Jaume Mesquida - Academia.edu (original) (raw)
Papers by Jaume Mesquida
The non-invasive monitoring of the hemodynamics and metabolism of the sternocleidomastoid muscle ... more The non-invasive monitoring of the hemodynamics and metabolism of the sternocleidomastoid muscle (SCM) during respiration became a topic of increased interest partially due to the increased use of mechanical ventilation during the COVID-19 pandemic. Near-infrared diffuse optical spectroscopies were proposed as potential practical monitors of increased recruitment of SCM during respiratory distress. They can provide clinically relevant information on the degree of the patient’s respiratory effort that is needed to maintain an optimal minute ventilation, with potential clinical application ranging from evaluating chronic pulmonary diseases to more acute settings, such as acute respiratory failure, or to determine the readiness to wean from invasive mechanical ventilation.In this paper, we present a detailed characterization of the optical properties (wave-length dependent absorption and reduced scattering coefficients) and hemodynamic properties (oxy-, deoxy- and total hemoglobin conc...
Biophotonics in Exercise Science, Sports Medicine, Health Monitoring Technologies, and Wearables III
European Journal of Trauma and Emergency Surgery
Purpose Persistent occult hypoperfusion after initial resuscitation is strongly associated with i... more Purpose Persistent occult hypoperfusion after initial resuscitation is strongly associated with increased morbidity and mortality after severe trauma. The objective of this study was to analyze regional tissue oxygenation, along with other global markers, as potential detectors of occult shock in otherwise hemodynamically stable trauma patients. Methods Trauma patients undergoing active resuscitation were evaluated 8 h after hospital admission with the measurement of several global and local hemodynamic/metabolic parameters. Apparently hemodynamically stable (AHD) patients, defined as having SBP ≥ 90 mmHg, HR < 100 bpm and no vasopressor support, were followed for 48 h, and finally classified according to the need for further treatment for persistent bleeding (defined as requiring additional red blood cell transfusion), initiation of vasopressors and/or bleeding control with surgery and/or angioembolization. Patients were labeled as “Occult shock” (OS) if they required any interv...
Journal of clinical monitoring and computing, Jan 9, 2015
Early recognition of tissue hypoperfusion, and monitoring tissue response to resuscitation interv... more Early recognition of tissue hypoperfusion, and monitoring tissue response to resuscitation interventions, are key points in the management of critically ill patients. In the present issue of J Clin Monit Comput, Dr. Koch and coworkers present the results of a study evaluating regional and global markers of tissue perfusion in a population of septic shock patients. We propose an integrative approach to tissue perfusion assessment, where combining both, global and regional variables, might account for a better understanding of tissue oxygenation status, and might prove useful for septic shock patients' management.
Neurophotonics
Ayaz et al.: Optical imaging and spectroscopy for the study of the human brain: status report Neu... more Ayaz et al.: Optical imaging and spectroscopy for the study of the human brain: status report Neurophotonics S24001-2 Vol. 9(S2)
Translational Biophotonics: Diagnostics and Therapeutics
The VASCOVID project aims to develop an hybrid diffuse optical device with a vascular occlusion p... more The VASCOVID project aims to develop an hybrid diffuse optical device with a vascular occlusion protocol for evaluating endothelial and microvascular health in severe COVID-19 patients admitted to the ICU.
Additional file 1. Depiction of the StO2-parameters obtained as results of the vascular occlusion... more Additional file 1. Depiction of the StO2-parameters obtained as results of the vascular occlusion test (VOT).
Additional file 2: Figure S1. StO2-derived score according to extubation outcome. The cut-off val... more Additional file 2: Figure S1. StO2-derived score according to extubation outcome. The cut-off value of − 1.23 is also represented.
Additional file 1: Table S1. Suspected etiology of extubation failure.
Journal of clinical monitoring and computing, 2017
info:eu-repo/semantics/publishedVersio
Journal of clinical monitoring and computing, Jan 17, 2018
Central venous-to-arterial carbon dioxide difference (PCO), and its correction by the arterial-to... more Central venous-to-arterial carbon dioxide difference (PCO), and its correction by the arterial-to-venous oxygen content difference (PCO/CO) have been proposed as additional tools to evaluate tissue hypoxia. Since the relationship between pressure and content of CO (CCO) might be affected by several factors, some authors advocate for the use of CCO/CO. The aim of the present study was to explore the factors that might intervene in the difference between PCO/CO and CCO/CO, and to analyze their association with mortality. Observational study in a 30-bed mixed ICU. Fifty-two septic shock patients within the first 24 h of ICU admission were studied. After restoration of mean arterial pressure, hemodynamic and metabolic parameters were evaluated. A total of 110 sets of measurements were performed. Simultaneous PCO/CO and CCO/CO values were correlated, but agreement analysis showed a significant proportional bias. The difference between PCO/CO and CCO/CO was independently associated with p...
Journal of clinical monitoring and computing, Jan 12, 2018
We want to thank Drs. Chiarla and Giovannini for their interest and their insightful comments on ... more We want to thank Drs. Chiarla and Giovannini for their interest and their insightful comments on our study [1, 2]. We absolutely agree with the conclusion that PcvaCO2/CavO2 reflects not only the ongoing anaerobic CO2 production, but also the buffer power of blood [2], and we congratulate Chiarla and Giovannini for their concise physiological elucidation. We also believe that the combination of these effects is highly responsible for the enhanced prognostic significance of this variable. In addition to their contribution to a deeper understanding of the magnifying effect of pH on PcvaCO2/CavO2 prognostic value, the Authors emphasize their special interest in several cases where CcvaCO2/CavO2 exceeded PcvaCO2/CavO2. As the authors already comment, over the physiological range of CO2 contents, where the relationship between CO2 content and pressure remains quasi linear, the difference should be close to zero, but some variability could derive from the amplification of slight measurement errors. From a theoretical point of view, CcvaCO2 will exceed PcvaCO2 in those cases where the proportion of the free form of CO2 is diminished, especially at the venous site, consequently narrowing the central venous-to-arterial CO2 pressure difference, as compared to the CO2 content. Since the decrease in the free form of CO2 depends on pH and oxygen, this phenomenon should be expected in alkalosis and hypoxia situations. Indeed, our observations are in agreement with the effect of pH on this relationship (Fig. 2 of the original study [1]), and it becomes particularly relevant during metabolic acidosis. The effect of profound hypoxia can not be inferred from our data, but hypothesizing that tissue hypoxia would result in lower PcvaCO2 as compared to CcvaCO2 seems complicated, since in septic shock situations the effect of tissue hypoxia on the hemoglobin-CO2 dissociation curve would not be isolated, and hypoxic conditions would also lead to anaerobic metabolism, causing metabolic acidosis, and therefore causing the contrary effect. Although increased CO2 binding to hemoglobin in hypoxic conditions is a well-known effect that ensures CO2 removal from the tissues (Haldane effect) [3], the shift in the PCO2/CCO2 relationship as results of metabolic acidosis is also determinant in the buffer capacity of blood, resulting in increased free CO2 for a given CCO2. Of note, as observed with pH, a significant and proportional magnifying effect in our study was observed in situations where hyperoxia was confirmed at the venous site, although this effect was limited in our range of venous oxygenation values. However, to some extent, our observations are bad news for the clinicians. There are currently an infinity of prognostic variables in severe sepsis and septic shock, but what clinicians demand are variables that will help in taking decisions at the bedside. In the hemodynamic resuscitation process, detecting the oxygen consumption (VO2)/supply (DO2) dependency is crucial in order to decide to further increase oxygen delivery to the tissues. On that behalf, venous-toarterial CO2 (either content or pressure) to arterial–venous O2 content difference ratios seemed powerful tools to detect the presence of ongoing anaerobic metabolism, with higher performance than lactate not only for anaerobic metabolism detection purposes, but also for short-term changes in response to hemodynamic interventions [4, 5]. Monnet et al. [5] observations reinforced the idea that PcvaCO2/CavO2 could play an important role in the detection of VO2/DO2 dependency. Regrettably, our results suggest that elevations in PcvaCO2/CavO2 might not only reflect this flow-dependent tissue hypoxia, and therefore, the interpretation of this variable might be much more complex. To date, we do not dispose of a holy grail for VO2/DO2 dependency detection at the bedside, and further exploring and understanding the limitations of the few metabolic * J. Mesquida jmesquida@tauli.cat
Current opinion in critical care, 2017
To evaluate the existing evidence on the passive leg raising (PLR) test for fluid responsiveness ... more To evaluate the existing evidence on the passive leg raising (PLR) test for fluid responsiveness prediction. It has been well established that either insufficient or excessive fluid administration derives in worse outcomes in critically ill patients, highlighting that a more accurate assessment of fluid management is required. Accordingly, several cardiovascular indices have been tested to improve our ability to predict patients' response to fluid loading at the bedside, the so-called functional hemodynamic monitoring. The standardized PLR is a relatively novel maneuver that, over the past 10 years, has repeatedly demonstrated high sensitivity and specificity for fluid responsiveness prediction. The current review underlines that PLR is an easy-to-perform and reliable method to assess fluid responsiveness. Its excellent performance is maintained even in many situations in which other dynamic predictive indices are not consistent and represents a valid alternative to the fluid ch...
Current Opinion in Critical Care, 2015
Purpose of review In shock states, optimizing intravascular volume is crucial to promote an adequ... more Purpose of review In shock states, optimizing intravascular volume is crucial to promote an adequate oxygen delivery to the tissues. Our current practice in fluid management pivots on the Frank-Starling law of the heart, and the effects of fluids are measured according to the induced changes on stroke volume. The purpose of this review is to evaluate the boundaries of current macrohemodynamic approach to fluid administration, and to introduce the microcirculatory integration as a fundamental part of tissue perfusion monitoring. Recent findings Macrocirculatory changes induced by volume expansion are not always coupled to proportional changes in microcirculatory perfusion. Loss of hemodynamic coherence limits the value of guiding fluid therapy according to macrohemodynamics, and highlights the importance of evaluating the ultimate target of volume administration, the microcirculation.
BioMed Research International, 2013
According to current critical care management guidelines, the overall hemodynamic optimization pr... more According to current critical care management guidelines, the overall hemodynamic optimization process seeks to restore macrocirculatory oxygenation, pressure, and flow variables. However, there is increasing evidence demonstrating that, despite normalization of these global parameters, microcirculatory and regional perfusion alterations might occur, and persistence of these alterations has been associated with worse prognosis. Such observations have led to great interest in testing new technologies capable of evaluating the microcirculation. Near-infrared spectroscopy (NIRS) measures tissue oxygen saturation (StO2) and has been proposed as a noninvasive system for monitoring regional circulation. The present review aims to summarize the existing evidence on NIRS and its potential clinical utility in different scenarios of critically ill patients.
Intensive Care Medicine, 2012
Shock, 2011
This prospective study was aimed to test the hypothesis that tissue hemoglobin oxygen saturation ... more This prospective study was aimed to test the hypothesis that tissue hemoglobin oxygen saturation (StO 2) measured noninvasively using near-infrared spectroscopy is a reliable indicator of global oxygen delivery (DO 2) measured invasively using a pulmonary artery catheter (PAC) in patients with septic shock. The study setting was a 26-bed medicalsurgical intensive care unit at a university hospital. Subjects were adult patients in septic shock who required PAC hemodynamic monitoring for resuscitation. Interventions included transient ischemic challenge on the forearm. After blood pressure normalization, hemodynamic and oximetric PAC variables and, simultaneously, steady-state StO 2 and its changes from ischemic challenge (deoxygenation and reoxygenation rates) were measured. Fifteen patients were studied. All the patients had a mean arterial pressure above 65 mmHg. The DO 2 index (iDO 2) range in the studied population was 215 to 674 mL O 2 /min per m 2. The mean mixed venous oxygen saturation value was 61% T 10%, mean cardiac index was 3.4 T 0.9 L/min per m 2 , and blood lactate level was 4.6 T 2.7 mmol/L. Steady-state StO 2 significantly correlated with iDO 2 , arterial and venous O 2 content, and O 2 extraction ratio. A StO 2 cutoff value of 75% predicted iDO 2 below 450, with a sensitivity of 0.9 and a specificity of 0.9. In patients in septic shock and normalized MAP, low StO 2 reflects extremely low iDO 2. Steadystate StO 2 does not correlate with moderately low iDO 2 , indicating poor sensitivity of StO 2 to rule out hypoperfusion.
The non-invasive monitoring of the hemodynamics and metabolism of the sternocleidomastoid muscle ... more The non-invasive monitoring of the hemodynamics and metabolism of the sternocleidomastoid muscle (SCM) during respiration became a topic of increased interest partially due to the increased use of mechanical ventilation during the COVID-19 pandemic. Near-infrared diffuse optical spectroscopies were proposed as potential practical monitors of increased recruitment of SCM during respiratory distress. They can provide clinically relevant information on the degree of the patient’s respiratory effort that is needed to maintain an optimal minute ventilation, with potential clinical application ranging from evaluating chronic pulmonary diseases to more acute settings, such as acute respiratory failure, or to determine the readiness to wean from invasive mechanical ventilation.In this paper, we present a detailed characterization of the optical properties (wave-length dependent absorption and reduced scattering coefficients) and hemodynamic properties (oxy-, deoxy- and total hemoglobin conc...
Biophotonics in Exercise Science, Sports Medicine, Health Monitoring Technologies, and Wearables III
European Journal of Trauma and Emergency Surgery
Purpose Persistent occult hypoperfusion after initial resuscitation is strongly associated with i... more Purpose Persistent occult hypoperfusion after initial resuscitation is strongly associated with increased morbidity and mortality after severe trauma. The objective of this study was to analyze regional tissue oxygenation, along with other global markers, as potential detectors of occult shock in otherwise hemodynamically stable trauma patients. Methods Trauma patients undergoing active resuscitation were evaluated 8 h after hospital admission with the measurement of several global and local hemodynamic/metabolic parameters. Apparently hemodynamically stable (AHD) patients, defined as having SBP ≥ 90 mmHg, HR < 100 bpm and no vasopressor support, were followed for 48 h, and finally classified according to the need for further treatment for persistent bleeding (defined as requiring additional red blood cell transfusion), initiation of vasopressors and/or bleeding control with surgery and/or angioembolization. Patients were labeled as “Occult shock” (OS) if they required any interv...
Journal of clinical monitoring and computing, Jan 9, 2015
Early recognition of tissue hypoperfusion, and monitoring tissue response to resuscitation interv... more Early recognition of tissue hypoperfusion, and monitoring tissue response to resuscitation interventions, are key points in the management of critically ill patients. In the present issue of J Clin Monit Comput, Dr. Koch and coworkers present the results of a study evaluating regional and global markers of tissue perfusion in a population of septic shock patients. We propose an integrative approach to tissue perfusion assessment, where combining both, global and regional variables, might account for a better understanding of tissue oxygenation status, and might prove useful for septic shock patients' management.
Neurophotonics
Ayaz et al.: Optical imaging and spectroscopy for the study of the human brain: status report Neu... more Ayaz et al.: Optical imaging and spectroscopy for the study of the human brain: status report Neurophotonics S24001-2 Vol. 9(S2)
Translational Biophotonics: Diagnostics and Therapeutics
The VASCOVID project aims to develop an hybrid diffuse optical device with a vascular occlusion p... more The VASCOVID project aims to develop an hybrid diffuse optical device with a vascular occlusion protocol for evaluating endothelial and microvascular health in severe COVID-19 patients admitted to the ICU.
Additional file 1. Depiction of the StO2-parameters obtained as results of the vascular occlusion... more Additional file 1. Depiction of the StO2-parameters obtained as results of the vascular occlusion test (VOT).
Additional file 2: Figure S1. StO2-derived score according to extubation outcome. The cut-off val... more Additional file 2: Figure S1. StO2-derived score according to extubation outcome. The cut-off value of − 1.23 is also represented.
Additional file 1: Table S1. Suspected etiology of extubation failure.
Journal of clinical monitoring and computing, 2017
info:eu-repo/semantics/publishedVersio
Journal of clinical monitoring and computing, Jan 17, 2018
Central venous-to-arterial carbon dioxide difference (PCO), and its correction by the arterial-to... more Central venous-to-arterial carbon dioxide difference (PCO), and its correction by the arterial-to-venous oxygen content difference (PCO/CO) have been proposed as additional tools to evaluate tissue hypoxia. Since the relationship between pressure and content of CO (CCO) might be affected by several factors, some authors advocate for the use of CCO/CO. The aim of the present study was to explore the factors that might intervene in the difference between PCO/CO and CCO/CO, and to analyze their association with mortality. Observational study in a 30-bed mixed ICU. Fifty-two septic shock patients within the first 24 h of ICU admission were studied. After restoration of mean arterial pressure, hemodynamic and metabolic parameters were evaluated. A total of 110 sets of measurements were performed. Simultaneous PCO/CO and CCO/CO values were correlated, but agreement analysis showed a significant proportional bias. The difference between PCO/CO and CCO/CO was independently associated with p...
Journal of clinical monitoring and computing, Jan 12, 2018
We want to thank Drs. Chiarla and Giovannini for their interest and their insightful comments on ... more We want to thank Drs. Chiarla and Giovannini for their interest and their insightful comments on our study [1, 2]. We absolutely agree with the conclusion that PcvaCO2/CavO2 reflects not only the ongoing anaerobic CO2 production, but also the buffer power of blood [2], and we congratulate Chiarla and Giovannini for their concise physiological elucidation. We also believe that the combination of these effects is highly responsible for the enhanced prognostic significance of this variable. In addition to their contribution to a deeper understanding of the magnifying effect of pH on PcvaCO2/CavO2 prognostic value, the Authors emphasize their special interest in several cases where CcvaCO2/CavO2 exceeded PcvaCO2/CavO2. As the authors already comment, over the physiological range of CO2 contents, where the relationship between CO2 content and pressure remains quasi linear, the difference should be close to zero, but some variability could derive from the amplification of slight measurement errors. From a theoretical point of view, CcvaCO2 will exceed PcvaCO2 in those cases where the proportion of the free form of CO2 is diminished, especially at the venous site, consequently narrowing the central venous-to-arterial CO2 pressure difference, as compared to the CO2 content. Since the decrease in the free form of CO2 depends on pH and oxygen, this phenomenon should be expected in alkalosis and hypoxia situations. Indeed, our observations are in agreement with the effect of pH on this relationship (Fig. 2 of the original study [1]), and it becomes particularly relevant during metabolic acidosis. The effect of profound hypoxia can not be inferred from our data, but hypothesizing that tissue hypoxia would result in lower PcvaCO2 as compared to CcvaCO2 seems complicated, since in septic shock situations the effect of tissue hypoxia on the hemoglobin-CO2 dissociation curve would not be isolated, and hypoxic conditions would also lead to anaerobic metabolism, causing metabolic acidosis, and therefore causing the contrary effect. Although increased CO2 binding to hemoglobin in hypoxic conditions is a well-known effect that ensures CO2 removal from the tissues (Haldane effect) [3], the shift in the PCO2/CCO2 relationship as results of metabolic acidosis is also determinant in the buffer capacity of blood, resulting in increased free CO2 for a given CCO2. Of note, as observed with pH, a significant and proportional magnifying effect in our study was observed in situations where hyperoxia was confirmed at the venous site, although this effect was limited in our range of venous oxygenation values. However, to some extent, our observations are bad news for the clinicians. There are currently an infinity of prognostic variables in severe sepsis and septic shock, but what clinicians demand are variables that will help in taking decisions at the bedside. In the hemodynamic resuscitation process, detecting the oxygen consumption (VO2)/supply (DO2) dependency is crucial in order to decide to further increase oxygen delivery to the tissues. On that behalf, venous-toarterial CO2 (either content or pressure) to arterial–venous O2 content difference ratios seemed powerful tools to detect the presence of ongoing anaerobic metabolism, with higher performance than lactate not only for anaerobic metabolism detection purposes, but also for short-term changes in response to hemodynamic interventions [4, 5]. Monnet et al. [5] observations reinforced the idea that PcvaCO2/CavO2 could play an important role in the detection of VO2/DO2 dependency. Regrettably, our results suggest that elevations in PcvaCO2/CavO2 might not only reflect this flow-dependent tissue hypoxia, and therefore, the interpretation of this variable might be much more complex. To date, we do not dispose of a holy grail for VO2/DO2 dependency detection at the bedside, and further exploring and understanding the limitations of the few metabolic * J. Mesquida jmesquida@tauli.cat
Current opinion in critical care, 2017
To evaluate the existing evidence on the passive leg raising (PLR) test for fluid responsiveness ... more To evaluate the existing evidence on the passive leg raising (PLR) test for fluid responsiveness prediction. It has been well established that either insufficient or excessive fluid administration derives in worse outcomes in critically ill patients, highlighting that a more accurate assessment of fluid management is required. Accordingly, several cardiovascular indices have been tested to improve our ability to predict patients' response to fluid loading at the bedside, the so-called functional hemodynamic monitoring. The standardized PLR is a relatively novel maneuver that, over the past 10 years, has repeatedly demonstrated high sensitivity and specificity for fluid responsiveness prediction. The current review underlines that PLR is an easy-to-perform and reliable method to assess fluid responsiveness. Its excellent performance is maintained even in many situations in which other dynamic predictive indices are not consistent and represents a valid alternative to the fluid ch...
Current Opinion in Critical Care, 2015
Purpose of review In shock states, optimizing intravascular volume is crucial to promote an adequ... more Purpose of review In shock states, optimizing intravascular volume is crucial to promote an adequate oxygen delivery to the tissues. Our current practice in fluid management pivots on the Frank-Starling law of the heart, and the effects of fluids are measured according to the induced changes on stroke volume. The purpose of this review is to evaluate the boundaries of current macrohemodynamic approach to fluid administration, and to introduce the microcirculatory integration as a fundamental part of tissue perfusion monitoring. Recent findings Macrocirculatory changes induced by volume expansion are not always coupled to proportional changes in microcirculatory perfusion. Loss of hemodynamic coherence limits the value of guiding fluid therapy according to macrohemodynamics, and highlights the importance of evaluating the ultimate target of volume administration, the microcirculation.
BioMed Research International, 2013
According to current critical care management guidelines, the overall hemodynamic optimization pr... more According to current critical care management guidelines, the overall hemodynamic optimization process seeks to restore macrocirculatory oxygenation, pressure, and flow variables. However, there is increasing evidence demonstrating that, despite normalization of these global parameters, microcirculatory and regional perfusion alterations might occur, and persistence of these alterations has been associated with worse prognosis. Such observations have led to great interest in testing new technologies capable of evaluating the microcirculation. Near-infrared spectroscopy (NIRS) measures tissue oxygen saturation (StO2) and has been proposed as a noninvasive system for monitoring regional circulation. The present review aims to summarize the existing evidence on NIRS and its potential clinical utility in different scenarios of critically ill patients.
Intensive Care Medicine, 2012
Shock, 2011
This prospective study was aimed to test the hypothesis that tissue hemoglobin oxygen saturation ... more This prospective study was aimed to test the hypothesis that tissue hemoglobin oxygen saturation (StO 2) measured noninvasively using near-infrared spectroscopy is a reliable indicator of global oxygen delivery (DO 2) measured invasively using a pulmonary artery catheter (PAC) in patients with septic shock. The study setting was a 26-bed medicalsurgical intensive care unit at a university hospital. Subjects were adult patients in septic shock who required PAC hemodynamic monitoring for resuscitation. Interventions included transient ischemic challenge on the forearm. After blood pressure normalization, hemodynamic and oximetric PAC variables and, simultaneously, steady-state StO 2 and its changes from ischemic challenge (deoxygenation and reoxygenation rates) were measured. Fifteen patients were studied. All the patients had a mean arterial pressure above 65 mmHg. The DO 2 index (iDO 2) range in the studied population was 215 to 674 mL O 2 /min per m 2. The mean mixed venous oxygen saturation value was 61% T 10%, mean cardiac index was 3.4 T 0.9 L/min per m 2 , and blood lactate level was 4.6 T 2.7 mmol/L. Steady-state StO 2 significantly correlated with iDO 2 , arterial and venous O 2 content, and O 2 extraction ratio. A StO 2 cutoff value of 75% predicted iDO 2 below 450, with a sensitivity of 0.9 and a specificity of 0.9. In patients in septic shock and normalized MAP, low StO 2 reflects extremely low iDO 2. Steadystate StO 2 does not correlate with moderately low iDO 2 , indicating poor sensitivity of StO 2 to rule out hypoperfusion.