For almost four years, the Dr. Antonio Artigas, from the translational patient research group in the area of infections and immunology at I3PT, is working on a line of research on the critically ill elderly in intensive care units (ICU): how to classify them, what are their prognoses, superinfections, sepsis…
Due to the COVID-19 pandemic, several sub-studies on the critically ill elderly patient and how the virus affects the sex of the patient have been derived from his research over the last year. posting in the journal Scientific Reports. He has also recently participated in a protocol for developing countries on the practice of a technique that helps to breathe non-intubated patients with severe breathing problems.
Aligned with the commitment of this institution to the RRI (Responsible Research and Innovation), Dr. Artigas will talk about sex differentiation in his studies, what conclusions he has reached in relation to the critically ill elderly with COVID-19 and his latest research results:
What determinant pushed him to start a line of research on the critically ill elderly in ICUs?
The number of critically ill elderly people has increased significantly in recent years as a result of the aging of our population. The European Society of Intensive Care Medicine decided to set up a working group to find out the characteristics of these patients and determine their prognostic factors. Fragility and severity in their entry (and not chronological age) are the main factors determining their short- and long-term prognosis.
How do you relate in the last year what until now was your research with the irruption of COVID-19?
The emergence of COVID-19 with its serious consequences has forced us to devote efforts to better understand the disease and investigate new therapeutic strategies. In our laboratory we are studying at a preclinical level the effect of anticoagulant nebulization and cell therapy with mesenchymal cells. Patients with severe COVID-19 are characterized by coagulopathy and inflammatory endothelitis that conditions a worsening of their clinical course and increased mortality.
We are analyzing the mechanisms of coagulation alteration and its relationship to the inflammatory response in patients with severe COVID-19 from the multicenter CIBER-COVID study. This clinical research, along with preclinical studies, will facilitate the establishment of a new therapeutic strategy to improve the survival of these patients.
How are you seeing it affect the virus in men and women?
There are differences in the prognosis of critically ill elderly patients and in patients with severe COVID-19. Our studies have been able to show a higher mortality in men compared to women admitted to the ICU. These differences are related to hormonal differences and the expression of receptors by the virus.
The pandemic has also had a greater social impact on women and also a greater risk of severity on pregnant women. All these facts must be taken into account in the management and prevention of the virus. " says Artigas
How important is sex differentiation to you in your search?
Today, and as I explained before, I believe that the impact of sex on the treatment of patients must be taken into account, as well as in experimental preclinical studies with animals (in the planning of our experiments with animals we always have in count their sex).
The last publication in which he has participated is serving as an influence in some countries. What did it consist of and what was that impact?
Invasive mechanical ventilation is necessary in patients with severe hypoxemic respiratory failure, but is very often associated with complications that may influence their prognosis. Many poor countries (or with fewer resources than more developed countries) do not have sufficient artificial ventilation systems. Our group together with a group of international experts has put forward recommendations and guidelines for implementing a non-invasive prone (lower abdomen) system to improve the oxygenation of these patients.
Its impact on preventing invasive ventilation has already been felt in countries such as Brazil. Simultaneously, our group is coordinating a multicenter international study in more than 40 centers to prospectively assess the benefit of applying pron decubitus in patients with severe hypoxemic respiratory failure. This study has the backing of companies Catalan, Spanish and European intensive care and its duration is three years.
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