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Barcelona, October 2010.- the team of the ICU of Hospital Vall d ’ Hebron and from the research group of Sepsis and respiratory infection serious of the Vall d ’ Hebron Institut de Recerca (VHIR), with Dr. Jordi Rello front, have presented important developments at the European Congress in intensive care (ESICM) that took place these days in Barcelona with the participation of more than 6,000 ICU. In addition to Dr. Rello, Mercedes Palomar, Joan Ramon Masclans, Oriol Roca and other prominent intensivistas of Vall D ’ Hebron have lectured on developments in the treatment of patients in the ICU.

This team has found his gravitas in the specialty to be the European Group which has submitted communications in the European Society of Intensive Care Medicine (ESICM), a reference to the specialty. His research team, as other many researchers, have benefited from the European register of cases of the flu virus A (H1N1), is Coordinator Dr. Rello, CIBERES researcher who led the field of intensive care during the most intense period of this pandemic. The registry has allowed to collect information and design studies of those who now start to be able to analyze the results. These results, no doubt, will provide valuable information and experience for future epidemics caused by similar viruses or inclús own seasonal flu.

In addition, at the meeting of the editorial board of the journal Intensive Care Medicine, been made public 10 consulted articles on the Internet during the year 2010. Two articles of the Group of Dr. Rello, one on prevention of pneumonia in patients with artificial respiration and the other on community pneumonia treatment are among the 10 most visited articles.

The Group of respiratory infection and Sepsis investigation serious the VHIR and the ICU of the Hospital of la Vall d ’ Hebron in the ESICM

Dr. Rello and his team have presented at this important Congress news and aspects related to his experience in the intensive care units, such as for example those related to flu itself, but also with other infections – more or less common in our environment. Because of the fragility of patients admitted in the ICU and the fact that they are often subjected to invasive techniques (catheters, mechanical ventilators, probes, etc.), to prevent infections acquired by these patients is one of the most concern to the experts. In this field, Dr. Rello has delivered a conference where rated the most innovative strategies to prevent these infections. These infections are often the cause of these sick descompensen, and for this reason have been discussed widely in this Congress, e.g., Aspergillus infection, – an opportunistic fungus that takes advantage of situations of weakness of the body to settle on the respiratory system. There have been guides of strategies to prevent these and other nosocomial infections (hospital acquired). Pneumonias caused by various pathogens, (very disturbing during the pandemic influenza to) killing pneumonias, techniques of routine in the ICU, echocardiography or techniques of nursing, among others.

A space that has been the great challenge of this last year for the intensivistas has also been highlighted: the income of patients in the ICU with influenza infection – this year influenza A (H1N1). An unusual fact that had not been previously lived. The severity of some cases with subsequent entry in the ICU and the fact that serious cases would have far more young people than usual, has aroused great interest in the research on this new virus. This was, and still, is what has more focused efforts by specialists, in the time trials to try to combat a disease that behaved very differently, and now researchers, to respond to these riddles. A paper presented by Dr. Martin-Loeches, and where also involved Dr. Rello has been singled out among the most prominent.

In this Congress also have been submitted, after the experience, the foundations for the treatments which proved to be useful and which not. This is the case of steroids, quite controversial, and which finally and after analysing the cases in the European register has confirmed that its use is not recommended “ routine ”, not the evolution of the patients improved and increased the risk of pneumonia. “ Systems non-invasive respiratory support did not change the evolution of those who had pneumonia ”, explains Dr. Rello. On the contrary, “ the use of antiviral drugs during the first two days of symptoms prevented serious complications, particularly among pregnant women ”, continues the doctor.

Other recent studies on the Grip to the Group of the VHIR serious respiratory infection and Sepsis research

This group, led by Dr. Jordi Rello, seeks answers to all questions raised during the pandemic, and in this sense has headed the clinical part of the study of the immune response in patients requiring admission to the ICU for severe pneumonia during the acute phase of influenza. The study has been conducted in collaboration with Dr. Jesus Bermejo of the national centre of Valladolid influenza, Pumarola Dr. of the Hospital Clínic de Barcelona and researchers from seven Spanish UCI, among them intensivistas of the Instituto Pere Virgil de Tarragona, the Fe of Valencia or Hospital Valme Seville, as well as Canadian groups. The findings of the study indicate that, in more serious cases, the failure of the immune response is unable to prevent the virus further replicating and this causes a vicious cycle that makes worse clinical situation to a critical situation. These results have been published in the latest edition of the journal Critical Care.

Patients infected with influenza A – H1N1 virus, with severe respiratory illness in the ICUs, suffer a failure in the activation of a group of genes involved in the Adaptive immune response, resulting in the persistence of the virus in respiratory treatment. In those patients resulting in more severe cases, “ the failure of activation of these genes leads to a constant cycle of replication of the virus which stimulates the release of citokinas, a few molecules mediators of inflammation, and which could be the cause of the pulmonary damage observed in these cases ”concrete Dr. Rello. On the other hand, in cases which have not been so serious noted that genes that regulate the Adaptive immune response were activated.

Researchers conclude that the interruption of this harmful cycle could be the key to controlling viral infection and improving the progression of the disease and at the moment are analyzing the results allow to conclude what treatments in these extreme casesthey can avoid a deterioration that will lead to the patient in the ICU or rescuing the patient of an artificial respirator.