Víctor D. Gumucio-Sanguino

Bellvitge University Hospital

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Jordi Riera

Vall d'Hebron Institut de Recerca

Lorenzo Socías

Hospital Son Llatzer

Jessica González

Biomedical Research Institute of Lleida

José Barberán

Hospital Universitario HM Madrid

Yhivian Peñasco

Marqués de Valdecilla University Hospital

Pablo Vidal

Complejo Hospitalario de Ourense

Jesús Caballero

Hospital Universitari Arnau de Vilanova

Mercedes Catalán-González

Research Institute Hospital 12 de Octubre

Laia Fernández‐Barat

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias

Jordi Solé‐Violán

Hospital Universitario de Gran Canaria Doctor Negrín

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Instituto de Salud Carlos III

120

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias

118

Universitat de Barcelona

Hospital Universitari Arnau de Vilanova

Centro de Investigación Biomédica en Red

Bellvitge University Hospital

Consorci Institut D'Investigacions Biomediques August Pi I Sunyer

Hospital Clínic de Barcelona

Biomedical Research Institute of Lleida

Universitat Autònoma de Barcelona

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Severe Acute Kidney Injury in Patients with COVID-19 and Acute Respiratory Distress Syndrome (vol 202, pg 1299, 2020)

American Journal of Respiratory and Critical Care Medicine (2021)

Khalil Chaïbi Melissa Dominicé Dao Thaidan Pham Víctor D. Gumucio-Sanguino Fabio Alessandro Di Paolo

2019-20 coronavirus outbreak

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Citations (1)

Continuous Infusion of Piperacillin/Tazobactam and Meropenem in ICU Patients Without Renal Dysfunction: Are Patients at Risk of Underexposure?

European Journal of Drug Metabolism and Pharmacokinetics (2021)

E Esteve Pitarch Víctor D. Gumucio-Sanguino Sara Cobo‐Sacristán Evelyn Shaw Kristel Maisterra-Santos

Piperacillin/tazobactam

Pharmacodynamics

Tazobactam

10.1007/s13318-021-00694-0

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Citations (4)

Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

Archivos de Bronconeumología (2023)

Jessica González Jordi de Batlle Iván D. Benítez Gerard Torres Sally Santisteve

2019-20 coronavirus outbreak

10.1016/j.arbres.2022.12.017

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Citations (4)

Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

The Lancet Regional Health - Europe (2022)

Iván D. Benítez Jordi de Batlle Gerard Torres Jessica González David de Gonzalo‐Calvo

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.Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months.Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01).Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae.ISCIII, UNESPA, CIBERES, FEDER, ESF.

10.1016/j.lanepe.2022.100422

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Citations (10)

Prognostic Value of D-Dimer Across Four Populations of Critically Ill Patients (Pulmonary Embolism, Influenza a Pneumonia, Covid-19 and Septic Shock) Dataset

Patricia Fanlo-Garcia M.P. Fuset-Cabanes Xose Pérez Fernández Luisa Corral Víctor D. Gumucio-Sanguino

D-dimer is a product of cross-linked fibrin degradation that can be used as a sensitive but non-specific biomarker of thrombotic activity. Coronavirus disease 2019 (COVID-19) pandemics showed that d-dimer could be a good predictor of severity and mortality in patients with COVID-19 pneumonia. The primary objective for creating this dataset was to understand the role of d-dimer as a prognostic biomarker in critically ill patients across four different diseases characterised by inflammation and thrombosis: pulmonary embolism, influenza-A pneumonia, severe COVID-19 pneumonia, and septic shock. However, this dataset can be reused in order to determine other parameters in the four populations of critically ill patients, as the fact that most of the patients included presented advanced AKI reflects the severity of this cohort, which is well representative of septic critically ill patients admitted to our intensive care units (ICUs).The patients included in this dataset were critically ill adults admitted to the ICU of Bellvitge University Hospital in Spain, between 2000 and 2021. The data collection process entailed review of hospital charts and Catalunya’s shared health records.

D-dimer

Value (mathematics)

2019-20 coronavirus outbreak

10.2139/ssrn.4648531

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Long-Term Effects of a Stepwise, Multimodal, Non-Restrictive Antimicrobial Stewardship Programme for Reducing Broad-Spectrum Antibiotic Use in the ICU

Antibiotics (2024)

Mar Ronda Víctor D. Gumucio-Sanguino Evelyn Shaw R. Granada Fé Tubau

Information on the long-term effects of non-restrictive antimicrobial stewardship (AMS) strategies is scarce. We assessed the effect of a stepwise, multimodal, non-restrictive AMS programme on broad-spectrum antibiotic use in the intensive care unit (ICU) over an 8-year period. Components of the AMS were progressively implemented. Appropriateness of antibiotic prescribing was also assessed by monthly point-prevalence surveys from 2013 onwards. A Poisson regression model was fitted to evaluate trends in the reduction of antibiotic use and in the appropriateness of their prescription. From 2011 to 2019, a total of 12,466 patients were admitted to the ICU. Antibiotic use fell from 185.4 to 141.9 DDD per 100 PD [absolute difference, −43.5 (23%), 95% CI −100.73 to 13.73; p = 0.13] and broad-spectrum antibiotic fell from 41.2 to 36.5 [absolute difference, −4.7 (11%), 95% CI −19.58 to 10.18; p = 0.5]. Appropriateness of antibiotic prescribing rose by 11% per year [IRR: 0.89, 95% CI 0.80 to 1.00; p = 0.048], while broad-spectrum antibiotic use showed a dual trend, rising by 22% until 2015 and then falling by 10% per year since 2016 [IRR: 0.90, 95% CI 0.81 to 0.99; p = 0.03]. This stepwise, multimodal, non-restrictive AMS achieved a sustained reduction in broad-spectrum antibiotic use in the ICU and significantly improved appropriateness of antibiotic prescribing.

Antimicrobial Stewardship

Defined daily dose

Broad spectrum

10.3390/antibiotics13020132

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Citations (0)

Predictive Factors of Piperacillin Exposure and the Impact on Target Attainment after Continuous Infusion Administration to Critically Ill Patients

Antibiotics (2023)

Javier Martínez-Casanova E Esteve Pitarch Helena Colom Víctor D. Gumucio-Sanguino Sara Cobo‐Sacristán

Critically ill patients undergo significant pathophysiological changes that affect antibiotic pharmacokinetics. Piperacillin/tazobactam administered by continuous infusion (CI) improves pharmacokinetic/pharmacodynamic (PK/PD) target attainment. This study aimed to characterize piperacillin PK after CI administration of piperacillin/tazobactam in critically ill adult patients with preserved renal function and to determine the empirical optimal dosing regimen. A total of 218 piperacillin concentrations from 106 patients were simultaneously analyzed through the population PK approach. A two-compartment linear model best described the data. Creatinine clearance (CLCR) estimated by CKD-EPI was the covariate, the most predictive factor of piperacillin clearance (CL) interindividual variability. The mean (relative standard error) parameter estimates for the final model were: CL: 12.0 L/h (6.03%); central and peripheral compartment distribution volumes: 20.7 L (8.94%) and 62.4 L (50.80%), respectively; intercompartmental clearance: 4.8 L/h (26.4%). For the PK/PD target of 100% fT>1×MIC, 12 g of piperacillin provide a probability of target attainment > 90% for MIC < 16 mg/L, regardless of CLCR, but higher doses are needed for MIC = 16 mg/L when CLCR > 100 mL/min. For 100% fT>4×MIC, the highest dose (24 g/24 h) was not sufficient to ensure adequate exposure, except for MICs of 1 and 4 mg/L. Our model can be used as a support tool for initial dose guidance and during therapeutic drug monitoring.

Piperacillin/tazobactam

Pharmacodynamics

Tazobactam

10.3390/antibiotics12030531

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Citations (2)

ICU-Acquired Pneumonia Is Associated with Poor Health Post-COVID-19 Syndrome

Journal of Clinical Medicine (2021)

Ignacio Martín‐Loeches Ana Motos Rosario Menéndez Albert Gabarrús Jessica González

Background. Some patients previously presenting with COVID-19 have been reported to develop persistent COVID-19 symptoms. While this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the incidence and factors associated with the characteristics of persistent COVID-19. On the other hand, these patients very often have intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence on poor health post-COVID 19 syndrome in ICU-discharged patients. Methods: This prospective, multicentre, and observational study was carrid out across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. Results: A total of 1255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP). Patients requiring invasive mechanical ventilation had more persistent post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, development of ICUAP, and ARDS were independent factors for persistent poor health post-COVID-19. Conclusions: Persistent post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay, development of ICUAP, and ARDS all comprised independent factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-COVID-19.

10.3390/jcm11010224

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Citations (16)

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Critical Care (2021)

Antoni Torres Ana Motos Jordi Riera Laia Fernández‐Barat Adrián Ceccato

Abstract Background Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO 2 /FiO 2 increased from 115.6 [80.0–171.2] to 180.0 [135.4–227.9] mmHg and the ventilatory ratio from 1.73 [1.33–2.25] to 1.96 [1.61–2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01–1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01–1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93–1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO 2 /FiO 2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO 2 /FiO 2 variation.

10.1186/s13054-021-03727-x

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Citations (36)

Voriconazole Pharmacokinetics in Critically Ill Patients and Extracorporeal Membrane Oxygenation Support: A Retrospective Comparative Case-Control Study

Antibiotics (2023)

Mar Ronda Josep Manuel Llop-Talaveron MariPaz Fuset E. Leiva Badosa Evelyn Shaw

Voriconazole, an antifungal agent, displays high intra- and inter-individual variability. The predictive pharmacokinetic (PK) index requires a minimum plasma concentration (Cmin) in patient serum of between 1-5.5 mg/L. It is common to encounter fungal infections in patients undergoing extracorporeal membrane oxygenation (ECMO) support, and data regarding voriconazole PK changes during ECMO are scarce. Our study compared voriconazole PKs in patients with and without ECMO support in a retrospective cohort of critically-ill patients. Fifteen patients with 26 voriconazole Cmin determinations in the non-ECMO group and nine patients with 27 voriconazole Cmin determinations in the ECMO group were recruited. The ECMO group had lower Cmin (0.38 ± 2.98 vs. 3.62 ± 3.88, p < 0.001) and higher infratherapeutic Cmin values (16 vs. 1, p < 0.001) than the non-ECMO group. Multivariate analysis identified ECMO support (-0.668, CI95 -0.978--0.358) and plasma albumin levels (-0.023, CI95 -0.046--0.001) as risk factors for low Cmin values. When comparing pre- and post-therapeutic drug optimisation samples from the ECMO group, the dose required to achieve therapeutic Cmin was 6.44 mg/kg twice a day. Therapeutic drug optimisation is essential to improve target attainment.

Cmin

Therapeutic Drug Monitoring

Therapeutic index

10.3390/antibiotics12071100

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Citations (6)