Josep M Abadal

Hospital Universitari Son Espases, Palma, Balearic Islands, Spain

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Publications (13)34.23 Total impact

  • Transplantation 04/2013; 95(7):e45. · 3.78 Impact Factor
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    ABSTRACT: The diagnosis of brain death remains a clinical challenge for intensive care unit physicians. Worldwide regulations in its diagnosis may differ, and the need of ancillary tests after a clinical examination is not uniform. Transcranial sonography is a noninvasive, bedside, and widely available technique that can be used in the diagnosis of the cerebral circulatory arrest that preceeds brain death. In this paper we review the general concepts, the technical requisites, the patterns of Doppler signal confirming cerebral circulatory arrest, the vessels to insonate, and the options in cases with poor acoustic window. Future research perspectives in the field of transcranial sonography are discussed as well.
    ISRN Critical Care. 10/2012; 2013.
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    ABSTRACT: Objective The aim of this study is to prospectively compare the accuracies of transcranial color-coded sonography (TCCS) and transcranial Doppler (TCD) in the diagnosis of elevated intracranial pressure.
    The American journal of emergency medicine 01/2012; 30(1):244-5; author reply 245. · 1.15 Impact Factor
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    ABSTRACT: Case reportA case of a 43-year-old male with severe pancreatitis complicated with neurological deterioration is presented. Methods and resultDifferent neurosonological examinations using transcranial color coded duplex sonography (TCCS) were combined to obtain a certain diagnosis. ConclusionThis case illustrates some of the applications of TCCS at bedside in ICU patients. These sonographic explorations are useful in the monitoring of ICU patients, and may avoid hazardous transfers to the radiology department for the patient. KeywordsTranscranial color coded duplex sonography–Critically ill patients–Intensive care unit
    Critical ultrasound journal 04/2011; 3(1):47-49.
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    ABSTRACT: To determine the evolution of cytokine patterns using microdialysis in patients with traumatic brain injury with diffuse lesions and to study the relationship between cytokines and intracranial pressure, brain tissue oxygenation and lesion type on the computed cranial tomography scan (patients with and without brain swelling). Prospective and observational study. Third-level university hospital. Patients between 15 and 65 yrs with severe traumatic brain injury and a diffuse lesion requiring intracranial pressure and brain tissue oxygenation monitoring were eligible. Microdialysis catheters with a high-cutoff membrane of 100 kDa were inserted. Sixteen patients were included in the analysis. There was a substantial interindividual variability between cytokine values. The highest concentrations for the interleukin-1β, interleukin-6, and interleukin-8 were measured during the first 24 hrs followed by a gradual decline. The average concentration for interleukin-10 did not vary over time. This pattern is the most frequent in patients with traumatic brain injury with diffuse lesions. The intracranial pressure-cytokines correlation coefficients for the 16 patients varied substantially: interleukin-1β-intracranial pressure (-0.76 to 0.63); interleukin-6-intracranial pressure (-0.83 to 0.78); interleukin-8-intracranial pressure (-0.86 to 0.84); and interleukin-10-intracranial pressure (-0.36 to 0.65). The brain tissue oxygenation-cytokine correlation coefficients, like with intracranial pressure, also varied between patients: interleukin-1β-brain tissue oxygenation (-0.49 to 0.68), interleukin-6-brain tissue oxygenation (-0.99 to 0.84); interleukin-8-brain tissue oxygenation (-0.65 to 0.74); and interleukin-10-brain tissue oxygenation (-0.34 to 0.52). Similarly, we found no difference in the cytokine values inpatient microdialysis with and without swelling in the computed tomographic scan. No clear relationship was found between the temporal pattern of cytokines and the behavior of the intracranial pressure, brain tissue oxygenation, and the presence or absence of swelling in the computed tomography scan. This study demonstrates the feasibility of microdialysis in recovering cytokines for a prolonged time, although there may be some nonresolved methodologic problems with this technique when we try to study the inflammation during traumatic brain injury that could affect the results and make interpretation of microdialysis data prone to difficulties.
    Critical care medicine 03/2011; 39(3):533-40. · 6.15 Impact Factor
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    ABSTRACT: Traumatic brain injury (TBI) is commonly associated with disturbances of the hypothalamic-pituitary-adrenal axis secretion. Cerebral microdialysis techniques have been recently applied to measure brain interstitial cortisol levels. We evaluated for the first time the circadian rhythm of cortisol secretion at 08:00, 16:00, and 24:00 h in the acute phase of TBI by determination of total serum and brain interstitial cortisol levels (microdialysis samples) in 10 patients with TBI. Non-parametric Friedman's two way analysis of variance test was used. Mean age was 29.8 ± 13.6 years. Median Glasgow Coma Scale score after resuscitation was 5 (range 3-10). No differences were found in total serum (P = 0.26) and brain interstitial cortisol (P = 0.77) in the whole sample. Intraindividual analysis showed that circadian variability was lost in all patients, both in serum and brain interstitial cortisol samples in the acute phase after TBI. In our series, circadian variability of cortisol evaluated by serum and cerebral microdialysis samples seems to be lost in TBI patients.
    Neurocritical Care 10/2010; 13(2):211-6. · 3.04 Impact Factor
  • Journal of Neurosurgery 12/2009; 111(6):1295; author reply 1295-6. · 3.15 Impact Factor
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    ABSTRACT: Posttraumatic tissular hypoxia can be due to multiple causes, including microcirculation disturbances, which can be studied with the SDF (Side Stream Dark Field) system. This system is based on a small hand-held microscope that eliminates directly reflected green polarised light from an organ surface using an orthogonal analyser. It offers clear images of red and white blood cells flow through microcirculation. Specific software is later used to determine the length and density of microvessels. We present a case of a TBI patient who required surgical evacuation of a brain contusion. Images of the microcirculatory bed were recorded with the SDF microscope and compared with a normal pattern obtained from another patient who was operated on for an unruptured cerebral aneurysm. Both imaging and quantitative analyses showed significant differences in the cerebral microcirculatory status in these patients. Total length and density of vessels were markedly reduced in the TBI patient. SDF imaging allows direct and non-invasive in vivo observation of cerebral microcirculation, and may allow us to deepen our knowledge of the pathophysiology of posttraumatic brain ischemia.
    Medicina Intensiva 01/2009; 33(5):256-9. · 1.24 Impact Factor
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    ABSTRACT: Posttraumatic tissular hypoxia can be due to multiple causes, including microcirculation disturbances, which can be studied with the SDF (Side Stream Dark Field) system. This system is based on a small hand-held microscope that eliminates directly reflected green polarised light from an organ surface using an orthogonal analyser. It offers clear images of red and white blood cells flow through microcirculation. Specific software is later used to determine the lenght and density of microvessels. We present a case of a TBI patient who required surgical evacuation of a brain contusion. Images of the microcirculatory bed were recorded with the SDF microscope and compared with a normal pattern obtained from another patient who was operated on for an unruptured cerebral aneurysm. Both imaging and quantitative analyses showed significant differences in the cerebral microcirculatory status in these patients. Total length and density of vessels were markedly reduced in the TBI patient. SDF imaging allows direct and non-invasive in vivo observation of cerebral microcirculation, and may allow us to deepen our knowledge of the pathophysiology of posttraumatic brain ischemia.
    Medicina Intensiva 01/2009; 33(5):256-259. · 1.24 Impact Factor
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    ABSTRACT: Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studies be undertaken. The objectives of the present study were to assess the effectiveness of pentobarbital and thiopental in terms of controlling refractory intracranial hypertension in patients with severe traumatic brain injury, and to evaluate the adverse effects of treatment. This was a prospective, randomized, cohort study comparing two treatments: pentobarbital and thiopental. Patients who had suffered a severe traumatic brain injury (Glasgow Coma Scale score after resuscitation < or = 8 points or neurological deterioration during the first week after trauma) and with refractory intracranial hypertension (intracranial pressure > 20 mmHg) first-tier measures, in accordance with the Brain Trauma Foundation Guidelines. A total of 44 patients (22 in each group) were included over a 5-year period. There were no statistically significant differences in ' baseline characteristics, except for admission computed cranial tomography characteristics, using the Traumatic Coma Data Bank classification. Uncontrollable intracranial pressure occurred in 11 patients (50%) in the thiopental treatment group and in 18 patients (82%) in the pentobarbital group (P = 0.03). Under logistic regression analysis--undertaken in an effort to adjust for the cranial tomography characteristics, which were unfavourable for pentobarbital--thiopental was more effective than pentobarbital in terms of controlling intracranial pressure (odds ratio = 5.1, 95% confidence interval 1.2 to 21.9; P = 0.027). There were no significant differences between the two groups with respect to the incidence of arterial hypotension or infection. Thiopental appeared to be more effective than pentobarbital in controlling intracranial hypertension refractory to first-tier measures. These findings should be interpreted with caution because of the imbalance in cranial tomography characteristics and the different dosages employed in the two arms of the study. The incidence of adverse effects was similar in both groups. (Trial registration: US Clinical Trials registry NCT00622570.).
    Critical care (London, England) 09/2008; 12(4):R112. · 5.04 Impact Factor
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    ABSTRACT: The purpose of this series was to describe the ultrasonographic perfusion pattern in patients with brain death. Thirteen patients with different neurologic disorders in whom brain death developed were studied. Transcranial perfusion was analyzed after injection of 2.5 mL of a sulfur hexafluoride ultrasonographic contrast agent. Time-intensity curves were analyzed in predetermined regions of interest. In all patients, analysis of regions of interest showed no bolus-like curve progression. This finding implies a complete absence of cerebral perfusion. Patients with brain death studied by ultrasonographic perfusion techniques have a characteristic pattern.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2008; 27(5):791-4. · 1.53 Impact Factor
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    Intensive Care Medicine 01/2007; 32(12):2078; author reply 2079. · 5.54 Impact Factor
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    ABSTRACT: Sir, We read with interest the recent article by Kochanowicz et al., “Detection and monitoringofcerebraldisturbanceswith transcranial color-coded sonography in patients with head injury” [1]. In this preliminaryreport,theauthorsshowthat low end-diastolic velocities and low resistance index values are associated with poor outcome in patients with moderate to severe head injury. The authorsalsostatethatreportsconcerning the use of transcranial color-coded sonography (TCCS) in traumatic brain injury (TBI) are scarce and based on small patient groups. We agree with the authors that TCCS is infrequently used in TBI patient monitoring in neurocritical care units compared to conventional transcranial Doppler sonography. In our Neurocritical Intensive Care Unit, TCCS is routinely used to monitor TBI patients. We would like to point out that along with the advantages in cerebral hemodynamic evaluations described by the authors, TCCS can monitor midline shift in patients with TBI, achieving good correlation with cranial computed tomography (CT) measurements [2]. The detection of posttraumatic carotid cavernous fistulas at a non-symptomatic stage has also been recently described [3]. We concur with the authors’ conclusions regarding the advantages of TCCS over conventional and blind transcranial Doppler sonography [4]. We appreciate the findings that Dr Krejza’s group presents on the use of TCCS in TBI patients. We expect TCCS to be more widely used in patients with head injury, as this will enhance the quality of multimonitoring of TBI patients with the aim of decreasing secondary ischemic insults.
    Neuroradiology 06/2006; 48(5):353; author reply 354-5. · 2.37 Impact Factor