Publications by authors named "Joan Ramon Badia"

19 Publications

  • Page 1 of 1

Role of respiratory intermediate care units during the SARS-CoV-2 pandemic.

BMC Pulm Med 2021 Jul 13;21(1):228. Epub 2021 Jul 13.

Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic Respiratori, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain.

Rationale: The SARS-CoV2 pandemic increased exponentially the need for both Intensive (ICU) and Intermediate Care Units (RICU). The latter are of particular importance because they can play a dual role in critical and post-critical care of COVID-19 patients. Here, we describe the setup of 2 new RICUs in our institution to face the SARS-CoV-2 pandemic and discuss the clinical characteristics and outcomes of the patients attended.

Methods: Retrospective analysis of the characteristics and outcomes of COVID-19 patients admitted to 2 new RICUs built specifically in our institution to face the first wave of the SARS-CoV-2 pandemic, from April 1 until May 30, 2020.

Results: During this period, 106 COVID-19 patients were admitted to these 2 RICUs, 65 of them (61%) transferred from an ICU (step-down) and 41 (39%) from the ward or emergency room (step-up). Most of them (72%) were male and mean age was 66 ± 12 years. 31% of them required support with oxygen therapy via high-flow nasal cannula (HFNC) and 14% non-invasive ventilation (NIV). 42 of the 65 patients stepping down (65%) had a previous tracheostomy performed and most of them (74%) were successfully decannulated during their stay in the RICU. Length of stay was 7 [4-11] days. 90-day mortality was 19% being significantly higher in stepping up patients than in those transferred from the ICU (25 vs. 10% respectively; p < 0.001).

Conclusions: RICUs are a valuable hospital resource to respond to the challenges of the SARS-CoV-2 pandemic both to treat deteriorating and recovering COVID-19 patients.
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http://dx.doi.org/10.1186/s12890-021-01593-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275902PMC
July 2021

Lung Function sequelae in COVID-19 Patients 3 Months After Hospital Discharge.

Arch Bronconeumol 2021 Apr 24;57 Suppl 2:59-61. Epub 2021 Feb 24.

Respiratory Institute, Hospital Clinic, University of Barcelona, C/Villaroel 170, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/Roselló 149, 08036 Barcelona, Spain.

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http://dx.doi.org/10.1016/j.arbres.2021.01.036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903150PMC
April 2021

Once-daily 1 g ceftriaxone optimizes exposure in patients with septic shock and hypoalbuminemia receiving continuous veno-venous hemodiafiltration.

Eur J Clin Pharmacol 2021 Aug 9;77(8):1169-1180. Epub 2021 Feb 9.

Pharmacy Department, Division of Medicines, Hospital Clinic de Barcelona, Barcelona, Spain.

Purpose: Ceftriaxone total and unbound pharmacokinetics (PK) can be altered in critically ill patients with septic shock and hypoalbuminemia receiving continuous veno-venous hemodiafiltration (CVVHDF). The objective of this study was to determine the dosing strategy of ceftriaxone that maximizes the probability of maintaining the concentration above the MIC of the susceptible bacteria (≤2 mg/L by the EUCAST) for a 100% of the dosing interval (100% ƒT).

Methods: In a prospective PK study in the intensive care units of two tertiary Spanish hospitals, six timed blood samples were collected per patient; for each sample, ceftriaxone total and unbound concentrations were measured using a liquid chromatography coupled to tandem mass spectrometry method. Population PK analysis and Monte-Carlo simulations were performed using NONMEMv.7.3®.

Results: We enrolled 8 critically ill patients that met the inclusion criteria (47 blood samples). Median age (range) was 70 years (47-85), weight 72.5 kg (40-95), albumin concentration 24.2 g/L (22-34), APACHE II score at admission 26 (17-36), and SOFA score on the day of study 12 (9-15). The unbound fraction (ƒ) of ceftriaxone was 44%, and total CL was 1.27 L/h, 25-30% higher than the CL reported in septic critically ill patients not receiving renal replacement therapies, and dependent on albumin concentration and weight. Despite this increment in ƒ and CL, Monte-Carlo simulations showed that a dose of 1 g once-daily ceftriaxone is sufficient to achieve a 100% ƒT for MICs ≤2 mg/L for any range of weight and albumin concentration.

Conclusion: Once-daily 1 g ceftriaxone provides optimal exposure in critically ill patients with septic shock and hypoalbuminemia receiving CVVHDF.
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http://dx.doi.org/10.1007/s00228-021-03100-5DOI Listing
August 2021

Low birth weight as a potential risk factor for severe COVID-19 in adults.

Sci Rep 2021 02 3;11(1):2909. Epub 2021 Feb 3.

BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Universitat de Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.

The identification of factors predisposing to severe COVID-19 in young adults remains partially characterized. Low birth weight (LBW) alters cardiovascular and lung development and predisposes to adult disease. We hypothesized that LBW is a risk factor for severe COVID-19 in non-elderly subjects. We analyzed a prospective cohort of 397 patients (18-70 years) with laboratory-confirmed SARS-CoV-2 infection attended in a tertiary hospital, where 15% required admission to Intensive Care Unit (ICU). Perinatal and current potentially predictive variables were obtained from all patients and LBW was defined as birth weight ≤ 2.500 g. Age (adjusted OR (aOR) 1.04 [1-1.07], P = 0.012), male sex (aOR 3.39 [1.72-6.67], P < 0.001), hypertension (aOR 3.37 [1.69-6.72], P = 0.001), and LBW (aOR 3.61 [1.55-8.43], P = 0.003) independently predicted admission to ICU. The area under the receiver-operating characteristics curve (AUC) of this model was 0.79 [95% CI, 0.74-0.85], with positive and negative predictive values of 29.1% and 97.6% respectively. Results were reproduced in an independent cohort, from a web-based survey in 1822 subjects who self-reported laboratory-positive SARS-CoV-2 infection, where 46 patients (2.5%) needed ICU admission (AUC 0.74 [95% CI 0.68-0.81]). LBW seems to be an independent risk factor for severe COVID-19 in non-elderly adults and might improve the performance of risk stratification algorithms.
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http://dx.doi.org/10.1038/s41598-021-82389-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859212PMC
February 2021

Severe acute kidney injury in critically ill COVID-19 patients.

J Nephrol 2021 04 2;34(2):285-293. Epub 2021 Jan 2.

Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona and REDinREN, Villarroel 170, 08036, Barcelona, Spain.

Background: Acute kidney injury (AKI) is frequent in Coronavirus Infection Disease 2019 (COVID-19) patients. Factors associated with AKI in COVID-19 intensive care unit (ICU) patients and their outcomes have not been previously explored.

Methods: Prospective observational study of COVID-19 patients admitted to the ICUs of the Hospital Clínic of Barcelona (Spain), from March 25th to April 21st, 2020, who developed AKI stage 2 or higher (AKIN classification). The primary goal was to describe the characteristics of moderate-severe AKI of COVID-19 patients in an ICU context. As a secondary goal, we aimed to find independent predictors of AKI progression, Renal Replacement Therapy (RRT) requirement and mortality among these patients.

Results: During the study period, 52 out of 237 ICU patients, developed AKIN stage 2 or higher and were included in the study. A Sequential Organ Failure Assessment (SOFA) score at AKI diagnosis of 8 or higher was associated with RRT, OR 5.2, p 0.032. At the time of AKI diagnosis, patients had a worse liver profile and higher inflammation markers than at admission. Fifty per cent of the patients presented AKI progression from AKIN 2 to 3 and 28.85% required RRT. The use of corticosteroids in 69.2% of patients was associated with a reduced requirement of RRT, OR 0.13 (CI 95% 0.02-0.89), p 0.037. AKI was associated with high mortality (50%) and a longer hospital stay, median 35 vs 18 days (p 0.024).

Conclusions: The prevalence of moderate/severe AKI in COVID-19 patients admitted to the ICU is high and has a strong correlation with mortality and length of hospital stay.
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http://dx.doi.org/10.1007/s40620-020-00918-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776310PMC
April 2021

Do chronic respiratory diseases or their treatment affect the risk of SARS-CoV-2 infection?

Lancet Respir Med 2020 05 3;8(5):436-438. Epub 2020 Apr 3.

Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, University of Barcelona and National Spanish Network for Respiratory Research, Barcelona, Spain.

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http://dx.doi.org/10.1016/S2213-2600(20)30167-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270536PMC
May 2020

Sequential intrapleural administration of fibrinolytic drugs and dornase alfa for empyema management. Treatment protocol based on its physicochemical stability.

Farm Hosp 2019 12 26;44(1):16-19. Epub 2019 Dec 26.

Pneumology Service, Clinic Respiratory Institute, Hospital Clínic, Barcelona.

Objective: Intrapleural administration of fibrinolytics and dornase alfa has been shown in randomized studies to be able to reduce both the  need for surgical debridement of empyema and the average  hospital stay. However, its application in clinical practice is limited,  probably due to the lack of protocols that simplify its administration. The  present study aims to analyze the physicochemical stability of the  simultaneous urokinase and dornase alfa administration for the  subsequent development of a clinical practice use protocol.

Method: In vitro stability test of urokinase, dornase alfa and a  combination of both. Its stability was evaluated as (i) absence of  particles, (ii) color variation and (iii) pH changes at times 0, 30 minutes,  1, 2 and 4 hours at 37 °C. Each sample was prepared and  analyzed in triplicate.

Results: Individual solutions of urokinase and dornase alfa showed slight changes in pH, finding no changes in either color or  presence of suspended particles. The urokinase and dornase alfa  combination was not stable after 2 hours, when turbidity emerged due  to flocculation and phase separation. After 4 hours, precipitate  formation was found. A pro tocol for clinical use was developed based on  urokinase and dornase alfa sequential administration, since it was  not possible to guarantee the physicochemical stability of the simultaneous administration of both drugs.

Conclusions: The physicochemical stability data obtained does not allow to ensure a simultaneous administration of both drugs in a  safe and effective way, thus a sequential administration protocol is  proposed.
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http://dx.doi.org/10.7399/fh.11276DOI Listing
December 2019

Distribution, temporal stability and association with all-cause mortality of the 2017 GOLD groups in the ECLIPSE cohort.

Respir Med 2018 08 19;141:14-19. Epub 2018 Jun 19.

CIBER Enfermedades Respiratorias, Spain; Institut de Recerca Biomedica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Respiratory Institute, Hospital Clinic, University of Barcelona, Spain. Electronic address:

Background: In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) proposed a new classification of patients with chronic obstructive pulmonary disease (COPD).

Material And Methods: We contrasted the distribution of COPD patients according to GOLD 2017 and 2011 classifications, the temporal stability of the 2017 groups during 3 years follow-up and their association with all-cause mortality in the ECLIPSE cohort.

Results: We found that GOLD 2017: (1) switched a substantial proportion of GOLD 2011C and D patients to A and B groups at recruitment; (2) about half of A, B and D patients remained in the same group at the end of follow-up, whereas 74% of C patients (the smallest group of all) changed, either because exacerbation rate decreased or dyspnea increased; and, (3) all-cause mortality by group was not significantly different between GOLD 2011 and 2017. Of note, mortality in B (16%) and D patients (18%) was similar, both with similar severity of airflow limitation, the best individual mortality risk factor.

Conclusions: These results illustrate the cross-sectional and longitudinal effects of excluding FEV1 from GOLD 2017, and highlight both the clinical relevance of symptom assessment in the management of COPD and the prognostic capacity of FEV1.
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http://dx.doi.org/10.1016/j.rmed.2018.06.015DOI Listing
August 2018

Medical and surgical management for chronic thromboembolic pulmonary hypertension: a single center experience.

Arch Bronconeumol 2014 Dec 21;50(12):521-7. Epub 2014 Jun 21.

Servicio de Neumología y Alergia Respiratoria, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, España. Electronic address:

Introduction: Pulmonary endarterectomy (PE) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to analyze our experience in the medical and surgical management of CTEPH.

Methods: We included 80 patients diagnosed with CTEPH between January 2000 and July 2012. Thirty two patients underwent PE and 48 received medical treatment (MT). We analyzed functional class (FC), six-minute walking distance (6MWD) and pulmonary hemodynamics. Mortality in both groups and periods were analyzed.

Results: Patients who underwent PE were younger, mostly men, and had longer 6MWD. No differences were observed in pulmonary hemodynamics or FC at diagnosis. One year after treatment, all PE patients versus 41% in MT group were at FCI-II. At follow-up, the PE group showed greater increase in 6MWD, and greater reduction in mean pulmonary arterial pressure and pulmonary vascular resistance than the MT group (P<.05). Overall survival in the MT group at 1 and 5years was 83% and 69%, respectively. Conditional survival in patients alive 100days post-PE at 1 and 5years was 95% and 88%, respectively. Surgical mortality in operated patients in the first period (2000-2006) was 31,3%, and 6,3% in the second (2007-2012).

Conclusions: PE provides good clinical results, and improves pulmonary hemodynamics in patients who successfully overcome the immediate postoperative period. After a learning period, the current operatory mortality in our center is similar to international standards.
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http://dx.doi.org/10.1016/j.arbres.2014.04.011DOI Listing
December 2014

[Extracorporeal lung assist in severe respiratory failure and ARDS. Current situation and clinical applications].

Arch Bronconeumol 2010 Oct 17;46(10):531-7. Epub 2010 Jun 17.

Instituto del Tórax, Hospital Clínic de Barcelona, Universidad de Barcelona, CIBER de enfermedades respiratorias CIBERES, España.

Despite improvements in ventilation support techniques, lung protection strategies, and the application of new support treatment, acute respiratory distress syndrome continues to have a high mortality rate. Many strategies and treatments for this syndrome have been investigated over the last few year. However, the only therapeutic measure that has systematically shown to be able to improve survival is that of low volume lung protective ventilation. Thus, using a low tidal volume prevents added lung damage by the same mechanical ventilation that is essential for life support. In this context, the use of extracorporeal lung assist systems is considered an exceptional use rescue treatment in extreme cases. On the other hand, it could be a potentially useful complementary method for an ultra-protective ventilation strategy, that is, by using even lower tidal volumes. The currently available extracorporeal lung assist systems are described in this article, including high flow systems such as traditional extracorporeal membrane oxygenation, CO₂ removal systems (interventional lung assist or iLA, with or without associated centrifugal pumps), and the new low flow and less invasive systems under development. The aim of this review is to update the latest available clinical and experimental data, the indications for these devices in adult respiratory distress syndrome (ARDS), and their potential indications in other clinical situations, such as the bridge to lung transplantation, multiple organ dysfunction syndrome, or COPD.
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http://dx.doi.org/10.1016/j.arbres.2010.05.005DOI Listing
October 2010

Treatment guidelines and outcomes of hospital-acquired and ventilator-associated pneumonia.

Clin Infect Dis 2010 Aug;51 Suppl 1:S48-53

Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Ciber de Enfermedades Respiratorias, Barcelona, Spain.

Hospital-acquired pneumonia is the second most frequent nosocomial infection and the first in terms of morbidity, mortality, and cost. In recent years, international societies and, most recently, the American Thoracic Society jointly with the Infectious Disease Society of America, have developed guidelines for the management of hospital-acquired pneumonia, health care-associated pneumonia, and ventilator-associated pneumonia. These guidelines include recommendations for risk stratification, initial and definitive antibiotic treatment, and prevention. The validation of these guidelines is important because it confirms that they can be used in clinical practice, as quality indicators, and as a standard of care. Several processes can be validated and are included in the guidelines, such as the accuracy of the prediction of microorganisms according to stratification criteria and the impact of guidelines on outcomes, including length of hospital and intensive care unit stay, duration of mechanical ventilation, complications, and in-hospital and 30-day mortality. Clinical studies have shown that the accuracy of predicting microorganisms according to risk stratification is reliable ( approximately 80% and approximately 90%). Three studies suggest that the implementation of guidelines, with a special emphasis on antibiotic treatment, improves several parameters of outcome. Only one study, using a before-and-after design, showed a decrease in 14-day mortality after guidelines implementation. A key issue for these studies is to modify recommendations according to local patterns of microbiology and drug resistance. In summary, implementation of guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia decreases the rate of initial inappropriate antibiotic treatment and decreased 14-day mortality in a study. More clinical studies to validate the influence of guidelines on outcome are warranted.
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http://dx.doi.org/10.1086/653049DOI Listing
August 2010

Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial.

Lancet 2009 Sep 12;374(9695):1082-8. Epub 2009 Aug 12.

Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.

Background: Non-invasive ventilation can prevent respiratory failure after extubation in individuals at increased risk of this complication, and enhanced survival in patients with hypercapnia has been recorded. We aimed to assess prospectively the effectiveness of non-invasive ventilation after extubation in patients with hypercapnia and as rescue therapy when respiratory failure develops.

Methods: We undertook a randomised controlled trial in three intensive-care units in Spain. We enrolled 106 mechanically ventilated patients with chronic respiratory disorders and hypercapnia after a successful spontaneous breathing trial. We randomly allocated participants by computer to receive after extubation either non-invasive ventilation for 24 h (n=54) or conventional oxygen treatment (n=52). The primary endpoint was avoidance of respiratory failure within 72 h after extubation. Analysis was by intention to treat. This trial is registered with clinicaltrials.gov, identifier NCT00539708.

Findings: Respiratory failure after extubation was less frequent in patients assigned non-invasive ventilation than in those allocated conventional oxygen therapy (8 [15%] vs 25 [48%]; odds ratio 5.32 [95% CI 2.11-13.46]; p<0.0001). In patients with respiratory failure, non-invasive ventilation as rescue therapy avoided reintubation in 17 of 27 patients. Non-invasive ventilation was independently associated with a lower risk of respiratory failure after extubation (adjusted odds ratio 0.17 [95% CI 0.06-0.44]; p<0.0001). 90-day mortality was lower in patients assigned non-invasive ventilation than in those allocated conventional oxygen (p=0.0146).

Interpretation: Early non-invasive ventilation after extubation diminished risk of respiratory failure and lowered 90-day mortality in patients with hypercapnia during a spontaneous breathing trial. Routine implementation of this strategy for management of mechanically ventilated patients with chronic respiratory disorders is advisable.

Funding: IDIBAPS, CibeRes, Fondo de Investigaciones Sanitarias, European Respiratory Society.
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http://dx.doi.org/10.1016/S0140-6736(09)61038-2DOI Listing
September 2009

Extrapulmonary ventilation for unresponsive severe acute respiratory distress syndrome after pulmonary resection.

Ann Thorac Surg 2008 Jan;85(1):237-44; discussion 244

Department of General Thoracic Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.

Background: The purpose of this study was to evaluate the feasibility of integrating an artificial, pumpless extracorporeal membrane ventilator (Novalung) to near static mechanical ventilation and its efficacy in patients with severe postresectional acute respiratory distress syndrome (ARDS) unresponsive to optimal conventional treatment.

Methods: Indications were severe postresectional and unresponsive acute respiratory distress syndrome, hemodynamic stability, and no significant peripheral arterial occlusive disease or heparin-induced thrombocytopenia. Management included placement of the arteriovenous femoral transcutaneous interventional lung-assist membrane ventilator, lung rest at minimal mechanical ventilator settings, and optimization of systemic oxygen consumption and delivery.

Results: Among 239 pulmonary resections performed between 2005 and 2006, 7 patients (2.9%) experienced, 4 +/- 0.8 days after 5 pneumonectomies and 2 lobectomies, a severe (Murray score, 2.9 +/- 0.3) acute respiratory distress syndrome unresponsive to 4 +/- 2 days of conventional therapy. The interventional lung-assist membrane ventilator was left in place 4.3 +/- 2.5 days, and replaced only once for massive clotting. During this time, 29% +/- 0.3% or 1.4 +/- 0.36 L/min of the cardiac output perfused the device, without hemodynamic impairment. Using a sweep gas flow of 10.7 +/- 3.8 L/min, the device allowed an extracorporeal carbon dioxide removal of 255 +/- 31 mL/min, lung(s) rest (tidal volume, 2.7 +/- 0.8 mL/kg; respiratory rate, 6 +/- 2 beats/min; fraction of inspired oxygen, 0.5 +/- 0.1), early (<24 hours) significant improvement of respiratory function, and reduction of plasmatic interleukin-6 levels (p < 0.001) and Murray score (1.25 +/- 0.1; p < 0.003). All but 1 patient (14%) who died of multiorgan failure were weaned from mechanical ventilation 8 +/- 3 days after removal of the interventional lung-assist membrane ventilator, and all of them were discharged from the hospital.

Conclusions: The integration of this device to near static mechanical ventilation of the residual native lung(s) is feasible and highly effective in patients with severe and unresponsive acute respiratory distress syndrome after pulmonary resection.
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http://dx.doi.org/10.1016/j.athoracsur.2007.06.004DOI Listing
January 2008

Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial.

Crit Care Med 2007 Jun;35(6):1543-9

Unitat de Cures Intensives I Intermèdies, Servei de Pneumologia, Institut Clinic del Torax, Hospital Clinic, Barcelona, Spain.

Objective: The aspiration of subglottic secretions colonized by bacteria pooled around the tracheal tube cuff due to inadvertent deflation (<20 cm H2O) of the cuff plays a relevant role in the pathogenesis of ventilator-associated pneumonia. We assessed the efficacy of an automatic, validated device for the continuous regulation of tracheal tube cuff pressure in preventing ventilator-associated pneumonia.

Design: Prospective randomized controlled trial.

Setting: Respiratory intensive care unit and general medical intensive care unit.

Patients: One hundred and forty-two mechanically ventilated patients (age, 64 +/- 17 yrs; Acute Physiology and Chronic Health Evaluation II score, 18 +/- 6) without pneumonia or aspiration at admission.

Interventions: Within 24 hrs of intubation, patients were randomly allocated to undergo continuous regulation of the cuff pressure with the automatic device (n = 73) or routine care of the cuff pressure (control group, n = 69). Patients remained in a semirecumbent position in bed.

Measurements And Main Results: The primary end point variable was the incidence of ventilator-associated pneumonia. Main causes for intubation were decreased consciousness (43, 30%) and exacerbation of chronic respiratory diseases (38, 27%). Cuff pressure <20 cm H2O was more frequently observed in the control than the automatic group (45.3 vs. 0.7% determinations, p < .001). However, the rate of ventilator-associated pneumonia with clinical criteria (16, 22% vs. 20, 29%) and microbiological confirmation (11, 15% vs. 10, 15%), the distribution of early and late onset, the causative microorganisms, and intensive care unit (20, 27% vs. 16, 23%) and hospital mortality (30, 41% vs. 23, 33%) were similar for the automatic and control groups, respectively.

Conclusions: Cuff pressure is better controlled with the automatic device. However, it did not result in additional benefits to the semirecumbent position in preventing ventilator-associated pneumonia.
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http://dx.doi.org/10.1097/01.CCM.0000266686.95843.7DDOI Listing
June 2007

Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial.

Am J Respir Crit Care Med 2006 Jan 13;173(2):164-70. Epub 2005 Oct 13.

Unitat de Cures Intensives i Intermèdies, Servei de Pneumologia, Hospital Clinic, Institut Clinic del Tòrax, Villarroel 170, 08036 Barcelona, Spain.

Rationale: Respiratory failure after extubation and reintubation is associated with increased morbidity and mortality.

Objectives: To assess the efficacy of noninvasive ventilation in averting respiratory failure after extubation in patients at increased risk.

Methods: A prospective randomized controlled trial was conducted in 162 mechanically ventilated patients who tolerated a spontaneous breathing trial after recovery from the acute episode but had increased risk for respiratory failure after extubation. Patients were randomly allocated after extubation to receive noninvasive ventilation for 24 h (n = 79), or conventional management with oxygen therapy (control group, n = 83).

Measurements And Main Results: The primary end-point variable was the decrease in respiratory failure after extubation. In the noninvasive ventilation group, respiratory failure after extubation was less frequent (13, 16 vs. 27, 33%; p = 0.029) and the intensive care unit mortality was lower (2, 3 versus 12, 14%; p = 0.015). However, 90-d survival did not change significantly between groups. Separate analyses of patients without and with hypercapnia (arterial CO(2) tension greater than 45 mm Hg) during the spontaneous breathing trial showed that noninvasive ventilation improved intensive care unit mortality (0 vs. 4, 18%; p = 0.035) and 90-d survival (p = 0.006) in hypercapnic patients only; of them, 98% had chronic respiratory disorders.

Conclusions: The early use of noninvasive ventilation averted respiratory failure after extubation and decreased intensive care unit mortality among patients at increased risk. The beneficial effect of noninvasive ventilation in improving survival of hypercapnic patients with chronic respiratory disorders warrants a new prospective clinical trial.
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http://dx.doi.org/10.1164/rccm.200505-718OCDOI Listing
January 2006

[Outcomes and clinical characteristics of patients with pulmonary fibrosis and respiratory failure admitted to an intensive care unit. A study of 20 cases].

Med Clin (Barc) 2003 Jun;121(2):63-7

Unitat de Vigilància Intensiva Respiratoria. Servei de Pneumologia. Institut Clínic de Pneumologia i Cirurgia Toràcica (ICPCT). Hospital Clínic. Barcelona. Spain.

Background And Objective: Previous reports on the outcome of patients with pulmonary fibrosis admitted to the intensive care unit (ICU) suggest a bad prognosis. The aim of our study was to evaluate the course and prognosis of patients with pulmonary fibrosis admitted to the ICU of our hospital because of acute respiratory failure.

Patients And Method: Retrospective, case-series, observational study. We evaluated the clinical records of patients with pulmonary fibrosis referred to the intensive care unit in a tertiary university teaching hospital between January 1986 and June 2002. Complete information on the diagnosis and clinical course of the pulmonary disease, pulmonary function tests, current clinical status, ventilatory support and adjunctive therapies applied in the ICU, length of stay and mortality was collected.

Results: Twenty patients were included, 14 with idiopathic pulmonary fibrosis and 6 with pulmonary fibrosis and associated collagen vascular diseases. The mean (SD) interval between the diagnosis of fibrosis and the admission to ICU was 14 (20) months. All patients presented with severe acute respiratory failure (PaO2/FiO2 < 200). The cause of clinical worsening was identified in 8 (40%) cases (5 bacterial and 3 fungal infections). In the ICU, 17 patients required mecanical ventilation. All patients worsened progressively, with refractory hypoxemic respiratory failure (100%) and hemodynamic instability after endotraqueal intubation (70%). Mechanical ventilation was associated with a 100% mortality.

Conclusion: An identifiable cause of acute respiratory failure could not be found in a significant proportion of patients despite a systematic work-up. Mechanical ventilation and aggressive life support measures do not seem to provide any further benefit in patients with pulmonary fibrosis and severe respiratory failure.
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http://dx.doi.org/10.1016/s0025-7753(03)73856-1DOI Listing
June 2003
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