Browsing by Author "Cecconi, M."

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    Early goal-directed therapy using a physiological holistic view: the ANDROMEDA-SHOCK-a randomized controlled trial
    (2018) Hernández P., Glenn; Cavalcanti, A.; Ospina Tascón, Gustavo A.; Zampieri, F.; Dubin, A.; Hurtado, F.; Friedman, G.; Castro, R.; Alegría, Leyla,; Cecconi, M.; Teboul, J.; Bakker, Jan
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    International point prevalence study of Intensive Care Unit transfusion practices-Pilot study in the Netherlands
    (2019) De Bruin, S.; Alders, M.Y.; Van Bruggen, R.; De Korte, D.; Scheeren, T.W.L.; Bakker, Jan; Aubron, C.; Feldheiser, A.; Meieri, J.; Cecconi, M.; Vlaar, A.P.J.
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    Systematic assessment of fluid responsiveness during early septic shock resuscitation: secondary analysis of the ANDROMEDA-SHOCK trial
    (2020) Kattan Tala, Eduardo José; Castro López, Ricardo; Bakker, Jan; Hernández P., Glenn; Ospina-Tascón, G. A.; Teboul, Jean-Louis.; Cecconi, M.; Ferri, Giorgio.
    Abstract Background Fluid boluses are administered to septic shock patients with the purpose of increasing cardiac output as a means to restore tissue perfusion. Unfortunately, fluid therapy has a narrow therapeutic index, and therefore, several approaches to increase safety have been proposed. Fluid responsiveness (FR) assessment might predict which patients will effectively increase cardiac output after a fluid bolus (FR+), thus preventing potentially harmful fluid administration in non-fluid responsive (FR−) patients. However, there are scarce data on the impact of assessing FR on major outcomes. The recent ANDROMEDA-SHOCK trial included systematic per-protocol assessment of FR. We performed a post hoc analysis of the study dataset with the aim of exploring the relationship between FR status at baseline, attainment of specific targets, and clinically relevant outcomes. Methods ANDROMEDA-SHOCK compared the effect of peripheral perfusion- vs. lactate-targeted resuscitation on 28-day mortality. FR was assessed before each fluid bolus and periodically thereafter. FR+ and FR− subgroups, independent of the original randomization, were compared for fluid administration, achievement of resuscitation targets, vasoactive agents use, and major outcomes such as organ dysfunction and support, length of stay, and 28-day mortality. Results FR could be determined in 348 patients at baseline. Two hundred and forty-two patients (70%) were categorized as fluid responders. Both groups achieved comparable successful resuscitation targets, although non-fluid responders received less resuscitation fluids (0 [0–500] vs. 1500 [1000–2500] mL; p 0.0001), exhibited less positive fluid balances, but received more vasopressor testing. No difference in clinically relevant outcomes between FR+ and FR− patients was found, including 24-h SOFA score (9 [5–12] vs. 8 [5–11], p = 0.4), need for MV (78% vs. 72%, p = 0.16), need for RRT (18% vs. 21%, p = 0.7), ICU-LOS (6 [3–11] vs. 6 [3–16] days, p = 0.2), and 28-day mortality (40% vs. 36%, p = 0.5). Only thirteen patients remained fluid responsive along the intervention period. Conclusions Systematic assessment allowed determination of fluid responsiveness status in more than 80% of patients with early septic shock. Fluid boluses could be stopped in non-fluid responsive patients without any negative impact on clinical relevant outcomes. Our results suggest that fluid resuscitation might be safely guided by FR assessment in septic shock patients. Trial registration ClinicalTrials.gov identifier, NCT03078712. Registered retrospectively on March 13, 2017.Abstract Background Fluid boluses are administered to septic shock patients with the purpose of increasing cardiac output as a means to restore tissue perfusion. Unfortunately, fluid therapy has a narrow therapeutic index, and therefore, several approaches to increase safety have been proposed. Fluid responsiveness (FR) assessment might predict which patients will effectively increase cardiac output after a fluid bolus (FR+), thus preventing potentially harmful fluid administration in non-fluid responsive (FR−) patients. However, there are scarce data on the impact of assessing FR on major outcomes. The recent ANDROMEDA-SHOCK trial included systematic per-protocol assessment of FR. We performed a post hoc analysis of the study dataset with the aim of exploring the relationship between FR status at baseline, attainment of specific targets, and clinically relevant outcomes. Methods ANDROMEDA-SHOCK compared the effect of peripheral perfusion- vs. lactate-targeted resuscitation on 28-day mortality. FR was assessed before each fluid bolus and periodically thereafter. FR+ and FR− subgroups, independent of the original randomization, were compared for fluid administration, achievement of resuscitation targets, vasoactive agents use, and major outcomes such as organ dysfunction and support, length of stay, and 28-day mortality. Results FR could be determined in 348 patients at baseline. Two hundred and forty-two patients (70%) were categorized as fluid responders. Both groups achieved comparable successful resuscitation targets, although non-fluid responders received less resuscitation fluids (0 [0–500] vs. 1500 [1000–2500] mL; p 0.0001), exhibited less positive fluid balances, but received more vasopressor testing. No difference in clinically relevant outcomes between FR+ and FR− patients was found, including 24-h SOFA score (9 [5–12] vs. 8 [5–11], p = 0.4), need for MV (78% vs. 72%, p = 0.16), need for RRT (18% vs. 21%, p = 0.7), ICU-LOS (6 [3–11] vs. 6 [3–16] days, p = 0.2), and 28-day mortality (40% vs. 36%, p = 0.5). Only thirteen patients remained fluid responsive along the intervention period. Conclusions Systematic assessment allowed determination of fluid responsiveness status in more than 80% of patients with early septic shock. Fluid boluses could be stopped in non-fluid responsive patients without any negative impact on clinical relevant outcomes. Our results suggest that fluid resuscitation might be safely guided by FR assessment in septic shock patients. Trial registration ClinicalTrials.gov identifier, NCT03078712. Registered retrospectively on March 13, 2017.
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    The European Solar Telescope
    (2022) Noda, C. Quintero; Schlichenmaier, R.; Bellot Rubio, L. R.; Lofdahl, M. G.; Khomenko, E.; Leenaarts, J.; Kuckein, C.; Gonzalez Manrique, S. J.; Gunar, S.; Nelson, C. J.; Rodriguez, J. de la Cruz; Tziotziou, K.; Tsiropoula, G.; Aulanier, G.; Aboudarham, J.; Allegri, D.; Alsina Ballester, E.; Amans, J. P.; Asensio Ramos, A.; Bailen, F. J.; Balaguer, M.; Baldini, V; Balthasar, H.; Barata, T.; Barczynski, K.; Barreto Cabrera, M.; Baur, A.; Bechet, C.; Beck, C.; Belio-Asin, M.; Bello-Gonzalez, N.; Belluzzi, L.; Bentley, R. D.; Berdyugina, S., V; Berghmans, D.; Berlicki, A.; Berrilli, F.; Berkefeld, T.; Bettonvil, F.; Bianda, M.; Bienes Perez, J.; Bonaque-Gonzalez, S.; Brajsa, R.; Bommier, V; Bourdin, P-A; BurgosMartin, J.; Calchetti, D.; Calcines, A.; Calvo Tovar, J.; Campbell, R. J.; Carballo-Martin, Y.; Carbone, V; Carlin, E. S.; Carlsson, M.; Castro Lopez, J.; Cavaller, L.; Cavallini, F.; Cauzzi, G.; Cecconi, M.; Chulani, H. M.; Cirami, R.; Consolini, G.; Coretti, I; Cosentino, R.; Cozar-Castellano, J.; Dalmasse, K.; Danilovic, S.; Ovelar, M. De Juan; Del Moro, D.; del Pino Aleman, T.; del Toro Iniesta, J. C.; Denker, C.; Dhara, S. K.; Di Marcantonio, P.; Baso, C. J. Diaz; Diercke, A.; Dineva, E.; Diaz-Garcia, J. J.; Doerr, H-P; Doyle, G.; Erdelyi, R.; Ermolli, I; Escobar Rodriguez, A.; Esteban Pozuelo, S.; Faurobert, M.; Felipe, T.; Feller, A.; Feijoo Amoedo, N.; Femenia Castella, B.; Fernandes, J.; Ferro Rodriguez, I; Figueroa, I; Fletcher, L.; Franco Ordovas, A.; Gafeira, R.; Gardenghi, R.; Gelly, B.; Giorgi, F.; Gisler, D.; Giovannelli, L.; Gonzalez, F.; Gonzalez, J. B.; Gonzalez-Cava, J. M.; Gonzalez Garcia, M.; Gomory, P.; Gracia, F.; Grauf, B.; Greco, V; Grivel, C.; Guerreiro, N.; Guglielmino, S. L.; Hammerschlag, R.; Hanslmeier, A.; Hansteen, V; Heinzel, P.; Hernandez-Delgado, A.; Hernandez Suarez, E.; Hidalgo, S. L.; Hill, F.; Hizberger, J.; Hofmeister, S.; Jagers, A.; Janett, G.; Jarolim, R.; Jess, D.; Jimenez Mejias, D.; Jolissaint, L.; Kamlah, R.; Kapitan, J.; Kasparova, J.; Keller, C. U.; Kentischer, T.; Kiselman, D.; Kleint, L.; Klvana, M.; Kontogiannis, I; Krishnappa, N.; Labrosse, N.; Lagg, A.; Degl'Innocenti, E. Landi; Langlois, M.; Lafon, M.; Laforgue, D.; Le Men, C.; Lepori, B.; Lepreti, F.; Lindberg, B.; Lilje, P. B.; Ariste, A. Lopez; Lopez Fernandez, V. A.; Lopez Jimenez, A. C.; Lopez Lopez, R.; Sainz, R. Manso; Marassi, A.; Marco de la Rosa, J.; Marino, J.; Marrero, J.; Martin, A.; Martin Galvez, A.; Martin Hernando, Y.; Masciadri, E.; MartinezGonzalez, M.; Matta-Gomez, A.; Mato, A.; Mathioudakis, M.; Matthews, S.; Mein, P.; Merlos Garcia, F.; Moity, J.; Montilla, I; Molinaro, M.; Molodij, G.; Montoya, L. M.; Munari, M.; Murabito, M.; Nunez Cagigal, M.; Oliviero, M.; Orozco Suarez, D.; Ortiz, A.; Padilla-Hernandez, C.; Paez Mana, E.; Paletou, F.; Pancorbo, J.; Pastor Canedo, A.; Yabar, A. Pastor; Peat, A. W.; Pedichini, F.; Peixinho, N.; Penate, J.; Perez de Taoro, A.; Peter, H.; Petrovay, K.; Piazzesi, R.; Pietropaolo, E.; Pleier, O.; Poedts, S.; Potzi, W.; Podladchikova, T.; Prieto, G.; Quintero Nehrkorn, J.; Ramelli, R.; Ramos Sapena, Y.; Rasilla, J. L.; Reardon, K.; Rebolo, R.; Regalado Olivares, S.; Reyes Garcia-Talavera, M.; Riethmuller, T. L.; Rimmele, T.; Rodriguez Delgado, H.; Rodriguez Gonzalez, N.; Rodriguez-Losada, J. A.; Rodriguez Ramos, L. F.; Romano, P.; Roth, M.; vander Voort, L. Rouppe; Rudawy, P.; Ruiz de Galarreta, C.; Rybak, J.; Salvade, A.; Sanchez-Capuchino, J.; Sanchez Rodriguez, M. L.; Sangiorgi, M.; Sayede, F.; Scharmer, G.; Scheiffelen, T.; Schmidt, W.; Schmieder, B.; Scire, C.; Scuderi, S.; Siegel, B.; Sigwarth, M.; Simoes, P. J. A.; Snik, F.; Sliepen, G.; Sobotka, M.; Socas-Navarro, H.; Sola La Serna, P.; Solanki, S. K.; Soler Trujillo, M.; Soltau, D.; Sordini, A.; Sosa Mendez, A.; Stangalini, M.; Steiner, O.; Stenflo, J. O.; Stepan, J.; Strassmeier, K. G.; Sudar, D.; Suematsu, Y.; Sutterlin, P.; Tallon, M.; Temmer, M.; Tenegi, F.; Tritschler, A.; Trujillo Bueno, J.; Turchi, A.; Utz, D.; van Harten, G.; VanNoort, M.; van Werkhoven, T.; Vansintjan, R.; Vaz Cedillo, J. J.; Vega Reyes, N.; Verma, M.; Veronig, A. M.; Viavattene, G.; Vitas, N.; Vogler, A.; von der Luhe, O.; Volkmer, R.; Waldmann, T. A.; Walton, D.; Wisniewska, A.; Zeman, J.; Zeuner, F.; Zhang, L. Q.; Zuccarello, F.; Collados, M.
    The European Solar Telescope (EST) is a project aimed at studying the magnetic connectivity of the solar atmosphere, from the deep photosphere to the upper chromosphere. Its design combines the knowledge and expertise gathered by the European solar physics community during the construction and operation of state-of-the-art solar telescopes operating in visible and near-infrared wavelengths: the Swedish 1m Solar Telescope, the German Vacuum Tower Telescope and GREGOR, the French Telescope Heliographique pour l'etude du Magnetisme et des Instabilites Solaires, and the Dutch Open Telescope. With its 4.2 m primary mirror and an open configuration, EST will become the most powerful European ground-based facility to study the Sun in the coming decades in the visible and near-infrared bands. EST uses the most innovative technological advances: the first adaptive secondary mirror ever used in a solar telescope, a complex multi-conjugate adaptive optics with deformable mirrors that form part of the optical design in a natural way, a polarimetrically compensated telescope design that eliminates the complex temporal variation and wavelength dependence of the telescope Mueller matrix, and an instrument suite containing several (etalon-based) tunable imaging spectropolarimeters and several integral field unit spectropolarimeters. This publication summarises some fundamental science questions that can be addressed with the telescope, together with a complete description of its major subsystems.
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    Year in review in Intensive Care Medicine 2013: I. Acute kidney injury, ultrasound, hemodynamics, cardiac arrest, transfusion, neurocritical care, and nutrition
    (2014) Citerio, G.; Bakker, J.; Bassetti, M.; Benoit, D.; Cecconi, M.; Curtis, J.; Herridge, M.; Hernández P., Glenn