Awake prone positioning in nonintubated spontaneous breathing ICU patients with acute hypoxemic respiratory failure (PRONELIFE)-protocol for a randomized clinical trial.

BACKGROUND: It is uncertain whether awake prone positioning can prevent intubation for invasive ventilation in spontaneous breathing critically ill patients with acute hypoxemic respiratory failure. Awake prone positioning could benefit these patients for various reasons, including a reduction in direct harm to lung tissue, and prevention of tracheal intubation-related complications. DESIGN AND METHODS: The PRONELIFE study is an investigator-initiated, international, multicenter, randomized clinical trial in patients who may need invasive ventilation because of acute hypoxemic respiratory failure. Consecutive patients admitted to participating ICUs are randomly assigned to standard care with awake prone positioning, versus standard care without awake prone positioning. The primary endpoint is a composite of tracheal intubation and all-cause mortality in the first 14 days after enrolment. Secondary endpoints include time to tracheal intubation and effects of awake prone positioning on oxygenation parameters, dyspnea sensation, and complications. Other endpoints are the number of days free from ventilation and alive at 28 days, total duration of use of noninvasive respiratory support, total duration of invasive ventilation, length of stay in ICU and hospital, and mortality in ICU and hospital, and at 28, 60, and 90 days. We will also collect data regarding the tolerance of prone positioning. DISCUSSION: The PRONELIFE study is among the first randomized clinical trials investigating the effect of awake prone positioning on intubation rate in ICU patients with acute hypoxemic failure from any cause. The PRONELIFE study is sufficiently sized to determine the effect of awake prone positioning on intubation for invasive ventilation-patients are eligible in case of acute hypoxemic respiratory failure without restrictions regarding etiology. The PRONELIFE study is a pragmatic trial in which blinding is impossible-however, as around 35 ICUs worldwide will participate in this study, its findings will be highly generalizable. The findings of the PRONELIFE study have the potential to change clinical management of patients who may need invasive ventilation because of acute hypoxemic respiratory failure. TRIAL REGISTRATION: ISRCTN ISRCTN11536318 . Registered on 17 September 2021. The PRONELIFE study is registered at clinicaltrials.gov with reference number NCT04142736 (October, 2019).

Clinical risk factors for early mortality in patients with community-acquired septic shock. The importance of adequate source control.

OBJECTIVE: To evaluate the incidence and risk factors for early mortality (EM) in the ICU in patients with community-acquired septic shock (CASS). DESIGN: A retrospective cohort study of patients with CASS admitted to the ICU (2003-2016). SETTING: ICU at a University Hospital in Spain. PATIENTS: All consecutive patients admitted to the ICU with CASS. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: CASS was defined according to the Sepsis-3 definitions. EM were defined as occurring within of 72h following ICU admission. A multinomial logistic regression analysis was performed to identify the risk factors associated with early deaths. RESULTS: During the study period, 625 patients met the Sepsis-3 criteria and admitted with CASS. 14.4% of all patients died within the first 72h. Of 161 patients who died in the ICU, 90 (55.9%) died within the first 72h. The percentage of early and late mortality did not vary significantly during the study period. The need and adequacy of source control were significantly lower in patients with EM. In the multivariate analysis, ARDS, non-respiratory infections, bacteremia and severity at admission were variables independently associated with EM. The only factor that decreased EM was adequate source control in patients with infections amenable to source control. CONCLUSIONS: The incidence of EM has remained stable over time, which means that more than half of the patients who die from CASS do so within the first 72h. Infections where adequate source control can be performed have lower EM.

Double and multiple cycling in mechanical ventilation: Complex events with varying clinical effects / Doble y múltiples ciclados en ventilación mecánica: eventos complejos con diferentes significado clínico

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Clinical risk factors for early mortality in patients with community-acquired septic shock. The importance of adequate source control.

OBJECTIVE: To evaluate the incidence and risk factors for early mortality (EM) in the ICU in patients with community-acquired septic shock (CASS). DESIGN: A retrospective cohort study of patients with CASS admitted to the ICU (2003-2016). SETTING: ICU at a University Hospital in Spain. PATIENTS: All consecutive patients admitted to the ICU with CASS. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: CASS was defined according to the Sepsis-3 definitions. EM were defined as occurring within of 72h following ICU admission. A multinomial logistic regression analysis was performed to identify the risk factors associated with early deaths. RESULTS: During the study period, 625 patients met the Sepsis-3 criteria and admitted with CASS. 14.4% of all patients died within the first 72h. Of 161 patients who died in the ICU, 90 (55.9%) died within the first 72h. The percentage of early and late mortality did not vary significantly during the study period. The need and adequacy of source control were significantly lower in patients with EM. In the multivariate analysis, ARDS, non-respiratory infections, bacteremia and severity at admission were variables independently associated with EM. The only factor that decreased EM was adequate source control in patients with infections amenable to source control. CONCLUSIONS: The incidence of EM has remained stable over time, which means that more than half of the patients who die from CASS do so within the first 72h. Infections where adequate source control can be performed have lower EM.

[Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)]. / Recomendaciones de «hacer¼ y «no hacer¼ en el tratamiento de los pacientes críticos ante la pandemia por coronavirus causante de COVID-19 de los Grupos de Trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC).

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.

Lactobacillus casei CRL 431 improves endothelial and platelet functionality in a pneumococcal infection model.

Streptococcus pneumoniae is able to activate coagulation and induce platelet aggregation, both of which are typical responses to systemic inflammation. The interactions between inflammation and coagulation and between soluble adhesion molecules and endothelial cells are important in the pathogenesis of an unbalanced haemostatic system. Therefore, an exaggerated and/or insufficiently controlled haemostatic activity may appreciably contribute to the severity of the disease. The aim of the present study was to evaluate the effect of the oral administration of Lactobacillus casei CRL 431 on platelet and endothelial activation mechanisms in a respiratory pneumococcal infection model in mice. S. pneumoniae induced an increase in platelet counts and enhanced the expression of P-selectin in control group, with higher endothelial activation in lung shown by the increase in von Willebrand factor (vWF) and vascular cell adhesion molecule 1 (VCAM-1) expression. Also, infection induced a decrease in CXCR-4 leukocytes, increased expression in annexinV and cell death at the pulmonary level and decreased antithrombin levels in bronchoalveolar lavage. In contrast, L. casei mice restored platelet counts, favoured faster P-selectin expression, lower vWF levels and VCAM-1 expression than control group. Also, L. casei induced higher levels of annexinV expression and lower cell death in the lung. Moreover, it was able to modulate antithrombin levels within the normal range, which would indicate lower coagulation activation and a protective effect locally exerted by L. casei. In this work, the ability of L. casei to favourably modulate platelet and endothelial functionality during a pulmonary infection with S. pneumoniae was demonstrated. Our findings offer a promising perspective for the use of this probiotic strain in the prevention of thrombotic complications associated with pneumococcal pneumonia, especially in at-risk patients. In addition, the use of L. casei would provide novel alternatives for the prevention and treatment of thrombosis associated with various diseases.

Do sedation and analgesia contribute to long-term cognitive dysfunction in critical care survivors? / ¿Contribuye la sedación y la analgesia a la disfunción cognitiva en supervivientes de una enfermedad crítica?

Deep sedation during stay in the Intensive Care Unit (ICU) may have deleterious effects upon the clinical and cognitive outcomes of critically ill patients undergoing mechanical ventilation. Over the last decade a vast body of literature has been generated regarding different sedation strategies, with the aim of reducing the levels of sedation in critically ill patients. There has also been a growing interest in acute brain dysfunction, or delirium, in the ICU. However, the effect of sedation during ICU stay upon long-term cognitive deficits in ICU survivors remains unclear. Strategies for reducing sedation levels in the ICU do not seem to be associated with worse cognitive and psychological status among ICU survivors. Sedation strategy and management efforts therefore should seek to secure the best possible state in the mechanically ventilated patient and lower the prevalence of delirium, in order to prevent long-term cognitive alterations (AU)

La sedación profunda durante la estancia en una Unidad de Cuidados Intensivos (UCI) puede afectar negativamente al estado clínico y cognitivo de los pacientes críticos sometidos a ventilación mecánica. En la última década ha aparecido gran cantidad de literatura sobre diferentes estrategias dirigidas a reducir los niveles de sedación en el paciente crítico. Además, ha aumentado el interés sobre la disfunción cerebral aguda o delirium. Sin embargo, el efecto de la sedación sobre los déficits cognitivos a largo plazo continúa siendo poco conocido. Las estrategias centradas en reducir los niveles de sedación en UCI no parecen estar asociadas con un peor estado cognitivo y psicológico de los supervivientes. Por lo tanto, las estrategias de manejo de la sedación en UCI deberían focalizarse en mejorar el estado del paciente ventilado, así como en disminuir el delirium, con el fin de prevenir las alteraciones cognitivas a largo plazo (AU)

Do sedation and analgesia contribute to long-term cognitive dysfunction in critical care survivors?

Deep sedation during stay in the Intensive Care Unit (ICU) may have deleterious effects upon the clinical and cognitive outcomes of critically ill patients undergoing mechanical ventilation. Over the last decade a vast body of literature has been generated regarding different sedation strategies, with the aim of reducing the levels of sedation in critically ill patients. There has also been a growing interest in acute brain dysfunction, or delirium, in the ICU. However, the effect of sedation during ICU stay upon long-term cognitive deficits in ICU survivors remains unclear. Strategies for reducing sedation levels in the ICU do not seem to be associated with worse cognitive and psychological status among ICU survivors. Sedation strategy and management efforts therefore should seek to secure the best possible state in the mechanically ventilated patient and lower the prevalence of delirium, in order to prevent long-term cognitive alterations.

Toward a personalized response approach in sepsis 4.0 / Hacia una estrategia de respuesta personalizada en sepsis 4.0

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Riggia puyensis n. sp. (Isopoda: Cymothoidae) parasitizing Chaetostoma breve and Chaetostoma microps (Siluriformes: Loricariidae) from Ecuador.

A new isopod was found parasitizing Chaetostoma breve and Chaetostoma microps from the Puyo and Bobonaza rivers. The parasite found belongs to the Cymothoidae family and could be located within the genus Riggia instead of Artystone by the presence of abdominal plates fused with the telson. The specimens found represent a new species, Riggia puyensis n. sp., and could be distinguished from Riggia cryptocularis by the presence of developed eyes. The main difference of the new specie from Riggia nana and Riggia brasiliensis is the size, bigger compared with the first and smaller compared with the last species. Riggia acuticaudata have the maxilliped with simple setae, the palp without spination, and maxillule with five spines (two terminal and three subterminal) instead in R. puyensis n. sp. the maxilliped have plumose setae, the palp have spination (with one apical spine, two setae on middle article and one in the basal article) and the maxillule have five spines: two terminal, two subterminal and other spine lower to the others. Riggia paranaensis have similar size, same number of segments in the antena, and similar maxilla to R. puyensis n. sp., but the antennule in the new specie have seven segments instead 6 in R. paranaensis, the antennule and antenna present spines not mentioned in R. paranaensis. Besides, the relative position of the mandible in R. puyensis n. sp. is different compared with R. paranaensis, the maxillule have the same number of spines but with different disposition, and the maxilliped have simple setae in R. paranaensis but those are plumose in the new specie.

Riggia puyensis n. sp. (Isopoda: Cymothoidae) parasitizing Chaetostoma breve and Chaetostoma microps (Siluriformes: Loricariidae) from Ecuador.

A new isopod was found parasitizing Chaetostoma breve and Chaetostoma microps from the Puyo and Bobonaza rivers. The parasite found belongs to the Cymothoidae family and could be located within the genus Riggia instead of Artystone by the presence of abdominal plates fused with the telson. The specimens found represent a new species, Riggia puyensis n. sp., and could be distinguished from Riggia cryptocularis by the presence of developed eyes. The main difference of the new specie from Riggia nana and Riggia brasiliensis is the size, bigger compared with the first and smaller compared with the last species. Riggia acuticaudata have the maxilliped with simple setae, the palp without spination, and maxillule with five spines (two terminal and three subterminal) instead in R. puyensis n. sp. the maxilliped have plumose setae, the palp have spination (with one apical spine, two setae on middle article and one in the basal article) and the maxillule have five spines: two terminal, two subterminal and other spine lower to the others. Riggia paranaensis have similar size, same number of segments in the antena, and similar maxilla to R. puyensis n. sp., but the antennule in the new specie have seven segments instead 6 in R. paranaensis, the antennule and antenna present spines not mentioned in R. paranaensis. Besides, the relative position of the mandible in R. puyensis n. sp. is different compared with R. paranaensis, the maxillule have the same number of spines but with different disposition, and the maxilliped have simple setae in R. paranaensis but those are plumose in the new specie.

Colecistitis acalculosa secundaria a infección por virus de la Hepatitis A / Acute acalculous cholecystitis secondary to viral hepatitis A

Abstract Introduction: The hepatitis A (HAV) is usually limited and common disease in children; very little is known about a calculous cholecystitis secondary to hepatitis because there are few reports worldwide. Case report: We report the case of a woman of 33 years who began with diarrhea, fever, jaundice and right upperquadrant pain, laboratory HAV IgM positive. No improvement of pain to medical treatment, we request anultrasound and cholangioresonance identifying signs of cholecystitis and edema of the wall; we performed laparoscopic cholecystectomy with symptom improvement. Secondary VHA cholecystitis is a rare entity, a medical or surgical treatment according to the patient’s clinical is needed to avoid complications.

Resumen Introducción: El virus de la hepatitis A (VHA) es por lo general una enfermedad limitada y frecuente en niños; se conoce muy poco sobre la colecistitis a calculosa secundaria a hepatitis ya que existen pocos reportes a nivel mundial. Caso clínico: Presentamos el caso de una mujer de 33 años la cual inició con diarrea, fiebre, ictericia y dolor en hipocondrio derecho, laboratorio con IgM positivo a VHA. Sin mejoría del dolora tratamiento médico, solicitamos un ultrasonido y colangio resonancia identificando datos de colecistitis y edema de pared; sometiéndola a colecistectomía con mejoría de los síntomas. La colecistitis secundaria a VHA es una entidad poco frecuente, es necesario un tratamiento médico o quirúrgico de acuerdo a la clínica del paciente para evitar complicaciones.

Match performance comparison in top English soccer leagues.

The purpose of this study was to compare motions of soccer players in the English Premier (1st) and Championship (2nd) League. A total of 26 449 observations were obtained from players during 4 seasons (2006-2010) in the 2 leagues. Time-motions of all players (attackers, central defenders, central midfielders, wide defenders, wide midfielders) were recorded during each match using the Prozone® System, (Leeds, UK), and categorized by speed intensity. Number of actions, total distance and the mean distance covered at each speed intensity were measured. Players in the Championship league covered a total match distance of 11.1±0.9 km compared with 10.8±1.0 km for players from the Premiership (p<0.001). Championship players also covered greater distances during jogging, running, high-speed running, and sprinting. Premiership players covered more distance walking. Players in the Soccer League Championship had more instances of each condition. Although these differences were statistically significant, they were negligible in practical terms, suggesting match-related activities do not explain the general superiority of Premiership players over Championship players in England.

Terapia de reemplazo renal en paciente crítico: cambios evolutivos del tratamiento en los últimos años / Renal replacement therapy in the critical patient: treatment variation over time

Objetivos: Analizar la evolución de los pacientes con insuficiencia renal aguda tratados con terapia de reemplazo renal (TRR) y determinar los factores de riesgo asociados a mortalidad y recuperación de la función renal. Diseño: Estudio prospectivo y observacional en pacientes críticos. Ámbito: Unidad de Cuidados Intensivos (UCI) polivalente del Hospital de Sabadell. Pacientes: Inclusión de los pacientes con insuficiencia renal que precisaron TRR en nuestra unidad. Principales variables de interés: Registro de variables epidemiológicas, de gravedad (APACHE II) así como el tipo y duración de la TRR, mortalidad y recuperación de la función renal al alta de UCI. El periodo de estudio comprende 10 años, repartiendo la muestra en 2 periodos: inicial (2000-2004) y reciente (2005-2009). Análisis estadístico comparativo de ambos periodos y análisis de regresión logística múltiple para determinar factores de riesgo de mortalidad y de (..) (AU)

Objectives: To analyze the evolution of patients subjected to renal replacement therapy (RRT), andto determine risk factorsassociated with mortality and the recovery of renal function. Design: A prospective, observational study of critically ill patients. Setting: Clinical-surgical Intensive Care Unit (ICU) of Sabadell Hospital (Spain). Patients: Inclusion of all patients treated in our Unit due to acute renal failure (ARF) requiring RRT. Primary variables of interest: We recorded epidemiological data, severity using the APACHE II score, days of the technique, ICU mortality, and renal function recovery. The study period was divided into 2 parts: part 1 (2000-2004) and part 2 (2005-2009). The 2 periods were compared using the Student t-test for continuous variables and the chi-squared test for categorical variables. Multiple regression analysis was performed to determine the risk factors for mortality and recovery of renal function. Results: A total of 304 patients were treated. Sepsis was the main etiology of ARF (61%), involving principally respiratory and abdominal foci. In the second period the convective technique and community-acquired ARF were far more prevalent than in the first period. There were fewer days of therapy in the second period (19.7 versus 12.3 days; P=.015). Total ICU mortality was 52.3%, with a decrease in the last period (61.9% to 45.5%: P=.003). The risk factors associated to mortality were creatinine upon admission (odds ratio [OR] 0.77; 95% confidence interval [95%CI] 0.61-0.97) and treatment with IHD alone (OR 0.37, 95%CI 0.16-0.87). Survivors had normal renal function at ICU discharge in 56.7% of the cases in the second period, vs in 72.9% in the first period, with (..) (AU)

Renal replacement therapy in the critical patient: treatment variation over time.

OBJECTIVES: To analyze the evolution of patients subjected to renal replacement therapy (RRT), and to determine risk factors associated with mortality and the recovery of renal function. DESIGN: A prospective, observational study of critically ill patients. SETTING: Clinical-surgical Intensive Care Unit (ICU) of Sabadell Hospital (Spain). PATIENTS: Inclusion of all patients treated in our Unit due to acute renal failure (ARF) requiring RRT. PRIMARY VARIABLES OF INTEREST: We recorded epidemiological data, severity using the APACHE II score, days of the technique, ICU mortality, and renal function recovery. The study period was divided into 2 parts: part 1 (2000-2004) and part 2 (2005-2009). The 2 periods were compared using the Student t-test for continuous variables and the chi-squared test for categorical variables. Multiple regression analysis was performed to determine the risk factors for mortality and recovery of renal function. RESULTS: A total of 304 patients were treated. Sepsis was the main etiology of ARF (61%), involving principally respiratory and abdominal foci. In the second period the convective technique and community-acquired ARF were far more prevalent than in the first period. There were fewer days of therapy in the second period (19.7 versus 12.3 days; P=.015). Total ICU mortality was 52.3%, with a decrease in the last period (61.9% to 45.5%: P=.003). The risk factors associated to mortality were creatinine upon admission (odds ratio [OR] 0.77; 95% confidence interval [95%CI] 0.61-0.97) and treatment with IHD alone (OR 0.37, 95%CI 0.16-0.87). Survivors had normal renal function at ICU discharge in 56.7% of the cases in the second period, vs in 72.9% in the first period, with more patients subjected to IHD in the second period (10.4% versus 26.8%). The factors related to the recovery of renal function were creatinine upon admission (OR 1.98, 95%CI 1.12-3.48), acute renal failure (OR 0.11, 95%CI 0.04-0.34) and treatment with continuous techniques (OR 0.18, 95%CI 0.03-0.85). CONCLUSIONS: Mortality among critically ill patients subjected to RRT has improved in recent years.