Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program.

In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.

Usefulness of severity scales for cardiogenic shock in-hospital mortality. Proposal for a new prognostic model.

Cardiogenic shock (CS) is a condition comprising multiple etiologies, which associates high mortality rates. Some scoring systems have been shown to be good predictors of hospital mortality in patients admitted to Critical Care Units (CCU). The main objective of this study is to analyze their usefulness and validity in a cohort of CS patients. METHODS: Observational unicentric study of a cohort of CS patients. SOFA, SAPS II and APACHE II scores were calculated in the first 24 h of CCU admission. RESULTS: 130 patients with CS were included. SOFA, SAPS II and APACHE II scores revealed good discrimination for hospital mortality: (AUC) ROC values (AUC: 0.711, 0.752 and 0.742 respectively; P = .6). Calibration, estimated by the Hosmer-Lemeshow test, was adequate in all cases. Acute coronary syndrome, lactate serum values, SAPS II score and vasoactive inotropic score (VIS) were found to be independent predictors for mortality, upon ICU admission. With these variables, a specific prognostic indicator was developed (SAPS-2-LIVE), which improved predictive capability for mortality in our series (AUC) ROC, 0.825 (95% CI 0.752-0.89). CONCLUSION: In this contemporary CS cohort, the aforementioned scores have been shown to have good predictive ability for hospital mortality. These findings could contribute to a more accurate risk stratification in CS.

Utilidad de las escalas de gravedad en la predicción de mortalidad intrahospitalaria en el shock cardiogénico. Propuesta de un nuevo modelo pronóstico / Usefulness of severity scales for cardiogenic shock in-hospital mortality. Proposal for a new prognostic model

El shock cardiogénico (SC) es una entidad que comprende múltiples etiologías y asocia elevada mortalidad. Algunas escalas de gravedad han demostrado ser buenos predictores de mortalidad hospitalaria en pacientes ingresados en Unidades de Cuidados Intensivos (UCI). El objetivo principal de este estudio es analizar su utilidad y validez en una cohorte de pacientes en SC. Métodos: Estudio observacional unicéntrico. Se calcularon las escalas SOFA, SAPSII y APACHEII en las primeras 24horas de ingreso en UCI. Resultados: Se incluyeron 130 pacientes con SC. Las escalas SOFA, SAPSII y APACHEII mostraron buena discriminación para la mortalidad hospitalaria, obteniendo valores de área bajo la curva (AUC) ROC similares (AUC: 0,711, 0,752 y 0,742, respectivamente; p=0,6). La calibración, estimada por el test de Hosmer-Lemeshow, fue adecuada en todos los casos, SOFA (p=0,787), SAPSII (p=0,078) y APACHEII (p=0,522). Resultaron: predictores independientes de mortalidad intrahospitalaria: el síndrome coronario agudo (SCA), los valores de lactato sérico, el SAPSII y el índice de vasoactivos inotrópicos (VIS) en las primeras 24horas de ingreso en UCI.Con estas variables se desarrolló un indicador pronóstico específico para el SC (SAPS-2-LIVE) que mejora la capacidad predictiva de mortalidad en nuestra serie (AUC) ROC, 0,825 (IC 95% 0,752-0,89). Conclusión: En esta cohorte contemporánea de SC, las escalas SOFA, SAPSII y APACHEII han demostrado una buena capacidad de predicción de mortalidad hospitalaria. Estos hallazgos podrían contribuir a una mejor estratificación del riesgo en el SC.(AU)

Cardiogenic shock (CS) is a condition comprising multiple etiologies, which associates high mortality rates. Some scoring systems have been shown to be good predictors of hospital mortality in patients admitted to Critical Care Units (CCU). The main objective of this study is to analyze their usefulness and validity in a cohort of CS patients. Methods: Observational unicentric study of a cohort of CS patients. SOFA, SAPSII and APACHEII scores were calculated in the first 24hours of CCU admission. Results: 130 patients with CS were included. SOFA, SAPSII and APACHEII scores revealed good discrimination for hospital mortality: (AUC) ROC values (AUC: 0.711, 0.752 and 0.742 respectively; p=0.6). Calibration, estimated by the Hosmer-Lemeshow test, was adequate in all cases.Acute coronary syndrome, lactate serum values, SAPSII score and vasoactive inotropic score (VIS) were found to be independent predictors for mortality, upon ICU admission. With these variables, a specific prognostic indicator was developed (SAPS-2-LIVE), which improved predictive capability for mortality in our series (AUC) ROC, 0.825 (95% CI 0.752-0.89). Conclusion: In this contemporary CS cohort, the aforementioned scores have been shown to have good predictive ability for hospital mortality. These findings could contribute to a more accurate risk stratification in CS.(AU)

Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. / Recomendaciones de la Sociedad Española de Cirugía Torácica y de la Sección de Cardiotorácica y Cirugía Vascular de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor, para los pacientes sometidos a cirugía pulmonar incluidos en un programa de recuperación intensificada.

In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyses, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.

[Antifungal prophylaxis in the postoperative period of lung transplant surgery in Spain]. / Profilaxis antifúngica en el postoperatorio de trasplante de pulmón en España.

OBJECTIVES: To examine the type and duration of antifungal prophylaxis provided during the postoperative period of lung transplant recipients, together with the most frequent complications during admission to Intensive Care Units in Spain. PATIENTS AND METHODS: A questionnaire was developed including demographic data on each transplant center, the type of antifungal prophylaxis used, its duration, and the most frequent complications. The questionnaire was distributed among the 7 Spanish national lung transplant centers, followed by analysis of the results obtained. RESULTS: All 7 centers completed the questionnaire. All of them provided universal prophylaxis in lung transplant patients. Monotherapy was the most widely used protocol (5/7; 71.4%), with amphotericin B in liposomal or conventional form being the most frequent drug, administered via the inhalatory route. In the case of combination therapy, a great diversity of drugs was observed. The most frequently administered second choice drug was anidulafungin (3/7; 43%), followed by voriconazole (2/7; 28.5%). Antifungal therapy was maintained on an indefinite basis by 43% of the centers. Invasive fungal infection (IFI) in the postoperative period of transplantation during admission to the Intensive Care Unit was suspected in 5-10% of the cases but was confirmed in less than 5%. Among other complications registered in these patients in the Intensive Care Unit, the most frequent problems were respiratory infections (5/7; 71.5%). CONCLUSIONS: Antifungal prophylaxis during the postoperative period of lung transplantation is provided on a universal basis, though consensus is lacking as to the drug of choice, the administration route and the duration of such treatment.

Ambulatory blood pressure monitoring in kidney transplant patients: RETENAL study.

Hypertension is common following renal transplantation, affecting up to 80% of transplant recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy, contributing to increased cardiovascular risk factors and mortality rates. The aim of the study was to compare the blood pressure (BP) control in kidney transplant patients through the use of ambulatory BP monitoring (ABMP) versus office BP measurements (oBP). A multicenter, cross-sectional, observational study was conducted in 30 nephrology/kidney transplant units. Eligible patients included hypertensive cadaveric kidney transplant recipients aged <70 years, with a functioning kidney for at least 1 year and with an estimated glomerular filtration ≥30 mL/min/1.73 m(2) and a serum creatinine < 2.5 mg/dL. Recorded data included demographic characteristics, oBP, and ABPM and labroatory investigations. The 868 patients showed a mean recipient age of was 53.2 ± 11.6 years and mean follow-up after transplantation, 5.5 ± 2.8 years. Mean systolic and diastolic oBP were 140.2 ± 18 and 80.4 ± 10 mm Hg, respectively. Seventy-six percent of patients had oBP higher than or equal to 130/80 mm Hg. Mean 24 hour ABPM were 131.5 ± 14 and 77.4 ± 8.7 mm Hg for systolic and diastolic BP, respectively. Using the ABPM, we observed that 36.5% of subjects were controlled (mean 24-hour BP < 130/85 mm Hg). The two methods (oBP and ABPM) showed significant agreement. After ABPM, 65% of patients diagnosed as true controlled hypertension were considered to have white-coat RH. In clinical practice ABPM may help for better adjustment of drugs for adequate BP control.

Automedida de la presión arterial. Documento de Consenso Español 2007 / Self-measurement of blood pressure. Consensus Paper Spain 2007

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Automedida de la presión arterial. Documento de Consenso Español 2007 / Self-measurement of blood pressure. Consensus Paper Spain 2007

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Automedida de la presión arterial. Documento de Consenso Español 2007 / No disponible

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Documento de Consenso Español 2007 / Self-measurement of blood pressure. Consensus Paper Spain 2007

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[Strategies for effective control of arterial hypertension in Spain. Consensus document]. / Estrategias para un control eficaz de la hipertensión arterial en España. Documento de consenso.

Blood pressure (BP) control is inadequate among treated hypertensive patients in Spain. Control rates are lower than 40% of all treated patients and the cause of this problem is multifactorial. Despite the fact that possible solutions to this problem have been repeatedly suggested by expert groups along the last 10 years, BP control rates are still low. This fact have a negative impact on cardiovascular morbidity and mortality of patients with hypertension. The aim of the present document has been to achieve a consensus on effective specific measures in order to improve hypertension control rates in Spain. These measures involve health care professionals (physicians, nurses, pharmaceutics), health care authorities and patients. The document summarizes the consensus conference of several scientific societies involved in cardiovascular medicine in five group of measures: a) improvement of the methodology of office BP measurement; b) improvement of compliance to treatment by patients; c) clarification of pressure targets to be achieved in hypertensive patients; d) optimization of life style modifications and pharmacological treatment of hypertension; and e) continuous medical education. The document emphasize life style changes as a crucial aspect to be implemented in all patients. These changes have a beneficial impact on pressure reduction, contribute to a better control of associated cardiovascular risk factors, and increase the effectiveness of antihypertensive drugs. Health care professionals should base their clinical practice on the recommendations of guidelines in order to modify their therapeutic attitudes in patients whose targets have not been achieved.

Estrategias para un control eficaz de la hipertensión arterial en España. Documento de consenso / Strategies for effective control of arterial hypertension in Spain. Consensus document

El control de las cifras de presión arterial (PA) en los hipertensos tratados en España es insuficiente, no alcanza al 40% de los pacientes tratados y las causas son múltiples. Las posibles soluciones al problema han sido repetidamente sugeridas por grupos de expertos desde hace años, a pesar de lo cual las tasas de control siguen siendo inadecuadas, lo que repercute negativamente en la morbilidad y mortalidad de los pacientes. El objeto del presente documento ha sido analizar medidas concretas efectivas que mejoren el control de la hipertensión en España. Tales medidas afectan a los profesionales de la salud (médicos, profesionales de enfermería y farmacéuticos), a la administración sanitaria y a los propios pacientes. Este documento resume los resultados de esta conferencia de consenso en cinco grandes grupos: a) medidas para mejorar la metodología habitual en la medición de la PA en la consulta; b) medidas para mejorar el cumplimiento terapéutico por el paciente; c) medidas para clarificar el objetivo de PA que el médico debe fijar; d) medidas para optimizar el tratamiento y control de la hipertensión arterial; y e) aspectos de formación continuada. El documento enfatiza la recomendación de los cambios del estilo de vida en todos los pacientes hipertensos, tanto su acción beneficiosa sobre la hipertensión como por lo que implica en la corrección de otros factores de riesgo y en el aumento de la efectividad del tratamiento farmacológico. Los profesionales deben actuar conforme a guías terapéuticas o algoritmos que obliguen a modificar la conducta en los casos en que los objetivos pautados para cada paciente no hayan sido alcanzados

Blood pressure (BP) control is inadequate among treated hypertensive patients in Spain. Control rates are lower than 40% of all treated patients and the cause of this problem is multifactorial. Despite the fact that possible solutions to this problem have been repeatedly suggested by expert groups along the last 10 years, BP control rates are still low. This fact have a negative impact on cardiovascular morbidity and mortality of patients with hypertension. The aim of the present document has been to achieve a consensus on effective specific measures in order to improve hypertension control rates in Spain. These measures involve health care professionals (physicians, nurses, pharmaceutics), health care authorities and patients. The document summarizes the consensus conference of several scientific societies involved in cardiovascular medicine in five group of measures: a) improvement of the methodology of office BP measurement; b) improvement of compliance to treatment by patients; c) clarification of pressure targets to be achieved in hypertensive patients; d) optimization of life style modifications and pharmacological treatment of hypertension; and e) continuous medical education. The document emphasize life style changes as a crucial aspect to be implemented in all patients. These changes have a beneficial impact on pressure reduction, contribute to a better control of associated cardiovascular risk factors, and increase the effectiveness of antihypertensive drugs. Health care professionals should base their clinical practice on the recommendations of guidelines in order to modify their therapeutic attitudes in patients whose targets have not been achieved

Hipertensión arterial y embarazo / High blood pressure and pregnancy

La hipertensión arterial (HTA) complica el 10 % de las gestaciones y es una causa importante de morbilidad y mortalidad materna y fetal. La preeclampsia es una forma de HTA inducida por el embarazo, con etiopatogenia todavía no aclarada, presencia de vasoespasmo generalizado y expresividad clínica variable que puede traducirse simplemente en HTA ligera y proteinuria o alcanzar cuadros muy graves con trombopenia, anemia hemolítica, disfunción hepática, edema pulmonar y convulsiones (eclampsia). Muchos casos de HTA inducida por el embarazo cursan sin proteinuria y reciben el nombre de HTA gestacional. La HTA crónica es casi siempre de origen esencial, se asocia con mayor morbilidad fetal y puede complicarse con preeclampsia. El tratamiento de este tipo de HTA viene limitado por la tolerabilidad fetal a los agentes antihipertensivos. Las indicaciones sobre su uso sólo están bien reconocidas en los casos de HTA grave. La *-metildopa sigue siendo el fármaco de elección. Hoy día se admite que la HTA en el embarazo constituye un marcador precoz de HTA esencial y también de enfermedad cardiovascular futura

High blood pressure (HBP) complicates 10 % of pregnancies and is a significant cause of maternal and fetal morbidity and mortality. Preeclampsia is a form of hypertension induced by pregnancy, with a still unclarified etiopathogeny, presence of generalized vasospasm and variable clinical expressiveness that may simply be translated into mild HBP and proteinuria or reach very serious clinical pictures with thrombopenia, hemolytic anemia, hepatic dysfunction, pulmonary edema and seizures (eclampsia). Many cases of pregnancy-induced hypertension occur without proteinuria and receive the name of gestational HBP. Chronic HBP almost always has an essential origin, is associated with greater fetal morbidity and may be complicated with preeclampsia. Treatment of this type of hypertension is limited by fetal tolerability to antihypertensive agents. Indications on its use are only well recognized in the cases of serious BHP. a-methyldopa is still the drug of choice. Currently, it is admitted that HBP in pregnancy is an early marker of essential HBP and also of future cardiovascular disease

Estrategias para un control eficaz de la hipertensión arterial en España. Documento de Consenso / Strategies for an effective control of arterial hypertension in Spain. Consensus Document

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Estrategias para un control eficaz de la hipertensión arterial en España. Documento de Consenso / No disponible

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Hipertensión arterial, hipokaliemia grave e hiperaldosteronismo como forma de presentación de un carcinoma suprarrenal / Arterial hypertension, serious hypokaliemia and hyperaldosteronism as presentation form of adrenal gland carcinoma

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Association of maternal protein intake before conception and throughout pregnancy with birth weight.

BACKGROUND: The aim of this study is to analyze how the maternal intake of macronutrients before conception and in the 6th, 10th, 26th, and 38th weeks of pregnancy affects birth weight. METHODS: A longitudinal study of food consumption to assess the nutritional status of 77 healthy female volunteers (age range: 24-36) who were planning immediate pregnancy was performed in Reus between 1992 and 1996. A seven-consecutive-day dietary record was used in order to evaluate the dietary intake. We fitted multiple linear regression models of macronutrients on birth weight adjusted for energy intake, maternal age, pre-conceptional body mass index, sex of the newborn, length of pregnancy, parity, physical activity in leisure time, and smoking. RESULTS: In the 6th, 10th, and 26th weeks of pregnancy, 7.2-12.7% of the variability of the birth weight can be explained by the intake of macronutrients. In the protein and fat model, a 1 g increase in maternal protein intake during preconception and in the 10th, 26th, and 38th weeks of pregnancy leads to a significant increase of 7.8-11.4 g in birth weight. CONCLUSIONS: The diet of well-nourished women in the preconception period and throughout most of pregnancy has a significant effect on birth weight, and proteins are the macronutrient that has the greatest influence.