Update in the management of severe traumatic brain injury

Traumatic brain injury is the main cause of death and disability in the young population, which presumes a large number of years of potential life lost and a great economic impact. Vital and functional outcomes after suffering a traumatic brain injury depend both on the severity of the initial biomechanical impact (primary injury) and on the presence and the severity of systemic or intracranial insults that magnify and/or produce new brain injuries, the so-called secondary injuries. Currently, no treatment in effective in improving functional recovery, except for usual medical care. Therefore, the main purpose of the care provided to a patient with severe cranial trauma is based on preventing and treating secondary brain injuries by maintaining an adequate cerebral perfusion and oxygenation. Increased intracranial pressure is associated with mortality and with unfavorable functional outcomes is patients with severe traumatic brain injury. The main clinical practice guidelines recommend using a number of staggered therapeutic measures. However, although these measures seem to be efficient in reducing intracranial pressure, this effect is not often translated into clinical improvement. This review describes the essential principles of the management of patients with severe traumatic brain injury in intensive care units

A blood microRNA classifier for the prediction of ICU mortality in COVID-19 patients: a multicenter validation study

Background: The identification of critically ill COVID-19 patients at risk of fatal outcomes remains a challenge. Here, we first validated candidate microRNAs (miRNAs) as biomarkers for clinical decision-making in critically ill patients. Second, we constructed a blood miRNA classifier for the early prediction of adverse outcomes in the ICU. Methods: This was a multicenter, observational and retrospective/prospective study including 503 critically ill patients admitted to the ICU from 19 hospitals. qPCR assays were performed in plasma samples collected within the first 48 h upon admission. A 16-miRNA panel was designed based on recently published data from our group. Results: Nine miRNAs were validated as biomarkers of all-cause in-ICU mortality in the independent cohort of critically ill patients (FDR < 0.05). Cox regression analysis revealed that low expression levels of eight miRNAs were associated with a higher risk of death (HR from 1.56 to 2.61). LASSO regression for variable selection was used to construct a miRNA classifier. A 4-blood miRNA signature composed of miR-16-5p, miR-192-5p, miR-323a-3p and miR-451a predicts the risk of all-cause in-ICU mortality (HR 2.5). Kaplan‒Meier analysis confirmed these findings. The miRNA signature provides a significant increase in the prognostic capacity of conventional scores, APACHE-II (C-index 0.71, DeLong test p-value 0.055) and SOFA (C-index 0.67, DeLong test p-value 0.001), and a risk model based on clinical predictors (C-index 0.74, DeLong test-p-value 0.035). For 28-day and 90-day mortality, the classifier also improved the prognostic value of APACHE-II, SOFA and the clinical model. The association between the classifier and mortality persisted even after multivariable adjustment. The functional analysis reported biological pathways involved in SARS-CoV infection and inflammatory, fibrotic and transcriptional pathways. Conclusions: A blood miRNA classifier improves the early prediction of fatal outcomes in critically ill COVID-19 patients.11 página

Actualización sobre el tratamiento de enfermos quemados críticos

The management of critically ill burn patients is challenging. These patients have to be managed in specialized centers, where the expertise of physicians and nursing personnel guarantees the best treatment. Mortality of burn patients has improved over the past decades due to a better understanding of burn shock pathophysiology, optimal surgical management, infection control and nutritional support. Indeed, a more aggressive resuscitation, early excision and grafting, the judicious use of topical antibiotics, and the provision of an adequate calorie and protein intake are key to attain best survival results. General advances in critical care have also to be implemented, including protective ventilation, glycemic control, selective decontamination of the digestive tract, and implementation of sedation protocols.El manejo de enfermos quemados críticos supone un gran reto para el clínico. Estos pacientes han de ser tratados en centros especializados, donde la experiencia del personal médico y de enfermería garantiza el mejor tratamiento. El pronóstico de los enfermos quemados ha mejorado durante las últimas décadas debido a una mejor comprensión de la fisiopatología del shock y a un mejor tratamiento quirúrgico, de la infección y soporte nutricional. La reanimación intensiva, el tratamiento quirúrgico más puntual, el uso juicioso del tratamiento tópico antimicrobiano y el aporte de la cantidad de nutrientes necesaria son aspectos claveFIS PI 12/029891.231 JCR (2016) Q4, 31/33 Critical Care MedicineUE

MicroRNAs as biomarkers of acute lung injury

Acute respiratory distress syndrome (ARDS) is a common and complex inflammatory lung diseases affecting critically ill patients requiring mechanical ventilation. MicroRNAs (miRNAs), a novel pathway of non-coding RNA molecules that regulate gene expression at the post-transcriptional level, have emerged as a novel class of gene expression, and can play important roles in inflammation or apoptosis, which are common manifestations of ARDS and diffuse alveolar damage (DAD). In the present review, we discuss the role of miRNAs as biomarkers of ARDS and DAD, and their potential use as therapeutic targets for this condition.Sin financiación3.689 JCR (2018) Q1, 121/244 Oncology0.958 SJR (2018) Q1, 602/2844 Medicine (miscellaneous)No data IDR 2018UE

New insights into the mechanisms of pulmonary edema in acute lung injury

Appearance of alveolar protein-rich edema is an early event in the development of acute respiratory distress syndrome (ARDS). Alveolar edema in ARDS results from a significant increase in the permeability of the alveolar epithelial barrier, and represents one of the main factors that contribute to the hypoxemia in these patients. Damage of the alveolar epithelium is considered a major mechanism responsible for the increased pulmonary permeability, which results in edema fluid containing high concentrations of extravasated macromolecules in the alveoli. The breakdown of the alveolar-epithelial barrier is a consequence of multiple factors that include dysregulated inflammation, intense leukocyte infiltration, activation of pro-coagulant processes, cell death and mechanical stretch. The disruption of tight junction (TJ) complexes at the lateral contact of epithelial cells, the loss of contact between epithelial cells and extracellular matrix (ECM), and relevant changes in the communication between epithelial and immune cells, are deleterious alterations that mediate the disruption of the alveolar epithelial barrier and thereby the formation of lung edema in ARDS.Sin financiación3.689 JCR (2018) Q1, 121/244 Oncology0.958 SJR (2018) Q1, 602/2844 Medicine (miscellaneous)No data IDR 2018UE

Ebola virus: understanding the 2014 outbreak

La epidemia causada por el virus del Ébola (VE) no es nueva en África. El VE se identificó por primera vez en1976. El actual es el 25.° brote conocido de infección por el VE1, 2. A 28 de noviembre, se habían registrado un total de 16.933 casos (10.585 confirmados en laboratorio), con 6.002 fallecimientos3. Los casos registrados corresponden a países con una transmisión extendida (16.899 casos en Guinea, Liberia y Sierra Leona), países con un caso inicial o transmisión limitada (4 casos en los EE.UU. y 8 casos en Mali) y países afectados previamente (uno en Senegal, 20 en Nigeria y uno en España, donde los brotes se declararon erradicados el 17 de octubre, el 19 de octubre y el 2 de diciembre de 2014, respectivamente).1.771 JCR (2015) Q3, 41/58 Respiratory systemUE

Restoration of Alveolar Epithelial Function as a Therapeutic Strategy for Acute Lung Injury

Acute lung injury (ALI), and its severe form, acute respiratory distress syndrome (ARDS), is a common disorder with a high mortality rate (40 %). Only two supportive strategies have shown to improve survival in patients with ALI/ARDS, namely lung protective ventilation that reduces stretch of the lungs and a fluid conservative strategy [1, 2]. Unfortunately, molecular-based therapies aimed at improving the outcome of these patients have so far been unsuccessful.No data (2013)UE

Interleukin-6 and intrapulmonary shunt

Sin financiación33.809 JCR (2021) Q1, 2/65 Respiratory System4.336 SJR (2021) Q1, 46/2489 Medicine (Miscellaneous)No data IDR 2021UE

Data on risk factors related to in-hospital mortality in patients less than 55 years of age with ST-segment elevation myocardial infarction

Risk factors associated with in-hospital mortality in young patients with ST-segment elevation myocardial infarction are poorly described. In addition, it is increasingly recognized that these risk factors might differ from those of older patients. The dataset herein presented describes the association between different variables and in-hospital mortality in patients <55 years old with ST-segment elevation myocardial infarction. This data supplements the manuscript "Sex Related Differences in the Treatment of ST-Segment Elevation Acute Myocardial Infarction in Patients Aged <55 Years" (Lorente-Ros et al.) Data for this data in brief article were obtained from a prospective database of patients <55 years old with confirmed ST-segment elevation myocardial infarction admitted to a tertiary care hospital during an 11-year period. The data were collected via review of the clinical charts. The dataset describes the relative risk and 95% confidence interval of in-hospital mortality for each variable, including cardiovascular risk factors, angiographic findings, treatment received, and complications developed. Patients in this dataset represent a unique population, given that it only includes confirmed ST-segment elevation myocardial infarction while excluding other types of acute coronary syndrome, the patient's young age, and the reflection of contemporary up-to-date practices. This dataset will be valuable to further build on knowledge on the prognostic markers of acute myocardial infarction in a younger patient population.Sin financiaciónNo data JCR 20210.131 SJR (2021) Q4, 110/138 MultidisciplinaryNo data IDR 2021UE