Intensiva, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
| | - María Bringas-Bollada
- Servicio de Medicina Intensiva, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | | | - Íker García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, 20014 Donostia, Spain
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
- Correspondence:
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11
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Larraga-García B, Quintana-Díaz M, Gutiérrez Á. Simulation-Based Education in Trauma Management: A Scoping Review. Int J Environ Res Public Health 2022; 19:13546. [PMID: 36294122 PMCID: PMC9603596 DOI: 10.3390/ijerph192013546] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Trauma injuries are an important healthcare problem and one of the main leading causes of death worldwide. The purpose of this review was to analyze current practices in teaching trauma management using simulations, with the aim of summarizing them, identifying gaps and providing a critical overview on what has already been achieved. A search on the Web of Science website for simulation-based trauma training articles published from 2010 onwards was performed, obtaining 1617 publications. These publications were screened to 35 articles, which were deeply analyzed, gathering the following information: the authors, the publication type, the year of the publication, the total number of citations, the population of the training, the simulation method used, the skills trained, the evaluation type used for the simulation method presented in the paper, if skills improved after the training and the context in which the simulation took place. Of the 35 articles included in this review, only a few of them had students as the target audience. The more used simulation method was a high-fidelity mannequin, in which the participants trained in more technical than non-technical skills. Almost none of the studies introduced an automated evaluation process and most of the evaluation methods consisted of checklists or questionnaires. Finally, trauma training focused more on treating trauma patients in a hospital environment than in a pre-hospital one. Overall, improvements in the evaluation method, as well as in the development of trauma training on undergraduate education, are important areas for further development.
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Affiliation(s)
- Blanca Larraga-García
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Álvaro Gutiérrez
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain
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12
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Larraga-García B, Quintana-Díaz M, Gutiérrez Á. The Need for Trauma Management Training and Evaluation on a Prehospital Setting. Int J Environ Res Public Health 2022; 19:13188. [PMID: 36293767 PMCID: PMC9602774 DOI: 10.3390/ijerph192013188] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Trauma is one of the leading causes of death in the world, being the main cause of death in people under 45 years old. The epidemiology of these deaths shows an important peak during the first hour after a traumatic event. Therefore, learning how to manage traumatic injuries in a prehospital setting is of great importance. Medical students from Universidad Autónoma performed 66 different simulations to stabilize a trauma patient on a prehospital scene by using a web-based trauma simulator. Then, a panel of trauma experts evaluated the simulations performed, observing that, on average, an important number of simulations were scored below 5, being the score values provided from 0, minimum, to 10, maximum. Therefore, the first need detected is the need to further train prehospital trauma management in undergraduate education. Additionally, a deeper analysis of the scores provided by the experts was performed. It showed a great dispersion in the scores provided by the different trauma experts per simulation. Therefore, a second need is identified, the need to develop a system to objectively evaluate trauma management.
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Affiliation(s)
- Blanca Larraga-García
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Álvaro Gutiérrez
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain
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13
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Nanwani Nanwani KL, Estébanez Montiel B, Quintana-Díaz M, García Erce JA. Reflections and aspects to consider about blood donation in brain-dead patients. Med Intensiva 2022; 46:540-541. [PMID: 35753974 DOI: 10.1016/j.medine.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/12/2022] [Accepted: 02/19/2022] [Indexed: 06/15/2023]
Affiliation(s)
- K L Nanwani Nanwani
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Grupo idiPAZ "Gestión del Paciente Sangrante", Madrid, Spain.
| | - B Estébanez Montiel
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Coordinación de Trasplantes, Hospital Universitario La Paz, Madrid, Spain
| | - M Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Grupo idiPAZ "Gestión del Paciente Sangrante", Madrid, Spain
| | - J A García Erce
- Servicio de Hematología y Hemoterapia, Hospital San Jorge, Huesca, Spain
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14
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Nanwani Nanwani KL, Estébanez Montiel B, García Erce JA, Quintana-Díaz M. Blood donation from brain-dead patients: Feasible and ethical? Med Intensiva 2022; 46:538-539. [PMID: 35753977 DOI: 10.1016/j.medine.2022.06.008] [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: 07/28/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 06/15/2023]
Affiliation(s)
- K L Nanwani Nanwani
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Grupo idiPAZ "Gestión del Paciente Sangrante", Madrid, Spain.
| | - B Estébanez Montiel
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Coordinación de Trasplantes, Hospital Universitario La Paz, Madrid, Spain
| | - J A García Erce
- Servicio de Hematología y Hemoterapia, Hospital San Jorge, Huesca, Spain
| | - M Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Grupo idiPAZ "Gestión del Paciente Sangrante", Madrid, Spain
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15
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Juárez-Vela R, García-Erce JA, Gea-Caballero V, Ruiz de Viñaspre-Hernandez R, Santos-Sánchez JÁ, Sánchez-González JL, Andrés-Esteban EM, Czapla M, Tejada CI, Nanwani-Nanwani KL, Serrano-Lázaro A, Quintana-Díaz M. A Cohort Study in Intensive Care Units: Health Decisions Related to Blood Transfusion during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11154396. [PMID: 35956012 PMCID: PMC9368991 DOI: 10.3390/jcm11154396] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Critically ill polytrauma patients with hemorrhage require a rapid assessment to initiate hemostatic resuscitation in the shortest possible time with the activation of a massive transfusion or a critical hemorrhage management protocol. The hospital reality experienced during the COVID-19 pandemic in all countries was critical, as it was in Spain; according to the data published daily by the Ministry of Health on its website, during the period of this study, the occupancy rate of intensive care units (ICUs) by patients diagnosed with the novel coronavirus disease (COVID-19) rose to 23.09% in Spain, even reaching 45.23% at the end of January 2021. We aimed to analyze the changes observed during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic period regarding the effectiveness of Spanish ICUs in terms of mortality reduction. We present a cross-sectional study that compares two cohorts of patients admitted to ICUs across all autonomous communities of Spain with a diagnosis of polytrauma. Results: Only age was slightly higher at admission during the first wave of the pandemic (47.74 ± 18.65 vs. 41.42 ± 18.82 years, p = 0.014). The transfusion rate during the pandemic increased by 10.4% compared to the previous stage (p = 0.058). Regarding hemostatic components, the use of tranexamic acid increased from 1.8% to 10.7% and fibrinogen concentrates from 0.9% to 1.9%. In the case of prothrombin complex concentrates, although there was a slight increase in their use, there were no significant differences during the pandemic compared to the previous period. Conclusion: Mortality showed no difference before and during the pandemic, despite the observed change in the transfusion policy. In summary, the immediate and global implementation of patient blood management (PBM) based on clinical transfusion algorithms should be mandatory in all hospitals in our country.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Program in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain; (R.J.-V.); (M.Q.-D.)
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
| | - José Antonio García-Erce
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Bank of Blood and Tissue of Navarra, Government of Navarra, 31008 Pamplona, Spain
- Correspondence:
| | - Vicente Gea-Caballero
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Faculty of Health Sciences, Valencian International University, 46002 Valencia, Spain
| | - Regina Ruiz de Viñaspre-Hernandez
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
| | - José Ángel Santos-Sánchez
- Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain;
- Salamanca Hospital Complex, 37008 Salamanca, Spain
| | | | - Eva María Andrés-Esteban
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Department of Business Economics and Applied Economy, Faculty of Legal and Economic Sciences, University Rey Juan Carlos, 28032 Madrid, Spain
| | - Michał Czapla
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
- Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Clara Isabel Tejada
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
| | - Kapil Laxman Nanwani-Nanwani
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- La Paz Hospital Intensive Care Unit, 28046 Madrid, Spain
| | - Ainhoa Serrano-Lázaro
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Intensive Care Unit, Hospital Clinico de Valencia, 46010 Valencia, Spain
| | - Manuel Quintana-Díaz
- Doctoral Program in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain; (R.J.-V.); (M.Q.-D.)
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- La Paz Hospital Intensive Care Unit, 28046 Madrid, Spain
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16
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Díaz-García E, Nanwani-Nanwani K, García-Tovar S, Alfaro E, López-Collazo E, Quintana-Díaz M, García-Rio F, Cubillos-Zapata C. NLRP3 Inflammasome Overactivation in Patients with Aneurysmal Subarachnoid Hemorrhage. Transl Stroke Res 2022; 14:334-346. [PMID: 35819747 PMCID: PMC10160181 DOI: 10.1007/s12975-022-01064-x] [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: 04/08/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is an uncommon and severe subtype of stroke leading to the loss of many years of productive life. We analyzed NLRP3 activity as well as key components of the inflammasome cascade in monocytes and plasma from 28 patients with aSAH and 14 normal controls using flow cytometry, western blot, ELISA, and qPCR technologies. Our data reveal that monocytes from patients with aSAH present an overactivation of the NLRP3 inflammasome, which results in the presence of high plasma levels of interleukin (IL)-1β, IL-18, gasdermin D, and tissue factor. Although further research is needed, we propose that serum tissue factor concentration might be a useful prognosis biomarker for clinical outcome, and for Tako-Tsubo cardiomyopathy and cerebral vasospasm prediction. Remarkably, MCC-950 inhibitor effectively blocks NLRP3 activation in aSAH monocyte culture and supresses tissue factor release to the extracellular space. Finally, our findings suggest that NLRP3 activation could be due to the release of erythrocyte breakdown products to the subarachnoid space during aSAH event. These data define NLRP3 activation in monocytes from aSAH patients, indicating systemic inflammation that results in serum TF upregulation which in turns correlates with aSAH severity and might serve as a prognosis biomarker for aSAH clinical outcome and for cerebral vasospasm and Tako-Tsubo cardiomyopathy prediction.
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Affiliation(s)
- Elena Díaz-García
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain. .,Biomedical Research Networking Center On Respiratory Diseases (CIBERES), Madrid, Spain.
| | | | - Sara García-Tovar
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Enrique Alfaro
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Manuel Quintana-Díaz
- Department of Intensive Care Medicine, La Paz University Hospital, Madrid, Spain.,Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Francisco García-Rio
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain.,Biomedical Research Networking Center On Respiratory Diseases (CIBERES), Madrid, Spain.,Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Carolina Cubillos-Zapata
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain. .,Biomedical Research Networking Center On Respiratory Diseases (CIBERES), Madrid, Spain.
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17
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Rodríguez-Matesanz M, Guzmán-García C, Oropesa I, Rubio-Bolivar J, Quintana-Díaz M, Sánchez-González P. A New Immersive Virtual Reality Station for Cardiopulmonary Resuscitation Objective Structured Clinical Exam Evaluation. Sensors (Basel) 2022; 22:4913. [PMID: 35808422 PMCID: PMC9269536 DOI: 10.3390/s22134913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
The Objective Structured Clinical Exam (OSCE) is an assessment tool used as a reliable method for clinical competence evaluation of students. This paper presents an investigation focused on the chain of survival, its related exploration, management, and technical skills, and how Virtual Reality (VR) can be used for the creation of immersive environments capable of evaluating students' performance while applying the correct protocols. In particular, the Cardiopulmonary Resuscitation (CPR) procedure is studied as an essential step in the development of the chain of survival. The paper also aims to highlight the limitations of traditional methods using mechanical mannequins and the benefits of the new approaches that involve the students in virtual, immersive, and dynamic environments. Furthermore, an immersive VR station is presented as a new technique for assessing CPR performance through objective data collection and posterior evaluation. A usability test was carried out with 33 clinicians and OSCE evaluators to test the viability of the presented scenario, reproducing conditions of a real examination. Results suggest that the environment is intuitive, quick, and easy to learn and could be used in clinical practice to improve CPR performance and OSCE evaluation.
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Affiliation(s)
- Manuel Rodríguez-Matesanz
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Carmen Guzmán-García
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | | | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, 28029 Madrid, Spain
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18
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Juárez-Vela R, Andrés-Esteban EM, Santolalla-Arnedo I, Ruiz de Viñaspre-Hernández R, Benito-Puncel C, Serrano-Lázaro A, Marcos-Neira P, López-Fernández A, Tejada-Garrido CI, Sánchez-González JL, Quintana-Díaz M, García-Erce JA. Epidemiology and Associated Factors in Transfusion Management in Intensive Care Unit. J Clin Med 2022; 11:jcm11123532. [PMID: 35743602 PMCID: PMC9225042 DOI: 10.3390/jcm11123532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Severe traumatic injury is one of the main global health issues which annually causes more than 5.8 million worldwide deaths. Uncontrolled haemorrhage is the main avoidable cause of death among severely injured individuals. Management of trauma patients is the greatest challenge in trauma emergency care, and its proper diagnosis and early management of bleeding trauma patients, including blood transfusion, are critical for patient outcomes. Aim: We aimed to describe the epidemiology of transfusion practices in severe trauma patients admitted into Spanish Intensive Care Units. Material and Methods: We performed a multicenter cross-sectional study in 111 Intensive Care Units across Spain. Adult patients with moderate or severe trauma were eligible. Distribution of frequencies was used for qualitative variables and the mean, with its 95% CI, for quantitative variables. Transfusion programmes, the number of transfusions performed, and the blood component transfused were recorded. Demographic variables, mortality rate, hospital stay, SOFA-score and haemoglobin levels were also gathered. Results: We obtained results from 109 patients. The most transfused blood component was packet red blood cells with 93.8% of total transfusions versus 43.8% of platelets and 37.5% of fresh plasma. The main criteria for transfusion were analytical criteria (43.75%), and acute anaemia with shock (18.75%) and without haemodynamic impact (18.75%). Conclusion: Clinical practice shows a ratio of red blood cells, platelets, and Fresh Frozen Plasma (FFP) of 2:1:1. It is necessary to implement Massive Transfusion Protocols as they appear to improve outcomes. Our study suggests that transfusion of RBC, platelets and FFP in a 2:1:1 ratio could be beneficial for trauma patients.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Programme in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain;
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
- Research Institute IdiPaz, 28029 Madrid, Spain;
| | - Eva María Andrés-Esteban
- Research Institute IdiPaz, 28029 Madrid, Spain;
- Department of Business Economics and Applied Economy, Faculty of Legal and Economic Sciences, Rey Juan Carlos University, 28933 Madrid, Spain
| | - Ivan Santolalla-Arnedo
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
| | | | | | | | - Pilar Marcos-Neira
- Intensive Care Unit, Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | | | - Clara Isabel Tejada-Garrido
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
- Correspondence: (C.I.T.-G.); (M.Q.-D.)
| | | | - Manuel Quintana-Díaz
- Research Institute IdiPaz, 28029 Madrid, Spain;
- Intensive Care Unit, University Hospital of La Paz, 28046 Madrid, Spain;
- Correspondence: (C.I.T.-G.); (M.Q.-D.)
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19
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Jericó C, Zalba-Marcos S, Quintana-Díaz M, López-Villar O, Santolalla-Arnedo I, Abad-Motos A, Laso-Morales MJ, Sancho E, Subirà M, Bassas E, Ruiz de Viñaspre-Hernández R, Juárez-Vela R, García-Erce JA. Relationship between ABO Blood Group Distribution and COVID-19 Infection in Patients Admitted to the ICU: A Multicenter Observational Spanish Study. J Clin Med 2022; 11:jcm11113042. [PMID: 35683430 PMCID: PMC9181327 DOI: 10.3390/jcm11113042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023] Open
Abstract
Since the beginning of the COVID-19 pandemic in December 2019, a relationship between the ABO blood group type and the novel coronavirus SARS-CoV-2, the etiological agent of COVID-19, has been reported, noting that individuals with the O blood group are the least likely to be infected. Spain is one of the most badly affected countries worldwide, with high rates of patients diagnosed, hospitalized, and deceased due to COVID-19 infection. The present study aimed to analyze the possible relationship of ABO in COVID-19 patients hospitalized in different Spanish centers during the first wave of the COVID-19 pandemic, for which the ABO group was available. Physicians from the transfusion services of different Spanish hospitals, who have developed a multicenter retrospective observational study, were invited to participate voluntarily in the research and 12,115 patients with COVID-19 infection were admitted to the nine participating hospitals. The blood group was known in 1399 cases (11.5%), of which 365 (26.1%) were admitted to the ICU. Regarding the distribution of ABO blood groups, a significant increase in the non-O blood groups and reduction for the O blood group was observed in patients hospitalized due to COVID-19, compared to the reference general population. Among the patients admitted to the ICU, after multivariate analysis, adjusted for the rest of the confounding variables, patients with the O blood group presented a significantly lower risk for admission to the ICU. We conclude that an association was observed between patients with the O blood group and their lower susceptibility to SARS-CoV-2 infection, both for those admitted to the hospitalization ward and for those who required admission to the ICU.
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Affiliation(s)
- Carlos Jericó
- Internal Medicine Department, Complex Hospitalari Moisés Broggi, 08970 Sant Joan Despí, Spain;
| | - Saioa Zalba-Marcos
- Haematology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain;
| | - Manuel Quintana-Díaz
- PBM Research Group, Idi-Paz Research Institute, 28046 Madrid, Spain; (M.Q.-D.); (J.A.G.-E.)
- Intensive Care Unit, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Olga López-Villar
- Transfusion Service, Haematology Department, Hospital Universitario de Salamanca, 37007 Salamanca, Spain;
| | | | - Ane Abad-Motos
- Anaesthesia Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain;
| | | | - Esther Sancho
- Haematology Department, Hospital General de Granollers, 08402 Granollers, Spain;
| | - Maricel Subirà
- Haematology Department, Hospital Sagrat Cor, 08029 Barcelona, Spain;
| | - Eva Bassas
- Anaesthesia Department, Complex Hospitalari Moisés Broggi, 08970 Sant Joan Despí, Spain;
| | | | - Raúl Juárez-Vela
- PBM Research Group, Idi-Paz Research Institute, 28046 Madrid, Spain; (M.Q.-D.); (J.A.G.-E.)
- Department of Nursing-GRUPAC, University of La Rioja, La Rioja, 26006 Logroño, Spain;
- Correspondence: (R.R.d.V.-H.); (R.J.-V.)
| | - José Antonio García-Erce
- PBM Research Group, Idi-Paz Research Institute, 28046 Madrid, Spain; (M.Q.-D.); (J.A.G.-E.)
- Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, 31003 Pamplona, Spain
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20
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Quintana-Díaz M, Garay-Fernández M, Ariza-Cadena F. Advancing in the understanding of coagulopathy during hemorrhagic shock: From the triad to the deadly pentad. Colomb J Anesthesiol 2022. [DOI: 10.5554/22562087.e1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The deadly triad concept represented a dogma in the definition of poor outcomes and death associated with major bleeding in trauma. This model of end-stage disease was then rapidly transferred to other major bleeding scenarios. However, and notwithstanding the fact that it represented a severe scenario, the original triad fails to establish a sequence, which would be relevant when defining the objectives during the initial treatment of severe bleeding. It has been recently suggested that hypoxia and hyperglycemia should be included as isolated, determining factors in this model. Likewise, the model admits only one scenario where all the conditions shall co-exist, knowing that each one of them contributes with a different risk burden. Based on a structured review, we submit a pentad model that includes a natural pattern of events occurring with hypoxemia as the main trigger for the development of hypocalcemia, hyperglycemia, acidosis and hypothermia, as hallmarks of multiple system impairment. This severity model of major bleeding ends with coagulopathy as a result of the failure to resolve the rest of the previous components.
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Nanwani-Nanwani K, López-Pérez L, Giménez-Esparza C, Ruiz-Barranco I, Carrillo E, Arellano MS, Díaz-Díaz D, Hurtado B, García-Muñoz A, Relucio MÁ, Quintana-Díaz M, Úrbez MR, Saravia A, Bonan MV, García-Río F, Testillano ML, Villar J, García de Lorenzo A, Añón JM. Prevalence of post-intensive care syndrome in mechanically ventilated patients with COVID-19. Sci Rep 2022; 12:7977. [PMID: 35562379 PMCID: PMC9105588 DOI: 10.1038/s41598-022-11929-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/29/2022] [Indexed: 01/10/2023] Open
Abstract
Coronavirus disease 19 (COVID-19) patients usually require long periods of mechanical ventilation and sedation, which added to steroid therapy, favours a predisposition to the development of delirium and subsequent mental health disorders, as well as physical and respiratory sequelae. The aim of this study was to determine the prevalence of post-intensive care syndrome (PICS) at 3 months after hospital discharge, in a cohort of mechanically ventilated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An ambispective, observational study was conducted in three hospitals with intensive care unit (ICU) follow-up clinics. We studied adults who survived a critical illness due to SARS-CoV-2 infection requiring invasive mechanical ventilation. A physical (muscle strength and pulmonary function), functional [12-Item Short Form Health Survey (SF-12), and Barthel score], psychological [hospital anxiety and depression (HADS) and posttraumatic stress disorder symptom severity scales], and cognitive [Montreal cognitive assessment (MoCA) test] assessment were performed. A total of 186 patients were evaluated at 88 days (IQR 68-121) after hospital discharge. Mean age was 59 ± 12 years old, 126 (68%) patients were men, and median length of mechanical ventilation was 14 days (IQR 8-31). About 3 out of 4 patients (n = 139, 75%) met PICS criteria. Symptoms of cognitive and psychiatric disorders were found in 59 (32%) and 58 (31%) patients, respectively. Ninety-one (49%) patients had muscle weakness. Pulmonary function tests in patients with no respiratory comorbidities showed a normal pattern in 93 (50%) patients, and a restrictive disorder in 62 (33%) patients. Also, 69 patients (37%) were on sick leave, while 32 (17%) had resumed work at the time of assessment. In conclusion, survivors of critical illness due to SARS-CoV-2 infection requiring mechanical ventilation have a high prevalence of PICS. Physical domain is the most frequently damaged, followed by cognitive and psychiatric disorders. ICU follow-up clinics enable the assistance of this vulnerable population.
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Affiliation(s)
- Kapil Nanwani-Nanwani
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | | | - Inés Ruiz-Barranco
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Elena Carrillo
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - María Soledad Arellano
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Domingo Díaz-Díaz
- Intensive Care Unit, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Beatriz Hurtado
- Intensive Care Unit, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - Andoni García-Muñoz
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Manuel Quintana-Díaz
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - María Rosario Úrbez
- Department of Physical Medicine and Rehabilitation, Hospital Universitario La Paz, Madrid, Spain
| | - Andrés Saravia
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Francisco García-Río
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Jesús Villar
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Abelardo García de Lorenzo
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - José Manuel Añón
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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Nanwani Nanwani K, Estébanez Montiel B, Quintana-Díaz M, García Erce J. Reflexiones y aspectos a considerar de la donación de sangre de pacientes en muerte encefálica. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.02.007] [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: 12/01/2022]
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Calderón-Moreno J, Juárez-Vela R, Delgado-Rodríguez MJ, Quintana-Díaz M, Magallón-Botaya R, Olivan-Blázquez B, Cobos-Rincón A, Santolalla-Arnedo I, Ramírez-Torres CA, Gea-Caballero V, Andrés-Esteban EM. Approximation to the Consumption of Healthcare Resources and the Economic Cost of SARS-CoV-2 Patient Management: A Retrospective Study. Front Public Health 2022; 10:843751. [PMID: 35433597 PMCID: PMC9008573 DOI: 10.3389/fpubh.2022.843751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/02/2022] [Indexed: 12/05/2022] Open
Abstract
Spain has become one of the countries most affected by coronavirus disease 2019 (COVID-19), with the highest testing rates, and one of the worst-performing countries in the fight against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. There are no studies related to the consumption of health resources and the economic cost of the SARS-CoV-2 virus. We present a retrospective analysis of 9,811 (Primary Care and Hospital) patients which aimed to estimate public health expenditure by the consumption of health resources due to COVID-19. According to the results, the gender distribution of patients has a similar rate in both groups, with slightly higher rates in women. Similarly, age is the same in both groups, with a median of 62 years in the case of hospitalizations and 61 years in the case of primary care; using a weighted average of these rates and costs, we can estimate that the average cost of care per patient infected with the SARS-CoV-2 virus, regardless of the course is €2373.24. We conclude that a patient with COVID-19 without hospitalization costs €729.79, while the expenses of a hospitalized patient are between €4294.36 and €14440.68, if there is ICU admission.
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Affiliation(s)
- Jesús Calderón-Moreno
- Business Economics Department, University of Rey Juan Carlos, Madrid, Spain
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
| | - Raúl Juárez-Vela
- Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain
| | | | - Manuel Quintana-Díaz
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
- Intensive Care Unit, Research Group Blood Patient Management, IDI-Paz Research Institute, University Hospital “La Paz, ” Madrid, Spain
| | - Rosa Magallón-Botaya
- Primary Care Prevention and Health Promotion Network, Research Unit in Primary Care, IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Olivan-Blázquez
- Department of Psychology and Sociology, Institute for Health Research Aragón (IISA), University of Zaragoza, Zaragoza, Spain
| | - Ana Cobos-Rincón
- Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain
- *Correspondence: Ana Cobos-Rincón
| | | | | | - Vicente Gea-Caballero
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
- Faculty of Health Sciences, Valencia International University, Valencia, Spain
| | - Eva María Andrés-Esteban
- Business Economics Department, University of Rey Juan Carlos, Madrid, Spain
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
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Juárez-Vela R, Andrés-Esteban EM, Gea-Caballero V, Sánchez-González JL, Marcos-Neira P, Serrano-Lázaro A, Tirado-Anglés G, Ruiz-Rodríguez JC, Durante Á, Santolalla-Arnedo I, García-Erce JA, Quintana-Díaz M. Related Factors of Anemia in Critically Ill Patients: A Prospective Multicenter Study. J Clin Med 2022; 11:jcm11041031. [PMID: 35207301 PMCID: PMC8878830 DOI: 10.3390/jcm11041031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 12/20/2022] Open
Abstract
Anemia is common in critically ill patients; almost 95% of patients admitted to intensive care units (ICUs) have hemoglobin levels below normal. Several causes may explain this phenomenon as well as the tendency to transfuse patients without adequate cause: due to a lack of adherence to protocols, lack of supervision, incomplete transfusion request forms, or a lack of knowledge about the indications, risks, and costs of transfusions. Daily sampling to monitor the coagulation parameters and the acid-base balance can aggravate anemia as the main iatrogenic factor in its production. We studied the association and importance of iatrogenic blood loss and other factors in the incidence of anemia in ICUs. We performed a prospective, observational, multicenter study in five Spanish hospitals. A total of 142 patients with a median age of 58 years (IQI: 48-69), 71.83% male and 28.17% female, were admitted to ICUs without a diagnosis of iatrogenic anemia. During their ICU stay, anemia appeared in 66.90% of the sample, 95 patients, (95% CI: 58.51-74.56%). Risk factors associated with the occurrence of iatrogenic anemia were arterial catheter insertion (72.63% vs. 46.81%, p-value = 0.003), venous catheter insertion (87.37% vs. 72.34%, p-value = 0.023), drainages (33.68% vs. 12. 77%, p-value = 0.038), and ICU stay, where the longer the stay, the higher the rate of iatrogenic anemia (p-value < 0.001). We concluded that there was a statistical significance in the production of iatrogenic anemia due to the daily sampling for laboratory monitoring and critical procedures in intensive care units. The implementation of patient blood management programs could address these issues.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Program in Medicine and Surgery, Autonomous University of Madrid, 28049 Madrid, Spain;
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Department of Nursing, GRUPAC, University of La Rioja, 26004 Logroño, Spain;
| | - Eva María Andrés-Esteban
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Department of Business Economics and Applied Economy, Faculty of Legal and Economic Sciences, University Rey Juan Carlos, 28032 Madrid, Spain
| | - Vicente Gea-Caballero
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Faculty of Health Sciences, International University of Madrid, 46010 Valencia, Spain
| | | | - Pilar Marcos-Neira
- Intensive Care Unit, Germans Trial I Pujol Hospital, 08916 Badalona, Spain;
| | | | | | - Juan Carlos Ruiz-Rodríguez
- Shock, Organ Dysfunction and Resuscitation Research Group, Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron, 08035 Barcelona, Spain;
| | - Ángela Durante
- Department of Nursing, GRUPAC, University of La Rioja, 26004 Logroño, Spain;
| | - Iván Santolalla-Arnedo
- Department of Nursing, GRUPAC, University of La Rioja, 26004 Logroño, Spain;
- Correspondence: (I.S.-A.); (J.A.G.-E.)
| | - José Antonio García-Erce
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Blood and Tissue Bank of Navarra, Navarre Health Service, 31015 Pamplona, Spain
- Correspondence: (I.S.-A.); (J.A.G.-E.)
| | - Manuel Quintana-Díaz
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Intensive Care Unit, La Paz University Hospital, 28046 Madrid, Spain
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25
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Barea-Mendoza JA, Chico-Fernández M, Quintana-Díaz M, Pérez-Bárcena J, Serviá-Goixart L, Molina-Díaz I, Bringas-Bollada M, Ruiz-Aguilar AL, Ballesteros-Sanz MÁ, Llompart-Pou JA. Risk Factors Associated with Mortality in Severe Chest Trauma Patients Admitted to the ICU. J Clin Med 2022; 11:jcm11010266. [PMID: 35012008 PMCID: PMC8745825 DOI: 10.3390/jcm11010266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Our objective was to determine outcomes of severe chest trauma admitted to the ICU and the risk factors associated with mortality. An observational, prospective, and multicenter registry of trauma patients admitted to the participating ICUs (March 2015-December 2019) was utilized to collect the patient data that were analyzed. Severe chest trauma was defined as an Abbreviated Injury Scale (AIS) value of ≥3 in the thoracic area. Logistic regression analysis was used to evaluate the contribution of severe chest trauma to crude and adjusted ORs for mortality and to analyze the risk factors associated with mortality. Overall, 3821 patients (39%) presented severe chest trauma. The sample's characteristics were as follows: a mean age of 49.88 (19.21) years, male (77.6%), blunt trauma (93.9%), a mean ISS of 19.9 (11.6). Crude and adjusted (for age and ISS) ORs for mortality in severe chest trauma were 0.78 (0.68-0.89) and 0.43 (0.37-0.50) (p < 0.001), respectively. In-hospital mortality in the severe chest trauma patients without significant traumatic brain injury (TBI) was 5.63% and was 25.71% with associated significant TBI (p < 0.001). Age, the severity of injury (NISS and AIS-head), hemodynamic instability, prehospital intubation, acute kidney injury, and multiorgan failure were risk factors associated with mortality. The contribution of severe chest injury to the mortality of trauma patients admitted to the ICU was very low. Risk factors associated with mortality were identified.
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Affiliation(s)
- Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (J.A.B.-M.); (M.C.-F.)
| | - Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (J.A.B.-M.); (M.C.-F.)
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain;
| | - Luís Serviá-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, 25198 Lleida, Spain;
| | - Ismael Molina-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | - María Bringas-Bollada
- Servicio de Medicina Intensiva, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain;
| | | | | | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain;
- Correspondence: ; Tel.: +34-871205974
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Martínez-Alés G, Fernández-Jiménez E, Mediavilla R, Quintana-Díaz M, Louzao I, Cebolla S, Muñoz-Sanjosé A, Bayón C, Susser ES, Bravo-Ortiz MF. Role of medical comorbidity in the association between psychiatric disorders and mortality among patients with COVID-19. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1727-1730. [PMID: 35322285 PMCID: PMC8942759 DOI: 10.1007/s00127-022-02271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
We examined whether excess chronic medical comorbidity mediated excess COVID-19 inpatient mortality among people with mental disorders in the early phase of the pandemic, a question with important implications for public health and clinical decision-making. Using records of 2599 COVID-19 hospitalized patients, we conducted a formal causal mediation analysis to estimate the extent to which chronic comorbidity mediates the association between mental disorders and COVID-19 mortality. The Odds Ratio (95% CI) for Natural Indirect Effect and Controlled Direct Effect were 1.07(1.02, 1.14) and 1.40 (1.00, 1.95), respectively, suggesting that a large proportion of excess COVID-19 mortality among people with mental disorders may be explained by factors other than comorbidity.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Harvard University T.H. Chan School of Public Health, Boston, MA, USA. .,Columbia University Mailman School of Public Health, New York, NY, USA. .,Mental Health Network Biomedical Research Center (CIBERSAM), Madrid, Spain. .,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain. .,CAUSALab, Harvard University T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Eduardo Fernández-Jiménez
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,La Paz University Hospital, Madrid, Spain
| | - Roberto Mediavilla
- Mental Health Network Biomedical Research Center (CIBERSAM), Madrid, Spain ,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,La Paz University Hospital, Madrid, Spain ,Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | | | | | - Ainoa Muñoz-Sanjosé
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,La Paz University Hospital, Madrid, Spain
| | - Carmen Bayón
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,La Paz University Hospital, Madrid, Spain ,Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Ezra S. Susser
- Columbia University Mailman School of Public Health, New York, NY USA ,New York Psychiatric Institute, New York, NY USA
| | - María Fe Bravo-Ortiz
- Mental Health Network Biomedical Research Center (CIBERSAM), Madrid, Spain ,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,La Paz University Hospital, Madrid, Spain ,Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
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Robles-Caballero A, Henríquez-Recine MA, Juárez-Vela R, García-Olmos L, Yus-Teruel S, Quintana-Díaz M. Usefulness of the optic nerve sheath ultrasound in patients with cessation of cerebral flow. Neurocirugia (Astur : Engl Ed) 2022; 33:9-14. [PMID: 34998492 DOI: 10.1016/j.neucie.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/03/2020] [Indexed: 06/14/2023]
Abstract
UNLABELLED Optic nerve sheath diameter (ONSD) ultrasound has proven to be a useful tool for the detection of intracranial hypertension (IH). The DVNO values, in patients with cessation of cerebral blood flow (CCBF), has not been clarified yet. OBJECTIVE Establish an association between DVNO and CFSC in neurocritical patients admitted to an ICU. PATIENTS AND METHODS Cross-sectional study of patients admitted in a third level ICU, between April 2017 and April 2018, with neurological pathology. ONSD ultrasound was performed in the first 24 h and as the patient was diagnosed of CCBF. The ONSD values of patients with and without diagnosis of CCBF were compared. RESULTS 99 patients were included, 29 of whom showed CCBF in transcranial Doppler. The ONSD measurement did not demonstrate significant differences between both groups, 65.94 ± 7.55 in the group with CCBF and 63.88 ± 5.56 in the group without CCBF, p = 0.14. CONCLUSION In our study, ONSD values capable of recognizing CCBF were not identified.
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Affiliation(s)
- Alejandro Robles-Caballero
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Grupo BMP, Instituto de Investigación-IdiPaz, Madrid, Spain
| | - María Angélica Henríquez-Recine
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Grupo BMP, Instituto de Investigación-IdiPaz, Madrid, Spain
| | - Raúl Juárez-Vela
- Grupo BMP, Instituto de Investigación-IdiPaz, Madrid, Spain; Universidad de la Rioja, Logroño, Spain.
| | - Luís García-Olmos
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Sureste, Madrid, Spain
| | - Santiago Yus-Teruel
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Grupo BMP, Instituto de Investigación-IdiPaz, Madrid, Spain
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Grupo BMP, Instituto de Investigación-IdiPaz, Madrid, Spain
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28
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Artiga-Sainz LM, Ibáñez-Navarro A, Morante-Ruiz M, Bilbao JSV, Rodríguez de Lema-Tapetado G, Sarria-Santamera A, Quintana-Díaz M. Overview of coronavirus pandemic. Computational Approaches for Novel Therapeutic and Diagnostic Designing to Mitigate SARS-CoV-2 Infection 2022. [PMCID: PMC9300555 DOI: 10.1016/b978-0-323-91172-6.00013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
During the last months of 2019, numerous cases of respiratory illness such as pneumonia and acute respiratory distress syndrome were described in Wuhan, the capital city of Hubei province in China. At the same time, several research groups identified and reported the etiological agent, that included within the Coronaviridae family and the order Nidovirales, named SARS-CoV-2. Subsequently, the pathological and clinical status caused by the pathogen is commonly known as Coronavirus disease 2019 (COVID-19). In a short period, the outbreak of emerging spread across the world. Therefore the World Health Organization declared a public health emergency of international concern on January 30, 2020, and as a pandemic on March 11, 2020. Many different public health and epidemiological studies have been published since the COVID-19 outbreak, but fatality rates (those that relate the number of cases to mortality) are difficult to assess with certainty. Mean and median case-fatality rates worldwide are near to 3% and 2%, respectively. The median infection fatality calculated from serologic prevalence varies from 0.00% to 1.63% but is mostly estimated between 0.27% and 0.9%. These indexes are influenced by geographic location, socioeconomic status, sex, age, and health conditions, among others.
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29
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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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Chico-Fernández M, Abelardo Barea-Mendoza J, Servià-Goixart L, Ormazabal-Zabala T, Quintana-Díaz M, González-Robledo J, Iglesias-Santiago A, Sánchez-Arguiano MJ, Pérez-Bárcena J, Llompart-Pou JA. Factors associated with death due to trauma in patients with a Glasgow Coma Scale score of 3 and bilateral fixed dilated pupils. Emergencias 2021; 33:121-127. [PMID: 33750053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To compare patients with a Glasgow Coma Scale (GCS) score of 3 stratified according to pupillary reaction and to explore factors associated with in-hospital death in those with bilateral fixed dilated pupils. MATERIAL AND METHODS Prospective, observational, multicenter study. We included all patients with trauma and GCS scores of 3 admitted to the intensive care unit from March 2015 to December 2019. Factors associated with in-hospital mortality in the patients with bilateral dilated pupils were explored using multiple regression analysis. RESULTS Of the 933 patients included, 454 (48.7%) had responsive pupils, 201 (21.5%) had a single fixed dilated pupil, and 278 (29.8%) had bilateral dilation. Hospital mortality was high in all 3 groups: 32.5% in those with normal responsive pupils, 54.6% in those with a single unreactive pupil, and 91.0% in those with bilateral dilation. Factors significantly associated with in-hospital death were age, a score of 3 or more on the Abbreviated Injury Scale for the head, and shock or refractory shock. Types I or II diffuse lesions and evacuated mass lesions were protective in patients with GCS scores of 3 and bilateral dilated pupils. Twelve of the 26 patients (46.1%) with bilateral dilated pupils and GCS scores of 3 had GCS scores of 14 or 15 on discharge from the hospital. CONCLUSION The in-hospital mortality was 91% in this study of trauma patients with GCS scores of 3 and bilateral dilated pupils. Factors significantly associated with in-hospital death were age, a score of 3 or more on the Abbreviated Injury Scale for the head, and shock or refractory shock. Types I or II diffuse lesions and evacuated mass lesions were protective in patients with GCS scores of 3 and bilateral dilated pupils.
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Affiliation(s)
- Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - Luis Servià-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, España
| | | | | | - Javier González-Robledo
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | | | | | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, España
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, España
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Nanwani Nanwani K, Estébanez Montiel B, García Erce J, Quintana-Díaz M. Donación de sangre de pacientes en muerte encefálica: ¿factible y ético? Med Intensiva 2021. [DOI: 10.1016/j.medin.2021.09.001] [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: 10/19/2022]
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Beverina I, Jericó C, Quintana-Díaz M, García-Erce JA. Therapeutic Alternative to Transfusion in Nonpregnant Women With Iron Deficiency Anemia Caused by Uterine Blood Loss. J Emerg Med 2021; 60:565-566. [PMID: 33902882 DOI: 10.1016/j.jemermed.2020.09.052] [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: 07/31/2020] [Accepted: 09/12/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Ivo Beverina
- Blood Transfusion Centre, Legnano General Hospital, Legnano, Italy
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain; Department of Medicine, Autonomous University of Madrid, Madrid, Spain; PBM Group, Hospital La Paz, Institute for Health Research, Madrid, Spain
| | - Manuel Quintana-Díaz
- Department of Medicine, Autonomous University of Madrid, Madrid, Spain; PBM Group, Hospital La Paz, Institute for Health Research, Madrid, Spain; Intensive Care Unit, University Hospital La Paz, Madrid, Spain
| | - José Antonio García-Erce
- PBM Group, Hospital La Paz, Institute for Health Research, Madrid, Spain; Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, 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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García-Erce JA, Romón-Alonso Í, Jericó C, Domingo-Morera JM, Arroyo-Rodríguez JL, Sola-Lapeña C, Bueno-Cabrera JL, Juárez-Vela R, Zalba-Marcos S, Abad-Motos A, Gea-Caballero V, Santolalla-Arnedo I, Quintana-Díaz M. Blood Donations and Transfusions during the COVID-19 Pandemic in Spain: Impact According to Autonomous Communities and Hospitals. Int J Environ Res Public Health 2021; 18:ijerph18073480. [PMID: 33801650 PMCID: PMC8037479 DOI: 10.3390/ijerph18073480] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 01/28/2023]
Abstract
Worldwide, the COVID-19 pandemic has caused a decline in blood donations, between 30% and 70% in some of the most affected countries. In Spain, during the initial eight weeks after the State of Emergency was decreed on 14 March 2020, in the weekly reports of the Health Ministry, an average decrease of 20% was observed between 11 and week 25 compared with the 2018 donation. We aimed to investigate the impact of the COVID-19 pandemic on blood donations and blood distribution in four autonomous communities, and to explore the evolution of the consumption of blood components (BCs) in ten hospitals of six autonomous communities. We performed a prospective study of grouped cohorts on the donation and distribution of blood in four regional transfusion centers in four autonomous communities in Spain, and a retrospective study of the consumption of blood components in ten hospitals in six autonomous communities. Regarding donations, there was no significant decrease in donations, with differences between autonomous communities, which started between 1 and 15 March 2020 (−11%). The increase in donations in phase II (from 26 May 2020) stands out. Regarding consumption, there was a significant reduction in the consumption of packed red blood cells (RBCs) (24.5%), plasma (45.3%), and platelets (25.3%) in the central period (16 March–10 May). The reduction in the consumption of RBCs was significant in the period from 1–15 March. Conclusions: The COVID-19 pandemic has affected the donation and consumption of BCs.
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Affiliation(s)
- José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro Salud, Grupo Español de Rehabilitación Multimodal (GERM), IACS, Zaragoza, Grupo IdiPaz. Madrid, 31008 Pamplona, Spain;
| | - Íñigo Romón-Alonso
- Servicio Hematología y Hemoterapia, Universitario Marqués de Valdecilla, 39003 Santander, Spain;
| | - Carlos Jericó
- Hospital Sant Joan Despí de Barcelona Servicio de Medicina Interna, 08970 Barcelona, Spain;
| | | | | | | | - José Luis Bueno-Cabrera
- Servicio Hematología-Hemoterapia, Hospital Universitario Puerta de Hierro, 28222 Majadahonda-Madrid, Spain;
| | - Raúl Juárez-Vela
- Departamento de Enfermería, Universidad de la Rioja, Centro de Investigación Biomédica de La Rioja CIBIR-GISOSS, 26004 Logroño, Spain
- Correspondence: (R.J.-V.); (I.S.-A.)
| | - Saioa Zalba-Marcos
- Servicio Hematología-Hemoterapia, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Ane Abad-Motos
- Servicio Anestesia y Reanimación, Hospital Infanta Leonor, 28031 Madrid, Spain;
| | - Vicente Gea-Caballero
- Health Research Institut La Fe, Adscript Center Universidad de Valencia, Nursing School La Fe, 46026 Valencia, Spain;
| | - Iván Santolalla-Arnedo
- Departamento de Enfermería, Universidad de la Rioja, Centro de Investigación Biomédica de La Rioja CIBIR-GISOSS, 26004 Logroño, Spain
- Correspondence: (R.J.-V.); (I.S.-A.)
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Grupo IdiPaz. Madrid, 28046 Madrid, Spain;
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Weinberg I, Fernández-Capitán C, Quintana-Díaz M, Demelo-Rodriguez P, García de Casasola G, Fidalgo Á, Maria Suriñach J, Díaz-Pedroche C, Galeano-Valle F, Siniscalchi C, Visonà A, Bikdeli B, Jiménez D, Monreal M. Systematic testing for venous thromboembolism in hospitalized patients with COVID-19 and raised D-dimer levels. Thromb Update 2021; 2:100029. [PMID: 38620598 PMCID: PMC7832524 DOI: 10.1016/j.tru.2020.100029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background Hospitalized patients with COVID-19 and raised D-dimer levels have high rates of venous thromboembolism (VTE). Methods We used data from hospitalized patients with COVID-19 that were tested for pulmonary embolism (PE) or deep vein thrombosis (DVT) because of raised D-dimer levels. We aimed to identify patients at increased risk for VTE. Results From March 25 to July 5th, 2020, 1,306 hospitalized patients with COVID-19 and raised D-dimer levels underwent testing for VTE in 12 centers. In all, 171 of 714 (24%) had PE, and 161 of 810 (20%) had DVT. The median time elapsed from admission to VTE testing was 12 days, and the median time from D-dimer measurement to testing 2 days. Most patients with VTE were men (62%), mean age was 62 ± 15 years, 45% were in an intensive care unit. Overall, 681 patients (52%) received VTE prophylaxis with standard doses, 241 (18%) with intermediate doses and 100 (7.7%) with therapeutic doses of anticoagulants. On multivariable analysis, patients with D-dimer levels >20 times the upper normal range (19% of the whole cohort) were at increased risk for VTE (odds ratio [OR]: 3.24; 95%CI: 2.18-4.83), as were those with a platelet count <100,000/μL (OR: 4.17; 95%CI: 1.72-10.0). Conclusions Hospitalized patients with COVID-19 and D-dimer levels >20 times the upper normal range were at an increased risk for VTE. This may help to identify what patients could likely benefit from the use of higher than recommended doses of anticoagulants for VTE prophylaxis.
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Affiliation(s)
- Ido Weinberg
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Manuel Quintana-Díaz
- Department of Intensive Care Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Pablo Demelo-Rodriguez
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Josep Maria Suriñach
- Department of Internal Medicine, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| | - Carmen Díaz-Pedroche
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Francisco Galeano-Valle
- Department of Internal and Emergency Medicine, Angiology Unit, Parma University Hospital, Parma, Italy
| | - Carmine Siniscalchi
- Department of Internal and Emergency Medicine, Angiology Unit, Parma University Hospital, Parma, Italy
| | - Adriana Visonà
- Department of Vascular Medicine, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
| | - Behnood Bikdeli
- Yale/YNHH Center for Outcomes Research & Evaluation, New Haven, CT, USA, Cardiovascular Research Foundation, New York, NY, USA
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain. Universidad de Alcalá (IRYCIS), Madrid, Spain, CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias I Pujol, Badalona. Universidad Autònoma de Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Martínez-Alés G, Domingo-Relloso A, Arribas JR, Quintana-Díaz M, Hernán MA. Critical Care Requirements Under Uncontrolled Transmission of SARS-CoV-2. Am J Public Health 2021; 111:923-926. [PMID: 33734835 PMCID: PMC8034012 DOI: 10.2105/ajph.2020.306151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate the critical care bed capacity that would be required to admit all critical COVID-19 cases in a setting of unchecked SARS-CoV-2 transmission, both with and without elderly-specific protection measures.Methods. Using electronic health records of all 2432 COVID-19 patients hospitalized in a large hospital in Madrid, Spain, between February 28 and April 23, 2020, we estimated the number of critical care beds needed to admit all critical care patients. To mimic a hypothetical intervention that halves SARS-CoV-2 infections among the elderly, we randomly excluded 50% of patients aged 65 years and older.Results. Critical care requirements peaked at 49 beds per 100 000 on April 1-2 weeks after the start of a national lockdown. After randomly excluding 50% of elderly patients, the estimated peak was 39 beds per 100 000.Conclusions. Under unchecked SARS-CoV-2 transmission, peak critical care requirements in Madrid were at least fivefold higher than prepandemic capacity. Under a hypothetical intervention that halves infections among the elderly, critical care peak requirements would have exceeded the prepandemic capacity of most high-income countries.Public Health Implications. Pandemic control strategies that rely exclusively on protecting the elderly are likely to overwhelm health care systems.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Gonzalo Martínez-Alés is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Arce Domingo-Relloso is with the National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain, and the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health. José R. Arribas and Manuel Quintana-Díaz are with the Instituto de Investigación Hospital Universitario, La Paz University Hospital, Madrid, Spain. Manuel Quintana-Díaz is also with the Universidad Autónoma de Madrid School of Medicine, Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatics, Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology, Boston, MA
| | - Arce Domingo-Relloso
- Gonzalo Martínez-Alés is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Arce Domingo-Relloso is with the National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain, and the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health. José R. Arribas and Manuel Quintana-Díaz are with the Instituto de Investigación Hospital Universitario, La Paz University Hospital, Madrid, Spain. Manuel Quintana-Díaz is also with the Universidad Autónoma de Madrid School of Medicine, Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatics, Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology, Boston, MA
| | - José R Arribas
- Gonzalo Martínez-Alés is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Arce Domingo-Relloso is with the National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain, and the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health. José R. Arribas and Manuel Quintana-Díaz are with the Instituto de Investigación Hospital Universitario, La Paz University Hospital, Madrid, Spain. Manuel Quintana-Díaz is also with the Universidad Autónoma de Madrid School of Medicine, Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatics, Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology, Boston, MA
| | - Manuel Quintana-Díaz
- Gonzalo Martínez-Alés is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Arce Domingo-Relloso is with the National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain, and the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health. José R. Arribas and Manuel Quintana-Díaz are with the Instituto de Investigación Hospital Universitario, La Paz University Hospital, Madrid, Spain. Manuel Quintana-Díaz is also with the Universidad Autónoma de Madrid School of Medicine, Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatics, Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology, Boston, MA
| | - Miguel A Hernán
- Gonzalo Martínez-Alés is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Arce Domingo-Relloso is with the National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain, and the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health. José R. Arribas and Manuel Quintana-Díaz are with the Instituto de Investigación Hospital Universitario, La Paz University Hospital, Madrid, Spain. Manuel Quintana-Díaz is also with the Universidad Autónoma de Madrid School of Medicine, Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatics, Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology, Boston, MA
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- Gonzalo Martínez-Alés is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Arce Domingo-Relloso is with the National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain, and the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health. José R. Arribas and Manuel Quintana-Díaz are with the Instituto de Investigación Hospital Universitario, La Paz University Hospital, Madrid, Spain. Manuel Quintana-Díaz is also with the Universidad Autónoma de Madrid School of Medicine, Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatics, Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology, Boston, MA
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Robles-Caballero A, Henríquez-Recine MA, Juárez-Vela R, García-Olmos L, Yus-Teruel S, Quintana-Díaz M. Usefulness of the optic nerve sheath ultrasound in patients with cessation of cerebral flow. Neurocirugia (Astur) 2020; 33:S1130-1473(20)30134-2. [PMID: 33384224 DOI: 10.1016/j.neucir.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/09/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
Optic nerve sheath diameter (ONSD) ultrasound has proven to be a useful tool for the detection of intracranial hypertension (IH). The ONSD values, in patients with cessation of cerebral blood flow (CCBF), has not been clarified yet. OBJECTIVE Establish an association between ONSD and CCBF in neurocritical patients admitted to an ICU. PATIENTS AND METHODS Cross-sectional study of patients admitted in a third level ICU, between April 2017 and April 2018, with neurological pathology. ONSD ultrasound was performed in the first 24 hours and as the patient was diagnosed of CCBF. The ONSD values of patients with and without diagnosis of CCBF were compared. RESULTS 99 patients were included, 29 of whom showed CCBF in transcranial Doppler. The ONSD measurement did not demonstrate significant differences between both groups, 6,59 ± 0,75 in the group with CCBF and 6,39 ± 0,56 in the group without CCBF p=0.141. CONCLUSION In our study, ONSD values capable of recognizing CCBF were not identified.
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Affiliation(s)
- Alejandro Robles-Caballero
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España; Grupo BMP, Instituto de Investigación-IdiPaz, Madrid, España
| | - María Angélica Henríquez-Recine
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España; Grupo BMP, Instituto de Investigación-IdiPaz, Madrid, España
| | - Raúl Juárez-Vela
- Grupo BMP, Instituto de Investigación-IdiPaz, Madrid, España; Universidad de la Rioja , Logroño, España.
| | - Luís García-Olmos
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Sureste, Madrid, España
| | - Santiago Yus-Teruel
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España; Grupo BMP, Instituto de Investigación-IdiPaz, Madrid, España
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España; Grupo BMP, Instituto de Investigación-IdiPaz, Madrid, España
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Muñoz-Lucas MÁ, Jareño-Esteban J, Gutiérrez-Ortega C, López-Guijarro P, Collado-Yurrita L, Quintana-Díaz M, Callol-Sánchez L. Influence of Chronic Obstructive Pulmonary Disease on Volatile Organic Compounds in Patients with Non-Small Cell Lung Cancer. Arch Bronconeumol 2020; 56:801-805. [PMID: 35373775 DOI: 10.1016/j.arbr.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/17/2019] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The etiology of lung cancer is multifactorial. Exposure to tobacco smoke and the role played by the carcinogenic compounds that it contains would explain the common association between lung cancer and chronic obstructive pulmonary disease (COPD), which is closely linked to tobacco use. In both diseases, sustained inflammation is caused by increased oxidative stress (for example, lipid peroxidation). This generates low molecular weight substances called volatile organic compounds (VOC) that are excreted during breathing. VOC metabolomics provides an indirect measure of oxidative stress. OBJECTIVE The aim of this study was to establish the relative influence of COPD on the VOC profile in patients with non-small cell lung cancer (NSCLC), by first studying the possible variation of VOC associated with lung cancer histology. PATIENTS AND METHODS Exhaled air was tested in 107 NSCLC patients, who were divided into 2 groups: NSCLC with COPD and non-COPD with NSCLC. The exhaled air sample was obtained with the BIOVOC® sampler, and transferred to desorption tubes for later analysis by thermal desorption-gas chromatography-mass spectrometry. The VOC analysis showed lineal aldehydes and carboxylic acids. RESULTS AND CONCLUSIONS No statistically significant differences were found in VOC associated with histology. NSCLC and COPD patients present a 1.7-fold (1.1-2.7) greater probability of detection of propionic acid (95% CI: 1.22-6.2) than patients without COPD or NSCLC (p = 0.013).
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Affiliation(s)
- Maria Ángeles Muñoz-Lucas
- Unidad de Apoyo a la Investigación, Jefatura de Docencia e Investigación, Hospital Central de la Defensa, Madrid, Spain.
| | - Javier Jareño-Esteban
- Servicio de Neumología, Hospital Central de la Defensa, Universidad de Alcalá de Henares (Madrid), Spain
| | - Carlos Gutiérrez-Ortega
- Unidad de Apoyo a la Investigación, Servicio de Medicina Preventiva Hospital Central de la Defensa Gómez Ulla Hospital Central de la Defensa, Madrid, Spain
| | | | | | - Manuel Quintana-Díaz
- Departamento Medicina, Universidad Autónoma de Madrid, Servicio de Medicina Intensiva del Hospital Universitario La Paz, Madrid, Spain
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Quintana-Díaz M, Andrés-Esteban E, Sánchez-Serrano J, Martínez-Virto A, Juárez-Vela R, García-Erce J. Transfusions in the Emergency department: More than a blood transfusion. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Quintana-Díaz M, Jericó-Alba C, Zalba-Marcos S, García-Erce J. Reply to "Transfusions in the emergency department: Are there other care alternatives?". Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2020.05.009] [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: 10/23/2022]
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Chico-Fernández M, Barea-Mendoza JA, Pérez-Bárcena J, García-Sáez I, Quintana-Díaz M, Marina L, Mayor-García DM, Serviá-Goixart L, Jiménez-Moragas JM, Llompart-Pou JA. Concomitant Traumatic Brain Injury and Hemorrhagic Shock: Outcomes Using the Spanish Trauma ICU Registry (RETRAUCI). Am Surg 2020; 87:370-375. [PMID: 32993317 DOI: 10.1177/0003134820949990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND To compare the main outcomes of trauma patients with and without traumatic brain injury (TBI), hemorrhagic shock, and the combination of both using data from the Spanish trauma intensive care unit (ICU) registry (RETRAUCI). METHODS Patients admitted to the participating ICUs from March 2015 to May 2019 were included in the study. The main outcomes were analyzed according to the presence of TBI, hemorrhagic shock, and/or both. Comparison of groups with quantitative variables was performed using the Kruskal-Wallis test, and differences between groups with categorical variables were compared using the Chi-square test or Fisher's exact test as appropriate. A P value <.05 was considered significant. RESULTS Overall, 310 patients (3.98%) were presented with TBI and hemorrhagic shock. Patients with TBI and hemorrhagic shock received more red blood cell (RBC) concentrates, fresh frozen plasma (FFP), a higher ratio FFP/RBC, and had a higher incidence of trauma-induced coagulopathy (60%) (P < .001). These patients had higher mortality (P < .001). Intracranial hypertension was the leading cause of death (50.4%). CONCLUSIONS Concomitant TBI and hemorrhagic shock occur in nearly 4% of trauma ICU patients. These patients required a higher amount of RBC concentrates and FFP and had an increased mortality.
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Affiliation(s)
- Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jesús A Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain
| | - Iker García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, Donostia, Spain
| | | | - Luis Marina
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | | | - Luis Serviá-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain
| | | | - Juan A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain
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Quintana-Díaz M, Jericó-Alba C, Zalba-Marcos S, García-Erce J. Réplica a «Transfusión en urgencias: ¿existen dispositivos asistenciales alternativos?». Rev Clin Esp 2020; 220:456. [DOI: 10.1016/j.rce.2020.05.015] [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: 05/25/2020] [Accepted: 05/31/2020] [Indexed: 11/16/2022]
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Ariza F, Castaño DA, Bolaños-Aldana JD, Quintana-Díaz M. Surgical site infection in adults undergoing major non-cardiac surgery and its association with anemia, severe bleeding and intraoperative transfusion: A preliminary report from a prospective registry. Colomb j anesthesiol 2020. [DOI: 10.5554/22562087.e925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction
Surgical site infection (SSI) is among the most common healthcare-related infections. Given their greater morbidity and surgical complexity, patients undergoing major surgery are exposed to a high risk of SSI.
Objective
To determine the incidence of SSI in adult patients undergoing major elective non-cardiac surgery, and to identify risk factors associated with its occurrence within the first 30 days after surgery.
Methods
An analytical study was designed on the basis of a prospective institutional registry. Clinical and laboratory variables associated with perioperative management were recorded. An active search was conducted in order to find SSI episodes, renal failure and multiple organ dysfunction during the first 30 days after surgery. Adjusted logistic regression was done to identify potential associations between risk factors and the development of SSI.
Results
Overall, 1501 patients were included. The incidence of SSI during the first 30 days after surgery was 6.72% (95% CI 5.57-8.11). ASA III, abdominal surgery and longer procedures were more frequent in the SSI group. Association with the occurrence of SSI was documented for preoperative hemoglobin levels (adjusted OR 0.79 [95% CI 0.72-0.88], p = 0.04), intraoperative transfusion (adjusted OR 2,47 [95% CI 1.16-5.27], p = 0.02) and major blood loss (adjusted OR 3.80 [95% CI 1.63-8.88], p = 0.04).
Conclusion
Preoperative hemoglobin level, intraoperative transfusion and major bleeding are independent risk factors associated with the occurrence of SSI in adult patients undergoing major elective non-cardiac surgery.
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Sobrino Jiménez C, Romero-Garrido JA, García-Martín Á, Quintana-Díaz M, Jiménez-Vicente C, González-Del Valle L, Herrero Ambrosio A, Benedí-González J. Safety and effectiveness of a four-factor prothrombin complex concentrate for vitamin K antagonist reversal following a fixed-dose strategy. Eur J Hosp Pharm 2020; 28:e66-e71. [PMID: 32591479 DOI: 10.1136/ejhpharm-2019-002114] [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: 10/08/2019] [Revised: 03/06/2020] [Accepted: 06/01/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Early reversal of anticoagulation improves outcomes in major bleeding and emergency surgery. To reverse vitamin K antagonists (VKA), vitamin K in addition to prothrombin complex concentrate (PCC) is recommended. Dosing recommendations for VKA reversal provided by the manufacturer are 25-50 IU/kg depending on the baseline international normalised ratio (INR). Nevertheless, we recommend an initial fixed dose of 1000 IU, and additional 500 IU doses evaluated on a case-by-case basis. As there is a paucity of clinical data demonstrating the efficacy and safety of this strategy, we designed this study to assess the effectiveness and safety of a four-factor (4F)-PCC for VKA reversal following a fixed-dose strategy. METHODS This was a retrospective study of adult patients who received 4F-PCC for VKA reversal. The primary outcome was INR correction. INR correction was achieved if the first INR draw after 4F-PCC was ≤1.5. Safety outcome was any confirmed thromboembolic event within 3 months after 4F-PCC. Secondary outcomes included activated partial thromboplastin time (aPTT) correction, as well as haemostatic effectiveness for bleeding patients. RESULTS A total of 145 patients were included: 106 (73.1%) in the bleeding group and 39 (26.9%) in the emergency surgery group. The INR target was reached in 102 (70.3%) patients (p<0.0001). In one case, a thromboembolic complication was possibly related to 4F-PCC. The aPTT ratio target was reached in 113 (77.9%) patients (p<0.0001), and 79 of the 106 (74.5%) patients reversed for bleeding achieved haemostatic effectiveness. CONCLUSIONS After 4F-PCC, the majority of patients achieved the target INR, meaning 4F-PCC is a useful modality for rapid INR reduction. The safety profile may be considered acceptable. Fixed-dose 4F-PCC was able to restore haemostasis rapidly while minimising the risk of adverse events and optimising available resources.
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Egea-Guerrero JJ, Ballesteros MÁ, Quintana-Díaz M. Tranexamic acid in patients with multiple injuries: good, elegant, and cheap? Emergencias 2020; 31:281-282. [PMID: 31347809] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Juan José Egea-Guerrero
- Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Sevilla, España
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Viejo-Moreno R, Cabrejas-Aparicio A, Arriero-Fernández N, Quintana-Díaz M, Galván-Roncero E, Gálvez-Marco MDLN, Carriedo-Scher C, Balaguer-Recena J, Marian-Crespo C. Mobile Intensive Care Unit versus Hospital walk-in patients, in the treatment of first episode ST- elevation myocardial infarction. Eur J Intern Med 2020; 73:83-89. [PMID: 31874804 DOI: 10.1016/j.ejim.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the impact of the attention given by emergency medical services teams working in mobile intensive care units (MICU) versus patients arriving at the hospital under their own means with ST-elevation myocardial infarction (STEMI) event in terms of time to reperfusion (TR), mortality at 30 days and six months. METHODS We retrospectively studied 634 consecutive patients with STEMI who underwent primary a percutaneous coronary intervention from January 1st 2015 to December 31st 2018 in a single centre. Depending on the first medical contact patients were classified into two groups, MICU versus walk-in patients. We extracted data on patients' characteristics, symptoms, treatments, times to reperfusion and mortality. RESULTS In our study 634 patients were included, of whom 59.0% were initially attended by the MICU. Differences were seen between the two groups in time delays to the first medical contact (120.0 vs 63.0 min; p < 0.001) and TR (208.0 Vs 150.0 min; p < 0.001). Patients attended by the MICUs presented a shorter ICU and hospital stay. The lowest 30-day mortality rate was observed in MICU group: 9.0% in contrast with 4.5%, p = 0.03; remaining after 6 months. The multivariable analysis showed that the initial attention given by MICU to STEMI patients was a protective agent against mortality [OR: 0.32 (0.11-0.90); p = 0.03]. CONCLUSION Initial attention of the patients with STEMI by doctor-on-board-MICU and available 24 h a day 7 days a week as part of a regional network (CORECAM), was associated with a decrease in the ischemia time, hospital stay and mortality of these patients in our environment.
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Affiliation(s)
- Rubén Viejo-Moreno
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España; Intensive care unit, Hospital Universitario Guadalajara, SESCAM. Guadalajara, España.
| | - Alberto Cabrejas-Aparicio
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España
| | | | | | - Enrique Galván-Roncero
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España
| | - María de Las Nieves Gálvez-Marco
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España.
| | - Cristina Carriedo-Scher
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España.
| | | | - Carlos Marian-Crespo
- Intensive care unit, Hospital Universitario Guadalajara, SESCAM. Guadalajara, España.
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Del Moral-Barbudo B, Blancas R, Ballesteros-Ortega D, Quintana-Díaz M, Martínez-González Ó. Current and research therapies for the prevention and treatment of delayed neurological syndrome associated with carbon monoxide poisoning: A narrative review. Hum Exp Toxicol 2020; 39:765-772. [PMID: 31965860 DOI: 10.1177/0960327120901572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Severe carbon monoxide (CO) poisoning causes fulminant deaths in common environment as well as neurological sequelae to survivors. Prevention of delayed neurological syndrome (DNS) after exposure to CO, the most important sequela, is based up to date on hyperbaric oxygen administration. Nevertheless, its use remains controversial due to the lack of evidence regarding its efficacy. The aim of this review is to report therapies under investigation for preventing or improving DNS, some of them with promising results in humans.
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Affiliation(s)
| | - R Blancas
- Alfonso X El Sabio University, Villanueva de la Cañada, Spain.,Critical Care Department, Del Tajo University Hospital, Aranjuez, Spain
| | - D Ballesteros-Ortega
- Alfonso X El Sabio University, Villanueva de la Cañada, Spain.,Critical Care Department, Puerta de Hierro University Hospital, Boadilla del Monte, Spain
| | - M Quintana-Díaz
- Alfonso X El Sabio University, Villanueva de la Cañada, Spain.,Critical Care Department, La Paz University Hospital, Madrid, Spain
| | - Ó Martínez-González
- Alfonso X El Sabio University, Villanueva de la Cañada, Spain.,Critical Care Department, Del Tajo University Hospital, Aranjuez, Spain
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Quintana-Díaz M, Andrés-Esteban EM, Sánchez-Serrano J, Martínez-Virto A, Juárez-Vela R, García-Erce JA. Transfusions in the Emergency department: More than a blood transfusion. Rev Clin Esp 2019; 220:393-399. [PMID: 31744619 DOI: 10.1016/j.rce.2019.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 11/17/2022]
Abstract
Increasing haemoglobin and haematocrit levels with blood transfusions has been the gold standard for treating severe anaemia; however, the indication for transfusing concentrated red blood cells is based merely on a few laboratory markers, such as haemoglobin and haematocrit levels, rather than based on the symptoms according to clinical practice guidelines, the implementation of legal regulations and the consensus achieved by the hospitals' transfusion committees. The aim of this multicentre study was to reassess the suitability of the indication for transfusing concentrated red blood cells and the volumes transfused in emergency departments. We established an observational, multicentre, cross-sectional design with 2 participating centres: the La Paz University Hospital and the Hospital of Salamanca. In total, we obtained data from 381 patients, 220 (57.74%) of whom were men with an average age of 71.4±14.0 years and 161 (42.26%) of whom were women with an average age of 75.3±15.3 years (P<.001). The most prevalent underlying diseases in the patients who underwent transfusions were heart disease, which included haemorrhaging due to antiplatelet or anticoagulant therapy (57.7%), haemato-oncologic (15.3%) diseases and neurological disease. Only 54.9% (209/381) of the prescriptions for transfusion were considered appropriate, with significant differences according to the indication.
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Affiliation(s)
- M Quintana-Díaz
- Servicio de Urgencias, Hospital Universitario La Paz, Grupo PBM, Instituto de Investigación-IdiPAZ, Madrid, España
| | - E M Andrés-Esteban
- Universidad Rey Juan Carlos, Grupo PBM, Instituto de Investigación-IdiPAZ, Madrid, España
| | - J Sánchez-Serrano
- Servicio de Urgencias, Hospital Universitario de Salamanca, Instituto de Investigación-IdiPAZ, Salamanca, España
| | - A Martínez-Virto
- Servicio de Urgencias, Hospital Universitario La Paz, Grupo PBM, Instituto de Investigación-IdiPAZ, Madrid, España
| | - R Juárez-Vela
- Universidad de La Rioja, Logroño, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España.
| | - J A García-Erce
- Banco de Sangre y Tejidos de Navarra (Navarra), Grupo PBM, Instituto de Investigación -IdiPAZ, Madrid, España
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Palomo-López N, Quintana-Díaz M, Egea-Guerrero JJ. Early fresh frozen plasma for hemorrhagic shock: Are we sure? Emergencias 2019; 31:353-354. [PMID: 31625308] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Nora Palomo-López
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
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Marcos-Jubilar M, García Erce JA, Martínez-Calle N, Páramo JA, Martínez Virto A, Quintana-Díaz M. Safety and effectiveness of a prothrombin complex concentrate in approved and off-label indications. Transfus Med 2019; 29:268-274. [PMID: 31347218 DOI: 10.1111/tme.12621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/21/2018] [Revised: 03/10/2019] [Accepted: 06/30/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of prothrombin complex concentrates (PCCs) in approved and off-label indications. BACKGROUND PCCs are approved for the urgent reversal of vitamin K antagonists (VKAs). Data concerning the efficacy, safety and dosing for off-label indications are limited, but they are included in massive bleeding protocols. METHODS This was a retrospective review of cases treated with four-factor PCCs (4F-PCCs) between January 2009 and 2016. Efficacy end-points include: (i) VKA reversal efficacy assessed by international normalised ratio (INR) normalisation (<1·5) and (ii) clinical efficacy as bleeding cessation and/or decreased number of transfused blood components and 24-h mortality in bleeding coagulopathy. The safety end-point is the incidence of thromboembolic events. RESULTS A total of 328 patients were included (51·8% male, median age 78 years old). Indications were as follows: VKA reversal (66·6%), bleeding coagulopathy (30·5%) and direct anticoagulant (DOAC) reversal due to bleeding (2·5%). VKA reversal was effective in 97·1% of patients, and 76·5% demonstrated complete reversal (INR < 1·5); only 34·3% patients needed hemoderivatives. Prior to emergency procedures, PCCs achieved global responses in 83% of patients, with no bleeding complication during intervention. DOAC reversal was effective in 88·9% of patients. Bleeding cessation was associated with the dose administered (P = 0·002). In coagulopathy bleeding, haemorrhage cessation, established by the International Society of Thrombosis and Haemostais (ISTH) definition, occurred in 56·7% of massive bleeding events and in 42·5% of other coagulopathies; 24-h mortality was 30%, mainly related to active bleeding. Ten thrombotic episodes were observed (3·1%). CONCLUSION 4F-PCC was effective as adjuvant treatment with an acceptable safety profile, not only for the emergent reversal of VKAs but also for refractory coagulopathy associated with major bleeding.
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Affiliation(s)
- M Marcos-Jubilar
- Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - N Martínez-Calle
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J A Páramo
- Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - A Martínez Virto
- Emergency Department, Hospital Universitario La Paz, Madrid, Spain
| | - M Quintana-Díaz
- Intensive Medicine, Hospital Universitario La Paz, Madrid, Spain
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