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Citation Analysis

Rodríguez A, Martín-Loeches I, Moreno G, Díaz E, Ferré C, Salgado M, Marín-Corral J, Estella A, Solé-Violán J, Trefler S, Zaragoza R, Socias L, Borges-Sa M, Restrepo MI, Guardiola JJ, Reyes LF, Albaya-Moreno A, Berlanga AC, Ortiz MDV, Ballesteros JC, Chinesta SS, Laderas JCP, Gómez J, Bodí M. Association of obesity on the outcome of critically ill patients affected by COVID-19. Med Intensiva 2024;48:142-154. [PMID: 37923608 DOI: 10.1016/j.medine.2023.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/19/2023] [Accepted: 08/16/2023] [Indexed: 11/07/2023]

Affiliation(s)

Alejandro Rodríguez Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain; Universidad Rovira & Virgili/Institut d'Investigació Sanitaria Pere Virigili/CIBERES, Tarragona, Spain.
Ignacio Martín-Loeches Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland.
Gerard Moreno Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.
Emili Díaz Critical Care Department, Hospital Parc Tauli, Sabadell, Spain.
Cristina Ferré Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.
Melina Salgado Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.
Judith Marín-Corral Critical Care Department, Hospital del Mar, Barcelona, Spain.
Angel Estella Critical Care Department, Hospital Universitario de Jerez, Jerez de la Frontera, Spain.
Jordi Solé-Violán Critical Care Department, Hospital Universitario Dr. Negrin/Universidad Fernando Pessoa, Las Palmas de Gran Canaria, Spain.
Sandra Trefler Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.
Rafael Zaragoza Critical Care Department, Hospital Dr. Peset, Valencia, Spain.
Lorenzo Socias Critical Care Department, Hospital Son Llatzer, Palma de Mallorca, Spain.
Marcio Borges-Sa Critical Care Department, Hospital Son Llatzer, Palma de Mallorca, Spain.
Marcos I Restrepo Medical Intensive Care Unit South Texas Veterans Health Care System Audie L. Murphy Division/University of Texas Health San Antonio, San Antonio, TX, USA.
Juan J Guardiola Robley Rex VA Medical Center/University of Louisville, Louisville, USA.
Luis F Reyes Unisabana Center for Translational Science, Universidad de La Sabana, Clinica Universidadde La Sabana, Chía, Colombia/Pandemic Sciences Institute, University of Oxford, Oxford, UK.
Antonio Albaya-Moreno Critical Care Department, Hospital Universitario de Guadalajara, Guadalajara, Spain.
Alfonso Canabal Berlanga Critical Care Department, Hospital de La Princesa, Madrid, Spain.
María Del Valle Ortiz Critical Care Department, Hospital Universitario de Burgos, Burgos, Spain.
Juan Carlos Ballesteros Critical Care Department, Hospital Clínico de Salamanca, Salamanca, Spain.
Susana Sancho Chinesta Critical Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Juan Carlos Pozo Laderas Critical Care Department, Hospital Universitario Reina Sofía, Córdoba, Spain.
Josep Gómez Technical Secretary, Hospital Universitario de Tarragona Joan XXIII/URV, Tarragona, Spain.
María Bodí Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain; Universidad Rovira & Virgili/Institut d'Investigació Sanitaria Pere Virigili/CIBERES, Tarragona, Spain.

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Rodríguez A, Gómez F, Sarvisé C, Gutiérrez C, Giralt MG, Guerrero-Torres MD, Pardo-Granell S, Picó-Plana E, Benavent-Bofill C, Trefler S, Berrueta J, Canadell L, Claverias L, Esteve Pitarch E, Olona M, García Pardo G, Teixidó X, Bordonado L, Sans MT, Bodí M. Clinical and Microbiological Impact of Implementing a Decision Support Algorithm through Microbiologic Rapid Diagnosis in Critically Ill Patients: An Epidemiological Retrospective Pre-/Post-Intervention Study. Biomedicines 2023;11:3330. [PMID: 38137551 PMCID: PMC10741655 DOI: 10.3390/biomedicines11123330] [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: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open

Affiliation(s)

Alejandro Rodríguez Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Faculty of Medicine, Department of Basic Medical Sciences, Rovira & Virgili University, 43005 Tarragona, Spain; Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), 43005 Tarragona, Spain
Frederic Gómez Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain Centre for Biomedical Research in Infectious Diseases Network (CIBERINFEC), 28220 Madrid, Spain
Carolina Sarvisé Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Cristina Gutiérrez Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Montserrat Galofre Giralt Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
María Dolores Guerrero-Torres Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Sergio Pardo-Granell Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Ester Picó-Plana Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Clara Benavent-Bofill Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Sandra Trefler Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
Julen Berrueta Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Tarragona Health Data Research Working Group (THeDaR), Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Laura Canadell Faculty of Medicine, Department of Basic Medical Sciences, Rovira & Virgili University, 43005 Tarragona, Spain; Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Hospital Pharmacy, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Laura Claverias Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
Erika Esteve Pitarch Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Hospital Pharmacy, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Montserrat Olona Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain Preventive Medicine, Infection Control Group, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Graciano García Pardo Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Preventive Medicine, Infection Control Group, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Xavier Teixidó ICU Nursing, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain; (X.T.); (L.B.)
Laura Bordonado ICU Nursing, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain; (X.T.); (L.B.)
María Teresa Sans Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
María Bodí Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), 43005 Tarragona, Spain Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain

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Villavicencio C, Daniel X, Cartanyá M, Leache J, Ferré C, Roure M, Bodí M, Vives M, Rodriguez A. CARDIAC OUTPUT IN CRITICALLY ILL PATIENTS CAN BE ESTIMATED EASILY AND ACCURATELY USING THE MINUTE DISTANCE OBTAINED BY PULSED-WAVE DOPPLER. Shock 2023;60:553-559. [PMID: 37698504 DOI: 10.1097/shk.0000000000002210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]

Abstract

ABSTRACT

Background: Cardiac output (CO) assessment is essential for management of patients with circulatory failure. Among the different techniques used for their assessment, pulsed-wave Doppler cardiac output (PWD-CO) has proven to be an accurate and useful tool. Despite this, assessment of PWD-CO could have some technical difficulties, especially in the measurement of left ventricular outflow tract diameter (LVOTd). The use of a parameter such as minute distance (MD) which avoids LVOTd in the PWD-CO formula could be a simple and useful way to assess the CO in critically ill patients. Therefore, the aim of this study was to evaluate the correlation and agreement between PWD-CO and MD. Methods: A prospective and observational study was conducted over 2 years in a 30-bed intensive care unit (ICU). Adult patients who required CO monitoring were included. Clinical echocardiographic data were collected within the first 24 h and at least once more during the first week of ICU stay. PWD-CO was calculated using the average value of three LVOTd and left ventricular outflow tract velocity-time integral (LVOT-VTI) measurements, and heart rate. Minute distance was obtained from the product of LVOT-VTI × heart rate. Pulsed-wave Doppler cardiac output was correlated with MD using linear regression. Cardiac output was quantified from the MD using the equation defined by linear regression. Bland-Altman analysis was also used to evaluate the level of agreement between CO calculated from MD (MD-CO) and PWD-CO. The percentage error was calculated. Results: A total of 98 patients and 167 CO measurements were analyzed. Sixty-seven (68%) were male, the median age was 66 years (interquartile range [IQR], 53-75 years), and the median Acute Physiology and Chronic Health Evaluation II score was 22 (IQR, 16-26). The most common cause of admission was shock in 81 patients (82.7%). Sixty-nine patients (70.4%) were mechanically ventilated, and 68 (70%) required vasoactive drugs. The median CO was 5.5 L/min (IQR, 4.8-6.6 L/min), and the median MD was 1,850 cm/min (IQR, 1,520-2,160 cm/min). There was a significant correlation between PWD-CO and MD-CO in the general population ( R2 = 0.7; P < 0.05). This correlation improved when left ventricular ejection fraction (LVEF) was less than 60% ( R2 = 0.85, P < 0.05). Bland-Altman analysis showed good agreement between PWD-CO and MD-CO in the general population, the median bias was 0.02 L/min, the limits of agreement were -1.92 to +1.92 L/min. The agreement was better in patients with LVEF less than 60% with a median bias of 0.005 L/min and limits of agreement of -1.56 to 1.55 L/min. The percentage error was 17% in both cases. Conclusion: Measurement of MD in critically ill patients provides a simple and accurate estimate of CO, especially in patients with reduced or preserved LVEF. This would allow earlier cardiovascular assessment in patients with circulatory failure, which is of particular interest in difficult clinical or technical conditions.

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Castillejos DG, Rubio ML, Ferre C, de Los Ángeles de Gracia M, Bodí M, Sandiumenge A. Psychological symptoms in difficult-to-sedate critical care survivors. Nurs Crit Care 2023;28:679-688. [PMID: 34549485 DOI: 10.1111/nicc.12714] [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: 12/26/2020] [Revised: 08/22/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]

Abstract

BACKGROUND

Critical care survivors often experience symptoms of anxiety, depression, or post-traumatic stress disorder (PTSD).

AIMS

To determine the prevalence and severity of psychological symptoms during the first 6 months after discharge from the intensive care unit (ICU) and to evaluate its association with patients who are difficult to sedate during admission.

DESIGN

Descriptive, prospective analysis of psychological symptoms in survivors from medicosurgical ICU over a 2-year period.

METHODS

All ICU survivors who required mechanical ventilation (MV) for more than 24 hours were followed for 6 months after their ICU discharge. ICU outcome and complications as well as the presence of psychological symptoms, 1 to 3 to 6 months after discharge were prospectively evaluated through phone interviews comparing the incidence and intensity of patients who were difficult to sedate during their ICU stay with those who were not. Descriptive analysis and multivariate logistic regression were performed.

RESULTS

Data were obtained for 195 patients, of whom 30% experienced difficult sedation (DS). Difficult-to-sedate patients were younger (P = .001), less critically ill (APACHE II score P = .002), and more likely to engage in harmful use of alcohol (P = .001) and psychoactive/psychotropic drug abuse. They also spent longer times on MV and in the ICU (P = .001). Anxiety incidence at 1 to 3 to 6 months post-discharge was significantly higher in DS patients than in those who were not (87.7% vs 45.4%, 75.5% vs 29.0%, and 70.8% vs 23.7%; P < .01), respectively. Depression incidence was also significantly higher in the DS group (82.4% vs 43.1%, 66% vs 33.9%, and 60.4% vs 27.2%; [P = .001]) at 1 to 3 to 6 months, respectively. A higher percentage of patients in the DS group reported symptoms of PTSD at 1 month (28.1% vs 11.5%) (P = .007) when compared with non-DS group.

CONCLUSIONS

Critical care survivors who are difficult to sedate during their ICU stay are more likely to present psychological sequelae. Early identification of at-risk patients is necessary to implement appropriate preventive strategies.

RELEVANCE TO CLINICAL PRACTICE

Patients who are difficult to sedate in the ICU may develop psychological disorders upon discharge, which may negatively affect their recovery. The prevention of DS and the early detection of psychological disorders are essential to minimize its subsequent impact.

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Moreno G, Carbonell R, Díaz E, Martín-Loeches I, Restrepo MI, Reyes LF, Solé-Violán J, Bodí M, Canadell L, Guardiola J, Trefler S, Vidaur L, Papiol E, Socias L, Correig E, Marín-Corral J, Rodríguez A. Effectiveness of prolonged versus standard-course of oseltamivir in critically ill patients with severe influenza infection: A multicentre cohort study. J Med Virol 2023;95:e29010. [PMID: 37537755 DOI: 10.1002/jmv.29010] [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: 05/03/2023] [Revised: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023]

Abstract

The aim of this study is to investigate the effectiveness of prolonged versus standard course oseltamivir treatment among critically ill patients with severe influenza. A retrospective study of a prospectively collected database including adults with influenza infection admitted to 184 intensive care units (ICUs) in Spain from 2009 to 2018. Prolonged oseltamivir was defined if patients received the treatment beyond 5 days, whereas the standard-course group received oseltamivir for 5 days. The primary outcome was all-cause ICU mortality. Propensity score matching (PSM) was constructed, and the outcome was investigated through Cox regression and RCSs. Two thousand three hundred and ninety-seven subjects were included, of whom 1943 (81.1%) received prolonged oseltamivir and 454 (18.9%) received standard treatment. An optimal full matching algorithm was performed by matching 2171 patients, 1750 treated in the prolonged oseltamivir group and 421 controls in the standard oseltamivir group. After PSM, 387 (22.1%) patients in the prolonged oseltamivir and 119 (28.3%) patients in the standard group died (p = 0.009). After adjusting confounding factors, prolonged oseltamivir significantly reduced ICU mortality (odds ratio [OR]: 0.53, 95% confidence interval [CI]: 0.40-0.69). Prolonged oseltamivir may have protective effects on survival at Day 10 compared with a standard treatment course. Sensitivity analysis confirmed these findings. Compared with standard treatment, prolonged oseltamivir was associated with reduced ICU mortality in critically ill patients with severe influenza. Clinicians should consider extending the oseltamivir treatment duration to 10 days, particularly in higher-risk groups of prolonged viral shedding. Further randomized controlled trials are warranted to confirm these findings.

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Affiliation(s)

Gerard Moreno Critical Care Department, Institut d'Investigació Sanitaria Pere Virgili (IISPV)/Hospital Universitari Joan XXIII, Tarragona, Spain
Raquel Carbonell Critical Care Department, Institut d'Investigació Sanitaria Pere Virgili (IISPV)/Hospital Universitari Joan XXIII, Tarragona, Spain
Emili Díaz Critical Care Department, Universitat Autónoma de Barcelona (UAB), Hospital Parc Taulí, Sabadell, Spain
Ignacio Martín-Loeches Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
Marcos I Restrepo Department of Medicine, South Texas Veterans Health Care System and University of Texas Health, San Antonio, Texas, USA
Luis F Reyes Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
Jordi Solé-Violán Critical Care Department, Universidad Fernando Pessoa Canarias, Hospital Universitario Doctor Negrín, Gran Canaria, Spain
María Bodí Critical Care Department, Institut d'Investigació Sanitaria Pere Virgili (IISPV)/Hospital Universitari Joan XXIII, Tarragona, Spain Universitat Rovira i Virgili (URV)/Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Tarragona, Spain
Laura Canadell Pharmacology Department, Universitat Rovira I Virgili (URV)/Institut d'Investigació Sanitaria Pere Virgili (IISPV), Hospital Universitari Joan XXIII, Tarragona, Spain
Juan Guardiola Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville and Robley Rex VA Medical Center, Louisville, Kentucky, USA
Sandra Trefler Critical Care Department, Institut d'Investigació Sanitaria Pere Virgili (IISPV)/Hospital Universitari Joan XXIII, Tarragona, Spain
Loreto Vidaur Critical Care Deptartment, Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario de Donostia, San Sebastián, Spain
Elisabeth Papiol Critical Care Department, Hospital Univesitari Vall d'Hebrón, Barcelona, Spain
Lorenzo Socias Critical Care Department, Hospital Son Llàtzer, Palma de Mallorca, Spain
Eudald Correig Department of Biostatistics, Universitat Rovira i Virgili (URV), Reus, Spain
Judith Marín-Corral Critical Care Department, Research Group in Critical Disorders (GREPAC), IMIM, Hospital Del Mar, Barcelona, Spain
Alejandro Rodríguez Critical Care Department, Institut d'Investigació Sanitaria Pere Virgili (IISPV)/Hospital Universitari Joan XXIII, Tarragona, Spain Universitat Rovira i Virgili (URV)/Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Tarragona, Spain

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Plans-Galván O, Daniel X, Rosich S, Blázquez-Alcaide V, Gil-Castillejos D, Bodí M. [Use of isoflurane as treatment for super-refractory status epilepticus]. Rev Neurol 2023;76:309-312. [PMID: 37102255 PMCID: PMC10478142 DOI: 10.33588/rn.7609.2022191] [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: 10/28/2022] [Indexed: 04/28/2023]

Reyes LF, Rodriguez A, Fuentes YV, Duque S, García-Gallo E, Bastidas A, Serrano-Mayorga CC, Ibáñez-Prada ED, Moreno G, Ramirez-Valbuena PC, Ospina-Tascon G, Hernandez G, Silva E, Díaz AM, Jibaja M, Vera-Alarcon M, Díaz E, Bodí M, Solé-Violán J, Ferrer R, Albaya-Moreno A, Socias L, Figueroa W, Lozano-Villanueva JL, Varón-Vega F, Estella Á, Loza-Vazquez A, Jorge-García R, Sancho I, Shankar-Hari M, Martin-Loeches I. Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study. Sci Rep 2023;13:6553. [PMID: 37085552 PMCID: PMC10119842 DOI: 10.1038/s41598-023-32265-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/24/2023] [Indexed: 04/23/2023] Open

Abstract

Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40-2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98-1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes.Trial registration: This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.

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Affiliation(s)

Luis Felipe Reyes Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia. Clinica Universidad de La Sabana, Chía, Colombia. Pandemic Sciences Institute, University of Oxford, Oxford, UK.
Alejandro Rodriguez Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
Yuli V Fuentes Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia Clinica Universidad de La Sabana, Chía, Colombia
Sara Duque Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
Esteban García-Gallo Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
Alirio Bastidas Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
Cristian C Serrano-Mayorga Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia Clinica Universidad de La Sabana, Chía, Colombia
Elsa D Ibáñez-Prada Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
Gerard Moreno Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
Paula C Ramirez-Valbuena Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
Gustavo Ospina-Tascon Fundación Valle del Lili, Cali, Colombia
Glenn Hernandez Critical Care Department, Pontificia Universidad Católica de Chile, Santiago, Chile
Edwin Silva Fundación Clínica Shaio, Bogotá, Colombia
Ana Maria Díaz Eugenio Espejo Hospital of Specialties, Quito, Pichincha, Ecuador
Manuel Jibaja Eugenio Espejo Hospital of Specialties, Quito, Pichincha, Ecuador
Magdalena Vera-Alarcon Critical Care Department, Pontificia Universidad Católica de Chile, Santiago, Chile
Emili Díaz Critical Care Department, Hospital Universitari Parc Taulí, Universitat Autonoma Barcelona, Sabadell, Spain
María Bodí Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
Jordi Solé-Violán Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain Universidad Fernando Pessoa, Canarias, Spain
Ricard Ferrer Vall d'Hebron Hospital Universitari, Barcelona, Spain
Antonio Albaya-Moreno Guadalajara University Hospital, Guadalajara, Spain
Lorenzo Socias Son Llatzer University Hospital, Palma de Mallorca, Spain
William Figueroa Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
Jose L Lozano-Villanueva Fundación Clínica Shaio, Bogotá, Colombia
Fabio Varón-Vega Fundación Neumológica Colombiana, La Cardio, Bogotá, Colombia
Ángel Estella Jerez University Hospital, Jerez de la Frontera, Spain
Ana Loza-Vazquez Critical Care Department, Hospital Universitario Virgen del Valme, Sevilla, Spain
Ruth Jorge-García Hospital Providencial Nuestra Señora de Gracia, Zaragoza, Spain
Isabel Sancho Critical Care Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
Manu Shankar-Hari Intensive Care Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK Centre for Inflammation Research, The University of Edinburgh, Edinburgh, Scotland, UK
Ignacio Martin-Loeches Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, UK

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Moreno G, Ruiz-Botella M, Martín-Loeches I, Gómez Álvarez J, Jiménez Herrera M, Bodí M, Armestar F, Marques Parra A, Estella Á, Trefler S, Jorge García R, Murcia Paya J, Vidal Cortes P, Díaz E, Ferrer R, Albaya-Moreno A, Socias-Crespi L, Bonell Goytisolo J, Sancho Chinesta S, Loza A, Forcelledo Espina L, Pozo Laderas J, deAlba-Aparicio M, Sánchez Montori L, Vallverdú Perapoch I, Hidalgo V, Fraile Gutiérrez V, Casamitjana Ortega A, Martín Serrano F, Nieto M, Blasco Cortes M, Marín-Corral J, Solé-Violán J, Rodríguez A. A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients. Med Intensiva 2023;47:23-33. [PMID: 36272908 PMCID: PMC9579897 DOI: 10.1016/j.medine.2021.10.016] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/02/2021] [Indexed: 11/06/2022]

Abstract

OBJECTIVE

To determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes.

DESIGN

A secondary analysis derived from multicenter, observational study.

SETTING

Critical Care Units.

PATIENTS

Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain.

INTERVENTIONS

Corticosteroids vs. no corticosteroids.

MAIN VARIABLES OF INTEREST

Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). We performed a multivariate analysis after propensity optimal full matching (PS) for whole population and weighted Cox regression (HR) and Fine-Gray analysis (sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes.

RESULTS

A total of 2017 patients were analyzed, 1171 (58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR: 1.0; 95% CI: 0.98-1.15). Corticosteroids were administered in 298/537 (55.5%) patients of "A" phenotype and their use was not associated with ICU mortality (HR=0.85 [0.55-1.33]). A total of 338/623 (54.2%) patients in "B" phenotype received corticosteroids. No effect of corticosteroids on ICU mortality was observed when HR was performed (0.72 [0.49-1.05]). Finally, 535/857 (62.4%) patients in "C" phenotype received corticosteroids. In this phenotype HR (0.75 [0.58-0.98]) and sHR (0.79 [0.63-0.98]) suggest a protective effect of corticosteroids on ICU mortality.

CONCLUSION

Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate dose. Only patients with the highest inflammatory levels could benefit from steroid treatment.

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Affiliation(s)

G. Moreno ICU, Hospital Universitario Joan XXIII/URV/IISPV, Tarragona, Spain
M. Ruiz-Botella Tarragona Health Data Research Working Group (THeDaR) – ICU Hospital Universitario Joan XXIII, Tarragona, Spain
I. Martín-Loeches Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
J. Gómez Álvarez Tarragona Health Data Research Working Group (THeDaR) – ICU Hospital Universitario Joan XXIII, Tarragona, Spain
M. Jiménez Herrera Dean Nursing Faculty, Universitat Rovira i Virgili, Tarragona, Spain
M. Bodí ICU, Hospital Universitario Joan XXIII/URV/IISPV, Tarragona, Spain,eCIBERES/CIBERESUCICOVID
F. Armestar ICU, Hospital Universitario German Trias i Pujol, Badalona, Spain
A. Marques Parra ICU, Hospital de la Ribera, Alzira, Spain
Á. Estella ICU, Hospital Universitario de Jerez, Jerez de la Frontera, Spain
S. Trefler ICU, Hospital Universitario Joan XXIII/URV/IISPV, Tarragona, Spain
R. Jorge García ICU, Hospital Nuestra Señora de Gracia, Zaragoza, Spain
J. Murcia Paya UCI, Hospital Santa Lucía, Cartagena, Spain
P. Vidal Cortes UCI, Complejo Hospitalario Universitario de Ourense, Orense, Spain
E. Díaz UCI, Hospital Parc Taulí/UAB/CIBERES, Barcelona, Spain
R. Ferrer UCI, Hospital Universitario Vall d’Hebron, Barcelona, Spain
A. Albaya-Moreno ICU, Hospital Universitario de Guadalajara, Guadalajara, Spain
L. Socias-Crespi UCI, Hospital Universitario Son Llátzer, Palma de Mallorca, Spain
J.M. Bonell Goytisolo UCI, Hospital QuironSalud Palmaplanas, Palma de Mallorca, Spain
S. Sancho Chinesta ICU, Hospital Universitario y Politécnico La Fe, Valencia, Spain
A. Loza ICU, Hospital Universitario Nuestra Señora de Valme, Sevilla, Spain
L. Forcelledo Espina ICU, Hospital Central de Asturias, Grupo de Investigación de Microbiología Traslacional del ISPA, Oviedo, Spain
J.C. Pozo Laderas ICU, Hospital Universitario Reina Sofía, Córdoba, Spain
M. deAlba-Aparicio ICU, Hospital Universitario Reina Sofía, Córdoba, Spain
L. Sánchez Montori ICU, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
I. Vallverdú Perapoch ICU, Hospital Universitario Sant Joan, Reus, Spain
V. Hidalgo ICU, Hospital Complejo Asistencial de Segovia, Segovia, Spain
V. Fraile Gutiérrez ICU, Hospital Universitario Río Hortega, Valladolid, Spain
A.M. Casamitjana Ortega UCI, Complejo Hospitalario Universitario Insular – Materno Infantil, Las Palmas de Gran Canaria, Spain
F. Martín Serrano UCI, Hospital de La Moncloa, Madrid, Spain
M. Nieto UCI, Hospital Clínico San Carlos, Madrid, Spain
M. Blasco Cortes UCI, Hospital Clínico Universitario, Valencia, Spain
J. Marín-Corral ICU, Hospital del Mar/GREPAC – IMIM, Barcelona, Spain,adDivision of Pulmonary Diseases & Critical Care Medicine, UTH San Antonio, San Antonio, TX, USA
J. Solé-Violán ICU, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
A. Rodríguez ICU, Hospital Universitario Joan XXIII/URV/IISPV, Tarragona, Spain,eCIBERES/CIBERESUCICOVID,⁎Corresponding author
on behalf COVID-19 SEMICYUC Working Group

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Villavicencio C, Daniel X, Ferré C, Cartanyá M, Pobo Á, Oliva I, Roure M, Leache J, Bodí M. Myocardial injury as a prognostic factor in critically ill patients with severe SARS-Cov-2 pneumonia. Med Intensiva 2023;47:48-51. [PMID: 36344344 PMCID: PMC9635858 DOI: 10.1016/j.medine.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/21/2022] [Indexed: 11/06/2022]

Otero MJ, Merino de Cos P, Aquerreta Gónzalez I, Bodí M, Domingo Chiva E, Marrero Penichet SM, Martín Muñoz R, Martín Delgado MC. Assessment of the implementation of safe medication practices in Intensive Medicine Units. Med Intensiva 2022;46:680-689. [PMID: 35660285 DOI: 10.1016/j.medine.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 06/15/2023]

Manrique S, Ruiz-Botella M, Rodríguez A, Gordo F, Guardiola JJ, Bodí M, Gómez J. Secondary use of data extracted from a clinical information system to assess the adherence of tidal volume and its impact on outcomes. Med Intensiva 2022;46:619-629. [PMID: 36344013 DOI: 10.1016/j.medine.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/09/2022] [Indexed: 06/16/2023]

Abstract

OBJECTIVES

To extract data from clinical information systems to automatically calculate high-resolution quality indicators to assess adherence to recommendations for low tidal volume.

DESIGN

We devised two indicators: the percentage of time under mechanical ventilation with excessive tidal volume (>8mL/kg predicted body weight) and the percentage of patients who received appropriate tidal volume (≤8mL/kg PBW) at least 80% of the time under mechanical ventilation. We developed an algorithm to automatically calculate these indicators from clinical information system data and analyzed associations between them and patients' characteristics and outcomes.

SETTINGS

This study has been carried out in our 30-bed polyvalent intensive care unit between January 1, 2014 and November 30, 2019.

PATIENTS

All patients admitted to intensive care unit ventilated >72h were included.

INTERVENTION

Use data collected automatically from the clinical information systems to assess adherence to tidal volume recommendations and its outcomes.

MAIN VARIABLES OF INTEREST

Mechanical ventilation days, ICU length of stay and mortality.

RESULTS

Of all admitted patients, 340 met the inclusion criteria. Median percentage of time under mechanical ventilation with excessive tidal volume was 70% (23%-93%); only 22.3% of patients received appropriate tidal volume at least 80% of the time. Receiving appropriate tidal volume was associated with shorter duration of mechanical ventilation and intensive care unit stay. Patients receiving appropriate tidal volume were mostly male, younger, taller, and less severely ill. Adjusted intensive care unit mortality did not differ according to percentage of time with excessive tidal volume or to receiving appropriate tidal volume at least 80% of the time.

CONCLUSIONS

Automatic calculation of process-of-care indicators from clinical information systems high-resolution data can provide an accurate and continuous measure of adherence to recommendations. Adherence to tidal volume recommendations was associated with shorter duration of mechanical ventilation and intensive care unit stay.

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Perelló P, Gómez J, Mariné J, Cabas MT, Arasa A, Ramos Z, Moya D, Reynals I, Bodí M, Magret M. Analysis of adherence to an early mobilization protocol in an intensive care unit: Data collected prospectively over a period of three years by the clinical information system. Medicina Intensiva (English Edition) 2022;47:203-211. [PMID: 36344338 DOI: 10.1016/j.medine.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/02/2022] [Indexed: 11/06/2022]

Sirgo G, Olona M, Martín-Delgado MC, Gordo F, Trenado J, García M, Bodí M. Cross-cultural adaptation of the SCORE survey and evaluation of the impact of Real-Time Random Safety Audits in organizational culture: A multicenter study. Med Intensiva 2022;46:568-576. [PMID: 36155679 DOI: 10.1016/j.medine.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/20/2021] [Indexed: 06/16/2023]

Claverias L, Daniel X, Martín-Loeches I, Vidal-Cortez P, Gómez-Bertomeu F, Trefler S, Zaragoza R, Borges-Sa M, Reyes LF, Quindós G, Peman J, Bodí M, Díaz E, Sarvisé C, Pico E, Papiol E, Solé-Violan J, Marín-Corral J, Guardiola JJ, Rodríguez A. Impact of Aspergillus spp. isolation in the first 24 hours of admission in critically ill patients with severe influenza virus pneumonia. Med Intensiva 2022;46:426-435. [PMID: 35868719 DOI: 10.1016/j.medine.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/05/2021] [Indexed: 06/15/2023]

Affiliation(s)

L Claverias Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain; Institut d'Investigació Sanitaria Pere Virgili, Reus, Spain.
X Daniel Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain
I Martín-Loeches Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, St James's University Hospital, Dublin, Ireland
P Vidal-Cortez Critical Care Department, Complejo Hospitalario Universitario Ourense, Spain
F Gómez-Bertomeu Microbiology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
S Trefler Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain; Institut d'Investigació Sanitaria Pere Virgili, Reus, Spain
R Zaragoza Critical Care Department, Hospital Dr Peset, Valencia, Spain
M Borges-Sa Multidisciplinar Sepsis Unit, Critical Care Department, Hospital Son Llàtzer, Palma de Mallorca, Spain
L F Reyes Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia; Critical Care Department, Clinica Universidad de La Sabana, Chía, Colombia
G Quindós Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Bilbao, Spain
J Peman Institute of Sanitary Investigation La Fe, Hospital Universitari I Politècnic La Fe, Valencia, Spain
M Bodí Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII Tarragona, Spain
E Díaz Critical Care Department, Hospital Parc Taulí, Sabadell, Spain
C Sarvisé Microbiology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
E Pico Microbiology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
E Papiol Critical Care Department, Hospital Valle Hebrón, Barcelona, Spain
J Solé-Violan Critical Care Department Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
J Marín-Corral Critical Care Department, Hospital del Mar, Barcelona, Spain
J J Guardiola Department of Pulmonary, Critical Care and Sleep Medicine, University of Louisville, USA
A Rodríguez Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII Tarragona, Spain

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Proaños NJ, Reyes LF, Bastidas A, Martín-Loeches I, Díaz E, Suberviola B, Moreno G, Bodí M, Nieto M, Estella A, Sole-Violán J, Curcio D, Papiol E, Guardiola J, Rodríguez A. Prior influenza vaccine is not a risk factor for bacterial coinfection in patients admitted to the ICU due to severe influenza. Med Intensiva 2022;46:436-445. [PMID: 35868720 DOI: 10.1016/j.medine.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/22/2021] [Indexed: 06/15/2023]

Vidal-Cortés P, Martín MC, Díaz E, Bodí M, Igeño JC, Garnacho-Montero J. Impact of one year of pandemic on Spanish Intensive Care Units. Rev Esp Quimioter 2022;35:392-400. [PMID: 35678324 PMCID: PMC9333115 DOI: 10.37201/req/025.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]

Perelló P, Gómez J, Mariné J, Cabas M, Arasa A, Ramos Z, Moya D, Reynals I, Bodí M, Magret M. Analysis of adherence to an early mobilization protocol in an intensive care unit: Data collected prospectively over a period of three years by the clinical information system. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.03.008] [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: 11/24/2022]

Reyes LF, Rodriguez A, Bastidas A, Parra-Tanoux D, Fuentes YV, García-Gallo E, Moreno G, Ospina-Tascon G, Hernandez G, Silva E, Díaz AM, Jibaja M, Vera-Alarcon M, Díaz E, Bodí M, Solé-Violán J, Ferrer R, Albaya-Moreno A, Socias L, Estella Á, Loza-Vazquez A, Jorge-García R, Sancho I, Martin-Loeches I. Dexamethasone as risk-factor for ICU-acquired respiratory tract infections in severe COVID-19. J Crit Care 2022;69:154014. [PMID: 35217370 PMCID: PMC8863516 DOI: 10.1016/j.jcrc.2022.154014] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 12/15/2022]

Affiliation(s)

Luis Felipe Reyes Universidad de La Sabana, Chia, Colombia; Clínica Universidad de La Sabana, Chía, Colombia.
Alejandro Rodriguez ICU Hospital Universitario Joan XXIII/IISPV/URV, CIBERes, Tarragona, Spain
Alirio Bastidas Universidad de La Sabana, Chia, Colombia
Daniela Parra-Tanoux Universidad de La Sabana, Chia, Colombia
Yuli V Fuentes Universidad de La Sabana, Chia, Colombia; Clínica Universidad de La Sabana, Chía, Colombia
Esteban García-Gallo Universidad de La Sabana, Chia, Colombia
Gerard Moreno ICU Hospital Universitario Joan XXIII/IISPV/URV, CIBERes, Tarragona, Spain
Gustavo Ospina-Tascon Department of Intensive Care, Fundación Valle del Lili, Cali, Colombia; TransLab- CCM, Universidad Icesi, Cali, Colombia
Gleen Hernandez Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile
Edwin Silva Fundación Clínica Shaio, Bogotá, Colombia
Ana Maria Díaz Eugenio Espejo Hospital of Specialties, Quito, Pichincha, Ecuador
Manuel Jibaja Eugenio Espejo Hospital of Specialties, Quito, Pichincha, Ecuador
Magdalena Vera-Alarcon Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile
Emilio Díaz Parc Tauli Universitary Hospital / UAB/CIBERES, Barcelona, Spain
María Bodí ICU Hospital Universitario Joan XXIII/IISPV/URV, CIBERes, Tarragona, Spain
Jordi Solé-Violán Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
Ricard Ferrer Vall d'Hebron Hospital Universitari, Barcelona, Spain
Antonio Albaya-Moreno Guadalajara University Hospital, Guadalajara, Spain
Lorenzo Socias Son Llatzer University Hospital, Palma de Mallorca, Spain
Ángel Estella Jerez University Hospital, Jerez de la Frontera, Spain
Ana Loza-Vazquez Hospital Universitario de Valme Sevilla, Andalucía, Spain
Ruth Jorge-García Hospital Providencial Nuestra Señora de Gracia, Zaragoza, Spain
Isabel Sancho Hospital Politécnico y Universitario La Fe Valencia, Comunidad Valenciana, Spain
Ignacio Martin-Loeches Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, St. James's Hospital, Dublin 8, Dublin, Ireland

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Wendel-Garcia PD, Mas A, González-Isern C, Ferrer R, Máñez R, Masclans JR, Sandoval E, Vera P, Trenado J, Fernández R, Sirvent JM, Martínez M, Ibarz M, Garro P, Lopera JL, Bodí M, Yébenes-Reyes JC, Triginer C, Vallverdú I, Baró A, Bodí F, Saludes P, Valencia M, Roche-Campo F, Huerta A, Cambra FJ, Barberà C, Echevarria J, Peñuelas Ó, Mancebo J. Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study. Crit Care 2022;26:37. [PMID: 35135588 PMCID: PMC8822661 DOI: 10.1186/s13054-022-03905-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/26/2022] [Indexed: 01/12/2023] Open

Abstract

Background

Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by nasal cannula and non-invasive mechanical ventilation in critically ill intensive care unit (ICU) patients remain unclear.

Methods

In this retrospective study, we used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020.

Results

Of the 1093 non-invasively oxygenated patients at ICU admission treated with one of the three stand-alone non-invasive oxygenation strategies, 897 (82%) required endotracheal intubation and 310 (28%) died during the ICU stay. High-flow oxygen therapy by nasal cannula (n = 439) and non-invasive mechanical ventilation (n = 101) were associated with a lower rate of endotracheal intubation (70% and 88%, respectively) than oxygen masks (n = 553 and 91% intubated), p < 0.001. Compared to oxygen masks, high-flow oxygen therapy by nasal cannula was associated with lower ICU mortality (hazard ratio 0.75 [95% CI 0.58–0.98), and the hazard ratio for ICU mortality was 1.21 [95% CI 0.80–1.83] for non-invasive mechanical ventilation.

Conclusion

In critically ill COVID-19 ICU patients and, in the absence of conclusive data, high-flow oxygen therapy by nasal cannula may be the approach of choice as the primary non-invasive oxygenation support strategy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-022-03905-5.

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Affiliation(s)

Pedro David Wendel-Garcia Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
Arantxa Mas Intensive Care Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
Cristina González-Isern Medical Technology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
Ricard Ferrer Intensive Care Department/SODIR Research Group, Hospital Universitari General de La Vall d'Hebron, Barcelona, Spain
Rafael Máñez Intensive Care Department, L'Hospitalet de Llobregat, Barcelona, Spain
Joan-Ramon Masclans Intensive Care Department, Hospital del Mar, GREPAC Research Group - IMIM, Department Ciències, Experimentals I de La Salut (DCEXS) UPF, Barcelona, Spain
Elena Sandoval Cardiovascular Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain
Paula Vera Intensive Care Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
Josep Trenado Intensive Care Department, Hospital Mútua de Terrassa, Terrassa, Spain
Rafael Fernández Intensive Care Department, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain
Josep-Maria Sirvent Intensive Care Department, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
Melcior Martínez Intensive Care Department, Hospital General De Cataluña, Sant Cugat del Vallès, Spain
Mercedes Ibarz Intensive Care Department, Hospital Universitari Sagrat Cor - Grup Quirónsalut, Barcelona, Spain
Pau Garro Intensive Care Department, Hospital General de Granollers, Granollers, Spain
José Luis Lopera Intensive Care Department, Hospital General de Vic, Consorci Hospitalari de Vic, Vic, Spain
María Bodí Intensive Care Department, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
Joan Carles Yébenes-Reyes Intensive Care Department, Hospital de Mataró, Mataró, Spain
Carles Triginer Intensive Care Department, Hospital d'Igualada, Igualada, Spain
Imma Vallverdú Intensive Care Department, Hospital Sant Joan de Reus, Reus, Spain
Anna Baró Intensive Care Department, Hospital de Santa Caterina, Salt, Spain
Fernanda Bodí Intensive Care Department, Hospital de Sant Pau I Santa Tecla, Tarragona, Spain
Paula Saludes Intensive Care Department, Hospital HM Delfos, Barcelona, Spain
Mauricio Valencia Intensive Care Department, Hospital El Pilar - Grup Quirónsalut, Barcelona, Spain
Ferran Roche-Campo Intensive Care Department, Hospital de Tortosa Verge de La Cinta, Tortosa, Spain
Arturo Huerta Intensive Care Department, Clínica Sagrada Família, Barcelona, Spain
Francisco José Cambra Pediatric Intensive Care Department, Hospital Sant Joan de Déu de Barcelona, Esplugues de Llobregat, Spain
Carme Barberà Intensive Care Department, Hospital Santa Maria, Lleida, Spain
Jorge Echevarria Intensive Care Department, Hospital ASEPEYO de Barcelona, Sant Cugat del Vallés, Spain
Óscar Peñuelas Intensive Care Department Hospital, Universitario de Getafe, CIBER Enfermedades Respiratorias, CIBERES (Spain), Madrid, Spain
Jordi Mancebo Intensive Care Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain. .,Institut d, Investigació Biomèdica Sant Pau, ', Servei Medicina Intensiva, Hospital Universitari Sant Pau, Barcelona, Spain.

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Claverias L, Daniel X, Martín-Loeches I, Vidal-Cortez P, Gómez-Bertomeu F, Trefler S, Zaragoza R, Borges-Sa M, Reyes L, Quindós G, Peman J, Bodí M, Díaz E, Sarvisé C, Pico E, Papiol E, Solé-Violan J, Marín-Corral J, Guardiola J, Rodríguez A. Impact of Aspergillus spp. isolation in the first 24 hours of admission in critically ill patients with severe influenza virus pneumonia. Med Intensiva 2022. [DOI: 10.1016/j.medin.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]

Moreno G, Carbonell R, Martin-Loeches I, Solé-Violán J, Correig I Fraga E, Gómez J, Ruiz-Botella M, Trefler S, Bodí M, Murcia Paya J, Díaz E, Vidal-Cortes P, Papiol E, Albaya Moreno A, Sancho Chinesta S, Socias Crespi L, Lorente MDC, Loza Vázquez A, Vara Arlanzon R, Recio MT, Ballesteros JC, Ferrer R, Fernandez Rey E, Restrepo MI, Estella Á, Margarit Ribas A, Guasch N, Reyes LF, Marín-Corral J, Rodríguez A. Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study. Ann Intensive Care 2021;11:159. [PMID: 34825976 PMCID: PMC8617372 DOI: 10.1186/s13613-021-00951-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open

Abstract

Background

Some unanswered questions persist regarding the effectiveness of corticosteroids for severe coronavirus disease 2019 (COVID-19) patients. We aimed to assess the clinical effect of corticosteroids on intensive care unit (ICU) mortality among mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients.

Methods

This was a retrospective study of prospectively collected data conducted in 70 ICUs (68 Spanish, one Andorran, one Irish), including mechanically ventilated COVID-19-associated ARDS patients admitted between February 6 and September 20, 2020. Individuals who received corticosteroids for refractory shock were excluded. Patients exposed to corticosteroids at admission were matched with patients without corticosteroids through propensity score matching. Primary outcome was all-cause ICU mortality. Secondary outcomes were to compare in-hospital mortality, ventilator-free days at 28 days, respiratory superinfection and length of stay between patients with corticosteroids and those without corticosteroids. We performed survival analysis accounting for competing risks and subgroup sensitivity analysis.

Results

We included 1835 mechanically ventilated COVID-19-associated ARDS, of whom 1117 (60.9%) received corticosteroids. After propensity score matching, ICU mortality did not differ between patients treated with corticosteroids and untreated patients (33.8% vs. 30.9%; p = 0.28). In survival analysis, corticosteroid treatment at ICU admission was associated with short-term survival benefit (HR 0.53; 95% CI 0.39–0.72), although beyond the 17th day of admission, this effect switched and there was an increased ICU mortality (long-term HR 1.68; 95% CI 1.16–2.45). The sensitivity analysis reinforced the results. Subgroups of age < 60 years, severe ARDS and corticosteroids plus tocilizumab could have greatest benefit from corticosteroids as short-term decreased ICU mortality without long-term negative effects were observed. Larger length of stay was observed with corticosteroids among non-survivors both in the ICU and in hospital. There were no significant differences for the remaining secondary outcomes.

Conclusions

Our results suggest that corticosteroid treatment for mechanically ventilated COVID-19-associated ARDS had a biphasic time-dependent effect on ICU mortality. Specific subgroups showed clear effect on improving survival with corticosteroid use. Therefore, further research is required to identify treatment-responsive subgroups among the mechanically ventilated COVID-19-associated ARDS patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13613-021-00951-0.

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Affiliation(s)

Gerard Moreno Critical Care Department, Autonomous University of Barcelona (UAB), Joan XXIII University Hospital, C/ Dr Mallafrè Guasch, 4, 43005, Tarragona, Spain.
Raquel Carbonell Critical Care Department, Autonomous University of Barcelona (UAB), Joan XXIII University Hospital, C/ Dr Mallafrè Guasch, 4, 43005, Tarragona, Spain
Ignacio Martin-Loeches Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
Jordi Solé-Violán Critical Care Department, Doctor Negrín University Hospital, Gran Canaria, Spain
Eudald Correig I Fraga Department of Biostatistics, University of Rovira i Virgili (URV), Reus, Spain
Josep Gómez Critical Care Department, Autonomous University of Barcelona (UAB), Joan XXIII University Hospital, C/ Dr Mallafrè Guasch, 4, 43005, Tarragona, Spain.,Tarragona Health Data Research Working Group (THeDaR), Joan XXIII University Hospital, Tarragona, Spain
Manuel Ruiz-Botella Critical Care Department, Autonomous University of Barcelona (UAB), Joan XXIII University Hospital, C/ Dr Mallafrè Guasch, 4, 43005, Tarragona, Spain.,Tarragona Health Data Research Working Group (THeDaR), Joan XXIII University Hospital, Tarragona, Spain
Sandra Trefler Critical Care Department, URV/IISPV/CIBERES, Joan XXIII University Hospital, Tarragona, Spain
María Bodí Critical Care Department, URV/IISPV/CIBERES, Joan XXIII University Hospital, Tarragona, Spain
Josefa Murcia Paya Critical Care Department, Santa Lucía General University Hospital, Cartagena, Spain
Emili Díaz Critical Care Department, Autonomous University of Barcelona (UAB), Parc Taulí Hospital, Sabadell, Spain
Pablo Vidal-Cortes Critical Care Department, Ourense University Hospital, Ourense, Spain
Elisabeth Papiol Critical Care Department, Vall d'Hebrón University Hospital, Barcelona, Spain
Antonio Albaya Moreno Critical Care Department, UAH, Guadalajara University Hospital, Guadalajara, Spain
Susana Sancho Chinesta Critical Care Department, University and Polytechnic Hospital of La Fe, Valencia, Spain
Lorenzo Socias Crespi Critical Care Department, Son Llàtzer Hospital, Palma de Mallorca, Spain
María Del Carmen Lorente Critical Care Department, Rafael Méndez Hospital, Murcia, Spain
Ana Loza Vázquez Critical Care Department, Virgen de Valme University Hospital, Sevilla, Spain
Rebeca Vara Arlanzon Critical Care Department, Burgos University Hospital, Burgos, Spain
María Teresa Recio Critical Care Department, University Hospital of Salamanca, Salamanca, Spain
Juan Carlos Ballesteros Critical Care Department, University Hospital of Salamanca, Salamanca, Spain
Ricard Ferrer Critical Care Department, Investigation Group SODIR-VIHR, Vall d'Hebrón University Hospital, Barcelona, Spain
Elisabeth Fernandez Rey Critical Care Department, University Central Hospital of Asturias, Oviedo, Spain
Marcos I Restrepo Department of Medicine, South Texas Veterans Health Care System and University of Texas Health, San Antonio, TX, USA
Ángel Estella Critical Care Department, Jerez University Hospital, Jerez, Spain
Antonio Margarit Ribas Critical Care Department, Nostra Senyora de Meritxell Hospital, Escaldes-Engordany, Andorra
Neus Guasch Critical Care Department, Nostra Senyora de Meritxell Hospital, Escaldes-Engordany, Andorra
Luis F Reyes Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
Judith Marín-Corral Autonomous University of Barcelona (UAB) - Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
Alejandro Rodríguez Critical Care Department, URV/IISPV/CIBERES, Joan XXIII University Hospital, Tarragona, Spain

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Carbonell R, Urgelés S, Rodríguez A, Bodí M, Martín-Loeches I, Solé-Violán J, Díaz E, Gómez J, Trefler S, Vallverdú M, Murcia J, Albaya A, Loza A, Socias L, Ballesteros JC, Papiol E, Viña L, Sancho S, Nieto M, Lorente MDC, Badallo O, Fraile V, Arméstar F, Estella A, Sanchez L, Sancho I, Margarit A, Moreno G. Mortality comparison between the first and second/third waves among 3,795 critical COVID-19 patients with pneumonia admitted to the ICU: A multicentre retrospective cohort study. Lancet Reg Health Eur 2021;11:100243. [PMID: 34751263 PMCID: PMC8566166 DOI: 10.1016/j.lanepe.2021.100243] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]

Abstract

Background

It is unclear whether the changes in critical care throughout the pandemic have improved the outcomes in coronavirus disease 2019 (COVID-19) patients admitted to the intensive care units (ICUs).

Methods

We conducted a retrospective cohort study in adults with COVID-19 pneumonia admitted to 73 ICUs from Spain, Andorra and Ireland between February 2020 and March 2021. The first wave corresponded with the period from February 2020 to June 2020, whereas the second/third waves occurred from July 2020 to March 2021. The primary outcome was ICU mortality between study periods. Mortality predictors and differences in mortality between COVID-19 waves were identified using logistic regression.

Findings

As of March 2021, the participating ICUs had included 3795 COVID-19 pneumonia patients, 2479 (65·3%) and 1316 (34·7%) belonging to the first and second/third waves, respectively. Illness severity scores predicting mortality were lower in the second/third waves compared with the first wave according with the Acute Physiology and Chronic Health Evaluation system (median APACHE II score 12 [IQR 9–16] vs 14 [IQR 10–19]) and the organ failure assessment score (median SOFA 4 [3–6] vs 5 [3–7], p<0·001). The need of invasive mechanical ventilation was high (76·1%) during the whole study period. However, a significant increase in the use of high flow nasal cannula (48·7% vs 18·2%, p<0·001) was found in the second/third waves compared with the first surge. Significant changes on treatments prescribed were also observed, highlighting the remarkable increase on the use of corticosteroids to up to 95.9% in the second/third waves. A significant reduction on the use of tocilizumab was found during the study (first wave 28·9% vs second/third waves 6·2%, p<0·001), and a negligible administration of lopinavir/ritonavir, hydroxychloroquine, and interferon during the second/third waves compared with the first wave. Overall ICU mortality was 30·7% (n = 1166), without significant differences between study periods (first wave 31·7% vs second/third waves 28·8%, p = 0·06). No significant differences were found in ICU mortality between waves according to age subsets except for the subgroup of 61–75 years of age, in whom a reduced unadjusted ICU mortality was observed in the second/third waves (first 38·7% vs second/third 34·0%, p = 0·048). Non-survivors were older, with higher severity of the disease, had more comorbidities, and developed more complications. After adjusting for confounding factors through a multivariable analysis, no significant association was found between the COVID-19 waves and mortality (OR 0·81, 95% CI 0·64–1·03; p = 0·09). Ventilator-associated pneumonia rate increased significantly during the second/third waves and it was independently associated with ICU mortality (OR 1·48, 95% CI 1·19–1·85, p<0·001). Nevertheless, a significant reduction both in the ICU and hospital length of stay in survivors was observed during the second/third waves.

Interpretation

Despite substantial changes on supportive care and management, we did not find significant improvement on case-fatality rates among critical COVID-19 pneumonia patients.

Funding

Ricardo Barri Casanovas Foundation (RBCF2020) and SEMICYUC.

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Affiliation(s)

Raquel Carbonell Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain
Silvia Urgelés Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain
Alejandro Rodríguez Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
María Bodí Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
Ignacio Martín-Loeches Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
Jordi Solé-Violán Critical Care Department, Hospital Universitario Doctor Negrín, Gran Canaria, Spain
Emili Díaz Critical Care Department, Hospital Universitari Parc Taulí, Universitat Autonoma Barcelona, Sabadell, Spain
Josep Gómez Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
Sandra Trefler Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
Montserrat Vallverdú Critical Care Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
Josefa Murcia Critical Care Deparment, Hospital Santa Lucía, Cartagena, Spain
Antonio Albaya Critical Care Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
Ana Loza Critical Care Department, Hospital Universitario Virgen del Valme, Sevilla, Spain
Lorenzo Socias Critical Care Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
Juan Carlos Ballesteros Critical Care Department, Hospital de Salamanca, Salamanca, Spain
Elisabeth Papiol Critical Care Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
Lucía Viña Critical Care Department, Hospital Universitario Central de Asturias, Oviedo, Spain
Susana Sancho Critical Care Department, Hospital Universitario y Politecnico de La Fe, Valencia, Spain
Mercedes Nieto Critical Care Department, Hospital Clínico San Carlos, Madrid, Spain
Maria del Carmen Lorente Critical Care Department, Hospital Rafael Mendez, Lorca, Spain
Oihane Badallo Critical Care Department, Hospital Universitario de Burgos, Burgos, Spain
Virginia Fraile Critical Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain
Fernando Arméstar Critical Care Department, Hospital Germans Trias i Pujol, Universitat Autonoma Barcelona, Badalona, Spain
Angel Estella Critical Care Department, Hospital Universitario de Jerez, Jerez de la Frontera, Spain
Laura Sanchez Critical Care Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain
Isabel Sancho Critical Care Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
Antonio Margarit Critical Care Department, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
Gerard Moreno Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain Corresponding author: Gerard Moreno MD, Dr Mallafrè Guasch Street, n° 4, 43007, Tarragona, Spain.
COVID-19 SEMICYUC Working Group$

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Otero MJ, Merino de Cos P, Aquerreta González I, Bodí M, Domingo Chiva E, Marrero Penichet SM, Martín Muñoz R, Martín Delgado MC. Assessment of the implementation of safe medication practices in Intensive Medicine Units. Med Intensiva 2021;46:S0210-5691(21)00176-5. [PMID: 34452772 DOI: 10.1016/j.medin.2021.07.002] [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: 05/09/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]

Proaños NJ, Reyes LF, Bastidas A, Martín-Loeches I, Díaz E, Suberviola B, Moreno G, Bodí M, Nieto M, Estella A, Sole-Violán J, Curcio D, Papiol E, Guardiola J, Rodríguez A. Prior influenza vaccine is not a risk factor for bacterial coinfection in patients admitted to the ICU due to severe influenza. Med Intensiva 2021;46:S0210-5691(21)00118-2. [PMID: 34175139 DOI: 10.1016/j.medin.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/01/2021] [Accepted: 05/22/2021] [Indexed: 11/26/2022]

Sirgo G, Olona M, Martín-Delgado MC, Gordo F, Trenado J, García M, Bodí M. Cross-cultural adaptation of the SCORE survey and evaluation of the impact of Real-Time Random Safety Audits in organizational culture: A multicenter study. Med Intensiva 2021;46:S0210-5691(21)00074-7. [PMID: 34052044 DOI: 10.1016/j.medin.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 11/21/2022]

Carbonell R, Moreno G, Martín-Loeches I, Gomez-Bertomeu F, Sarvisé C, Gómez J, Bodí M, Díaz E, Papiol E, Trefler S, Nieto M, Estella A, Jiménez Herrera M, Vidal Cortés P, Guardiola JJ, Solé-Violán J, Rodríguez A. Prognostic Value of Procalcitonin and C-Reactive Protein in 1608 Critically Ill Patients with Severe Influenza Pneumonia. Antibiotics (Basel) 2021;10:antibiotics10040350. [PMID: 33810263 PMCID: PMC8066504 DOI: 10.3390/antibiotics10040350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 12/29/2022] Open

Affiliation(s)

Raquel Carbonell Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (G.M.); (S.T.) Correspondence: ; Tel.: +34-687047670
Gerard Moreno Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (G.M.); (S.T.)
Ignacio Martín-Loeches Department of Anaesthesia and Critical Care, St James’s University Hospital, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin 8, Ireland;
Frederic Gomez-Bertomeu Microbiology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (F.G.-B.); (C.S.)
Carolina Sarvisé Microbiology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (F.G.-B.); (C.S.)
Josep Gómez Tarragona Health Data Research Working Group (THeDaR)-ICU Hospital Joan XXIII, 43005 Tarragona, Spain;
María Bodí Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (M.B.); (A.R.)
Emili Díaz Critical Care Department/CIBERES, Hospital Parc Taulí, 08208 Sabadell, Spain;
Elisabeth Papiol Critical Care Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
Sandra Trefler Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (G.M.); (S.T.)
Mercedes Nieto Critical Care Department, Hospital Clínico San Carlos, 28040 Madrid, Spain;
Angel Estella Critical Care Department, Hospital de Jerez, 11407 Jerez de la Frontera, Spain;
María Jiménez Herrera Dean Nursing Faculty, Universitat Rovira i Virgili, 43003 Tarragona, Spain;
Pablo Vidal Cortés Critical Care Department, Complejo Hospitalario Universitario Ourense, 32005 Ourense, Spain;
Juan José Guardiola Department of Pulmonary, Critical Care and Sleep Medicine, University of Louisville, Louisville, KY 40202, USA;
Jordi Solé-Violán Critical Care Department Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain;
Alejandro Rodríguez Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (M.B.); (A.R.)

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Moreno G, Rodríguez A, Sole-Violán J, Martín-Loeches I, Díaz E, Bodí M, Reyes LF, Gómez J, Guardiola J, Trefler S, Vidaur L, Papiol E, Socias L, García-Vidal C, Correig E, Marín-Corral J, Restrepo MI, Nguyen-Van-Tam JS, Torres A. Early oseltamivir treatment improves survival in critically ill patients with influenza pneumonia. ERJ Open Res 2021;7:00888-2020. [PMID: 33718494 PMCID: PMC7938052 DOI: 10.1183/23120541.00888-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 11/05/2022] Open

Affiliation(s)

Gerard Moreno Critical Care Dept, Hospital Universitari de Tarragona Joan XXIII, URV/IISPV/CIBERES, Tarragona, Spain.,These authors contributed equally
Alejandro Rodríguez Critical Care Dept, Hospital Universitari de Tarragona Joan XXIII, URV/IISPV/CIBERES, Tarragona, Spain.,These authors contributed equally
Jordi Sole-Violán Critical Care Dept, Hospital Universitario de Gran Canaria Dr Negrín, CIBERES, Las Palmas de Gran Canaria, Spain
Ignacio Martín-Loeches Dept of Anaesthesia and Critical Care, St James's University Hospital, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organisation (MICRO), Dublin, Ireland
Emili Díaz Critical Care Dept, Hospital Parc Taulí, CIBERES, Sabadell, Spain
María Bodí Critical Care Dept, Hospital Universitari de Tarragona Joan XXIII, URV/IISPV/CIBERES, Tarragona, Spain
Luis F Reyes Microbiology Dept, Universidad de La Sabana, Bogotá, Colombia
Josep Gómez Critical Care Dept, Hospital Universitari de Tarragona Joan XXIII, URV/IISPV/CIBERES, Tarragona, Spain
Juan Guardiola Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville and Robley Rex VA Medical Center, Louisville, KY, USA
Sandra Trefler Critical Care Dept, Hospital Universitari de Tarragona Joan XXIII, URV/IISPV/CIBERES, Tarragona, Spain
Loreto Vidaur Critical Care Dept, Hospital Universitario Donostia, San Sebastián, Spain
Elisabet Papiol Critical Care Dept, Hospital Vall d'Hebrón, Barcelona, Spain
Lorenzo Socias Critical Care Dept, Hospital Son Llàtzer, Palma de Mallorca, Spain
Carolina García-Vidal Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
Eudald Correig Critical Care Dept, Hospital Universitari de Tarragona Joan XXIII, URV/IISPV/CIBERES, Tarragona, Spain
Judith Marín-Corral Critical Care Dept, Hospital Del Mar, Research Group in Critical Disorders (GREPAC), IMIM, Barcelona, Spain
Marcos I Restrepo South Texas Veterans Health Care System, University of Texas Health Sciences at San Antonio, San Antonio, TX, USA
Jonathan S Nguyen-Van-Tam Health Protection and Influenza Research Group, Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
Antoni Torres Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic del Tórax, Hospital Clínic de Barcelona, CIBERES, Barcelona, Spain.,GETGAG Study Group Investigators are listed in the supplementary material

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Fabregat A, Magret M, Ferré JA, Vernet A, Guasch N, Rodríguez A, Gómez J, Bodí M. A Machine Learning decision-making tool for extubation in Intensive Care Unit patients. Comput Methods Programs Biomed 2021;200:105869. [PMID: 33250280 DOI: 10.1016/j.cmpb.2020.105869] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 08/05/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]

Rodríguez A, Ruiz-Botella M, Martín-Loeches I, Jimenez Herrera M, Solé-Violan J, Gómez J, Bodí M, Trefler S, Papiol E, Díaz E, Suberviola B, Vallverdu M, Mayor-Vázquez E, Albaya Moreno A, Canabal Berlanga A, Sánchez M, Del Valle Ortíz M, Ballesteros JC, Martín Iglesias L, Marín-Corral J, López Ramos E, Hidalgo Valverde V, Vidaur Tello LV, Sancho Chinesta S, Gonzáles de Molina FJ, Herrero García S, Sena Pérez CC, Pozo Laderas JC, Rodríguez García R, Estella A, Ferrer R. Deploying unsupervised clustering analysis to derive clinical phenotypes and risk factors associated with mortality risk in 2022 critically ill patients with COVID-19 in Spain. Crit Care 2021;25:63. [PMID: 33588914 PMCID: PMC7883885 DOI: 10.1186/s13054-021-03487-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/04/2021] [Indexed: 02/07/2023]

Abstract

BACKGROUND

The identification of factors associated with Intensive Care Unit (ICU) mortality and derived clinical phenotypes in COVID-19 patients could help for a more tailored approach to clinical decision-making that improves prognostic outcomes.

METHODS

Prospective, multicenter, observational study of critically ill patients with confirmed COVID-19 disease and acute respiratory failure admitted from 63 ICUs in Spain. The objective was to utilize an unsupervised clustering analysis to derive clinical COVID-19 phenotypes and to analyze patient's factors associated with mortality risk. Patient features including demographics and clinical data at ICU admission were analyzed. Generalized linear models were used to determine ICU morality risk factors. The prognostic models were validated and their performance was measured using accuracy test, sensitivity, specificity and ROC curves.

RESULTS

The database included a total of 2022 patients (mean age 64 [IQR 5-71] years, 1423 (70.4%) male, median APACHE II score (13 [IQR 10-17]) and SOFA score (5 [IQR 3-7]) points. The ICU mortality rate was 32.6%. Of the 3 derived phenotypes, the A (mild) phenotype (537; 26.7%) included older age (< 65 years), fewer abnormal laboratory values and less development of complications, B (moderate) phenotype (623, 30.8%) had similar characteristics of A phenotype but were more likely to present shock. The C (severe) phenotype was the most common (857; 42.5%) and was characterized by the interplay of older age (> 65 years), high severity of illness and a higher likelihood of development shock. Crude ICU mortality was 20.3%, 25% and 45.4% for A, B and C phenotype respectively. The ICU mortality risk factors and model performance differed between whole population and phenotype classifications.

CONCLUSION

The presented machine learning model identified three clinical phenotypes that significantly correlated with host-response patterns and ICU mortality. Different risk factors across the whole population and clinical phenotypes were observed which may limit the application of a "one-size-fits-all" model in practice.

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Affiliation(s)

Alejandro Rodríguez ICU Hospital Universitario Joan XXIII/IISPV/URV, Mallafre Guasch 4, 43007, Tarragona, Spain. .,CIBERESUCICOVID, Barcelona, Spain.
Manuel Ruiz-Botella Tarragona Health Data Research Working Group (THeDaR), ICU Hospital Universitario Joan XXIII, Tarragona, Spain
Ignacio Martín-Loeches Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
María Jimenez Herrera Dean Nursing Faculty, Universitat Rovira i Virgili, Tarragona, Spain
Jordi Solé-Violan ICU Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
Josep Gómez Tarragona Health Data Research Working Group (THeDaR), ICU Hospital Universitario Joan XXIII, Tarragona, Spain
María Bodí ICU Hospital Universitario Joan XXIII/IISPV/URV, Mallafre Guasch 4, 43007, Tarragona, Spain.,CIBERESUCICOVID, Barcelona, Spain
Sandra Trefler ICU Hospital Universitario Joan XXIII/IISPV/URV, Mallafre Guasch 4, 43007, Tarragona, Spain
Elisabeth Papiol ICU Hospital Universitario Vall d'Hebron, Barcelona, Spain
Emili Díaz ICU Hospital Parc Tauli, Sabadell, Spain
Borja Suberviola ICU Hospital Marqués de Valdecilla, Santander, Spain
Montserrat Vallverdu ICU Hospital Universitario Arnau de Vilanova, Lleida, Spain
Eric Mayor-Vázquez ICU Hospital Verge de la Cinta, Tortosa, Spain
Antonio Albaya Moreno ICU Hospital Universitario de Guadalajara, Guadalajara, Spain
Alfonso Canabal Berlanga ICU Hospital de La Princesa, Madrid, Spain
Miguel Sánchez ICU Hospital Clinico San Carlos, Madrid, Spain
María Del Valle Ortíz ICU Hospital Universitario de Burgos, Burgos, Spain
Juan Carlos Ballesteros ICU Hospital Clínico de Salamanca, Salamanca, Spain
Lorena Martín Iglesias ICU Hospital Universitario Central de Asturias, Oviedo, Spain
Judith Marín-Corral ICU Hospital del Mar, Barcelona, Spain
Esther López Ramos ICU Hospital Príncipe de Asturias, Alcalá de Henares, Spain
Virginia Hidalgo Valverde ICU Hospital Complejo Asistencial de Segovia, Segovia, Spain
Loreto Vidaur Vidaur Tello ICU Hospital Universitario de Donostia, Donosia, Spain
Susana Sancho Chinesta ICU Hospital Universitario y Politécnico La Fe, Valencia, Spain
Francisco Javier Gonzáles de Molina ICU Hospital Universitario de Terrasa, Terrasa, Spain
Sandra Herrero García ICU Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
Carmen Carolina Sena Pérez ICU Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain
Juan Carlos Pozo Laderas ICU Hospital Universitario Reina Sofía, Córdoba, Spain
Raquel Rodríguez García ICU Complejo Hospitalario Universitario a Coruña, A Coruña, Spain
Angel Estella ICU Hospital Universitario de Jerez, Jerez de la Frontera, Spain
Ricard Ferrer ICU Hospital Universitario Vall d'Hebron, Barcelona, Spain

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Moreno G, Carbonell R, Bodí M, Rodríguez A. [Systematic review of the prognostic utility of D-dimer, disseminated intravascular coagulation, and anticoagulant therapy in COVID-19 critically ill patients]. Med Intensiva 2021;45:42-55. [PMID: 32646669 PMCID: PMC7298463 DOI: 10.1016/j.medin.2020.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022]

Moreno G, Carbonell R, Bodí M, Rodríguez A. Systematic review of the prognostic utility of D-dimer, disseminated intravascular coagulation, and anticoagulant therapy in COVID-19 critically ill patients. Medicina Intensiva (English Edition) 2021. [PMCID: PMC7833662 DOI: 10.1016/j.medine.2020.06.006] [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: 12/15/2022]

Rodríguez A, Moreno G, Gómez J, Carbonell R, Picó-Plana E, Benavent Bofill C, Sánchez Parrilla R, Trefler S, Esteve Pitarch E, Canadell L, Teixido X, Claverias L, Bodí M. Severe infection due to the SARS-CoV-2 coronavirus: Experience of a tertiary hospital with COVID-19 patients during the 2020 pandemic. Medicina Intensiva (English Edition) 2020. [PMCID: PMC7649628 DOI: 10.1016/j.medine.2020.05.005] [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: 01/08/2023]

Abstract

Objective

To describe the clinical and respiratory characteristics of a cohort of 43 patients with COVID-19 after an evolutive period of 28 days.

Design

A prospective, single-center observational study was carried out.

Setting

Intensive care.

Patients

Patients admitted due to COVID-19 and respiratory failure.

Interventions

None.

Variables

Automatic recording was made of demographic variables, severity parameters, laboratory data, assisted ventilation (HFO: high-flow oxygen therapy and IMV: invasive mechanical ventilation), oxygenation (PaO2, PaO2/FiO2) and complications. The patients were divided into three groups: survivors (G1), deceased (G2) and patients remaining under admission (G3). The chi-squared test or Fisher exact test (categorical variables) was used, along with the Mann-Whitney U-test or Wilcoxon test for analyzing the differences between medians. Statistical significance was considered for p < 0.05.

Results

A total of 43 patients were included (G1 = 28 [65.1%], G2 = 10 [23.3%] and G3 = 5[11.6%]), with a mean age of 65 years (range 52-72), 62% males, APACHE II 18 (15-24), SOFA 6 (4-7). Arterial hypertension (30.2%) and obesity (25.6%) were the most frequent comorbidities. High-flow oxygen therapy was used in 62.7% of the patients, with failure in 85%. In turn, 95% of the patients required IMV and 85% received ventilation in prone decubitus. In the general population, initial PaO2/FiO2 improved after 7 days (165 [125-210] vs.194 [153-285]; p = 0.02), in the same way as in G1 (164 [125-197] vs. 207 [160-294]; p = 0.07), but not in G2 (163 [95-197] vs. 135 [85-177]). No bacterial coinfection was observed. The incidence of IMV-associated pneumonia was high (13 episodes/1000 days of IMV).

Conclusions

Patients with COVID-19 require early IMV, a high frequency of ventilation in prone decubitus, and have a high incidence of failed HFO. The lack of improvement of PaO2/FiO2 at 7 days could be a prognostic marker.

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Claverías L, Gómez J, Rodríguez A, Albiol J, Esteban F, Bodí M. Support to the organization of the Intensive Care Units during the pandemic through maps created from the Clinical Information Systems. Med Intensiva 2020;45:59-61. [PMID: 33020015 PMCID: PMC7531993 DOI: 10.1016/j.medin.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/14/2022]

Gil Castillejos D, Rubio ML, Ferre C, de Gracia MDLÁ, Bodí M, Sandiumenge A. Impact of difficult sedation on the management and outcome of critically ill patients. Nurs Crit Care 2020;27:528-536. [DOI: 10.1111/nicc.12558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/22/2022]

Ballesteros Sanz MÁ, Hernández-Tejedor A, Estella Á, Jiménez Rivera JJ, González de Molina Ortiz FJ, Sandiumenge Camps A, Vidal Cortés P, de Haro C, Aguilar Alonso E, Bordejé Laguna L, García Sáez I, Bodí M, García Sánchez M, Párraga Ramírez MJ, Alcaraz Peñarrocha RM, Amézaga Menéndez R, Burgueño Laguía P. [Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)]. Med Intensiva 2020;44:371-388. [PMID: 32360034 PMCID: PMC7142677 DOI: 10.1016/j.medin.2020.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]

Affiliation(s)

M Á Ballesteros Sanz Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
A Hernández-Tejedor Departamento de Operaciones, SAMUR-Protección Civil, Madrid, España
Á Estella Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
J J Jiménez Rivera Servicio de Medicina Intensiva, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España
F J González de Molina Ortiz Servicio de Medicina Intensiva, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, España
A Sandiumenge Camps Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, España
P Vidal Cortés Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, España
C de Haro Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Medicina Intensiva, CIBERES Enfermedades Respiratorias, Instituto de Salud Carlos III (ISCIII), Madrid, España
E Aguilar Alonso Servicio de Medicina Intensiva, Hospital Infanta Margarita, Cabra, Córdoba, España
L Bordejé Laguna Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
I García Sáez Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, España
M Bodí Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
M García Sánchez Servicio de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, España
M J Párraga Ramírez Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, España
R M Alcaraz Peñarrocha Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, España
R Amézaga Menéndez Servicio de Medicina Intensiva, Hospital Universitari Son Espases, Palma, Islas Baleares, España
P Burgueño Laguía Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España

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Ballesteros Sanz M, Hernández-Tejedor A, Estella Á, Jiménez Rivera J, González de Molina Ortiz F, Sandiumenge Camps A, Vidal Cortés P, de Haro C, Aguilar Alonso E, Bordejé Laguna L, García Sáez I, Bodí M, García Sánchez M, Párraga Ramírez M, Alcaraz Peñarrocha R, Amézaga Menéndez R, Burgueño Laguía P. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19). Medicina Intensiva (English Edition) 2020. [PMCID: PMC7340388 DOI: 10.1016/j.medine.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]

Blazquez V, Rodríguez A, Sandiumenge A, Bodí M. In reply to «Veteran or novice in end-of-life decision-making in intensive care medicine? Promote ethical deliberation». Med Intensiva 2019;44:202-203. [PMID: 31859016 DOI: 10.1016/j.medin.2019.10.010] [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: 10/04/2019] [Accepted: 10/20/2019] [Indexed: 11/17/2022]

Villavicencio C, Leache J, Marin J, Oliva I, Rodriguez A, Bodí M, Soni NJ. Basic critical care echocardiography training of intensivists allows reproducible and reliable measurements of cardiac output. Ultrasound J 2019;11:5. [PMID: 31359188 PMCID: PMC6638616 DOI: 10.1186/s13089-019-0120-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/15/2019] [Indexed: 12/17/2022] Open

Abstract

BACKGROUND

Although pulmonary artery catheters (PACs) have been the reference standard for calculating cardiac output, echocardiographic estimation of cardiac output (CO) by cardiologists has shown high accuracy compared to PAC measurements. A few studies have assessed the accuracy of echocardiographic estimation of CO in critically ill patients by intensivists with basic training. The aim of this study was to evaluate the accuracy of CO measurements by intensivists with basic training using pulsed-wave Doppler ultrasound vs. PACs in critically ill patients.

METHODS

Critically ill patients who required hemodynamic monitoring with a PAC were eligible for the study. Three different intensivists with basic critical care echocardiography training obtained three measurements of CO on each patient. The maximum of three separate left-ventricular outflow tract diameter measurements and the mean of three LVOT velocity time integral measurements were used. The inter-observer reliability and correlation of CO measured by PACs vs. critical care echocardiography were assessed.

RESULTS

A total of 20 patients were included. Data were analyzed comparing the measurements of CO by PAC vs. echocardiography. The inter-observer reliability for measuring CO by echocardiography was good based on a coefficient of intraclass correlation of 0.6 (95% CI 0.48-0.86, p < 0.001). Bias and limits of agreement between the two techniques were acceptable (0.64 ± 1.18 L/min, 95% limits of agreement of - 1.73 to 3.01 L/min). In patients with CO < 6.5 L/min, the agreement between CO measured by PAC vs. echocardiography improved (0.13 ± 0.89 L/min; 95% limits of agreement of - 1.64 to 2.22 L/min). The mean percentage of error between the two methods was 17%.

CONCLUSIONS

Critical care echocardiography performed at the bedside by intensivists with basic critical care echocardiography training is an accurate and reproducible technique to measure cardiac output in critically ill patients.

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Cuadrado D, Riaño D, Gómez J, Bodí M, Sirgo G, Esteban F, García R, Rodríguez A. Pursuing Optimal Prediction of Discharge Time in ICUs with Machine Learning Methods. Artif Intell Med 2019. [DOI: 10.1007/978-3-030-21642-9_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]

Moreno G, Rodríguez A, Reyes LF, Gomez J, Sole-Violan J, Díaz E, Bodí M, Trefler S, Guardiola J, Yébenes JC, Soriano A, Garnacho-Montero J, Socias L, Del Valle Ortíz M, Correig E, Marín-Corral J, Vallverdú-Vidal M, Restrepo MI, Torres A, Martín-Loeches I. Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study. Intensive Care Med 2018;44:1470-1482. [PMID: 30074052 PMCID: PMC7095489 DOI: 10.1007/s00134-018-5332-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/21/2018] [Indexed: 12/15/2022]

Abstract

PURPOSE

To determine clinical predictors associated with corticosteroid administration and its association with ICU mortality in critically ill patients with severe influenza pneumonia.

METHODS

Secondary analysis of a prospective cohort study of critically ill patients with confirmed influenza pneumonia admitted to 148 ICUs in Spain between June 2009 and April 2014. Patients who received corticosteroid treatment for causes other than viral pneumonia (e.g., refractory septic shock and asthma or chronic obstructive pulmonary disease [COPD] exacerbation) were excluded. Patients with corticosteroid therapy were compared with those without corticosteroid therapy. We use a propensity score (PS) matching analysis to reduce confounding factors. The primary outcome was ICU mortality. Cox proportional hazards and competing risks analysis was performed to assess the impact of corticosteroids on ICU mortality.

RESULTS

A total of 1846 patients with primary influenza pneumonia were enrolled. Corticosteroids were administered in 604 (32.7%) patients, with methylprednisolone the most frequently used corticosteroid (578/604 [95.7%]). The median daily dose was equivalent to 80 mg of methylprednisolone (IQR 60-120) for a median duration of 7 days (IQR 5-10). Asthma, COPD, hematological disease, and the need for mechanical ventilation were independently associated with corticosteroid use. Crude ICU mortality was higher in patients who received corticosteroids (27.5%) than in patients who did not receive corticosteroids (18.8%, p < 0.001). After PS matching, corticosteroid use was associated with ICU mortality in the Cox (HR = 1.32 [95% CI 1.08-1.60], p < 0.006) and competing risks analysis (SHR = 1.37 [95% CI 1.12-1.68], p = 0.001).

CONCLUSION

Administration of corticosteroids in patients with severe influenza pneumonia is associated with increased ICU mortality, and these agents should not be used as co-adjuvant therapy.

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Affiliation(s)

Gerard Moreno Critical Care Department URV/IISPV/CIBERES, Hospital Universitari de Tarragona Joan XXIII, Mallafré Guasch 4, 43007, Tarragona, Spain
Alejandro Rodríguez Critical Care Department URV/IISPV/CIBERES, Hospital Universitari de Tarragona Joan XXIII, Mallafré Guasch 4, 43007, Tarragona, Spain.
Luis F Reyes Department of Microbiology, Universidad de La Sabana, Chia, Colombia Department of Critical Care Medicine, Clinica Universidad de La Sabana, Chia, Colombia
Josep Gomez Critical Care Department URV/IISPV/CIBERES, Hospital Universitari de Tarragona Joan XXIII, Mallafré Guasch 4, 43007, Tarragona, Spain
Jordi Sole-Violan Critical Care Department, Hospital Dr. Negrín Gran Canaria, Las Palmas, Gran Canaria, Spain
Emili Díaz Critical Care Department/CIBERES, Hospital Parc Taulí, Sabadell, Spain
María Bodí Critical Care Department URV/IISPV/CIBERES, Hospital Universitari de Tarragona Joan XXIII, Mallafré Guasch 4, 43007, Tarragona, Spain
Sandra Trefler Critical Care Department URV/IISPV/CIBERES, Hospital Universitari de Tarragona Joan XXIII, Mallafré Guasch 4, 43007, Tarragona, Spain
Juan Guardiola Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville and Robley Rex VA Medical Center, Louisville, KY, USA
Juan C Yébenes Critical Care Department, Hospital de Mataró, Mataró, Spain
Alex Soriano Hospital Clínic Infectious Diseases, Hospital Clínic, Barcelona, Spain
José Garnacho-Montero Critical Care Department, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
Lorenzo Socias Critical Care Department, Hospital Son Llàtzer, Palma, Spain
María Del Valle Ortíz Critical Care Department, Hospital Universitario de Burgos, Burgos, Spain
Eudald Correig Departamento de Bioestadística, Universitat Rovira I Virgili, Tarragona, Spain
Judith Marín-Corral Critical Care Department, Hospital Del Mar, Research Group in Critical Disorders (GREPAC), IMIM, Barcelona, Spain
Montserrat Vallverdú-Vidal Critical Care Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
Marcos I Restrepo South Texas Veterans Health Care System, University of Texas Health Sciences at San Antonio, San Antonio, Texas, USA
Antoni Torres Hospital Clínic de Barcelona, Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic del Tórax/CIBERES, Barcelona, Spain
Ignacio Martín-Loeches Department of Anaesthesia and Critical Care, St James ́s University Hospital, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland

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Núñez Reiz A, Martínez Sagasti F, Álvarez González M, Blesa Malpica A, Martín Benítez JC, Nieto Cabrera M, Del Pino Ramírez Á, Gil Perdomo JM, Prada Alonso J, Celi LA, Armengol de la Hoz MÁ, Deliberato R, Paik K, Pollard T, Raffa J, Torres F, Mayol J, Chafer J, González Ferrer A, Rey Á, González Luengo H, Fico G, Lombroni I, Hernandez L, López L, Merino B, Cabrera MF, Arredondo MT, Bodí M, Gómez J, Rodríguez A, Sánchez García M. Big data and machine learning in critical care: Opportunities for collaborative research. Med Intensiva 2018;43:52-57. [PMID: 30077427 DOI: 10.1016/j.medin.2018.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/23/2018] [Accepted: 06/09/2018] [Indexed: 01/25/2023]

Affiliation(s)

Antonio Núñez Reiz Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España.
Fernando Martínez Sagasti Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España
Manuel Álvarez González Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España
Antonio Blesa Malpica Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España
Juan Carlos Martín Benítez Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España
Mercedes Nieto Cabrera Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España
Ángela Del Pino Ramírez Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España
José Miguel Gil Perdomo Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España
Jesús Prada Alonso Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España
Leo Anthony Celi MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States
Miguel Ángel Armengol de la Hoz MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States; Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States; Harvard Medical School, Boston, Massachusetts, United States; Biomedical Engineering and Telemedicine Group, Biomedical Technology Centre CTB, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
Rodrigo Deliberato MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States
Kenneth Paik MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States
Tom Pollard MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States
Jesse Raffa MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States
Felipe Torres MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States
Julio Mayol Department of Surgery, Hospital Clinico San Carlos de Madrid, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
Joan Chafer Unidad de Innovación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
Arturo González Ferrer Unidad de Innovación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
Ángel Rey Unidad de Innovación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
Henar González Luengo Unidad de Innovación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
Giuseppe Fico Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
Ivana Lombroni Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
Liss Hernandez Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
Laura López Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
Beatriz Merino Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
María Fernanda Cabrera Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
María Teresa Arredondo Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
María Bodí Service of Intensive Care Medicine, Hospital Universitari Joan XXIII, IISPV-URV, Tarragona, Spain
Josep Gómez Service of Intensive Care Medicine, Hospital Universitari Joan XXIII, IISPV-URV, Tarragona, Spain; Department of Electronic Engineering, Metabolomics Platform, Rovira i Virgili University, IISPV, Tarragona
Alejandro Rodríguez Service of Intensive Care Medicine, Hospital Universitari Joan XXIII, IISPV-URV, Tarragona, Spain
Miguel Sánchez García Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España.

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Blazquez V, Rodríguez A, Sandiumenge A, Oliver E, Cancio B, Ibañez M, Miró G, Navas E, Badía M, Bosque MD, Jurado MT, López M, Llauradó M, Masnou N, Pont T, Bodí M. Factors related to limitation of life support within 48h of intensive care unit admission: A multicenter study. Med Intensiva 2018;43:352-361. [PMID: 29747939 DOI: 10.1016/j.medin.2018.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/09/2018] [Accepted: 03/22/2018] [Indexed: 12/14/2022]

Sirgo G, Esteban F, Gómez J, Moreno G, Rodríguez A, Blanch L, Guardiola JJ, Gracia R, De Haro L, Bodí M. Validation of the ICU-DaMa tool for automatically extracting variables for minimum dataset and quality indicators: The importance of data quality assessment. Int J Med Inform 2018;112:166-172. [PMID: 29500016 DOI: 10.1016/j.ijmedinf.2018.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/05/2018] [Accepted: 02/07/2018] [Indexed: 10/18/2022]

Abstract

BACKGROUND

Big data analytics promise insights into healthcare processes and management, improving outcomes while reducing costs. However, data quality is a major challenge for reliable results. Business process discovery techniques and an associated data model were used to develop data management tool, ICU-DaMa, for extracting variables essential for overseeing the quality of care in the intensive care unit (ICU).

OBJECTIVE

To determine the feasibility of using ICU-DaMa to automatically extract variables for the minimum dataset and ICU quality indicators from the clinical information system (CIS).

METHODS

The Wilcoxon signed-rank test and Fisher's exact test were used to compare the values extracted from the CIS with ICU-DaMa for 25 variables from all patients attended in a polyvalent ICU during a two-month period against the gold standard of values manually extracted by two trained physicians. Discrepancies with the gold standard were classified into plausibility, conformance, and completeness errors.

RESULTS

Data from 149 patients were included. Although there were no significant differences between the automatic method and the manual method, we detected differences in values for five variables, including one plausibility error and two conformance and completeness errors. Plausibility: 1) Sex, ICU-DaMa incorrectly classified one male patient as female (error generated by the Hospital's Admissions Department). Conformance: 2) Reason for isolation, ICU-DaMa failed to detect a human error in which a professional misclassified a patient's isolation. 3) Brain death, ICU-DaMa failed to detect another human error in which a professional likely entered two mutually exclusive values related to the death of the patient (brain death and controlled donation after circulatory death). Completeness: 4) Destination at ICU discharge, ICU-DaMa incorrectly classified two patients due to a professional failing to fill out the patient discharge form when thepatients died. 5) Length of continuous renal replacement therapy, data were missing for one patient because the CRRT device was not connected to the CIS.

CONCLUSIONS

Automatic generation of minimum dataset and ICU quality indicators using ICU-DaMa is feasible. The discrepancies were identified and can be corrected by improving CIS ergonomics, training healthcare professionals in the culture of the quality of information, and using tools for detecting and correcting data errors.

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Rodríguez A, Ferri C, Martin-Loeches I, Díaz E, Masclans JR, Gordo F, Sole-Violán J, Bodí M, Avilés-Jurado FX, Trefler S, Magret M, Moreno G, Reyes LF, Marin-Corral J, Yebenes JC, Esteban A, Anzueto A, Aliberti S, Restrepo MI. Risk Factors for Noninvasive Ventilation Failure in Critically Ill Subjects With Confirmed Influenza Infection. Respir Care 2017;62:1307-1315. [DOI: 10.4187/respcare.05481] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]

Bodí M, Oliva I, Martín MC, Gilavert MC, Muñoz C, Olona M, Sirgo G. Impact of random safety analyses on structure, process and outcome indicators: multicentre study. Ann Intensive Care 2017;7:23. [PMID: 28247300 PMCID: PMC5331020 DOI: 10.1186/s13613-017-0245-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 02/13/2017] [Indexed: 01/10/2023] Open

Bodí M, Oliva I, Martín MC, Sirgo G. Real-time random safety audits: A transforming tool adapted to new times. Med Intensiva 2016;41:368-376. [PMID: 27776937 DOI: 10.1016/j.medin.2016.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/30/2016] [Accepted: 09/06/2016] [Indexed: 02/02/2023]

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ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open

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Canadell L, Olona M, Sirgo G, Gilabert MC, López PA, Martín M, De dios A, Canela M, Bodí M. PS-036 Improving pharmacological treatment: Real time safety audits. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.520] [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: 11/03/2022] Open

Rodríguez AH, Avilés-Jurado FX, Díaz E, Schuetz P, Trefler SI, Solé-Violán J, Cordero L, Vidaur L, Estella Á, Pozo Laderas JC, Socias L, Vergara JC, Zaragoza R, Bonastre J, Guerrero JE, Suberviola B, Cilloniz C, Restrepo MI, Martín-Loeches I, Cobo P, Martins J, Carbayo C, Robles-Musso E, Cárdenas A, Fierro J, Fernández DO, Sierra R, Huertos MJ, Carmona Pérez ML, Pozo Laderas JC, Guerrero R, Robles JC, León ME, Gómez AB, Márquez E, Rodríguez-Carvajal M, Estella Á, Pomares J, Ballesteros JL, Romero OM, Fernández Y, Lobato F, Prieto JF, Albofedo-Sánchez J, Martínez P, de la Torre MV, Nieto M, Sola EC, Díaz Castellanos MA, Soler GS, Leyba CO, Garnacho-Montero J, Hinojosa R, Fernández E, Loza A, León C, López SG, Arenzana A, Ocaña D, Navarrete I, Beryanaki MZ, Sánchez I, Pérez Alé M, Poullet Brea AM, Machado Casas JF, Serón C, Avellanas ML, Lander A, de Arellano SGR, Lacueva MM, Luque P, Serrano EP, Martín Lázaro JF, Polo CS, Cia IG, Bartolomé BJ, Nuñez CL, González I, Tomás Marsilla JI, Andrés CJ, Ibañes PG, Aguilar PA, Montón JM, Regil PD, Iglesias L, González CP, Fernández BQ, Iglesias LM, Soria LV, Escudero RY, Revuelta MDRM, Quiroga, García-Rodríguez Á, Cuadrado MM, Balán Mariño AL, Socias L, Ibánez P, Borges-Sa M, Socias A, Del Castillo A, Marcos RJ, Muñoz C, Bonell JM, Amestarán I, López MAG, Pàmies CV, Bonell Goytisolo JM, Morales Carbonero JA, Bonell Goytisolo JM, Morales Carbonero JA, Senoff RP, López de Medrano MG, Ruiz-Santana S, Díaz JJ, Ramírez CS, Sisón M, Hernández D, Trujillo A, Regalado L, Fndez SR, Lorente L, Rivero JC, Mora Quintero ML, Martín M, Martínez S, Cáceres J, Sanchez Palacio M, Marcos, García Rodríguez D, Leria MR, Suberviola B, Ugarte P, García-López F, Iniesta RS, Alonso AÁ, Padilla A, Palacios BM, Grande MLG, Martín Rodríguez MC, Adbel-Hadi Álvarez H, Ambros Checa A, Hernández HM, Albaya A, Obregón AS, Crespo CM, Estrella CA, Benito Puncel C, Oyargue EQ, Canabal A, Marina L, López de Toro I, Simón A, Añón JM, López Messa JB, López Pueyo MJ, del valle Sergio Ossa Echeverri OM, Ferreras Z, Ballesteros Herraez JC, Macias S, Berezo JÁ, Varela JB, Schweizer PB, Salamanca AG, Lomas LT, Anzález AO, Cicuéndez Avila R, Francisco Javier PG, Terrero AÁ, Ezpeleta FT, Sala C, López O, Paez Z, García Á, Carriedo Ule D, Crespo MR, Rebolledo JP, Andrés NH, Zirena ACC, García BR, López Messa JB, del Valle Ortiz M, Echeverri SO, Catalán RM, Ferrer M, Torres A, Cilloniz C, Ansorregui SB, Cabré L, Baeza I, Rovira A, Álvarez-Lerma F, Vázquez A, Nolla J, Fernández F, Cervelló JR, Iglesia R, Mañéz R, Ballús J, Granada RM, Vallés J, Díaz E, Ortíz M, Guía C, Martín-Loeches I, Páez J, Almirall J, Balanzo X, Güell E, Yebenes JC, Rello J, Arnau E, Pérez M, Laborda C, Souto J, Lagunes L, Catalán I, Sirvent JM, de Arbina NL, Serra AB, Sánchez A, Cuenca; 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Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis. J Infect 2016;72:143-51. [DOI: 10.1016/j.jinf.2015.11.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/12/2015] [Accepted: 11/28/2015] [Indexed: 01/22/2023]