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Papers by Emiliano Descotte

Research paper thumbnail of Síndrome de obesidad e hipoventilación en terapia intensiva Reporte de serie de casos de un Hospital de Comunidad

Revista Americana de Medicina Respiratoria, Dec 1, 2014

El Síndrome de Obesidad e Hipoventilación (SOH) incluye hipercapnia, trastornos del sueño y obesi... more El Síndrome de Obesidad e Hipoventilación (SOH) incluye hipercapnia, trastornos del sueño y obesidad. Se describen características clínicas y evolución de una serie retrospectiva de pacientes con SOH internados en una Unidad de Terapia Intensiva (UTI) polivalente. Durante 24 meses se identificaron 13 pacientes, 9 hombres (69.23%), media de edad de 58.6 años (SD ± 12.4), IMC medio; 48.5 kg/m 2 (SD ± 9.1). Los motivos de internación fueron: fallo respiratorio con hipercapnia en 8 (61.53%), titulación de la VNI en 3 (23.07%) y evento coronario en 2 (15.38%). El tiempo medio de internación en UTI fue de 8.9 días. En 11 casos (84.6%) se realizó una poligrafía respiratoria (PR). Todos tuvieron IAH > 5/hora y en el 90.9% este fue > 30/h. Se utilizó ventilación no invasiva (VNI) en modalidad bilevel (modo S/T) con presiones; IPAP de 23 (SD ± 4.17), EPAP de 12 (SD ± 4.25), frecuencia respiratoria de 18 por minuto (SD ± 1.7). Se realizaron 13 titulaciones con VNI. Cuatro casos (30.77%) requirieron modalidad con volumen asegurado. Con VNI existieron cambios significativos para pH arterial (p = 0.0019), PaO 2 (p = 0.0001), PaCO 2 (p = 0.0001) y HCO 3 (p = 0.008) y la ESS al alta (6.23 ± 2.20) p = 0.0001. Ningún paciente requirió intubación traqueal (IOT) ni se registraron fallecimientos. Todos egresaron con interfases nasobucales e indicación de uso nocturno. En nuestra experiencia la mayoría de las admisiones se debieron a falla respiratoria con hipercapnia y recibieron modalidad bilevel. La PR al lado de la cama del paciente permitió el acceso al diagnóstico y monitoreo de la VNI.

Research paper thumbnail of Risk Factors and Precipitants Associated With Delirium in Critical Ill Patients: Proposal of a Predictive Model

Research paper thumbnail of Everolimus Related Acute Respiratory Distress Syndrome

Chest, Oct 1, 2013

ABSTRACT

Research paper thumbnail of Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis

Intensive Care Medicine

Purpose To describe data on epidemiology, microbiology, clinical characteristics and outcome of a... more Purpose To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult ICU patients with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (<2 hours), 'urgent' (2-6 hours), and 'delayed' (>6 hours). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and [95% confidence interval]. Results The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p=0.102). A stepwise increase in mortality was observed with increasing SOFA scores (19.6% for a value £4 to 55.4% for a value >12, p<0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at Day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (<2 hours of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusions 'Urgent' and successful source control were associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome.

Research paper thumbnail of Septic patients in the intensive care unit do not have higher systemic levels of reactive oxygen species (ROS) than healthy volunteers

Introducción. El daño oxidativo es postulado como parte de la fisiopatología de la sepsis. Las es... more Introducción. El daño oxidativo es postulado como parte de la fisiopatología de la sepsis. Las especies reactivas de oxígeno (reactive oxygen species, ROS) serían su causa. No hay evidencia de los niveles de ROS medidos en sangre venosa en pacientes sépticos y su relación con la mortalidad en terapia intensiva (UTI). Objetivos. Observar si hay diferencias entre los niveles de ROS medidos en sangre venosa en pacientes sépticos y aquellos obtenidos en controles sanos y determinar si los pacientes que mueren en UTI tienen niveles de ROS más altos que los que sobreviven. Material y métodos. Estudio prospectivo observacional. Se incluyeron pacientes sépticos internados en UTI mayores de 18 años y menores 80 años entre 2014 y 2016 y voluntarios sanos. Se excluyeron pacientes embarazadas. Se midió con la técnica de diclorofluorosceína. Resultados. No hubo diferencias significativas en los niveles de ROS medidos con diclorofluorosceína entre pacientes sépticos y voluntarios sanos (emisión m...

Research paper thumbnail of Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Intensive Care Medicine, 2019

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ... more Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospitalacquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation.

Research paper thumbnail of ESICM LIVES 2016: part three : Milan, Italy. 1-5 October 2016

Intensive care medicine experimental, 2016

Introduction: Critically ill children in the pediatric intensive care unit (PICU) are at high ris... more Introduction: Critically ill children in the pediatric intensive care unit (PICU) are at high risk for developing nutritional deficiencies and undernutrition is known to be a risk factor for morbidity and mortality. Malnutrition represents a continuous spectrum ranging from marginal nutrient status to severe metabolic and functional alterations and this in turn, affects clinical outcome. Objectives: The aim of the study was to assess nutritional status of critically ill children admitted to the PICU and its association to clinical outcomes. Methods: Critically ill children age 6 months to 18 years were prospectively enrolled on PICU admission. Nutritional status was assessed by weight for age (WFA: underweight), weight for height (WFH: wasting), height for age (HFA: stunting) z-scores and mid upper arm circumference (MUAC: wasting) according to the WHO. (1,2) Malnutrition was defined as mild, moderate, and severe if z-scores were > −1, > − 2, and > −3, respectively. Hospital and PICU length of stay (LOS), duration of mechanical ventilation (MV), and risk of mortality (ROM) by the Pediatric Index of Mortality 2 (PIM2) were obtained. Sensitivity and specificity of the MUAC to identify children with wasting (WFH) were calculated. Results: Two hundred and fifty children (136 males), aged 81 months (23-167; median (25-75 th IQR)), were prospectively included in the study. The hospital LOS was 8 (4-16) days; PICU LOS: 2 (1-4) days; duration of MV, 0 (0-1.5) days;

Research paper thumbnail of Everolimus Related Acute Respiratory Distress Syndrome

CHEST Journal, 2013

ABSTRACT

Research paper thumbnail of Nasoenteric tube doppler guided insertion. A case report and review of literature

European Journal of Clinical Nutrition, Oct 22, 2021

Nasoenteric tube placement is needed in patients with gastric enteral feeding intolerance or high... more Nasoenteric tube placement is needed in patients with gastric enteral feeding intolerance or high risk of aspiration. Several techniques are described. Ultrasound is used more commonly for gastric tube placement, but also is described in enteral tube feeding placement. Doppler technique with cold water injection is not described in the literature. We describe a new and easy to realize technique. A case of a 65 years old male patient in the intensive care unit (ICU) with gastroparesis is described. Before beginning a prokinetic drug was administered. In this technique gastric tube placement was bedside assessed with ultrasound, and then the tube was progressed with cold water injection. Duodenal position was confirmed with doppler ultrasound. Ultrasound and doppler technique for nasoenteric tube placement could be a feasible technique to use in the ICU. More studies are needed to assess the effectiveness of the technique.

Research paper thumbnail of Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units

Drugs

Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainl... more Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.

Research paper thumbnail of Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Intensive Care Medicine

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ... more Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospitalacquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation.

Research paper thumbnail of Efficacy of a ventilator bundle for the prevention of the ventilator-associated pneumonia

European Respiratory Journal, 2011

Introduction: Several specific and general strategies have proven effectiveness for prevention of... more Introduction: Several specific and general strategies have proven effectiveness for prevention of ventilator-associated pneumonia (VAP). Objective: To evaluate the impact of a ventilator bundle and the control of process measures on the rate of VAP in our Intensive Care Unit. Methods: A prospectively ventilator bundle have applied to every patient who received mechanical ventilation (MV). Daily control of the application of ventilator bundle was registered and weekly control of ventilator bundle compliance was registered. We compare the VAP rate of two periods, 25 months before the implementation of the bundle and 11 months after. The Poisson regression test was used. The methodology of the NHSN (National Healthcare Safety Network) was used for infection surveillance and the methodology of IHI (Institute of Healthcare Improvement) was used for compliance control. Results: The MV use rate was (ventilator day/patients day) higher during the bundle period compare to the previous period...

Research paper thumbnail of Síndrome de obesidad e hipoventilación en terapia intensiva Reporte de serie de casos de un Hospital de Comunidad

Obesity and Hypoventilation Syndrome in an Intensive Care Unit Obesity Hypoventilation Syndrome (... more Obesity and Hypoventilation Syndrome in an Intensive Care Unit Obesity Hypoventilation Syndrome (OHS) includes hypercapnia, sleep disturbances and obesity after other causes of hypoventilation have been excluded. We describe clinical features and evolution of a retrospective series of patients with OHS admitted to a polyvalent ICU. During 24 months, 13 patients, 9 males (69.23%) with an average age of 58.6 years old (SD ± 12.4) and a BMI mean of 48.5 kg/m 2 (SD ± 9.1) were identified. The reasons for hospitalizations were: respiratory failure with hypercapnia in 8 patients (61.53%), titration of non invasive ventilation (NIV) in 3 (23.07%) and acute coronary event in 2 cases (15.38%). The mean hospitalization time was 8.9 days. We performed a respiratory polygraphy (RP) in 11 cases (84.6%). All patients had AHI >5/hour; in 90.9% the AHI was severely elevated (> 30/h). We used non invasive ventilation in bilevel modality (S/T mode) in all patients. The pressures used in H2O cm ...

Research paper thumbnail of Mechanical ventilation and lung injury : new advances

printing supported by . Visit Chiesi at Stand D.30 MONDAY, SEPTEMBER 26TH 2011 = 110±71 mmHg). Mo... more printing supported by . Visit Chiesi at Stand D.30 MONDAY, SEPTEMBER 26TH 2011 = 110±71 mmHg). Most of our population (26/38 patients, 68%) resolved their acute episode with HFO. In this group, invasive ventilation was not required and this decision was not stated on EOL care (success group). PaO2/FiO2 at admission was found higher in the success group (126 vs. 76 mmHg, p=0.04). Failure patients (12/38, 32%) exhibited more comorbidities (Charlson’s score = 4.5 vs. 2.5, p=0.034) and appeared more severe at admission (SAPS2 = 45 vs. 31, p=0.0054). After 24 hours, the %FiO2 under HFO was significantly lower in the success group (50% vs. 70%, p=0.004). The hospitalization length was similar in both groups (p=0.28). Hospital mortality rate was significantly higher in the failure group than in the success group ((92% vs. 4%, p<0.0001) as was the 28-days mortality rate (respectively: 83% and 4%, p<0.0001). In conclusion, HFO may avoid endotracheal intubation during ALI/ARDS and its u...

Research paper thumbnail of Los pacientes sépticos en terapia intensiva no tienen mayores niveles sistémicos de especies reactivas de oxígeno (ROS) que los voluntarios sanos

Introduccion . El dano oxidativo es postulado como parte de la fisiopatologia de la sepsis. Las e... more Introduccion . El dano oxidativo es postulado como parte de la fisiopatologia de la sepsis. Las especies reactivas de oxigeno (reactive oxygen species, ROS) serian su causa. No hay evidencia de los niveles de ROS medidos en sangre venosa en pacientes septicos y su relacion con la mortalidad en terapia intensiva (UTI). Objetivos. Observar si hay diferencias entre los niveles de ROS medidos en sangre venosa en pacientes septicos y aquellos obtenidos en controles sanos y determinar si los pacientes que mueren en UTI tienen niveles de ROS mas altos que los que sobreviven. Material y metodos. Estudio prospectivo observacional. Se incluyeron pacientes septicos internados en UTI mayores de 18 anos y menores 80 anos entre 2014 y 2016 y voluntarios sanos. Se excluyeron pacientes embarazadas. Se midio con la tecnica de diclorofluorosceina. Resultados. No hubo diferencias significativas en los niveles de ROS medidos con diclorofluorosceina entre pacientes septicos y voluntarios sanos (emision...

Research paper thumbnail of Nasoenteric tube doppler guided insertion. A case report and review of literature

European Journal of Clinical Nutrition

Nasoenteric tube placement is needed in patients with gastric enteral feeding intolerance or high... more Nasoenteric tube placement is needed in patients with gastric enteral feeding intolerance or high risk of aspiration. Several techniques are described. Ultrasound is used more commonly for gastric tube placement, but also is described in enteral tube feeding placement. Doppler technique with cold water injection is not described in the literature. We describe a new and easy to realize technique. A case of a 65 years old male patient in the intensive care unit (ICU) with gastroparesis is described. Before beginning a prokinetic drug was administered. In this technique gastric tube placement was bedside assessed with ultrasound, and then the tube was progressed with cold water injection. Duodenal position was confirmed with doppler ultrasound. Ultrasound and doppler technique for nasoenteric tube placement could be a feasible technique to use in the ICU. More studies are needed to assess the effectiveness of the technique.

Research paper thumbnail of Utility of Respiratory Polygraphy in the Intensive Care Unit

CHEST Journal, 2013

ABSTRACT

Research paper thumbnail of Utility of Respiratory Polygraphy in the Intensive Care Unit

CHEST Journal, 2013

ABSTRACT

Research paper thumbnail of Risk Factors and Precipitants Associated With Delirium in Critical Ill Patients: Proposal of a Predictive Model

Research paper thumbnail of Everolimus Related Acute Respiratory Distress Syndrome

CHEST Journal, 2013

ABSTRACT

Research paper thumbnail of Síndrome de obesidad e hipoventilación en terapia intensiva Reporte de serie de casos de un Hospital de Comunidad

Revista Americana de Medicina Respiratoria, Dec 1, 2014

El Síndrome de Obesidad e Hipoventilación (SOH) incluye hipercapnia, trastornos del sueño y obesi... more El Síndrome de Obesidad e Hipoventilación (SOH) incluye hipercapnia, trastornos del sueño y obesidad. Se describen características clínicas y evolución de una serie retrospectiva de pacientes con SOH internados en una Unidad de Terapia Intensiva (UTI) polivalente. Durante 24 meses se identificaron 13 pacientes, 9 hombres (69.23%), media de edad de 58.6 años (SD ± 12.4), IMC medio; 48.5 kg/m 2 (SD ± 9.1). Los motivos de internación fueron: fallo respiratorio con hipercapnia en 8 (61.53%), titulación de la VNI en 3 (23.07%) y evento coronario en 2 (15.38%). El tiempo medio de internación en UTI fue de 8.9 días. En 11 casos (84.6%) se realizó una poligrafía respiratoria (PR). Todos tuvieron IAH > 5/hora y en el 90.9% este fue > 30/h. Se utilizó ventilación no invasiva (VNI) en modalidad bilevel (modo S/T) con presiones; IPAP de 23 (SD ± 4.17), EPAP de 12 (SD ± 4.25), frecuencia respiratoria de 18 por minuto (SD ± 1.7). Se realizaron 13 titulaciones con VNI. Cuatro casos (30.77%) requirieron modalidad con volumen asegurado. Con VNI existieron cambios significativos para pH arterial (p = 0.0019), PaO 2 (p = 0.0001), PaCO 2 (p = 0.0001) y HCO 3 (p = 0.008) y la ESS al alta (6.23 ± 2.20) p = 0.0001. Ningún paciente requirió intubación traqueal (IOT) ni se registraron fallecimientos. Todos egresaron con interfases nasobucales e indicación de uso nocturno. En nuestra experiencia la mayoría de las admisiones se debieron a falla respiratoria con hipercapnia y recibieron modalidad bilevel. La PR al lado de la cama del paciente permitió el acceso al diagnóstico y monitoreo de la VNI.

Research paper thumbnail of Risk Factors and Precipitants Associated With Delirium in Critical Ill Patients: Proposal of a Predictive Model

Research paper thumbnail of Everolimus Related Acute Respiratory Distress Syndrome

Chest, Oct 1, 2013

ABSTRACT

Research paper thumbnail of Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis

Intensive Care Medicine

Purpose To describe data on epidemiology, microbiology, clinical characteristics and outcome of a... more Purpose To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult ICU patients with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (<2 hours), 'urgent' (2-6 hours), and 'delayed' (>6 hours). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and [95% confidence interval]. Results The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p=0.102). A stepwise increase in mortality was observed with increasing SOFA scores (19.6% for a value £4 to 55.4% for a value >12, p<0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at Day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (<2 hours of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusions 'Urgent' and successful source control were associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome.

Research paper thumbnail of Septic patients in the intensive care unit do not have higher systemic levels of reactive oxygen species (ROS) than healthy volunteers

Introducción. El daño oxidativo es postulado como parte de la fisiopatología de la sepsis. Las es... more Introducción. El daño oxidativo es postulado como parte de la fisiopatología de la sepsis. Las especies reactivas de oxígeno (reactive oxygen species, ROS) serían su causa. No hay evidencia de los niveles de ROS medidos en sangre venosa en pacientes sépticos y su relación con la mortalidad en terapia intensiva (UTI). Objetivos. Observar si hay diferencias entre los niveles de ROS medidos en sangre venosa en pacientes sépticos y aquellos obtenidos en controles sanos y determinar si los pacientes que mueren en UTI tienen niveles de ROS más altos que los que sobreviven. Material y métodos. Estudio prospectivo observacional. Se incluyeron pacientes sépticos internados en UTI mayores de 18 años y menores 80 años entre 2014 y 2016 y voluntarios sanos. Se excluyeron pacientes embarazadas. Se midió con la técnica de diclorofluorosceína. Resultados. No hubo diferencias significativas en los niveles de ROS medidos con diclorofluorosceína entre pacientes sépticos y voluntarios sanos (emisión m...

Research paper thumbnail of Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Intensive Care Medicine, 2019

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ... more Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospitalacquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation.

Research paper thumbnail of ESICM LIVES 2016: part three : Milan, Italy. 1-5 October 2016

Intensive care medicine experimental, 2016

Introduction: Critically ill children in the pediatric intensive care unit (PICU) are at high ris... more Introduction: Critically ill children in the pediatric intensive care unit (PICU) are at high risk for developing nutritional deficiencies and undernutrition is known to be a risk factor for morbidity and mortality. Malnutrition represents a continuous spectrum ranging from marginal nutrient status to severe metabolic and functional alterations and this in turn, affects clinical outcome. Objectives: The aim of the study was to assess nutritional status of critically ill children admitted to the PICU and its association to clinical outcomes. Methods: Critically ill children age 6 months to 18 years were prospectively enrolled on PICU admission. Nutritional status was assessed by weight for age (WFA: underweight), weight for height (WFH: wasting), height for age (HFA: stunting) z-scores and mid upper arm circumference (MUAC: wasting) according to the WHO. (1,2) Malnutrition was defined as mild, moderate, and severe if z-scores were > −1, > − 2, and > −3, respectively. Hospital and PICU length of stay (LOS), duration of mechanical ventilation (MV), and risk of mortality (ROM) by the Pediatric Index of Mortality 2 (PIM2) were obtained. Sensitivity and specificity of the MUAC to identify children with wasting (WFH) were calculated. Results: Two hundred and fifty children (136 males), aged 81 months (23-167; median (25-75 th IQR)), were prospectively included in the study. The hospital LOS was 8 (4-16) days; PICU LOS: 2 (1-4) days; duration of MV, 0 (0-1.5) days;

Research paper thumbnail of Everolimus Related Acute Respiratory Distress Syndrome

CHEST Journal, 2013

ABSTRACT

Research paper thumbnail of Nasoenteric tube doppler guided insertion. A case report and review of literature

European Journal of Clinical Nutrition, Oct 22, 2021

Nasoenteric tube placement is needed in patients with gastric enteral feeding intolerance or high... more Nasoenteric tube placement is needed in patients with gastric enteral feeding intolerance or high risk of aspiration. Several techniques are described. Ultrasound is used more commonly for gastric tube placement, but also is described in enteral tube feeding placement. Doppler technique with cold water injection is not described in the literature. We describe a new and easy to realize technique. A case of a 65 years old male patient in the intensive care unit (ICU) with gastroparesis is described. Before beginning a prokinetic drug was administered. In this technique gastric tube placement was bedside assessed with ultrasound, and then the tube was progressed with cold water injection. Duodenal position was confirmed with doppler ultrasound. Ultrasound and doppler technique for nasoenteric tube placement could be a feasible technique to use in the ICU. More studies are needed to assess the effectiveness of the technique.

Research paper thumbnail of Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units

Drugs

Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainl... more Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.

Research paper thumbnail of Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Intensive Care Medicine

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ... more Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospitalacquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation.

Research paper thumbnail of Efficacy of a ventilator bundle for the prevention of the ventilator-associated pneumonia

European Respiratory Journal, 2011

Introduction: Several specific and general strategies have proven effectiveness for prevention of... more Introduction: Several specific and general strategies have proven effectiveness for prevention of ventilator-associated pneumonia (VAP). Objective: To evaluate the impact of a ventilator bundle and the control of process measures on the rate of VAP in our Intensive Care Unit. Methods: A prospectively ventilator bundle have applied to every patient who received mechanical ventilation (MV). Daily control of the application of ventilator bundle was registered and weekly control of ventilator bundle compliance was registered. We compare the VAP rate of two periods, 25 months before the implementation of the bundle and 11 months after. The Poisson regression test was used. The methodology of the NHSN (National Healthcare Safety Network) was used for infection surveillance and the methodology of IHI (Institute of Healthcare Improvement) was used for compliance control. Results: The MV use rate was (ventilator day/patients day) higher during the bundle period compare to the previous period...

Research paper thumbnail of Síndrome de obesidad e hipoventilación en terapia intensiva Reporte de serie de casos de un Hospital de Comunidad

Obesity and Hypoventilation Syndrome in an Intensive Care Unit Obesity Hypoventilation Syndrome (... more Obesity and Hypoventilation Syndrome in an Intensive Care Unit Obesity Hypoventilation Syndrome (OHS) includes hypercapnia, sleep disturbances and obesity after other causes of hypoventilation have been excluded. We describe clinical features and evolution of a retrospective series of patients with OHS admitted to a polyvalent ICU. During 24 months, 13 patients, 9 males (69.23%) with an average age of 58.6 years old (SD ± 12.4) and a BMI mean of 48.5 kg/m 2 (SD ± 9.1) were identified. The reasons for hospitalizations were: respiratory failure with hypercapnia in 8 patients (61.53%), titration of non invasive ventilation (NIV) in 3 (23.07%) and acute coronary event in 2 cases (15.38%). The mean hospitalization time was 8.9 days. We performed a respiratory polygraphy (RP) in 11 cases (84.6%). All patients had AHI >5/hour; in 90.9% the AHI was severely elevated (> 30/h). We used non invasive ventilation in bilevel modality (S/T mode) in all patients. The pressures used in H2O cm ...

Research paper thumbnail of Mechanical ventilation and lung injury : new advances

printing supported by . Visit Chiesi at Stand D.30 MONDAY, SEPTEMBER 26TH 2011 = 110±71 mmHg). Mo... more printing supported by . Visit Chiesi at Stand D.30 MONDAY, SEPTEMBER 26TH 2011 = 110±71 mmHg). Most of our population (26/38 patients, 68%) resolved their acute episode with HFO. In this group, invasive ventilation was not required and this decision was not stated on EOL care (success group). PaO2/FiO2 at admission was found higher in the success group (126 vs. 76 mmHg, p=0.04). Failure patients (12/38, 32%) exhibited more comorbidities (Charlson’s score = 4.5 vs. 2.5, p=0.034) and appeared more severe at admission (SAPS2 = 45 vs. 31, p=0.0054). After 24 hours, the %FiO2 under HFO was significantly lower in the success group (50% vs. 70%, p=0.004). The hospitalization length was similar in both groups (p=0.28). Hospital mortality rate was significantly higher in the failure group than in the success group ((92% vs. 4%, p<0.0001) as was the 28-days mortality rate (respectively: 83% and 4%, p<0.0001). In conclusion, HFO may avoid endotracheal intubation during ALI/ARDS and its u...

Research paper thumbnail of Los pacientes sépticos en terapia intensiva no tienen mayores niveles sistémicos de especies reactivas de oxígeno (ROS) que los voluntarios sanos

Introduccion . El dano oxidativo es postulado como parte de la fisiopatologia de la sepsis. Las e... more Introduccion . El dano oxidativo es postulado como parte de la fisiopatologia de la sepsis. Las especies reactivas de oxigeno (reactive oxygen species, ROS) serian su causa. No hay evidencia de los niveles de ROS medidos en sangre venosa en pacientes septicos y su relacion con la mortalidad en terapia intensiva (UTI). Objetivos. Observar si hay diferencias entre los niveles de ROS medidos en sangre venosa en pacientes septicos y aquellos obtenidos en controles sanos y determinar si los pacientes que mueren en UTI tienen niveles de ROS mas altos que los que sobreviven. Material y metodos. Estudio prospectivo observacional. Se incluyeron pacientes septicos internados en UTI mayores de 18 anos y menores 80 anos entre 2014 y 2016 y voluntarios sanos. Se excluyeron pacientes embarazadas. Se midio con la tecnica de diclorofluorosceina. Resultados. No hubo diferencias significativas en los niveles de ROS medidos con diclorofluorosceina entre pacientes septicos y voluntarios sanos (emision...

Research paper thumbnail of Nasoenteric tube doppler guided insertion. A case report and review of literature

European Journal of Clinical Nutrition

Nasoenteric tube placement is needed in patients with gastric enteral feeding intolerance or high... more Nasoenteric tube placement is needed in patients with gastric enteral feeding intolerance or high risk of aspiration. Several techniques are described. Ultrasound is used more commonly for gastric tube placement, but also is described in enteral tube feeding placement. Doppler technique with cold water injection is not described in the literature. We describe a new and easy to realize technique. A case of a 65 years old male patient in the intensive care unit (ICU) with gastroparesis is described. Before beginning a prokinetic drug was administered. In this technique gastric tube placement was bedside assessed with ultrasound, and then the tube was progressed with cold water injection. Duodenal position was confirmed with doppler ultrasound. Ultrasound and doppler technique for nasoenteric tube placement could be a feasible technique to use in the ICU. More studies are needed to assess the effectiveness of the technique.

Research paper thumbnail of Utility of Respiratory Polygraphy in the Intensive Care Unit

CHEST Journal, 2013

ABSTRACT

Research paper thumbnail of Utility of Respiratory Polygraphy in the Intensive Care Unit

CHEST Journal, 2013

ABSTRACT

Research paper thumbnail of Risk Factors and Precipitants Associated With Delirium in Critical Ill Patients: Proposal of a Predictive Model

Research paper thumbnail of Everolimus Related Acute Respiratory Distress Syndrome

CHEST Journal, 2013

ABSTRACT