The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Caso Moot Madrid 2016. Escrito de demanda (parte de Derecho Procesal)

Treball Final de Grau en Dret. Codi: DR1052. Curs acadèmic 2015-201

Análisis de la demolición como medida de restablecimiento de la legalidad urbanística (Con especial mención al Término Municipal de Castellón)

Treball Final de Màster Universitari en Advocacia. Codi: SRJ010. Curs: 2016/2017En el presente trabajo se pretende analizar la evolución jurisprudencial de la orden de demolición como medida de restablecimiento de la legalidad urbanística, desde la visión de la práctica urbanística del término municipal de Castellón. Se ofrece un breve recorrido del tratamiento de esta institución de derecho urbanístico, así como el planteamiento de las posibles vías de impugnación y las perspectivas de un modelo urbanístico sostenible acorde a la preservación y protección de los valores paisajísticos