We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
A procedure that, by introducing a flexible tube (bronchoscope) into the nose or mouth, allows the bronchial tree to be viewed, for diagnostic and/or therapeutic purposes.
To examine the bronchial tree and obtain samples of secretions or tissues for analysis with the aim of gaining an aetiological diagnosis of the causative illness. It can also be a therapeutic test, allowing suction of secretions or clots, extraction of foreign bodies, permeability of the airway in lung tumours and treatment of complications resulting from lung transplant.
With the patient normally lying down and consciously sedated, the bronchoscope is introduced into the airway, administering local anaesthesia in the passageways (larynx, trachea and bronchi). After examining all the bronchi and identifying any possible lesions, samples are taken, which may include: bronchial aspiration, bronchoalveolar lavage, bronchial brushing, transbronchial puncture, bronchial biopsy or transbronchial biopsy.
Minor undesirable affects may appear, such as snoring, cough, fever, localised pain, nausea or sickness and coughing up small amounts of blood, which are usually self-limiting and present no risk to life. Less commonly, major complications may occur, such as haemorrhage, low blood pressure, high blood pressure, pneumothorax (entry of air into the thorax outside of the lung). In very rare cases, complications such as arrhythmia or arrest of the heart, respiratory depression or arrest and acute stroke, may be severe and require medical or surgical treatment, including a small risk of death.
Rigid bronchoscopy, CT-guided needle lung biopsy, mediastinoscopy, surgical lung biopsy.
Pneumonia is an infection of the lung tissue.
Depending on the extent of pneumonia in the respiratory tract, different types are identified:
It can be caused by many different microorganisms, although the most common causes are S. pneumoniae (pneumococcus) and Mycoplasma.
Other microorganisms that can also cause pneumonia include Haemophilus, Klebsiella, Staphylococcus aureus, Legionella pneumophila, Chlamydia pneumoniae and some viruses.
Characterised by high fever, coughing, with or without sputum, and often chest pain, which may increase with respiratory movements. Sometimes sputum has a brownish or rusty appearance, which points to pneumonia caused by pneumococcus.
The so-called atypical pneumonia, caused by Mycoplasma or Chlamydia among others, is often characterised by fever with very few respiratory symptoms.
Pneumonia is a very common disease (350,000 cases/year in Spain) and is a significant cause of mortality in the general population. It can affect all age groups.
In previously healthy people it is a disease of mild or moderate severity. It can even be treated at home or in outpatient care, but in patients with previous pathology (immunocompromised, heart failure, previous respiratory failure), it is generally serious.
The appropriate use of antibiotics, together with occasional respiratory support measures (oxygen therapy or even intubation), contributes significantly to improving the chances of cure in the most severe cases.
It is performed based on the patient's clinical history (age, previous pathology, evolution time and type of symptoms), auscultation, chest radiography and blood and sputum cultures to identify the causative organism.
Antigens can also be detected in urine for pneumococcus and Legionella.
The treatment is antibiotic, based on a clinical estimate of the possibility of it being caused by one germ or another (in many cases treatment is started immediately without knowing the causal organism). Treatment is later maintained or changed according to the cultures and the patient's evolution.
The criterion for inpatient or outpatient treatment depends on the estimation of the risks that may occur (older age, previous pathology, impairment of respiratory function).
In a previously healthy patient, treatment may be in outpatient care.
Chest x-ray, blood and sputum or respiratory secretion cultures and determination of antigens in urine.
ECMO is a technique used in critical patients suffering from extremely serious respiratory and/or cardiovascular diseases where conventional life support is insufficient. The machine temporarily replaces lung or heart function, enabling the organs to rest while the underlying illness is treated.
The machine removes blood through a thick tube inserted into a major vein and transfers it to a centrifugal pump. The pump pushes it through an oxygenator, where oxygen is added and carbon dioxide removed. Subsequently, it is reintroduced into the patient’s body. If this is done through another vein, it is known as veno-venous (VV) ECMO and provides respiratory support. Where it is done via an artery, this is known as veno-arterial (VA) ECMO and provides support for both the heart and lungs.
ECMO is not a treatment per se but rather a support mechanism. It optimises organ recovery but does not resolve the underlying problem. In fact, one of the reasons to use the procedure is its reversibility for patients. The system is highly effective in replacing vital organ function. However, it is currently a last option for a specific patient group given its complex nature and associated risks, such as bleeding, thrombosis and infection.
Regardless of the support strategy chosen, this is a highly complex technique associated with a high risk of serious complications. That is why, in order to ensure excellent care, a well-organised programme is required, with optimal material and sufficient numbers of properly trained staff. Cases need to be clustered at leading centres and units with the necessary resources and material to ensure effectiveness, as well as a highly trained multidisciplinary team.
The Extracorporeal Life Support Organization (ELSO) is the benchmark international scientific association for ECMO. It establishes care and organisational guidelines, coordinates teaching activities and promotes research in the field. The organisation has a multi-centre database with information on over 200,000 patients. Although patients receive optimal care through ECMO with excellent survival rates, they often have later side effects due to the seriousness of their illness and the intense nature of their care, both during ECMO and with prior treatment.
Vall d’Hebron is home to two ECMO programmes. One is for adult patients and led by Dr Jordi Riera, and the other is for children and new-born patients, led by Dr Joan Balcells.
Our programmes follow ELSO guidelines at all levels, from lifelong, multidisciplinary and skill-based training for ECMO teams to filling in records for continuous assessment, as well as optimised protocols that align with our context and setting.
Our programmes take a long-term outlook, focused on getting patients back to their daily lives with maximum functional recovery. In this sense, we prioritise minimal deep sedation and safe early physical rehabilitation, even where recovery of the failed organ is still ongoing. ECMO support makes this possible by substituting heart and lung functions. Moreover, patients are able to directly interact with professionals and family members.
Veno-Arterial (VA) and Veno-Venous (VV):
The VA option provides heart and lung support by taking over organ functions. It is used when there is a cardiorespiratory problem, such as a heart attack or myocarditis (inflammation). The VV option is used to provide respiratory support and takes over lung function. It is used where there is a breathing issue, such as pneumonia or an acute blockage in the airways.
Peripheral or central line:
Patients are normally connected to an ECMO machine through cannulae (thick tubes) in the neck or groin. This is known as a peripheral line. At times, the machine needs to be directly connected to a patient’s heart or very close to the heart through the chest. This is known as a central line.
Special scenarios:
ECMO is an effective system but can pose major risks for patients. In terms of frequency and potential seriousness, these risks include bleeding and infection.
Bleeding is due to the fact that patients are often treated with blood thinners. Infection is due to receiving highly invasive therapy and the severity of the illness.
In order to minimise these risks, it is essential to have a properly trained multidisciplinary ECMO team, cluster ECMO cases and resources, and ensure robust records comparable to other consolidated external records.
Our mission is to restore the health of all critical or potentially critical hospital patients using advanced monitoring and support systems. Our work with patients is carried out both within the Intensive Care Unit and outside it, 24 hours a day, every day of the year. We have the knowledge and technical means to treat the most complex patients.
The Intensive Care Unit (ICU) treats 1,200 of the most complex critical patients every year. Additionally, the Department supports other serious patients not in the ICU but who require assessment from specialists in intensive care medicine.
The Intensive Care Medicine Department leads many hospital programmes, such as: Code Sepsis, care for cardiorespiratory disease and the ECMO programme, and collaborates actively in the Organ Donation and Transplant Programme.
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