Publications by authors named "Penuelas O"
Background: Bacterial pulmonary superinfections develop in a substantial proportion of mechanically ventilated COVID-19 patients and are associated with prolonged mechanical ventilation requirements and an increased mortality. Albeit recommended, evidence supporting the use of empirical antibiotics at intubation is weak and of low quality. The aim of this study was to elucidate the effect of empirical antibiotics, administered within 24hours of endotracheal intubation, on superinfections, duration of mechanical ventilation, and mortality in mechanically ventilated patients with COVID-19.
View Article and Find Full Text PDFBackground: The trend over time and across different geographical areas of outcomes and management with noninvasive ventilation or invasive mechanical ventilation in patients admitted for acute exacerbations of chronic obstructive pulmonary disease and treated with ventilatory support is unknown. The purpose of this study was to describe outcomes and identify variables associated with survival for patients admitted to an intensive care unit (ICU) with acute exacerbation of chronic obstructive pulmonary disease [aeCOPD] who received noninvasive or invasive mechanical ventilation worldwide.
Methods: Retrospective, multi-national, and multicenter studies, including four observational cohort studies, were carried out in 1998, 2004, 2010, and 2016 for the VENTILAGROUP following the same methodology.
Background: Ventilation management may differ between COVID-19 ARDS (COVID-ARDS) patients and patients with pre-COVID ARDS (CLASSIC-ARDS); it is uncertain whether associations of ventilation management with outcomes for CLASSIC-ARDS also exist in COVID-ARDS.
Methods: Individual patient data analysis of COVID-ARDS and CLASSIC-ARDS patients in six observational studies of ventilation, four in the COVID-19 pandemic and two pre-pandemic. Descriptive statistics were used to compare epidemiology and ventilation characteristics.
Objective: To analyze the presence of frailty in survivors of severe COVID-19 admitted in the Intensive Care Unit (ICU) and followed six months after discharge.
Design: An observational, prospective and multicenter, nation-wide study.
Setting: Eight adult ICU across eight academic acute care hospitals in Mexico.
Article Synopsis
- * Key aspects of managing severe cases include deciding when to start non-invasive support, recognizing treatment failures, and implementing palliative or de-escalation strategies when improvement happens.
- * The document compiles insights from four scientific societies and 25 experts to enhance care approaches for severe COVID-19, reflecting on recent evidence rather than old guidelines from acute respiratory distress syndrome.
Background: Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates the effectiveness of procalcitonin (PCT) and C-reactive protein (CRP) as biomarkers for identifying bacterial coinfection in COVID-19 patients admitted to ICUs in Spain.
- Of 4,076 patients studied, only 3% had bacterial coinfection, and while PCT and CRP showed high negative predictive values, their overall predictive capability was found to be low.
- The findings indicate that measuring PCT and CRP at hospital admission is not a reliable method for diagnosing bacterial coinfection in COVID-19 pneumonia patients.
Background: The identification of critically ill COVID-19 patients at risk of fatal outcomes remains a challenge. Here, we first validated candidate microRNAs (miRNAs) as biomarkers for clinical decision-making in critically ill patients. Second, we constructed a blood miRNA classifier for the early prediction of adverse outcomes in the ICU.
View Article and Find Full Text PDFIntroduction And Objectives: Critically-ill elderly ICU patients with COVID-19 have poor outcomes. We aimed to compare the rates of in-hospital mortality between non-elderly and elderly critically-ill COVID-19 ventilated patients, as well as to analyze the characteristics, secondary outcomes and independent risk factors associated with in-hospital mortality of elderly ventilated patients.
Patients And Methods: We conducted a multicentre, observational cohort study including consecutive critically-ill patients admitted to 55 Spanish ICUs due to severe COVID-19 requiring mechanical ventilation (non-invasive respiratory support [NIRS; include non-invasive mechanical ventilation and high-flow nasal cannula] and invasive mechanical ventilation [IMV]) between February 2020 and October 2021.
Objective: To compare adherence to protective mechanical ventilation (MV) parameters in patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 with patients with ARDS from other etiologies.
Design: Multiple prospective cohort study.
Setting: Two Brazilian cohorts of ARDS patients were evaluated.
Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation.
Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries.
Article Synopsis
- Critical COVID-19 survivors have a significant risk of respiratory issues, leading to a study that identifies factors linked to poor lung function and CT scan abnormalities in these patients.
- The study involved 1,327 patients from 52 Spanish intensive care units, examining their health data at hospital admission and follow-up, which occurred around 3.57 months after discharge.
- Results showed many patients had reduced lung capacity and CT scans revealed issues like pulmonary infiltrates and fibrosis, with age, chronic lung disease, and mechanical ventilation duration being key predictors of these complications.
Background: There are no studies in large series of burn patients on the relationship between acute kidney injury (AKI) and adverse outcomes using the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.
Methods: We retrospectively analysed data from a cohort of burn patients admitted to the intensive care unit (ICU) with the diagnosis of burn injury. The diagnosis of AKI over the first 7 days after injury was made according to the KDIGO guidelines.
Background: The primary aim of our study was to investigate the association between intubation timing and hospital mortality in critically ill patients with coronavirus disease 2019 (COVID-19)-associated respiratory failure. We also analysed both the impact of such timing throughout the first four pandemic waves and the influence of prior noninvasive respiratory support on outcomes.
Methods: This is a secondary analysis of a multicentre, observational and prospective cohort study that included all consecutive patients undergoing invasive mechanical ventilation due to COVID-19 from across 58 Spanish intensive care units (ICUs) participating in the CIBERESUCICOVID project.
Article Synopsis
- - Survivors of ARDS due to SARS-CoV-2 often have ongoing lung function issues, with 80% experiencing problems even after leaving the hospital, but the specific biological mechanisms behind these issues are not well understood.
- - This study involved evaluating lung function and analyzing blood samples from patients with severe lung impairment, using RNA sequencing to identify key genes and pathways related to these pulmonary issues.
- - The research found 1357 differently expressed genes relevant to lung health, highlighting immune responses and cell death as significant factors, with the gene TUBB4A being a potential target for existing FDA-approved drugs.
Background: Despite the need for specific weaning strategies in neurological patients, evidence is generally insufficient or lacking. We aimed to describe the evolution over time of weaning and extubation practices in patients with acute brain injury compared with patients who are mechanically ventilated (MV) due to other reasons.
Methods: We performed a secondary analysis of three prospective, observational, multicenter international studies conducted in 2004, 2010, and 2016 in adults who had need of invasive MV for more than 12 h.
Background: Prone positioning reduces mortality in patients with moderate/severe ARDS. It remains unclear which physiological parameters could guide clinicians to assess which patients are likely to benefit from prone position. This study aimed to determine the association between relative changes in physiological parameters at 24 h of prone positioning and ICU mortality in adult subjects with ARDS.
View Article and Find Full Text PDFIntroduction: Bronchial aspirates (BAS) obtained during invasive mechanical ventilation (IMV) constitutes a useful tool for molecular phenotyping and decision making.
Aim: To identify the proteomic determinants associated with disease pathogenesis, all-cause mortality and respiratory sequelae in BAS samples from critically ill patients with SARS-CoV-2-induced ARDS.
Methods: Multicenter study including 74 critically ill patients with COVID-19 and non-COVID-19 ARDS.
The long-term clinical management and evolution of a cohort of critical COVID-19 survivors have not been described in detail. We report a prospective observational study of COVID-19 patients admitted to the ICU between March and August 2020. The follow-up in a post-COVID consultation comprised symptoms, pulmonary function tests, the 6-minute walking test (6MWT), and chest computed tomography (CT).
View Article and Find Full Text PDFPurpose: Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19.
Methods: Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs.
Background: The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae.
Methods: Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals.
There is a limited understanding of the pathophysiology of postacute pulmonary sequelae in severe COVID-19. The aim of current study was to define the circulating microRNA (miRNA) profiles associated with pulmonary function and radiologic features in survivors of SARS-CoV-2-induced ARDS. The study included patients who developed ARDS secondary to SARS-CoV-2 infection (n = 167) and a group of infected patients who did not develop ARDS (n = 33).
View Article and Find Full Text PDFPurpose: To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016.
Design: Post-hoc analysis of four cohort studies.
Ambit: 138 Spanish ICUs.