Antonio Santos-Bouza

Publications (4)17.52 Total impact

• Article: A universal definition of ARDS: the PaO(2)/FiO (2) ratio under a standard ventilatory setting-a prospective, multicenter validation study.

  Jesús Villar, Lina Pérez-Méndez, Jesús Blanco, José Manuel Añón, Lluís Blanch, Javier Belda, Antonio Santos-Bouza, Rosa Lidia Fernández, Robert M Kacmarek
  [show abstract] [hide abstract]
  ABSTRACT: PURPOSE: The PaO(2)/FiO(2) is an integral part of the assessment of patients with acute respiratory distress syndrome (ARDS). The American-European Consensus Conference definition does not mandate any standardization procedure. We hypothesized that the use of PaO(2)/FiO(2) calculated under a standard ventilatory setting within 24 h of ARDS diagnosis allows a more clinically relevant ARDS classification. METHODS: We studied 452 ARDS patients enrolled prospectively in two independent, multicenter cohorts treated with protective mechanical ventilation. At the time of ARDS diagnosis, patients had a PaO(2)/FiO(2) ≤ 200. In the derivation cohort (n = 170), we measured PaO(2)/FiO(2) with two levels of positive end-expiratory pressure (PEEP) (≥5 and ≥10 cmH(2)O) and two levels of FiO(2) (≥0.5 and 1.0) at ARDS onset and 24 h later. Dependent upon PaO(2) response, patients were reclassified into three groups: mild (PaO(2)/FiO(2) > 200), moderate (PaO(2)/FiO(2) 101-200), and severe (PaO(2)/FiO(2) ≤ 100) ARDS. The primary outcome measure was ICU mortality. The standard ventilatory setting that reached the highest significance difference in mortality among these categories was tested in a separate cohort (n = 282). RESULTS: The only standard ventilatory setting that identified the three PaO(2)/FiO(2) risk categories in the derivation cohort was PEEP ≥ 10 cmH(2)O and FiO(2) ≥ 0.5 at 24 h after ARDS onset (p = 0.0001). Using this ventilatory setting, patients in the validation cohort were reclassified as having mild ARDS (n = 47, mortality 17 %), moderate ARDS (n = 149, mortality 40.9 %), and severe ARDS (n = 86, mortality 58.1 %) (p = 0.00001). CONCLUSIONS: Our method for assessing PaO(2)/FiO(2) greatly improved risk stratification of ARDS and could be used for enrolling appropriate ARDS patients into therapeutic clinical trials.
  European Journal of Intensive Care Medicine 01/2013; · 5.17 Impact Factor
• Article: The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation.

  Jesús Villar, Jesús Blanco, José Manuel Añón, Antonio Santos-Bouza, Lluís Blanch, Alfonso Ambrós, Francisco Gandía, Demetrio Carriedo, Fernando Mosteiro, Santiago Basaldúa, Rosa Lidia Fernández, Robert M Kacmarek
  [show abstract] [hide abstract]
  ABSTRACT: While our understanding of the pathogenesis and management of acute respiratory distress syndrome (ARDS) has improved over the past decade, estimates of its incidence have been controversial. The goal of this study was to examine ARDS incidence and outcome under current lung protective ventilatory support practices before and after the diagnosis of ARDS. This was a 1-year prospective, multicenter, observational study in 13 geographical areas of Spain (serving a population of 3.55 million at least 18 years of age) between November 2008 and October 2009. Subjects comprised all consecutive patients meeting American-European Consensus Criteria for ARDS. Data on ventilatory management, gas exchange, hemodynamics, and organ dysfunction were collected. A total of 255 mechanically ventilated patients fulfilled the ARDS definition, representing an incidence of 7.2/100,000 population/year. Pneumonia and sepsis were the most common causes of ARDS. At the time of meeting ARDS criteria, mean PaO(2)/FiO(2) was 114 ± 40 mmHg, mean tidal volume was 7.2 ± 1.1 ml/kg predicted body weight, mean plateau pressure was 26 ± 5 cmH(2)O, and mean positive end-expiratory pressure (PEEP) was 9.3 ± 2.4 cmH(2)O. Overall ARDS intensive care unit (ICU) and hospital mortality was 42.7% (95%CI 37.7-47.8) and 47.8% (95%CI 42.8-53.0), respectively. This is the first study to prospectively estimate the ARDS incidence during the routine application of lung protective ventilation. Our findings support previous estimates in Europe and are an order of magnitude lower than those reported in the USA and Australia. Despite use of lung protective ventilation, overall ICU and hospital mortality of ARDS patients is still higher than 40%.
  European Journal of Intensive Care Medicine 12/2011; 37(12):1932-41. · 5.17 Impact Factor
• Article: Erratum to: The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation.

  Jesús Villar, Jesús Blanco, José Manuel Añón, Antonio Santos-Bouza, Lluís Blanch, Alfonso Ambrós, Francisco Gandía, Demetrio Carriedo, Fernando Mosteiro, Santiago Basaldúa, Rosa Lidia Fernández, Robert M Kacmarek
  European Journal of Intensive Care Medicine 10/2011; · 5.17 Impact Factor
• Article: A risk tertiles model for predicting mortality in patients with acute respiratory distress syndrome: age, plateau pressure, and P(aO(2))/F(IO(2)) at ARDS onset can predict mortality.

  Jesús Villar, Lina Pérez-Méndez, Santiago Basaldúa, Jesús Blanco, Gerardo Aguilar, Darío Toral, Elizabeth Zavala, Miguel A Romera, Gumersindo González-Díaz, Frutos Del Nogal, Antonio Santos-Bouza, Luís Ramos, Santiago Macías, Robert M Kacmarek
  [show abstract] [hide abstract]
  ABSTRACT: Predicting mortality has become a necessary step for selecting patients for clinical trials and defining outcomes. We examined whether stratification by tertiles of respiratory and ventilatory variables at the onset of acute respiratory distress syndrome (ARDS) identifies patients with different risks of death in the intensive care unit. We performed a secondary analysis of data from 220 patients included in 2 multicenter prospective independent trials of ARDS patients mechanically ventilated with a lung-protective strategy. Using demographic, pulmonary, and ventilation data collected at ARDS onset, we derived and validated a simple prediction model based on a population-based stratification of variable values into low, middle, and high tertiles. The derivation cohort included 170 patients (all from one trial) and the validation cohort included 50 patients (all from a second trial). Tertile distribution for age, plateau airway pressure (P(plat)), and P(aO(2))/F(IO(2)) at ARDS onset identified subgroups with different mortalities, particularly for the highest-risk tertiles: age (> 62 years), P(plat) (> 29 cm H(2)O), and P(aO(2))/F(IO(2)) (< 112 mm Hg). Risk was defined by the number of coexisting high-risk tertiles: patients with no high-risk tertiles had a mortality of 12%, whereas patients with 3 high-risk tertiles had 90% mortality (P < .001). A prediction model based on tertiles of patient age, P(plat), and P(aO(2))/F(IO(2)) at the time the patient meets ARDS criteria identifies patients with the lowest and highest risk of intensive care unit death.
  Respiratory care 01/2011; 56(4):420-8. · 2.01 Impact Factor