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2. Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Author

Wahlster, S, Sharma, M, Taran, S, Town, J, Stevens, R, Cinotti, R, Asehoune, K, Pelosi, P, Robba, C, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Wahlster S., Sharma M., Taran S., Town J. A., Stevens R. D., Cinotti R., Asehoune K., Pelosi P., Robba C., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Gomez Haedo M. M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Velarde Pineda A. A., Nubert Castillo V. H., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Mijangos J. C., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Digitale J. C., Fong N., Cerda R. C., de la Torre Peredo N., Wahlster, S, Sharma, M, Taran, S, Town, J, Stevens, R, Cinotti, R, Asehoune, K, Pelosi, P, Robba, C, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Wahlster S., Sharma M., Taran S., Town J. A., Stevens R. D., Cinotti R., Asehoune K., Pelosi P., Robba C., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Gomez Haedo M. M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Velarde Pineda A. A., Nubert Castillo V. H., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Mijangos J. C., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Digitale J. C., Fong N., Cerda R. C., and de la Torre Peredo N.

Abstract

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2–15.1], 13 J/min [IQR 10–17], and 14 J/min [IQR 11–20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14–1.30) and HD3 (1.38, 95% CI 1.23–1.53), reintubation on HD1 (1.64; 95% CI 1.57–1.72), and tracheostomy on HD7 (1

Published
2023

3. Individualized Thresholds of Hypoxemia and Hyperoxemia and their Effect on Outcome in Acute Brain Injured Patients: A Secondary Analysis of the ENIO Study

Author

Robba, C, Battaglini, D, Cinotti, R, Asehnoune, K, Stevens, R, Taccone, F, Badenes, R, Pelosi, P, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Agrippino, B, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez-Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Cracchiolo Neville, A, Palma, M, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Robba C., Battaglini D., Cinotti R., Asehnoune K., Stevens R., Taccone F. S., Badenes R., Pelosi P., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Agrippino B., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Gomez-Haedo M. M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Cracchiolo Neville A., Palma M. D., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Mijangos J. C., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Elbuzidi A. A. S., Piagnerelli M., Elhadi M., Digitale J. C., Fong N., Cerda R. C., de la Torre Peredo N., Robba, C, Battaglini, D, Cinotti, R, Asehnoune, K, Stevens, R, Taccone, F, Badenes, R, Pelosi, P, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Agrippino, B, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez-Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Cracchiolo Neville, A, Palma, M, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Robba C., Battaglini D., Cinotti R., Asehnoune K., Stevens R., Taccone F. S., Badenes R., Pelosi P., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Agrippino B., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Gomez-Haedo M. M., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Cracchiolo Neville A., Palma M. D., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Mijangos J. C., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Elbuzidi A. A. S., Piagnerelli M., Elhadi M., Digitale J. C., Fong N., Cerda R. C., and de la Torre Peredo N.

Abstract

Background: In acute brain injury (ABI), the effects of hypoxemia as a potential cause of secondary brain damage and poor outcome are well documented, whereas the impact of hyperoxemia is unclear. The primary aim of this study was to assess the episodes of hypoxemia and hyperoxemia in patients with ABI during the intensive care unit (ICU) stay and to determine their association with in-hospital mortality. The secondary aim was to identify the optimal thresholds of arterial partial pressure of oxygen (PaO2) predicting in-hospital mortality. Methods: We conducted a secondary analysis of a prospective multicenter observational cohort study. Adult patients with ABI (traumatic brain injury, subarachnoid aneurysmal hemorrhage, intracranial hemorrhage, ischemic stroke) with available data on PaO2 during the ICU stay were included. Hypoxemia was defined as PaO2 < 80 mm Hg, normoxemia was defined as PaO2 between 80 and 120 mm Hg, mild/moderate hyperoxemia was defined as PaO2 between 121 and 299 mm Hg, and severe hyperoxemia was defined as PaO2 levels ≥ 300 mm Hg. Results: A total of 1,407 patients were included in this study. The mean age was 52 (±18) years, and 929 (66%) were male. Over the ICU stay, the fractions of patients in the study cohort who had at least one episode of hypoxemia, mild/moderate hyperoxemia, and severe hyperoxemia were 31.3%, 53.0%, and 1.7%, respectively. PaO2 values below 92 mm Hg and above 156 mm Hg were associated with an increased probability of in-hospital mortality. Differences were observed among subgroups of patients with ABI, with consistent effects only seen in patients without traumatic brain injury. Conclusions: In patients with ABI, hypoxemia and mild/moderate hyperoxemia were relatively frequent. Hypoxemia and hyperoxemia during ICU stay may influence in-hospital mortality. However, the small number of oxygen values collected represents a major limitation of the study.

Published
2023

4. Risk factors of extubation failure in neurocritical patients with the most impaired consciousness

Author

de Courson, H, Massart, N, Asehnoune, K, Cinotti, R, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espino-sa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Fong, N, Digitale, J, Stevens, R, Mijangos, J, Haenngi, M, Gurjar, M, Schultz, M, Godoy, D, Alvarez, P, Kaye, C, Ioakeimidou, A, Ueno, Y, Badenes, R, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Cerda, R, Peredo, N, de Courson H., Massart N., Asehnoune K., Cinotti R., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Haedo M. M. G., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espino-sa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Fong N., Digitale J., Stevens R., Mijangos J. C., Haenngi M., Gurjar M., Schultz M., Godoy D. A., Alvarez P., Kaye C., Ioakeimidou A., Ueno Y., Badenes R., Elbuzidi A. S., Piagnerelli M., Elhadi M., Cerda R., Peredo N., de Courson, H, Massart, N, Asehnoune, K, Cinotti, R, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espino-sa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Fong, N, Digitale, J, Stevens, R, Mijangos, J, Haenngi, M, Gurjar, M, Schultz, M, Godoy, D, Alvarez, P, Kaye, C, Ioakeimidou, A, Ueno, Y, Badenes, R, Elbuzidi, A, Piagnerelli, M, Elhadi, M, Cerda, R, Peredo, N, de Courson H., Massart N., Asehnoune K., Cinotti R., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Haedo M. M. G., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azab M. A., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espino-sa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Reza S. T., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Fong N., Digitale J., Stevens R., Mijangos J. C., Haenngi M., Gurjar M., Schultz M., Godoy D. A., Alvarez P., Kaye C., Ioakeimidou A., Ueno Y., Badenes R., Elbuzidi A. S., Piagnerelli M., Elhadi M., Cerda R., and Peredo N.

Published
2023

5. In-droplet cell lysis of AC16 human cardiomyocyte cells via surface acoustic waves.

Author

Trujillo, R. M., Almanza, G., Sanchez-Saldaña, D., Rosand, Ø., Høydal, M., Fernandino, M., and Dorao, C. A.

Subjects
*ACOUSTIC surface waves, *LYSIS, *ACOUSTIC streaming, *ACOUSTIC wave propagation, *CELL size, *CELL survival
Abstract

Although several lysis methods are available, biomedical applications are pushing the demand for miniaturised systems and thus for new ways to lyse cells in small volumes. In this work, we demonstrate in-droplet cell lysis of AC16 human cardiomyocyte cells in 20 μL droplets using high frequency surface acoustic waves. The acoustic streaming leads to high shear flow creating porous or breaking the cell membrane and releasing intracellular material. Contrary to previous work where the lysis efficiency is measured by a cell-permeant dye that can be used to determine cell viability, here we propose to quantify the DNA extracted from the cells as a measure of the lysis efficiency. This reagent-free method provides a valuable cell lysis alternative for many biological and biomedical applications, particularly for the development of point-of-care platforms. [ABSTRACT FROM AUTHOR]

Published
2023
Full Text
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6. Extubation in neurocritical care patients: the ENIO international prospective study

Author

Cinotti, R, Mijangos, J, Pelosi, P, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Reza, S, Azab, M, Mccredie, V, Stevens, R, Digitale, J, Fong, N, Asehnoune, K, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Cinotti R., Mijangos J. C., Pelosi P., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Reza S. T., Azab M. A., McCredie V., Stevens R. D., Digitale J. C., Fong N., Asehnoune K., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Haedo M. M. G., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., Samal S., Cinotti, R, Mijangos, J, Pelosi, P, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Reza, S, Azab, M, Mccredie, V, Stevens, R, Digitale, J, Fong, N, Asehnoune, K, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Robba, C, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Pineda, A, Castillo, V, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Cinotti R., Mijangos J. C., Pelosi P., Haenggi M., Gurjar M., Schultz M. J., Kaye C., Godoy D. A., Alvarez P., Ioakeimidou A., Ueno Y., Badenes R., Suei Elbuzidi A. A., Piagnerelli M., Elhadi M., Reza S. T., Azab M. A., McCredie V., Stevens R. D., Digitale J. C., Fong N., Asehnoune K., Abback P. -S., Codorniu A., Citerio G., Sala V. L., Astuto M., Tringali E., Alampi D., Rocco M., Maugeri J. G., Bellissima A., Filippini M., Lazzeri N., Cortegiani A., Ippolito M., Robba C., Battaglini D., Biston P., Al-Gharyani M. F., Chabanne R., Astier L., Soyer B., Gaugain S., Zimmerli A., Pietsch U., Filipovic M., Brandi G., Bicciato G., Serrano A., Monleon B., van Vliet P., Gerretsen B. M., Ortiz-Macias I. X., Oto J., Enomoto N., Matsuda T., Masui N., Garcon P., Zarka J., Vermeijden W. J., Cornet A. D., Inurrigarro S. R., Dominguez R. C. L., Bellini M. M., Haedo M. M. G., Lamot L., Orquera J., Biais M., Georges D., Baronia A., Miranda-Ackerman R. C., Barbosa-Camacho F. J., Porter J., Lopez-Morales M., Geeraerts T., Compagnon B., Perez-Torres D., Prol-Silva E., Yahya H. B., Khaled A., Ghula M., Andrea C. N., Daniela P. M., Deana C., Vetrugno L., Chavez M. J. R., Trujillo R. M., Legros V., Brochet B., Huet O., Geslain M., van der Jagt M., van Steenkiste J., Ahmed H., Coombs A. E., Welbourne J., Pineda A. A. V., Castillo V. H. N., Azzam A. Y., van Meenen D. M. P., Gasca G. A., Arellano A., Galicia-Espinosa F., Garcia-Ramos J. C., Yadav G., Jha A. K., Robert-Edan V., Rodie-Talbere P. -A., Jain G., Panda S., Agarwal S., Deewan Y., Hossain M. M., Papadas C., Chantziara V., Sklavou C., Hourmant Y., Grillot N., Pirracchio R., Akkari A., Abdelaty M., Hashim A., Launey Y., Masseret E., Lasocki S., Gergaud S., Mouclier N., Saxena S., Agrawal A., Mishra S. B., and Samal S.

Abstract

Purpose: Neurocritical care patients receive prolonged invasive mechanical ventilation (IMV), but there is poor specific information in this high-risk population about the liberation strategies of invasive mechanical ventilation. Methods: ENIO (NCT03400904) is an international, prospective observational study, in 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Neurocritical care patients with a Glasgow Coma Score (GCS) ≤ 12, receiving IMV ≥ 24 h, undergoing extubation attempt or tracheostomy were included. The primary endpoint was extubation failure by day 5. An extubation success prediction score was created, with 2/3 of patients randomly allocated to the training cohort and 1/3 to the validation cohort. Secondary endpoints were the duration of IMV and in-ICU mortality. Results: 1512 patients were included. Among the 1193 (78.9%) patients who underwent an extubation attempt, 231 (19.4%) failures were recorded. The score for successful extubation prediction retained 20 variables as independent predictors. The area under the curve (AUC) in the training cohort was 0.79 95% confidence interval (CI95) [0.71–0.87] and 0.71 CI95 [0.61–0.81] in the validation cohort. Patients with extubation failure displayed a longer IMV duration (14 [7–21] vs 6 [3–11] days) and a higher in-ICU mortality rate (8.7% vs 2.4%). Three hundred and nineteen (21.1%) patients underwent tracheostomy without extubation attempt. Patients with direct tracheostomy displayed a longer duration of IMV and higher in-ICU mortality than patients with an extubation attempt (success and failure). Conclusions: In neurocritical care patients, extubation failure is high and is associated with unfavourable outcomes. A score could predict extubation success in multiple settings. However, it will be mandatory to validate our findings in another prospective independent cohort.

Published
2022

7. Abordaje Percutaneo del Sistema Venoso Central. Comparación de la Punción de la Vena Subclavia con la de la Yugular Interna

Author

Trujillo R., M. H., Castillo V., A., España, J., Guevara, P., Lauder, O., Plotnikov, S., Trujillo R., M. H., Castillo V., A., España, J., Guevara, P., Lauder, O., and Plotnikov, S.

Abstract

Se analizan los resultados obtenidos en dos grupos comparables de pacientes sometidos a cateterismo prolongado del sistema venoso central por punción percutánea de las venas subclavia y yugular interna respectivamente. Se hace una revisión de las indicaciones, aspectos técnicos generales y de las contraindicaciones en relación con ambos procedimientos. Del análisis de las complicaciones se concluye que con la técnica de punción de la vena yugular interna no se observan las complicaciones graves y eventualmente fatales que se pueden presentar cuando se utiliza la vía subclavia; de lo cual se deduce que esta técnica debe ser la de elección para los casos que requieran cateterismo prolongado del sistema venoso central.

Published
2009

9. A preliminary study of platelet hyperactivity in the chronic indeterminate phase of Chagas’ disease

Author

Castillejos, F. R., Mayoral, L. P. -C, Andrade, G. M., MARIA TERESA HERNANDEZ HUERTA, Pina-Canseco, S., Cruz, R. M., Colmenares, E. H., Mayoral, E. P. -C, Salazar, P. M., Torres, M. B., Bravo, M. C., Cruz, M. M., Cervantes, C. M., Albarraz, R. D., Matias, J. L., Arias, G. I. R., Bernardino, G. H., Matus, E. P., Trujillo, R. M., Navarro, L. M. S., Santiago, A. D. P., and Campos, E. P.

Abstract

The chronic indeterminate phase of Chagas' disease is asymptomatic despite positive test results for antibodies specific to Trypanosoma cruzi. CD62P-APC (P-selectin) and PAC-1 FITC (GpIIb/IIIa) may improve diagnosis as biomarkers of platelet activity. Nine asymptomatic seropositive subjects, previously untreated, were selected from a blood bank within a year of Chagas' disease detection, in addition to a control group of four. All subjects were evaluated by flow cytometry for CD62P, PAC-1 and CD41, and in a complementary study, by Tissue Doppler Echocardiography for isovolumic relaxation times (IVRT) and E/A ratios. The subjects were classified as positive or negative for CD62P and PAC-1 by a cut off obtained from their mean±2SD. For IVRT and E/A ratios, cut offs were obtained from the American Society of Echocardiography and the European Association of Cardiovascular Imaging recommendations. Fisher's exact test was used for associated findings. Pre-test and post-test probability, sensitivity, specificity, positive and negative predictive values and likelihood ratios were calculated. Abnormalities were expressed as platelet hyperactivity and ventricular dysfunction in CD62P, PAC-1, IVRT and E/A ratios. CD62P appears to have greater sensitivity (0.75) and PAC-1, more accurate specificity (0.75), which may explain thrombotic events in Chagas' disease. We recommend the use of CD62P and PAC-1 as biomarkers of platelet hyperactivity in patients in the chronic indeterminate phase of Chagas' disease.

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