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1. Propofol Versus Midazolam

Author

Jose L. Perez-Vela, Jose A. Cantalapiedra-Santiago, Emilio Alted-Lopez, Rafael E. Caballero-Cubedo, Jose A. Sanchez-Izquierdo-Riera, and Alfonso Ambros-Checa

Subjects
Adult, Male, medicine.medical_specialty, Intracranial Pressure, medicine.drug_class, Midazolam, Sedation, Blood Pressure, Head trauma, Heart Rate, Intensive care, medicine, Craniocerebral Trauma, Humans, Hypnotics and Sedatives, Prospective Studies, Cerebral perfusion pressure, Infusions, Intravenous, Propofol, Triglycerides, Intracranial pressure, Morphine, business.industry, Incidence, Hemodynamics, Brain, Respiration, Artificial, Surgery, Analgesics, Opioid, Oxygen, Drug Combinations, Anesthesiology and Pain Medicine, Anesthesia, Sedative, Anesthesia Recovery Period, Wounds and Injuries, Female, Jugular Veins, Safety, medicine.symptom, business, medicine.drug
Abstract

UNLABELLED Previous studies have compared sedation profiles with midazolam (Mz) and propofol (Pf), particularly in heterogeneous populations of patients. Decreases in blood pressure and heart rate have been reported after the administration of propofol. These side effects are potentially deleterious in severe trauma patients, particularly in patients with head trauma. To assess the safety and efficacy of Mz and Pf, alone or in combination, in the prolonged sedation of severe trauma patients, we designed a prospective, controlled, randomized, study. One hundred consecutively admitted trauma patients requiring mechanical ventilation and sedation for more than 48 h were studied. Patients were sedated according to three different protocols based on the continuous i.v. administration of Mz alone, Pf alone, and Mz in combination with Pf. All patients received morphine chloride. Safety and efficacy were assessed during the sedation and wake-up periods according to clinical and laboratory variables. Cerebral hemodynamics were also studied in patients with head trauma. Patients were sedated for 6.3 +/- 4.0 days (mean +/- SD). All three sedation regimens were equally efficacious in achieving the desired sedation goal. The incidence of adverse events during the sedation period was also similar. In head trauma patients with intracranial pressure (ICP) monitoring, we did not find differences in ICP, cerebral perfusion pressure, or jugular venous oxygen saturation among the three groups. The serum triglyceride concentration was significantly higher in the Pf group. Wake-up time was significantly shorter in the Pf group. We conclude that both Mz and Pf are safe and efficacious in the sedation of severe trauma patients. The use of Pf in these patients is associated with a high incidence of hypertriglyceridemia and a shorter wake-up time. IMPLICATIONS In a prospective, controlled, randomized study, we confirmed the safety and efficacy of midazolam and propofol, alone or in combination, in the prolonged sedation of a homogeneous group of severe trauma patients, particularly in patients with head trauma. The propofol group had shorter wake-up times and higher triglyceride levels.

Published
1998
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2. Pulmonary thromboembolism after long car travel (Tromboembolismo pulmonar tras viaje prolongado en automóvil)

Author

Julian Ortega-Carnicer, Carlos Gutiérrez-Tirado, Alfonso Ambros-Checa, and Juan Bertos-Polo

Subjects
Male, medicine.medical_specialty, Travel, Time Factors, integumentary system, business.industry, medicine.medical_treatment, Bed rest, Risk Factors, Internal medicine, Emergency Medicine, medicine, Cardiology, Humans, business, Pulmonary Embolism, human activities, Automobiles
Abstract

Prolonged immobility, especially bed rest for medical or surgical processes, constitutes one of the main risk factors for developing pulmonary thromboembolism. Immobility during extended plane or coach journeys (economy class syndrome) is not a frequent cause of serious pulmonary thromboembolism in healthy travellers. We report a case of serious pulmonary thromboembolism after a prolonged journey by car.

Published
2003

3. MORTALITY PROGNOSTIC FACTORS IN IMMUNOSUPPRESSED PATIENTS ADMITTED IN INTENSIVE CARE UNIT

Author

Julián Ortega-Carnicer, Jorge E. Sinclair-Avila, Alfonso Ambros-Checa, Juan Ros-Izquierdo, Alfredo Martin-Vivas, and Maria Luisa Gomez-Grande

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, law, Emergency medicine, Medicine, Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine, business, Intensive care unit, law.invention
Published
2007
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4. Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis

Author

Alejandro H. Rodríguez, Francesc X. Avilés-Jurado, Emili Díaz, Philipp Schuetz, Sandra I. Trefler, Jordi Solé-Violán, Lourdes Cordero, Loreto Vidaur, Ángel Estella, Juan C. Pozo Laderas, Lorenzo Socias, Juan C. Vergara, Rafael Zaragoza, Juan Bonastre, José E. Guerrero, Borja Suberviola, Catia. Cilloniz, Marcos I. Restrepo, Ignacio Martín-Loeches, Pedro Cobo, Javier Martins, Cecilia Carbayo, Emilio Robles-Musso, Antonio Cárdenas, Javier Fierro, Dolores Ocaña Fernández, Rafael Sierra, Mª Jesús Huertos, Mª Luz Carmona Pérez, Juan Carlos Pozo Laderas, R. Guerrero, Juan Carlos Robles, Melissa Echevarría León, Alberto Bermejo Gómez, Enrique Márquez, Manuel Rodríguez-Carvajal, José Pomares, José Luis Ballesteros, Olga Moreno Romero, Yolanda Fernández, Francisco Lobato, José F. Prieto, José Albofedo-Sánchez, Pilar Martínez, María Victoria de la Torre, María Nieto, Estefanía Camara Sola, Miguel Angel Díaz Castellanos, Guillermo Sevilla Soler, Carlos Ortiz Leyba, José Garnacho-Montero, Rafael Hinojosa, Esteban Fernández, Ana Loza, Cristóbal León, Samuel González López, Angel Arenzana, Dolores Ocaña, Inés Navarrete, Medhi Zaheri Beryanaki, Ignacio Sánchez, Manuel Pérez Alé, Ana Mª Poullet Brea, Juan Francisco Machado Casas, Carlos Serón, Manuel Luis Avellanas, Arantxa Lander, S. Garrido Ramírez de Arellano, M.I. Marquina Lacueva, Pilar Luque, Elena Plumed Serrano, Juan Francisco Martín Lázaro, Carlos Sánchez Polo, Isabel Gutiérrez Cia, Belén Jiménez Bartolomé, Carlos López Nuñez, Ignacio González, José Ignacio Tomás Marsilla, Clara Jaques Andrés, Pablo Gtiérrez Ibañes, Pilar Araujo Aguilar, Jose Mª Montón, Paloma Dorado Regil, Lisardo Iglesias, Carmen Pascual González, Brígida Quindós Fernández, Lorena Martín Iglesias, Lucía Viña Soria, Raquel Yano Escudero, Mª del Rosario Mtnez Revuelta, null Quiroga, Águeda García-Rodríguez, Marta Martín Cuadrado, Ana Luz Balán Mariño, Pedro Ibánez, Marcío Borges-Sa, A. Socias, A. Del Castillo, Ricard Jordà Marcos, Cristina Muñoz, José M. Bonell, Ignacio Amestarán, M. Angeles González López, Cecilia Vilanova Pàmies, José Ma. Bonell Goytisolo, José Antonio Morales Carbonero, Rossana Pérez Senoff, Marta Generelo López de Medrano, Sergio Ruiz-Santana, Juan José Díaz, Catalina Sánchez Ramírez, Montse Sisón, David Hernández, Ana Trujillo, Luis Regalado, Sonia Rodríguez Fndez, Leonardo Lorente, Judith Cabrera Rivero, Mª Luisa Mora Quintero, Mar Martín, Sergio Martínez, J.J. Cáceres, Manuel Sanchez Palacio, null Marcos, D. García Rodríguez, María Ripoll Leria, P. Ugarte, Fernando García-López, Rafael Sánchez Iniesta, Angel Álvaro Alonso, Antonio Padilla, Basi Martínez Palacios, Mª Luisa Gómez Grande, Ma. Carmen Martín Rodríguez, Hasania Adbel-Hadi Álvarez, Alfonso Ambros Checa, Higinio Martín Hernández, Antonio Albaya, Alberto Silva Obregón, Carlos Marian Crespo, Carlos Armendariz Estrella, Carmen Benito Puncel, Eduardo Quirós Oyargue, Alfonso Canabal, Luis Marina, Ismael López de Toro, Almudena Simón, José María Añón, Juan B. López Messa, Mª Jesús López Pueyo, Ortíz María del valle Sergio Ossa Echeverri, Zulema Ferreras, Juan C. Ballesteros Herraez, Santiago Macias, José Ángel Berezo, Jesús Blanco Varela, Pablo Blanco Schweizer, Angela González Salamanca, Luis Tamayo Lomas, Andaluz Ojeda Anzález, Ramón Cicuéndez Avila, Pérez G. Francisco Javier, Antonio Álvarez Terrero, Fabiola Tena Ezpeleta, Christian Sala, Oliverio López, Zulema Paez, Álvaro García, Demetrio Carriedo Ule, Miriam Riesco Crespo, Jesús Pino Rebolledo, Nicolás Hidalgo Andrés, Ana Carolina Caballero Zirena, Belén Román García, Juan Bautista López Messa, María del Valle Ortiz, Sergio Ossa Echeverri, Rosa Mª Catalán, Miquel Ferrer, Antoni Torres, Catia Cilloniz, Sandra Barbadillo Ansorregui, Lluís Cabré, Ignacio Baeza, Assumpta Rovira, Francisco Álvarez-Lerma, Antonia Vázquez, Joan Nolla, Francisco Fernández, Joaquim Ramón Cervelló, Raquel Iglesia, Rafael Mañéz, J. Ballús, Rosa Mª Granada, Jordi Vallés, Marta Ortíz, C. Guía, Joaquim Páez, Jordi Almirall, Xavier Balanzo, Estel Güell, Juan Carlos Yebenes, Jordi Rello, Elena Arnau, Marcos Pérez, César Laborda, Jesica Souto, Leonel Lagunes, Iñaki Catalán, Josep Mª Sirvent, Nerea López de Arbina, Anna Baró Serra, Adriana Sánchez, Silvia M. Cuenca, Mariona Badía, Begonia Baseda-Garrido, Montserrat Valverdú-Vidal, Fernando Barcenilla, Mercedes Palomar, Xavier Nuvials, Pedro Garrido Benedicto, Ferran Roche Campo, M.F. Esteban, José Luna, Gaspar Masdeu Eixarch, Angels Pascual Diago, Juan Mª Nava, J. González de Molina, Josep Trenado, Ricard Ferrer, Zoran Josic, Montserrat Casanovas, Francisco Gurri, Paula Rodríguez, Alejandro Rodríguez, Laura Claverias, Sandra Trefler, María Bodí, Mónica Magret, Cristina Ferri, Rosa María Díaz, Eduard Mesalles, Fernando Arméstar, Diego de Mendoza, Carmen Lomas Fernández, José Julián Berrade, Alfonso Bonet Saris, Marina Pechkova, Cristina Mora Jiménez, Santiago Picos Gil, José Juliá-Narváez, Manuel Robles Marcos, Vanessa Farje Mallqui, Mª. Angeles Santiago Triviño, Pablo Martínez García, Alberto Fernández-Zapata, Teresa Recio, Abilio Arrascaeta, Mª José García-Ramos, Elena Gallego, Esther Saiz Rodrigo, Fernándo Bueno, Mercedes Díaz, Noemí Gil Pérez, David López Hormigo, Juan Diego Jiménez Delgado, Pérez Frutos, M.J. Rivera Pinna, Mª Lourdes Cordero, José A. Pastor, Luis Álvarez-Rocha, Alexandra Ceniceros Barros, Alejandra Virgós Pedreira, Dolores Vila, Carmen Fernández González, Javier Blanco Pérez, M. Ortiz Piquer, Eleuterio Merayo, Victor Jose López-Ciudad, Juan Cortes Cañones, Eva Vilaboy, José Villar Chao, Francisco Savira Cid López, Pablo Vidal Cortés, Marcos A. Pérez Veloso, Eva Maria Saborido, Enrique Alemparte Pardavila, Ana Ortega Montes, Raul José González, Santiago Freita, Enrique Alemparte, Ana Ortega, Ana María López, Julio Canabal, Enrique Ferres, Santiago Freitas Ramos, Lucas Lage Cendón, Vanesa Gómez Casal, Sabela Vara Adrio, Eva Menor Fernández, Susana González Prado, Antonio Varela Franco, José Luis Monzón, Félix Goñi, Frutos Del Nogal Sáez, M. Blasco Navalpotro, Ricardo Díaz Abad, José Luis Flordelis Lasierra, Mª Carmen García-Torrejón, César Pérez–Calvo, Diego López, Luis Arnaiz, S. Sánchez-Alonso, Carlos Velayos, Francisco del Río, Miguel Ángel González, Mercedes Nieto, Carmen Sánchez Cesteros, María Cruz Martín, José Mª Molina, Juan Carlos Montejo, Mercedes Catalán, Patricia Albert, Ana de Pablo, José Eugenio Guerrero, María Zurita, Jaime Benitez Peyrat, Miriam Díaz Cámara, Enrique Cerdá, Manuel Alvarez, Carlos Pey, Eva Manteiga Riestra, Concepción Martinez-Fidalgo, Montse Rodríguez, Eduardo Palencia, Rafael Caballero, Concepción Vaquero, Francisco Mariscal, S. García, Rico Cepeda, Nieves Carrasco, Isidro Prieto, A. Liétor, R. Ramos, Rosario Cuadra Casas, Cruz Soriano Cuesta, Susana Sánchez Alonso, Beatriz Galván, Juan C. Figueira, M. Cruz Soriano, Bélen Civantos Martín, Alejgandro Robles Caballero, P. Galdós, Bárbara Balandin Moreno, Sara Alcántara Carmona, Fernández del Cabo, Cecilia Hermosa, Federico Gordo, Alejandro Algora, Amparo Paredes, Teodoro Grau Carmona, J.A. Cambroner, Esther López Ramos, Yaiza Ortiz de Zárate, Sonia Gómez-Rosado, Margarita Mas Lodo, Nieves Franco Garrobo, Silvia Álvarez Hernández, Teresa Honrubia, Luis Miguel Prado López, A. Esteban, J.A. Lorente, N. Nin, Carlos Jaramillo Sotomayor, Esperanza Molero Silvero, Eduardo Morales Fdez. de la Reguera, Rosa Mª de la Casa Monje, Fátima Martín Serrano, Mª Victoria Trasmonte Martínez, M. Cruz Martín Delgado, Sofía Martínez, F. Felices Abad, Isabel Cremades Navalon, Martín Vigil Velis, Mariano Martínez, Domingo Martínez Baño, Enriqueta Andreu, Sergio Manuel Butí, Bernardo Gil Rueda, Francisco García, Noemí Llamas Fernández, Luis Herrera Para, Alejandro Ortín Freire, Mª Rosa Nvarro Ruiz, C.R. Hernández Romero, Enrique Maraví-Poma, I. Jimenez Urra, Laura Macaya Redin, A. Tellería, Josu Insansti, Noelia Artesero Garcia, Laura Macaya, Joaquín Lobo Palanco, Nagore González, Pilar Marco, Estibaliz Salas, Ruth Salaberría Udabe, B. Santamaría, Tomás Rodríguez, Juan Carlos Vergara, Jose Ramon Iruretagoyena Amiano, Iratí Garrido Santos, Alberto Manzano, Carlos Castillo Arenal, Pedro María Olaechea, Alejandro Martín López, Fernando Fonseca San Miguel, José Blanquer, Nieves Carbonell, José Ferreres Franco, Roberto Reig Valero, A. Belenger, Susana Altaba, Bernabé Álvarez–Sánchez, José Canovas Robles, Jaime Sánchez Francisco, Mar Ruiz Sánchez, Santiago Alberto Picos, Abilio Arrascaeta Llanes, Eugenio Herrero Gutiérrez, Alberto Fernández Zapata, Ángel Sánchez-Miralles, José Luis Antón Pascual, M. Palamo, Javier Cebrian, José Cuñat, Mónica Gordón Sahuquillo, Belén Romero, Santiago Borrás Pallé, Javier de León Belmar, Constantino Tormo, Susana Sancho Chinesta, Virgilio Paricio, Asunción Marques, S. Sánchez-Morcillo, S. Tormo, J. Latour, M. Ángel García, Manuel Palomo, Francisco Tarín Royo, Pedro Manzano Hinojosa, Mª Salomé Sánchez Pino, Concha Maragues Ribes, Rubén González Luis, Antoli Ribas, and Universitat de Barcelona

Subjects
Male, Procalcitonin, 0302 clinical medicine, Community-acquired pneumonia, Septic shock, Prospective Studies, 030212 general & internal medicine, Coinfection, Bacterial Infections, Middle Aged, Prognosis, Intensive Care Units, Infectious Diseases, Female, Pèptids, Adult, Calcitonin, Microbiology (medical), medicine.medical_specialty, Icu patients, Calcitonin Gene-Related Peptide, CHAID analysis, Respiratory coinfection, Sensitivity and Specificity, Influenzavirus, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Influenza, Human, parasitic diseases, medicine, Humans, Influenza viruses, Protein Precursors, Intensive care medicine, Influenza A(H1N1)pmd, business.industry, Decision Trees, 030208 emergency & critical care medicine, Influenza a, medicine.disease, CHAID, Observational study, business, Peptides, Biomarkers
Abstract

Objectives: To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis. Methods: A secondary analysis from a prospective, multicentre, observational study (2009 -2014) in ICU patients with confirmed A(H1N1)pdm09 infection. We assessed the potential of biomarkers and clinical variables upon admission to the ICU for coinfection diagnosis using CHAID analysis. Performance of cut-off points obtained was determined on the basis of the bi-nominal distributions of the true (+) and true (-) results. Results: Of the 972 patients included, 196 (20.3%) had coinfection. Procalcitonin (PCT; ng/mL 2.4 vs. 0.5, p < 0.001), but not C-reactive protein (CRP; mg/dL 25 vs. 38.5; p = 0.62) was higher in patients with coinfection. In CHAID analyses, PCT was the most important variable for coinfection. PCT < 0.29 ng/mL showed high sensitivity (Se = 88.2%), low Sp (33.2%) and high negative predictive value (NPV = 91.9%). The absence of shock improved classification capacity. Thus, for PCT < 0.29 ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%. Conclusion: PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock. (C) 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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