Monedero, P. (Pablo)

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    Inflation of the endotracheal tube cuff in the pharynx for ventilation of paralyzed patients with unanticipated difficult airway
    (Lippincott, Williams & Wilkins, 1999) Panadero-Sánchez, A. (Alfredo); Macias, A. (Antonio); Monedero, P. (Pablo); Olavide, I. (Isidro); Mendieta, J.M. (José Manuel); Fernandez-Liesa, I. (Ignacio)
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    Karnofsky performance score in acute renal failure as a predictor of short-term survival
    (Wiley-Blackwell, 2007) Perez-Valdivieso, J.R. (José Ramón); Lavilla, F.J. (Francisco Javier); Bes-Rastrollo, M. (Maira); Monedero, P. (Pablo); Irala, J. (Jokin) de
    Karnofsky Performance Scale Index (KPS) is a measure of functional status that allows patients to be classified according to their functional impairment. We aim to assess if the prior KPS may predict the risk of death among patients with acute renal failure (ARF). METHODS: A cohort of 668 consecutive patients who had been admitted in an university-affiliated hospital between June 2000 and June 2006, and had been diagnosed with ARF, were studied. Three hundred and eighty-six patients with ARF who matched at least one of the RIFLE (Risk, Injury, Failure, Loss and End stage) criteria on increased serum creatinine were included for subsequent analysis. The group was divided into four categories, according to different Karnofsky scores measured by a nephrologist (>or=80, 70, 60 and or=80 Karnofsky group. Adjusted odds ratios were 8.87 (95% confidence interval (CI) 3.03-25.99), 6.78 (95% CI 2.61-17.58) and 2.83 (95% CI 1.04-7.68), for Karnofsky groups of
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    Depresión del sistema mononuclear-fagocítico provocada por altas dosis de morfínico
    (Universidad de Navarra, 1992) Subira, M.L. (María L.); Arroyo, J.L. (José L.); Catala, J.C. (J.C.); Carrera, J. (José); Monedero, P. (Pablo); Carrascosa, F. (Francisco)
    We evaluated in human monocytes the effect of high doses of alfentanyl on the expression of vimentin filaments, the phagocytic activity and the membrane display of HLA-DR molecules in the subjects undergoing surgery. The study was performed on 30 patients, ASAI-II. The patients received 100 mcg/kg i.v. of Alfentanil and the maintenance of anaesthesia was made with Alfentanil (2-3 mcg/kg/min.). The patients were randomized in two groups. The patients were ventilated with N2O:O2 (1:1) (Group I) or air: O2 (1:1) (Group II). After surgery, all patients of the Group II received Naloxone (0.2-0.4 mg). Central venous blood samples were obtained before induction, one and two hours after induction of anaesthesia and at the end of surgery. Separation of monocytes was performed according to Boyum technique. CD35 and HLA-DR molecules and vimentin filaments were studied by indirect immunofluorescence method using monoclonal antibodies. Percentage of positive cells were read with a cytofluorometer. The phagocytic function of monocytes was determined by ingestion of latex particles. Cortisol and ACTH plasma levels were determined by RIA. High doses of Alfentanyl depress phagocytic function and membrane display of CD35 and HLA-DR molecules in monocyte and induce marked changes in the organization of vimentin filaments in these cells in patients undergoing surgery. This monocytic depression was more marked in the patients ventilated with N2O. In our results there was uninhibition of ACTH and cortisol plasma levels responses to surgical stress by Alfentanil administration. Since the effects of Alfentanil were reversed by Naloxone, an opioid receptor mechanism seems to mediate these events
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    Timing of renal replacement therapy after cardiac surgery: a retrospective multicenter Spanish Cohort Study
    (Karger Publishers, 2011) Herreros, J. (Jesús); Perez-Valdivieso, J.R. (José Ramón); Lavilla, J. (Javier); Bes-Rastrollo, M. (Maira); Vives, M. (Marc); Monedero, P. (Pablo); Garcia-Fernandez, N. (Nuria)
    Background: The optimal time to initiate renal replacement therapy (RRT) in cardiac surgery-associated acute kidney injury (CSA-AKI) is unknown. Evidence suggests that the early use of RRT in critically ill patients is associated with improved outcomes. We studied the effects of time to initiation of RRT on outcome in patients with CSA-AKI. Methods: This was a retrospective observational multicenter study (24 Spanish hospitals). We analyzed data on 203 patients who required RRT after cardiac surgery in 2007. The cohort was divided into 2 groups based on the time at which RRT was initiated: in the early RRT group, therapy was initiated within the first 3 days after cardiac surgery; in the late group, RRT was begun after the 3rd day. Multivariate nonconditional logistic and linear regression models were used to adjust for potential confounders. Results: In-hospital mortality was significantly higher in the late RRT group compared with early RRT patients (80.4 vs. 53.2%; p < 0.001; adjusted odds ratio of 4.1, 95% CI: 1.6–10.0). Also, patients in the late RRT group had longer adjusted hospital stays by 11.6 days (95% CI: 1.4–21.9) and higher adjusted percentage increases in creatinine at discharge compared with baseline by 67.7% (95% CI: 28.5–106.4). Conclusions: Patients who undergo early initiation of RRT after CSA-AKI have improved survival rates and renal function at discharge and decreased lengths of hospital stay.
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    Manejo anestésico del paciente acondroplásico
    (Elsevier España, 1995) Garcia-Pedrajas, F. (F.); Coca, I. (I.); Monedero, P. (Pablo); Osorio, G. (G.); Carrascosa, F. (Francisco); Fernandez-Liesa, I. (Ignacio)
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    El buen cuidado de pacientes que fallecen en unidades de cuidados intensivos en España. Un estudio basado en indicadores internacionales de calidad asistencial
    (2017) Centeno, C. (Carlos); Monedero, P. (Pablo); Grupo Español de Cuidados al Final de la Vida en UCI; Girbau-Campo, M.B. (Mª Begoña)
    Fundamento. Evaluar la calidad de la atención clínica de los pacientes fallecidos en unidades de cuidados intensivos (UCI) españolas a través de las historias clínicas. Metodología. Estudio de cohorte, observacional, retrospectivo, de pacientes que fallecieron en la UCI de una muestra de UCI españolas. El criterio de inclusión fue pacientes mayores de 18 años fallecidos en UCI tras ingreso mínimo de 24h. Se analizaron ingresos consecutivos, sin exclusiones. Se valoraron criterios de excelencia específicos para la UCI mediante los indicadores y medidas de calidad desarrollados por el Robert Wood Johnson Foundation Critical Care Workgroup. Resultados. Se incluyeron 282 pacientes de 15 UCI españolas. Se observó una mediana de 13% de cumplimiento de los indicadores. Casi todas las historias clínicas documentaron la capacidad de decisión del paciente (96%) y la comunicación con la familia (98%) pero solo el 50% contenían un plan u objetivo del cuidado. Sólo dos UCI tenían régimen abierto de visitas de familiares. Estaba mejor documentada la valoración de la disnea (48%) que la del dolor (28%). En trece UCI no había protocolos de retirada de medidas de soporte. En los indicadores de apoyo emocional y apoyo espiritual se observó un cumplimiento inferior al 10%. Conclusiones. La calidad del cuidado del final de vida en las UCI estudiadas puede mejorar. El estudio identifica déficits y señala recursos reales de la práctica clínica a partir de los cuales se puede diseñar un plan de mejora gradual adaptado a cada realidad hospitalaria. El análisis, poco costoso en su realización, coincide con la recomendación unánime de las sociedades profesionales de cuidados intensivos.
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    Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study
    (BioMed Central, 2007) Perez-Valdivieso, J.R. (José Ramón); Lavilla, F.J. (Francisco Javier); Bes-Rastrollo, M. (Maira); Monedero, P. (Pablo); Irala, J. (Jokin) de
    The aim of this study is to evaluate the association between acute serum creatinine changes in acute renal failure (ARF), before specialized treatment begins, and in-hospital mortality, recovery of renal function, and overall mortality at 6 months, on an equal degree of ARF severity, using the RIFLE criteria, and comorbid illnesses. METHODS: Prospective cohort study of 1008 consecutive patients who had been diagnosed as having ARF, and had been admitted in an university-affiliated hospital over 10 years. Demographic, clinical information and outcomes were measured. After that, 646 patients who had presented enough increment in serum creatinine to qualify for the RIFLE criteria were included for subsequent analysis. The population was divided into two groups using the median serum creatinine change (101%) as the cut-off value. Multivariate non-conditional logistic and linear regression models were used. RESULTS: A >or= 101% increment of creatinine respect to its baseline before nephrology consultation was associated with significant increase of in-hospital mortality (35.6% vs. 22.6%, p < 0.001), with an adjusted odds ratio of 1.81 (95% CI: 1.08-3.03). Patients who required continuous renal replacement therapy in the >or= 101% increment group presented a higher increase of in-hospital mortality (62.7% vs 46.4%, p = 0.048), with an adjusted odds ratio of 2.66 (95% CI: 1.00-7.21). Patients in the >or= 101% increment group had a higher mean serum creatinine level with respect to their baseline level (114.72% vs. 37.96%) at hospital discharge. This was an adjusted 48.92% (95% CI: 13.05-84.79) more serum creatinine than in the < 101% increment group. CONCLUSION: In this cohort, patients who had presented an increment in serum level of creatinine of >or= 101% with respect to basal values, at the time of nephrology consultation, had increased mortality rates and were discharged from hospital with a more deteriorated renal function than those with similar Liano scoring and the same RIFLE classes, but with a < 101% increment. This finding may provide more information about the factors involved in the prognosis of ARF. Furthermore, the calculation of relative serum creatinine increase could be used as a practical tool to identify those patients at risk, and that would benefit from an intensive therapy.
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    Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study
    (BioMed Central, 2009-09) Perez-Valdivieso, J.R. (José Ramón); Bes-Rastrollo, M. (Maira); Vives, M. (Marc); Monedero, P. (Pablo); Garcia-Fernandez, N. (Nuria)
    Acute kidney injury is among the most serious complications after cardiac surgery and is associated with an impaired outcome. Multiple factors may concur in the development of this disease. Moreover, severe renal failure requiring renal replacement therapy (RRT) presents a high mortality rate. Consequently, we studied a Spanish cohort of patients to assess the risk factors for RRT in cardiac surgery-associated acute kidney injury (CSA-AKI). METHODS: A retrospective case-cohort study in 24 Spanish hospitals. All cases of RRT after cardiac surgery in 2007 were matched in a crude ratio of 1:4 consecutive patients based on age, sex, treated in the same year, at the same hospital and by the same group of surgeons. RESULTS: We analyzed the data from 864 patients enrolled in 2007. In multivariate analysis, severe acute kidney injury requiring postoperative RRT was significantly associated with the following variables: lower glomerular filtration rates, less basal haemoglobin, lower left ventricular ejection fraction, diabetes, prior diuretic treatment, urgent surgery, longer aortic cross clamp times, intraoperative administration of aprotinin, and increased number of packed red blood cells (PRBC) transfused. When we conducted a propensity analysis using best-matched of 137 available pairs of patients, prior diuretic treatment, longer aortic cross clamp times and number of PRBC transfused were significantly associated with CSA-AKI.Patients requiring RRT needed longer hospital stays, and suffered higher mortality rates. CONCLUSION: Cardiac-surgery associated acute kidney injury requiring RRT is associated with worse outcomes. For this reason, modifiable risk factors should be optimised and higher risk patients for acute kidney injury should be identified before undertaking cardiac surgery.
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    Cardiac surgery-associated acute kidney injury
    (Oxford University Press, 2014) Vives, M. (Marc); Monedero, P. (Pablo); Marczin, N. (Nandor); Rao, V. (Vivek); Wijeysundera, D.N. (D.N.)
    Acute kidney injury develops in up to 30% of patients who undergo cardiac surgery, with up to 3% of patients requiring dialysis. The requirement for dialysis after cardiac surgery is associated with an increased risk of infection, prolonged stay in critical care units and longterm need for dialysis. The development of acute kidney injury is independently associated with substantial short- and long-term morbidity and mortality. Its pathogenesis involves multiple pathways. Haemodynamic, inflammatory, metabolic and nephrotoxic factors are involved and overlap each other leading to kidney injury. Clinical studies have identified predictors for cardiac surgery-associated acute kidney injury that can be used effectively to determine the risk for acute kidney injury in patients undergoing cardiac surgery. High-risk patients can be targeted for renal protective strategies. Nonetheless, there is little compelling evidence from randomized trials supporting specific interventions to protect or prevent acute kidney injury in cardiac surgery patients. Several strategies have shown some promise, including less invasive procedures in those at greatest risk, natriuretic peptide, fenoldopam, preoperative hydration, preoperative optimization of anaemia and postoperative early use of renal replacement therapy. The efficacy of larger-scale trials remains to be confirmed.
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    Ácido úrico y daño renal agudo en pacientes con alto riesgo de desarrollar daño renal agudo sometidos a cirugía cardiaca: cohorte prospectiva multicéntrica
    (Elsevier, 2024) Tamayo-Gómez, E. (Eduardo); Gómez, L. (L.); Esteva, C. (Carlos); Pereira, M.A. (Miguel Ángel); Sánchez, J. (J.); Aparicio, R. (Rosa); Vives, M. (Marc); Candela, A. (A.); Pita-Romero, R. (Rafael); Monedero, P. (Pablo); Murie-Fernández, M. (Manuel); Medina, A. (A.); Mon, T. (T.); Nagore-Setién, D. (David); Matilla, A. (Ana); Gragera, I. (Isabel); Calderón, E. (Enrique); Varela-Durán, M. (Marina); Mendez, E. (Elena); Rodríguez, J.M. (J.M.); Álvarez-Escudero, J. (Julián); Pasqualetto, A. (Alberto); García, A. (A.); Rodríguez, M.A. (M.A.); Vicente, R. (Rosario); López, M. (Marta); Marcos, J.M. (J. M.); Bürge, M. (M.); Carmona, P. (Paula); Pajares, A. (Azuzena)
    Objetivo: No está claro si la elevación de ácido úrico sérico (AUS) preoperatorio puede desempeñar un papel en el desarrollo de daño renal agudo (DRA) asociado a cirugía cardiaca (DRA-CS). Se realizó un estudio de cohortes para evaluar la influencia de la hiperuricemia en el DRA en pacientes de alto riesgo para desarrollar DRA-CS. Diseño: Estudio de cohortes prospectivo multicéntrico. Entorno: Catorce hospitales universitarios en España y en Reino Unido. Participantes: Se estudiaron a 261 pacientes consecutivos con alto riesgo de desarrollar DRA-CS, según una puntuación de Cleveland ≥ 4 puntos, de julio a diciembre de 2017. Intervenciones: Ninguna. Mediciones y resultados principales: Se utilizaron los criterios AKIN para la definición de DRA. Para determinar la asociación ajustada entre hiperuricemia (> = 7 mg/dL) e DRA se utilizaron modelos de regresión logística multivariable y análisis de pares emparejados por puntuaje de propensión. El AUS preoperatorio elevado (> = 7 mg/dL) estaba presente en 190 pacientes (72,8%), mientras que la DRA-CS se produjo en 145 pacientes (55,5%). En los modelos de regresión logística multivariable, la hiperuricemia no se asoció con un aumento significativo del riesgo de DRA (Odds Ratio [OR] ajustado: 1,58; intervalo de confianza [IC] 95%: 0,81-3; p = 0,17). En el análisis de emparejamiento por puntaje de propensión de 140 pacientes, el grupo de hiperuricemia experimentó probabilidades ajustadas similares de DRA (OR 1,05; IC 95%: 0,93-1,19; p = 0,37). Conclusiones: La hiperuricemia no se asoció con un mayor riesgo de DRA en esta cohorte de pacientes con alto riesgo de desarrollar DRA-CS.