Proteolysis in septic shock patients: plasma peptidomic patterns are associated with mortality.

BACKGROUND: Uncontrolled proteolysis contributes to cell injury and organ dysfunction in animal models of circulatory shock. We investigated in humans the relationship between septic shock, proteolysis, and outcome. METHODS: Intensive care patients with septic shock (n=29) or sepsis (n=6) and non-hospitalised subjects (n=9) were recruited as part of the prospective observational trial 'ShockOmics' (ClinicalTrials.gov Identifier NCT02141607). A mass spectrometry-based approach was used to analyse the plasma peptidomes and the origin of circulating peptides from proteolysis in the enrolled subjects. RESULTS: Evidence of systemic proteolysis was indicated by a larger number of circulating peptides in septic shock patients, compared with septic patients and non-hospitalised healthy subjects. The peptide count and abundance in the septic shock patients were greater in patients who died (n=6) than in survivors (n=23), suggesting an association between magnitude of proteolysis and outcome. In silico analysis of the peptide sequences and of the sites of cleavage on the proteins of origin indicated a predominant role for serine proteases, such as chymotrypsin, and matrix metalloproteases in causing the observed proteolytic degradation. CONCLUSIONS: Systemic proteolysis is a novel fundamental pathological mechanism in septic shock. Plasma peptidomics is proposed as a new tool to monitor clinical trajectory in septic shock patients. CLINICAL TRIAL REGISTRATION: NCT02141607.

Management of myocardial dysfunction in septic shock. Potential role of extracorporeal membrane oxygenation / Manejo de la disfunción miocárdica en el shock séptico. Potencial papel de la oxigenación por membrana extracorpórea

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Cobertura vacunal de la gripe en el personal del Hospital Universitario de Fuenlabrada / Strategies and influenza vaccination coverage in the staff of Fuenlabrada Hospital Universitary

Objetivos: la gripe es una enfermedad que ocasiona un alto gasto sanitario, por lo que es necesario implementar todas las medidas necesarias para evitar su transmisión, una de ellas es la vacunación antigripal de los trabajadores del ámbito sanitario, que evita el contagio tanto del paciente hacia el personal, como del personal hacia el paciente. El objetivo principal del estudio fue conocer la cobertura vacunal antigripal entre el personal del Hospital Universitario de Fuenlabrada, así como los objetivos secundarios analizar la cobertura vacunal por profesión, edad y año de vacunación, y establecer estrategias de vacunación, para aumentar la adherencia del personal hospitalario. Material y Métodos: se realizó un estudio descriptivo longitudinal entre el año 2006 y 2015 en el Hospital Universitario de Fuenlabrada, que tuvo una media de 1.505 workers trabajadores entre los años 2006 a 2015.Variables de estudio: tipo de profesión, edad y número de vacunas administradas. Resultados: se vacunó un total de 2.749 personas en los años desde 2006-2015, con un índice general de cobertura vacunal de 18,25%. La cobertura vacunal total fue mayor en el año 2009, año de la epidemia de Gripe A (H1N1) donde en Índice de vacunación fue 38,36%, y el año 2007 con el más bajo registro vacunal, con un Índice de 13,95%. Por categorías profesionales el personal no sanitario se vacuna más (25,64%) que el personal sanitario (17,00%); y por rango de edades se vacuna más entre los 41-50 años y menos entre los menores e iguales a 30 años. Conclusiones: las coberturas vacunales se incrementan en los años en los que aparecen ondas epidémicas específicas, como la ocurrida en el año 2009. La modificación en la estrategia de vacunación, generando mayor adherencia del profesional, una educación específica y facilitando la accesibilidad de horario y acudiendo a sus unidades sin necesidad de desplazamiento del personal, ayudará significativamente al aumento de la aceptación de la vacunación (AU)

Objectives: the flu is a disease which causes a high health care costs. To avoid the contagion, both of the patient toward the staff and the staff to the patient, is the recommended influenza vaccination of healthcare workers. The main objective of the study was to assess the coverage of influenza vaccination in Fuenlabrada Hospital University of workers between the years 2006 to 2015. Secondary objectives: the analysis of the vaccination coverage by type of profession, age and year of vaccination, and finally to assess a strategic planning of flu vaccination. Material and methods: the hospital has an average population of 20171,505 workers, in the study period 2006-2015. Descriptive study was conducted by analyzing longitudinal vaccination coverage. Results: 2,749 healthcare workers ere vaccinated a total of in the years from 2006-2015, with a general index of vaccine coverage of 18.25%. The vaccine coverage was higher in the year 2009, the year of the last epidemic Influenza A (H1N1), with a vaccination in index of 38.36 %. The worst vaccine registry is obtained in the year 2007 with an index of 13.95 %. Professional categories non-health personnel is more vaccine (25.64 %) that the health personnel (17.00 %). Vaccine is more in the range between the ages of 41-50 years and less between minors and equal to 30 years. Conclusions: the vaccine coverage increases in those years in which specific epidemic waves appear, as occurred in the year 2009. It seems necessary a odification of the vaccination strategy, generating greater adhesion of the professional, a specific education and facilitating schedules and flocking to their units (AU)

Declining mortality due to severe sepsis and septic shock in Spanish intensive care units: A two-cohort study in 2005 and 2011 / Disminución de la mortalidad de la sepsis grave y shock séptico en las ucis españolas: un estudio de dos cohortes en 2005 y 2011

OBJECTIVE: To analyze the evolution of sepsis-related mortality in Spanish Intensive Care Units (ICUs) following introduction of the Surviving Sepsis Campaign (SSC) guidelines and the relationship with sepsis process-of-care. DESIGN: A prospective cohort study was carried out, with the inclusion of all consecutive patients presenting severe sepsis or septic shock admitted to 41 Spanish ICUs during two time periods: 2005 (Edusepsis study pre-intervention group) and 2011 (ABISS-Edusepsis study pre-intervention group). Scope: Patients with severe sepsis or septic shock admitted to Spanish ICUs. PATIENTS: All ICU admissions from the emergency department or wards and all ICU patients with a diagnosis of severe sepsis or septic shock. A total of 1348 patients were included: 630 in the 2005 group and 718 in the 2011 group. Intervention: None. Primary endpoints: ICU mortality, 28-day mortality and Hospital mortality, hospital length of stay, ICU length of stay and compliance with the resuscitation bundle. RESULTS: Compliance with the resuscitation bundle was significantly greater in the 2011 group (5.7% vs. 9.9%; p = 0.005), and was associated to lower mortality (OR 0.602 [0.365-0.994]; p = 0.048). The 2011 group had lower absolute in-hospital mortality (44.0% vs. 32.6%; p = 0.01), 28-day mortality (36.5% vs. 23.0%; p = 0.01), and adjusted mortality (OR 0.64 [0.49-0.83], p = 0.001). CONCLUSIONS: Mortality related to severe sepsis or septic shock in Spain decreased between two patient cohorts in 2005 and 2011, and was attributable to earliness and improvement in sepsis care

OBJETIVO: Analizar la evolución de la mortalidad relacionada con la sepsis en las unidades de cuidados intensivos (UCI) españolas desde la introducción de las directrices Surviving Sepsis Campaing y la relación con el proceso de atención de la sepsis. DISEÑO: Estudio prospectivo de cohortes. Se incluyeron de manera consecutiva, todos los pacientes con sepsis grave o shock séptico ingresados en 41 UCI españolas durante 2 periodos de tiempo: en 2005 (grupo pre-intervención en el estudio Edusepsis) y en 2011 (grupo pre-intervención en el estudio ABISS-Edusepsis). Ámbito: Pacientes con sepsis grave o shock séptico ingresados en las UCI españolas. PACIENTES: Todos los ingresos en UCI procedentes de Urgencias o planta y todos los pacientes de UCI con diagnóstico de sepsis grave/shock séptico. Se incluyeron 1348 pacientes: 630 del grupo de 2005 y 718 del grupo de 2011. Intervención: Ninguna. Variables de interés principal: Mortalidad en UCI, a 28 días y hospitalaria, estancia en la UCI y en el hospital y cumplimiento con el bundle de reanimación. RESULTADOS: El cumplimiento del bundle de reanimación fue significativamente mayor en el grupo de 2011 (5,7 frente a 9,9%, p = 0,005) y se asoció con una menor mortalidad (OR 0,602 [0,365 a 0,994], p = 0,048). El grupo de 2011 tuvo una menor mortalidad absoluta hospitalaria (44,0 frente a 32,6%, p = 0,01), mortalidad a los 28 días (36,5 frente a 23,0%, p = 0,01) y mortalidad ajustada (OR 0,64 [0,49 a 0,83], p = 0,001). CONCLUSIONES: La mortalidad relacionada con la sepsis grave y el shock séptico en España disminuyó entre las 2 cohortes de pacientes de 2005 y 2011, atribuible a la precocidad y las mejoras en la atención de la sepsis

Declining mortality due to severe sepsis and septic shock in Spanish intensive care units: A two-cohort study in 2005 and 2011.

OBJECTIVE: To analyze the evolution of sepsis-related mortality in Spanish Intensive Care Units (ICUs) following introduction of the Surviving Sepsis Campaign (SSC) guidelines and the relationship with sepsis process-of-care. DESIGN: A prospective cohort study was carried out, with the inclusion of all consecutive patients presenting severe sepsis or septic shock admitted to 41 Spanish ICUs during two time periods: 2005 (Edusepsis study pre-intervention group) and 2011 (ABISS-Edusepsis study pre-intervention group). SCOPE: Patients with severe sepsis or septic shock admitted to Spanish ICUs. PATIENTS: All ICU admissions from the emergency department or wards and all ICU patients with a diagnosis of severe sepsis or septic shock. A total of 1348 patients were included: 630 in the 2005 group and 718 in the 2011 group. INTERVENTION: None. PRIMARY ENDPOINTS: ICU mortality, 28-day mortality and Hospital mortality, hospital length of stay, ICU length of stay and compliance with the resuscitation bundle. RESULTS: Compliance with the resuscitation bundle was significantly greater in the 2011 group (5.7% vs. 9.9%; p=0.005), and was associated to lower mortality (OR 0.602 [0.365-0.994]; p=0.048). The 2011 group had lower absolute in-hospital mortality (44.0% vs. 32.6%; p=0.01), 28-day mortality (36.5% vs. 23.0%; p=0.01), and adjusted mortality (OR 0.64 [0.49-0.83], p=0.001). CONCLUSIONS: Mortality related to severe sepsis or septic shock in Spain decreased between two patient cohorts in 2005 and 2011, and was attributable to earliness and improvement in sepsis care.

¿Se puede controlar el Formaldehído? / Is it possible to control formaldehyde?

El Formaldehido es utilizado ampliamente en Anatomía Patológica para fijar y conservar las muestras, desde el 1 de Enero de 2016 ha entrado en vigor la nueva clasificación de este agente como cancerígeno, por ello es importante la evaluación de riesgo ante tal exposición. Objetivo: demostrar la efectividad de la aplicación de medidas preventivas para disminuir la exposición al formaldehido en salas de tallado de laboratorios de Anatomía Patológica. Metodología: se realizó una valoración ambiental de la exposición al formaldehido, en la sala de tallado del Hospital Universitario de Fuenlabrada, en los puestos de trabajo de técnico y facultativo de Anatomía Patológica, en el año 2008 y posteriormente en el 2012 tras aplicar medidas preventivas. El método de muestreo seguido fue el Método NIOSH 2016 Determinación de Formaldehido en Aire. Método de absorción en Gel de sílice tratado con 2,4- dinitrophenylhydrazine y se compararon los resultados con el Valor Limite Ambiental de Corta Exposición (VLA-EC: 0.37 mg/ m3) establecido en la guía de «Limites de Exposición Profesional para Agentes Químicos» del Instituto Nacional de Seguridad e Higiene en el Trabajo. Resultados: el índice de exposición en 2012 después de incrementar la ventilación (22 renovaciones por hora en sala de tallado y a 15 renovaciones por hora en almacén de muestras) y de efectuar almacenamiento independiente con extracción localizada, es de una Media Geométrica (MG) ￡ 0.5 siendo el valor aceptable. Conclusiones: La ventilación general y el almacenamiento independiente son medidas preventivas con gran impacto, sin embargo lo recomendado para controlar tal exposición es la sustitución del formaldehido por otro producto de menor toxicidad y posteriormente las modificaciones de los procedimientos de trabajo que esto conlleve (AU)

Formaldehyde is widely used in Pathology to set and store samples. From January 1, 2016 this agent was classified as carcinogen, so it is important to risk assessment to such exposure. Objective: To demonstrate the effectiveness of preventive measures to reduce exposure to formaldehyde in rooms carved Laboratory of Pathology. Methodology: We made an environmental assessment of formaldehyde exposure in the room carved from Hospital Universitario de Fuenlabrada, in the jobs of technician and pathologist, in 2008 and later in 2012 after preventive measures. The sampling method was followed NIOSH Method 2016 Determination of Formaldehyde in Air. Absorption method silica gel treated with 2,4- dinitrophenylhydrazine and the results were compared with the Environmental Exposure Limit Value Short (STEL: 0.37 mg / m3) established in the guide «Occupational Exposure Limits for Chemical Agents» National Institute for Safety and Health at Work. Results: the exposure index in 2012 after increasing ventilation (22 air changes per hour in room carved and 15 air changes per hour in store samples) and perform independent storage localized extraction is a geometric mean (GM) 0.5 being the acceptable value. Conclusions: General ventilation and separate storage are preventive measures with great impact, however recommended to control such exposure is the substitution of formaldehyde by another product of lower toxicity and subsequent changes in work procedures that this entails (AU)

Eliminación extracorpórea de CO2: fundamentos fisiológicos y técnicos y principales indicaciones / Extracorporeal CO2 removal: technical and physiological fundaments and principal indications

Recientemente las mejoras tecnológicas han permitido reducir la complejidad de los dispositivos de oxigenación por membrana extracorpórea, dando paso al desarrollo de dispositivos específicos para la eliminación extracorpórea de CO2. Estos dispositivos tienen un montaje más simple y utilizan flujos sanguíneos más bajos, lo que potencialmente disminuye las complicaciones vasculares y hemodinámicas. Estudios experimentales han demostrado la factibilidad, eficacia y seguridad de la eliminación extracorpórea de CO2 y algunos de sus efectos en humanos. Esta técnica, que fue concebida como un tratamiento complementario en los pacientes con SDRA grave, permite la optimización de la ventilación protectora e incluso ha abierto el camino a nuevos conceptos, como lo que se ha denominado ventilación «ultraprotectora», cuyos beneficios aún están por determinarse. Además, la eliminación extracorpórea de CO2 se está implementando en pacientes con insuficiencia respiratoria hipercápnica agudizada con resultados prometedores. En esta revisión describiremos los fundamentos fisiológicos y técnicos de esta terapia y sus distintas variantes, así como la evidencia clínica disponible hasta la fecha, enfocados en su potencial en el paciente con insuficiencia respiratoria

In recent years, technological improvements have reduced the complexity of extracorporeal membrane oxygenation devices. This have enabled the development of specific devices for the extracorporeal removal of CO2. These devices have a simpler configuration than extracorporeal membrane oxygenation devices and uses lower blood flows which could reduce the potential complications. Experimental studies have demonstrated the feasibility, efficacy and safety of extracorporeal removal of CO2 and some of its effects in humans. This technique was initially conceived as an adjunct therapy in patients with severe acute respiratory distress syndrome, as a tool to optimize protective ventilation. More recently, the use of this technique has allowed the emergence of a relatively new concept called 'tra-protective ventilation' whose effects are still to be determined. In addition, the extracorporeal removal of CO2 has been used in patients with exacerbated hypercapnic respiratory failure with promising results. In this review we will describe the physiological and technical fundamentals of this therapy and its variants as well as an overview of the available clinical evidence, focused on its current potential

Extracorporeal CO2 removal: Technical and physiological fundaments and principal indications.

In recent years, technological improvements have reduced the complexity of extracorporeal membrane oxygenation devices. This have enabled the development of specific devices for the extracorporeal removal of CO2. These devices have a simpler configuration than extracorporeal membrane oxygenation devices and uses lower blood flows which could reduce the potential complications. Experimental studies have demonstrated the feasibility, efficacy and safety of extracorporeal removal of CO2 and some of its effects in humans. This technique was initially conceived as an adjunct therapy in patients with severe acute respiratory distress syndrome, as a tool to optimize protective ventilation. More recently, the use of this technique has allowed the emergence of a relatively new concept called "tra-protective ventilation"whose effects are still to be determined. In addition, the extracorporeal removal of CO2 has been used in patients with exacerbated hypercapnic respiratory failure with promising results. In this review we will describe the physiological and technical fundamentals of this therapy and its variants as well as an overview of the available clinical evidence, focused on its current potential.