Orlando Rubén Pérez Nieto

• Doctor of Medicine
• Medical Doctor at Hospital General San Juan del Río

Background The role of the ratio between the arterial partial pressure of oxygen and the inspired fraction of oxygen (PaO 2 /FiO 2 ratio) during the change in position is not fully established. Methods This retrospective, single-center cohort study included 98 patients with severe COVID-19 pneumonia. Objective This study aimed to evaluate the pre...

Objective: We aimed to test the association between acute kidney injury (AKI) and mortality in critically ill patients with Coronavirus disease 2019 (COVID-19). Method: We conducted a single-center case-control study at the intensive care unit (ICU) of a second-level hospital in Mexico. We included 100 patients with critical COVID-19 from Januar...

BACKGROUND Pulmonary atelectasis is present even before surgery in patients with obesity. We aimed to estimate the prevalence and extension of preoperative atelectasis in patients with obesity undergoing bariatric surgery and to determine if variation in preoperative Sp o 2 values in the seated position at room air is explained by the extent of ate...

Background: Pulmonary atelectasis is present even before surgery in patients with obesity. No study has reported the prevalence of preoperative atelectasis in obese patients to date. We aimed to estimate the prevalence and extension of preoperative atelectasis in patients with obesity undergoing bariatric surgery and to determine if variation in pr...

In the ICU, providing better care with less is the holy grail. This mnemonic tries to resume a list of the key interventions for human, evidence-based and patient-centred care.

To the Editor—We read with great interest the Infectious Diseases Society of America (IDSA) 2023 guidance on the treatment of antimicrobial resistant gram-negative infections. The guideline mentions that in patients with hypoalbuminemia and critical illness, the free fraction of ertapenem increases, leading to a significant decrease in the serum ha...

Objective To evaluate the central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference (∆Pv-aCO2/∆Ca-vO2 ratio) as a predictor of mortality in patients with COVID-19-related severe acute respiratory distress syndrome (ARDS). Methods Patients admitted to the intensive care unit with severe ARDS sec...

Almost a year after the declaration of the pandemic due to the SARS-CoV-2 virus which causes the COVID-19 disease and the need to contain the progression and treatment, the promising option was designing an effective and safe vaccine to reach a state of massive immunity. The first vaccine approved was the one produced by Pfizer-BioNTech, and its ap...

Background Alactic base excess (ABE) is a novel biomarker that estimates the renal capability of handling acid–base alterations during the sepsis. Hence, the aim of this study was to evaluate the use of ABE to predict the renal replacement therapy (RRT) in patients with septic shock. Methods A total of 164 patients admitted to the intensive care u...

The coronavirus disease 2019 has been demonstrated to be a trigger for multiple immune-mediated diseases, such as antineutrophil cytoplasmic antibody-associated vasculitis. Associated vasculitis consists of rare autoimmune disorders that predominantly affect small vessels, leading to endothelial injury and tissue damage. We present a case of a newl...

Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS), serious complications of diabetes, have significant morbidity and mortality. Objectives: To identify risk factors, epidemiological and pathophysiological bases of Hyperglycemic Crises (HC) and describe the proper management of HC. Inclusion criteria: Scientific arti...

Key Clinical Massage Preeclampsia is defined as elevation of blood pressure and any of the following severity criteria: proteinuria, thrombocytopenia, elevation of creatinine in the absence of another renal pathology, elevation of transaminases, pulmonary edema, or neurological symptoms. However, after 20 weeks of gestation in a previously normoten...

Pulmonary embolism is a common and potentially fatal disease, with a significant burden on health and survival. Right ventricular dysfunction and hemodynamic instability are considered two key determinants of mortality in pulmonary embolism, which can reach up to 65% in severe cases. Therefore, timely diagnosis and management are of paramount impor...

Compendio de bolsillo sobre enfermedades hepáticas y digestivas

Pain management is one of the greatest challenges in critical care. It is necessary to carry out a timely and optimal treatment with the least possible adverse effects, which is why multimodal analgesia is at the core of the critically ill patient. For this article, we did a search on PubMed based on an analysis of 7,109 indexed articles, from whic...

ARTÍCULO DE REVISIÓN Resumen La utilización de vasopresores es una práctica común en el paciente críticamente enfermo para mejorar la perfusión tisular. Las decisiones de su uso deben ser guiadas por una evaluación hemodinámica previa para la identificación del tipo de estado de choque y del tratamiento para su resolución. De igual forma, la movili...

Introducción: la ventilación mecánica es una práctica común en las unidades de cuidados intensivos y anestesiología. Tiene implicaciones terapéuticas, pero también es potencialmente nociva para el sistema respiratorio y los órganos distantes, por lo cual es imprescindible monitorizar los parámetros ventilatorios de manera continua. Objetivo: descr...

High-flow nasal cannula has become one of the main strategies for non-invasive ventilatory support in hypoxemic acute respiratory failure, mainly after the COVID-19 pandemic. However, its use extends beyond this scenario and covers different clinical conditions such as the post-extubation period, post-surgical period, hypercapnic respiratory failur...

Purpose: In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods: We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treate...

Background: Preeclampsia is defined as the elevation of blood pressure levels and any of the following severity criteria: proteinuria, thrombocytopenia, elevation of creatinine in the absence of another renal pathology, elevation of transaminases, pulmonary oedema or neurological symptoms. This after 20 weeks of gestation in a previously normotensi...

501 www.nietoeditores.com.mx revisión narrativa Necrólisis epidérmica tóxica Resumen La necrólisis epidérmica tóxica es una afección dermatológica grave asociada con insuficiencia multiorgánica y alta mortalidad. La causa más frecuente se relaciona con la administración de fármacos. Inicia con un cuadro prodrómico, seguido de exantema constituido p...

The prone position in patients under invasive mechanical ventilation (IMV) has been widely studied and used for the treatment of ARDS. This posture has shown beneficial effects on gas exchange and ventilatory mechanics compared to the supine position. Some well-designed trials demonstrated that the prone position is a strategy that improves outcome...

Objective: The objective of this study was to assess the association and interaction of laboratory parameters, Simplified Acute Physiology Score II (SAPSII), Modified Shock Index (MSI), and Mannheim Peritonitis Index (MPI) with in-hospital mortality. Material and methods: We conducted a single-center case-control study. Adult patients with abdom...

Introduction: Vaccination against COVID-19 has been one of the most important strategies to diminish the impact of the pandemic, with important reductions in COVID-19 mortality and infection rates (1), while also allowing less stringent non-pharmacological interventions to prevent contagion (i.e., less lockdowns) that allow economic and social acti...

Introduction: Delays in medical care have been shown to be a risk fac- tor for mortality in patients with COVID-19 who receive medical care in non-developed countries such as Mexico (1). The low availability of resources alongside saturation of hospitals during infectious disease outbreaks lead to delays in medical care (2). Other adverse outcomes...

We thank the authors for their interest in our work and their insightful comments regarding our article. Indeed , we agree that the issue raised is not limited only to the white coat, but also extends to some other items that comprise the traditional attire of various healthcare professionals , including nurses, dietitians, physical therapists, den...

In their article, Dr Qian and colleagues reported the results of a trial comparing awake prone positioning (APP) with usual care in nonintubated adults with COVID-19–induced hypoxemia. Although it provides insights into the nuances and perils of APP, their findings contrast with the results of a recent metatrial in which lower intubation rates were...

In the nineteenth century, physicians did not use white coats regularly. Instead, they used a black suit very similar to a tuxedo, a garment which conveyed not only a sense of elegance, but also the subtle notion that seeking medical attention was a last resort preceding death. The use of the white coat was popularized by nurses until the beginning...

665 www.medicinainterna.org.mx artículo dE opinión Med Int Méx 2022; 38 (3): 665-668. Retiro de ventilación mecánica: en busca de la euboxia Resumen La palabra euboxia es un neologismo del griego eu, bueno o normal, y la palabra del inglés box, traducida al castellano como caja, describe en el argot médico la obsesión que tenemos de intentar restau...

The approach on the best strategy to diagnose and manage patients in shock disease (CD) quickly and efficiently is dynamic, it depends on the characteristics of the patient, the available technology, the scientific evidence always in evolution; All of this leads to considerable variation in daily practice. The objective of this proposal is to prese...

La pancreatitis aguda es una enfermedad grave y causa frecuente de ingreso a los servicios de emergencias en México y los Estado Unidos de América debido a los factores de riesgo de la población, como obesidad, alcoholismo y hábitos dietéticos. Presenta una alta morbilidad y mortalidad, con una incidencia global de 33.74 casos por cada 100,000 pers...

The awake prone position (AP) strategy for patients with acute respiratory distress syndrome (ARDS) is a safe, simple, and cost-effective technique used to improve hypoxemia. We aimed to evaluate intubation and mortality risk in patients with coronavirus disease (COVID-19) who underwent AP during hospitalisation. In this retrospective, multicentre...

Ultrasound focused on the critical patient or «Point-Of-Care ultrasound» (POCUS) is a tool used at the patient’s bedside in different areas of critical medicine and emergency services due to its practicality as it provides great information quickly and non-invasive for diagnostic and therapeutic approaches. Cardiac arrest (CA) is a critical situati...

The use of the end inspiratory pause (EIP) in mechanical ventilation has been going on for more than 50 years and with greater momentum in the 1970s, an improvement in the partial pressure of arterial oxygen (PaO2) is attributed to the increase mean airway pressure, greater clearance of partial pressure of arterial carbon dioxide and allows monitor...

Dysnatremia is the most frequent electrolyte alteration in critically ill patients, with repercussions on morbidity and mortality. Sodium is the most important regulating electrolyte of blood osmolarity; the inherent relationship with the water molecule makes this pair have an interdependent and reciprocal ratio. Through this unsystematic review of...

La pandemia debida a la enfermedad por coronavirus 2019 (COVID-19) causada por el virus SARS-CoV-2 ha creado retos para su diagnóstico y tratamiento. Al día de hoy no se cuenta con una terapia antiviral específica, esta situación ha presionado al clínico a ofrecer terapias farmacológicas alternas cuyo beneficio puede ser opacado por sus riesgos. De...

Obstetric care in the context of COVID-19 must be supported by the best clinical practices and the most recent scientific evidence available, therefore, the development of recommendations must be based on clinical research, in order to obtain policies and practices that reduce the risk of contagion and the spread of the disease. The update of this...

How would a patient describe their stay inside an Intensive Care Unit (ICU)? Would it be cold, lonely, a place full of uncertainty? Painful, uncomfortable or scary? The length of stay (LOS) in the ICU may be the most traumatic experience a person can endure. A duel between life and death. A change in hospital infrastructure, an organised multidisci...

Introduction: Computed tomography (chest CT scan) may be a valuable preoperative COVID-19 screening method for bariatric and metabolic surgery candidates during this COVID-19 pandemic. Methods: A descriptive, incidence single-center study was conducted in June 2020. Two study groups were evaluated: surgical team group and bariatric patient group....

Objective: Determine whether the levels of glycated hemoglobin (HbA1c) measured on admission to the intensive care unit (ICU) are associated with mortality in patients with severe SARS-CoV-2 pneumonia with invasive mechanical ventilation. Design: cohort study, retrospective, observational. A single center. Place: ICU of a second level care hos...

Critically ill patients are often presumed to be in a state of “constant dehydration” or in need of fluid, thereby justifying a continuous infusion with some form of intravenous (IV) fluid, despite their clinical data suggesting otherwise. Overzealous fluid administration and subsequent fluid accumulation and overload are associated with poorer out...

Early mobilization (EM) is the implementation of physical exercise in patients admitted to the Intensive Care Unit (ICU), with important benefits being observed such as reduction of ventilator-associated pneumonia, deep vein thrombosis, pressure ulcers and ICU-acquired weakness (ICU-AW). It also has a financial impact by reducing hospital length of...

We have read the article by Kimura et al (1) with exceptional interest published in the recent issue of Critical Care Explorations. It should be considered that not all anions and cations are measured in daily clinical practice in seriously ill patients, of the measured ions sodium (Na+) represents the highest percentage of cations and chloride (Cl...

For eons, the study on the management of positive end-expiratory pressure (PEEP) has been exponential and fundamental for the study of pulmonary pathologies, mainly due to its direct relationship with acute respiratory distress syndrome (ARDS) presenting changes and advances in pulmonary protection goals including low tidal volume (Vt), plateau pre...

Purpose: The awake prone position (PP) strategy for patients with acute respiratory distress syndrome (ARDS) is a safe, simple, and cost-effective technique used to improve hypoxemia. We aimed to evaluate the relationship between awake PP (AP) and endotracheal intubation in patients with coronavirus disease (COVID-19). Methods: In this retrospectiv...

Introduction: Obstetric hemorrhage is the main cause of maternal morbidity and mortality in developing countries.1 Despite the fact that the anti-shock garment (AG) is an alternative for the management of obstetric hemorrhage, there is no evidence about when is the optimal time of its withdrawal.

In the last decade, the use of e-cigarettes in Mexico has increased indiscriminately. Recently the association between the use of vaporizers, commonly called «vaping» and lung lesions, has been reported. Lung injury associated with the use of e-cigarettes (E-VALI) poses a life threat, regardless of frequency or intensity. It is necessary to suspect...

El monitoreo hemodinámico de un paciente en estado crítico es una herramienta indispensable tanto dentro como fuera de la terapia intensiva; ac-tualmente se cuenta con dispositivos invasivos, mínimamente invasivos y no invasivos; sin embargo, ningún dispositivo ha demostrado tener impacto positivo en la evolución del paciente; la gasometría arteria...

Introduction: Given that obesity is a risk factor for adverse outcomes in COVID-19, bariatric and metabolic surgery (BMS) has become increasingly critical. Computed tomography (chest CT scan) may be a valuable preoperative screening method for BMS candidates during this COVID-19 pandemic. Methods: A prospective, single-center study was conducted in...

Critically ill patients can develop a series of complications due to ICU risk factors that may lead to permanent disability. The implementation of strategies to reduce its incidence is essential.

Mechanical ventilation is a type of respiratory support therapy frequently used in pregnant patients in intensive care or during the intraoperative period, and understanding the physiological and pathophysiological changes in the respiratory system that are caused during pregnancy and its complications is key to management. Strategic knowledge of m...

The gradual reversal of the population pyramid that has developed in recent decades has resulted in older adults being mostly affected in a pandemic situation. Senior people are the defenceless group, and the ones who have experienced the severest form of this disease. A patient who is positive for SARS-CoV2, and is over the age of 70 years old is...

Introducción: El síndrome de distrés respiratorio agudo (SDRA) se caracteriza por una heterogeneidad del daño en el parénquima pulmonar; la asociación entre el volumen tidal (Vt) y la distensibilidad pulmonar estática (Cst) puede ser evaluada mediante la presión de distensión (PD). Se desconoce hasta el día de hoy si el control de la PD impacta en...

Introduction: Posttraumatic Stress Disorder (PTSD) is a disease triggered by a traumatic life event, to which the individual reacts with symptoms of fear, intrusive thought s and despair, persistently reliving the event over and over again through what is known as flashbacks.

Introducción: La ventilación mecánica simultánea a varios pacientes con un solo ventilador podría disminuir el déficit de esos dispositivos para atender a los enfermos con insuficiencia respiratoria aguda por Covid-19. Objetivo: Comunicar los resultados de un ejercicio de ventilación mecánica con un ventilador en un simulador de pulmón, y simultán...

Introduction: Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. Objective: To communicate the results of a mechanical ventilation exercise with a ventilator in a lung simulator, and simultaneously in t...

Protocolo de manejo prehospitalario para paciente con sospecha o confirmación de enfermedad COVID-19

Protocolo de atención para COVID-19 (SARS-CoV-2) de la Sociedad Mexicana de Medicina de Emergencias.