Anti-inflammatory effects of clarithromycin in ventilator-induced lung injury

Supported by Instituto de Salud Carlos III (FIS-PI07/0597 and FIS-PI10/0606). AGL is the recipient of a grant from Universidad de Oviedo (UNOV-09-pf). AA and ILA are the recipients of grants from Instituto Universitario de Oncología del Principado de Asturias (IUOPA). EBS is the recipient of a grant from FICYT (COF-11-40). GMA is the recipient of a grant from Instituto de Salud Carlos III (Intensificación de la Actividad Investigadora-INT 11/14)

Beyond volutrauma in ARDS: the critical role of lung tissue deformation

Ventilator-induced lung injury (VILI) consists of tissue damage and a biological response resulting from the application of inappropriate mechanical forces to the lung parenchyma. The current paradigm attributes VILI to overstretching due to very high-volume ventilation (volutrauma) and cyclic changes in aeration due to very low-volume ventilation (atelectrauma); however, this model cannot explain some research findings. In the present review, we discuss the relevance of cyclic deformation of lung tissue as the main determinant of VILI. Parenchymal stability resulting from the interplay of respiratory parameters such as tidal volume, positive end-expiratory pressure or respiratory rate can explain the results of different clinical trials and experimental studies that do not fit with the classic volutrauma/atelectrauma model. Focusing on tissue deformation could lead to new bedside monitoring and ventilatory strategies

Survival of hematological patients after discharge from the intensive care unit: a prospective observational study

INTRODUCTION: Although the survival rates of hematological patients admitted to the ICU are improving, little is known about the long-term outcome. Our objective was to identify factors related to long-term outcome in hematological patients after ICU discharge. METHODS: A prospective, observational study was carried out in seven centers in Spain. From an initial sample of 161 hematological patients admitted to one of the participating ICUs during the study period, 62 were discharged alive and followed for a median time of 23 (1 to 54) months. Univariate and multivariate analysis were performed to identify the factors related to long term-survival. Finally, variables that influence the continuation of the scheduled therapy for the hematological disease were studied. RESULTS: Mortality after ICU discharge was 61%, with a median survival of 18 (1 to 54) months. In the multivariate analysis, an Eastern Cooperative Oncology Group score (ECOG) >2 at ICU discharge (Hazard ratio 11.15 (4.626 to 26.872)), relapse of the hematological disease (Hazard ratio 9.738 (3.804 to 24.93)) and discontinuation of the planned treatment for the hematological disease (Hazard ratio 4.349 (1.286 to 14.705)) were independently related to mortality. Absence of stem cell transplantation, high ECOG and high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores decreased the probability of receiving the planned therapy for the hematological malignancy. CONCLUSIONS: Both ICU care and post-ICU management determine the long-term outcome of hematological patients who are discharged alive from the ICU

The effects of using collaborative writing vs. peer review treatments on subsequent individual writings

Los efectos tanto de la escritura colaborativa como de la revisión por pares se han investigado por separado sin comparar ambos enfoques. Este trabajo tiene como objetivo comparar el efecto que estos dos tratamientos tienen en una redacción posterior tomando en consideración la complejidad, la corrección, y la fluidez (Medidas CAF), y además la calidad. 29 estudiantes de nivel de inglés intermedio bajo participaron en este estudio, 16 en el grupo de escritura colaborativa y 13 en el grupo de revisión por pares. Se analizaron dos redacciones, una como pre-test y otra como post-test, utilizando las medidas CAF y una rúbrica análitica. Los resultados sugieren que los estudiantes de la escritura colaborativa escribieron textos más largos y usaron un lenguaje más complejo, mientras los de la revisión por pares mejoraron sus redacciones en variedad léxica y corrección.Previous research has investigated separately the effects of collaborative writing and peer review. However, there has not been any research comparing both approaches. This study is aimed to analyse the effects of those two treatments on a subsequent individually written production in terms of complexity accuracy, and fluency (CAF measures), as well as quality. The participants were 29 students of lower-intermediate English proficiency level, 16 in the collaborative writing group and 13 in the peer review group. Two compositions were analysed as pre-test and post-test using CAF measures and an analytic rubric. The results suggest that students in the collaborative writing group produced longer writings and more complex language, while those in the peer review group improved their final individual writing in terms of lexical variety and accuracy

Comparative study of four sigmoid models of pressure-volume curve in acute lung injury

BACKGROUND: The pressure-volume curve of the respiratory system is a tool to monitor and set mechanical ventilation in acute lung injury. Mathematical models of the static pressure-volume curve of the respiratory system have been proposed to overcome the inter- and intra-observer variability derived from eye-fitting. However, different models have not been compared. METHODS: The goodness-of-fit and the values of derived parameters (upper asymptote, maximum compliance and points of maximum curvature) in four sigmoid models were compared, using pressure-volume data from 30 mechanically ventilated patients during the early phase of acute lung injury. RESULTS: All models showed an excellent goodness-of-fit (R(2 )always above 0.92). There were significant differences between the models in the parameters derived from the inspiratory limb, but not in those derived from the expiratory limb of the curve. The within-case standard deviations of the pressures at the points of maximum curvature ranged from 2.33 to 6.08 cmH(2)O. CONCLUSION: There are substantial variabilities in relevant parameters obtained from the four different models of the static pressure-volume curve of the respiratory system

Ventilatory support in critically ill hematology patients with respiratory failure

INTRODUCTION: Hematology patients admitted to the ICU frequently experience respiratory failure and require mechanical ventilation. Noninvasive mechanical ventilation (NIMV) may decrease the risk of intubation, but NIMV failure poses its own risks. METHODS: To establish the impact of ventilatory management and NIMV failure on outcome, data from a prospective, multicenter, observational study were analyzed. All hematology patients admitted to one of the 34 participating ICUs in a 17-month period were followed up. Data on demographics, diagnosis, severity, organ failure, and supportive therapies were recorded. A logistic regression analysis was done to evaluate the risk factors associated with death and NIVM failure. RESULTS: Of 450 patients, 300 required ventilatory support. A diagnosis of congestive heart failure and the initial use of NIMV significantly improved survival, whereas APACHE II score, allogeneic transplantation, and NIMV failure increased the risk of death. The risk factors associated with NIMV success were age, congestive heart failure, and bacteremia. Patients with NIMV failure experienced a more severe respiratory impairment than did those electively intubated. CONCLUSIONS: NIMV improves the outcome of hematology patients with respiratory insufficiency, but NIMV failure may have the opposite effect. A careful selection of patients with rapidly reversible causes of respiratory failure may increase NIMV success

Procalcitonin and c-reactive protein to rule out early bacterial coinfection in covid-19 critically ill patients

Financial support was provided by the Instituto de Salud Carlos III de Madrid (COV20/00110, ISCIII); Fondo Europeo de Desarrollo Regional (FEDER); “Una manera de hacer Europa”; Centro de Investigación Biomedica En Red–Enfermedades Respiratorias (CIBERES); and Donation program “estar preparados” UNESPA, Madrid, Spain. DdGC has received financial support from the Instituto de Salud Carlos III (Miguel Servet 2020: CP20/00041), co‑funded by European Social Fund (ESF)/ “Investing in your future”. Adrian Ceccato acknowledges receiving financial support from Instituto de Salud Carlos III (ISCIII; Sara Borrell 2021: CD21/00087).Galli F., Bindo F., Motos A., Fernández-Barat L., Barbeta E., Gabarrús A., Ceccato A., Bermejo-Martin J.F., Ferrer R., Riera J., Peñuelas O., Lorente J.Á., de Gonzalo-Calvo D., Menéndez R., Gonzalez J., Misuraca S., Palomeque A., Amaya-Villar R., Añón J.M., Balan Mariño A., Barberà C., Barberán J., Blandino Ortiz A., Bustamante-Munguira E., Caballero J., Cantón-Bulnes M.L., Carbajales Pérez C., Carbonell N., Catalán-González M., de Frutos R., Franco N., Galbán C., Lopez Lago A., Gumucio-Sanguino V.D., de la Torre M.C., Díaz E., Estella Á., Gallego Curto E., García-Garmendia J.L., Gómez J.M., Huerta A., Jorge García R.N., Loza-Vázquez A., Marin-Corral J., Martin Delgado M.C., Martínez de la Gándara A., Martínez Varela I., Lopez Messa J., M. Albaiceta G., Nieto M.T., Novo M.A., Peñasco Y., Pérez-García F., Pozo-Laderas J.C., Ricart P., Sagredo V., Sánchez-Miralles A., Sancho Chinesta S., Roche-Campo F., Socias L., Solé-Violan J., Suarez-Sipmann F., Tamayo Lomas L., Trenado J., Úbeda A., Valdivia L.J., Vidal P., Boado M.V., Rodríguez A., Antonelli M., Blasi F., Barbé F., Torres A