Marina Soro

Hospital Clínico Universitario de Valencia

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Carlos Ferrando

Instituto de Salud Carlos III

F. J. Belda

Median SCP (Spain)

Gerardo Aguilar

Hospital Clínico Universitario de Valencia

Jesús Villar

St. Michael's Hospital

Javier Belda

Hospital Clínico Universitario de Valencia

Gerardo Tusman

Hospital Privado de Comunidad

Aurélio Rodriguez

Hospital Universitario de Gran Canaria Doctor Negrín

Lucía Gallego

Universidad Complutense de Madrid

Fernando Suarez‐Sipmann

Instituto de Salud Carlos III

J Carbonell

Hospital Clínico Universitario de Valencia

Cooperative Institutions

Hospital Clínico Universitario de Valencia

134

University College London

114

University of Birmingham

Istituti di Ricovero e Cura a Carattere Scientifico

University of Toronto

Instituto de Salud Carlos III

University of Edinburgh

Hospital Clínic de Barcelona

Hospital Universitari i Politècnic La Fe

Universitat de València

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Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial

The Lancet Respiratory Medicine (2018)

Carlos Ferrando Marina Soro Carmen Unzueta Fernando Suárez-Sipmann Jaume Canet

10.1016/s2213-2600(18)30024-9

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Citations (200)

Closed-system anaesthesia for laparoscopic surgery: is there a risk for carbon monoxide intoxication?

European Journal of Anaesthesiology (2004)

Marina Soro M. L. García-Pérez Raquel Ferrandis Gerardo Aguilar F. J. Belda

Background and objective: One of the complications of laparoscopic surgery is carbon monoxide production during electrocautery. The aim of our study was to ascertain the relationship between intraperitoneal and alveolar concentrations of carbon monoxide and systemic carboxyhaemoglobin in patients undergoing laparoscopic cholecystectomy and anaesthetized with a closed system, where the carbon monoxide excreted through the lungs is accumulated in the circuit and thus re-inhaled. Methods: Nine consecutive patients undergoing laparoscopic cholecystectomy were studied. Patients' lungs were ventilated with a closed anaesthesia breathing system (Physioflex®). Measurements were taken after establishing pneumoperitoneum (baseline) and at 5, 15 and 30 min after starting electrocautery. Results: Mean duration of pneumoperitoneum was 42 ± 13 min with cumulative electrocautery time of 2.4 ± 1.8 min. Intraperitoneal carbon monoxide concentrations increased significantly at 5, 15 and 30 min reaching peak values of 481 ± 151 ppm at 15 min. No significant differences were found in alveolar carbon monoxide and carboxyhaemoglobin concentrations with respect to baseline. Conclusions: No significant increase in carboxyhaemoglobin is produced during laparoscopic surgery, even under closed-system anaesthesia without pulmonary carbon monoxide elimination. This is most likely due to a low peritoneal absorption of carbon monoxide. We conclude that in adult patients, no carbon monoxide intoxication is caused if reasonable periods of electrocautery are used and the intraperitoneal gas is regularly renewed.

Carboxyhemoglobin

Carbon monoxide poisoning

10.1097/00003643-200406000-00011

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Citations (10)

Individualized, perioperative, hemodynamic goal-directed therapy in major abdominal surgery (iPEGASUS trial): study protocol for a randomized controlled trial

Trials (2018)

Sandra Funcke Bernd Saugel Christian Koch Dagmar Schulte Thomas Zajonz

Postoperative morbidity and mortality in patients undergoing surgery is high, especially in patients who are at risk of complications and undergoing major surgery. We hypothesize that perioperative, algorithm-driven, hemodynamic therapy based on individualized fluid status and cardiac output optimization is able to reduce mortality and postoperative moderate and severe complications as a major determinant of the patients' postoperative quality of life, as well as health care costs. This is a multi-center, international, prospective, randomized trial in 380 patients undergoing major abdominal surgery including visceral, urological, and gynecological operations. Eligible patients will be randomly allocated to two treatment arms within the participating centers. Patients of the intervention group will be treated perioperatively following a specific hemodynamic therapy algorithm based on pulse-pressure variation (PPV) and individualized optimization of cardiac output assessed by pulse-contour analysis (ProAQT© device; Pulsion Medical Systems, Feldkirchen, Germany). Patients in the control group will be treated according to standard local care based on established basic hemodynamic treatment. The primary endpoint is a composite comprising the occurrence of moderate or severe postoperative complications or death within 28 days post surgery. Secondary endpoints are: (1) the number of moderate and severe postoperative complications in total, per patient and for each individual complication; (2) the occurrence of at least one of these complications on days 1, 3, 5, 7, and 28 in total and for every complication; (3) the days alive and free of mechanical ventilation, vasopressor therapy and renal replacement therapy, length of intensive care unit, and hospital stay at day 7 and day 28; and (4) mortality and quality of life, assessed by the EQ-5D-5L™ questionnaire, after 6 months. This is a large, international randomized controlled study evaluating the effect of perioperative, individualized, algorithm-driven ,hemodynamic optimization on postoperative morbidity and mortality. Trial registration: NCT03021525 . Registered on 12 January 2017.

Clinical endpoint

Renal replacement therapy

10.1186/s13063-018-2620-9

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Rationale and study design for an individualised perioperative open-lung ventilatory strategy with a high versus conventional inspiratory oxygen fraction (iPROVE-O2) and its effects on surgical site infection: study protocol for a randomised controlled trial

BMJ Open (2017)

Carlos Ferrando Marina Soro Carmen Unzueta Jaume Canet Gerardo Tusman

Surgical site infection (SSI) is a serious postoperative complication that increases morbidity and healthcare costs. SSIs tend to increase as the partial pressure of tissue oxygen decreases: previous trials have focused on trying to reduce them by comparing high versus conventional inspiratory oxygen fractions (FIO2) in the perioperative period but did not use a protocolised ventilatory strategy. The open-lung ventilatory approach restores functional lung volume and improves gas exchange, and therefore it may increase the partial pressure of tissue oxygen for a given FIO2. The trial presented here aims to compare the efficacy of high versus conventional FIO2 in reducing the overall incidence of SSIs in patients by implementing a protocolised and individualised global approach to perioperative open-lung ventilation.This is a comparative, prospective, multicentre, randomised and controlled two-arm trial that will include 756 patients scheduled for abdominal surgery. The patients will be randomised into two groups: (1) a high FIO2 group (80% oxygen; FIO2 of 0.80) and (2) a conventional FIO2 group (30% oxygen; FIO2 of 0.30). Each group will be assessed intra- and postoperatively. The primary outcome is the appearance of postoperative SSI complications. Secondary outcomes are the appearance of systemic and pulmonary complications.The iPROVE-O2 trial has been approved by the Ethics Review Board at the reference centre (the Hospital Clínico Universitario in Valencia). Informed consent will be obtained from all patients before their participation. If the approach using high FIO2 during individualised open-lung ventilation decreases SSIs, use of this method will become standard practice for patients scheduled for future abdominal surgery. Publication of the results is anticipated in early 2019.NCT02776046; Pre-results.

10.1136/bmjopen-2017-016765

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Citations (14)

Remote Ischemic Preconditioning Decreases Oxidative Lung Damage After Pulmonary Lobectomy: A Single-Center Randomized, Double-Blind, Controlled Trial

Anesthesia & Analgesia (2017)

José García‐de‐la‐Asunción Laura Bruno Jaume Perez-Griera Genaro Galán Alfonso Morcillo

BACKGROUND: During lobectomy in patients with lung cancer, the operated lung is often collapsed and hypoperfused. Ischemia/reperfusion injury may then occur when the lung is re-expanded. We hypothesized that remote ischemic preconditioning (RIPC) would decrease oxidative lung damage and improve gas exchange in the postoperative period. METHODS: We conducted a single-center, randomized, double-blind trial in patients with nonsmall cell lung cancer undergoing elective lung lobectomy. Fifty-three patients were randomized to receive limb RIPC immediately after anesthesia induction (3 cycles: 5 minutes ischemia/5 minutes reperfusion induced by an ischemia cuff applied on the thigh) and/or control therapy without RIPC. Oxidative stress markers were measured in exhaled breath condensate (EBC) and arterial blood immediately after anesthesia induction and before RIPC and surgery (T 0 , baseline); during operated lung collapse, immediately before resuming two-lung ventilation (TLV) (T 1 ); immediately after resuming TLV (T 2 ); and 120 minutes after resuming TLV (T 3 ). The primary outcome was 8-isoprostane levels in EBC at T 1 , T 2 , and T 3 . Secondary outcomes included the following: NO 2 − +NO 3 − , H 2 O 2 levels, and pH in EBC and in blood (8-isoprostane, NO 2 − +NO 3 − ) and pulmonary gas exchange variables (PaO 2 /FiO 2 , A-aDO 2 , a/A ratio, and respiratory index). RESULTS: Patients subjected to RIPC had lower EBC 8-isoprostane levels when compared with controls at T 1 , T 2 , and T 3 (differences between means and 95% confidence intervals): −15.3 (5.8–24.8), P = .002; −20.0 (5.5–34.5), P = .008; and −10.4 (2.5–18.3), P = .011, respectively. In the RIPC group, EBC NO 2 − +NO 3 − and H 2 O 2 levels were also lower than in controls at T 2 and T 1 –T 3 , respectively (all P < .05). Blood levels of 8-isoprostane and NO 2 − +NO 3 − were lower in the RIPC group at T 2 ( P < .05). The RIPC group had better PaO 2 /FiO 2 compared with controls at 2 hours, 8 hours, and 24 hours after lobectomy in 95% confidence intervals for differences between means: 78 (10–146), 66 (14–118), and 58 (12–104), respectively. CONCLUSIONS: Limb RIPC decreased EBC 8-isoprostane levels and other oxidative lung injury markers during lung lobectomy. RIPC also improved postoperative gas exchange as measured by PaO 2 /FiO 2 ratio.

Ischemic Preconditioning

Exhaled breath condensate

10.1213/ane.0000000000002065

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Citations (32)

Matching tidal volume to stress index in an open lung condition optimizes ventilation and prevents VILI in an experimental model of lung injury and intra-abdominal hypertension

European Journal of Anaesthesiology (2014)

Amanda Miñana Carlos Ferrando Blanca Arocas Andrea Gutiérrez Marina Soro

Miñana, A.; Ferrando, C.; Arocas, B.; Gutiérrez, A.; Soro, M.; Belda, J. Author Information

10.1097/00003643-201406001-00208

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Citations (0)

Evaluating the efficacy of dexamethasone in the treatment of patients with persistent acute respiratory distress syndrome: study protocol for a randomized controlled trial

Trials (2016)

Jesús Villar Javier Belda José M. Añón Jesús Blanco Lina Pérez‐Méndez

Although much has evolved in our understanding of the pathogenesis and factors affecting outcome of patients with acute respiratory distress syndrome (ARDS), still there is no specific pharmacologic treatment for ARDS. Several clinical trials have evaluated the utility of corticoids but none of them has demonstrated a definitive benefit due to small sample sizes, selection bias, patient heterogeneity, and time of initiation of treatment or duration of therapy. We postulated that adjunctive treatment of persistent ARDS with intravenous dexamethasone might change the pulmonary and systemic inflammatory response and thereby reduce morbidity, leading to a decrease in duration of mechanical ventilation and a decrease in mortality. This is a prospective, multicenter, randomized, controlled trial in 314 patients with persistent moderate/severe ARDS. Persistent ARDS is defined as maintaining a PaO2/FiO2 ≤ 200 mmHg on PEEP ≥ 10 cmH2O and FiO2 ≥ 0.5 after 24 hours of routine intensive care. Eligible patients will be randomly allocated to two arms: (i) conventional treatment without dexamethasone, (ii) conventional treatment plus dexamethasone. Patients in the dexamethasone group will be treated with a daily dose of 20 mg iv from day 1 to day 5, and 10 mg iv from day 6 to day 10. Primary outcome is the number of ventilator-free days, defined as days alive and free from mechanical ventilation at day 28 after intubation. Secondary outcome is all-cause mortality at day 60 after enrollment. This study will be the largest randomized controlled clinical trial to assess the role of dexamethasone in patients with persistent ARDS. Registered on 21 November 2012 as DEXA-ARDS at ClinicalTrials.gov website ( NCT01731795 ).

10.1186/s13063-016-1456-4

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Citations (50)

Efficiency of the AnaConDa (Anesthesia Conserving Device) with sevoflurane: in vitro study

European Journal of Anaesthesiology (2004)

Marina Soro F. J. Belda M. J. Alcantara Rafael Badenes

Department of Anesthesiology and Surgical Intensive Care, Hospital Clinico Universitario, Valencia, Spain

Pain medicine

10.1097/00003643-200406002-00216

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Citations (15)

P6-9 - Profil épidémiologique des décès maternels de la région sanitaire d'Abidjan 1, Côte d'Ivoire, janvier-décembre 2023

Deleted Journal (2024)

Alexandre Dazzi P. Wilnique J. Otshudiandjeka Marina Soro E.E. N'guetta

La mortalité maternelle est un indicateur clé de développement international. Sa réduction reste un défi et une préoccupation pour la Côte d'Ivoire qui enregistre un fort ratio de décès maternels (385 pour 100 000 naissances vivantes). Dans la région d'Abidjan 1, les données sont analysées de façon parcellaire d'où l'objectif d'analyser les décès maternels dans cette région. Une étude transversale à visée descriptive. Les données ont été extraites de la base MAGPI, administrée par l'Institut national de l'hygiène publique (INHP). Elles couvrent la période allant du 1er janvier 2023 au 4 décembre 2023. Les variables d'intérêts sont les caractéristiques sociodémographiques, cliniques des femmes enceintes. Le traitement et l'analyse des données ont été faits à travers le logiciels Excel. La médiane, des proportions et taux ont été calculés. Au total, 83 décès maternel ont été enregistrées. L'âge médian était de 30 ans (15 ; 43). Les tranches d'âge 19-29 ans et 30-39 ans représentaient respectivement 41 % (34/83) et 47 % (39/83) des décès. Les causes inconnues représentent 37 % des décès suivies des hémorragies obstétricales 29 %, et des troubles hypertensifs 9 % ; 60 % des hémorragies se produisent en post partum immédiat. La majorité des décès maternels se sont produits dans les districts sanitaires d'Abobo-Est (13 décès pour 10 000 naissances vivantes et Yopougon-ouest-Songon (9 décès pour 10 000 naissances vivantes). Les femmes de 30-39 ans sont les plus affectées avec pour cause l'hémorragie du post-partum immédiat. Le ratio de mortalité maternel est élevé au district sanitaire d'Abobo-Est. Il faut améliorer la prise en charge pré et post-partum, renforcer la surveillance et réaliser l'audit des décès maternels dans la région.

Cote d ivoire

10.1016/j.jeph.2024.202691

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Rationale and study design for an individualized perioperative open lung ventilatory strategy (iPROVE): study protocol for a randomized controlled trial

Trials (2015)

Carlos Ferrando Marina Soro Jaume Canet Ma Carmen Unzueta Fernando Suárez

Postoperative pulmonary and non-pulmonary complications are common problems that increase morbidity and mortality in surgical patients, even though the incidence has decreased with the increased use of protective lung ventilation strategies. Previous trials have focused on standard strategies in the intraoperative or postoperative period, but without personalizing these strategies to suit the needs of each individual patient and without considering both these periods as a global perioperative lung-protective approach. The trial presented here aims at comparing postoperative complications when using an individualized ventilatory management strategy in the intraoperative and immediate postoperative periods with those when using a standard protective ventilation strategy in patients scheduled for major abdominal surgery.

10.1186/s13063-015-0694-1

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Citations (41)