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J R Masclans

Publications and source records attributed to J R Masclans.

At least 19 recordsLinked to original sources
PubMed1999

[The prognostic value of eicosanoids in the acute respiratory distress syndrome].

BACKGROUND: There is a great number of agents involved in the acute respiratory distress syndrome (ARDS) physiopathology, and some of them may have a prognostic value. The objective of the present study has been to analyse the prognostic value of eicosanoids in this syndrome. MATERIAL AND METHOD: A prospective study with 21 consecutive ARDS patients admitted to the intensive care unit of a therapy hospital in Barcelona, Spain, was carried out. In the first 48 h of the ARDS diagnosis, at baseline, the plasma levels, (in peripheral arterial and pulmonary arterial samples) of thromboxane B2 (TXB2), prostaglandin F1-alpha) (PGF1-alpha) and leukotriene B4 (LTB4) were analysed by RIA. Simultaneously we measured different pulmonary and systemic hemodynamical variables, as well as the pulmonary gas exchange data. We also studied the venous levels of the same eicosanoids in 17 healthy adults, used as reference. RESULTS: Plasma levels of eicosanoids in the ARDS patients were higher than reference subjects (p < 0.05). No differences were observed between systemic arterial and pulmonary arterial values. From all the eicosanoids, only LTB4, (in both systemic arterial and pulmonary blood), was correlated with LIS (r = 0.49, p < 0.05; and r = 0.45, p < 0.05, respectively). Patients who did not survive presented a lower systemic-pulmonary arterial gradient of eicosanoids levels than survivors (-1.27 vs -0.10 ng/ml; p < 0.01). CONCLUSIONS: In our ARDS patients only LTB4 plasma levels correlated with the severity of respiratory failure. Patients who did not survive presented a lower LTB4 gradient than survivors.

Adult↗
PubMed1998

Severe acute pancreatitis: treatment with somatostatin.

OBJECTIVE: To investigate the efficacy of somatostatin for the treatment of severe acute pancreatitis. DESIGN: Prospective, randomized and unblinded study. SETTING: A general intensive care unit (ICU) in a university hospital. PATIENTS: 50 patients with severe acute pancreatitis. INTERVENTIONS: All patients received the conventional treatment for this clinical condition. The study group received, in addition, somatostatin over a 10-day period. MEASUREMENTS AND RESULTS: We evaluated age, gender, etiology of the pancreatitis, severity of the illness, complications, length of hospitalization, and mortality in the ICU. The patients were classified as severe (Acute Physiology and Chronic Health Evaluation II score, Ranson's criteria, and computed tomography Balthazar classification). Biliary lithiasis was the most common etiologic factor (63.6% in the control group, 37.5% in study group; NS). The study group required fewer overall surgical interventions than the control group (45.8 vs 86.4%; p = 0.005). Late surgical procedures related to the evolution of pancreatic necrosis were more common in the controls (63.6 vs 37.5%; p = 0.07). No differences in length of stay in hospital or mortality in the ICU were observed. CONCLUSION: The only advantage of somatostatin administration in the patients studied was a slight reduction in the need for surgery due to local complications.

APACHE↗
PubMed1998

Anticoagulative effect of nitric oxide inhalation in ARDS.

Some studies have suggested that nitric oxide (NO) may cause platelet dysfunction. We present an ARDS patient who need this treatment, with a transient alteration of platelet function and a significant prolongation of bleeding time.

Acute Disease↗
PubMed1998

Gas exchange and pulmonary haemodynamic responses to fat emulsions in acute respiratory distress syndrome.

OBJECTIVE: To investigate the gas exchange and pulmonary haemodynamic responses to two different intravenous fat emulsions in patients with acute respiratory distress syndrome (ARDS). DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: Intensive care unit in a university-affiliated hospital. PATIENTS: 21 patients with ARDS [mean age, 57 +/- 3 (SEM) years; Acute Physiology and Chronic Health Evaluation II, 20 +/- 3; Murray's score, 2.85 +/- 0.12] consecutively admitted. INTERVENTIONS: Patients were assigned to three groups (n = 7 each): group A (LCT) received long-chain triglycerides (20% LCT), group B (MCT/LCT), medium-chain triglycerides/long-chain triglycerides (20% MCT/LCT: 50/50) and group C placebo (0.9% sodium chloride, NaCl). The infusion was always given at the rate of 2 mg/kg min over a total period of 12 h, with a volume infusion of 500 ml in each group. MEASUREMENTS: Data were collected before, immediately after and 12 h after infusion ceased. Pulmonary and systemic haemodynamic and gas exchange variables were measured at each time point. Serum triglyceride cholesterol, and non-esterified fatty acids levels were measured. RESULTS: During LCT infusion, cardiac output, oxygen consumption and oxygen delivery increased (all p < 0.05), whereas pulmonary haemodynamics, arterial oxygen tension, mixed venous partial pressure of oxygen and venous admixture ratio remained essentially unaltered. No changes were observed following MCT/LCT infusion. CONCLUSIONS: The administration of LCT emulsion given at a slow rate did not alter arterial oxygenation because of the beneficial effect of a high cardiac output, hence offsetting the detrimental effect of increased O2 consumption.

Adult↗
PubMed1998

Effect of inverse I:E ratio ventilation on pulmonary gas exchange in acute respiratory distress syndrome.

BACKGROUND: It is not known whether inverse I:E ratio ventilation (IRV) offers any real benefit over conventional mechanical ventilation with positive end-expiratory pressure (CMV-PEEP) at similar levels of end-expiratory pressure. METHODS: The effects of volume-controlled and pressure-controlled IRV (VC-IRV and PC-IRV, respectively) on VA/Q inequality were compared with those of CMV-PEEP at a similar level of end-expiratory pressure and with CMV without PEEP (CMV) in eight patients in the early stages of acute respiratory distress syndrome (ARDS). Respiratory blood gases, inert gases, lung mechanics, and hemodynamics were measured 30 min after the onset of each ventilatory mode. RESULTS: Recruitment of nonventilated, poorly ventilated (or both) but well-perfused alveoli increased the partial pressure of oxygen (PaO2) during CMV-PEEP (+13 mmHg) and IRV-VC (+10 mmHg; P < 0.05) compared with CMV. In contrast, PC-IRV did not affect PaO2 but caused a decrease in PaCO2 (-7 mmHg; P < 0.05). The latter was due to a concomitant decrease in dead space (P < 0.01) and shift to the right of VA/Q distributions. During PC-IRV, the increase in the mean of blood flow distribution (mean Q; P < 0.01) without a change in the dispersion (log SD Q) did not result in an increase in PaO2, probably because it reflected redistribution of blood flow within well-ventilated areas. CONCLUSIONS: Short-term PC-IRV improved carbon dioxide clearance, but the lung became less efficient as an oxygen exchanger. Furthermore, based on mean airway and plateau pressures, the risk of barotrauma was not reduced with this type of ventilation.

Adult↗
PubMed1998

Effects of F(I)O2 on leg VO2 during cycle ergometry in sedentary subjects.

In a recent study of completely sedentary normal young subjects, leg VO2max was reduced by hypoxia in proportion to mean capillary PO2 as F(I)O2 was reduced from 0.15 to 0.12. However, the increase in VO2max from F(I)O2 = 0.15 to 0.21 was less than expected for the increase in mean capillary PO2. This finding has led us to hypothesize that in sedentary subjects breathing room air, VO2max is not limited by O2 supply but rather by oxidative capacity of mitochondria. The present study sought to obtain further evidence for or against this hypothesis in sedentary subjects by assessing leg VO2max (VO2leg) breathing 100% O2, as well as in normoxia and hypoxia. Data from 18 subjects studied at F(I)O2 = 0.12, 0.15, and 0.21 and from six more studied at 0.12, 0.15, and 1.00 were analyzed. In all 24 we measured VO2leg by arterial and venous blood sampling and thermodilution leg blood flow during maximal cycle ergometry at each F(I)O2. VO2leg was not increased by room air or 100% O2 breathing relative to that observed at F(I)O2 = 0.15, but it was reduced while breathing 12% O2. The data at F(I)O2 = 0.12 and 0.15 conformed to the predictions of O2 supply limitation of maximal VO2 as previously. These results confirm and extend our prior observations that in sedentary, as opposed to trained subjects, muscle VO2max is O2 supply limited only in hypoxia.

Adolescent↗
PubMed1997

Neurological disturbances and hyperdynamic shock in a patient with esophagocoloplasty.

A 39-year-old man, with no history of alcohol intake, who had had an esophago-ileo-colo-gastroplasty with ileotransversostomy, developed diplopia, seizures, metabolic acidosis, and cardiac failure and finally refractory hyperdynamic shock. He died 20 h after admission to our intensive care unit from cardiocirculatory collapse. Postmortem results revealed low erythrocyte transketolase activity, which was increased by 22% by in vitro addition of thiamine diphosphate (TDP effect). Cerebral pathology showed the alterations of Wernicke's encephalopathy. We discuss the possible mechanisms of fatal cardiovascular collapse and the unusual presentation of a case without a history of alcoholic intake or clinical malnutrition.

Acidosis↗
PubMed1997

Eicosanoids and fat emulsions in acute respiratory distress syndrome patients.

Lipid emulsions have been associated with changes in pulmonary function. Although these changes were related to the physical effects of the infusion-induced lipemia on gas exchange, several animal and human studies suggest that the impairment in pulmonary function observed with lipid infusions was mediated by prostaglandins. Prostaglandins are synthesized enzymatically from essential fatty acids. We studied the effects of two lipid emulsions, with different amounts of essential fatty acids (20% long-chain triacylglycerols [LCT] with 55% of linoleic acid and 7% of alpha linolenic acid in 100 g of emulsion, and a physical mixture of 20% medium-chain triacyglycerols [MCT] and LCT with 26% of linoleic acid and 4% of alpha linolenic acid in 100 g of emulsion), on plasma levels of eicosanoids in patients with acute respiratory distress syndrome (ARDS). Although in patients with ARDS, plasma levels of prostanoids were higher than the reference values, neither lipid emulsion, administered at the rate of 2 mg.kg-1.min-1 induced significant changes in the eicosanoids except for a decrease in systemic-pulmonary arterial 6-keto prostaglandin F1 alpha difference.

6-Ketoprostaglandin F1 alpha↗
PubMed1996

Effects of erythropoietin on muscle O2 transport during exercise in patients with chronic renal failure.

Erythropoietin (rHuEPO) has proven to be effective in the treatment of anemia of chronic renal failure (CRF). Despite improving the quality of life, peak oxygen uptake after rHuEPO therapy is not improved as much as the increase in hemoglobin concentration ([Hb)] would predict. We hypothesized that this discrepancy is due to failure of O2 transport rates to rise in a manner proportional to [Hb]. To test this, eight patients with CRF undergoing regular hemodialysis were studied pre- and post-rHuEPO ([Hb] = 7.5 +/- 1.0 vs. 12.5 +/- 1.0 g x dl-1) using a standard incremental cycle exercise protocol. A group of 12 healthy sedentary subjects of similar age and anthropometric characteristics served as controls. Arterial and femoral venous blood gas data were obtained and coupled with simultaneous measurements of femoral venous blood flow (Qleg) by thermodilution to obtain O2 delivery and oxygen uptake (VO2). Despite a 68% increase in [Hb], peak VO2 increased by only 33%. This could be explained largely by reduced peak leg blood flow, limiting the gain in O2 delivery to 37%. At peak VO2, after rHuEPO, O2 supply limitation of maximal VO2 was found to occur, permitting the calculation of a value for muscle O2 conductance from capillary to mitochondria (DO2). While DO2 was slightly improved after rHuEPO, it was only 67% of that of sedentary control subjects. This kept maximal oxygen extraction at only 70%. Two important conclusions can be reached from this study. First, the increase in [Hb] produced by rHuEPO is accompanied by a significant reduction in peak blood flow to exercising muscle, which limits the gain in oxygen transport. Second, even after restoration of [Hb], O2 conductance from the muscle capillary to the mitochondria remains considerably below normal.

Adult↗
PubMed1996

Cellular bioenergetics after erythropoietin therapy in chronic renal failure.

After erythropoietin (rHuEPO) therapy, patients with chronic renal failure (CRF) do not improve peak O2 uptake (VO2 peak) as much as expected from the rise in hemoglobin concentration ([Hb]). In a companion study, we explain this phenomenon by the concurrent effects of fall in muscle blood flow after rHuEPO and abnormal capillary O2 conductance observed in CRF patients. The latter is likely associated with a poor muscle microcirculatory network and capillary-myofiber dissociation due to uremic myopathy. Herein, cellular bioenergetics and its relationships with muscle O2 transport, before and after rHuEPO therapy, were examined in eight CRF patients (27 +/- 7.3 [SD] yr) studied pre- and post-rHuEPO ([Hb] = 7.8 +/- 0.7 vs. 11.7 +/- 0.7 g x dl-1) during an incremental cycling exercise protocol. Eight healthy sedentary subjects (26 +/- 3.1 yr) served as controls. We hypothesize that uremic myopathy provokes a cytosolic dysfunction but mitochondrial oxidative capacity is not abnormal. 31P-nuclear magnetic resonance spectra (31P-MRS) from the vastus medialis were obtained throughout the exercise protocol consisting of periods of 2 min exercise (at 1.67 Hz) at increasing work-loads interspersed by resting periods of 2.5 min. On a different day, after an identical exercise protocol, arterial and femoral venous blood gas data were obtained together with simultaneous measurements of femoral venous blood flow (Qleg) to calculate O2 delivery (QO2leg) and O2 uptake (VO2leg). Baseline resting [phosphocreatine] to [inorganic phosphate] ratio ([PCr]/[Pi]) did not change after rHuEPO (8.9 +/- 1.2 vs. 8.8 +/- 1.2, respectively), but it was significantly lower than in controls (10.9 +/- 1.5) (P = 0.01 each). At a given submaximal or peak VO2leg, no effects of rHuEPO were seen on cellular bioenergetics ([PCr]/[Pi] ratio, %[PCr] consumption halftime of [PCr] recovery after exercise), nor in intracellular pH (pHi). The post-rHuEPO bioenergetic status and pHi, at a given VO2leg, were below those observed in the control group. However, at a given pHi, no differences in 31P-MRS data were detected between post-rHuEPO and controls. After rHuEPO, at peak VO2, Qleg fell 20% (P < 0.04), limiting the change in QO2leg to 17%, a value that did not reach statistical significance. The corresponding O2 extraction ratio decreased from 73 +/- 4% to 68 +/- 8.2% (P < 0.03). These changes indicate that maximal O2 flow from microcirculation to mitochondria did not increase despite the 50% increase in [Hb] and explain how peak VO2leg and cellular bioenergetics (31P-MRS) did not change after rHuEPO. Differences in pHi, possibly due to lactate differences, between post-rHeEPO and controls appear to be a key factor in the abnormal muscle cell bioenergetics during exercise observed in CRF patients.

Adult↗
PubMed1996

Salbutamol reduces pulmonary neutrophil sequestration of platelet-activating factor in humans.

To investigate whether salbutamol inhibits platelet-activating factor (PAF)-induced neutrophil sequestration in the lungs, we studied eight nonatopic, nonsmoking, healthy subjects (six men; aged 27.0 +/- 1.5 (SE) yr) with PAF-induced bronchial response. Prior to PAF challenge (24 micrograms), they inhaled either salbutamol (300 micrograms) or placebo in a randomized, double-blind, crossover manner two weeks apart. Respiratory system resistance (Rrs), arterial blood gases, and neutrophil counts were measured 4, 8, 12 and 30 min after PAF. Neutrophil kinetics in the lungs were assessed by tracking autologous 99mTc-erythrocytes and 111in-neutrophils. Compared with salbutamol, arterial blood neutrophil counts fell (p < 0.04) maximally at 4 min after PAF, followed by a mild rebound neutrophilia, whereas Rrs increased (p < 0.01) and Pao2 decreased (p < 0.05) at 4 min only. The intrapulmonary activity of 111in-neutrophils after pretreatment with placebo was higher compared with salbutamol (1.98 +/- 0.15 versus 1.33 +/- 0.23 cps/mCi/pixel) (p < 0.01) although both their initial sequestration (first-pass) and subsequent washout were not significantly different. Inhaled salbutamol blocks pulmonary neutrophil sequestration and lung function abnormalities following PAF challenge in humans.

Administration, Inhalation↗
PubMedDate not supplied

[Cohort study on incidence of ARDS in patients admitted to the ICU and prognostic factors of mortality].

OBJECTIVE: Analyze acute respiratory distress syndrome (ARDS) in patients admitted to an Intensive Care Medicine Service (ICMS) and prognostic factors of mortality in these patients. DESIGN: Prospective study of all the patients admitted consecutively in the ICMS from January 1998 to February 2003. SCOPE: ICMS of a third level university site with 32 beds in its General Area and 10 beds in the Traumatology Area. PATIENTS: Patients who met the ARDS criteria of the European-North American Consensus Conference at any time during admission in ICMS. ENDPOINTS OF INTEREST: Mortality at 28 days. RESULTS: One hundred and ninety-one patients (3.4 of all the admissions in ICMS) had ARDS criteria. The origin of ARDS was intrapulmonary in 63%. A total of 77% of the patients had multiorgan dysfunction and 26% respiratory superinfection. Median stay in the ICMS was 20 days. Mortality at 28 days was 48% and hospital mortality 58%. Multivariant analysis showed that the variables associated independently with an increase in mortality were the following: APACHE II > 22 (odds ratio [OR] 2.7; 95% CI: 1.3-5.8; p = 0.007), minimum PaO2/FIO2 during evolution of ARDS < 81 mmHg (odds ratio 5.5; 95% CI: 2.6-11.9; p < 0.0001), dysfunction > or = 3 organs (odds ratio 11.8; 95% CI: 2.5-55.4; p = 0.002). CONCLUSIONS: ARDS is an entity with elevated mortality whose prognosis is associated not only with the seriousness of pulmonary function deterioration but also of systemic function, on which some treatment could modulate its evolution.

Adult↗
PubMedDate not supplied

[Nutrition in the first 100 liver transplants performed at the Hospital General Vall d'Hebrón].

The orthotopic liver transplant (OLT) is a therapeutic alternative in the terminal stages of liver pathology. It is a surgical procedure which is being used on a steadily increasing basis. In our Hospital, a OLT program was started in 1988. Coinciding with the one hundredth OLT, we have gathered, retrospectively the methods of nourishing these patients, as well as the possible connections existing between the nutritional support system and the time spent by these patients in the intensive care unit on one hand, and the mortality presented on the other hand. Parenteral nutrition (PN) was the initial nutritional support system most used by the patients in our unit. Those patients needing PN as the primary nutritional support system, presented significantly longer stays in the ICU and a tendency towards higher mortality than did those who required another type of nutrition as the primary nutritional support system. In 21% of the patients, the PN could, possibly, have been avoided. Oral nutrition (ON) was the next most frequent method of primary nutritional support, and the most frequent method as far as global nutrition, with enteral nutrition (EN) being used in very few cases.

Adolescent↗
PubMedDate not supplied

[The nutrition of liver transplant patients in an intensive medicine service comparing the years 1989 and 1992].

We examined the possible changes undergone in the form of feeding post liver-transplant patients admitted to our Intensive Care Unit (ICU), comparing 1989 and 1992. As biological nutritional parameters, we reviewed blood lymphocyte values and albumin prior to the transplant, immediately after, seven days following and on discharge from the ICU. In the two periods studied, we assessed the features of the nutritional support received by these patients (type and chronology). We found that, in 1992, parenteral nutrition (in significant form, p = 0.04) and oral diet (as trend, p = 0.06) was initiated earlier than in 1989. We noted a tendency to change the overall nutritional pattern, with an increase seen in 1992 in oral diet and a reduction in parenteral nutritional when compared to the 1989 period. In 1992, 24% of patients received oral diet as a first nutrition as against none in 1989. These data must be correlated with the time in the Intensive Medicine Service and the tendency to reduce mortality, even though transplant patients in 1992 were significantly older than in 1989, while their selection and the base pathology altered the pattern of these patients.

Adolescent↗