Limitation of life support treatments in Spanish Intensive Care Units: Analysis of the ETHICUS II study.

Objective: The aim of this study is to describe the results of Spanish ICUs in ETHICUS II study.

Design: Planned substudy of patients from ETHICUS II study.

Setting: 12 Spanish ICU.

Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak: A Propensity-Matched Cohort Study.

Background: During the first wave of the COVID-19 pandemic, shortages of ventilators and ICU beds overwhelmed health care systems. Whether early tracheostomy reduces the duration of mechanical ventilation and ICU stay is controversial.

Research Question: Can failure-free day outcomes focused on ICU resources help to decide the optimal timing of tracheostomy in overburdened health care systems during viral epidemics?

Study Design And Methods: This retrospective cohort study included consecutive patients with COVID-19 pneumonia who had undergone tracheostomy in 15 Spanish ICUs during the surge, when ICU occupancy modified clinician criteria to perform tracheostomy in Patients with COVID-19.

The Moderator Role of Passion for Work in the Association between Work Stressors and Secondary Traumatic Stress: A Cross-Level Diary Study among Health Professionals of Intensive Care Units.

Background: Secondary traumatic stress (STS), a construct formed by compassion fatigue, shattered assumptions, and symptomatology, has been scarcely studied in intensive care units (ICU). In these units, healthcare workers encounter daily work stressors which impact on their health and well-being. Also, previous literature revealed a passion for caring among these workers, finding two types: harmonious passion, which may protect them against negative outcomes, and obsessive passion, which may boost negative consequences.

Nutritrauma: A Key Concept for Minimising the Harmful Effects of the Administration of Medical Nutrition Therapy.

Critically ill patients often require life support measures such as mechanical ventilation or haemodialysis. Despite the essential role of nutrition in patients' recovery, the inappropriate use of medical nutrition therapy can have deleterious effects, as is the case with the use of respiratory, circulatory, or renal support. To increase awareness and to monitor the effects of inappropriate medical nutrition therapy, we propose to introduce the concept of nutritrauma in clinical practice, defined as metabolic adverse events related to the inappropriate administration of medical nutrition therapy or inadequate nutritional monitoring.

ESPEN guideline on clinical nutrition in the intensive care unit.

Following the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to start and how to progress in the administration of adequate provision of nutrients is also described.

Monitoring nutrition in the ICU.

Background & Aims: This position paper summarizes theoretical and practical aspects of the monitoring of artificial nutrition and metabolism in critically ill patients, thereby completing ESPEN guidelines on intensive care unit (ICU) nutrition.

Methods: Available literature and personal clinical experience on monitoring of nutrition and metabolism was systematically reviewed by the ESPEN group for ICU nutrition guidelines.

Results: We did not identify any studies comparing outcomes with monitoring versus not monitoring nutrition therapy.

Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study.

Purpose: To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission.

Methods: This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals' characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients' characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)).

Impact of obesity in patients infected with 2009 influenza A(H1N1).

Objective: A large proportion of patients infected with 2009 influenza A(H1N1) (A[H1N1]) are obese. Obesity has been proposed as a risk factor influencing outcome in these patients. However, its role remains unclear.

Isolation of Aspergillus lentulus in Spain from a critically ill patient with chronic obstructive pulmonary disease.

Aspergillus lentulus was first described in the year 2005, and since it cannot be phenotypically distinguished from Aspergillus fumigatus, it is conceivable that earlier descriptions (before 2005) could be attributed to this new species. Currently invasive infections caused by A. lentulus are rare and very few cases have been previously published in neutropenic patients, all of them with fatal outcome.

The early phase of the minute ventilation recovery curve predicts extubation failure better than the minute ventilation recovery time.

Study Objectives: To determine, in patients who had successful outcomes in spontaneous breathing trials (SBTs), whether the analysis of the minute ventilation (Ve) recovery time obtained by minute-by-minute sequential monitoring after placing the patient back on mechanical ventilation (MV) may be useful in predicting extubation outcome.

Design: Twelve-month prospective observational study.

Setting: Medical-surgical ICU of a university hospital.

Liver dysfunction associated with artificial nutrition in critically ill patients.

Introduction: Liver dysfunction associated with artificial nutrition in critically ill patients is a complication that seems to be frequent, but it has not been assessed previously in a large cohort of critically ill patients.

Methods: We conducted a prospective cohort study of incidence in 40 intensive care units. Different liver dysfunction patterns were defined: (a) cholestasis: alkaline phosphatase of more than 280 IU/l, gamma-glutamyl-transferase of more than 50 IU/l, or bilirubin of more than 1.

[Systemic antifungals. Pharmacodynamics and pharmacokinetics].

Invasive fungal infections are important causes of morbidity and mortality in critically ill non neutropenic patients. For many years, amphotericin B and flucytosine have been the only available antifungal agents for invasive fungal infections. Fortunately, the antifungal armamentarium has increased during the past two decades with the addition of several new agents.

[Prevention of invasive candidiasis in the critically ill non neutropenic patient].

Prevention of invasive candidiasis (IC) in the setting of critically ill non neutropenic patients should be based on evidenced-based recommendations, namely improved hand hygiene, optimal catheter care, and rational and reduced use of broad-spectrum antibiotics. Concomitant interventions aimed at reducing risk factors are important to decrease IC.

[Importance of invasive candidiasis in critical non-neutropenic patients].

Invasive candidiasis (IC) is the most frequent fungal infection in high risk patients in intensive care setting. IC is associated with high attributable mortality and increased healthcare cost. In this review current, epidemiological, diagnostic and clinical management is updated and discussed in the critically ill non netropenic patient.

Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically ill patients with systemic inflammatory response syndrome: a randomized, single-blind, prospective, multicenter study.

We investigated the effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity and mortality in critically ill patients who developed systemic inflammatory response syndrome after an acute event. Eleven intensive care units in tertiary-care hospitals participated in a prospective, randomized, single blind, multicenter trial. Eighty-four patients with systemic inflammatory response syndrome of any etiology were randomly allocated to receive a glutamine-enriched enteral diet or a control diet without glutamine.