Alejandro González-Castro

• PhD
• Hospital Universitario Marques de Valdecilla

Background In standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmH2O pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices might promote derecruitment. Evidence supports the f...

Background: the best spontaneous breathing test (SBT) during weaning from mechanical ventilation is a 30-min test with pressure support ventilation (PSV) 8 cmH2O without positive end expiratory pressure (PEEP). There is a debate about the possible collapse of some alveolar units during such SBT and during extubation with continuous suctioning. A fe...

Objective: To analyze the characteristics of seriously ill elderly patients during the six waves of the COVID-19 pandemic. Method: Retrospective, observational and analytical study of patients over 70 years of age admitted to the ICU (March-2020 to March-2022). Patients were categorized into three groups based on age: 70-74 years; 75-79 years; a...

Background and objective: Our study aims to compare the clinical and epidemiological characteristics, length of stay in the ICU, and mortality rates of COVID-19 patients admitted to the ICU who are fully vaccinated, partially vaccinated, or unvaccinated. Patients and methods: Retrospective cohort study (March 2020-March 2022). Patients were clas...

Objective: To specify the degree of probative force of the statistical hypotheses in relation to mortality at 28 days and the threshold value of 17 J/min mechanical power (MP) in patients with respiratory failure secondary to SARS-CoV-2. Design: Cohort study, longitudinal, analytical. Setting: Intensive care unit of a third level hospital in S...

Mechanical ventilation is currently the most widely used supportive therapy for the treatment of moderate and severe hypoxemia of any etiology. However, the decision of "when" is the right time to initiate the withdrawal of this support is currently a matter of debate worldwide. Many authors describe that the disconnection process should be gradual...

Objective: To specify the degree of probative force of the statistical hypotheses in relation to mortality at 28 days and the threshold value of 17 J/min mechanical power (MP) in patients with respiratory failure secondary to SARS-CoV-2. Design: Cohort study, longitudinal, analytical. Setting: Intensive care unit of a third level hospital in S...

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multi...

Resumen Introducción: las cánulas nasales de alto flujo de oxígeno en pacientes con insuficiencia respiratoria secundaria a neumonía por SARS-CoV-2 no han sido estudiadas desde un punto de vista coste-efectividad. Métodos: Análisis retrospectivo de datos obtenidos de enfermos ingresados en área-COVID de un servicio de medicina intensiva en un hospi...

Resumen El uso de dispositivos de oxigenación con membrana extracorpórea, cada vez es más frecuente en diferentes situaciones que pueden suponer un reto en muchas ocasiones dada la variabilidad de escenarios clínicos a los que nos podemos enfrentar. Su manejo se puede complicar más todavía cuando la situación hemodinámica y/o respiratoria del pacie...

End-of-life care and the limitation of therapeutic effort are among the most controversial aspects of medical practice. Many subjective factors can influence decision-making regarding these issues. The Q methodology provides a scientific basis for the systematic study of subjectivity by identifying different thought patterns. This methodology was p...

Objective To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. Design Prospective, multicentrico. Scope 62 ICU from Spain between February 2018 and March 2019. Patients Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. Interventions None....

Background End-of-life care and the limitation of therapeutic effort are among the most controversial aspects of medical practice. There are many factors that can influence decision-making regarding these issues. Most of them are subjective and personal. In this context, the Q methodology provides a scientific basis for the systematic study of subj...

Introduction Decisions not to admit a patient to intensive care units (ICU) as a way of limiting life support treatment (LLST) is a practice that can affect the operation of the emergency services and the way in which patients die. Methods Post hoc analysis of the ADENI-UCI study. The main variable analysed was the reason for refusal of admission...

We have read with great interest the study of Nicolas Bonnet et al. [1]. Propensity Score (PS) based on Inverse Probability of Treatment Weight (IPTW) estimator analysis is an outstanding statistical method to obtain robust causal inference from observational studies. We really appreciate the effort made by these French investigators to report scie...

Resumen Introducción Las decisiones de no ingresar a un paciente en las unidades de cuidados intensivos (UCI) como forma de limitación de un tratamiento de soporte vital (LTSV) es una práctica que puede afectar al funcionamiento de los servicios de urgencias y a la forma en que los pacientes mueren. Métodos Análisis post hoc del estudio ADENI-UCI...

Resumen Objetivo Analizar las variables asociadas a las decisiones de rechazo al ingreso en una Unidad de Cuidados Intensivos (UCI) como medida de limitación de tratamiento de soporte vital. Diseño Prospectivo, multicéntrico. Ámbito Sesenta y dos UCI de España entre febrero de 2018 y marzo de 2019. Pacientes Mayores de 18 años a los que se les...