Papers by Ignacio Garutti
BJA: British Journal of Anaesthesia, Mar 1, 2015
European Journal of Anaesthesiology, 2020
BACKGROUND The effectiveness of prophylactic continuous positive pressure ventilation (CPAP) afte... more BACKGROUND The effectiveness of prophylactic continuous positive pressure ventilation (CPAP) after thoracic surgery is not clearly established. OBJECTIVE The aim of this study was to assess the effectiveness of CPAP immediately after lung resection either by thoracotomy or thoracoscopy in preventing atelectasis and pneumonia. DESIGN A multicentre, randomised, controlled, open-label trial. SETTINGS Four large University hospitals at Madrid (Spain) from March 2014 to December 2016. PATIENTS Immunocompetent patients scheduled for lung resection, without previous diagnosis of sleep-apnoea syndrome or severe bullous emphysema. Four hundred and sixty-four patients were assessed, 426 were randomised and 422 were finally analysed. INTERVENTION Six hours of continuous CPAP through a Boussignac system versus standard care. MAIN OUTCOME MEASURES Primary outcome: incidence of the composite endpoint ‘atelectasis + pneumonia’. Secondary outcome: incidence of the composite endpoint ‘persistent air...
BioMed Research International, 2021
Background. Ischemia-reperfusion injury is one of the most critical phenomena in lung transplanta... more Background. Ischemia-reperfusion injury is one of the most critical phenomena in lung transplantation and causes primary graft failure. Its pathophysiology remains incompletely understood, although the inflammatory response and apoptosis play key roles. Lidocaine has anti-inflammatory properties. The aim of this research is to evaluate the effect of intravenous lidocaine on the inflammatory and apoptotic responses in lung ischemia-reperfusion injury. Methods. We studied the histological and immunohistochemical changes in an experimental model of lung transplantation in pigs. Twelve pigs underwent left pneumonectomy, cranial lobectomy, caudal lobe reimplantation, and 60 minutes of graft reperfusion. Six of the pigs made up the control group, while six other pigs received 1.5 mg/kg of intravenous lidocaine after induction and a 1.5 mg/kg/h intravenous lidocaine infusion during surgery. In addition, six more pigs underwent simulated surgery. Lung biopsies were collected from the left c...
INTED2019 Proceedings, 2019
Resumen OBJETIVO: Comparar los efectos antipireticos y hemodinamicos del metamizol y propacetamol... more Resumen OBJETIVO: Comparar los efectos antipireticos y hemodinamicos del metamizol y propacetamol administrados a pacientes criticamente enfermos que presentaban fiebre. MATERIAL Y METODOS: Estudio prospectivo y aleatorio sobre 60 pacientes ingresados en nuestra Unidad de Reanimacion que presentaban una temperatura central >38 o C. Los pacientes fueron distribuidos en dos grupos: grupo M: se administraron 2 g de metamizol iv, grupo P: se administraron 2 g de propacetamol iv. Se midio temperatura central (T a ), presion arterial sistolica (PAS), diastolica (PAD) y media (PAM), presion de arteria pulmonar media, presion venosa central, presion capilar pulmonar, indice de resistencias vasculares sistemicas (IRVS) y pulmonares y saturacion venosa mixta en cuatro momentos: basal y a los 30, 60 y 120 minutos tras la administracion del farmaco. Los pacientes con una disminucion de la PAS hasta valores menores de 90 mmHg eran excluidos del estudio. RESULTADOS: Los dos grupos fueron homog...
Enfermedades Infecciosas y MicrobiologÃa ClÃnica, 2021
Introduction Our work describes the frequency of superinfections in COVID-19 ICU patients and ide... more Introduction Our work describes the frequency of superinfections in COVID-19 ICU patients and identifies risk factors for its appearance. Second, we evaluated ICU length of stay, in-hospital mortality and analyzed a subgroup of multidrug-resistant microorganisms (MDROs) infections. Methods Retrospective study conducted between March and June 2020. Superinfections were defined as appeared ≥48h. Bacterial and fungal infections were included, and sources were ventilator-associated lower respiratory tract infection (VA-LRTI), primary bloodstream infection (BSI), secondary BSI, and urinary tract infection (UTI). We performed a univariate analysis and a multivariate analysis of the risk factors. Results Two-hundred thirteen patients were included. We documented 174 episodes in 95 (44.6%) patients: 78 VA-LRTI, 66 primary BSI, 9 secondary BSI and 21 UTI. MDROs caused 29.3% of the episodes. The median time from admission to the first episode was 18 days and was longer in MDROs than in non-MDROs (28 vs. 16 days, p <0.01). In multivariate analysis use of corticosteroids (OR 4.9, 95% CI 1.4–16.9, p 0.01), tocilizumab (OR 2.4, 95% CI 1.1–5.9, p 0.03) and broad-spectrum antibiotics within first 7 days of admission (OR 2.5, 95% CI 1.2–5.1, p <0.01) were associated with superinfections. Patients with superinfections presented respect to controls prolonged ICU stay (35 vs. 12 days, p <0.01) but not higher in-hospital mortality (45.3% vs. 39.7%, p 0.13). Conclusions Superinfections in ICU patients are frequent in late course of admission. Corticosteroids, tocilizumab, and previous broad-spectrum antibiotics are identified as risk factors for its development.
Revista Española de AnestesiologÃa y Reanimación (English Edition), 2021
Due to the serious pandemic situation that we live caused by COVID-19, the Cardiac, Vascular and ... more Due to the serious pandemic situation that we live caused by COVID-19, the Cardiac, Vascular and Thoracic Anesthesia Section of SEDAR aims to provide information on the most relevant aspects to consider in patients with suspected infection or infection confirmed by coronavirus that they will undergo thoracic surgery. We believe that it is essential to maintain an optimal transmission of information to carry out safe maneuvers, both for patients and healthcare personnel. The management strategy must be based on an exquisite organization of work, defining who, how and when will perform each task and procedure. The proposed recommendations, after assessing the risk-benefit in the specific scenario of thoracic surgery and the experience of thoracic experts obtained in the COV2-VIAEREA study, try to advise on the key anesthetic aspects to take into account on the eventual need for thoracic surgery in the context of this COVI-19 pandemic.
Therapeutic Advances in Gastroenterology, 2021
Background: Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-thr... more Background: Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-threatening condition. A previous diagnosis of chronic liver disease is associated with poorer outcomes. Nevertheless, the impact of silent liver injury has not been investigated. We aimed to explore the association of pre-admission liver fibrosis indices with the prognosis of critically ill COVID-19 patients. Methods: The work presented was an observational study in 214 patients with COVID-19 consecutively admitted to the intensive care unit (ICU). Pre-admission liver fibrosis indices were calculated. In-hospital mortality and predictive factors were explored with Kaplan–Meier and Cox regression analysis. Results: The mean age was 59.58 (13.79) years; 16 patients (7.48%) had previously recognised chronic liver disease. Up to 78.84% of patients according to Forns, and 45.76% according to FIB-4, had more than minimal fibrosis. Fibrosis indices were higher in non-survivors [Forns: 6.04 (1.42)...
The Lancet Respiratory Medicine, 2021
Background To date, 750 000 patients with COVID-19 worldwide have required mechanical ventilation... more Background To date, 750 000 patients with COVID-19 worldwide have required mechanical ventilation and thus are at high risk of acute brain dysfunction (coma and delirium). We aimed to investigate the prevalence of delirium and coma, and risk factors for delirium in critically ill patients with COVID-19, to aid the development of strategies to mitigate delirium and associated sequelae. This multicentre cohort study included 69 adult intensive care units (ICUs), across 14 countries. We included all patients (aged ≥18 years) admitted to participating ICUs with severe acute respiratory syndrome coronavirus 2 infection before April 28, 2020. Patients who were moribund or had life-support measures withdrawn within 24 h of ICU admission, prisoners, patients with pre-existing mental illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug overdose, suicide attempt, or those who were blind or deaf were excluded. We collected de-identified data from electronic health records on patient demographics, delirium and coma assessments, and management strategies for a 21-day period. Additional data on ventilator support, ICU length of stay, and vital status was collected for a 28-day period. The primary outcome was to determine the prevalence of delirium and coma and to investigate any associated risk factors associated with development of delirium the next day. We also investigated predictors of number of days alive without delirium or coma. These outcomes were investigated using multivariable regression. Between Jan 20 and April 28, 2020, 4530 patients with COVID-19 were admitted to 69 ICUs, of whom 2088 patients were included in the study cohort. The median age of patients was 64 years (IQR 54 to 71) with a median Simplified Acute Physiology Score (SAPS) II of 40•0 (30•0 to 53•0). 1397 (66•9%) of 2088 patients were invasively mechanically ventilated on the day of ICU admission and 1827 (87•5%) were invasively mechanical ventilated at some point during hospitalisation. Infusion with sedatives while on mechanical ventilation was common: 1337 (64•0%) of 2088 patients were given benzodiazepines for a median of 7•0 days (4•0 to 12•0) and 1481 (70•9%) were given propofol for a median of 7•0 days (4•0 to 11•0). Median Richmond Agitation-Sedation Scale score while on invasive mechanical ventilation was -4 (-5 to -3). 1704 (81•6%) of 2088 patients were comatose for a median of 10•0 days (6•0 to 15•0) and 1147 (54•9%) were delirious for a median of 3•0 days (2•0 to 6•0). Mechanical ventilation, use of restraints, and benzodiazepine, opioid, and vasopressor infusions, and antipsychotics were each associated with a higher risk of delirium the next day (all p≤0•04), whereas family visitation (in person or virtual) was associated with a lower risk of delirium (p<0•0001). During the 21-day study period, patients were alive without delirium or coma for a median of 5•0 days (0•0 to 14•0). At baseline, older age, higher SAPS II scores, male sex, smoking or alcohol abuse, use of vasopressors on day 1, and invasive mechanical ventilation on day 1 were independently associated with fewer days alive and free of delirium and coma (all p<0•01). 601 (28•8%) of 2088 patients died within 28 days of admission, with most of those deaths occurring in the ICU. Interpretation Acute brain dysfunction was highly prevalent and prolonged in critically ill patients with COVID-19. Benzodiazepine use and lack of family visitation were identified as modifiable risk factors for delirium, and thus these data present an opportunity to reduce acute brain dysfunction in patients with COVID-19.
Background Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-thre... more Background Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-threatening condition. A previous diagnosis of chronic liver disease is associated with poorer outcomes. Nevertheless, the impact of silent liver injury has not been investigated. We aimed to explore the association of pre-admission liver fibrosis indexes with the prognosis of critically ill COVID-19 patients.Methods Observational study in 214 patients with COVID-19 consecutively admitted to the ICU. Pre-admission liver fibrosis indexes were calculated. In-hospital mortality and predictive factors were explored with Kaplan-Meier and Cox regression analysis.Results The mean age was 59.58 (13.79) years. Sixteen patients (7.48%) had previously recognized chronic liver disease. Up to 78.84% of patients according to Forns, and 45.76% according to FIB-4, had more than minimal fibrosis. Fibrosis indexes were higher in non-survivors [Forns: 6.04 (1.42) vs 4.99 (1.58), p < 0.001; FIB-4: 1.77 (1.17...
Revista Española de AnestesiologÃa y Reanimación, 2020
Since January 2020 Elsevier has created a COVID-19 resource centre with free information in Engli... more Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Background: Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-1... more Background: Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone.Methods: Prospective, multicentre, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June, 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory sequential organ failure assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, labo...
Brazilian Journal of Anesthesiology, 2018
Cirurgia torácica; Ventilac ¸ão monopulmonar; Variac ¸ão do volume sistólico; Terapia alvo-dirigi... more Cirurgia torácica; Ventilac ¸ão monopulmonar; Variac ¸ão do volume sistólico; Terapia alvo-dirigida; Interac ¸ão corac ¸ão-pulmão Introduc ¸ão: Nos últimos anos, a importância da terapia alvo-dirigida foi enfatizada para aprimorar o estado hemodinâmico do paciente e melhorar seu prognóstico. Os parâmetros baseados na interac ¸ão entre o corac ¸ão e os pulmões foram questionados em situac ¸ões como baixo volume corrente e cirurgia aberta do tórax. O objetivo do estudo foi analisar as alterac ¸ões que a ventilac ¸ão monopulmonar pode produzir na variac ¸ão do volume sistólico e avaliar o possÃvel impacto das pressões da via aérea e da complacência pulmonar sobre a variac ¸ão do volume sistólico. Métodos: Estudo observacional prospectivo, no qual 112 pacientes submetidos à cirurgia de ressecc ¸ão pulmonar com perÃodos de ventilac ¸ão monopulmonar foram incluÃdos. A terapia de fluÃdos intravenosos com cristaloides foi ajustada a 2 mL.kg -1 .h -1 . Os episódios de hipotensão foram tratados com vasoconstritores. A ventilac ¸ão dos dois pulmões (VDP) foi implantada com volume corrente de 8 mL.kg -1 e a ventilac ¸ão monopulmonar foi controlada com volume corrente de 6 mL.kg -1 . Foi monitorada a pressão arterial invasiva. Registramos os seguintes valores cardiorrespiratórios: frequência cardÃaca, pressão arterial média, Ãndice cardÃaco, Ãndice de volume sistólico, pressão de pico das vias aéreas, pressão de platô das vias aéreas e complacência pulmonar estática em três tempos durante a cirurgia: imediatamente após o colapso do pulmão, 30 minutos após o inÃcio da ventilac ¸ão monopulmonar e após a restaurac ¸ão da ventilac ¸ão dos dois pulmões. Resultados: Os valores de variac ¸ão do volume sistólico foram influenciados pelo colapso pulmonar (antes do colapso pulmonar 14,6 [DS] vs. ventilac ¸ão monopulmonar 9,9% [DS], p < 0,0001), * Autor para correspondência.
Trials, 2019
Background Use of minimally invasive surgical techniques for lung resection surgery (LRS), such a... more Background Use of minimally invasive surgical techniques for lung resection surgery (LRS), such as video-assisted thoracoscopy (VATS), has increased in recent years. However, there is little information about the best anesthetic technique in this context. This surgical approach is associated with a lower intensity of postoperative pain, and its use has been proposed in programs for enhanced recovery after surgery (ERAS). This study compares the severity of postoperative complications in patients undergoing LRS who have received lidocaine intraoperatively either intravenously or via paravertebral administration versus saline. Methods/design We will conduct a single-center randomized controlled trial involving 153 patients undergoing LRS through a thoracoscopic approach. The patients will be randomly assigned to one of the following study groups: intravenous lidocaine with more paravertebral thoracic (PVT) saline, PVT lidocaine with more intravenous saline, or intravenous remifentanil...
Canadian Medical Association Journal, 2019
orldwide, 100 million patients aged 45 years and older undergo inpatient noncardiac surgery each ... more orldwide, 100 million patients aged 45 years and older undergo inpatient noncardiac surgery each year. Although surgery has the potential to improve and prolong quality and duration of life, it is also associated with complications and mortality. During the last several decades, advances in perioperative care have included less invasive surgery, improved anesthetic techniques, enhanced intraoperative monitoring and more rapid mobilization after surgery. 2 At the same time, the age and the number of comorbidities of patients undergoing surgery have increased substantially. Hence, in the current context, the frequency and timing of mortality is uncertain, as is the relation between perioperative complications to mortality. In a large prospective study (The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation [VISION] Study), we systematically followed patients who underwent noncardiac surgery and documented perioperative complications and death. Our a priori objectives included establishing the frequency and timing of death after noncardiac surgery, and the association between perioperative complications and postsurgical death. We previously reported details of the study design and methods. VISION was an international, prospective cohort study. Patients were included if they were aged 45 years or older, had undergone noncardiac surgery, had received general or regional anesthesia and remained in hospital for at least 1 night after surgery. Patients were recruited at 28 centres in 14 countries in North and South America, Asia, Europe, Africa and Australia,
Journal of Clinical Monitoring and Computing, 2019
Early detection of patients with a high risk of postoperative pulmonary complications (PPCs) coul... more Early detection of patients with a high risk of postoperative pulmonary complications (PPCs) could improve postoperative strategies. We investigated the role of monitoring systemic and lung inflammatory biomarkers during surgery and the early postoperative period to detect patients at high risk of PPCs after lung resection surgery (LRS). This is a substudy of a randomized control trial on the inflammatory effects of anaesthetic drugs during LRS. We classified patients into two groups, depending on whether or not they developed PPCs. We constructed three multivariate logistic regression models to analyse the power of the biomarkers to predict PPCs. Model 1 only included the usual clinical variables; Model 2 included lung and systemic inflammatory biomarkers; and Model 3 combined Models 1 and 2. Comparisons between mathematical models were based on the area under the receiver operating characteristic curve (AUROC) and tests of integrated discrimination improvement (IDI). Statistical significance was set at p < 0.05. PPCs were detected in 37 (21.3%) patients during admission. The AUROC for Models 1, 2, and 3 was 0.79 (95% CI 0.71-0.87), 0.80 (95% CI 0.72-0.88), and 0.93 (95% CI 0.88-0.97), respectively. Comparison of the AUROC between Models 1 and 2 did not reveal statistically significant values (p = 0.79). However, Model 3 was superior to Model 1 (p < 0.001). Model 3 had had an IDI of 0.29 (p < 0.001) and a net reclassification index of 0.28 (p = 0.007). A mathematical model combining inflammation biomarkers with clinical variables predicts PPCs after LRS better than a model that includes only clinical data. Clinical registration number Clinical Trial Registration NCT 02168751; EudraCT 2011-002294-29.
Brazilian Journal of Anesthesiology (English Edition), 2018
Background: Anesthetic pre-conditioning attenuates inflammatory response during ischemiareperfusi... more Background: Anesthetic pre-conditioning attenuates inflammatory response during ischemiareperfusion lung injury. The molecular mechanisms to explain it are not fully understood. The aim of our investigation was to analyze the molecular mechanism that explain the antiinflammatory effects of anesthetic pre-conditioning with sevoflurane focusing on its effects on MAPKs (mitogen-activated protein kinases), NF-B (nuclear factor kappa beta) pathways, and apoptosis in an experimental lung autotransplant model. Methods: Twenty large white pigs undergoing pneumonectomy plus lung autotransplant were divided into two 10-member groups on the basis of the anesthetic received (propofol or sevoflurane). Anesthetic pre-conditioning group received sevoflurane 3% after anesthesia induction and it stopped when one-lung ventilation get started. Control group did not receive sevoflurane in any moment during the whole study period. Intracellular signal-transduction pathways (MAPK family), transcription factor (NF-B), and apoptosis (caspases 3 and 9) were analyzed during experiment.
European Surgical Research, 2018
Purpose: Ischaemia-reperfusion injury (IRI) is a main cause of morbidity after pulmonary resectio... more Purpose: Ischaemia-reperfusion injury (IRI) is a main cause of morbidity after pulmonary resection surgery. The degradation of glycocalyx, a dynamic layer of macromolecules at the luminal surface of the endothelium, seems to participate in tissue dysfunction after IRI. Lidocaine has a proven anti-inflammatory activity in several tissues but its modulation of glycocalyx has not been investigated. This work aimed to investigate the potential involvement of glycocalyx in lung IRI in a lung auto-transplantation model and the possible effect of lidocaine in modulating IRI. Methods: Three groups (sham-operated, control, and lidocaine), each consisting of 6 Large White pigs, were subjected to lung auto-transplantation. All groups received the same anaesthesia. In addition, the lidocaine group received a continuous IV administration of lidocaine (1.5 mg/kg/h). Lung tissue and plasma samples were taken before pulmonary artery clamp, before reperfusion, and 30 and 60 min post-reperfusion in o...
British Journal of Anaesthesia, 2018
Blood troponins are used to diagnose perioperative myocardial injury and infarction. During liver... more Blood troponins are used to diagnose perioperative myocardial injury and infarction. During liver transplantation, a passive donor-recipient troponin transfer with the graft may result in an increase of troponins in the transplant recipient questioning the diagnosis of myocardial injury. We present a case of liver transplantation with sudden elevation of recipient's serum troponin levels immediately after graft reperfusion and its subsequent normalization in which myocardial damage and other non-ischaemic potential causes were ruled out. Patient consent for publication was obtained prior to submission of the manuscript.
British Journal of Anaesthesia, 2017
Background. Recent studies report the immunomodulatory lung-protective role of halogenated anaest... more Background. Recent studies report the immunomodulatory lung-protective role of halogenated anaesthetics during lung resection surgery (LRS) but have not investigated differences in clinical postoperative pulmonary complications (PPCs). The main goal of the present study was to compare the effect of sevoflurane and propofol on the incidence of PPCs in patients undergoing LRS. The second aim was to compare pulmonary and systemic inflammatory responses to LRS. Methods. Of 180 patients undergoing LRS recruited, data from 174 patients were analysed. Patients were randomized to two groups (propofol or sevoflurane) and were managed otherwise using the same anaesthetic protocol. Bronchoalveolar lavage (BAL) was performed in both lungs before and after one-lung ventilation for analysis of cytokines. Arterial blood was drawn for measurement of the cytokines analysed in the BAL fluid at five time points. Intraoperative haemodynamic and respiratory parameters, PPCs (defined following the ARISCAT study), and mortality during the first month and yr were recorded. Results. More PPCs were detected in the propofol group (28.4% vs 14%, OR 2.44 [95% CI, 1.14-5.26]). First-yr mortality was significantly higher in the propofol group (12.5% vs 2.3%, OR 5.37 [95% CI, 1.23-23.54]). Expression of lung and systemic pro-inflammatory cytokines was greater in the propofol group than in the sevoflurane group. Pulmonary and systemic IL-10 release was less in the propofol group. Conclusions. Our results suggest that administration of sevoflurane during LRS reduces the frequency of the PPCs recorded in our study and attenuates the pulmonary and systemic inflammatory response. Clinical trial registration. NCT 02168751; EudraCT 2011-002294-29.
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Papers by Ignacio Garutti