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5. The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Author

Torres Martí, Antoni, Motos, Anna, Riera, Jordi, Fernández Barat, Laia, Ceccato, Adrián, Pérez Arnal, Raquel, García Gasulla, Dario, Peñuelas, Oscar, Lorente, José Angel, Rodriguez Oviedo, Alejandro, Gonzalo Calvo, David de, Casacuberta Barberà, Núria, Rubio, Jorge, Bodi Saera, María, Suares Sipmann, Fernando, Bofill, Neus, Bouza Vieiro, María Teresa, Bueno, Leticia, Pérez Bastida, Leire, Bustamante-munguira, Juan, López Lago, Ana, Yang, Minlan, Muñoz Bermúdez, Rosana, Cachafeiro, Lucia, Martín Vicente, Paula, Mañez Mendiluce, Rafael, Campi Hermoso, David, Castellà, Manuel, Serra, Lidia, Bustamante Munguira, Elena, Castellví, Andrea, Díaz, Yolanda, Figueras, Albert, Salazar Degracia, Ana, Gordo, Federico, Rivas Vilas, María Digna, Dólera Moreno, Cristina, Nicolás, José María, Rubio López, Alberto, Dot, Irene, García Sagastume, Amaia, Servià, Lluís, García, Beatriz, Urrelo Cerrón, Luis, Enríquez Giraudo, Pedro, Barral Segade, Patricia, Esmorís Arijón, Inés, Farre Monjo, Teresa, Pérez Planelles, Gloria, Segura Pensado, Marta, Fernández, Javier, Ruiz Miralles, Miriam, Gabarrús, Albert, Nogue Bou, Ramon, Prados, Javier, Ferrando, Carlos, Pérez Rubio, Eva, Vilà Vilardel, Clara, Ossa, Sergio, García Prieto, Emilio, Herraiz, Alba, Amaya Villar, Rosario, Bermejo Martín, Jesús F., Herrán Monge, Rubén, Ryan Murúa, Pablo, Val, Estela, Ibarz, Mercedes, Mantellini, Cecilia L., Yang, Hua, Macias Guerrero, Desire, Iglesias, Silvia, Janer, Maria Teresa, Jiménez, Gabriel, Serra Fortuny, Mireia, Vidal Cortes, Pablo, Juan Díaz, Mar, Valdivia Ruiz, Luis, Novo, Mariana Andrea, Saborido Paz, Eva, Barberán, José, Serrano Lázaro, Ainhoa, Santacoloma, Bitor, Mamolar Herrera, Nuria, Martínez Juan, Maria Dolores, Salvador Adell, Inmaculada, Pozo Laderas, Juan Carlos, Masa Jimenez, Juan Fernando, Vallverdú, Montserrat, Masclans, Joan Ramon, Moreno Cano, Sara Guadalupe, Martínez de la Gándara, Amalia, Piñol-tena, Àngels, Maseda, Emilio, Menor Fernández, Eva María, Vilanova, Judit, Huerta, Arturo, Miralbés, Mar, Parera Pous, Anna, Climent, Cristina, Socias, Lorenzo, Ocón, Marta, Aldecoa, César, Monclou, Josman, Gracia, Maria Pilar, Montejo González, Juan Carlos, Montserrat, Neus, Añón, José M., Ricart, Pilar, Mora Aznar, María, Van Der Hofstadt Martin-Montalvo, Maria, Jorge García, Ruth Noemí, Moral Parras, Pedro, Villada Warrington, Tatiana, Carbajales, Cristina, Morales, Dulce, Barberà, Carme, Mariño, Ana Balan, Almansa Mora, Raquel, Ortega, Ana, Pujol, Andrés, Ángel, José, Soliva, Laura, Ramon Coll, Núria, Renedo Sanchez-Giron, Gloria, Loza Vázquez, Ana, Alegre, Cynthia, Roche Campo, Ferran, Sariñena, Maria Teresa, Barbeta, Enric, Sanchez, Miguel, Rodriguez, Laura, Martínez Fernández, Carmen Eulalia, Rodríguez de Castro, Felipe, Rodríguez, Silvia, Sánchez Miralles, Angel, Báez Pravia, Orville, Rodríguez Ruiz, Covadonga, Álvarez, Sergio, Cicuendez Ávila, Ramon, Marin Corral, Judith, Blandino Ortiz, Aaron, Sancho Chinesta, Susana, Cantón-bulnes, Maria Luisa, Albaiceta, Guillermo M., Sánchez, Ana, Tognetti, Daniel, Codina, Jordi, Clar, Luisa, Tormos, Adrián, Álvarez Ruiz, Antonjo, Torres, Mateu, Vengoechea, Javier, Carvalho, Sula, Vara Adrio, Sabela, Caballero, Jesús, Trefler, Sandra, Trujillano, Javier, Balsera, Begoña, Cano, Iosune, Úbeda, Alejandro, Menéndez, Rosario, Andrea, Rut, Martin, María Cruz, Barbena, Laura, Badia, Joan Ramon, Vázquez, Nil, Zapatero, Ana, Gómez Casal, Vanesa, Gascón Castillo, Maria Luisa, CIBERESUCICOVID Project (COV20/00110, ISCIII), Carbonell, Nieves, Gómez, José M., García, Felipe, Solé Violan, Jordi, Catalán González, Mercedes, Galbán, Cristóbal, Cardina Fernández, Pablo, Forcadell Ferreres, Eva, Gumucio Sanguino, Víctor D., Peñasco, Yhivian, González, Jessica, Martínez Varela, Ignacio, Kiarostami, Karsa, Torre, Maria del Carmen de la, Speziale, Carla, Díaz Santos, Emili, Estella, Ángel, Conde, Pamela, Gomà, Gemma, Gallego, Elena, Forcelledo Espina, Lorena, García Garmendia, José Luis, Carrión García, Laura, Busto Martínez, Cecilia del, Garnacho Montero, José, Contreras, Sofía, Marcos, Pilar, Castro, Pedro, López Messa, Juan, Tamayo Lomas, Luis, Bardi, Tommaso, Trenado, José, Barbé, Ferran, Franco, Nieves, Lazo Álvarez, Juan I., Adell Serrano, Berta, Badía, Mariona, Martínez, María, Arrieta, Marta, Agrifoglio, Alexander, Aguilar Cabello, María, Aguilera, Luciano, Gómez, Silvia, Marco Naya, Gregorio, Alcaraz Serrano, Victoria, León, Miguel, Pagliarani, Pablo, Furro, Àngels, Pablo Sánchez, Raul de, Gómez Gonzalez, Carmen, García Redruello, Carlos, Ayestarán, J. Ignacio, Barroso, Marta, Pérez, Purificación, Parrilla, Francisco, Berezo García, José Ángel, López Gavín, Alexandre, Bigas, Judit, Campos Fernández, Sandra, Nogueras Salinas, Rafaela, Mendoza, Diego de, Blancas, Rafael, Blasco Cortés, María Luisa, Marmol Peis, Enrique, Mosquera Rodríguez, David, Boado, María, Cillóniz, Catia, Ferrer Roca, Ricard, Pestaña Laguna, David, Institut Català de la Salut, [Torres A] Centro de Investigación Biomedica En Red – Enfermedades Respiratorias (CIBERES), Barcelona, Spain. Institut d’Investigacions August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain. Servei de Pneumologia i Al·lèrgia Respiratòria, Hospital Clínic, 08036 Barcelona, Spain. [Motos A, Fernández-Barat L] Centro de Investigación Biomedica En Red – Enfermedades Respiratorias (CIBERES), Barcelona, Spain. Institut d’Investigacions August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain. [Riera J, Ferrer R] Servei de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. [Ceccato A] Centro de Investigación Biomedica En Red – Enfermedades Respiratorias (CIBERES), Barcelona, Spain. [Pérez-Arnal R] Barcelona Supercomputing Center (BSC), Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Barcelona Supercomputing Center, and Universitat Politècnica de Catalunya. Departament de Ciències de la Computació

Subjects
Male, ARDS, medicine.medical_treatment, Enfermedad transmisible, terapéutica::terapéutica::tratamiento de urgencia::resucitación::terapéutica::respiración artificial [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Respiració artificial, Critical Care and Intensive Care Medicine, COVID-19 (Malaltia), Cohort Studies, chemistry.chemical_compound, COVID-19 (Disease), Mechanical ventilation, Medicine, Intubation, Enfermedades pulmonares, Hospital Mortality, Prospective Studies, Prospective cohort study, Aged, 80 and over, Respiratory Distress Syndrome, Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, Prognosis, enfermedades respiratorias::enfermedades pulmonares::síndrome de dificultad respiratoria del adulto [ENFERMEDADES], Intensive Care Units, Artificial respiration, Anesthesia, Female, Cohort study, Informàtica::Aplicacions de la informàtica::Bioinformàtica [Àrees temàtiques de la UPC], Critical Care, Pronòstic mèdic, Prognosi, Infecciones por coronavirus, Ventilation/perfusion ratio, Respiratory Tract Diseases::Lung Diseases::Respiratory Distress Syndrome, Adult [DISEASES], Therapeutics::Therapeutics::Emergency Treatment::Resuscitation::Therapeutics::Respiration, Artificial [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Ventilation-Perfusion Ratio, Humans, COVID-19 (Malaltia) - Espanya, Mortality, Diagnosis::Prognosis [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], diagnóstico::pronóstico [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Aged, Retrospective Studies, Creatinine, RC86-88.9, business.industry, SARS-CoV-2, Research, Correction, Ventilatory ratio, COVID-19, Retrospective cohort study, Aparato respiratorio, medicine.disease, Respiration, Artificial, Coronavirus, Meta-analysis, chemistry, Spain, Pulmonary Ventilation, business
Abstract

Following publication of the original article at https://doi.org/10.1186/s13054-021-03727-x the authors identified an error in the Funding section that has been corrected (https://doi.org/10.1186/s13054-021-03849-2), 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

6. Sedoanalgesia para procedimientos de desbridamiento enzimático en pacientes con quemaduras en cara y cuello

Author

Galeiras-Vázquez, Rita, Esmorís-Arijón, Inés, Mourelo-Fariña, Mónica, Pértega-Díaz, Sonia, and López-Suso, Eugenia

Subjects
Facial burns, Quemaduras cara, Desbridamiento enzimático, Enzymatic debridement, Analgesia, Quemaduras, Quemaduras cuello, Burns, Neck burns, Sedoanalgesia
Abstract

[Resumen] Introducción y Objetivo. La cantidad de procedimientos mínimamente invasivos realizados fuera del quirófano ha crecido en las últimas décadas. La sedación, la analgesia o ambas, pueden ser nece- sarias para muchos de estos procedimientos de intervención o diagnóstico. Sin embargo, y hasta donde hemos podido conocer, no hay experiencia en el uso de sedoanalgesia para procedimientos (SAP) en pacientes con quemaduras faciales que necesitan desbridamiento enzimático El objetivo de este trabajo es evaluar la eficacia y la seguridad de la SAP para el control del dolor en pacientes con quemaduras faciales sometidos a tratamiento con desbridamiento enzimático. Material y Método. Describimos 16 casos de pacientes adultos con quemaduras en cara y cuello que necesitaron desbridamiento enzimático. Cuatro pacientes sin ventilación mecánica fueron tratados con SAP. Resultados. La SAP generalmente requiere combinación de múltiples agentes para alcanzar los efectos deseados de analgesia más ansiolisis. El procedimiento fue bien tolerado y los pacientes no sufrieron complicaciones. Conclusiones. Presentamos la SAP como opción para el desbridamiento enzimático de quemaduras faciales en pacientes adultos sin ventilación mecánica. [Abstract] Background and Objective. The number of minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. However, to our knowledge, there is no experience on the use of procedural sedation analgesia (PSA) in patients with facial burns who need enzymatic debridement. The aim of this study is to assess the effectiveness and safety of PSA for pain relief in patients with facial burns undergoing enzymatic debridement. Methods. We describe 16 cases of adult patients with burns on the face and neck who needed enzymatic debridement. Four patients without mechanical ventilation were treated with PSA. The procedure was well tolerated and the patients did not suffer complications Results. PSA usually requires combinations of multiple agents to reach desired effects of analgesia plus anxiolysis. The procedure was well tolerated and the patients did not suffer complications. Conclusions. PSA can be an option for enzymatic debridement of facial burns in adults patients without mechanical ventilation.

Published
2018

8. Sedoanalgesia para procedimientos de desbridamiento enzimático en pacientes con quemaduras en cara y cuello.

Author

Vázquez, Rita Galeiras, ESMORÍS-ARIJÓN, Inés, MORUELO-FARIÑA, Mónica, PÉRTEGA-DÍAZ, Sonia, and LÓPEZ-SUSO, Eugenia

Abstract

Background and Objective. The number of minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. However, to our knowledge, there is no experience on the use of procedural sedation analgesia (PSA) in patients with facial burns who need enzymatic debridement. The aim of this study is to assess the effectiveness and safety of PSA for pain relief in patients with facial burns undergoing enzymatic debridement. Methods. We describe 16 cases of adult patients with burns on the face and neck who needed enzymatic debridement. Four patients without mechanical ventilation were treated with PSA. The procedure was well tolerated and the patients did not suffer complications Results. PSA usually requires combinations of multiple agents to reach desired effects of analgesia plus anxiolysis. The procedure was well tolerated and the patients did not suffer complications. Conclusions. PSA can be an option for enzymatic debridement of facial burns in adults patients without mechanical ventilation. [ABSTRACT FROM AUTHOR]

Published
2018
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