Rafael Fernandez

Rafael Fernandez
ALTHAIA, Xarxa Assistencial Universitària de Manresa · Critical Care

MD, PhD

About

201
Publications
44,103
Reads
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9,277
Citations
Additional affiliations
February 2013 - present
Universitat Internacional de Catalunya
Position
  • Professor (Full)
January 1989 - May 2008
January 1989 - May 2008
Autonomous University of Barcelona
Position
  • Universitat Autònoma de Barcelona

Publications

Publications (201)
Article
Full-text available
Background Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by na...
Article
Purpose To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. Design Post-hoc analysis of four cohort studies. Ambit 138 Spanish ICUs. Patients 2141 patients scheduled extubated. Interventions None. Variables of interest Demographics, reason for mechanical ventilation, complications, methods for disconn...
Article
Full-text available
Background: Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by n...
Article
Objectives: To characterize clusters of double triggering and ineffective inspiratory efforts throughout mechanical ventilation and investigate their associations with mortality and duration of ICU stay and mechanical ventilation. Design: Registry-based, real-world study. Background: Asynchronies during invasive mechanical ventilation can occu...
Conference Paper
Full-text available
Introduction. Post-Intensive Care Syndrome(PICS) affects 30–50% of the ICU survivors (1–5), and may last years after ICU discharge, impacting on their quality of life (6–8). Acute Respiratory Distress Syndrome (ARDS) patients undergoing invasive mechanical ventilation (IMV) are highly vulnerable to develop PICS-related sequelae, i.e. ICU-acquired m...
Conference Paper
Full-text available
Introduction. Post-Intensive Care Syndrome (PICS) refers to a set of physical, cognitive and emotional impairments that persists after hospital discharge (1) and has a high impact on the survivors’ quality of life (QoL) (2–4). The emotional state is one of the most affected domains after ICU stay. The prevalence for anxiety and depression is estima...
Article
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The ideal moment to withdraw respiratory supply of patients under Mechanical Ventilation at Intensive Care Units (ICU), is not easy to be determined for clinicians. Although the Spontaneous Breathing Trial (SBT) provides a measure of the patients’ readiness, there is still around 15–20% of predictive failure rate. This work is a proof of concept fo...
Article
Background: This was a pilot study to analyze the effects of tracheostomy on patient-ventilator asynchronies and respiratory system mechanics. Data were extracted from an ongoing prospective, real-world database that stores continuous output from ventilators and bedside monitors. Twenty adult subjects were on mechanical ventilation and were trache...
Article
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Mechanical ventilation induces a number of systemic responses for which the brain plays an essential role. During the last decade, substantial evidence has emerged showing that the brain modifies pulmonary responses to physical and biological stimuli by various mechanisms, including the modulation of neuroinflammatory reflexes and the onset of abno...
Article
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Resumen Objetivo Evaluar los cambios en la desconexión de la ventilación mecánica en España desde 1998 hasta 2016. Diseño Análisis post-hoc de 4 estudios de cohorte. Ámbito Un total de 138 UCI. Enfermos Un total de 2.141 enfermos extubados de forma programada. Intervenciones Ninguna. Variables de interés principales Demográficas, motivo de ve...
Article
Full-text available
Ineffective effort during expiration (IEE) occurs when there is a mismatch between the demand of a mechanically ventilated patient and the support delivered by a Mechanical ventilator during the expiration. This work presents a pressure–flow characterization for respiratory asynchronies and validates a machine-learning method, based on the presente...
Article
Purpose To evaluate changes in the epidemiology of mechanical ventilation in Spain from 1998 to 2016. Design A post hoc analysis of four cohort studies was carried out. Setting A total of 138 Spanish ICUs. Patients A sample of 4293 patients requiring invasive mechanical ventilation for more than 12 h or noninvasive ventilation for more than one...
Article
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Background ICU patients undergoing invasive mechanical ventilation experience cognitive decline associated with their critical illness and its management. The early detection of different cognitive phenotypes might reveal the involvement of diverse pathophysiological mechanisms and help to clarify the role of the precipitating and predisposing fact...
Article
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Patient-ventilator asynchronies can be detected by close monitoring of ventilator screens by clinicians or through automated algorithms. However, detecting complex patient-ventilator interactions (CP-VI), consisting of changes in the respiratory rate and/or clusters of asynchronies, is a challenge. Sample Entropy (SE) of airway flow (SE-Flow) and a...
Article
Resumen Objetivo: Evaluar cambios en la epidemiología de la ventilación mecánica en España desde 1998 hasta 2016. Diseño: Análisis post-hoc de cuatro estudios de cohortes Ámbito: 138 UCI españolas. Pacientes: 4293 enfermos con ventilación mecánica invasiva más de 12 horas o no invasiva más de una hora. Intervenciones. Ninguna Variables de interés p...
Article
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Background: In critically ill patients, poor patient-ventilator interaction may worsen outcomes. Although sedatives are often administered to improve comfort and facilitate ventilation, they can be deleterious. Whether opioids improve asynchronies with fewer negative effects is unknown. We hypothesized that opioids alone would improve asynchronies...
Article
In Reply We agree with Drs Friedrich and Burns that prophylaxis against postextubation respiratory failure with NIV or HFNC was more common in the PSV group than in the T-piece group (24.7% vs 18.7%).¹ However, the decision to apply prophylaxis was made before randomization, so this difference can only be attributed to chance. We would like to clar...
Article
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Abstract BACKGROUND: Proportional assist ventilation (PAV+) is an assisted ventilator mode usually applied during weaning. We aimed to determine the feasibility of using PAV+ in the early phase of acute respiratory failure compared to volume-assist control ventilation (V-ACV) in order to shorten the length of mechanical ventilation (MV). METHODS:...
Article
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Abstract In mechanical ventilation, it is paramount to ensure the patient’s ventilatory demand is met while minimizing asynchronies. We aimed to develop a model to predict the likelihood of asynchronies occurring. We analyzed 10,409,357 breaths from 51 critically ill patients who underwent mechanical ventilation >24 h. Patients were continuously mo...
Article
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Purpose To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. Methods This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals’ ch...
Article
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Background High red blood cell distribution width (RDW) is associated with worse outcome in diverse scenarios, including in critical illness. The Sabadell score (SS) predicts in-hospital survival after ICU discharge. We aimed to determine RDW’s association with survival after ICU discharge and whether RDW can improve the accuracy of the SS. Design...
Article
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Background Sepsis-associated brain dysfunction (SABD) is associated with high morbidity and mortality. The pathophysiology of SABD is multifactorial. One hypothesis is that impaired cerebral autoregulation (CAR) may result in brain hypoperfusion and neuronal damage leading to SABD. Methods We studied 100 adult patients with sepsis (July 2012–March...
Article
Objectives: To assess the effect of sound isolation versus music on the comfort of mechanically ventilated patients admitted to the intensive care unit (ICU) as a combined measurement of the hypnotic level, the level of sedation and the alteration of behaviour because of pain. Introduction: Patients admitted to the ICU who require mechanical ven...
Article
Objectives: Double cycling generates larger than expected tidal volumes that contribute to lung injury. We analyzed the incidence, mechanisms, and physiologic implications of double cycling during volume- and pressure-targeted mechanical ventilation in critically ill patients. Design: Prospective, observational study. Setting: Three general IC...
Article
Full-text available
Patient-ventilator asynchrony exists when the phases of breath delivered by the ventilator do not match those of the patient. Asynchronies occur throughout mechanical ventilation and negatively affect patient comfort, duration of mechanical ventilation, length of ICU stays, and mortality. Identifying asynchronies requires careful attention to patie...
Article
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Background Extubation failure is associated with increased morbidity and mortality, but cannot be safely predicted or avoided. High-flow nasal cannula (HFNC) prevents postextubation respiratory failure in low-risk patients. Objective To demonstrate that HFNC reduces postextubation respiratory failure in high-risk non-hypercapnic patients compared w...
Article
Background: Spontaneous breathing trials (SBT) can be exhausting, but the preventive role of rest has never been studied. This study aimed to evaluate whether reconnection to mechanical ventilation (MV) for 1 h after the effort of a successful SBT could reduce the need for reintubation in critically ill patients. Methods: Randomized multicenter...
Article
Objective: To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea. Methods: Single-center, prospective, observational study of patients aged over 15 requiring urgent attention for dyspnea, classified as level II or III according to the Andorran T...
Article
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Importance: High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Among the advantages of high-flow oxygen therapy are comfort, availability, lower costs, and additional physiopathological mechanisms. Objective: To test if high-flow conditioned oxy...
Article
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Background: Expert systems can help alleviate problems related to the shortage of human resources in critical care, offering expert advice in complex situations. Expert systems use contextual information to provide advice to staff. In mechanical ventilation, it is crucial for an expert system to be able to determine the ventilatory mode in use. Di...
Article
In Reply We agree with Dr Cadier and colleagues that a possible bias due to the unblinded design of the trial cannot totally be excluded, as discussed in the article. However, we think it is unlikely to account for the results. The definition of persistent postextubation respiratory failure was provided in eAppendix 5 in Supplement 2 of the article...
Article
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Importance Studies of mechanically ventilated critically ill patients that combine populations that are at high and low risk for reintubation suggest that conditioned high-flow nasal cannula oxygen therapy after extubation improves oxygenation compared with conventional oxygen therapy. However, conclusive data about reintubation are lacking.Object...
Article
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Objective: To determine the impact of delivering high flow conditioned oxygen therapy (HFO) through nasal cannula on prevention of reintubation in mechanically ventilated (MV) critically ill patients. Design: Prospective cohort sturdy. Setting: General ICU of a university hospital. Patients: all patients under MV > 12-h and after scheduled extubati...
Article
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Weaning from mechanical ventilation is still a major challenge in critical care units. Prolonged ventilation is clearly associated with poor prognosis and increased mortality. For this reason, in recent years, many studies have aimed to identify which patients are ready to breathe on their own.
Article
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This study aimed to assess the prevalence and time course of asynchronies during mechanical ventilation (MV). Prospective, noninterventional observational study of 50 patients admitted to intensive care unit (ICU) beds equipped with Better Care™ software throughout MV. The software distinguished ventilatory modes and detected ineffective inspirator...
Article
Full-text available
Objective. To determine whether the presence of nasal flaring is a clinical sign of severity and a predictor of hospital mortality in emergency patients with dyspnea. Methods. Prospective, observational, single-center study. We enrolled patients older than 15 years of age who required attention for dyspnea categorized as level II or III emergencie...
Article
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Before deciding increases in the number or capacitance of Intensive Care Units (ICUs), or the regionalization of Units, it is essential to know their present effectiveness. To analyze the daily occupancy rate of ICUs in Catalonia (Spain) and the frequency of denied admission due to lack of capacity. A prospective, observational multicenter study wa...
Article
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Background: Mechanical ventilation in the prone position is used to improve oxygenation and to mitigate the harmful effects of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). We sought to determine the effect of prone positioning on mortality among patients with ARDS receiving protective lung ventilation. Metho...
Article
Proportional assist ventilation plus (PAV+) applies pressure depending on the patient's inspiratory effort, automatically adjusting flow and volume assist to changes in respiratory mechanics. We aimed to assess the clinical factors associated with the success of PAV+ as first-line support in the acute phase of critical illness. A prospective cohort...
Article
Full-text available
Recent studies have found an association between increased volume and increased intensive care unit (ICU) survival; however, this association might not hold true in ICUs with permanent intensivist coverage. Our objective was to determine whether ICU volume correlates with survival in the Spanish healthcare system. Post hoc analysis of a prospective...
Article
Full-text available
Objective To determine the life-sustaining treatment limitation (LSTL) predisposition upon patient admission to the intensive care unit (ICU), the criteria upon which such predisposition is based, and whether these decisions are related to structural factors of the surveyed hospitals.DesignA descriptive multicenter study was made in 2010, involving...
Article
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Purpose: To determine the effects of deflating the tracheal cuff during disconnections from mechanical ventilation (MV) in tracheostomized patients. Methods: This was a single-center, randomized trial conducted in a general ICU of a tertiary hospital with regional referral for trauma patients. Patients at high risk of aspiration based on the dri...