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1. The Importance of Antimicrobial Strategies Associated with Clinical Cure and Increased Microbiological Eradication in Patients with Complicated Urinary Tract Infections and High Risk of Relapse

Author: José Medina Polo, Jose Luis Alfonso Sánchez, Jorge Arca-Suárez, Ángel Estella, Pablo González, Martí Blasco, Alicia Gil, Leonor del Mar Periañez Párraga, and Francisco Javier Membrillo de Novales
Subjects: Complicated urinary tract infections, Microbiological eradication, Consensus document, Diseases of the genitourinary system. Urology, RC870-923, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Background and objective: Complicated urinary tract infections (cUTIs) are serious, potentially life-threatening infections that occur in patients with an increased disease progression risk. Antimicrobial resistance represents an important health issue worldwide, contributing to relapses, which can generate further resistances. It is necessary to clarify the role of microbiological eradication as an additional objective in the management of cUTIs. Some publications suggest that relapses relate to insufficient bacterial suppression in the urinary tract. This study focuses on generating a consensus on how patients with cUTIs would benefit from effective antimicrobial agents associated with higher rates of bacterial eradication. Methods: The nominal group technique was followed: systematic literature review, development of a questionnaire, expert panel meeting to discuss results, individual review of draft consensus document, and expert panel meeting to discuss final views and finalise the consensus document. Key findings and limitations: Experts identified risk factors for cUTIs (patients with a higher risk of relapse, physiological obstruction of urinary tract, immune suppression, and previous relapse), and patients who would benefit most from a therapeutic strategy combining clinical cure and aim for microbiological eradication. While experts agreed that the scientific evidence discourages repetition of urine cultures after treatment, they proposed recommendations to prioritise antibiotics with higher evidence of microbiological eradication and close follow-up in patients with a higher risk of relapse, considering any symptoms appearing following clinical cure of the cUTI. Conclusions and clinical implications: Selection of active antimicrobial agents associated with increased microbiological eradication should be prioritised in patients with cUTIs and a high risk of relapse. Patient summary: Complicated urinary tract infections (cUTIs) occur in patients with an increased risk of disease progression or are caused by multidrug-resistant uropathogens. Antimicrobial resistance is of concern as it can result in relapses. Antimicrobial therapeutic strategies associated with increased microbiological eradication in cUTI patients with a high risk of relapse are crucial to prevent relapses and development of antibiotic resistance.
Published: 2025
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2. Assessing the impact of vaccines on COVID-19 efficacy in survival rates: a survival analysis approach for clinical decision support

Author: Juan Luis González Rodríguez, Andreea M. Oprescu, Sergio Muñoz Lezcano, Jaime Cordero Ramos, Juan Luis Romero Cabrera, Miguel Ángel Armengol de la Hoz, and Ángel Estella
Subjects: vaccine, COVID-19, clinical decision-making, predictive modeling, clinical decision support system, Public aspects of medicine, RA1-1270
Abstract: BackgroundThe global COVID-19 pandemic, caused by the SARS-CoV-2 virus, has presented significant challenges to healthcare systems worldwide.ObjectiveThis study, based on an analysis of a cohort from the Public Health System of Andalusia (Spain), aims to evaluate how vaccination affects case-fatality rate in patients hospitalized due to COVID-19 infection in Andalusia.MethodsThe cohort consists of 37,274 individuals after applying the inclusion criteria. We conducted survival analyses employing the Cox proportional hazards models and generated adjusted survival curves to examine the outcomes. The analyses were performed from three perspectives: vaccinated vs. unvaccinated patients, vaccinated and unvaccinated patients grouped by age, and stratified by vaccination status.ResultsResults indicate a substantial correlation between vaccination and a 20% reduction in the risk of case-fatality. Age-specific effects reveal varying degrees of protection across different age groups.ConclusionThese findings emphasize the pivotal role of vaccination status in COVID-19 risk assessment, supporting the development of a clinical decision support system for accurate predictions and optimizing healthcare management at admission.
Published: 2024
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3. Latest developments in early diagnosis and specific treatment of severe influenza infection

Author: Francisco Valenzuela-Sánchez, Blanca Valenzuela-Méndez, Juan Francisco Rodríguez-Gutiérrez, and Ángel Estella
Subjects: Influenza, Pandemic, Respiratory failure, Acute respiratory distress syndrome, Intensive care unit admission, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Influenza pandemics are unpredictable recurrent events with global health, economic, and social consequences. The objective of this review is to provide an update on the latest developments in early diagnosis and specific treatment of the disease and its complications, particularly with regard to respiratory organ failure. Despite advances in treatment, the rate of mortality in the intensive care unit remains approximately 30%. Therefore, early identification of potentially severe viral pneumonia is extremely important to optimize treatment in these patients. The pathogenesis of influenza virus infection depends on viral virulence and host response. Thus, in some patients, it is associated with an excessive systemic response mediated by an authentic cytokine storm. This process leads to severe primary pneumonia and acute respiratory distress syndrome. Initial prognostication in the emergency department based on comorbidities, vital signs, and biomarkers (e.g., procalcitonin, ferritin, human leukocyte antigen-DR, mid-regional proadrenomedullin, and lactate) is important. Identification of these biomarkers on admission may facilitate clinical decision-making to determine early admission to the hospital or the intensive care unit. These decisions are reached considering pathophysiological circumstances that are associated with a poor prognosis (e.g., bacterial co-infection, hyperinflammation, immune paralysis, severe endothelial damage, organ dysfunction, and septic shock). Moreover, early implementation is important to increase treatment efficacy. Based on a limited level of evidence, all current guidelines recommend using oseltamivir in this setting. The possibility of drug resistance should also be considered. Alternative options include other antiviral drugs and combination therapies with monoclonal antibodies. Importantly, it is not recommended to use corticosteroids in the initial treatment of these patients. Furthermore, the implementation of supportive measures for respiratory failure is essential. Current recommendations are limited, heterogeneous, and not regularly updated. Early intubation and mechanical ventilation is the basic treatment for patients with severe respiratory failure. Prone ventilation should be promptly performed in patients with acute respiratory distress syndrome, while early tracheostomy should be considered in case of planned prolonged mechanical ventilation. Clinical trials on antiviral treatment and respiratory support measures specifically for these patients, as well as specific recommendations for different at-risk populations, are necessary to improve outcomes.
Published: 2024
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4. A Machine Learning Approach to Determine Risk Factors for Respiratory Bacterial/Fungal Coinfection in Critically Ill Patients with Influenza and SARS-CoV-2 Infection: A Spanish Perspective

Author: Alejandro Rodríguez, Josep Gómez, Ignacio Martín-Loeches, Laura Claverias, Emili Díaz, Rafael Zaragoza, Marcio Borges-Sa, Frederic Gómez-Bertomeu, Álvaro Franquet, Sandra Trefler, Carlos González Garzón, Lissett Cortés, Florencia Alés, Susana Sancho, Jordi Solé-Violán, Ángel Estella, Julen Berrueta, Alejandro García-Martínez, Borja Suberviola, Juan J. Guardiola, and María Bodí
Subjects: influenza A (H1N1), COVID-19, bacterial coinfection, fungal coinfection, machine learning, Therapeutics. Pharmacology, RM1-950
Abstract: Background: Bacterial/fungal coinfections (COIs) are associated with antibiotic overuse, poor outcomes such as prolonged ICU stay, and increased mortality. Our aim was to develop machine learning-based predictive models to identify respiratory bacterial or fungal coinfections upon ICU admission. Methods: We conducted a secondary analysis of two prospective multicenter cohort studies with confirmed influenza A (H1N1)pdm09 and COVID-19. Multiple logistic regression (MLR) and random forest (RF) were used to identify factors associated with BFC in the overall population and in each subgroup (influenza and COVID-19). The performance of these models was assessed by the area under the ROC curve (AUC) and out-of-bag (OOB) methods for MLR and RF, respectively. Results: Of the 8902 patients, 41.6% had influenza and 58.4% had SARS-CoV-2 infection. The median age was 60 years, 66% were male, and the crude ICU mortality was 25%. BFC was observed in 14.2% of patients. Overall, the predictive models showed modest performances, with an AUC of 0.68 (MLR) and OOB 36.9% (RF). Specific models did not show improved performance. However, age, procalcitonin, CRP, APACHE II, SOFA, and shock were factors associated with BFC in most models. Conclusions: Machine learning models do not adequately predict the presence of co-infection in critically ill patients with pandemic virus infection. However, the presence of factors such as advanced age, elevated procalcitonin or CPR, and high severity of illness should alert clinicians to the need to rule out this complication on admission to the ICU.
Published: 2024
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5. Microbiological diagnosis of pulmonary invasive aspergillosis in critically ill patients with severe SARS-CoV-2 pneumonia: a bronchoalveolar study

Author: Ángel Estella, Ignacio Martín-Loeches, María Recuerda Núñez, Clara González García, Liliana Marcela Pesaresi, Alvaro Antón Escors, Maria Dolores López Prieto, and Juan Manuel Sánchez Calvo
Subjects: CAPA, covid-19, Galactomannan, Bronchoalveolar lavage, Lateral flow, Fungal culture, Therapeutics. Pharmacology, RM1-950, Infectious and parasitic diseases, RC109-216, Microbiology, QR1-502
Abstract: Abstract Background Diagnosing COVID-19-associated pulmonary aspergillosis (CAPA) can be challenging since radiological and clinical criteria in the critically ill patient are nonspecific. Microbiological diagnostic support is therefore crucial. The aim of this study was to document the incidence of aspergillosis using bronchoalveolar lavage (BAL) as the diagnostic method and to determine the performance of the current mycological diagnostic tests most widely used for the diagnosis of CAPA, together with evaluation of the Asp lateral flow device (LFD). Methods Prospective cohort study conducted between March 2020 and June 2022. Inclusion criteria were critically ill patients admitted to the ICU with SARS-CoV-2 pneumonia requiring invasive mechanical ventilation. Diagnostic bronchoscopy and BAL were performed at the beginning of invasive mechanical ventilation. The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (LR + and LR-) of BAL culture, direct examination with calcofluor white stain, ELISA (Platelia) and LFD (AspLFD) for detection of galactomannan (GM) were evaluated. Aspergillus-qPCR was applied when discrepancies between diagnostic tests arose. Results Of the 244 critically ill patients with SARS-CoV-2 pneumonia admitted to the ICU, the majority (n = 200, 82%) required invasive mechanical ventilation. Diagnostic bronchoscopic procedures were performed in 160 patients (80%), who were enrolled in this study. The incidence of CAPA was 18.7% (n = 30). LFD-GM demonstrated a sensitivity of 84%, specificity of 99%, PPV 94%, NPV 97%, LR(+) of 84, and LR(-) of 0.16. At GM-ELISA indices of ≥ 0.5 and ≥ 1.0, sensitivity was 92% and 79%, specificity was 95% and 99%, PPV 76% and 91%, NPV 99% and 96%, LR(+) 18 and 79, and LR(-) 0.08 and 0.21, respectively. The optimal cut-off index from the ROC curve was 0.48, with sensitivity of 95% and specificity of 95%. Conclusions Using a diagnostic strategy based on bronchoscopy and BAL, we documented a high incidence of pulmonary aspergillosis in patients with severe SARS-CoV-2 pneumonia. Asp-LFD showed moderate sensitivity and excellent specificity, with a high PPV, and could be used for rapid diagnosis of patients with suspected CAPA.
Published: 2023
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6. A blood microRNA classifier for the prediction of ICU mortality in COVID-19 patients: a multicenter validation study

Author: David de Gonzalo-Calvo, Marta Molinero, Iván D. Benítez, Manel Perez-Pons, Nadia García-Mateo, Alicia Ortega, Tamara Postigo, María C. García-Hidalgo, Thalia Belmonte, Carlos Rodríguez-Muñoz, Jessica González, Gerard Torres, Clara Gort-Paniello, Anna Moncusí-Moix, Ángel Estella, Luis Tamayo Lomas, Amalia Martínez de la Gándara, Lorenzo Socias, Yhivian Peñasco, Maria Del Carmen de la Torre, Elena Bustamante-Munguira, Elena Gallego Curto, Ignacio Martínez Varela, María Cruz Martin Delgado, Pablo Vidal-Cortés, Juan López Messa, Felipe Pérez-García, Jesús Caballero, José M. Añón, Ana Loza-Vázquez, Nieves Carbonell, Judith Marin-Corral, Ruth Noemí Jorge García, Carmen Barberà, Adrián Ceccato, Laia Fernández-Barat, Ricard Ferrer, Dario Garcia-Gasulla, Jose Ángel Lorente-Balanza, Rosario Menéndez, Ana Motos, Oscar Peñuelas, Jordi Riera, Jesús F. Bermejo-Martin, Antoni Torres, and Ferran Barbé
Subjects: Biomarker, COVID-19, ICU, microRNA, Prognosis, SARS-CoV-2, Diseases of the respiratory system, RC705-779
Abstract: Abstract Background The identification of critically ill COVID-19 patients at risk of fatal outcomes remains a challenge. Here, we first validated candidate microRNAs (miRNAs) as biomarkers for clinical decision-making in critically ill patients. Second, we constructed a blood miRNA classifier for the early prediction of adverse outcomes in the ICU. Methods This was a multicenter, observational and retrospective/prospective study including 503 critically ill patients admitted to the ICU from 19 hospitals. qPCR assays were performed in plasma samples collected within the first 48 h upon admission. A 16-miRNA panel was designed based on recently published data from our group. Results Nine miRNAs were validated as biomarkers of all-cause in-ICU mortality in the independent cohort of critically ill patients (FDR
Published: 2023
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7. Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study

Author: Luis Felipe Reyes, Alejandro Rodriguez, Yuli V. Fuentes, Sara Duque, Esteban García-Gallo, Alirio Bastidas, Cristian C. Serrano-Mayorga, Elsa D. Ibáñez-Prada, Gerard Moreno, Paula C. Ramirez-Valbuena, Gustavo Ospina-Tascon, Glenn Hernandez, Edwin Silva, Ana Maria Díaz, Manuel Jibaja, Magdalena Vera-Alarcon, Emili Díaz, María Bodí, Jordi Solé-Violán, Ricard Ferrer, Antonio Albaya-Moreno, Lorenzo Socias, William Figueroa, Jose L. Lozano-Villanueva, Fabio Varón-Vega, Ángel Estella, Ana Loza-Vazquez, Ruth Jorge-García, Isabel Sancho, Manu Shankar-Hari, Ignacio Martin-Loeches, LIVEN-Covid, and SEMICYUC Study Group
Subjects: Medicine, Science
Abstract: 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.
Published: 2023
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8. Correction: Microbiological diagnosis of pulmonary invasive aspergillosis in critically ill patients with severe SARS-CoV-2 pneumonia: a bronchoalveolar study

Author: Ángel Estella, Ignacio Martín-Loeches, María Recuerda Núñez, Clara González García, Liliana Marcela Pesaresi, Alvaro Antón Escors, Maria Dolores López Prieto, and Juan Manuel Sánchez Calvo
Subjects: Therapeutics. Pharmacology, RM1-950, Infectious and parasitic diseases, RC109-216, Microbiology, QR1-502
Published: 2023
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9. Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study

Author: Gerard Moreno, Raquel Carbonell, Ignacio Martin-Loeches, Jordi Solé-Violán, Eudald Correig i Fraga, Josep Gómez, Manuel Ruiz-Botella, Sandra Trefler, María Bodí, Josefa Murcia Paya, Emili Díaz, Pablo Vidal-Cortes, Elisabeth Papiol, Antonio Albaya Moreno, Susana Sancho Chinesta, Lorenzo Socias Crespi, María del Carmen Lorente, Ana Loza Vázquez, Rebeca Vara Arlanzon, María Teresa Recio, Juan Carlos Ballesteros, Ricard Ferrer, Elisabeth Fernandez Rey, Marcos I. Restrepo, Ángel Estella, Antonio Margarit Ribas, Neus Guasch, Luis F. Reyes, Judith Marín-Corral, Alejandro Rodríguez, and the COVID-19 SEMICYUC Working Group
Subjects: Corticosteroids, COVID-19-associated acute respiratory distress syndrome, Intensive care unit, Mortality, Invasive mechanical ventilation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: 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
Published: 2021
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10. The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Author: Antoni Torres, Anna Motos, Jordi Riera, Laia Fernández-Barat, Adrián Ceccato, Raquel Pérez-Arnal, Dario García-Gasulla, Oscar Peñuelas, José Angel Lorente, Alejandro Rodriguez, David de Gonzalo-Calvo, Raquel Almansa, Albert Gabarrús, Rosario Menéndez, Jesús F. Bermejo-Martin, Ricard Ferrer, Rosario Amaya Villar, José M. Añón, Carme Barberà, José Barberán, Aaron Blandino Ortiz, Elena Bustamante-Munguira, Jesús Caballero, Cristina Carbajales, Nieves Carbonell, Mercedes Catalán-González, Cristóbal Galbán, Víctor D. Gumucio-Sanguino, Maria del Carmen de la Torre, Emili Díaz, Ángel Estella, Elena Gallego, José Luis García Garmendia, José Garnacho-Montero, José M. Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marin-Corral, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan López Messa, Guillermo M. Albaiceta, Mariana Andrea Novo, Yhivian Peñasco, Juan Carlos Pozo-Laderas, Pilar Ricart, Inmaculada Salvador-Adell, Angel Sánchez-Miralles, Susana Sancho Chinesta, Lorenzo Socias, Jordi Solé-Violan, Fernando Suares Sipmann, Luis Tamayo Lomas, José Trenado, Ferran Barbé, and CIBERESUCICOVID Project (COV20/00110, ISCIII)
Subjects: Ventilatory ratio, Mechanical ventilation, COVID-19, SARS-CoV-2, Coronavirus, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0–171.2] to 180.0 [135.4–227.9] mmHg and the ventilatory ratio from 1.73 [1.33–2.25] to 1.96 [1.61–2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01–1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01–1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93–1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation.
Published: 2021
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11. Managing the Next Wave of Influenza and/or SARS-CoV-2 in the ICU—Practical Recommendations from an Expert Group for CAPA/IAPA Patients

Author: Jose Peral, Ángel Estella, Xavier Nuvials, Alejandro Rodríguez, Iratxe Seijas, Cruz Soriano, Borja Suberviola, and Rafael Zaragoza
Subjects: influenza-associated invasive aspergillosis, COVID-associated invasive aspergillosis, COVID-19, intensive care unit, critical patients, Biology (General), QH301-705.5
Abstract: The aim of this study was to establish practical recommendations for the diagnosis and treatment of influenza-associated invasive aspergillosis (IAPA) based on the available evidence and experience acquired in the management of patients with COVID-19-associated pulmonary aspergillosis (CAPA). The CAPA/IAPA expert group defined 14 areas in which recommendations would be made. To search for evidence, the PICO strategy was used for both CAPA and IAPA in PubMed, using MeSH terms in combination with free text. Based on the results, each expert developed recommendations for two to three areas that they presented to the rest of the group in various meetings in order to reach consensus. As results, the practical recommendations for the management of CAPA/IAPA patients have been grouped into 12 sections. These recommendations are presented for both entities in the following situations: when to suspect fungal infection; what diagnostic methods are useful to diagnose these two entities; what treatment is recommended; what to do in case of resistance; drug interactions or determination of antifungal levels; how to monitor treatment effectiveness; what action to take in the event of treatment failure; the implications of concomitant corticosteroid administration; indications for the combined use of antifungals; when to withdraw treatment; what to do in case of positive cultures for Aspergillus spp. in a patient with severe viral pneumonia or Aspergillus colonization; and how to position antifungal prophylaxis in these patients. Available evidence to support the practical management of CAPA/IAPA patients is very scarce. Accumulated experience acquired in the management of CAPA patients can be very useful for the management of IAPA patients. The expert group presents eminently practical recommendations for the management of CAPA/IAPA patients.
Published: 2023
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12. Anticipatory Antifungal Treatment in Critically Ill Patients with SARS-CoV-2 Pneumonia

Author: Ángel Estella, María Recuerda Núñez, Carolina Lagares, Manuel Gracia Romero, Eva Torres, Juan Carlos Alados Arboledas, Álvaro Antón Escors, Clara González García, Dolores Sandar Núñez, Dolores López Prieto, and Juan Manuel Sánchez Calvo
Subjects: SARS-CoV-2, liposomal amphotericin B, ARDS, aspergillus, bronchoalveolar lavage, ICU, Biology (General), QH301-705.5
Abstract: Background. The aim of this study was to investigate the incidence of COVID-19-associated pulmonary aspergillosis (CAPA) in critically ill patients and the impact of anticipatory antifungal treatment on the incidence of CAPA in critically ill patients. Methods. Before/after observational study in a mixed intensive care unit (ICU) of a university teaching hospital. The study took place between March 2020 and June 2022. Inclusion criteria were critically ill patients with severe SARS-CoV-2 pneumonia requiring invasive mechanical ventilation. Two analysis periods were compared according to whether or not antifungal therapy was given early. Results. A total of 160 patients with severe SARS-CoV-2 pneumonia and invasive mechanical ventilation were included. The incidence of CAPA in the first study period was 19 out of 58 patients (32.75%); during the second period, after implementation of the intervention (anticipatory antifungal therapy), the incidence of CAPA decreased to 10.78% (11 out of 102 patients). In patients with CAPA under invasive mechanical ventilation, the mortality rate decreased from 100% to 64%. Conclusions. Anticipating antifungal treatment in patients with SARS-CoV-2 pneumonia under invasive mechanical ventilation was associated with a decrease in the incidence and mortality of pulmonary aspergillosis.
Published: 2023
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13. Correction to: The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Author: Antoni Torres, Anna Motos, Jordi Riera, Laia Fernández-Barat, Adrián Ceccato, Raquel Pérez-Arnal, Dario García-Gasulla, Oscar Peñuelas, José Angel Lorente, Alejandro Rodriguez, David de Gonzalo-Calvo, Raquel Almansa, Albert Gabarrús, Rosario Menéndez, Jesús F. Bermejo-Martin, Ricard Ferrer, Rosario Amaya Villar, José M. Añón, Carme Barberà, José Barberán, Aaron Blandino Ortiz, Elena Bustamante-Munguira, Jesús Caballero, Cristina Carbajales, Nieves Carbonell, Mercedes Catalán-González, Cristóbal Galbán, Víctor D. Gumucio-Sanguino, Maria del Carmen de la Torre, Emili Díaz, Ángel Estella, Elena Gallego, José Luis García Garmendia, José Garnacho-Montero, José M. Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marin-Corral, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan López Messa, Guillermo M. Albaiceta, Mariana Andrea Novo, Yhivian Peñasco, Juan Carlos Pozo-Laderas, Pilar Ricart, Inmaculada Salvador-Adell, Angel Sánchez-Miralles, Susana Sancho Chinesta, Lorenzo Socias, Jordi Solé-Violan, Fernando Suares Sipmann, Luis Tamayo Lomas, José Trenado, Ferran Barbé, and CIBERESUCICOVID Project (COV20/00110, ISCIII)
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published: 2021
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14. Observational Study on Enhancing End-of-Life Care Competence Through OSCE: Educational Implications

Author: Mora-Delgado, Juan, Lojo-Cruz, Cristina, Bández, Manuel J., Rosety-Rodríguez, Manuel, and García, Ángel Estella
Published: 2025
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15. Effect of viral storm in patients admitted to intensive care units with severe COVID-19 in Spain: a multicentre, prospective, cohort study

Author: Jesús F Bermejo-Martin, Nadia García-Mateo, Anna Motos, Salvador Resino, Luis Tamayo, Pablo Ryan Murua, Elena Bustamante-Munguira, Elena Gallego Curto, Alejandro Úbeda-Iglesias, María del Carmen de la Torre, Ángel Estella, Sandra Campos-Fernández, Ignacio Martínez Varela, Felipe Pérez-García, Lorenzo Socias, Juan López Messa, Pablo Vidal-Cortés, Víctor Sagredo Meneses, Milagros González-Rivera, Nieves Carbonell, David de Gonzalo-Calvo, María Cruz Martín Delgado, Luis Jorge Valdivia, Caridad Martín-López, Ruth Noemí Jorge García, Emilio Maseda, Ana Loza-Vázquez, David J Kelvin, Ferrán Barbé, Antoni Torres, Alicia Ortega, Amanda de la Fuente, Raquel Almansa, Tamara Postigo, Noelia Jorge, Ana P Tedim, Laura González-González, Lara Sánchez Recio, Wysali Trapiello, José Ángel Berezo, Rubén Herrán-Monge, Jesús Blanco, Pedro Enríquez, Isidoro Martínez, María Martín-Vicente, María José Muñoz-Gómez, Vicente Más, Mónica Vázquez, Olga Cano, Amalia Martínez de la Gándara, Covadonga Rodríguez, Gloria Andrade, Gloria Renedo, Juan Bustamante-Munguira, Ramón Cicuendez Ávila, María Salgado-Villén, Enrique Berruguilla-Pérez, Estel Güell, Fernando Javier Casadiego Monachello, María Recuerda Núñez, Juan Manuel Sánchez Calvo, Yhivian Peñasco-Martín, María Teresa García Unzueta, Adrián Ceccato, Laia Fernández-Barat, María Teresa Bouza Vieiro, Ana Moreno-Romero, Leire Pérez Bastida, Lorena del Río-Carbajo, Noelia Albalá Martínez, José Manuel Gómez, María Luisa Blasco, Jesús Caballero, Carme Barberà, Jessica González, María Teresa Nieto, Jorge Nieto-del Olmo, Estefanía Prol-Silva, Joan Canseco-Ribas, Jose María Eiros, Instituto de Salud Carlos III, Canadian Institutes of Health Research, Li Ka Shing Foundation, European Society of Clinical Microbiology and Infectious Diseases, Centro de Investigación Biomédica en Red - CIBERES (Enfermedades Respiratorias), Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), and Unión Europea. Fondo Social Europeo (ESF/FSE)
Subjects: Microbiology (medical), Infectious Diseases, Spain, Virology, COVID-19, Microbiology
Abstract: Background: The contribution of the virus to the pathogenesis of severe COVID-19 is still unclear. We aimed to evaluate associations between viral RNA load in plasma and host response, complications, and deaths in critically ill patients with COVID-19. Methods: We did a prospective cohort study across 23 hospitals in Spain. We included patients aged 18 years or older with laboratory-confirmed SARS-CoV-2 infection who were admitted to an intensive care unit between March 16, 2020, and Feb 27, 2021. RNA of the SARS-CoV-2 nucleocapsid region 1 (N1) was quantified in plasma samples collected from patients in the first 48 h following admission, using digital PCR. Patients were grouped on the basis of N1 quantity: VIR-N1-Zero (2747 N1 copies per mL). The primary outcome was all-cause death within 90 days after admission. We evaluated odds ratios (ORs) for the primary outcome between groups using a logistic regression analysis. Findings: 1068 patients met the inclusion criteria, of whom 117 had insufficient plasma samples and 115 had key information missing. 836 patients were included in the analysis, of whom 403 (48%) were in the VIR-N1-Low group, 283 (34%) were in the VIR-N1-Storm group, and 150 (18%) were in the VIR-N1-Zero group. Overall, patients in the VIR-N1-Storm group had the most severe disease: 266 (94%) of 283 patients received invasive mechanical ventilation (IMV), 116 (41%) developed acute kidney injury, 180 (65%) had secondary infections, and 148 (52%) died within 90 days. Patients in the VIR-N1-Zero group had the least severe disease: 81 (54%) of 150 received IMV, 34 (23%) developed acute kidney injury, 47 (32%) had secondary infections, and 26 (17%) died within 90 days (OR for death 0·30, 95% CI 0·16-0·55; p
Published: 2023

16. Is (1,3)-β-d-glucan useless to guide antifungal therapy in ICU?

Author: Anahita Rouzé, Ángel Estella, and Jean-François Timsit
Subjects: Intensive Care Units, Antifungal Agents, beta-Glucans, Humans, Proteoglycans, Critical Care and Intensive Care Medicine, Glucans
Published: 2022
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17. Clindamycin but not Intravenous Immunoglobulins reduces mortality in a retrospective cohort of critically ill patients with bacteremic Group A Streptococcal infections

Author: Adela Fernández-Galilea, Ángel Estella, José Luis García-Garmendia, Ana Loza, Inmaculada Palacios-García, Rafael Sierra-Camerino, Gemma Seller, Marina Rodríguez-Delgado, Isabel Rodriguez-Higueras, and José Garnacho-Montero
Subjects: Microbiology (medical), Pharmacology, Adult, Streptococcus pyogenes, Clindamycin, Critical Illness, Immunoglobulins, Intravenous, Bacteremia, General Medicine, Middle Aged, Intensive Care Units, Critically ill patients, Streptococcal Infections, Group A Streptococcal infections, Bacteriemia, Humans, Hospital Mortality, Intravenous Immunoglobulins, Retrospective Studies
Abstract: Objectives. Mortality of patients requiring Intensive Care Unit (ICU) admission for an invasive group A streptococcal (GAS) infection continues being high. In critically ill patients with bacteremic GAS infection we aimed at determining risk factors for mortality. Patients and methods. Retrospective multicentre study carried out in nine ICU in Southern Spain. All adult patients admitted to the participant ICUs from January 2014 to June 2019 with one positive blood culture for S. pyogenes were included in this study. Patient characteristics, infection-related variables, therapeutic interventions, failure of organs, and outcomes were registered. Risk factors independently associated with ICU and in-hospital mortalities were determined by multivariate regression analyses. Results. Fifty-seven patients were included: median age was 63 (45-73) years, median SOFA score at admission was 11 (7-13). The most frequent source was skin and soft tissue infection (n=32) followed by unknown origin of bacteremia (n=12). In the multivariate analysis, age (OR 1.079; 95% CI 1.016-1.145), SOFA score (OR 2.129; 95% CI 1.339-3.383) were the risk factors for ICU mortality and the use of clindamycin was identified as a protective factor (OR 0.049; 95% CI 0.003-0.737). Age and SOFA were the independent factors associated with hospital mortality however the use of clindamycin showed a strong trend but without reaching statistical significance (OR 0.085; 95% CI 0.007-1.095). Conclusion. In this cohort of critically ill patients the use of intravenous immunoglobulin was not identified as a protective factor for ICU or hospital mortality treatment with clindamycin significantly reduced mortality after controlling for confounders
Published: 2022

18. Host response dysregulations amongst adults hospitalized by influenza A H1N1 virus pneumonia: A prospective multicenter cohort study

Author: Blanca Valenzuela-Méndez, Francisco Valenzuela-Sánchez, Juan Francisco Rodríguez-Gutiérrez, Rafael Bohollo-de-Austria, Ángel Estella, Pilar Martínez-García, María Ángela González-García, Grant Waterer, and Jordi Rello
Subjects: Cohort Studies, Hospitalization, Influenza A Virus, H1N1 Subtype, Immunoglobulin M, Influenza, Human, Internal Medicine, Immunity, Humans, Pneumonia, Prospective Studies
Abstract: Limited knowledge exists on how early host response impacts outcomes in influenza pneumonia.This study assessed what was the contribution of host immune response at the emergency department on hospital mortality amongst adults with influenza A H1N1pdm09 pneumonia and whether early stratification by immune host response anticipates the risk of death. This is a secondary analysis from a prospective, observational, multicenter cohort comparing 75 adults requiring intensive care with 38 hospitalized in medical wards. Different immune response biomarkers within 24 h of hospitalization and their association with hospital mortality were assessed.Fifty-three were discharged alive. Non-survivors were associated (plt;0.05) with lower lymphocytes (751 vs. 387), monocytes (450 vs. 220) expression of HLA-DR (1,662 vs. 962) and higher IgM levels (178 vs. 152;plt;0.01). Lymphocyte subpopulations amongst non-survivors showed a significantly (plt;0.05) lower number of TCD3+ (247.2 vs. 520.8), TCD4+ (150.3 vs. 323.6), TCD8+ (95.3 vs. 151.4) and NKCD56+ (21.9 vs. 91.4). Number of lymphocytes, monocytes and NKCD56+ predicted hospital mortality (AUC 0.854). Hospital mortality was independently associated with low HLA-DR values, low number of NKCD56+ cells, and high IgM levels, in a Cox-proportional hazard analysis. A second model, documented that hospital mortality was independently associated with a phenotype combining immunoparalysis with hyperinflammation (HR 5.53; 95%CI 2.16-14.14), after adjusting by predicted mortality.We conclude that amongst influenza pneumonia, presence of immunoparalysis was a major mortality driver. Influenza heterogeneity was partly explained by early specific host response dysregulations which should be considered to design personalized approaches of adjunctive therapy.
Published: 2022

19. 168 - Aspectos éticos en medicina intensiva: innovación docente en la UCI a través de la bioética y estudiantes de Medicina en la toma de decisiones

Author: García, Ángel Estella, Cruz, Antonio Cárdenas, and Garrido, José Julián Arias
Published: 2022
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20. 157 - Enfermedades reumatológicas en el paciente crítico

Author: Núñez, María Recuerda, Madueño, Virginia Pérez, and García, Ángel Estella
Published: 2022
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21. 97 - La pandemia por coronavirus en las UCI. Neumonía grave por SARS-CoV-2

Author: García, Ángel Estella
Published: 2022
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22. Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study

Author: Antoni, Torres, Ana, Motos, Catia, Cillóniz, Adrián, Ceccato, Laia, Fernández-Barat, Albert, Gabarrús, Jesús, Bermejo-Martin, Ricard, Ferrer, Jordi, Riera, Raquel, Pérez-Arnal, Dario, García-Gasulla, Oscar, Peñuelas, José Ángel, Lorente, David, de Gonzalo-Calvo, Raquel, Almansa, Rosario, Menéndez, Andrea, Palomeque, Rosario Amaya, Villar, José M, Añón, Ana, Balan Mariño, Carme, Barberà, José, Barberán, Aaron, Blandino Ortiz, Maria Victoria, Boado, Elena, Bustamante-Munguira, Jesús, Caballero, María Luisa, Cantón-Bulnes, Cristina, Carbajales Pérez, Nieves, Carbonell, Mercedes, Catalán-González, Raul, de Frutos, Nieves, Franco, Cristóbal, Galbán, Víctor D, Gumucio-Sanguino, Maria Del Carmen, de la Torre, Emili, Díaz, Ángel, Estella, Elena, Gallego, José Luis, García Garmendia, José M, Gómez, Arturo, Huerta, Ruth Noemí Jorge, García, Ana, Loza-Vázquez, Judith, Marin-Corral, María Cruz, Martin Delgado, Amalia, Martínez de la Gándara, Ignacio, Martínez Varela, Juan, López Messa, Guillermo M, Albaiceta, Maite, Nieto, Mariana Andrea, Novo, Yhivian, Peñasco, Felipe, Pérez-García, Juan Carlos, Pozo-Laderas, Pilar, Ricart, Victor, Sagredo, Angel, Sánchez-Miralles, Susana, Sancho Chinesta, Mireia, Serra-Fortuny, Lorenzo, Socias, Jordi, Solé-Violan, Fernando, Suarez-Sipmann, Luis, Tamayo Lomas, José, Trenado, Alejandro, Úbeda, Luis Jorge, Valdivia, Pablo, Vidal, Ferran, Barbé, and Bitor, Santacoloma
Subjects: Infecciones por coronavirus, Critical Illness, Enfermedad transmisible, COVID-19, Critical Care and Intensive Care Medicine, Respiration, Artificial, COVID-19 Drug Treatment, Tratamiento médico, Intensive Care Units, Adrenal Cortex Hormones, Intensive care, Corticosteroids, Humans, Steroids, Precision Medicine, Critically ill
Abstract: Purpose: Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19. Methods: Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (≥ 10 days) were also investigated. Results: Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65-0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58-0.84], p < 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (p = 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (p = 0.014 interaction term), and mechanical ventilation (p = 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged ≥ 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 [1.14-1.53], p < 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 [0.61-0.82], p < 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia. Conclusion: Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful. Instituto de Salud Carlos III de Madrid (ISCIII) (COV20/00110) Centro de Investigacion Biomedica En Red-Enfermedades Respiratorias (CIBERES) Instituto de Salud Carlos III European Commission Miguel Servet 2020: CP20/00041 Instituto de Salud Carlos III (PI19/00207) 41.787 JCR (2022) Q1, 2/35 Critical Care Medicine 4.344 SJR (2022) Q1, 2/98 Critical Care and Intensive Care Medicine No data IDR 2022 UEM
Published: 2022

23. Effectiveness and Safety of Tecneplase vs. Alteplase in the Acute Treatment of Ischemic Stroke

Author: Ángel Estella, Miriam Pérez Ruiz, and Juan José Serrano
Subjects: tenecteplase, Medicine (miscellaneous), stroke, thrombolytic therapy, alteplase
Abstract: Not all hospitals have interventional radiology services. This fact implies that in centers where this resource is not available, the treatment of stroke in the acute phase must be adapted and individualized. The aim of the study is to determine and compare the combined effect of thrombolysis and thrombectomy effectiveness and safety of tenecteplase versus alteplase in the acute treatment of ischemic stroke in patients who are candidates for endovascular therapy according to clinical practice guidelines. This paper details a retrospective multicenter cohort study of patients with ischemic stroke admitted in three hospitals between 2018 and 2020. The main outcome variables were the degree of recanalization and the functional outcome at 3 months; safety variables were mortality and the occurrence of intracranial hemorrhage (ICH). In total, 100 patients were included, 20 of which were treated with tenecteplase (TNK) and 80 with alteplase (rtPA). Of those treated with TNK, 75% obtained a successful recanalization compared to 83.8% in those treated with rtPA (OR 0.58; 95% CI 0.18–1.88; p = 0.56). No differences were found in obtaining an excellent functional result at 3 months (35% TNK vs. 58.8% rtPA; p = 0.38). Tenecteplase showed worse neurological results after 24 h (unfavorable result of 70% with TNK vs. 45% with rtPA; OR = 5.4; 95% CI 1.57–18.6). No significant differences were identified in mortality; 17.5% with rtPA and 20% with TNK (p = 0.79), nor in the appearance of intracranial hemorrhage ICH (15.2% with rtPA vs. 30% with TNK (p = 0.12). In our series, there were not significant differences shown regarding effectiveness and safety between tenecteplase and alteplase.
Published: 2022
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24. Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure : the DIANA study

Author: De Bus, Liesbet, Depuydt, Pieter, Steen, Johan, Dhaese, Sofie, De Smet, Ken, Tabah, Alexis, Akova, Murat, Cotta, Menino Osbert, De Pascale, Gennaro, Dimopoulos, George, Fujitani, Shigeki, Garnacho-Montero, Jose, Leone, Marc, Lipman, Jeffrey, Ostermann, Marlies, Paiva, José-Artur, Schouten, Jeroen, Sjövall, Fredrik, Timsit, Jean-François, Roberts, Jason A., Zahar, Jean-Ralph, Zand, Farid, Zirpe, Kapil, De Waele, Jan J., Fernando Rios, Alejandro Risso Vazquez, Maria Gabriela Vidal, Graciela Zakalik, Antony George Attokaran, Iouri Banakh, Smita Dey-Chatterjee, Julie Ewan, Janet Ferrier, Loretta Forbes, Cheryl Fourie, Anne Leditschke, Lauren Murray, Philipp Eller, Patrick Biston, Stephanie Bracke, Luc De Crop, Nicolas De Schryver, Eric Frans, Herbert Spapen, Claire Van Malderen, Stijn Vansteelandt, Daisy Vermeiren, Elias Pablo Arévalo, Mónica Crespo, Roberto Zelaya Flores, Petr Píza, Diego Morocho Tutillo, Andreas Elme, Anne Kallaste, Joel Starkopf, Jeremy Bourenne, Mathieu Calypso, Yves Cohen, Claire Dahyot-Fizelier, François Depret, Max Guillot, Nadia Imzi, Sebastien Jochmans, Achille Kouatchet, Alain Lepape, Olivier Martin, Markus Heim, Stefan J Schaller, Kostoula Arvaniti, Anestis Bekridelis, Panagiotis Ioannidis, Cornelia Mitrakos, Metaxia N Papanikolaou, Sofia Pouriki, Anna Vemvetsou, Babu Abraham, Pradip Kumar Bhattacharya, Anusha Budugu, Subhal Dixit, Sushma Gurav, Padmaja Kandanuri, Dattatray Arun Prabhu, Darshana Rathod, Kavitha Savaru, Ashwin Neelavar Udupa, Sunitha Binu Varghese, Hossein Haddad Bakhodaei, Gholamreza Dabiri, Mohammad Javad Fallahi, Farnia Feiz, Mohammad Firoozifar, Vahid Khaloo, Behzad Maghsudi, Mansoor Masjedi, Reza Nikandish, Golnar Sabetian, Brian Marsh, Ignacio Martin-Loeches, Jan Steiner, Maria Barbagallo, Anselmo Caricato, Andrea Cortegiani, Rocco D'Andrea, Cristian Deana, Abele Donati, Massimo Girardis, Giuliana Mandalà, Giovanna Panarello, Daniela Pasero, Lorella Pelagalli, Paolo Maurizio Soave, Savino Spadaro, Yoshihito Fujita, Shinsuke Fujiwara, Yuya Hara, Hideki Hashi, Satoru Hashimoto, Hideki Hashimoto, Katsura Hayakawa, Masash Inoue, Shutaro Isokawa, Shinya Kameda, Hidenobu Kamohara, Masafumi Kanamoto, Shinshu Katayama, Toshiomi Kawagishi, Yasumasa Kawano, Yoshiko Kida, Mami Kita, Atsuko Kobayashi, Akira Kuriyama, Takaki Naito, Hiroshi Nashiki, Kei Nishiyama, Shunsuke Shindo, Taketo Suzuki, Akihiro Takaba, Chie Tanaka, Komuro Tetsuya, Yoshihiro Tomioka, Youichi Yanagawa, Hideki Yoshida, Syamhanin Adnan, Mohd Shahnaz Hasan, Helmi Sulaiman, Gilberto A Gasca Lopez, Carmen M Hernández-Cárdenas, Silvio A Ñamendys-Silva, Carina Bethlehem, Dylan de Lange, Nicole Hunfeld, Sandra Numan, Henk van Leeuwen, Daniel Owens, Mónica Almeida, Elsa Fragoso, Tiago Leonor, José-Manuel Pereira, Daniela Filipescu, Ioana Grigoras, Mihai Popescu, Dana Tomescu, Mohammed S Alshahrani, Manuel Alvarez-Gonzalez, Irene Barrero-García, Miguel Angel Blasco-Navalpotro, Laura Claverias, Ángel Estella, Lorena Forcelledo Espina, Jose Luis Garcia Garmendia, Emilio García Prieto, Gracia Gómez-Prieto, Carlos Jiménez Conde, Fernando Martinez Sagasti, Alicia Muñoz Cantero, Alberto Orejas-Gallego, Elisabeth Papiol, Demetrio Pérez-Civantos, Juan Carlos Pozo Laderas, Josep Trenado Álvarez, Paula Vera-Artázcoz, Pablo Vidal Cortés, Anders Oldner, Martin Spångfors, Emine Alp, Iftihar Köksal, Volkan Korten, Arife Özveren, Anna Hall, Kevin W Hatton, Krzysztof Laudanski, Experimental and Applied Psychology, Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Johns Hopkins Bloomberg School of Public Health [Baltimore], Johns Hopkins University (JHU), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], University of Queensland [Brisbane], Centro Hospitalar Universitário São João - Faculty of Medicine - University of Porto - Grupo de Infecção e Sepsis, Porto, Radboud University Medical Center [Nijmegen], Skane University Hospital [Malmo], Lund University [Lund], Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Ghent University Hospital, Ghent, Belgium, De Bus, Liesbet, Depuydt, Pieter, Steen, Johan, Dhaese, Sofie, De Smet, Ken, Tabah, Alexi, Akova, Murat, Cotta, Menino Osbert, De Pascale, Gennaro, Dimopoulos, George, Fujitani, Shigeki, Garnacho-Montero, Jose, Leone, Marc, Lipman, Jeffrey, Ostermann, Marlie, Paiva, José-Artur, Schouten, Jeroen, Sjövall, Fredrik, Timsit, Jean-Françoi, Roberts, Jason A., Zahar, Jean-Ralph, Zand, Farid, Zirpe, Kapil, De Waele, Jan J., and Fernando Rios, Alejandro Risso Vazquez, Maria Gabriela Vidal, Graciela Zakalik, Antony George Attokaran, Iouri Banakh, Smita Dey-Chatterjee, Julie Ewan, Janet Ferrier, Loretta Forbes, Cheryl Fourie, Anne Leditschke, Lauren Murray, Philipp Eller, Patrick Biston, Stephanie Bracke, Luc De Crop, Nicolas De Schryver, Eric Frans, Herbert Spapen, Claire Van Malderen, Stijn Vansteelandt, Daisy Vermeiren, Elias Pablo Arévalo, Mónica Crespo, Roberto Zelaya Flores, Petr Píza, Diego Morocho Tutillo, Andreas Elme, Anne Kallaste, Joel Starkopf, Jeremy Bourenne, Mathieu Calypso, Yves Cohen, Claire Dahyot-Fizelier, François Depret, Max Guillot, Nadia Imzi, Sebastien Jochmans, Achille Kouatchet, Alain Lepape, Olivier Martin, Markus Heim, Stefan J Schaller, Kostoula Arvaniti, Anestis Bekridelis, Panagiotis Ioannidis, Cornelia Mitrakos, Metaxia N Papanikolaou, Sofia Pouriki, Anna Vemvetsou, Babu Abraham, Pradip Kumar Bhattacharya, Anusha Budugu, Subhal Dixit, Sushma Gurav, Padmaja Kandanuri, Dattatray Arun Prabhu, Darshana Rathod, Kavitha Savaru, Ashwin Neelavar Udupa, Sunitha Binu Varghese, Hossein Haddad Bakhodaei, Gholamreza Dabiri, Mohammad Javad Fallahi, Farnia Feiz, Mohammad Firoozifar, Vahid Khaloo, Behzad Maghsudi, Mansoor Masjedi, Reza Nikandish, Golnar Sabetian, Brian Marsh, Ignacio Martin-Loeches, Jan Steiner, Maria Barbagallo, Anselmo Caricato, Andrea Cortegiani, Rocco D'Andrea, Cristian Deana, Abele Donati, Massimo Girardis, Giuliana Mandalà, Giovanna Panarello, Daniela Pasero, Lorella Pelagalli, Paolo Maurizio Soave, Savino Spadaro, Yoshihito Fujita, Shinsuke Fujiwara, Yuya Hara, Hideki Hashi, Satoru Hashimoto, Hideki Hashimoto, Katsura Hayakawa, Masash Inoue, Shutaro Isokawa, Shinya Kameda, Hidenobu Kamohara, Masafumi Kanamoto, Shinshu Katayama, Toshiomi Kawagishi, Yasumasa Kawano, Yoshiko Kida, Mami Kita, Atsuko Kobayashi, Akira Kuriyama, Takaki Naito, Hiroshi Nashiki, Kei Nishiyama, Shunsuke Shindo, Taketo Suzuki, Akihiro Takaba, Chie Tanaka, Komuro Tetsuya, Yoshihiro Tomioka, Youichi Yanagawa, Hideki Yoshida, Syamhanin Adnan, Mohd Shahnaz Hasan, Helmi Sulaiman, Gilberto A Gasca Lopez, Carmen M Hernández-Cárdenas, Silvio A Ñamendys-Silva, Carina Bethlehem, Dylan de Lange, Nicole Hunfeld, Sandra Numan, Henk van Leeuwen, Daniel Owens, Mónica Almeida, Elsa Fragoso, Tiago Leonor, José-Manuel Pereira, Daniela Filipescu, Ioana Grigoras, Mihai Popescu, Dana Tomescu, Mohammed S Alshahrani, Manuel Alvarez-Gonzalez, Irene Barrero-García, Miguel Angel Blasco-Navalpotro, Laura Claverias, Ángel Estella, Lorena Forcelledo Espina, Jose Luis Garcia Garmendia, Emilio García Prieto, Gracia Gómez-Prieto, Carlos Jiménez Conde, Fernando Martinez Sagasti, Alicia Muñoz Cantero, Alberto Orejas-Gallego, Elisabeth Papiol, Demetrio Pérez-Civantos, Juan Carlos Pozo Laderas, Josep Trenado Álvarez, Paula Vera-Artázcoz, Pablo Vidal Cortés, Anders Oldner, Martin Spångfors, Emine Alp, Iftihar Köksal, Volkan Korten, Arife Özveren, Anna Hall, Kevin W Hatton, Krzysztof Laudanski
Subjects: Original, DELPHI METHOD, Critical Care and Intensive Care Medicine, GUIDELINES, law.invention, 0302 clinical medicine, Anti-Infective Agents, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, law, Epidemiology, Medicine and Health Sciences, Antimicrobial de-escalation, EPIDEMIOLOGY, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Ventilator-associated pneumonia, Intensive care unit, Anti-Bacterial Agents, 3. Good health, Intensive Care Units, STEWARDSHIP PROGRAM, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Cohort, Bacterial infection, Clinical cure, Empirical therapy, Adult, medicine.medical_specialty, Combination therapy, Critical Illness, ANTIBIOTIC-THERAPY, NO, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, BETA-LACTAM, Internal medicine, Settore MED/41 - ANESTESIOLOGIA, medicine, Humans, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, VENTILATOR-ASSOCIATED PNEUMONIA, business.industry, SEPTIC SHOCK, R-PACKAGE, bacterial infection, 030208 emergency & critical care medicine, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Discontinuation, SEVERE SEPSIS, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], Carbapenems, 030228 respiratory system, Relative risk, business, De-escalation
Abstract: © 2020 The Author(s)., [Purpose]: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation., [Methods]: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure., [Results]: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60–1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14–1.64)., [Conclusion]: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely.
Published: 2020
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25. Compassionate Communication and End-of-Life Care for Critically Ill Patients with SARS-CoV-2 Infection

Author: Ángel Estella
Subjects: Terminal Care, SARS-CoV-2, Communication, Critical Illness, Pneumonia, Viral, COVID-19, Betacoronavirus, Intensive Care Units, Spain, Humans, Family, Empathy, Coronavirus Infections, Pandemics
Abstract: Public health strategies recommend isolating patients with SARS-CoV-2 infection. But compassionate care in the intensive care unit (ICU) is an ethical obligation of modern medicine that cannot be justified by the risk of infection or the lack of personal protective equipment. This article describes the experiences of clinicians in ICUs in the south of Spain promoted by the Andalusian Society of Intensive Care SAMIUC, in the hope it will serve to improve the conditions in which these patients die, and to help their families who suffer when they cannot say good-bye to their loved ones. In the south of Spain, healthcare professionals use daily videoconferencing to improve communication between clinicians, patients, and their relatives who cannot visit them in the ICU. This close communication allows families to see their loved ones and extends communication between healthcare professionals, patients, and their relatives. To allow family members to accompany patients at the end of life, it is possible to adapt public health rules to the epidemic situation.
Published: 2020

26. Vaccinated Patients Admitted in ICU with Severe Pneumonia Due to SARS-CoV-2: A Multicenter Pilot Study

Author: Ángel Estella, Mª Luisa Cantón, Laura Muñoz, Isabel Rodriguez Higueras, María Recuerda Núñez, Julia Tejero Aranguren, Benito Zaya, Carmen Gómez, Rosario Amaya, Ángela Hurtado Martinez, María del Valle Odero Bernal, Carmen De la Fuente, Juan Carlos Alados, Jose Garnacho-Montero, and on behalf of the Group of Infectious Diseases of the Andalusian Society of Intensive Care and Coronary Units SAMIUC
Subjects: ARDS, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, business.industry, Critically ill, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Delta variant SARS-CoV-2, Medicine (miscellaneous), Antibody level, acute respiratory distress syndrome, medicine.disease, Article, Vaccination, Pneumonia, severe pneumonia, vaccine, Internal medicine, ICU, medicine, Medicine, business, Cohort study
Abstract: Background: The aim of this study was to analyze the percentage of patients admitted to the ICU having received the vaccine against COVID-19, to describe the clinical profile of vaccinated patients admitted to the ICU, and to assess the humoral immune response to vaccination. Methods: In this multicenter prospective descriptive cohort study, consecutive critically ill patients with confirmed SARS-CoV-2 pneumonia who received at least one dose of the SARS-CoV-2 vaccine were included. The time of study was from 1 July to 10 August of 2021. Results: Of the 94 consecutive patients from seven Andalusian ICUs admitted during the time of study, 50 (53.2%) received at least one dose of anti SARS-CoV-2 vaccine. No patient was admitted having previously had SARS-CoV-2 infection. The B.1.617.2 (Delta) variant was the most frequently identified, in 80.76% of cases. Patients with a complete vaccination with non-optimal antibody levels were immunocompromised. Fifteen patients were admitted to the ICU with Acute Respiratory Distress Syndrome (ARDS) without having completed their vaccination, the clinical profile was younger and with less comorbidities compared to patients with full vaccination. There were no differences in severity of ARDS. Conclusions: Most of the patients who were admitted to the ICU having received a dose of the vaccine were not optimally vaccinated, fully vaccinated patients who did not obtain optimal serum antibody levels were patients considered immunocompromised.
Published: 2021
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27. IMPORTANCIA DEL ABORDAJE PALIATIVO INTERPROFESIONAL EN EL PACIENTE CRÍTICO

Author: José Manuel Velasco-Bueno, Ángel Estella-García, Miriam del Barrio-Linares, Olga Rubio-Sanchiz, M. Raurell-Torredà, Iñaki Saralegui-Reta, and Tamara Raquel Velasco-Sanz
Subjects: Critical Care and Intensive Care Medicine, Critical Care Nursing
Published: 2019
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28. THE IMPORTANCE OF AN INTERPROFESSIONAL PALLIATIVE APPROACH FOR THE CRITICAL PATIENT

Author: Tamara Raquel, Velasco-Sanz, Ángel, Estella-García, Miriam, Del Barrio-Linares, José Manuel, Velasco-Bueno, Iñaki, Saralegui-Reta, Olga, Rubio-Sanchiz, and Marta, Raurell-Torredà
Subjects: Patient Care Team, Critical Illness, Palliative Care, Humans
Published: 2018

29. Plasma levels of mid-regional pro-adrenomedullin in sepsis are associated with risk of death

Author: María Ángela González-García, J. F. Rodríguez-Gutiérrez, Jordi Rello, Francisco Valenzuela-Sánchez, Rafael Bohollo de Austria, Laura Fernández-Ruiz, Blanca Valenzuela-Méndez, and Ángel Estella-García
Subjects: Male, medicine.medical_specialty, Risk Assessment, Severity of Illness Index, Procalcitonin, law.invention, Sepsis, 03 medical and health sciences, Adrenomedullin, 0302 clinical medicine, 030202 anesthesiology, law, Internal medicine, Cause of Death, Epidemiology, Severity of illness, medicine, Humans, Prospective Studies, Prospective cohort study, Cause of death, Aged, business.industry, Organ dysfunction, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Prognosis, Intensive care unit, Anesthesiology and Pain Medicine, Female, medicine.symptom, business
Abstract: BACKGROUND Identifying Intensive Care Unit (ICU) patients with sepsis and predicting the risk of death are unmet clinical needs. METHODS Prospective observational single-center study of 120 consecutive ICU patients with suspected severe sepsis at Jerez Hospital. Epidemiological, clinical, laboratory data and MR-proADM, Procalcitonin (PCT) and C-reactive protein (CRP) levels were recorded at ICU admission and follow-up. RESULTS At ICU discharge, 104 patients were diagnosed with severe sepsis and 39 died. Plasma MR-proADM was highly indicative of sepsis: 4.05 nmol/L vs. of 0.309 nmol/L (P
Published: 2018

30. Colaboradores

Author: Molina, Ana Abril, Valencia, Daniel Acevedo, Díaz, Fernando Acosta, Rotaeche, Alexander Agrifoglio, Alonso, Eduardo Aguilar, García, María del Carmen Aguilar, Arboledas, Francisco Javier Alados, Tomillero, Francisco Álamo, Romero, Pedro Alcázar, Pallás, María Teresa Aldabó, Marín, Amelia Alonso, Muñoz, Gema Alonso, Salas, María Teresa Alonso, Bueno, Miguel Álvarez, Sáiz, Alejandra Álvarez, Serna, Tania Amat, Villar, Rosario Amaya, González, César Aragón, Sánchez, José Andrés Arboleda, Garrido, José Julián Arias, Verdú, María Dolores Arias, Sánchez, Álvaro Arjona, Marín, María José Arroyo, Gallardo, Marc Ayala, Bravo, Esther Banderas, Pichardo, Rafael Barba, Ansorregui, Sandra Barbadillo, Mendoza, Jesús Abelardo Barea, Chacón, Juana María Barrera, Barrueco-Francioni, Jesús Emilio, Rodríguez, María Dolores Bautista, Alba, Rafael Bellido, Lozano, José Antonio Benítez, Moreno, María Palma Benítez, Gómez, Alberto Bermejo, Sáez, Isidro Blanco, Saera, María Bodí, Austria, Rafael Ángel Bohollo de, Saris, Alfonso Bonet, Marqués, Rafael Bravo, Cabeza, Francisca, Calandreia, Ana Cabrera, Fuciños, Lucía Cachafeiro, Rodríguez, Ana Calderón, Bonachera, María Dolores Calvo, León, Cristina Calvo, Macías, Custodio Calvo, Pulido, Jorge Calvo, Alonso, José Miguel Camacho, Sola, Estefanía Cámara, Redondo, Nuria Camino, Guerrero, Jesús Carbajal, Cruz, Antonio Cárdenas, Cruz, Dolores Purificación Cárdenas, Pérez, María Luz Carmona, Pinel, Antonio Carranza, Carmona, Francisco José Carrizosa, Hernández, Alejandra Carvajal, Adam, Ángela Casado, Laparra, Eloina Casanoves, Ribas, Patricia Castán, Pérez, José Castaño, Ortega, Álvaro Castellanos, Lorente, Encarnación Castillo, Barranquero, Francisca Gema Cazorla, Sánchez, María José Chaparro, Sáez, Violeta Chica, Fernández, Mario Chico, Ríos, Miguel Ángel Chirosa, Cabrera, Laura Claverias, Torres, Elisabeth Coll, Ruiz, Manuel Colmenero, Pino, Tamara Contreras del, Palomo, Yael Corcia, Lorenzana, María Lourdes Cordero, Delgado, Francisco Cota, Balsera, Emilio Curiel, Ruiz, Domingo Daga, Gestido, Azucena de la Campa, Ruano, Rafael de la Chica Ruiz, Moreno, Jesús de la Cruz, Martos, Carmen de la Fuente, García, Celia de la Hoz, Valverde, Carmen María de la Linde, Prados, María Victoria de la Torre, Blanc, Marina de Miguel, Casado, Nieves Delgado, Castellanos, Miguel Ángel Díaz, Contreras, Remedios Díaz, Monrové, Juan Carlos Díaz, Pernalete, Rosa María Díaz, Torres, Isabel Díaz, García, Pedro Jesús Domínguez, Domínguez-Gil, Beatriz, Roldán, José María Domínguez, Jurado, José María Dueñas, García, Ignacio Durbán, Brutus, Reginald Dusseck, León, Melisa Echeverría, Egea-Guerrero, Juan José, Mendoza, Ana Estalella, Montiel, Belén Estébanez, Foncea, María Antonia Estecha, García, Ángel Estella, Torrús, Andrés Estivill, López-Cuervo, Juan Fajardo, Fernández-Castanys, Esteban Feriche, Carmona, Alberto Fernández, Díez, Inés Fernández, Hinojosa, Esteban Fernández, Mondéjar, Enrique Fernández, Ortega, Juan Francisco Fernández, Porcel, Alba Fernández, Zamora, María Dolores Fernández, Higueras, María José Ferrer, López, Rafael Ferrer, Mata, Álvaro Ferrezuelo, Costa, Eva María Fieira, Rosón, Luis Javier Fierro, Lasierra, José Luis Flordelís, Cordero, Juan Manuel Flores, González, José Carlos Flores, Fregosi, Andrea, Freire-Aragón, María Dolores, Pérez, Manuel Ángel Frías, López, Juan Luis Galeas, Carbajo, Virginia Gallardo, Lara, Sonia Gallego, Martín, José Manuel Galván, Alfaro, Claudio García, Bautista, Ernesto García, Bautista, Jesús Alejo García, Cobo, José García, Lorenzo Mateos, Abelardo García de, Delgado, Manuel García, Rosado, Horacio García-Delgado, Acilu, Marina García García de, Morales, Juan José García, Sánchez, Manuela García, Soler, Patricia García, Garnacho-Montero, José, Castillo, María Luisa Gascón, Gómez, Raquel Gil, Pérez, Juan José Gilbert, Beltrán, Bárbara Giménez, González, Carmen Gómez, Jiménez, Francisco Javier Gómez, Luque, José María Gómez, Muñoz, Cristina Gómez, Ortiz, Francisco Javier González de Molina, Fenoy, Daniel González, Galilea, Ángel González, Gómez, José Manuel González, Hervás, Catalina González, López, Samuel González, Garzón, Manuel González-Ripoll, Brenes, Antonio Gordillo, Romero, Manuel Ángel Gracia, Mier, Manuel Guerrero de, López, Francisco Guerrero, Calle, Gabriel Heras La, Alonso, Benjamín Hernández, Cerdá, Laura Hernández, González, Arturo Hernández, Tejedor, Alberto Hernández, Vidaña, Adoración María Hernández, Gutiérrez, Manuel Enrique Herrera, Avilés, Ángel Herruzo, Muñoz, Fidel Alberto Hijano, Pérez, Rafael Hinojosa, Suazo, José Antonio Hurtado, Rosa, Ignacio Ibarra de la, Morales, Miriam Ibars, Santiago, Alberto Iglesias, Hernández, José Manuel Infantes, Sarrías, José Luis Iribarren, Rocamora, José Antonio Irles, Franco, Mercedes Jaén, Caballero, Susana Jaraba, Gómez-Coronado, Vicente Jerez, Guadarrama, Luis Roberto Jiménez, Moragas, José Manuel Jiménez, Rivera, Juan José Jiménez, Moreno, Belén Jordano, Montosa, Carolina Joya, Díaz, Mar Juan, Pujol, Jordi Klamburg, Aguayo, Pedro Lara, Rosales, Ramón Lara, Noval, Santiago Ramón Leal, Gallardo, Miguel Lebrón, Gil, Cristóbal León, López, Rafael León, Galera, Sagrario Lombardo, Sánchez, José María López, Vázquez, Ana Loza, Calderón, Francisco Lucena, Casas, Juan Francisco Machado, Guarasa, Inés Macías, Municio, Alejandro Manrique, Caño, Javier Manso del, Marín-Caballos, Antonio Jesús, Monserrat, Fernando Luis Maroto, Gamarra, Pilar Márquez, Bermúdez, Rafael Martín, Delgado, María Cruz Martín, García, José Antonio Martín, López, Javier Ignacio Martín, Santaella, Ana Martín, Carmona, Juan Francisco Martínez, Martínez-Caro, Leticia, Escobar, Sergio Martínez, García, Pilar Martínez, López, Pilar Martínez, Padilla, María del Carmen Martínez, Enviz, Joan Ramon Masclans, Arizmendi, Alfonso Mesejo, Febrer, Jaume Mesquida, Manso, Guillermo Milano, Collado, Zaira Molina, Hurtado, José Ramón Molina, García, Manuel Ignacio Monge, González, Juan Carlos Montejo, Candau, Miguel Montero de Espinosa, Pintado, Rocío Monterroso, Ordóñez, Juan Miguel Mora, Quintero, María Luisa Mora, Martínez, Antonio Morales, Fernández, Eduardo Morán, Cecilia, Gonzalo Moratalla, López, Josefina Moreno, Romero, Olga Moreno, Gómez, Ana Mula, Bono, Javier Muñoz, Caballero, María Ángeles Muñoz, Casares, Cristóbal Muñoz, Cabo, Carlos Muñoz de, Garach, Manuel Muñoz, Guillén, Noelia María Muñoz, López, Alfonso Muñoz, Marina, Vanessa Muñoz, Sánchez, Sergio Muñoz, Sánchez, María de los Ángeles Muñoz, Cabezas, Francisco Murillo, Pozo, María Ángeles Murillo, Izurieta, José Ricardo Naranjo, Galdó, Susana Narbona, Navarro, Pedro Navarrete, Guillamón, Laura Navarro, González, María Nieto, Guindo, Pablo Nieto, Vaeza, Nicolás Nin, Ortega, Pilar Nuevo, Hita, Esther Ocete, Jiménez, Victoria Olea, Granados, Gonzalo Olivares, Peña, Lorena Olivencia, Ordiales, Ane Ortega, Vinuesa, Francisco Jesús Ortega, Zarza, Pedro Ortega, Álvarez, Ana Ortiz, Pérez, María Ortiz, Moreno, Pedro Pardo, Parrilla, Julio Parrilla, Ruiz, Francisco Manuel Parrilla, Bailón, Ana Pérez, Civantos, Demetrio Pérez, González, Álvaro Pérez, Madueño, Virginia Pérez, Navero, Juan Luis Pérez, Vacas, Jonathan Pérez, Villares, José Miguel Pérez, Moya, Enrique Pino, Sánchez, Francisca Inmaculada Pino, Guzmán, María Dolores Pola Gallego, Ponce, María del Pilar, López, Francisco Manuel Porras, Pantojo, Manuel Francisco Porras, Aguilera, María Eugenia Poyatos, Laderas, Juan Carlos Pozo, Paula, Juan Francisco Prieto de, Morlán, Araceli Puerto, Valverde, Pablo Pujol, Moreno, Antonio Puppo, García, Juan Guillermo Quesada, Galleymore, Paula Ramírez, Puerta, Rosario Ramírez, Núñez, María Recuerda, Orts, María Redondo, Artacho, María del Carmen Reina, Parras, María del Pilar Reyes, Ferrari, María Dolores Rincón, Espinar, Francisco Rivera, Arista, Juan Carlos Robles, Marcos, Manuel Robles, Castillo, Emilio Martín Robles-Musso, Alonso, Rosa María Rodríguez, Campoy, Patricia Rodríguez, Castaño, Rocío Rodríguez, Delgado, Marina Rodríguez, Espejo, Rosa Rodríguez, Gómez, Jorge Rodríguez, Higueras, Isabel María Rodríguez, Medina, Juan Antonio Rodríguez, Mejías, Candela Rodríguez, Oviedo, Alejandro Rodríguez, Yáñez, Juan Carlos Rodríguez, Amezcua, María Rojas, Cutillas, Ana María Román, Faro, Xan Romaní, Barroso, Isidro Romero, Camacho, Vanessa Rosa, Molina, Carolina Rueda, Bailén, Manuel Ruiz, Azúa-López, Zaida Ruiz de, Fresno, Luis Ruiz del, Ferrón, Francisco Ruiz, Jiménez, Jesús Ruiz, Ruiz-Santana, Sergio, Casco, Luis Vicente Sáenz, Fuente, Ignacio Sáez de la, Coronas, Joaquín Salas, Ramírez, Cristina Salazar, González, Francisco José Saldaña, Díaz, Lourdes Salido, Fernández, María José Salmerón, Cejas, José María San Pedro, Fernández, Norma Sánchez, Ganfornina, Inmaculada Sánchez, González, Yolanda Sánchez, Ramírez, Catalina Sánchez, Rodríguez, Ángel Custodio Sánchez, Román, José Antonio Sánchez, Segovia, José Sánchez, Silos, Francisco Sánchez, Valderrábanos, Elia Sánchez, Gutiérrez, Carmen Santiago, González, Fernando Segura, Pérez, Gemma Seller, Vic, Joaquim Serra, Lázaro, Ainhoa Serrano, Martínez, José Luis Serrano, Simón, José Manuel Serrano, Martínez, María Sevilla, Camerino, Rafael Sierra, Pérez, Manuel Jesús Soriano, Corriente, Macarena Taguas-Casaño, Aranguren, Julia Tejero, Reynoso, Pablo Torrabadella de, Alcalá, José Tomás Torres, Delgado, Eva Torres, Torres, Antonio Torres, Fernández, Carmen Trujillano, Spasova, Tsvetelina Tsvetanova, Iglesias, Alejandro Úbeda, Santamaría, Esther Ulloa, Quintero, Juan Pablo Valencia, Sánchez, Francisco Valenzuela, Báez, Antonio Vallejo, Barrios, José Manuel Vaquero, Vargas, Francisco Javier Vasserot, Florido, Antonio Vázquez, Colmenero, Rosa María Vela, Bueno, José Manuel Velasco, Gimena, Francisco Velasco, Jabalquinto, María José Velasco, Gallardo, Juan Villar, Muñoz, Emilia Villegas, Mateos, Luis Yaguez, Castilla, Cristina Yun, Ossorio, María Eugenia Yuste, Periñán, María José Zarco, and Ganfornina, José Benito Zaya
Published: 2022
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31. 169 - Ética al final de la vida en el paciente crítico

Author: García, Ángel Estella and Garrido, José Julián Arias
Published: 2022
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32. 165 - El especialista en medicina intensiva en relación con el paciente crítico, su familia y el entorno social

Author: García, Ángel Estella
Published: 2022
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33. 163 - Participación de la medicina intensiva en la gestión de las emergencias colectivas y catástrofes a nivel hospitalario. Emergencias NBQ

Author: Garrido, José Julián Arias and García, Ángel Estella
Published: 2022
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34. 161 - Impacto de la inmigración en la medicina intensiva

Author: García, Ángel Estella and Garrido, José Julián Arias
Published: 2022
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35. Stroke Prophylaxis in Atrial Fibrillation: Searching for Management Improvement Opportunities in the Emergency Department: The HERMES-AF Study

Author: Blanca Coll-Vinent, Alfonso Martín, Francisco Malagón, Coral Suero, Juan Sánchez, Mercedes Varona, Manuel Cancio, Susana Sánchez, Eugeni Montull, Carmen del Arco, Emilio Román, Francisca Heredia, Ana Ma Sagarra, Ángel Estella, Francisco Manuel Brun, Elías Simón, José Manuel Torres, Elisa Lopera, Fuensanta Soriano, Fernando Santamarina, Matilde F. Feixas, F. Javier Hierro, José Ma Santos, Álvaro F. Perea, Francisco Tembury, Macarena Rizo, Adolfo Ramirez, Rafael Sindiones, Francisco Moya, Amparo Fernández, Francisco Ruiz, José Manuel Garrido, Enrique Almagro, Javier Povar, Elisa Aldea, Miguel Rivas, Fernando Galve, Manuel Muñoz, Juan Alberto García, Pedro Cals, Ana Gutierrez, Luis García-Castrillo, María José Rodriguez, Fernando Richard, Beatriz López, Luis Lapuerta, Tomás Toranzo, Nicanor Zapico, Ana Melendre, José Aguilar, Ma del Mar Sousa, Alberto Lopez, Luis Montero, Raimundo Rodriguez-Bobada, Ramón Perales, Rosa Roldán, Carolina Fuenzalida, Olga Ma Trejo, Alfons Aguirre, Teresa Soriano, Mireia Vila, Lluis Fornet, Francisco Casarramona, Ma Isabel Sánchez, Julio Font, Joan Espinach, Mercè Almirall, Joaquin Danés, Alvaro Herrera, Silvia Flores, Ali Jammoul, José Vicente, Ma Isabel Campos, Rafael Colomina, Joaquin Escámez, Begoña Arcos, Ma Carmen Navarro, Javier Millán, Jose Javier Noceda, Salvador Rubini, Ricardo Rubini, José Carbajosa, Ma Elena Díaz, Francisco J. Navarro, Matilde González, Adelaida Mateo, Cristina Gisbert, Francisco Navarro, Ignacio López, Francisco David Muñoz, Ma Teresa García, Pablo Lamas, Luis Amador, Ricardo Calvo, Carmen Seijas, Ma C. Selloso, Manuel García, Francisco José Aramburu, Ma A. Leciñena, Alex Planas, Ignacio Ayala, Jose Emilio Alonso, Benito Gutiérrez, Pedro Marco, Belén Rodríguez, Juan Manuel Parra, Juan González, Luis Diaz, Oscar Álvarez, Juan Andueza, Joaquin García, Gregorio Jiménez, Manuel Ruizy, Esther Mora, Juan Torres, Jesús Canora, Carlos Bibiano, Pascual Piñera, Enrique Retuerto, Jose Ma Melgares, Jesús Cruzado, Carmen Escudero, Ángel Hernández, Eduardo Jiménez, and Jose López
Subjects: Male, medicine.medical_specialty, Cross-sectional study, Risk Assessment, Sex Factors, Risk Factors, Internal medicine, Atrial Fibrillation, Humans, Medicine, Practice Patterns, Physicians', Medical prescription, Intensive care medicine, Stroke, Aged, business.industry, Age Factors, Anticoagulants, Atrial fibrillation, Odds ratio, Emergency department, medicine.disease, Cross-Sectional Studies, Spain, Heart failure, Emergency Medicine, Female, Emergency Service, Hospital, business, Risk assessment
Abstract: Study objective We determine the prevalence of stroke prophylaxis prescription in emergency department (ED) patients with atrial fibrillation and the factors associated with a lack of prescription of anticoagulation in high-risk patients without contraindications. Methods This was a multicenter, observational, cross-sectional study with prospective standardized data collection carried out in 124 Spanish EDs. Clinical variables, risk factors for stroke, type of prophylaxis prescribed, and reasons for not prescribing anticoagulation in high-risk patients (congestive heart failure/left ventricular dysfunction, hypertension, age >75 years, diabetes and previous stroke/transient ischemic attack/systemic embolism [CHADS2] score ≥2 and the congestive heart failure/left ventricular dysfunction, hypertension, age >75 years, diabetes, previous stroke/transient ischemic attack/systemic embolism, vascular disease age 65 to 74 years and sex category [CHA2DS2-VASc] score ≥2) without contraindications were collected. Results Of 3,276 patients enrolled, 71.5% were at high risk according to CHADS2; 89.7% according to CHA2DS2-VASc. At discharge from the ED, 2,255 patients (68.8%) were receiving anticoagulants, 1,691 of whom (75%) were high-risk patients. Of the 1,931 patients discharged home, anticoagulation was prescribed for 384 patients (19.9%) de novo and for 932 patients (48.3%) previously receiving anticoagulation. The main reasons for not prescribing anticoagulation to eligible patients were considering antiplatelet therapy as adequate prophylaxis (33.1%), advanced age (15%), and considering stroke risk as low (8.3%). Advanced age (odds ratio 0.46; 95% confidence interval 0.30 to 0.69) and female sex (odds ratio 0.50; 95% confidence interval 0.36 to 0.71) were significantly associated with the lack of prescription of anticoagulation to eligible patients. Conclusion In Spain, most patients with atrial fibrillation treated in EDs who do not receive anticoagulation are at high risk of stroke, with relevant differences with regard to the risk stratification scheme used. Anticoagulation is underused, mainly because the risk of stroke is underestimated by the treating physicians and the benefits of antiplatelets are overrated, principally in female patients and the elderly. Efforts to increase the prescription of anticoagulation in these patients appear warranted.
Published: 2015
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36. Colaboradores

Author: Martínez, Lourdes Alarcón, Marín, Amelia Alonso, Vázquez, Alberto Caballero, Cruz, Antonio Cárdenas, Gómez de Cáliz, Luis Cassini, de la Hoz García, Celia, García, Ángel Estella, Polo, Cayo García, Sánchez, Manuela García, Crespo, Estefanía Luque, Romero, Olga Moreno, Muñoz Caballero, María Ángeles, Navarro Guillamón, Laura Carmen, Parrilla Ruiz, Francisco Manuel, Castaño, Rocío Rodríguez, Romero, Beatriz Romero, García, Elena Trujillo, and Vasserot Vargas, Francisco Javier
Published: 2024
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37. New role of biomarkers: mid-regional pro-adrenomedullin, the biomarker of organ failure

Author: J. F. Rodríguez-Gutiérrez, Ángel Estella-García, Blanca Valenzuela-Méndez, María Ángela González-García, and Francisco Valenzuela-Sánchez
Subjects: medicine.medical_specialty, business.industry, Septic shock, Organ dysfunction, 030208 emergency & critical care medicine, General Medicine, Review Article, 030204 cardiovascular system & hematology, medicine.disease, Procalcitonin, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Respiratory failure, Internal medicine, Heart failure, medicine, Risk of mortality, Biomarker (medicine), medicine.symptom, business, Intensive care medicine
Abstract: Mid-regional pro-adrenomedullin (MR-proADM) has a good biomarker profile: its half-life is several hours, and its plasma concentrations can be determined in clinical practice, it is essentially irrelevant, but proportionally represents the levels and activity of adrenomedullin (ADM). ADM synthesis is widely distributed in tissues, including bone, adrenal cortex, kidney, lung, blood vessels and heart. Its fundamental biological effects include vasodilator, positive inotropic, diuretic, natriuretic and bronchodilator. It has been described high levels in septic patients, interacting directly with the relaxation of vascular tone, triggering hypotension of these patients. It is also found high levels in other diseases such as hypertension, heart failure, respiratory failure, renal failure, cirrhosis and cancer. MR-proADM has been identified as a prognostic marker, stratifying the mortality risk in patients with sepsis in emergency department (ED) and ICU. Evolutionary MR-proADM levels and clearance marker to the 2nd–5th days of admission help to determine the poor performance and the risk of mortality in patients with severe sepsis admitted to the ICU. The MR-proADM levels are more effective than procalcitonin (PCT) and C-reactive protein (CRP) levels to determine an unfavorable outcome and the risk of mortality in patients with sepsis admitted to the ICU. It has also proved useful in patients diagnosed with organ dysfunction of infectious etiology. MR-proADM levels are independent of the germ conversely it is related to the magnitude of organ failure and therefore severity. We consider advisable incorporating the MR-proADM the panel of biomarkers necessary for the diagnosis and treatment of critically ill patients admitted to the ICU with severe sepsis. The combined PCT and MR-proADM levels could represent a valid tool in the clinical practice to timely identify patients with bacterial infections and guide the diagnosis and treatment of sepsis and septic shock.
Published: 2016

38. Infección en el paciente anciano. Consenso de recomendaciones para su abordaje en los servicios de Urgencias

Author: Carmen Navarro, Cristobal Marchante, Ángel Estella, and Jose Cobos
Subjects: 03 medical and health sciences, Aging, 0302 clinical medicine, business.industry, 010102 general mathematics, Medicine (miscellaneous), Medicine, 030212 general & internal medicine, 0101 mathematics, Geriatrics and Gerontology, business, 01 natural sciences
Published: 2016
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39. [Infection in the elderly patient. Consensus recommendations for management in the Emergency Department]

Author: Ángel, Estella, Cristobal, Marchante, Jose, Cobos, and Carmen, Navarro
Subjects: Consensus, Evidence-Based Medicine, Patients, Humans, Emergency Service, Hospital, Infections, Aged
Published: 2015

40. Effects on respiratory mechanics of bronchoalveolar lavage in mechanically ventilated patients

Author: Ángel Estella
Subjects: Pulmonary and Respiratory Medicine, Mechanical ventilation, medicine.diagnostic_test, business.industry, Critically ill, medicine.medical_treatment, Respiratory physiology, respiratory system, medicine.disease, respiratory tract diseases, Pneumonia, Airway resistance, Bronchoalveolar lavage, Bronchoscopy, Anesthesia, medicine, Respiratory system, business
Abstract: INTRODUCTION Inconsistent findings have been reported about the effects of bronchoalveolar lavage (BAL) on respiratory mechanics. The aims of this study were to study the effects of BAL on respiratory mechanics in mechanically ventilated patients with suspected pneumonia and to find out whether these effects are related to the extension of radiographic infiltrate and preceding respiratory mechanics measurements. METHODS Bronchoscopy BAL was performed with 150 mL of sterile isotonic saline in 3 aliquots of 50 mL. Respiratory mechanics parameters were measured by the rapid airway occlusion technique, immediately before and after BAL and 90 minutes later. Patients were classified according to unilateral or bilateral radiological infiltrate occurrence. RESULTS Fifty critically ill patients undergoing mechanical ventilation were included. Respiratory system compliance (Crs) decreased from 43.32±13.17 mL/cm H2O to 33.02±9.56 mL/cm H2O (P
Published: 2012

41. Bronchoalveolar lavage for pandemic influenza A (H1N1)v pneumonia in critically ill patients

Author: Ángel Estella
Subjects: medicine.medical_specialty, Critical Illness, Critical Care and Intensive Care Medicine, Bronchoalveolar Lavage, Hypoxemia, Disease Outbreaks, Influenza A Virus, H1N1 Subtype, Nasopharyngeal aspirate, Internal medicine, Intensive care, Influenza, Human, medicine, Humans, medicine.diagnostic_test, business.industry, Reverse Transcriptase Polymerase Chain Reaction, Respiratory disease, Pneumonia, medicine.disease, respiratory tract diseases, Surgery, Intensive Care Units, Bronchoalveolar lavage, Respiratory failure, medicine.symptom, Chest radiograph, business
Abstract: Dear Editor, Microbiological diagnosis of pandemic influenza A (H1N1)v pneumonia is based on rapid and sensitive nucleic acid amplification test of respiratory samples [1], mainly nasopharyngeal aspirate or, alternatively, nasal and pharyngeal swabs. False negatives can be obtained due to errors in collection, inadequate handling or transport, but also because of low viral load in the specimen. Over 4 months, 18 patients with confirmed influenza virus A (H1N1)v infection were admitted to a medical surgical ICU of a community hospital. Of these, 15 patients presented with severe pneumonia. At ICU admission, respiratory specimens were obtained from the upper respiratory tract. The results of reverse transcriptase polymerase chain reaction (RT-PCR) were positive in 12 cases and negative in 3. Due to high clinical suspicion of the disease, the diagnostic study was extended with other samples. Based on the hypothesis that more extensive viral replication exists in the lower respiratory tract, bronchoalveolar lavage (BAL) was considered. Fiberoptic bronchoscopy is a safe procedure in critically ill patients without absolute contraindications, but in cases of severe hypoxemia, it is not recommended. One of the three patients presented hypoxemia despite high PEEP, and in this case the diagnosis was achieved by serology. Two cases are presented here in which BAL was performed due to a high clinical suspicion of influenza A (H1N1)v pneumonia despite negative RT-PCR results from upper respiratory samples. Case 1: Patient with morbid obesity and epilepsy was admitted to the emergency department with fever, dry cough, and myalgia of 5 days of duration, and required ICU admission due to respiratory failure and the presence of bilateral infiltrates on chest radiograph. At admission the patient was intubated for controlled mechanical ventilation. RT-PCR of nasopharyngeal exudate and aspirate performed at ICU admission tested negative for influenza A (H1N1)v. BAL performed 4 days after ICU admission was positive. Case 2: Young smoker patient was admitted to the pneumology ward with fever, diarrhea, nonproductive cough, and progressive dyspnea. During admission the patient developed respiratory failure and was admitted to the ICU. Chest radiograph showed bilateral alveolar infiltrates, and RT-PCR tests of upper respiratory samples for influenza A (H1N1)v performed at admission and 4 days later were negative. On the 5th day after ICU admission, a BAL was performed, obtaining a positive result. The incidence of false negatives in critically ill patients was documented in a subgroup of 21 such patients in Australia and New Zealand [2]. BAL samples were positive in all patients, but upper respiratory tract samples tested positive in only 17 of 21 patients. Rello and colleagues documented a 10% false negative rate for nasopharyngeal swabs [3]. Based on these findings and the presented cases, negative results of RT-PCR of upper respiratory samples can not rule out the diagnosis of pandemic influenza A (H1N1)v pneumonia [4]. We did not report viral load, as in cases of influenza A (H1N1)v with severe pneumonia, the natural history of viral shedding from the respiratory tract is uncertain. Well-conducted studies are needed to confirm the hypothesis that viral load is higher in the lower respiratory tract than in the
Published: 2010

42. Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

Author: Iván D. Benítez, Jordi de Batlle, Gerard Torres, Jessica González, David de Gonzalo-Calvo, Adriano D.S. Targa, Clara Gort-Paniello, Anna Moncusí-Moix, Adrián Ceccato, Laia Fernández-Barat, Ricard Ferrer, Dario Garcia-Gasulla, Rosario Menéndez, Anna Motos, Oscar Peñuelas, Jordi Riera, Jesús F. Bermejo-Martin, Yhivian Peñasco, Pilar Ricart, María Cruz Martin Delgado, Luciano Aguilera, Alejandro Rodríguez, Maria Victoria Boado Varela, Fernando Suarez-Sipmann, Juan Carlos Pozo-Laderas, Jordi Solé-Violan, Maite Nieto, Mariana Andrea Novo, José Barberán, Rosario Amaya Villar, José Garnacho-Montero, Jose Luis García-Garmendia, José M. Gómez, José Ángel Lorente, Aaron Blandino Ortiz, Luis Tamayo Lomas, Esther López-Ramos, Alejandro Úbeda, Mercedes Catalán-González, Angel Sánchez-Miralles, Ignacio Martínez Varela, Ruth Noemí Jorge García, Nieves Franco, Víctor D. Gumucio-Sanguino, Arturo Huerta Garcia, Elena Bustamante-Munguira, Luis Jorge Valdivia, Jesús Caballero, Elena Gallego, Amalia Martínez de la Gándara, Álvaro Castellanos-Ortega, Josep Trenado, Judith Marin-Corral, Guillermo M Albaiceta, Maria del Carmen de la Torre, Ana Loza-Vázquez, Pablo Vidal, Juan Lopez Messa, Jose M. Añón, Cristina Carbajales Pérez, Victor Sagredo, Neus Bofill, Nieves Carbonell, Lorenzo Socias, Carme Barberà, Angel Estella, Manuel Valledor Mendez, Emili Diaz, Ana López Lago, Antoni Torres, and Ferran Barbé
Subjects: COVID-19, Critical Care, Prognosis, Public aspects of medicine, RA1-1270
Abstract: Summary: Background: The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods: Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings: Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p
Published: 2022
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43. Capítulo 160 - Aspectos éticos generales en el entorno del paciente crítico

Author: Garrido, José Julián Arias and García, Ángel Estella
Published: 2017
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44. Capítulo 161 - Aspectos éticos de la atención al enfermo crítico al final de la vida

Author: García, Ángel Estella and Garrido, José Julián Arias
Published: 2017
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45. Capítulo 156 - Participación de la medicina intensiva en la gestión de las emergencias colectivas y catástrofes a nivel hospitalario. Emergencias NBQ

Author: Garrido, José Julián Arias and García, Ángel Estella
Published: 2017
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46. Capítulo 154 - Impacto de la inmigración en la medicina intensiva

Author: García, Ángel Estella and Garrido, José Julián Arias
Published: 2017
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47. Capítulo 150 - Paciente crítico con patología autoinmune

Author: Núñez, María Recuerda and García, Ángel Estella
Published: 2017
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48. Colaboradores

Author: Molina, Ana Abril, Valencia, Daniel Acevedo, Díaz, Fernando Acosta, de Hoyos, Eduardo Aguayo, Alonso, Eduardo Aguilar, Sánchez, Purificación Aguilera, Arboledas, Francisco Javier Alados, Romero, Pedro Alcázar, Pallás, Teresa Aldabó, Marín, Amelia Alonso, Muñoz, Gema Alonso, Salas, María Teresa Alonso, Bueno, Miguel Álvarez, Sáiz, Alejandra Álvarez, Serna, Tania Amat, Villar, Rosario Amaya, González, César Aragón, Sánchez, José Andrés Arboleda, Garrido, José Julián Arias, Verdú, María Dolores Arias, Sánchez, Álvaro Arjona, Marín, María José Arroyo, Gallardo, Marc Ayala, Bravo, Esther Banderas, Pichardo, Rafael Barba, Ansorregui, Sandra Barbadillo, Ruiz, Mercedes Barranco, Chacón, Juana María Barrera, Barrueco-Francioni, Jesús Emilio, Rodríguez, María Dolores Bautista, Alba, Rafael Bellido, Lozano, José Antonio Benítez, Gómez, Alberto Bermejo, Sáez, Isidro Blanco, Saera, María Bodí, de Austria, Rafael Ángel Bohollo, Saris, Alfonso Bonet, Perales, Antonio Bonillo, Marqués, Rafael Bravo, Cabeza, Francisca Cabeza, Rodríguez, Ana Calderón, Bonachera, María Dolores Calvo, Macías, Custodio Calvo, Pulido, Jorge Calvo, Alonso, José Miguel Camacho, Sola, Estefanía Cámara, de la Campa Gestido, Azucena, Guerrero, Jesús Carbajal, Cruz, Dolores Purificación Cárdenas, Pérez, María Luz Carmona, Sánchez, Purificación Carmona, Linde, María José Carpio, Carmona, Francisco José Carrizosa, Hernández, Alejandra Carvajal, Adam, Ángela Casado, Laparra, Eloina Casanoves, Ribas, Patricia Castán, Pérez, José Castaño, Ortega, Álvaro Castellanos, Barranquero, Francisca Gema Cazorla, Sánchez, María José Chaparro, de la Chica Ruiz Ruano, Rafael, Sáez, Violeta Chica, Fernández, Mario Chico, Ríos, Miguel Ángel Chirosa, González, Eva Chocano, Cabrera, Laura Claverias, García, José Cobo, Torres, Elisabeth Coll, Ruiz, Manuel Colmenero, Pino, Tamara Contreras del, Palomo, Yael Corcia, Lorenzana, María Lourdes Cordero, Delgado, Francisco Cota, de la Cruz Moreno, Jesús, Balsera, Emilio Curiel, Ruiz, Domingo Daga, Casado, Nieves Delgado, Castellanos, Miguel Ángel Díaz, Contreras, Remedios Díaz, Monrové, Juan Carlos Díaz, Pernalete, Rosa María Díaz, Torres, Isabel Díaz, García, Pedro Jesús Domínguez, Roldán, José María Domínguez, Jurado, José María Dueñas, García, Ignacio Durbán, Brutus, Reginald Dusseck, León, Melissa Echeverría, Egea-Guerrero, Juan José, Foncea, María Antonia Estecha, García, Ángel Estella, Fernández-Castanys, Esteban Feriche, Carmona, Alberto Fernández, Díez, Inés Fernández, Fernández, Rosario Fernández, Hinojosa, Esteban Fernández, Mondéjar, Enrique Fernández, Ortega, Juan Francisco Fernández, Porcel, Alba Fernández, Zamora, María Dolores Fernández, Higueras, María José Ferrer, López, Rafael Ferrer, Mata, Álvaro Ferrezuelo, Costa, Eva María Fieira, Rosón, Luis Javier Fierro, Lasierra, José Luis Flordelis, Cordero, Juan Manuel Flores, González, Juan Carlos Flores, Fregosi, Andrea, Freire-Aragón, María Dolores, Pérez, Manuel Ángel Frías, de la Fuente Martos, Carmen, López, Juan Luis Galeas, Tuero, Martín Galíndez, Lara, Sonia Gallego, Martín, José Manuel Galván, Calderón, Carmen Gálvez, Alcántara, Ángel García, Alfaro, Claudio García, Bautista, Ernesto García, Bautista, Jesús Alejo García, Cobo, José García, de Lorenzo y Mateos, Abelardo García, Moral, Raimundo García del, Delgado, Manuel García, de Acilu, Marina García García, Martínez, María Victoria García, Matas, Gerardo García, Morales, Juan José García, Paredes, Teresa García, Sánchez, Manuela García, Soler, Patricia García, Rosado, Horacio García-Delgado, Garnacho-Montero, José, Castillo, María Luisa Gascón, Cano, Anselmo Gil, Gómez, Raquel Gil, Pérez, Juan José Gilbert, González, Carmen Gómez, Jiménez, Francisco Javier Gómez, Luque, José María Gómez, Muñoz, Cristina Gómez, Tello, Vicente Gómez, Gómez–Coronado, Vicente Jerez, Rodríguez, Gema Gómiz, de Molina Ortiz, Francisco Javier González, Fenoy, Daniel González, Galilea, Ángel González, Gómez, José Manuel González, Hervás, Catalina González, López, Samuel González, González-Ripoll, Manuel, Brenes, Antonio Gordillo, Romero, Manuel Ángel Gracia, de Mier, Manuel Guerrero, López, Francisco Guerrero, González, Pedro Guijo, de Barbará, Alberto Hernández Abadía, Alonso, Benjamín Hernández, González, Arturo Hernández, Vidaña, Adoración María Hernández, Gutiérrez, Manuel Enrique Herrera, Avilés, Ángel Herruzo, Pérez, Rafael Hinojosa, Suazo, José Antonio Hurtado, de la Rosa, Ignacio Ibarra, Morales, Miriam Ibars, Santiago, Alberto Iglesias, Hernández, José Manuel Infantes, Sarrías, José Luis Iribarren, Rocamora, José Antonio Irles, Franco, Mercedes Jaén, Caballero, Susana Jaraba, Guadarrama, Luis Roberto Jiménez, Moragas, José Manuel Jiménez, Rivera, Juan José Jiménez, Montosa, Carolina Joya, Díaz, Mar Juan, Pujol, Jordi Klamburg, Aguayo, Pedro Lara, Rosales, Ramón Lara, Noval, Santiago Ramón Leal, Gallardo, Miguel Lebrón, Gil, Cristóbal León, López, Rafael León, de la Linde Valverde, Carmen María, Galera, Sagrario Lombardo, García, Isabel López, Granados, Amador López, Martín, Cristina López, Sánchez, José María López, López-Cuervo, Juan Fajardo, Vázquez, Ana Loza, Calderón, Francisco Lucena, Casas, Juan Francisco Machado, Guarasa, Inés Macías, Municio, Alejandro Manrique, Caño, Javier Manso del, Manzano, Francisco Manzano, Marín-Caballos, Antonio Jesús, Monserrat, Fernando Luis Maroto, Gamarra, Pilar Márquez, Delgado, María Cruz Martín, García, José Antonio Martín, López, Javier Ignacio Martín, Rubí, José Carlos Martín, Santaella, Ana Martín, Villén, Luis Martín, Arcos, María Ángeles Martínez, Carmona, Juan Francisco Martínez, Coronel, Juan Francisco Martínez, Escobar, Sergio Martínez, García, Pilar Martínez, López, Pilar Martínez, Padilla, María del Carmen Martínez, Martínez-Caro, Leticia, Enviz, Joan Ramon Masclans, Acedos, Rafael Matesanz, Troncoso, Elena Mellado, de Cos, Paz Merino, Arizmendi, Alfonso Mesejo, Febrer, Jaume Mesquida, Manso, Guillermo Milano, Collado, Zaira Molina, Hurtado, José Ramón Molina, García, Manuel Ignacio Monge, González, Juan Carlos Montejo, Álvarez, José Luis Montero, de Espinosa Candau, Miguel Montero, Valladares, Cristina Montero, Pintado, Rocío Monterroso, Ordóñez, Juan Miguel Mora, Quintero, María Luisa Mora, Martínez, Antonio Morales, Fernández, Eduardo Morán, Cecilia, Gonzalo Moratalla, López, Josefina Moreno, Quintana, José Diego Moreno, Romero, Olga Moreno, Gómez, Ana Mula, Aramburu, Lidia Muñoz, Bono, Javier Muñoz, Caballero, María Ángeles Muñoz, Casares, Cristóbal Muñoz, de Cabo, Carlos Muñoz, de la Casa, Sandra Muñoz, Garach, Manuel Muñoz, Guillén, Noelia María Muñoz, Muñoz, José Luis Muñoz, Sánchez, María Ángeles Muñoz, Sánchez, Sergio Muñoz, Trujillo, Javier Muñoz, Cabezas, Francisco Murillo, Pozo, María Ángeles Murillo, Galdó, Susana Narbona, Navarro, Pedro Navarrete, Sánchez, Inés Navarrete, Guillamón, Laura Navarro, Suay, Ricardo Navarro, Guindo, Pablo Nieto, Vaeza, Nicolás Nin, Ortega, Pilar Nuevo, Hita, Esther Ocete, Jiménez, Victoria Olea, Granados, Gonzalo Olivares, Peña, Lorena Olivencia, Vinuesa, Francisco Jesús Ortega, Zarza, Pedro Ortega, Moreno, Pedro Pardo, Parrilla, Julio Parrilla, Ruiz, Francisco Manuel Parrilla, Rodríguez, Josefa Peinado, Civantos, Demetrio Pérez, de la Cruz, Antonio Pérez, González, Álvaro Pérez, Navero, Juan Luis Pérez, Vacas, Jonathan Pérez, Villares, José Miguel Pérez, Moya, Enrique Pino, Sánchez, Francisca Inmaculada Pino, Guzmán, María Dolores Pola Gallego, Ponce, María Pilar Ponce, López, Manuel Porras, Pantojo, Manuel Francisco Porras, Brea, Ana María Poullet, Aguilera, María Eugenia Poyatos, Laderas, Juan Carlos Pozo, de Paula, Juan Francisco Prieto, Morlán, Araceli Puerto, Valverde, Pablo Pujol, Moreno, Antonio Puppo, García, Juan Guillermo Quesada, Otero, Sebastián Quintero, Galleymore, Paula Ramírez, Puerta, Rosario Ramírez, Cuadra, José Ángel Ramos, Fernández, Pedro Ramos, Núñez, María Recuerda, Orts, María Redondo, Artacho, María del Carmen Reina, Toral, Antonio Reina, Parras, María del Pilar Reyes, Conesa, Assumpta Ricart, Ferrari, María Dolores Rincón, García, Rocío Risquete, Espinar, Francisco Rivera, Arista, Juan Carlos Robles, Marcos, Manuel Robles, Sánchez, Juan Carlos Robles, Alonso, Rosa María Rodríguez, Castaño, Rocío Rodríguez, Delgado, Marina Rodríguez, Elvira, Manuel Rodríguez, Espejo, Rosa Rodríguez, Gómez, Jorge Rodríguez, Higueras, Isabel María Rodríguez, Medina, Juan Antonio Rodríguez, Mejías, Candela Rodríguez, Oviedo, Alejandro Rodríguez, Yáñez, Juan Carlos Rodríguez, Amezcua, María Rojas, Cutillas, Ana María Román, Faro, Xan Romaní, Barroso, Isidro Romero, Camacho, Vanessa Rosa, Quiñones, Fernando Rubio, Molina, Carolina Rueda, de Azúa-López, Zaida Ruiz, Fresno, Luis Ruiz del, Ferrón, Francisco Ruiz, Giménez, Jesús Ruiz, Ruiz-Santana, Sergio, de la Fuente, Ignacio Sáez, Coronas, Joaquín Salas, Ramírez, Cristina Salazar, González, Francisco José Saldaña, Díaz, Lourdes Salido, Fernández, María José Salmerón, Cejas, José María San Pedro, González, Yolanda Sánchez, Ortega, Daniel Sánchez, Ramírez, Catalina Sánchez, Rodríguez, Ángel Custodio Sánchez, Román, José Antonio Sánchez, Segovia, José Sánchez, Silos, Francisco Sánchez, Tatay, Victoria Sánchez, Gutiérrez, Carmen Santiago, González, Fernando Segura, Pérez, Gemma Seller, Vic, Joaquim Serra, Lázaro, Ainhoa Serrano, Simón, José Manuel Serrano, Martínez, María Sevilla, Camerino, Rafael Sierra, Fernández, María Soledad Silvente, Corriente, Macarena Taguas-Casaño, de Reynoso, Pablo Torrabadella, de la Torre Prados, María Victoria, Alcalá, José Tomás Torres, Delgado, Eva Torres, Ruiz, Juan Miguel Torres, Torres, Antonio Torres, Garzón, Antonia Tristancho, Fernández, Carmen Trujillano, Spasova, Tsvetelina Tsvetanova, Iglesias, Alejandro Úbeda, Santamaría, Esther Ulloa, Sánchez, Francisco Valenzuela, Báez, Antonio Vallejo, Barrios, José Manuel Vaquero, Vargas, Francisco Javier Vasserot, Florido, Antonio Vázquez, Colmenero, Rosa María Vela, Gimena, Francisco Velasco, Jabalquinto, María José Velasco, Muñoz, Emilia Villegas, Mateos, Luis Yaguez, Castilla, Cristina Yun, Ossorio, María Eugenia Yuste, Periñán, María José Zarco, and Ganfornina, José Benito Zaya
Published: 2017
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49. Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts

Author: Yasser Sakr, Bruno François, Jordi Solé-Violan, Katarzyna Kotfis, Ulrich Jaschinski, Angel Estella, Marc Leone, Stephan M. Jakob, Xavier Wittebole, Luis E. Fontes, Miguel de Melo Gurgel, Thais Midega, Jean-Louis Vincent, V. Marco Ranieri, and the SOAP and ICON Investigators
Subjects: Respiratory failure, ARDS, Airway pressures, Driving pressure, Tidal volume, Mechanical ventilation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies.
Published: 2021
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50. 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

Author: Alejandro Rodríguez, Manuel Ruiz-Botella, Ignacio Martín-Loeches, María Jimenez Herrera, Jordi Solé-Violan, Josep Gómez, María Bodí, Sandra Trefler, Elisabeth Papiol, Emili Díaz, Borja Suberviola, Montserrat Vallverdu, Eric Mayor-Vázquez, Antonio Albaya Moreno, Alfonso Canabal Berlanga, Miguel Sánchez, María del Valle Ortíz, Juan Carlos Ballesteros, Lorena Martín Iglesias, Judith Marín-Corral, Esther López Ramos, Virginia Hidalgo Valverde, Loreto Vidaur Vidaur Tello, Susana Sancho Chinesta, Francisco Javier Gonzáles de Molina, Sandra Herrero García, Carmen Carolina Sena Pérez, Juan Carlos Pozo Laderas, Raquel Rodríguez García, Angel Estella, Ricard Ferrer, and on behalf of COVID-19 SEMICYUC Working Group
Subjects: Severe SARS-CoV-2 infection, Phenotypes, Risk factors, Prognosis, Machine learning, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: 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), 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.
Published: 2021
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