ORCID Profile
0000-0001-7894-873X
Current Organisations
Chelsea and Westminster Hospital NHS Foundation Trust
,
Imperial College London
,
Stanford University
,
Universidad de Buenos Aires Facultad de Medicina
,
Imperial College London Faculty of Medicine
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Publications
Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial
Publisher: Elsevier BV
Date: 02-2020
Traumatic brain injury: intensive care management
Publisher: Elsevier BV
Date: 07-2007
DOI: 10.1093/BJA/AEM139
Abstract: Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. The modern management of severe TBI has fallen into the domain of a multidisciplinary team led by neurointensivists, neuroanaesthetists, and neurosurgeons and is based on the avoidance of secondary injury, maintenance of cerebral perfusion pressure (CPP), and optimization of cerebral oxygenation. In this review, we will discuss the intensive care management of severe TBI with emphasis on the specific measures directed at the control of intracranial pressure and CPP.
Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study
Publisher: Springer Science and Business Media LLC
Date: 26-02-2021
Platelet Quiescence in Patients With Acute Coronary Syndrome Undergoing Coronary Artery Bypass Graft Surgery
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-03-2021
Abstract: The optimal antiplatelet strategy for patients with acute coronary syndromes who require coronary artery bypass surgery remains unclear. While a more potent antiplatelet regimen will predispose to perioperative bleeding, it is hypothesized that through “platelet quiescence,” ischemic protection conferred by such therapy may provide a net clinical benefit. We compared patients undergoing coronary artery bypass surgery who were treated with a more potent antiplatelet inhibition strategy with those with a less potent inhibition through a meta‐analysis. The primary outcome was all‐cause mortality after bypass surgery. The analysis identified 4 studies in which the antiplatelet regimen was randomized and 6 studies that were nonrandomized. Combining all studies, there was an overall higher mortality with weaker strategies compared with more potent strategies (odds ratio, 1.38 95% CI, 1.03–1.85 P =0.03). Our findings support the concept of platelet quiescence, in reducing mortality for patients with acute coronary syndrome requiring coronary artery bypass surgery. This suggests the routine up‐front use of potent antiplatelet regimens in acute coronary syndrome, irrespective of likelihood of coronary artery bypass graft.
Perioperative Aspirin and Clonidine and Risk of Acute Kidney Injury
Publisher: American Medical Association (AMA)
Date: 03-12-2014
Abstract: Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury however, these effects are uncertain and each intervention has the potential for harm. To determine whether aspirin compared with placebo, and clonidine compared with placebo, alters the risk of perioperative acute kidney injury. A 2 × 2 factorial randomized, blinded, clinical trial of 6905 patients undergoing noncardiac surgery from 88 centers in 22 countries with consecutive patients enrolled between January 2011 and December 2013. Patients were assigned to take aspirin (200 mg) or placebo 2 to 4 hours before surgery and then aspirin (100 mg) or placebo daily up to 30 days after surgery, and were assigned to take oral clonidine (0.2 mg) or placebo 2 to 4 hours before surgery, and then a transdermal clonidine patch (which provided clonidine at 0.2 mg/d) or placebo patch that remained until 72 hours after surgery. Acute kidney injury was primarily defined as an increase in serum creatinine concentration from the preoperative concentration by either an increase of 0.3 mg/dL or greater (≥26.5 μmol/L) within 48 hours of surgery or an increase of 50% or greater within 7 days of surgery. Aspirin (n = 3443) vs placebo (n = 3462) did not alter the risk of acute kidney injury (13.4% vs 12.3%, respectively adjusted relative risk, 1.10 95% CI, 0.96-1.25). Clonidine (n = 3453) vs placebo (n = 3452) did not alter the risk of acute kidney injury (13.0% vs 12.7%, respectively adjusted relative risk, 1.03 95% CI, 0.90-1.18). Aspirin increased the risk of major bleeding. In a post hoc analysis, major bleeding was associated with a greater risk of subsequent acute kidney injury (23.3% when bleeding was present vs 12.3% when bleeding was absent adjusted hazard ratio, 2.20 95% CI, 1.72-2.83). Similarly, clonidine increased the risk of clinically important hypotension. In a post hoc analysis, clinically important hypotension was associated with a greater risk of subsequent acute kidney injury (14.3% when hypotension was present vs 11.8% when hypotension was absent adjusted hazard ratio, 1.34 95% CI, 1.14-1.58). Among patients undergoing major noncardiac surgery, neither aspirin nor clonidine administered perioperatively reduced the risk of acute kidney injury. clinicaltrials.gov Identifier: NCT01082874.
Clonidine in Patients Undergoing Noncardiac Surgery
Publisher: Massachusetts Medical Society
Date: 17-04-2014
Aspirin in Patients Undergoing Noncardiac Surgery
Publisher: Massachusetts Medical Society
Date: 17-04-2014
Related Organisations
Chelsea And Westminster Hospital NHS Foundation Trust
Location: United Kingdom of Great Britain and Northern Ireland
Imperial College London
Location: United Kingdom of Great Britain and Northern Ireland
Imperial College London Faculty Of Medicine
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for Marcela Vizcaychipi.