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Papers by XAVIER EDUARDO VELEZ SARMIENTO
Medicina clínica, Jan 25, 1995
Medicina Intensiva, 2011
This study has aimed to study the clinicopathological correlation of patients with secondary acut... more This study has aimed to study the clinicopathological correlation of patients with secondary acute respiratory distress syndrome (ARDS), specifically having extrapulmonary causes. A 22 beds intensive care unit. An observational study of case series. Seventeen patients whose death was caused by acute respiratory distress syndrome were included. A systematic histopathological study was made of all the pulmonary lobes of patients who died in our ICU with the clinical diagnosis of secondary ARDS, who had undergone an autopsy between 1999 and 2009. The Kappa analysis was used to analyze the grade of correlation between the clinical and the pathological diagnosis. The autopsy confirmed to cases of false positive in 17 patients with ARDS (11%). The kappa value was 0.77, so that the concordance analysis was considered to be satisfactory. The clinical criteria for ARDS correlate well with acute alveolar damage (AAD) in the autopsy study in patients with secondary ARDS, although some false positive cases can be observed.
Medicina Intensiva, 2013
To evaluate the efficiency of care in the ICU using a predictive model. A prospective, observatio... more To evaluate the efficiency of care in the ICU using a predictive model. A prospective, observational cohort study Seventeen Spanish polyvalent ICUs. A total of 1956 patients were initially considered (cohort A). Posteriorly, and at 6-year intervals, we documented cohorts B (n=453), C (n=2567) and D (n=711) in one of the studied ICUs. Five standard severity indices were calculated for all cohorts, and with these the standardized mortality ratios (observed/calculated) for each cohort were compared. Multiple regression analysis was used to develop a predictive model of length of stay in the ICU (ICU-LOS). This model was used for calculation of the standardized LOS ratios for each cohort. We analyzed the organizational changes in the studied ICU during these periods in relation to the results obtained. The calculated probability of in-hospital death was 15.4%, versus 14.7% as calculated 24 hours after admission. Actual in-hospital mortality was 20.3%. A final multiple regression model was constructed. Standardized LOS and mortality ratios were 1.8 and 1.2 (cohort B), 0.97 and 1.07 (cohort C), and 0.63 and 1.07 (cohort D), respectively. The progressive improvement in the results observed was related to the introduced organizational and structural changes. The model developed in this study was a good predictor of actual ICU-LOS, and both LOS and mortality analysis could be a good tool for ICU care evaluation.
Medicina Clínica, 2013
Alcohol has been considered an important risk factor for the development of pneumonia since the l... more Alcohol has been considered an important risk factor for the development of pneumonia since the last century. Nevertheless, it was not thought that it had relevant effects on lung structure and functions until recently. Recent studies have shown that the risk for acute respiratory distress syndrome (ARDS) is 2-4 times higher among alcoholic patients with sepsis or trauma, and that alcoholism can play a roll in more than 50% of cases in the pathogenesis of this syndrome. Although alcoholism per se does not cause acute lung injury it predisposes to pulmonary dysfunction after inflammatory stress, that is present in clinical situations that cause ARDS leading to its development and complicating its outcome. Recent investigations in animals and humans with alcohol abuse have uncovered several alterations currently known as the "alcoholic lung". This revision discusses the association between alcohol abuse and lung injury/ARDS and tries to explain the physiopathology along with possible treatments.
Respiratory Medicine, 2011
Diffuse alveolar damage (DAD) is the underlying pathological finding in most cases of acute respi... more Diffuse alveolar damage (DAD) is the underlying pathological finding in most cases of acute respiratory distress syndrome (ARDS). The objective of this study was to compare clinical criteria for ARDS secondary to community acquired pneumonia with autopsy findings of DAD and to determine the discrepancy rate between the two. We compared prospectively obtained clinical diagnosis of ARDS secondary to community acquired pneumonia with autopsy findings of DAD and pneumonia. Forty nine patients dead with a clinical diagnosis of ARDS secondary to pneumonia who underwent autopsy between 1986 and 2004 in our ICU were included with systematic histopathological analysis of all lung lobes. The discrepancy rate between the premortem clinical diagnosis of ARDS secondary to pneumonia and DAD at autopsy was determined. Seven patients were found to have neither infection nor DAD at autopsy. Six patients showed pathologic signs of DAD without evidence of infection. Out of 38 patients meeting clinical criteria for ARDS secondary to pneumonia and proven pneumonia at autopsy, 25 met criteria for DAD at autopsy. Therefore, 18 out of 49 patients who were clinically diagnosed with ARDS did not actually show pathological signs
Journal of Inflammation Research, 2008
Infl ammation is the body's response to insults, which include infection, trauma, and hypersensit... more Infl ammation is the body's response to insults, which include infection, trauma, and hypersensitivity. The inflammatory response is complex and involves a variety of mechanisms to defend against pathogens and repair tissue. In the lung, infl ammation is usually caused by pathogens or by exposure to toxins, pollutants, irritants, and allergens. During infl ammation, numerous types of infl ammatory cells are activated. Each releases cytokines and mediators to modify activities of other infl ammatory cells. Orchestration of these cells and molecules leads to progression of infl ammation. Clinically, acute infl ammation is seen in pneumonia and acute respiratory distress syndrome (ARDS), whereas chronic infl ammation is represented by asthma and chronic obstructive pulmonary disease (COPD). Because the lung is a vital organ for gas exchange, excessive infl ammation can be life threatening. Because the lung is constantly exposed to harmful pathogens, an immediate and intense defense action (mainly infl ammation) is required to eliminate the invaders as early as possible. A delicate balance between infl ammation and anti-infl ammation is essential for lung homeostasis. A full understanding of the underlying mechanisms is vital in the treatment of patients with lung infl ammation. This review focuses on cellular and molecular aspects of lung infl ammation during acute and chronic infl ammatory states.
Intensive Care Medicine, 1992
CHEST Journal, 1997
ABSTRACT
American Journal of Respiratory and Critical Care Medicine, 1997
Despite the fact that the epidemiology of community-acquired pneumonia and nosocomial Legionella ... more Despite the fact that the epidemiology of community-acquired pneumonia and nosocomial Legionella infection is well known, there are no specific reports dealing with severe cases of Legionella pneumophila pneumonia admitted to intensive care units. We undertook a prospective study upon 84 patients with a reliable diagnosis of L. pneumophila pneumonia that required ICU admission. The study assessed the prognostic factors, clinical, radiological and outcome variables of both nosocomial (n = 33) and community-acquired (n = 51) cases of L. pneumophila pneumonia. The following variables were more common in nosocomial acquired as compared to community-acquired Legionella pneumonia: Chronic obstructive pulmonary disease (COPD) (64 versus 41%), cardiac disease (39 versus 10%), chronic renal failure (21 versus 4%), alcoholism (54 versus 18%), septic shock (33 versus 16%), and unilateral chest X-ray involvement (61 versus 39%). The crude mortality rate in this study was 30% (25 of 84) with no differences when comparing mortality between nosocomial (9, 27%) to community-acquired (16, 31%) types. The univariate analysis showed that cardiac disease, diabetes mellitus, creatinine > or = 1.8 mg/dl, septic shock, chest X-ray extension, mechanical ventilation, hyponatremia < or = 136 mEq/L, PACO2/FIO2 < 130, and blood urea levels > or = 30 mg/dl were factors related to poor outcome. On the other hand, the following two variables were related to better outcome: adequate treatment for Legionella and pneumonia improvement. The logistic regression analysis demonstrated that APACHE II score > 15 at admission (RR: 11.5; 95% CI 1.75 to 76.1; p = 0.025), and serum Na levels < or = 136 (RR: 21.3; 95% CI 1.11 to 408; p = 0.023), were the only independent factors related to death. On the other hand, improving pneumonia is associated with better outcome in Legionnaires' disease than for patients not having improving pneumonia (RR: 0.019; 95% CI: 0.036 to 0.106; p < 0.0001). A better understanding of the prognostic factors in cases of severe Legionella pneumonia will optimize our therapeutic approach in this disease and help to decrease both its mortality and morbidity rates.
Medicina Intensiva, 2000
ABSTRACT
Medicina clínica, Jan 25, 1995
Medicina Intensiva, 2011
This study has aimed to study the clinicopathological correlation of patients with secondary acut... more This study has aimed to study the clinicopathological correlation of patients with secondary acute respiratory distress syndrome (ARDS), specifically having extrapulmonary causes. A 22 beds intensive care unit. An observational study of case series. Seventeen patients whose death was caused by acute respiratory distress syndrome were included. A systematic histopathological study was made of all the pulmonary lobes of patients who died in our ICU with the clinical diagnosis of secondary ARDS, who had undergone an autopsy between 1999 and 2009. The Kappa analysis was used to analyze the grade of correlation between the clinical and the pathological diagnosis. The autopsy confirmed to cases of false positive in 17 patients with ARDS (11%). The kappa value was 0.77, so that the concordance analysis was considered to be satisfactory. The clinical criteria for ARDS correlate well with acute alveolar damage (AAD) in the autopsy study in patients with secondary ARDS, although some false positive cases can be observed.
Medicina Intensiva, 2013
To evaluate the efficiency of care in the ICU using a predictive model. A prospective, observatio... more To evaluate the efficiency of care in the ICU using a predictive model. A prospective, observational cohort study Seventeen Spanish polyvalent ICUs. A total of 1956 patients were initially considered (cohort A). Posteriorly, and at 6-year intervals, we documented cohorts B (n=453), C (n=2567) and D (n=711) in one of the studied ICUs. Five standard severity indices were calculated for all cohorts, and with these the standardized mortality ratios (observed/calculated) for each cohort were compared. Multiple regression analysis was used to develop a predictive model of length of stay in the ICU (ICU-LOS). This model was used for calculation of the standardized LOS ratios for each cohort. We analyzed the organizational changes in the studied ICU during these periods in relation to the results obtained. The calculated probability of in-hospital death was 15.4%, versus 14.7% as calculated 24 hours after admission. Actual in-hospital mortality was 20.3%. A final multiple regression model was constructed. Standardized LOS and mortality ratios were 1.8 and 1.2 (cohort B), 0.97 and 1.07 (cohort C), and 0.63 and 1.07 (cohort D), respectively. The progressive improvement in the results observed was related to the introduced organizational and structural changes. The model developed in this study was a good predictor of actual ICU-LOS, and both LOS and mortality analysis could be a good tool for ICU care evaluation.
Medicina Clínica, 2013
Alcohol has been considered an important risk factor for the development of pneumonia since the l... more Alcohol has been considered an important risk factor for the development of pneumonia since the last century. Nevertheless, it was not thought that it had relevant effects on lung structure and functions until recently. Recent studies have shown that the risk for acute respiratory distress syndrome (ARDS) is 2-4 times higher among alcoholic patients with sepsis or trauma, and that alcoholism can play a roll in more than 50% of cases in the pathogenesis of this syndrome. Although alcoholism per se does not cause acute lung injury it predisposes to pulmonary dysfunction after inflammatory stress, that is present in clinical situations that cause ARDS leading to its development and complicating its outcome. Recent investigations in animals and humans with alcohol abuse have uncovered several alterations currently known as the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;alcoholic lung&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. This revision discusses the association between alcohol abuse and lung injury/ARDS and tries to explain the physiopathology along with possible treatments.
Respiratory Medicine, 2011
Diffuse alveolar damage (DAD) is the underlying pathological finding in most cases of acute respi... more Diffuse alveolar damage (DAD) is the underlying pathological finding in most cases of acute respiratory distress syndrome (ARDS). The objective of this study was to compare clinical criteria for ARDS secondary to community acquired pneumonia with autopsy findings of DAD and to determine the discrepancy rate between the two. We compared prospectively obtained clinical diagnosis of ARDS secondary to community acquired pneumonia with autopsy findings of DAD and pneumonia. Forty nine patients dead with a clinical diagnosis of ARDS secondary to pneumonia who underwent autopsy between 1986 and 2004 in our ICU were included with systematic histopathological analysis of all lung lobes. The discrepancy rate between the premortem clinical diagnosis of ARDS secondary to pneumonia and DAD at autopsy was determined. Seven patients were found to have neither infection nor DAD at autopsy. Six patients showed pathologic signs of DAD without evidence of infection. Out of 38 patients meeting clinical criteria for ARDS secondary to pneumonia and proven pneumonia at autopsy, 25 met criteria for DAD at autopsy. Therefore, 18 out of 49 patients who were clinically diagnosed with ARDS did not actually show pathological signs
Journal of Inflammation Research, 2008
Infl ammation is the body's response to insults, which include infection, trauma, and hypersensit... more Infl ammation is the body's response to insults, which include infection, trauma, and hypersensitivity. The inflammatory response is complex and involves a variety of mechanisms to defend against pathogens and repair tissue. In the lung, infl ammation is usually caused by pathogens or by exposure to toxins, pollutants, irritants, and allergens. During infl ammation, numerous types of infl ammatory cells are activated. Each releases cytokines and mediators to modify activities of other infl ammatory cells. Orchestration of these cells and molecules leads to progression of infl ammation. Clinically, acute infl ammation is seen in pneumonia and acute respiratory distress syndrome (ARDS), whereas chronic infl ammation is represented by asthma and chronic obstructive pulmonary disease (COPD). Because the lung is a vital organ for gas exchange, excessive infl ammation can be life threatening. Because the lung is constantly exposed to harmful pathogens, an immediate and intense defense action (mainly infl ammation) is required to eliminate the invaders as early as possible. A delicate balance between infl ammation and anti-infl ammation is essential for lung homeostasis. A full understanding of the underlying mechanisms is vital in the treatment of patients with lung infl ammation. This review focuses on cellular and molecular aspects of lung infl ammation during acute and chronic infl ammatory states.
Intensive Care Medicine, 1992
CHEST Journal, 1997
ABSTRACT
American Journal of Respiratory and Critical Care Medicine, 1997
Despite the fact that the epidemiology of community-acquired pneumonia and nosocomial Legionella ... more Despite the fact that the epidemiology of community-acquired pneumonia and nosocomial Legionella infection is well known, there are no specific reports dealing with severe cases of Legionella pneumophila pneumonia admitted to intensive care units. We undertook a prospective study upon 84 patients with a reliable diagnosis of L. pneumophila pneumonia that required ICU admission. The study assessed the prognostic factors, clinical, radiological and outcome variables of both nosocomial (n = 33) and community-acquired (n = 51) cases of L. pneumophila pneumonia. The following variables were more common in nosocomial acquired as compared to community-acquired Legionella pneumonia: Chronic obstructive pulmonary disease (COPD) (64 versus 41%), cardiac disease (39 versus 10%), chronic renal failure (21 versus 4%), alcoholism (54 versus 18%), septic shock (33 versus 16%), and unilateral chest X-ray involvement (61 versus 39%). The crude mortality rate in this study was 30% (25 of 84) with no differences when comparing mortality between nosocomial (9, 27%) to community-acquired (16, 31%) types. The univariate analysis showed that cardiac disease, diabetes mellitus, creatinine > or = 1.8 mg/dl, septic shock, chest X-ray extension, mechanical ventilation, hyponatremia < or = 136 mEq/L, PACO2/FIO2 < 130, and blood urea levels > or = 30 mg/dl were factors related to poor outcome. On the other hand, the following two variables were related to better outcome: adequate treatment for Legionella and pneumonia improvement. The logistic regression analysis demonstrated that APACHE II score > 15 at admission (RR: 11.5; 95% CI 1.75 to 76.1; p = 0.025), and serum Na levels < or = 136 (RR: 21.3; 95% CI 1.11 to 408; p = 0.023), were the only independent factors related to death. On the other hand, improving pneumonia is associated with better outcome in Legionnaires' disease than for patients not having improving pneumonia (RR: 0.019; 95% CI: 0.036 to 0.106; p < 0.0001). A better understanding of the prognostic factors in cases of severe Legionella pneumonia will optimize our therapeutic approach in this disease and help to decrease both its mortality and morbidity rates.
Medicina Intensiva, 2000
ABSTRACT