Graciela Martinez-Palli

Hospital Clínic de Barcelona · Servicio de Anestesia

Objective The main objective was to assess repeatability and learning effect of the 6-min walk test (6MWT) in a cohort of preoperative cancer patients referred to a prehabilitation program. As a secondary objective, we aimed to identify determinants of improvement in the second test. Materials and methods Secondary analysis from a large prospectiv...

Purpose The occurrence of adverse events (AE) in hospitalized patients substancially increases the risk of disability or death, having a major negative clinical and economic impact on public health. For early identification of patients at risk and to establish preventive measures, different healthcare systems have implemented rapid response systems...

Purpose Frailty and poor functional capacity in advanced heart failure patients in the waiting list for heart transplantation (HT) are associated with increased morbidity and mortality. Pilot studies show short-term benefits through an exercise training program (prehabilitation) in HT candidates. We aim to investigate the efficacy of a prehabilitat...

Background: Prehabilitation programs as part of ERAS protocols are being increasingly used in multiple surgeries, improving postoperative outcomes. Data regarding prehabilitation programs in patients awaiting liver transplantation and their outcomes is scarce. Objectives: To identify whether prehabilitation programs based on exercise training co...

Introduction: Treatment for advanced ovarian cancer (AOC) comprises cytoreductive surgery combined with chemotherapy. Multimodal prehabilitation programmes before surgery have demonstrated efficacy in postoperative outcomes in non-gynaecological surgeries. However, the viability and effects of these programmes on patients with AOC are unknown. We...

Resumen Los programas de prehabilitación que combinan entrenamiento físico, soporte nutricional y refuerzo emocional han demostrado eficacia como estrategia de optimización prequirúrgica en cirugía abdominal. La experiencia en cirugía cardiaca, una de las que asocia mayor morbimortalidad, es anecdótica. Objetivo Evaluación de la factibilidad de un...

Background Pain is a clinical feature of COVID-19, however data about persistent pain after hospital discharge, especially among ICU survivors is scarce. The aim of this study is to explore the incidence and characteristics of new-onset pain and its impact on Health-Related Quality of Life (HRQoL), and to quantify the presence of mood disorders in...

Introduction Adherence to Enhanced Recovery Protocols (ERPs) is associated with faster functional recovery, better patient satisfaction, lower complication rates and reduced length of hospital stay. Understanding institutional barriers and facilitators is essential for improving adherence to ERPs. The purpose of this study was to identify instituti...

Objective the main objective was to assess repeatability and learning effect of the six-minute walk test (6MWT) in a cohort of preoperative cancer patients referred to a prehabilitation program. As a secondary objective we aimed to identify determinants of improvement in the second test. Materials and Methods secondary analysis from a large prospe...

Purpose The feasibility and effects of multimodal prehabilitation in patients with advanced ovarian cancer (AOC) undergoing a cytoreductive surgery are unknown. We aimed to evaluate the feasibility of a multimodal prehabilitation program in patients with AOC and its impact on postoperative outcomes. Methods We prospectively compared 15 patients wit...

Prehabilitation has shown its potential for most intra-cavity surgery patients on enhancing preoperative functional capacity and postoperative outcomes. However, its large-scale implementation is limited by several constrictions, such as: i) unsolved practicalities of the service workflow, ii) challenges associated to change management in collabora...

Purpose Frailty and poor functional performance are associated with worse outcomes after heart transplantation (HT). Prehabilitation performed to improve patients preoperatively has been shown to improve surgery outcomes in other high-risk patients, but there is no experience in patients prior to HT. We postulate that a combined prehabilitation pro...

Background: To explore the incidence and characteristics of new-onset pain, its impact on quality of life (HRQoL), and to quantify the presence of mood disorders in critically ill COVID-19 survivors. Methods: This is a preliminary report of PAIN-COVID clinical trial (NCT04394169) presenting a descriptive analysis in critical ill COVID 19 survivors...

The original version of this article unfortunately contained mistakes in Figures 1 and 3.

Introduction Prehabilitation programmes that combine exercise training, nutritional support and emotional reinforcement (multimodal prehabilitation) have demonstrated efficacy reducing postoperative complications in the context of abdominal surgery. However, such programmes have seldom been studied in cardiac surgery, one of the surgeries associate...

Intensive Care Med Purpose: The main characteristics of mechanically ventilated ARDS patients affected with COVID-19, and the adherence to lung-protective ventilation strategies are not well known. We describe characteristics and outcomes of confirmed ARDS in COVID-19 patients managed with invasive mechanical ventilation (MV). Methods: This is a mu...

PurposeThe main characteristics of mechanically ventilated ARDS patients affected with COVID-19, and the adherence to lung-protective ventilation strategies are not well known. We describe characteristics and outcomes of confirmed ARDS in COVID-19 patients managed with invasive mechanical ventilation (MV).Methods This is a multicenter, prospective,...

Background Recipient hepatectomy during liver transplantation can be a challenging operation and can increase cold ischaemic time. The aim of this study is to assess factors associated with prolonged recipient hepatectomy.Methods From 2005 to 2015, 930 patients were submitted to liver transplantation in our hospital. Prolonged hepatectomy time was...

Background: Multimodal prehabilitation is a preoperative intervention with the objective to enhance cancer patients’ functional status which has been showed to reduce both postoperative morbidity and hospital length of stay in digestive oncologic surgery. However, in lung cancer surgery patients further studies with higher methodological quality ar...

Background: Multimodal prehabilitation is a preoperative intervention with the objective to enhance cancer patients' functional status which has been showed to reduce both postoperative morbidity and hospital length of stay in digestive oncologic surgery. However, in lung cancer surgery patients further studies with higher methodological quality a...

Background: We aimed to examine whether using a high fraction of inspired oxygen (FIO2) in the context of an individualised intra- and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery. Methods: We performed a multicentre, randomised controlled clinical trial in...

Introduction Prehabilitation programs designed to improve functional status showed efficacy to increase functional capacity and to prevent postoperative complications in selected high-risk surgical populations. Patients awaiting heart transplantation (HT) usually exhibit poor quality of life and this situation usually progresses while waiting for H...

Introduction: The efficacy of prehabilitation (PreHab) to reduce surgical complications, and facilitate postoperative recovery, has been demonstrated (Ann Surg. 2018; 267(1):50-56). Deployment of PreHab as mainstream service at Hospital Clínic de Barcelona (HCB) has been undertaken. However, there is a need for consolidation of modular digital heal...

Background & aims: Surgery in cirrhosis is associated with a high morbidity and mortality. Retrospectively reported prognostic factors include emergency procedures, liver function (MELD/Child-Pugh scores) and portal hypertension (assessed by indirect markers). This study assessed the prognostic role of hepatic venous pressure gradient (HVPG) and o...

Background Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-sc...

Background: Prehabilitation showed efficacy to reduce postoperative complications. However, sustainability of its health benefits and impact on costs needs further assessment. Objective: To assess the mid-term clinical impact and costs from a hospital perspective of an endurance exercise training-based prehabilitation program in high-risk patients...

Purpose To assess the effect of multimodal prehabilitation in patients listed for heart transplantation (HT) Prehabilitation programs that combine physical training, nutritional support and emotional reinforcement have been effective in increasing functional capacity and preventing postoperative complications in selected high risk surgical populati...

Background and study aims Endoscopic resection requires use of submucosal injection. This study was conducted to assess efficacy and impact on early healing of hyaluronic acid combined with chondroitin sulfate and poloxamer 407 (Ziverel) when used as a solution for submucosal injection. Materials and methods Prospective and comparative study of gas...

The use of sedation for diagnostic procedures including gastrointestinal endoscopy is rapidly growing. Recovery of cognitive function after sedation is important because it would be important for most patients to resume safe, normal life soon after the procedure. Computerized tests have shown being accurate descriptors of cognitive function. The pu...

Background Colorectal cancer (CRC) is the second most prevalent type of cancer in the world. Surgery is the only curative option. However, postoperative complications occur in up to 50% of patients and are associated with higher morbidity and mortality rates, lower health related quality of life (HRQoL) and increased expenditure in health care. The...

Background: Chronic diseases are generating a major health and societal burden worldwide. Healthy lifestyles, including physical activity (PA), have proven efficacy in the prevention and treatment of many chronic conditions. But, so far, national PA surveillance systems, as well as strategies for promotion of PA, have shown low impact. We hypothes...

Background: The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilat...

Objective: The aim of this study was to assess the impact of personalized prehabilitation on postoperative complications in high-risk patients undergoing elective major abdominal surgery. Summary background data: Prehabilitation, including endurance exercise training and promotion of physical activity, in patients undergoing major abdominal surg...

Foreword The PITES Telemedicine and e-Health innovation platform constitutes a network intervention framework for research and innovation in solutions, services and tools based on Information and Communications Technologies (ICTs) aimed at supporting the new assistance models. Formally, PITES is a grouping of nodes of technological innovation based...

Introduction Frailty and low physical activity and cardiorespiratory reserve are related to higher perioperative morbimortality. The crucial step in improving the prognosis is to implement specific measures to optimise these aspects. It is critical to know the magnitude of the problem in order to implement preoperative optimisation programmes. Obj...

Objectives: The PITES-ISA node in Catalonia focuses on integrated care services for chronic patients with a personalized medicine foundation and a three-fold objective: i) Regional deployment of healthcare services; ii) Catalan test-bed for international leadership as 4-star EIP-AHA reference site; and iii) Transfer and exploitation of new products...

Prehabilitation, including endurance exercise training and promotion of physical activity, in patients undergoing major abdominal surgery has been postulated as an effective preventive intervention to reduce postoperative complications. However, the existing studies provide controversial results likely explained by weaknesses in study designs. More...

Background: Prehabilitation (PREHAB), including endurance exercise training and promotion of physical activity, in patients undergoing major abdominal surgery has been postulated as an effective preventive intervention to reduce postoperative complications. However, the existing studies provide controversial results and show a clear bias toward low...

Background/objective: To assess the relationship between the presence of ascites detected by endoscopic ultrasonography (EUS) and peritoneal carcinomatosis (PC) in patients with pancreatic adenocarcinoma. Methods: Consecutive patients who underwent a EUS for preoperative staging of a pancreatic adenocarcinoma between 1998 and 2014 were retrospec...

Introduction: Frailty and low physical activity and cardiorespiratory reserve are related to higher perioperative morbimortality. The crucial step in improving the prognosis is to implement specific measures to optimize these aspects. It is critical to know the magnitude of the problem in order to implement preoperative optimization programmes. O...

Background: Colorectal cancer (CRC) screening programs result in the detection of early-stage asymptomatic carcinomas suitable to be surgically cured. Lymph nodes (LN) from early CRC are usually small and may be difficult to collect. Still, at least 12 LNs should be analyzed from colectomies, to ensure a reliable pN0 stage. Presurgical endoscopic...

Background Patients undergoing liver transplantation (LT) have a high risk of bleeding. The goal of this study was to assess whether the first derivative of the velocity waveform (V-curve) generated by whole blood rotation thromboelastometry (ROTEM®) can predict blood loss during LT. Methods Preoperative V-curve parameters were retrospectively eva...

Introduction: There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. Method: We created a working grou...

Liver transplantation (LT) offers patients with liver disease a real chance for long-term survival. In the past decade, successful survival after LT along with the Model for End-Stage Liver Disease–based allocation policy have increased willingness to accept patients with a higher risk profile and marginal organs and to prioritize the sickest patie...

La demanda de administración de sedación para procedimientos en entornos alejados de quirófano ha crecido extraordinariamente y cada vez requiere un abordaje más complejo. Por diferentes motivos, hoy en día la atención para estas sedaciones está sujeta a mucha variabilidad. Creemos que es necesaria una aproximación a ella desde la seguridad del pac...

Background and rationale for the study. Hyperglycemia after graft reperfusion is a consistent finding in liver transplantation (LT) that remains poorly studied. We aim to describe its appearance in LT recipients of different types of grafts and its relation to the graft function. 436 LT recipients of donors after brain death (DBD), donors after car...

Background: Safety is a concern in natural orifice transluminal endoscopic surgery (NOTES) mediastinoscopy. The objective of this study was to compare the safety of NOTES mediastinoscopy with video-assisted mediastinoscopy (VAM). Methods: Twenty-four pigs were randomly assigned to NOTES or VAM. Thirty-minute mediastinoscopies were performed with...

Our goal was to assess the accuracy of measuring cardiac output (CO) by the FloTrac/Vigileo (COV) device in comparison with thermodilution technique through pulmonary artery catheterization (PACTD) in morbidly obese patients. Cardiac output in 8 morbidly obese patients was assessed twice at upright and lying position breathing ambient air. At least...

Background: Transesophageal natural-orifice transluminal endoscopic surgery (NOTES) mediastinoscopy has been described as a feasible, less-invasive alternative to video-assisted mediastinoscopy (VAM). We aimed to investigate hemodynamic and respiratory effects during transesophageal NOTES mediastinoscopy compared with VAM. Patients and methods:...

Background: The use of fresh frozen plasma in liver resection has recently been questioned due to the lack of supportive evidence. The aim of the study was to evaluate the clinical impact of a transfusion protocol implemented in our Institution based on the avoidance of prophylactic use of plasma. Methods: 172 adult undergone liver resection were a...

In patients with advanced cirrhosis, stressful stimuli may reveal a silent reduced cardiac performance. During liver transplantation (LT), graft reperfusion strongly stresses the heart and may unmask latent myocardial dysfunction. The objective of this study was to assess heart response to acutely increased preload after liver graft reperfusion and...

Metabolic and inflammatory disturbances associated with obesity are considered important trigger factors for venous thromboembolism (VTE). Identification of clinical markers indicating a hypercoagulability state could define a group of high-risk patients in the surgical setting. This study aimed to identify these markers using rotational thrombelas...