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Papers by ANTONIO LUIS BLESA MALPICA
European Heart Journal, 1991
The purpose of the present study was to measure plasma levels of atrial natriuretic peptide (ANP)... more The purpose of the present study was to measure plasma levels of atrial natriuretic peptide (ANP) in patients with acute myocardial infarction without heart failure, and also to assess the temporal sequence of changes of plasma ANP during the first hours of recovery from myocardial infarction. The study was performed in 22 patients who were admitted to the Intensive Care Unit with the diagnosis of acute myocardial ischaemia that had an evolution of less than 6 h. Blood samples were drawn on admission and at 1, 8, and 24 h, and plasma concentrations of ANP, renin, aldosterone, epinephrine, norepinephrine and vasopressin were measured. Compared with control subjects, on admission patients showed increased plasma levels of ANP, as well as increased plasma renin activity (PRA), aldosterone, norepinephrine, epinephrine, dopamine, and antidiuretic hormone (ADH). ANP, but not renin or aldosterone plasma values, decreased with time, and there was a significant correlation between ANP and time after onset of pain. No increase in plasma creatinine was observed during the hospital stay, and the patients showed a negative fluid balance. No relationship was found between the location or extension of the infarction, or morphine treatment and ANP plasma levels. The high levels of ANP seem to counteract the haemodynamic and fluid-retention effects of the vasoconstrictive factors released after myocardial infarction.
Objective: To study compliance with an artificial nu- trition protocol at an Intensive Care Unit.... more Objective: To study compliance with an artificial nu- trition protocol at an Intensive Care Unit. During a se- cond stage and after introducing the modifications con- sidered appropriate in the protocol, to verify its implementation and compare both series. Reference population: All patients with artificial nu- trition support were included. Artificial nutrition (AN) was deemed to be the dispensation of commercial prepa- rations for enteral nutrition, formulas with amino acids and glucose and the parenteral provision of fat, inclu- ding propofol in this case, even where it was the only source of energy. The provision of crystalloid solutions was not consi- dered to be AN. The period of observation was two months in both ca- ses. Intervention: The provision of AN to all such patients was systematically recorded on a daily basis. After analysis of the first series, the members at the unit agreed to increase the nitrogen provision. A second series was recorded, with the data being co- ...
Nutrición hospitalaria, 2011
The Recommendations for Specialized Nutritional Support in Critically-Ill patients were drafted b... more The Recommendations for Specialized Nutritional Support in Critically-Ill patients were drafted by the Metabolism and Nutrition Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) in 2005. Given the time elapsed since then, these recommendations have been reviewed and updated as a Consensus Document in collaboration with the Spanish Society of Parenteral and Enteral Nutrition (SENPE). The primary aim of these Recommendations was to evaluate the best available scientific evidence for the indications of specialized nutritional and metabolic support in critically-ill patients. The Recommendations have been formulated by an expert panel with broad experience in nutritional and metabolic support in critically-ill patients and were drafted between October 2009 and March 2011. The studies analyzed encompassed metaanalyses, randomized clinical trials, observational studies, systematic reviews and updates relating to critically-ill adults in MEDLINE ...
Revista clínica española, 1999
Revista clínica española, 1989
The current treatment of fulminant liver failure, underscoring substitutive liver therapy, is rev... more The current treatment of fulminant liver failure, underscoring substitutive liver therapy, is reviewed. The usefulness of hemodialysis and hemofiltration with a high-permeability membrane, hemoperfusion with activated carbon, hemoperfusion with resins, plasma exchange, artificial cells and the combination of various techniques for the same patients has been studied. Finally, the indications for utility of these techniques and the role of liver transplantation are considered. Early onset of treatment is essential for achieving satisfactory results.
Nutrición hospitalaria
To study compliance with an artificial nutrition protocol at an Intensive Care Unit. During a sec... more To study compliance with an artificial nutrition protocol at an Intensive Care Unit. During a second stage and after introducing the modifications considered appropriate in the protocol, to verify its implementation and compare both series. REFERENCE POPULATION: All patients with artificial nutrition support were included. Artificial nutrition (AN) was deemed to be the dispensation of commercial preparations for enteral nutrition, formulas with amino acids and glucose and the parenteral provision of fat, including propofol in this case, even where it was the only source of energy. The provision of crystalloid solutions was not considered to be AN. The period of observation was two months in both cases. The provision of AN to all such patients was systematically recorded on a daily basis. After analysis of the first series, the members at the unit agreed to increase the nitrogen provision. A second series was recorded, with the data being collected for patients with AN during a simil...
Enfermería Intensiva, 2005
Enfermería Intensiva, 2004
La aspiración de secreciones bronquiales es una técnica habitual que puede repercutir en los pará... more La aspiración de secreciones bronquiales es una técnica habitual que puede repercutir en los parámetros hemodinámicos y respiratorios del paciente. Nuestro objetivo, ha sido valorar si existen cambios en dichos parámetros, en función de 2 sistemas distintos de aspiración: ...
Medicina Intensiva, 2011
Capítulo 2 Recomendaciones para el soporte nutricional y metabólico especializado del paciente cr... more Capítulo 2 Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Indicaciones, momento de inicio y vías de aporte
Enfermería Intensiva, 2012
Numerical scales are commonly used in intensive care units to predict hospital mortality and to a... more Numerical scales are commonly used in intensive care units to predict hospital mortality and to assess the therapeutic effort and care that critically ill patients require. The aim of this work was to study whether the NEMS value can be used as a predictor of mortality, comparing it with the APACHE II. A prospective study in a 24 intensive care unit beds was conducted. The APACHE II and NEMS values were stratified into three levels. Demographic data and the first 24 hours values of APACHE II and NEMS scales were collected. A total of 1257 patients were included, 16.4% of whom died. 69.6% were surgical; median stay was 2 days (1-4). Median age was 66 years (50-77), 59.3% were men. The median APACHE II and NEMS for the living and the dead in the subsequent course was 10 (6-20) versus 22.5 (17.25 to 29) (p <0.001) and 24 (18-29) versus 34 (25 to 39.7) (p<0.001) respectively. The correlation between both scales was rho=0.457 (p<0.01). Logistic regression controlled for age, sex and APACHE II showed an OR of 3.1 (95% CI: 1.5-6.6) only for high NEMS, compared to the lowest level. According to the results NEMS should not be used as a predictor of mortality, although the risk of death increases by three times with high NEMS.
Journal of Parenteral and Enteral Nutrition, 2004
Critical Care Medicine, 1986
Clinical Nutrition, 2003
The review assessed the effects of enteral nutrition with pharmaconutrient-enriched diets in crit... more The review assessed the effects of enteral nutrition with pharmaconutrient-enriched diets in critically ill patients. The authors concluded that enriched diets offer beneficial effects to patients requiring enteral feeding, although further research is required to identify the population who could benefit the most. The lack of individual study results, the inclusion of only published studies, and funding from the manufacturer of such diets may potentially bias the authors' conclusion. Authors' objectives To determine the effectiveness of enteral nutrition with pharmaconutrient-enriched diets in patients who were critically ill. Searching MEDLINE, EMBASE and the Cochrane CENTRAL Register were searched for articles published from 1966 to 2000. Additional studies were sought in the reference lists of retrieved articles and abstracts of proceedings of scientific meetings. Only published studies were included. Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs) were eligible for inclusion. Specific interventions included in the review Studies of enteral nutrition with an immune-enhancing diet, compared with a standard diet, were eligible for inclusion. Studies that compared immune-enhancing diets with nil-by-mouth or parenteral nutrition were excluded. The interventions evaluated in the included studies were commercial diets, or diets specifically prepared for the study (glutamine-enriched, fish-oil enriched, arginine-enriched, or enriched with arginine and n-3 fatty acids). The majority of control diets in the included studies were isocaloric or isonitrogenous. Participants included in the review Studies of patients who were critically ill (as defined by the trialist) were eligible for inclusion. The participants in the included studies were surgical patients, trauma patients, patients receiving treatment for burns, or mixed patient groups. The mean age of the participants ranged from 7 months to 66 years. Outcomes assessed in the review Studies that evaluated significant clinical outcomes (e.g. mortality or infectious complications) were eligible for inclusion. Studies that evaluated surrogate outcomes (e.g. nutrition-related outcomes) were excluded. The outcomes evaluated in the included studies were the nosocomial infection rate, the incidence of adult respiratory distress syndrome (ARDS) or multiple organ dysfunctional syndrome (MODS), length of stay in the hospital, duration of mechanical ventilation, in-hospital mortality and cost. How were decisions on the relevance of primary studies made? Clinicians screened all citations and selected those that met the inclusion criteria. The authors did not state how the papers were selected for the review, or how many reviewers performed the selection. Assessment of study quality The authors assigned a quality score to each study (1 being the lowest and 5 the highest), using the Jadad instrument to assess randomisation, blinding and withdrawals. The authors did not state how the papers were assessed for quality, or
European Heart Journal, 1991
The purpose of the present study was to measure plasma levels of atrial natriuretic peptide (ANP)... more The purpose of the present study was to measure plasma levels of atrial natriuretic peptide (ANP) in patients with acute myocardial infarction without heart failure, and also to assess the temporal sequence of changes of plasma ANP during the first hours of recovery from myocardial infarction. The study was performed in 22 patients who were admitted to the Intensive Care Unit with the diagnosis of acute myocardial ischaemia that had an evolution of less than 6 h. Blood samples were drawn on admission and at 1, 8, and 24 h, and plasma concentrations of ANP, renin, aldosterone, epinephrine, norepinephrine and vasopressin were measured. Compared with control subjects, on admission patients showed increased plasma levels of ANP, as well as increased plasma renin activity (PRA), aldosterone, norepinephrine, epinephrine, dopamine, and antidiuretic hormone (ADH). ANP, but not renin or aldosterone plasma values, decreased with time, and there was a significant correlation between ANP and time after onset of pain. No increase in plasma creatinine was observed during the hospital stay, and the patients showed a negative fluid balance. No relationship was found between the location or extension of the infarction, or morphine treatment and ANP plasma levels. The high levels of ANP seem to counteract the haemodynamic and fluid-retention effects of the vasoconstrictive factors released after myocardial infarction.
Objective: To study compliance with an artificial nu- trition protocol at an Intensive Care Unit.... more Objective: To study compliance with an artificial nu- trition protocol at an Intensive Care Unit. During a se- cond stage and after introducing the modifications con- sidered appropriate in the protocol, to verify its implementation and compare both series. Reference population: All patients with artificial nu- trition support were included. Artificial nutrition (AN) was deemed to be the dispensation of commercial prepa- rations for enteral nutrition, formulas with amino acids and glucose and the parenteral provision of fat, inclu- ding propofol in this case, even where it was the only source of energy. The provision of crystalloid solutions was not consi- dered to be AN. The period of observation was two months in both ca- ses. Intervention: The provision of AN to all such patients was systematically recorded on a daily basis. After analysis of the first series, the members at the unit agreed to increase the nitrogen provision. A second series was recorded, with the data being co- ...
Nutrición hospitalaria, 2011
The Recommendations for Specialized Nutritional Support in Critically-Ill patients were drafted b... more The Recommendations for Specialized Nutritional Support in Critically-Ill patients were drafted by the Metabolism and Nutrition Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) in 2005. Given the time elapsed since then, these recommendations have been reviewed and updated as a Consensus Document in collaboration with the Spanish Society of Parenteral and Enteral Nutrition (SENPE). The primary aim of these Recommendations was to evaluate the best available scientific evidence for the indications of specialized nutritional and metabolic support in critically-ill patients. The Recommendations have been formulated by an expert panel with broad experience in nutritional and metabolic support in critically-ill patients and were drafted between October 2009 and March 2011. The studies analyzed encompassed metaanalyses, randomized clinical trials, observational studies, systematic reviews and updates relating to critically-ill adults in MEDLINE ...
Revista clínica española, 1999
Revista clínica española, 1989
The current treatment of fulminant liver failure, underscoring substitutive liver therapy, is rev... more The current treatment of fulminant liver failure, underscoring substitutive liver therapy, is reviewed. The usefulness of hemodialysis and hemofiltration with a high-permeability membrane, hemoperfusion with activated carbon, hemoperfusion with resins, plasma exchange, artificial cells and the combination of various techniques for the same patients has been studied. Finally, the indications for utility of these techniques and the role of liver transplantation are considered. Early onset of treatment is essential for achieving satisfactory results.
Nutrición hospitalaria
To study compliance with an artificial nutrition protocol at an Intensive Care Unit. During a sec... more To study compliance with an artificial nutrition protocol at an Intensive Care Unit. During a second stage and after introducing the modifications considered appropriate in the protocol, to verify its implementation and compare both series. REFERENCE POPULATION: All patients with artificial nutrition support were included. Artificial nutrition (AN) was deemed to be the dispensation of commercial preparations for enteral nutrition, formulas with amino acids and glucose and the parenteral provision of fat, including propofol in this case, even where it was the only source of energy. The provision of crystalloid solutions was not considered to be AN. The period of observation was two months in both cases. The provision of AN to all such patients was systematically recorded on a daily basis. After analysis of the first series, the members at the unit agreed to increase the nitrogen provision. A second series was recorded, with the data being collected for patients with AN during a simil...
Enfermería Intensiva, 2005
Enfermería Intensiva, 2004
La aspiración de secreciones bronquiales es una técnica habitual que puede repercutir en los pará... more La aspiración de secreciones bronquiales es una técnica habitual que puede repercutir en los parámetros hemodinámicos y respiratorios del paciente. Nuestro objetivo, ha sido valorar si existen cambios en dichos parámetros, en función de 2 sistemas distintos de aspiración: ...
Medicina Intensiva, 2011
Capítulo 2 Recomendaciones para el soporte nutricional y metabólico especializado del paciente cr... more Capítulo 2 Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Indicaciones, momento de inicio y vías de aporte
Enfermería Intensiva, 2012
Numerical scales are commonly used in intensive care units to predict hospital mortality and to a... more Numerical scales are commonly used in intensive care units to predict hospital mortality and to assess the therapeutic effort and care that critically ill patients require. The aim of this work was to study whether the NEMS value can be used as a predictor of mortality, comparing it with the APACHE II. A prospective study in a 24 intensive care unit beds was conducted. The APACHE II and NEMS values were stratified into three levels. Demographic data and the first 24 hours values of APACHE II and NEMS scales were collected. A total of 1257 patients were included, 16.4% of whom died. 69.6% were surgical; median stay was 2 days (1-4). Median age was 66 years (50-77), 59.3% were men. The median APACHE II and NEMS for the living and the dead in the subsequent course was 10 (6-20) versus 22.5 (17.25 to 29) (p <0.001) and 24 (18-29) versus 34 (25 to 39.7) (p<0.001) respectively. The correlation between both scales was rho=0.457 (p<0.01). Logistic regression controlled for age, sex and APACHE II showed an OR of 3.1 (95% CI: 1.5-6.6) only for high NEMS, compared to the lowest level. According to the results NEMS should not be used as a predictor of mortality, although the risk of death increases by three times with high NEMS.
Journal of Parenteral and Enteral Nutrition, 2004
Critical Care Medicine, 1986
Clinical Nutrition, 2003
The review assessed the effects of enteral nutrition with pharmaconutrient-enriched diets in crit... more The review assessed the effects of enteral nutrition with pharmaconutrient-enriched diets in critically ill patients. The authors concluded that enriched diets offer beneficial effects to patients requiring enteral feeding, although further research is required to identify the population who could benefit the most. The lack of individual study results, the inclusion of only published studies, and funding from the manufacturer of such diets may potentially bias the authors' conclusion. Authors' objectives To determine the effectiveness of enteral nutrition with pharmaconutrient-enriched diets in patients who were critically ill. Searching MEDLINE, EMBASE and the Cochrane CENTRAL Register were searched for articles published from 1966 to 2000. Additional studies were sought in the reference lists of retrieved articles and abstracts of proceedings of scientific meetings. Only published studies were included. Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs) were eligible for inclusion. Specific interventions included in the review Studies of enteral nutrition with an immune-enhancing diet, compared with a standard diet, were eligible for inclusion. Studies that compared immune-enhancing diets with nil-by-mouth or parenteral nutrition were excluded. The interventions evaluated in the included studies were commercial diets, or diets specifically prepared for the study (glutamine-enriched, fish-oil enriched, arginine-enriched, or enriched with arginine and n-3 fatty acids). The majority of control diets in the included studies were isocaloric or isonitrogenous. Participants included in the review Studies of patients who were critically ill (as defined by the trialist) were eligible for inclusion. The participants in the included studies were surgical patients, trauma patients, patients receiving treatment for burns, or mixed patient groups. The mean age of the participants ranged from 7 months to 66 years. Outcomes assessed in the review Studies that evaluated significant clinical outcomes (e.g. mortality or infectious complications) were eligible for inclusion. Studies that evaluated surrogate outcomes (e.g. nutrition-related outcomes) were excluded. The outcomes evaluated in the included studies were the nosocomial infection rate, the incidence of adult respiratory distress syndrome (ARDS) or multiple organ dysfunctional syndrome (MODS), length of stay in the hospital, duration of mechanical ventilation, in-hospital mortality and cost. How were decisions on the relevance of primary studies made? Clinicians screened all citations and selected those that met the inclusion criteria. The authors did not state how the papers were selected for the review, or how many reviewers performed the selection. Assessment of study quality The authors assigned a quality score to each study (1 being the lowest and 5 the highest), using the Jadad instrument to assess randomisation, blinding and withdrawals. The authors did not state how the papers were assessed for quality, or