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Biomedical subjects

J L Manzano

Publications and source records attributed to J L Manzano.

At least 19 recordsLinked to original sources
PubMed1999

[Pneumonias in patients with malignant hemopathies. Their etiology, response to treatment and prognostic factors in 69 patients (88 episodes)].

BACKGROUND: To analyze the etiology, treatment response and prognostic factors in 88 episodes of pneumonia in patients with hematological malignancies diagnosed in one center during a period of 30 months. PATIENTS AND METHODS: 88 episodes of pneumonia in 69 adult patients were studied. Age, sex, hematological malignancy and its treatment, existence of neutropenia and hypogammaglobulinemia, administration of immunosuppressive agents, type (hospital or community-acquired) and localization of pneumonia, presence of respiratory failure and treatment response were reported. For etiologic diagnosis of pneumonias, cultures of blood, sputum, pleural fluid and bronchoalveolar lavage (BAL), as well as Legionella pneumophila, Aspergillus fumigatus and Streptococcus pneumoniae antigen detection in urine were performed. Univariate and multivariate analyses of prognostic factors for pneumonia evolution were carried out. RESULTS: The median age was 63 years. Acute leukemias (AL) were the predominant hematological malignancies. Microbiologic documentation was obtained in 40 (45%) of pneumonias. Fiberoptic bronchoscopy with BAL (71%) was the diagnostic procedure with highest yield followed by blood cultures (25%). Streptococcus pneumoniae (13) was the most frequent isolated pathogen, followed by Legionella pneumophila (6) and Pseudomonas aeruginosa (6). A significantly higher prevalence of Streptococcus pneumoniae was observed in community-acquired pneumonia. The overall mortality rate was 20%. Respiratory failure (p = 0.0009), existence of neutropenia (p = 0.0023), age equal or higher than 60 years (p = 0.012) and prolonged administration of immunosuppressive agents (p = 0.015) were the prognostic factors associated with unfavourable evolution of pneumonias in the multivariate analysis. CONCLUSIONS: The etiologic diagnosis of pneumonia in patients with hematological malignancies was only achieved in a half of cases. In our series, the high prevalence of Legionella pneumophila can be attributed to the special epidemiologic characteristics of our hospital. Prognostic factors of pneumonia are related to individual factors as well as to the hematological status of patients.

Adolescent↗
PubMed1996

[Effects of surfactant administration in premature infants with severe respiratory distress syndrome].

BACKGROUND: From January 1992 to June 1993 a study was performed to show whether the administration of surfactant to low birth weight infants with respiratory distress decreased the need for ventilatory support and improved survival. METHOD: Twenty three infants born at a single hospital received the surfactant (one dose of a 100 mg/kg divided in four aliquots) and they were eligible for the treatment if they met the following criteria: 1) Weight between 650 g and 2000 g; 2) postnatal age 4 to 24 hours; 3) clinical-radiographic signs of respiratory distress, and 4) need of mechanical ventilation with FiO2 > or = 0.6. The results of the treatment were evaluated comparing the arterial-alveolar oxygenation ratio, maximal inspiratory pressure and the oxygenation index before and after the administration of surfactant. The last consecutive eighteen infants born at our hospital, before our study was started, that met the same criteria were elected as control group. RESULTS: In the group of infants treated with surfactant the arterial-alveolar oxygenation ratio increased from 0.10 +/- 0.009 before treatment to 0.28 +/- 0.02 six hours after treatment (p < 0.01); the oxygenation index decreased from 37.79 +/- 4.27 to 12.71 +/- 1.17 (p < 0.01) and the maximal inspiratory pressure from 22.13 +/- 0.81 cmH2O to 19.52 +/- 0.76 (p < 0.001) in the same period of time. This improvement was maintained during the following 72 hours. In the group of infants treated with surfactant, mortality decreased (p < 0.01), the frequency of pneumothorax diminished (p < 0.001) and the frequency of pulmonary haemorrhage increased (p < 0.05). The ventilatory time was similar in both groups of infants but the global length of stay of the newborn that received surfactant was longer due to the fact that the non survivors of the control group died before the 72 hours of life. CONCLUSIONS: Treatment with surfactant improves the initial evolution of the respiratory distress syndrome of the newborn and decreases mortality.

Age Factors↗
PubMed1996

Bedside sonographic-guided versus blind nasoenteric feeding tube placement in critically ill patients.

OBJECTIVE: To compare a blind manual bedside method for placing feeding tubes into the small bowel vs. a sonographic bedside technique in critically ill patients. DESIGN: Prospective study with a random sample. SETTING: Multidisciplinary intensive care unit in a tertiary care university hospital. PATIENTS: Thirty-five adult patients. All patients were hemodynamically stable, mechanically ventilated, and required a nasoenteric tube placement for short-term enteral feeding due to impaired gastric emptying. INTERVENTIONS: A well-known, blind, manual, bedside method for postpyloric tube placement was always attempted first in all cases. The technique was considered successful when a postpyloric location of the tip of the tube was achieved as shown by abdominal roentgenogram. However, if after 30 mins we failed to enter the small bowel, a radiologist attempted a sonographic bedside technique for postpyloric tube insertion. Finally, when the feeding tube was in place, before starting enteral nutrition, a nasogastric tube was inserted into the stomach. MEASUREMENTS AND MAIN RESULTS: The blind manual method was successful in nine (25.7%) of the 35 patients and the final location of these feeding tubes was the proximal jejunum. The average time for placement of the feeding tubes with this manual technique was 13.9 +/- 7.4 mins (range 5 to 30). The sonographic technique was successful in 22 (84.6%) of the remaining patients and the final location of the feeding tubes was three (11%) tubes in the second portion of the duodenum, eight (31%) tubes in the third portion of the duodenum, and 11 (42%) tubes in the proximal jejunum. The average time for placement with the sonographic technique was 18.3 +/- 8.2 mins (range 5 to 35). The pyloric outlet was sonographically akinetic or severely hypokinetic in 13 patients, and in four of them, we were unable to achieve postpyloric tube placement. In these four patients, the tubes were subsequently placed by endoscopy. CONCLUSIONS: The sonographic bedside technique for placing feeding tubes into the small bowel in critically III patients has a success rate of 84.6% (confidence interval 71% to 98%) after the failure of the blind bedside manual method, proving that the former is significantly more successful. This sonographic technique facilitates the insertion of the tubes in patients who cannot be moved and in those patients with severe impairment of the peristaltic activity of the stomach.

Critical Illness↗
PubMed1995

Removal of infected dual chambered transvenous pacemaker and implantation of a new epicardial dual chambered device with cardiopulmonary bypass: experience with seven cases.

Seven patients with infected transvenous dual chambered pacemakers have undergone removal of the device using cardiopulmonary bypass. There were four women and three men with a mean age of 58 years. Six patients had localized infection in the generator pocket (mean of 4.6 previous unsuccessful operations for surgical sterilization). Four infections were due to Staphylococcus epidermidis, two to Staphylococcus aureus, and one patient presented septicemia caused by Staphylococcus epidermidis and Pseudomonas aeruginosa. The atrial and ventricular transvenous electrodes were removed under direct vision using cardiopulmonary bypass. A new dual chambered epicardial pacemaker was implanted. The procedure was well-tolerated, and all patients are infection free with working pacemakers after a mean follow-up of 25.4 months.

Cardiopulmonary Bypass↗
PubMed1993

Verbal communication of ventilator-dependent patients.

OBJECTIVE: To assess whether communication capabilities of ventilator-dependent patients are improved by the use of the Passy-Muir unidirectional valve. DESIGN: Prospective study. SETTING: An 18-bed multidisciplinary intensive care unit (ICU) at the University Hospital, Las Palmas, Spain. PATIENTS: Ten chronic ventilator-dependent patients who had undergone tracheostomy and met the following criteria: ability to eliminate tracheobronchial secretions in order to maintain a patent and unobstructed airway, adequate gas exchange while ventilated with an FIO2 of < or = 0.4 (Pao2 > 60 torr [8 kPa]), Paco2 of < 55 torr (7.3 kPa), normal hemodynamics without the need for administration of vasopressors, and normal mental state. Eight patients presented with pulmonary disease, and two presented with neuromuscular disease. INTERVENTIONS AND METHODS: Before attaching the Passy-Muir valve, the following procedures were performed: a) suction of tracheal and pharyngeal secretions; b) deflation of the tracheostomy tube cuff; c) increase in the ventilator's tidal volume setting to maintain the inspiratory pressure before cuff's deflation; d) set peak inspiratory pressure alarm and disconnect expiratory volume alarm. The valve was then connected between the tracheostomy tube and the Y-shaped piece of the ventilator's circuit. Respiratory movements, arterial blood gases, peak inspiratory pressure, respiratory rate, quantity of secretions, and changes in sense of smell were monitored during the study. The valve's efficacy was evaluated according to the patient's ability to talk and be understood during the entire respiratory cycle. RESULTS: The Passy-Muir valve was effective in improving communication in eight of ten patients who, during its use, presented insignificant cardiorespiratory changes, decreased secretions, and effected considerable improvement in well-being. Its use was impossible in two patients: one with severe pulmonary disease because cuff deflation prevented adequate ventilation, and one patient with neuromuscular disease and laryngopharyngeal dysfunction. CONCLUSIONS: The Passy-Muir unidirectional valve allows ventilator-dependent patients to talk and communicate without assistance. Patients felt better and were motivated to participate in their own care.

Adult↗
PubMed1992

[Hemodynamic differences do not exist in patients with adult respiratory syndrome with or without infection].

BACKGROUND: To verify whether patients with adult respiratory distress syndrome (ARDS), associated to sepsis or not, may be differentiated according to the values of the hemodynamic variables. METHODS: Thirty-two consecutive patients with ARDS admitted to an intensive care unit over a period of 32 months were prospectively studied. In 18 patients ARDS was associated to sepsis. The value of the hemodynamic variables were compared between both groups of patients (18 with sepsis and 14 without) within the first 24 hours of diagnosis of the syndrome. RESULTS: Mortality of patients with ARDS associated with sepsis was greater than in those without sepsis (78% vs 57%). In general both groups of patients with ARDS presented similar values of pulmonary hypertension (28 +/- 6 and 25 +/- 4 mmHg) with elevated pulmonary vascular resistance, and with an above normal cardiac index and ventricular function parameters. No significant differences were found in hemodynamic values, ventricular function and oxygen transport among patients with ARDS, with or without sepsis, or among survival or death in each group, or those considered in general. CONCLUSIONS: This study demonstrated that patients with the septic adult respiratory distress syndrome (ARDS) have the same hemodynamic changes as those observed in patients with ARDS without sepsis. This absence of differences may be explained by the presence of mechanisms common in sepsis and ARDS.

Adult↗
PubMed1991

Stress-induced gastroduodenal lesions and total parenteral nutrition in critically ill patients: frequency, complications, and the value of prophylactic treatment. A prospective, randomized study.

OBJECTIVE: To assess the frequency, complications, and value of prophylactic treatment of stress-induced gastroduodenal lesions. DESIGNS: Patients were prospectively randomized to treatment with total parenteral nutrition, either alone, with sucralfate, or with ranitidine. SETTING: A multidisciplinary ICU from a tertiary care referral center. PATIENTS: Ninety-seven patients submitted to prolonged mechanical ventilation, with normal hepatic and renal function, in metabolic stress, and receiving total parenteral nutrition. INTERVENTIONS: On admission, we determined the Acute Physiology and Chronic Health Evaluation II score and the catabolic index score. We also performed an endoscopic examination on day 3, every 7 days subsequently, and whenever needed. Thirty patients received total parenteral nutrition alone. Twenty-four patients received total parenteral nutrition and sucralfate (1 g by nasogastric tube every 4 hrs). Nineteen patients received total parenteral nutrition and ranitidine (50 mg iv every 6 hrs). MAIN RESULTS: The overall occurrence rate of gastroduodenal mucosal damage was 29.6%. The overall frequency rate for stress ulcerations was 15.6% and was 6.2% for stress hemorrhage. There were no deaths secondary to stress hemorrhage. The difference in the frequency of stress-induced mucosal lesions and stress hemorrhage between the studied groups was not statistically significant. CONCLUSIONS: Additional prophylaxis to total parenteral nutrition in the form of sucralfate and ranitidine to prevent acute upper gastrointestinal bleeding is not required in this group of ICU patients.

Adolescent↗
PubMed1989

Pulmonary hypertension in acute respiratory failure.

In order to examine the prognostic value of pulmonary arterial hypertension (PAH) in patients with moderate and severe acute respiratory failure (ARF), 225 patients with ARF who had been treated with mechanical ventilation and admitted to our ICU during a 3-yr period (January, 1983 to January, 1986) were prospectively studied. All 70 (31%) patients with moderate and severe ARF also had some form of hemodynamic or pulmonary instability, and were monitored with a pulmonary artery catheter. Of these 70 patients, 38 (54%) had PAH (mean BP 29 +/- 6 mm Hg); their mortality was 79% (30/38). The rest of the patients (n = 32) did not have PAH (mean BP was 15 +/- 3 mm Hg) and their mortality was 44% (14/32) (p less than .01). Thirty patients met all the criteria for adult respiratory distress syndrome (ARDS), and their mortality was 70% (21/30); all of them were included among the 38 PAH patients. ARDS patients who died had a significantly higher pulmonary vascular resistance and a significantly lower cardiac index than patients who survived (p less than .001). We conclude that PAH (present in all our ARDS patients) is a good predictor of mortality in ARF of diverse causes.

Acute Disease↗