Background: COVID-19, an infectious disease caused by SARS-CoV-2 virus, can provoke a vast range ... more Background: COVID-19, an infectious disease caused by SARS-CoV-2 virus, can provoke a vast range of clinical manifestations, ranging from asymptomatic to potentially life-threatening complications. At the beginning, convalescent plasma therapy has been proposed as an effective alternative to treat severe cases. The aim of this study was to follow over time a two-time renal transplanted COVID-19 severe patient treated with convalescent plasma from an immunological and virologic perspective.Case presentation: A 42-year-old female patient, two-time kidney transplanted was hospitalized with COVID-19. Due to worsening of respiratory symptoms, she was admitted to the intensive care unit where she received two doses of convalescent plasma. Conclusion: We analyzed the dynamics of viral load in nasopharyngeal swab, saliva and tracheal aspirate samples, before and after convalescent plasma transfusion. Pro-inflammatory cytokines and antibody titers were also measured in serum samples. A post-...
Background: To determine the frequency of, and factors associated with, death in hospital followi... more Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward.Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations.Results: 2,186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in ...
La ventilacion no invasiva (VNI) se utiliza con buenos resultados en la insuficiencia respiratori... more La ventilacion no invasiva (VNI) se utiliza con buenos resultados en la insuficiencia respiratoria con los objetivos de evitar la intubacion traqueal y la ventilacion invasiva. Sus indicaciones se han extendido a nuevas situaciones clinicas aunque en ocasiones la evidencia no permite hacer recomendaciones definitivas. Objetivos: describir los usos y resultados clinicos de la VNI. Metodologia: estudio clinico, prospectivo y observacional en una unidad de medicina intensiva (UMI) durante un ano. Resultados: la VNI se utilizo en 141/771 casos, representando el 18,3% de los egresos en el periodo de estudio. En 11,7% se aplico como tratamiento inicial (VNI-Inicial), mientras que en 6% se utilizo luego de un periodo de ventilacion invasiva (VNI-Pos VI). En este ultimo grupo se utilizo en diferentes situaciones: a) como puente para el destete de ventilacion invasiva; b) para prevenir la insuficiencia respiratoria posextubacion, o c) para el tratamiento de la insuficiencia respiratoria p...
Objetivo: conocer las caracteristicas epidemiologicas de pacientes que ingresan por sepsis severa... more Objetivo: conocer las caracteristicas epidemiologicas de pacientes que ingresan por sepsis severa (SS) y shock septico (ShS); valorar la implementacion de recomendaciones de la campana Sobrevivir a las Sepsis (CSS) y determinar variables asociadas con mal pronostico vital. Diseno: estudio prospectivo, observacional, cohorte unica, multicentrico, durante un ano (setiembre 2011 - agosto 2012). Ambito: cinco centros de Montevideo, del subsector publico y privado con cobertura de 800.000 habitantes. Pacientes y metodos: 153 pacientes que ingresaron con diagnostico de SS y ShS a las unidades de cuidados intensivos (UCI) de forma consecutiva. Variables de interes principales: aquellas relacionadas con caracteristicas del paciente y episodio de sepsis, medidas diagnosticas y terapeuticas segun la CSS en las primeras 48 horas, y pronosticas en UCI, hospital y a los seis meses. Resultados: se incluyeron 153 pacientes, la mediana de edad fue 68 anos, la de Acute Physiology and Chronic Heal...
blo Bou cha court §, Ja vier Hur ta do || RESUMEN La vía fi nal co mún de los efec tos de la cir ... more blo Bou cha court §, Ja vier Hur ta do || RESUMEN La vía fi nal co mún de los efec tos de la cir cu la ción ex tra cor pó rea es la hi po per fu sión pe ri fé ri ca, que se va lo ra in di rec ta men te a tra vés de la uti li za ción de O 2 en la pe ri fe ria. El Ortho go nal Po la ri za tion Spec tral Ima ging per mi te vi sua li zar di rec ta men te lo que ocu rre en la mi cro cir cu la ción. El ob je ti vo fue eva luar las al te ra cio nes de la mi cro cir cu la ción en nue ve pa cien tes so me ti dos a ci ru gía car día ca con cir cu la ción ex tra cor pó rea y su co rre la ción con los ni ve les de lac ta to plas má ti co. Como ob je ti vo se cun da rio: de sa rro llar una nue va téc ni ca no in va si va de mo ni to reo de la mi cro cir cu la ción en pa cien tes qui rúr gi cos. Se ob tu vie ron imá ge nes de la mi cro cir cu la ción: pre vio, du ran te y lue go de la cir cu la ción ex tra cor pó rea, mi dien do ta ma ño y flu jo a este ni vel y su co rre la ción con las me di das de lac ta to plas má ti co. Se evi den ció un au men to en el ín di ce de flu jo mi cro vas cu lar du ran te la cir cu la ción ex tra cor pó rea para los va sos me dia nos y gran des (p≤0,05). La he te ro ge nei dad de flu jo pre sen tó un au men to es ta dís ti ca men te sig ni fi ca ti vo du ran te la mis ma para los va sos pe que ños, y lue go de ésta para los gran des. La ten den cia ob ser va da fue que a ma yor flu jo mi cro vas cu lar los va lo res pico y post cir cu la ción ex tra cor pó rea de lac ta to plas má ti co fue ron ma yo res, aun que esto no tuvo sig ni fi ca ción es ta dís ti ca. Los re sul ta dos pre li mi na res mues tran un pa trón de al te ra cio nes de la mi cro cir cu la ción dado por un au men to y de la he te ro ge nei dad de flu jo. Es ne ce sa rio un nú me ro ma yor de pa cien tes para con fir mar o no la ten den cia a una co rre la ción con los pa rá me tros de la uti li za ción pe ri fé ri ca de O 2. PALABRAS CLAVE: mi cro cir cu la ción, Ortho go nal Spec tral Ima ging, cir cu la ción ex tra cor pó rea , ci ru gía car día ca SUMMARY Pe rip he ral hypo per fu sion is the fi nal com mon path way for ef fects of ex tra cor po real cir cu la tion, in di rectly as ses sed through pe rip he ral oxy gen uti li za tion. The Ortho go nal Po la ri za tion Spec tral Ima ging allows di rect vi sua li za tion of what hap pens in mi cro cir cu la tion. The pur po se of this study was to eva lua te mi cro cir cu la tion chan ges in nine pa tients un der going car diac sur gery with ex tra cor po real cir cu la tion and its co rre la tion with plas ma lac ta te le vels. As a se con dary ob jec ti ve: to de ve lop a noninvasive met hod for mo ni to ring mi cro cir cu la tion in sur gi cal pa tients. Ima ges of mi cro cir cu la tion were ob tai ned be fo re, du ring and af ter ex tra cor po real cir cu la tion, mea su ring size and flow at this le vel and its co rre la tion with plas ma lac ta te con cen tra tion ra tes. Du ring ex tra cor po real cir cu la tion the re was a sig ni fi cant in crea se in mi cro vas cu lar flow in dex, for me dium and lar ge si zed blood ves sels (p≤0.05). Flow he te ro ge neity sho wed a sta tis ti cally sig ni fi cant in crea se du ring ex tra cor po real cir cu la tion for small ves sels, and af ter per for med, for lar ger si zed. The re was a trend sho wing that the hig her the mi cro vas cu lar flow in dex, the hig her the peak ra tes and post-extracorporeal cir cu la tion plas ma lac ta te con cen tra tions, though with no sta tis ti cal sig ni fi can ce. Pre li mi nary re sults pre sen ted a pat tern of mi cro cir cu la tion al te ra tions cau sed by in crea sed mi cro vas cu lar flow in dex and flow he te ro ge neity. Furt her stu dies with lar ger num ber of pa tients is re qui red to con firm or not co rre la tion trends with pa ra me ters in pe rip he ral oxi gen uti li za tion. KEYWORDS: mi cro cir cu la tion, Ortho go nal Po la ri za tion Spec tral Ima gin, ex tra cor po real cir cu la tion, car diac sur gery 4 |
Uruguay controlled the viral dissemination during the first nine months of the SARS-CoV-2 pandemi... more Uruguay controlled the viral dissemination during the first nine months of the SARS-CoV-2 pandemic. Unfortunately, towards the end of 2020, the number of daily new cases exponentially increased. Herein, we analyzed the country-wide genetic diversity of SARS-CoV-2 between November 2020 and April 2021. We identified that the most prevalent viral variant during the first epidemic wave in Uruguay (December 2020–February 2021) was a B.1.1.28 sublineage carrying Spike mutations Q675H + Q677H, now designated as P.6, followed by lineages P.2 and P.7. P.6 probably arose around November 2020, in Montevideo, Uruguay’s capital department, and rapidly spread to other departments, with evidence of further local transmission clusters; it also spread sporadically to the USA and Spain. The more efficient dissemination of lineage P.6 with respect to P.2 and P.7 and the presence of mutations (Q675H and Q677H) in the proximity of the key cleavage site at the S1/S2 boundary suggest that P.6 may be more ...
Although oxygen (O2) is essential for aerobic life, it can also be an important source of cellula... more Although oxygen (O2) is essential for aerobic life, it can also be an important source of cellular damage. Supra-physiological levels of O2 determine toxicity due to exacerbated reactive oxygen species (ROS) production, impairing the homeostatic balance of several cellular processes. Furthermore, injured cells activate inflammation cascades, amplifying the tissue damage. The lung is the first (but not the only) organ affected by this condition. Critically ill patients are often exposed to several insults, such as mechanical ventilation, infections, hypo-perfusion, systemic inflammation, and drug toxicity. In this scenario, it is not easy to dissect the effect of oxygen toxicity. Translational investigations with animal models are essential to explore injuring stimuli in controlled experimental conditions, and are milestones in understanding pathological mechanisms and developing therapeutic strategies. Animal models can resemble what happens in critical care or anesthesia patients u...
Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patien... more Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 2...
IMPORTANCE Abnormal peripheral perfusion after septic shock resuscitation has been associated wit... more IMPORTANCE Abnormal peripheral perfusion after septic shock resuscitation has been associated with organ dysfunction and mortality. The potential role of the clinical assessment of peripheral perfusion as a target during resuscitation in early septic shock has not been established. OBJECTIVE To determine if a peripheral perfusion-targeted resuscitation during early septic shock in adults is more effective than a lactate level-targeted resuscitation for reducing mortality. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized trial conducted at 28 intensive care units in 5 countries. Four-hundred twenty-four patients with septic shock were included between March 2017 and March 2018. The last date of follow-up was June 12, 2018. INTERVENTIONS Patients were randomized to a step-by-step resuscitation protocol aimed at either normalizing capillary refill time (n = 212) or normalizing or decreasing lactate levels at rates greater than 20% per 2 hours (n = 212), during an 8-hour intervention period. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality at 28 days. Secondary outcomes were organ dysfunction at 72 hours after randomization, as assessed by Sequential Organ Failure Assessment (SOFA) score (range, 0 [best] to 24 [worst]); death within 90 days; mechanical ventilation-, renal replacement therapy-, and vasopressor-free days within 28 days; intensive care unit and hospital length of stay. RESULTS Among 424 patients randomized (mean age, 63 years; 226 [53%] women), 416 (98%) completed the trial. By day 28, 74 patients (34.9%) in the peripheral perfusion group and 92 patients (43.4%) in the lactate group had died (hazard ratio, 0.75 [95% CI, 0.55 to 1.02]; P = .06; risk difference, −8.5% [95% CI, −18.2% to 1.2%]). Peripheral perfusion-targeted resuscitation was associated with less organ dysfunction at 72 hours (mean SOFA score, 5.6 [SD, 4.3] vs 6.6 [SD, 4.7]; mean difference, −1.00 [95% CI, −1.97 to −0.02]; P = .045). There were no significant differences in the other 6 secondary outcomes. No protocol-related serious adverse reactions were confirmed. CONCLUSIONS AND RELEVANCE Among patients with septic shock, a resuscitation strategy targeting normalization of capillary refill time, compared with a strategy targeting serum lactate levels, did not reduce all-cause 28-day mortality.
Intensive care medicine is a relatively young discipline that has rapidly grown into a full-fledg... more Intensive care medicine is a relatively young discipline that has rapidly grown into a full-fledged medical subspecialty. Intensivists are responsible for managing an ever-increasing number of patients with complex, life-threatening diseases. Several factors may influence their performance, including age, training, experience, workload, and socioeconomic context. The aim of this study was to examine individual- and work-related aspects of the Latin American intensivist workforce, mainly with academic appointments, which might influence the quality of care provided. In consequence, we conducted a cross-sectional study of intensivists at public and private academic and nonacademic Latin American intensive care units (ICUs) through a web-based electronic survey submitted by email. Questions about personal aspects, work-related topics, and general clinical workflow were incorporated. Our study comprised 735 survey respondents (53% return rate) with the following country-specific breakdo...
Little information is available about the geo-economic variations in demographics, management, an... more Little information is available about the geo-economic variations in demographics, management, and outcomes of patients with acute respiratory distress syndrome (ARDS). We aimed to characterise the effect of these geo-economic variations in patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE). LUNG SAFE was done during 4 consecutive weeks in winter, 2014, in a convenience sample of 459 intensive-care units in 50 countries across six continents. Inclusion criteria were admission to a participating intensive-care unit (including transfers) within the enrolment window and receipt of invasive or non-invasive ventilation. One of the trial's secondary aims was to characterise variations in the demographics, management, and outcome of patients with ARDS. We used the 2016 World Bank countries classification to define three major geo-economic groupings, namely European high-income countries (Europe-High), high-...
Acute kidney injury (AKI) is a frequent complication in patients under mechanical ventilation (MV... more Acute kidney injury (AKI) is a frequent complication in patients under mechanical ventilation (MV). We aimed to assess the risk factors for AKI with particular emphasis on those potentially preventable. Retrospective analysis of a large, multinational database of MV patients with >24 hours of MV and normal renal function at admission. AKI was defined according to creatinine-based KDIGO criteria. Risk factors were analyzed according to the time point at which AKI occurred: early (≤48 hours after ICU admission, AKIE) and late (day 3 to day 7 of ICU stay, AKIL). A conditional logistic regression model was used to identify variables independently associated with AKI. 3206 patients were included. Seven-hundred patients had AKI (22%), the majority of them AKIE (547/704). The risk factor profile was highly dependent upon the timing of AKI onset. In AKIE risk factors were older age; SAPS II score; postoperative and cardiac arrest as the reasons for MV; worse cardiovascular SOFA, pH, seru...
To analyze the relationship between hypercapnia developing within the first 48 h after the start ... more To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality. We included 1899 patients with ARDS in this study. The relationship between maximum PaCO2 in the first 48 h and mortality suggests higher mortality at or above PaCO2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO2 ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expira...
In neurologically critically ill patients with mechanical ventilation (MV), the development of ac... more In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure with the development of ARDS in a population of patients with brain injury. Materials and methods: We performed a secondary analysis of a prospective, observational study on mechanical ventilation. Results: We included 986 patients mechanically ventilated due to an acute brain injury (hemorrhagic stroke, ischemic stroke or brain trauma). Incidence of ARDS in this cohort was 3%. Multivariate analysis suggested that driving pressure could be associated with the development of ARDS (odds ratio for unit increment of driving
Take-home message: The simultaneous administration of sedative and analgesic drugs in patients wi... more Take-home message: The simultaneous administration of sedative and analgesic drugs in patients with acute respiratory failure managed with noninvasive positive pressure ventilation may be associated with higher rate of failure.
; 13 for the Ventila group ABSTRACT Background There are limited data on the impact of body mass ... more ; 13 for the Ventila group ABSTRACT Background There are limited data on the impact of body mass index on outcomes in mechanically ventilated patients. Methods Secondary analysis of a cohort including 4698 patients mechanically ventilated. Patients were screened daily for management of mechanical ventilation, complications (acute respiratory distress syndrome, sepsis, ventilator associated pneumonia, barotrauma), organ failure (cardiovascular, respiratory, renal, hepatic, haematological) and mortality in the intensive care unit. To estimate the impact of body mass index on acute respiratory distress syndrome and mortality, the authors constructed models using generalised estimating equations (GEE). Results Patients were evaluated based on their body mass index: 184 patients (3.7%) were underweight, 1995 patients (40%) normal weight, 1781 patients (35.8%) overweight, 792 patients (15.9%) obese and 216 patients (4.3%) severely obese. Severely obese patients were more likely to receive low tidal volume based on actual body weight but high volumes based on predicted body weight. In obese patients, the authors observed a higher incidence of acute respiratory distress syndrome and acute renal failure. After adjustment, the body mass index was significantly associated with the development of acute respiratory distress syndrome: compared with normal weight; OR 1.69 (95% CI 1.07 to 2.69) for obese and OR 2.38 (95% CI 1.15 to 4.89) for severely obese. There were no differences in outcomes (duration of mechanical ventilation, length of stay and mortality in intensive care unit and hospital) based on body mass index categories. Conclusions In this cohort, obese patients were more likely to have significant complications but there were no associations with increased mortality.
Purpose: To compare characteristics and clinical outcomes of patients receiving airway pressure r... more Purpose: To compare characteristics and clinical outcomes of patients receiving airway pressure release ventilation (APRV) or biphasic positive airway pressure (BIPAP) to assist-control ventilation (A/C) as their primary mode of ventilatory support. The objective was to estimate if patients ventilated with APRV/BIPAP have a lower mortality. Methods: Secondary analysis of an observational study in 349 intensive care units from 23 countries. A total of 234 patients were included who were ventilated only with APRV/BI-PAP and 1,228 patients who were ventilated only with A/C. A casematched analysis according to a propensity score was used to make comparisons between groups. Results: In logistic regression analysis, the most important factor associated with the use of APRV/BI-PAP was the country (196 of 234 patients were from German units). Patients with coma or congestive heart failure as the reason to start mechanical ventilation, pH \7.15 prior to mechanical ventilation, and patients who developed respiratory failure (SOFA score [2) after intubation with or without criteria of acute respiratory distress syndrome were less likely to be ventilated with APRV/BIPAP. In the case-matched
Management and outcome of mechanically ventilated neurologic patients*
Critical Care Medicine, 2011
To describe and compare characteristics, ventilatory practices, and associated outcomes among mec... more To describe and compare characteristics, ventilatory practices, and associated outcomes among mechanically ventilated patients with different types of brain injury and between neurologic and nonneurologic patients. Secondary analysis of a prospective, observational, and multicenter study on mechanical ventilation. Three hundred forty-nine intensive care units from 23 countries. We included 552 mechanically ventilated neurologic patients (362 patients with stroke and 190 patients with brain trauma). For comparison we used a control group of 4,030 mixed patients who were ventilated for nonneurologic reasons. None. We collected demographics, ventilatory settings, organ failures, and complications arising during ventilation and outcomes. Multivariate logistic regression analysis was performed with intensive care unit mortality as the dependent variable. At admission, a Glasgow Coma Scale score ≤8 was observed in 68% of the stroke, 77% of the brain trauma, and 29% of the nonneurologic patients. Modes of ventilation and use of a lung-protective strategy within the first week of mechanical ventilation were similar between groups. In comparison with nonneurologic patients, patients with neurologic disease developed fewer complications over the course of mechanical ventilation with the exception of a higher rate of ventilator-associated pneumonia in the brain trauma cohort. Neurologic patients showed higher rates of tracheotomy and longer duration of mechanical ventilation. Mortality in the intensive care unit was significantly (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) higher in patients with stroke (45%) than in brain trauma (29%) and nonneurologic disease (30%). Factors associated with mortality were: stroke (in comparison to brain trauma), Glasgow Coma Scale score on day 1, and severity at admission in the intensive care unit. In our study, one of every five mechanically ventilated patients received this therapy as a result of a neurologic disease. This cohort of patients showed a higher mortality rate than nonneurologic patients despite a lower incidence of extracerebral organ dysfunction.
Background: Few data are available regarding the benefi ts of one mode over another for ventilato... more Background: Few data are available regarding the benefi ts of one mode over another for ventilatory support. We set out to compare clinical outcomes of patients receiving synchronized intermittent mandatory ventilation with pressure support (SIMV-PS) compared with assist-control (A/C) ventilation as their primary mode of ventilatory support. Methods: This was a secondary analysis of an observational study conducted in 349 ICUs from 23 countries. A propensity score stratifi ed analysis was used to compare 350 patients ventilated with SIMV-PS with 1,228 patients ventilated with A/C ventilation. The primary outcome was in-hospital mortality. Results: In a logistic regression model, patients were more likely to receive SIMV-PS if they were from North America, had lower severity of illness, or were ventilated postoperatively or for trauma. SIMV-PS was less likely to be selected if patients were ventilated because of asthma or coma, or if they developed complications such as sepsis or cardiovascular failure during mechanical ventilation. In the stratifi ed analysis according to propensity score, we did not fi nd signifi cant differences in the in-hospital mortality. After adjustment for propensity score, overall effect of SIMV-PS on in-hospital mortality was not signifi cant (odds ratio, 1.04; 95% CI, 0.77-1.42; P 5 .78). Conclusions: In our cohort of ventilated patients, ventilation with SIMV-PS compared with A/C did not offer any advantage in terms of clinical outcomes, despite treatment-allocation bias that would have favored SIMV-PS.
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Papers by Javier Hurtado