Person: Sánchez Luna, Manuel Ramón
Loading...
First Name
Manuel Ramón
Last Name
Sánchez Luna
Affiliation
Universidad Complutense de Madrid
Faculty / Institute
Medicina
Department
Salud Pública y Materno-Infantil
Area
Pediatría
Identifiers
6 results
Search Results
Now showing 1 - 6 of 6
Item DCO2/PaCO2 correlation on high-frequency oscillatory ventilation combined with volume guarantee using increasing frequencies in an animal model(European Journal of Pediatrics, 2019) González Pacheco, Noelia; Sánchez Luna, Manuel Ramón; Arribas Sánchez, Cristina; Santos González, Martín; Orden Quinto, Cristina; Tendillo Cortijo, Francisco JavierTo examine the correlation DCO2/PaCO2 on high-frequency oscillatory ventilation (HFOV) combined with volume guarantee (VG) throughout increasing frequencies in two different respiratory conditions, physiological and low compliance. Neonatal animal model was used, before and after a bronchoalveolar lavage (BAL). HFOV combined with VG was used. The frequency was increased from 10 to 20 Hz, and high-frequency tidal volume (VThf) was gradually decreased maintaining a constant DCO2. Arterial partial pressure of carbon dioxide (PaCO2) was evaluated after each frequency and VThf change. Six 2-day-old piglets were studied. A linear decrease in PaCO2 was observed throughout increasing frequencies in both respiratory conditions while maintaining a constant DCO2, showing a significant difference between the initial PaCO2 (at 10 Hz) and the PaCO2 obtained at 18 and 20 Hz. A new DCO2 equation (corrected DCO2) was calculated in order to better define the correlation between DCO2 and the observed PaCO2.Conclusion: The correlation DCO2/PaCO2 throughout increasing frequencies is not linear, showing a greater CO2 elimination efficiency at higher frequencies, in spite of maintaining a constant DCO2. So, using frequencies close to the resonant frequency of the respiratory system on HFOV combined with VG, optimizes the efficiency of gas exchange.What is Known: • The efficacy of CO2removal during high-frequency oscillatory ventilation (HFOV), described as the diffusion coefficient of CO2(DCO2) is related to the square of the high-frequency tidal volume (VThf) and the frequency (f), expressed as DCO2= VThf2× f.What is New: • The correlation between DCO2and PaCO2throughout increasing frequencies is not linear, showing a greater CO2elimination efficiency at higher frequencies. So, using very high frequencies on HFOV combined with volume guarantee optimizes the efficiency of gas exchange allowing to minimize lung injury.Item Use of very low tidal volumes during high-frequency ventilation reduces ventilator lung injury(Journal of Perinatology, 2019) González Pacheco, Noelia; Sánchez Luna, Manuel Ramón; Chimenti Camacho, Paz; Santos González, Martín; Palau Concejo, Paula; Tendillo Cortijo, Francisco JavierThe use of volume guarantee (VG) on high-frequency oscillatory ventilation (HFOV) allows to use fixed very low high-frequency tidal volume (VThf), maintaining adequate CO2 removal while potentially reducing the risk of ventilator-induced lung injury. Objective: To demonstrate that the use of very low VThf can be protective compared with standard VThf on HFOV combined with VG in a neonatal animal model. Study design: Experimental study in 2-day-old piglets with induced respiratory distress syndrome ventilated with two different HFOV strategies combined with VG (10 Hz with high VThf versus 20 Hz with very low VThf at similar PaCO2). After 12 h of mechanical ventilation, the pulmonary histologic pattern was analyzed. Results: We found in the 10 Hz group with the higher VThf compared with the 20 Hz and very low VThf group more evident and more severe histological lesions with inflammatory infiltrate within the alveolar wall and alveolar space, as well as large areas of parenchyma consolidation and areas of alveolar hemorrhage in the more severe cases. Conclusion: The use of very low VThf compared with higher VThf at similar CO2 removal reduces lung injury in a neonatal animal model of lung injury after prolonged mechanical ventilation with HFOV combined with VG.Item New Strategies of Pulmonary Protection of Preterm Infants in the Delivery Room with the Respiratory Function Monitoring(American Journal of Perinatology, 2019) Zeballos Sarrato, Gonzalo; Sánchez Luna, Manuel Ramón; Zeballos Sarrato, Susana; Pérez Pérez, Alba; Pescador Chamorro, Isabel; Bellón Cano, Jose MaríaObjective: To investigate if the use of a visible respiratory function monitor (RFM) to use lower tidal volumes (Vts) during positive pressure ventilation (PPV) in the delivery room (DR) reduces the need of surfactant administration and invasive mechanical ventilation during the first 72 hours after birth of preterm infants <32 weeks' gestational age (GA). Study design: Infants <32 weeks' GA (n = 106) requiring noninvasive PPV were monitored with a RFM at birth and randomized to visible (n = 54) or masked (n = 52) display on RFM. Pulmonary data were recorded during the first 10 minutes after birth. Secondary analysis stratified patients by GA (<28, 28-29+6, or ≥30 weeks). Results: Median expiratory Vts during inflations were greater in the masked group (7 mL/kg) than in the visible group (5.8 mL/kg; p = 0.001) same as peak inflation pressure (PIP) administered (21.5 vs. 19.7 cmH2O; p < 0.001). Consequently, minute volumes were greater in the masked group (256 vs. 214 mL/kg/min; p < 0.001), with no differences in respiratory rate. These differences were higher in those <30 weeks' GA. There was no difference in the need of surfactant administration or intubation during the first 72 hours of age. Conclusion: Using a RFM in the DR prevents the use of large Vt and PIP during respiratory support inflations, mostly in the more immature newborn infants, but with no other short-term benefits.Item Ceramide Mediates Acute Oxygen Sensing in Vascular Tissues(Antioxidants and Redox Signaling, 2014) Moreno Gutiérrez, Laura; Moral Sanz, Javier; Morales Cano, Daniel; Barreira, Bianca; Moreno, Enrique; Ferrarini, Alessia; Pandolfi, Rachele; Ruperez, Francisco J.; Cortijo, Julio; Sánchez Luna, Manuel Ramón; Villamor, Eduardo; Pérez Vizcaíno, Francisco; Cogolludo Torralba, Ángel LuisAims: A variety of vessels, such as resistance pulmonary arteries (PA) and fetoplacental arteries and the ductus arteriosus (DA) are specialized in sensing and responding to changes in oxygen tension. Despite opposite stimuli, normoxic DA contraction and hypoxic fetoplacental and PA vasoconstriction share some mechanistic features. Activation of neutral sphingomyelinase (nSMase) and subsequent ceramide production has been involved in hypoxic pulmonary vasoconstriction (HPV). Herein we aimed to study the possible role of nSMase-derived ceramide as a common factor in the acute oxygen-sensing function of specialized vascular tissues. Results: The nSMase inhibitor GW4869 and an anticeramide antibody reduced the hypoxic vasoconstriction in chicken PA and chorioallantoic arteries (CA) and the normoxic contraction of chicken DA. Incubation with interference RNA targeted to SMPD3 also inhibited HPV. Moreover, ceramide and reactive oxygen species production were increased by hypoxia in PA and by normoxia in DA. Either bacterial sphingomyelinase or ceramide mimicked the contractile responses of hypoxia in PA and CA and those of normoxia in the DA. Furthermore, ceramide inhibited voltage-gated potassium currents present in smooth muscle cells from PA and DA. Finally, the role of nSMase in acute oxygen sensing was also observed in human PA and DA. Innovation: These data provide evidence for the proposal that nSMase-derived ceramide is a critical player in acute oxygen-sensing in specialized vascular tissues. Conclusion: Our results indicate that an increase in ceramide generation is involved in the vasoconstrictor responses induced by two opposite stimuli, such as hypoxia (in PA and CA) and normoxia (in DA).Item Cost-utility analysis of Palivizumab for Respiratory Syncytial Virus infection prophylaxis in preterm infants: update based on the clinical evidence in Spain(BMC Infectious Diseases, 2017) Sánchez Luna, Manuel Ramón; Burgos Pol, R.; Oyagüez, I.; Figueras Aloy, J.; Sánchez Solís, M.; Martinón Torres, F.; Carbonell Estrany, X.Background: This study aimed at estimating the efficiency of palivizumab in the prevention of Respiratory Syncytial Virus (RSV) infection and its sequelae in preterm infants (32day 1-35day 0weeks of gestational age –wGA-) in Spain. Methods: A decision-tree model was developed to compare health benefits (Quality Adjusted Life Years-QALYs) and costs of palivizumab versus a non-prophylaxis strategy over 6 years. A hypothetical cohort of 1,000 preterm infants, 32day 1-35day 0 wGA (4.356 kg average weight) at the beginning of the prophylaxis (15 mg/kg of palivizumab; 3.88 average number of injections per RSV season) was analysed. The model considered the most recent evidence from Spanish observational and epidemiological studies on RSV infection: the FLIP II study provided hospital admission and Intensive Care Unit (ICU) admission rates; in-hospital mortality rate was drawn from an epidemiological study from 2004 to 2012; recurrent wheezing rates associated to RSV infection from SPRING study were adjusted by the evidence on the palivizumab effect from clinical trials. Quality of life baseline value, number of hospitalized infants and the presence of recurrent wheezing over time were granted to estimate QALYs. National Health Service and societal perspective (included also recurrent wheezing indirect cost) were analysed. Total costs (€, 2016) included pharmaceutical and administration costs, hospitalization costs and recurrent wheezing management annual costs. A discount rate of 3.0% was applied annually for both costs and health outcomes. Results: Over 6 years, the base case analysis showed that palivizumab was associated to an increase of 0. 0731 QALYs compared to non-prophylaxis. Total costs were estimated in €2,110.71 (palivizumab) and €671.68 (non-prophylaxis) from the National Health System (NHS) perspective, resulting in an incremental cost utility ratio (ICUR) of €19,697.69/QALYs gained (prophylaxis vs non-prophylaxis). Results derived from the risk-factors population subgroups analysed were in line with the total population results. From the societal perspective, the incremental cost associated to palivizumab decreased to an €1,253.14 (ICUR = €17,153.16€/QALYs gained for palivizumab vs non-prophylaxis). One-way and probabilistic sensitivity analyses confirmed the robustness of the model. Conclusions: The prophylaxis with palivizumab is efficient for preventing from RSV infections in preterm infants 32day 1-35day 0 wGA in SpainItem Spanish population‐study shows that healthy late preterm infants had worse outcomes one year after discharge than term‐born infants(Acta Paediatrica: Nurturing the Child, 2018) Sánchez Luna, Manuel Ramón; Fernández Pérez, Cristina; Bernal, José Luis; Elola Somoza, Francisco JavierAim: This study assessed the risks associated with healthy late preterm infants and healthy term-born infants using national hospital discharge records. Method: We used the minimum basic data set of the Spanish hospital discharge records database for 2012-2013 to analyse the hospitalisation of newborn infants. The outcomes were in-hospital mortality and hospital re-admissions at 30 days and one year after their first discharge. Results: Of the 95 011 newborn infants who were discharged, 2940 were healthy late preterm infants, born at 34 + 0-36 + 6 weeks, and 18 197 were healthy term-born infants. The mean and standard deviation (SD) length of hospital stay were 6.0 (4.5) days in late preterm infants versus 2.8 (1.3) days in term-born infants (p < 0.001). Re-admissions were also higher in the late preterm group at 30 days (9.0% versus 4.4%) and one year (22.0% versus 12.4) (p < 0.001). The relative risk for death at one year was 4.9 in the late preterm group, when compared to the term-born infants (p = 0.026). Conclusion: The hospital discharge codes for otherwise healthy newborn preterm infants were associated with significantly worse 30-day and one-year outcomes when their re-admission and mortality rates were compared with healthy term-born newborn infants