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Taboada M, Almeida X, Cariñena A, Costa J, Carmona-Monge J, Agilda A, Barreiro L, Castillo J, Williams K, Segurola J, Álvarez J, Seoane-Pillado T. Complications and degree of difficulty of orotracheal intubation in the Intensive Care Unit before and after the establishment of an intubation protocol for critically ill patients: a prospective, observational study. Rev Esp Anestesiol Reanim (Engl Ed) 2024; 71:17-27. [PMID: 38104962 DOI: 10.1016/j.redare.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/17/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The objective of our study was to compare the degree of difficulty and complications related to tracheal intubation in an Intensive Care Unit (ICU) before and after the introduction of an intubation protocol based on the Difficult Airway Society guidelines for the management of tracheal intubation in critically ill adults, published in 2018. METHODS Prospective, observational study comparing all intubations performed in our ICU over 2 periods: pre-protocol (January 2015-January 2019) and post-protocol (February 2019-July 2022). The material used for intubation, the degree of difficulty, and intubation-related complications were recorded. RESULTS During the study period, 661 patients were intubated - 437 in the pre-protocol period (96% by direct laryngoscopy) and 224 in the post-protocol period (53% with direct laryngoscopy, 46% with video laryngoscopy). We observed an improvement in laryngeal view in the post-protocol period compared to the pre-protocol period (Cormack-Lehane ≥ 2b in 7.6% vs. 29.8%, p < 0.001), and a decrease in the number of moderate-to-severely difficult intubations (6.7% vs. 17.4%, p < 0.001). The first-pass success rate was 92.8% in the post-protocol period compared to 90.2% pre-protocol (p = 0.508). We did not find significant differences in complications between the periods studied. CONCLUSIONS Intubations performed in the post-protocol period were associated with improved laryngeal view and fewer cases of difficult intubation compared with the pre-protocol period.
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Affiliation(s)
- M Taboada
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain.
| | - X Almeida
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - A Cariñena
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - J Costa
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - J Carmona-Monge
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - A Agilda
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - L Barreiro
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - J Castillo
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - K Williams
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - J Segurola
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - J Álvarez
- Unidad de Cuidados Intensivos, Servicio de Anestesia y Reanimación, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago de Compostela, La Coruña, Spain
| | - T Seoane-Pillado
- Preventive Medicine and Public Health Unit, Department of Health Sciences, University of A Coruña-INIBIC, La Coruña, Spain
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Boga JA, de Oña M, Fernández-Verdugo A, González D, Morilla A, Arias M, Barreiro L, Hidalgo F, Melón S. Molecular identification of two genotypes of mumps virus causing two regional outbreaks in Asturias, Spain. J Clin Virol 2008; 42:425-8. [PMID: 18440271 DOI: 10.1016/j.jcv.2008.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 03/18/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND In spite of universal vaccination, several sporadic cases of mumps infection, which could produce outbreaks, are detected every year in different countries. OBJECTIVE Mumps virus strains causing two regional outbreaks in Asturias (Spain) were phylogenetically characterized. STUDY DESIGN Mumps virus strains, which were detected in samples from patients belonging to two regional outbreaks in Asturias, were characterized by sequencing of the SH gene and further alignment to homologous sequences of representative strains of the different mumps genotypes. RESULTS Two different strains (Ast/SP02 and Ast/SP07) were isolated. Sequence analysis revealed that while Ast/SP02 belonged to genotype H, Ast/SP07 was phylogenetically close to UK02-19, a reference strain for a new genotype. Both strains belonged to different genotypes from those used in the vaccination (Jeryl-Lynn strain is genotype A). CONCLUSION Mumps virus strains different from those used in vaccination program can cause mumps outbreaks even in vaccinated patients.
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Affiliation(s)
- J A Boga
- Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, Spain.
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Solloso A, Barreiro L, Seoane R, Nogueira E, Cañibano C, Alvarez CV, Zalvide J, Diéguez C, Pombo CM. GHRH proliferative action on somatotrophs is cell-type specific and dependent on Pit-1/GHF-1 expression. J Cell Physiol 2008; 215:140-50. [PMID: 17941086 DOI: 10.1002/jcp.21295] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To investigate the mechanisms by which the hypothalamic peptide GHRH influences cell division, we analyzed its effects on the proliferation of two different cell lines: CHO-4, an ovary-derived cell line, and GH3, a pituitary-derived cell line. We found that GHRH induces the proliferation of pituitary-derived cells but inhibits the proliferation of ovary-derived cells. We further characterized this dual effect of GHRH to find that the cytoplasmic signals induced by this hormone are similar in both cell lines. Moreover, in CHO-4 cells GHRH stimulates two well-known positive cell cycle regulators, c-myc and cyclin D1, but is unable to induce the degradation of the negative cell cycle regulator p27(Kip1). Significantly, when the Pit-1/GHF-1 gene is exogenously expressed in CHO-4 cells, the negative effect of GHRH on the proliferation of these cells is attenuated. Furthermore, when the levels of Pit-1 are downregulated by siRNA in GH3-GHRHR cells, the positive effects of GHRH on the proliferation of these cells are diminished. These findings add to our understanding of the molecules involved in the regulation of cell proliferation by GHRH, as we demonstrate for the first time that Pit-1 is not only required to drive the expression of the GHRH receptor, as previously described, but is also needed for the downstream effects that occur after its activation to modulate cell proliferation. These data suggest that the regulation of cell proliferation in response to a specific growth factor depends in certain cell populations on the presence of a tissue-specific transcription factor.
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Affiliation(s)
- A Solloso
- Department of Physiology, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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