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Jover Pinillos JL, Basora Macaya M, Ripollés-Melchor J, Ferrandis Comes R, Llau Pitarch JV, Colomina Soler MJ. Perioperative colloids: From theory to practice. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:187-197. [PMID: 36858277 DOI: 10.1016/j.redare.2022.03.002] [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] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/10/2022] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Fluid administration is the cornerstone in hypovolemic patient's reanimation. Clinical guidelines restrict colloid administration favouring crystalloids. Currently, we don't know exactly which is the daily clinical practice during the perioperative period. The objective of this study is to describe perioperative use of colloids analysing possible reasons aiming to use them. MATERIAL AND METHODS Prospective, cross-section, national, multicentre observational study. Fluid Day sub-study. We enrolled all patient's older than 18 years old who underwent surgery during the 24 h of the 2-days study (February, 2019, 18th and 20th). We registered demographic data, comorbidities, anaesthetic and surgical procedure data, fluids administered, perioperative bleeding and monitoring type used during the perioperative period. RESULTS A total of 5928 cases were analysed and 542 patients (9.1%) received any type of colloids, being hydroxiethyl-starch the most frequently used (5.1%). Patients receiving colloids suffered more longing surgery (150 [90-255] vs. 75 [45-120] min), were urgently operated (13.7 vs. 7.5%) and were more frequent classified as high risk (22 vs. 4.8%). Their recovery was mostly in critical care units (45.1 vs.15.8%). Patients with bleeding less than 500 ml received colloids in a percentage of 5.9 versus 45.9% when this figure was overcome. Patients who received colloids were anaemic more frequently: 29.4 vs. 16.3%. Colloids administration had a higher risk for transfusion (OR 15.7). Advanced monitoring also increased the risk for receiving colloids (OR 9.43). CONCLUSIONS In our environment with routine clinical practice, colloids administration is limited and close linked to perioperative bleeding.
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Affiliation(s)
- J L Jover Pinillos
- Servicio de Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoy, Alicante, Spain.
| | - M Basora Macaya
- Servicio de Anestesiología y Reanimación, Hospital Clínic, Barcelona, Spain
| | - J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Ferrandis Comes
- Servicio de Anestesiología y Reanimación, Hospital Clínic Universitari La Fe, Valencia, Spain
| | - J V Llau Pitarch
- Servicio de Anestesiología y Reanimación, Hospital Clínic Universitari Dr. Pesset, Valencia, Spain
| | - M J Colomina Soler
- Servicio de Anestesiología y Reanimación, Hospital Clínic Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Sánchez Martín C, Madrid Martínez E, González Pellicer R, Armero Ibáñez R, Martínez González E, Llau Pitarch JV. Invasive pulmonary aspergillosis in patients with acute respiratory syndrome by COVID-19. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:48-53. [PMID: 35033481 PMCID: PMC8739016 DOI: 10.1016/j.redare.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
Abstract
Patients with COVID-19 who are admitted to intensive care unit (ICU) are at high risk of developing secondary infections, including invasive fungal infections such as invasive pulmonary aspergillosis (IPA). The main purpose was to analyse the putative COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients in our setting. In these patients, we performed mycological culture in bronchoalveolar lavage (BAL) for isolation of Aspergillus sp. We followed the AspICU algorithm to diagnose putative IPA. Moreover, we considered relevant the positivity of Galactomannan in BAL. We diagnosed putative IPA in 3 patients. The common features of these 3 patients were: more than 21 days of stay in ICU, severe acute respiratory distress syndrome (ARDS) and treatment with steroids (1 mg/kg per day). Therefore, CAPA has to be systematically considered although a new algorithm to diagnose it is needed to treat patients in early stages in order to avoid catastrophic outcomes.
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Affiliation(s)
- C Sánchez Martín
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain.
| | - E Madrid Martínez
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain
| | - R González Pellicer
- Servicio de Microbiología, Hospital Universitario Doctor Peset, Valencia, Spain
| | - R Armero Ibáñez
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain
| | - E Martínez González
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain
| | - J V Llau Pitarch
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain; Anestesiología, Universitat de València, Valencia, Spain
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Sánchez Martín C, Madrid Martínez E, González Pellicer R, Armero Ibáñez R, Martínez González E, Llau Pitarch JV. Invasive pulmonary aspergillosis in patients with acute respiratory syndrome by COVID-19. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00131-6. [PMID: 34565575 PMCID: PMC8057739 DOI: 10.1016/j.redar.2021.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
Patients with COVID-19 who are admitted to intensive care unit (ICU) are at high risk of developing secondary infections, including invasive fungal infections such as invasive pulmonary aspergillosis (IPA). The main purpose was to analyse the putative COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients in our setting. In these patients, we performed mycological culture in bronchoalveolar lavage (BAL) for isolation of Aspergillus sp. We followed the AspICU algorithm to diagnose putative IPA. Moreover, we considered relevant the positivity of galactomannan in BAL. We diagnosed putative IPA in 3 patients. The common features of these 3 patients were: more than 21 days of stay in ICU, severe acute respiratory distress syndrome (ARDS) and treatment with steroids (1mg/kg per day). Therefore, CAPA has to be systematically considered although a new algorithm to diagnose it is needed to treat patients in early stages in order to avoid catastrophic outcomes.
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Affiliation(s)
- C Sánchez Martín
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España.
| | - E Madrid Martínez
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España
| | - R González Pellicer
- Servicio de Microbiología, Hospital Universitario Doctor Peset, Valencia, España
| | - R Armero Ibáñez
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España
| | - E Martínez González
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España
| | - J V Llau Pitarch
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España; Anestesiología, Universitat de València, Valencia, España
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Ferrandis Comes R, Llau Pitarch JV. Perioperative and periprocedural management of antithrombotic therapy: Multidisciplinar consensus document. ACTA ACUST UNITED AC 2018; 65:423-425. [PMID: 30041946 DOI: 10.1016/j.redar.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022]
Affiliation(s)
- R Ferrandis Comes
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España; Universitat de València, Valencia, España.
| | - J V Llau Pitarch
- Servicio de Anestesiología y Reanimación, Hospital Doctor Peset, Valencia, España; Universitat de València, Valencia, España
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Pérez Solaz A, Ferrandis Comes R, Llau Pitarch JV, Alcántara Noalles MJ, Abengochea Cotaina A, Barberá Alacreu M, Belda Nácher FJ. [Obstetric bleeding: an update]. Rev Esp Anestesiol Reanim 2010; 57:224-235. [PMID: 20499801 DOI: 10.1016/s0034-9356(10)70209-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Massive bleeding in obstetrics still ranks among the most frequent causes of maternal morbidity and mortality worldwide. The most frequent type is primary postpartum hemorrhage, which is usually the result of an atonic uterus. The clinical priorities are to assure hemodynamic stability and to correct coagulation abnormalities. If pharmacologic treatment cannot achieve these goals, invasive methods such as interventional vascular radiology or artery ligation must be used. Hysterectomy is the last resort when the previous methods fail. For the best prognosis, in terms of preventing death, maintaining maternal fertility and minimizing morbidity, every maternity ward should have a well-defined multidisciplinary protocol that facilitates diagnosis and immediate treatment.
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Llau Pitarch JV, De Andrés Ibáñez J, Gomar Sancho C, Gómez Luque Z, Hidalgo Martínez F, Torres Morera LM. [Hemostasis-altering drugs and techniques for regional anesthesia and analgesia: safety recommendations]. Rev Esp Anestesiol Reanim 2005; 52:248-50. [PMID: 15901035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Llau Pitarch JV, De Andrés Ibáñez J, Gomar Sancho C, Gómez Luque A, Hidalgo Martínez F, Torres Morera LM. [Hemostasis-altering drugs and regional anesthetic techniques: safety guidelines]. Rev Esp Anestesiol Reanim 2004; 51:137-42. [PMID: 15200185] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
New developments--in the form of emerging clinical settings for regional anesthesia as well as problems arising with the concomitant use of regional techniques and hemostasis-altering drugs--require the ongoing revision of safety guidelines. The annual meeting of ESRA held in Spain in 2003 saw the discussion and clarification of a variety of issues of current concern, including conclusions reached on the estimated risk of spinal hematoma when published safety guidelines are followed or not, precautions to take in epidural anesthesia during cardiac surgery, guidelines for using fondaparinux for thromboprophylaxis, the circumstances under which neuroaxial techniques can be used safely in patients under the effects of platelet aggregation inhibitors such as thienopyridine, and the application of epidural anesthesia in parturients with eclampsia who have received platelet aggregation inhibitors. Conclusions drawn at the meeting enrich and clarify certain important safety issues related to local and regional anesthesia in patients receiving antiplatelet drugs and/or anticoagulants.
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Affiliation(s)
- J V Llau Pitarch
- Servicio de Anestesiología, Hospital Clínico Universitario, Valencia
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Llau Pitarch JV. [Perioperative transfusion medicine]. Rev Esp Anestesiol Reanim 2001; 48:103-5. [PMID: 11333792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Llau Pitarch JV, Díaz Alvarez A, Polonio Enríquez F, Castro Santamaría M, Ruiz Moyano J, García Enguita MA. [Reduction of blood transfusion need with aprotinin in orthopedic surgery. Spanish Study Group on the Use of Aprotinin in Hip Arthroplasty (GEEEAAC)]. Rev Esp Anestesiol Reanim 2000; 47:309-16. [PMID: 11002715] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Aprotinin is a protease inhibitor of interest for its antifibrinolytic effect of reducing perioperative bleeding in certain types of surgery, with wide use in heart surgery, liver transplantation and vascular surgery. The application of aprotinin during orthopedic surgery has recently been suggested. Such use is controversial, as there is lack of consensus as to the type of patient for whom aprotinin administration would be indicated, the surgical procedure during which it would be most effective (hip or knee arthroplasty, spinal arthrodesis, major tumor or septic surgery), the doses to administer, its safety and its real efficacy for conserving homologous blood. That is to say, there is no agreement as to the cost/benefit relation of aprotinin for the various types of orthopedic surgery. This critical review of the literature leads to the conclusion that aprotinin is a promising drug for use in orthopedic surgery, given that published studies have established the benefit in blood product savings and decreased blood loss during surgery.
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Aguilar Aguilar G, Belda Nacher FJ, Llau Pitarch JV, Maruenda Paulino A. [On Virginia apgar]. Rev Esp Anestesiol Reanim 1998; 45:355-6. [PMID: 9847650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Llau Pitarch JV, Sánchez de Merás AM. [Transfusion practice of anesthesiologists in Spain]. Rev Esp Anestesiol Reanim 1998; 45:226-32. [PMID: 9719719] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine the packed red cell transfusion practices of Spanish anesthesiologists and the importance they placed on techniques for reducing blood product use. MATERIAL AND METHODS One hundred letters with five copies of a questionnaire were sent to an equal number of anesthesiology and intensive care recovery departments of randomly chosen Spanish hospitals. RESULTS Forty-seven hospitals responded with 208 completed questionnaires. Responses following the questionnaire form were considered valid. Transfusions are regularly given when hematocrit falls 24% (39.4%) or 27% (37.8%) or when hemoglobin falls below 8 g% (37%) or 9 g% (30%). Most respondents considered that certain clinical situations can affect the need for transfusion: age (86.5%), coexistence of heart disease (95%) or respiratory disease (72.3%) and prior hematocrit or hemoglobin levels (88%). The most frequently applied technique for reducing the need for blood product transfusion of blood derivatives is normovolemic hemodilution, followed by autologous self-transfusion and controlled hypotension. Clinical judgement and prior blood test results are highly valued as indicators for transfusion (8.68 and 7.48 points out of 10, respectively). The respondents suggested the need for greater coordination of medical and surgical department transfusion policy, as well as the need to hold a consensus conference. CONCLUSIONS Perioperative transfusions of packed blood cells are mainly performed at 8 to 9 g% of hemoglobin, although need is often based on certain clinical features.
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Affiliation(s)
- J V Llau Pitarch
- Servicio de Anestesiología y Renimación, Hospital Clínico Universitario de Valencia
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