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González R, Maldonado F, Cornejo R. Individual PEEP in Obesity: Comment. Anesthesiology 2024; 140:1050-1051. [PMID: 38427817 DOI: 10.1097/aln.0000000000004882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Roberto González
- Clinical Hospital of the University of Chile, Santiago, Chile (R.G.).
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Cornejo R, Telias I, Brochard L. Measuring patient's effort on the ventilator. Intensive Care Med 2024; 50:573-576. [PMID: 38436722 DOI: 10.1007/s00134-024-07352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Rodrigo Cornejo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Irene Telias
- Division of Respirology and Critical Care Medicine, Department of Medicine, University Health Network and Sinai Health System, Toronto, Canada
- Medical Surgical Neuro ICU, Toronto Western Hospital, University Health Network, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada.
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Fernández Ceballos I, Steinberg E, Ems J, Nuñez Silveira JM, Madorno M, Carboni Bisso I, Las Heras M, Cornejo R. Physiological effect of high flow oxygen therapy measured by electrical impedance tomography in single-lung transplantation. Medicina (B Aires) 2024; 84:148-152. [PMID: 38271942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
In patients with chronic obstructive pulmonary disease (COPD), single lung transplantation (SLT) is sometimes performed as an alternative to bilateral lung transplantation due to limited organ availability. However, the postoperative management of SLT presents challenges, including complications related to the distinct compliance of each lung. This case report presents the case of a 65-year-old male patient who underwent SLT and was in the weaning period from mechanical ventilation. High-flow oxygen therapy (HFOT) was administered, and the physiological effects were measured using electrical impedance tomography (EIT). The results demonstrated that the application of HFOT increased air trapping and overdistention in the native lung without benefiting the transplanted lung. HFOT through a tracheostomy tube or nasal cannula resulted in a more heterogeneous distribution of ventilation, with increased end expiratory lung impedance, prolonged expiratory time constants, and an increase in silent spaces. The drop in tidal impedance after applying HFOT did not indicate hypoventilation but rather overdistention and air trapping in the native lung, while the transplanted lung showed evidence of hypoventilation. These findings suggest that HFOT may not be beneficial for SLT patients and could potentially worsen outcomes. However, due to the limited scope of this case report, further prospective studies with larger patient cohorts are needed to confirm these results.
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Affiliation(s)
| | - Emilio Steinberg
- Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Argentina
| | | | | | | | | | - Marcos Las Heras
- Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Argentina
| | - Rodrigo Cornejo
- Unidad de Pacientes Críticos, Hospital Clínico Universidad de Chile, Chile
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Basoalto R, Damiani LF, Jalil Y, Bachmann MC, Oviedo V, Alegría L, Valenzuela ED, Rovegno M, Ruiz-Rudolph P, Cornejo R, Retamal J, Bugedo G, Thille AW, Bruhn A. Physiological effects of high-flow nasal cannula oxygen therapy after extubation: a randomized crossover study. Ann Intensive Care 2023; 13:104. [PMID: 37851284 PMCID: PMC10584771 DOI: 10.1186/s13613-023-01203-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Prophylactic high-flow nasal cannula (HFNC) oxygen therapy can decrease the risk of extubation failure. It is frequently used in the postextubation phase alone or in combination with noninvasive ventilation. However, its physiological effects in this setting have not been thoroughly investigated. The aim of this study was to determine comprehensively the effects of HFNC applied after extubation on respiratory effort, diaphragm activity, gas exchange, ventilation distribution, and cardiovascular biomarkers. METHODS This was a prospective randomized crossover physiological study in critically ill patients comparing 1 h of HFNC versus 1 h of standard oxygen after extubation. The main inclusion criteria were mechanical ventilation for at least 48 h due to acute respiratory failure, and extubation after a successful spontaneous breathing trial (SBT). We measured respiratory effort through esophageal/transdiaphragmatic pressures, and diaphragm electrical activity (ΔEAdi). Lung volumes and ventilation distribution were estimated by electrical impedance tomography. Arterial and central venous blood gases were analyzed, as well as cardiac stress biomarkers. RESULTS We enrolled 22 patients (age 59 ± 17 years; 9 women) who had been intubated for 8 ± 6 days before extubation. Respiratory effort was significantly lower with HFNC than with standard oxygen therapy, as evidenced by esophageal pressure swings (5.3 [4.2-7.1] vs. 7.2 [5.6-10.3] cmH2O; p < 0.001), pressure-time product (85 [67-140] vs. 156 [114-238] cmH2O*s/min; p < 0.001) and ΔEAdi (10 [7-13] vs. 14 [9-16] µV; p = 0.022). In addition, HFNC induced increases in end-expiratory lung volume and PaO2/FiO2 ratio, decreases in respiratory rate and ventilatory ratio, while no changes were observed in systemic hemodynamics, Troponin T, or in amino-terminal pro-B-type natriuretic peptide. CONCLUSIONS Prophylactic application of HFNC after extubation provides substantial respiratory support and unloads respiratory muscles. Trial registration January 15, 2021. NCT04711759.
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Affiliation(s)
- Roque Basoalto
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile
- Programa de Medicina Física y Rehabilitación, Red Salud UC-CHRISTUS, Santiago, Chile
- CardioREspirAtory Research Laboratory (CREAR), Departamento de Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - L Felipe Damiani
- CardioREspirAtory Research Laboratory (CREAR), Departamento de Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yorschua Jalil
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile
- CardioREspirAtory Research Laboratory (CREAR), Departamento de Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Consuelo Bachmann
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile
- CardioREspirAtory Research Laboratory (CREAR), Departamento de Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago, Chile
- Carrera de Kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Vanessa Oviedo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile
| | - Leyla Alegría
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile
- Departamento de Salud del Adulto y Senescente, Escuela de. Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Emilio Daniel Valenzuela
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile
| | - Maximiliano Rovegno
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile
| | - Pablo Ruiz-Rudolph
- Programa de Epidemiología, Instituto de Salud Poblacional, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Rodrigo Cornejo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
- Center of Acute Respiratory Critical Illness (ARCI), Santiago, Chile
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile
- Center of Acute Respiratory Critical Illness (ARCI), Santiago, Chile
| | - Guillermo Bugedo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile
| | - Arnaud W Thille
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- INSERM Centre d'Investigation Clinique 1402 IS-ALIVE, Université de Poitiers, Poitiers, France
| | - Alejandro Bruhn
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile.
- Center of Acute Respiratory Critical Illness (ARCI), Santiago, Chile.
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Pham T, Heunks L, Bellani G, Madotto F, Aragao I, Beduneau G, Goligher EC, Grasselli G, Laake JH, Mancebo J, Peñuelas O, Piquilloud L, Pesenti A, Wunsch H, van Haren F, Brochard L, Laffey JG, Acharya SP, Amin P, Arabi Y, Aragao I, Bauer P, Beduneau G, Beitler J, Berkius J, Bugedo G, Camporota L, Cerny V, Cho YJ, Clarkson K, Estenssoro E, Goligher E, Grasselli G, Gritsan A, Hashemian SM, Hermans G, Heunks LM, Jovanovic B, Kurahashi K, Laake JH, Matamis D, Moerer O, Molnar Z, Ozyilmaz E, Panka B, Papali A, Peñuelas Ó, Perbet S, Piquilloud L, Qiu H, Razek AA, Rittayamai N, Roldan R, Serpa Neto A, Szuldrzynski K, Talmor D, Tomescu D, Van Haren F, Villagomez A, Zeggwagh AA, Abe T, Aboshady A, Acampo-de Jong M, Acharya S, Adderley J, Adiguzel N, Agrawal VK, Aguilar G, Aguirre G, Aguirre-Bermeo H, Ahlström B, Akbas T, Akker M, Al Sadeh G, Alamri S, Algaba A, Ali M, Aliberti A, Allegue JM, Alvarez D, Amador J, Andersen FH, Ansari S, Apichatbutr Y, Apostolopoulou O, Arabi Y, Arellano D, Arica M, Arikan H, Arinaga K, Arnal JM, Asano K, Asín-Corrochano M, Avalos Cabrera JM, Avila Fuentes S, Aydemir S, Aygencel G, Azevedo L, Bacakoglu F, Badie J, Baedorf Kassis E, Bai G, Balaraj G, Ballico B, Banner-Goodspeed V, Banwarie P, Barbieri R, Baronia A, Barrett J, Barrot L, Barrueco-Francioni JE, Barry J, Bauer P, Bawangade H, Beavis S, Beck E, Beehre N, Belenguer Muncharaz A, Bellani G, Belliato M, Bellissima A, Beltramelli R, Ben Souissi A, Benitez-Cano A, Benlamin M, Benslama A, Bento L, Benvenuti D, Berkius J, Bernabe L, Bersten A, Berta G, Bertini P, Bertram-Ralph E, Besbes M, Bettini LR, Beuret P, Bewley J, Bezzi M, Bhakhtiani L, Bhandary R, Bhowmick K, Bihari S, Bissett B, Blythe D, Bocher S, Boedjawan N, Bojanowski CM, Boni E, Boraso S, Borelli M, Borello S, Borislavova M, Bosma KJ, Bottiroli M, Boyd O, Bozbay S, Briva A, Brochard L, Bruel C, Bruni A, Buehner U, Bugedo G, Bulpa P, Burt K, Buscot M, Buttera S, Cabrera J, Caccese R, Caironi P, Canchos Gutierrez I, Canedo N, Cani A, Cappellini I, Carazo J, Cardonnet LP, Carpio D, Carriedo D, Carrillo R, Carvalho J, Caser E, Castelli A, Castillo Quintero M, Castro H, Catorze N, Cengiz M, Cereijo E, Ceunen H, Chaintoutis C, Chang Y, Chaparro G, Chapman C, Chau S, Chavez CE, Chelazzi C, Chelly J, Chemouni F, Chen K, Chena A, Chiarandini P, Chilton P, Chiumello D, Cho YJ, Chou-Lie Y, Chudeau N, Cinel I, Cinnella G, Clark M, Clark T, Clarkson K, Clementi S, Coaguila L, Codecido AJ, Collins A, Colombo R, Conde J, Consales G, Cook T, Coppadoro A, Cornejo R, Cortegiani A, Coxo C, Cracchiolo AN, Crespo Ramirez M, Crova P, Cruz J, Cubattoli L, Çukurova Z, Curto F, Czempik P, D'Andrea R, da Silva Ramos F, Dangers L, Danguy des Déserts M, Danin PE, Dantas F, Daubin C, Dawei W, de Haro C, de Jesus Montelongo F, De Mendoza D, de Pablo R, De Pascale G, De Rosa S, Decavèle M, Declercq PL, Deicas A, del Carmen Campos Moreno M, Dellamonica J, Delmas B, Demirkiran O, Demirkiran H, Dendane T, di Mussi R, Diakaki C, Diaz A, Diaz W, Dikmen Y, Dimoula A, Doble P, Doha N, Domingos G, Dres M, Dries D, Duggal A, Duke G, Dunts P, Dybwik K, Dykyy M, Eckert P, Efe S, Elatrous S, Elay G, Elmaryul AS, Elsaadany M, Elsayed H, Elsayed S, Emery M, Ena S, Eng K, Englert JA, Erdogan E, Ergin Ozcan P, Eroglu E, Escobar M, Esen F, Esen Tekeli A, Esquivel A, Esquivel Gallegos H, Ezzouine H, Facchini A, Faheem M, Fanelli V, Farina MF, Fartoukh M, Fehrle L, Feng F, Feng Y, Fernandez I, Fernandez B, Fernandez-Rodriguez ML, Ferrando C, Ferreira da Silva MJ, Ferreruela M, Ferrier J, Flamm Zamorano MJ, Flood L, Floris L, Fluckiger M, Forteza C, Fortunato A, Frans E, Frattari A, Fredes S, Frenzel T, Fumagalli R, Furche MA, Fusari M, Fysh E, Galeas-Lopez JL, Galerneau LM, Garcia A, Garcia MF, Garcia E, Garcia Olivares P, Garlicki J, Garnero A, Garofalo E, Gautam P, Gazenkampf A, Gelinotte S, Gelormini D, Ghrenassia E, Giacomucci A, Giannoni R, Gigante A, Glober N, Gnesin P, Gollo Y, Gomaa D, Gomero Paredes R, Gomes R, Gomez RA, Gomez O, Gomez A, Gondim L, Gonzalez M, Gonzalez I, Gonzalez-Castro A, Gordillo Romero O, Gordo F, Gouin P, Graf Santos J, Grainne R, Grando M, Granov Grabovica S, Grasselli G, Grasso S, Grasso R, Grimmer L, Grissom C, Gritsan A, Gu Q, Guan XD, Guarracino F, Guasch N, Guatteri L, Gueret R, Guérin C, Guerot E, Guitard PG, Gül F, Gumus A, Gurjar M, Gutierrez P, Hachimi A, Hadzibegovic A, Hagan S, Hammel C, Han Song J, Hanlon G, Hashemian SM, Heines S, Henriksson J, Herbrecht JE, Heredia Orbegoso GO, Hermans G, Hermon A, Hernandez R, Hernandez C, Herrera L, Herrera-Gutierrez M, Heunks L, Hidalgo J, Hill D, Holmquist D, Homez M, Hongtao X, Hormis A, Horner D, Hornos MC, Hou M, House S, Housni B, Hugill K, Humphreys S, Humbert L, Hunter S, Hwa Young L, Iezzi N, Ilutovich S, Inal V, Innes R, Ioannides P, Iotti GA, Ippolito M, Irie H, Iriyama H, Itagaki T, Izura J, Izza S, Jabeen R, Jamaati H, Jamadarkhana S, Jamoussi A, Jankowski M, Jaramillo LA, Jeon K, Jeong Lee S, Jeswani D, Jha S, Jiang L, Jing C, Jochmans S, Johnstad BA, Jongmin L, Joret A, Jovanovic B, Junhasavasdikul D, Jurado MT, Kam E, Kamohara H, Kane C, Kara I, Karakurt S, Karnjanarachata C, Kataoka J, Katayama S, Kaushik S, Kelebek Girgin N, Kerr K, Kerslake I, Khairnar P, Khalid A, Khan A, Khanna AK, Khorasanee R, Kienhorst D, Kirakli C, Knafelj R, Kol MK, Kongpolprom N, Kopitko C, Korkmaz Ekren P, Kubisz-Pudelko A, Kulcsar Z, Kumasawa J, Kurahashi K, Kuriyama A, Kutchak F, Laake JH, Labarca E, Labat F, Laborda C, Laca Barrera MA, Lagache L, Landaverde Lopez A, Lanspa M, Lascari V, Le Meur M, Lee SH, Lee YJ, Lee J, Lee WY, Lee J, Legernaes T, Leiner T, Lemiale V, Leonor T, Lepper PM, Li D, Li H, Li O, Lima AR, Lind D, Litton E, Liu N, Liu L, Liu J, Llitjos JF, Llorente B, Lopez R, Lopez CE, Lopez Nava C, Lovazzano P, Lu M, Lucchese F, Lugano M, Lugo Goytia G, Luo H, Lynch C, Macheda S, Madrigal Robles VH, Maggiore SM, Magret Iglesias M, Malaga P, Mallapura Maheswarappa H, Malpartida G, Malyarchikov A, Mansson H, Manzano A, Marey I, Marin N, Marin MDC, Markman E, Martin F, Martin A, Martin Dal Gesso C, Martinez F, Martínez-Fidalgo C, Martin-Loeches I, Mas A, Masaaki S, Maseda E, Massa E, Mattsson A, Maugeri J, McCredie V, McCullough J, McGuinness S, McKown A, Medve L, Mei C, Mellado Artigas R, Mendes V, Mervat MKE, Michaux I, Mikhaeil M, Milagros O, Milet I, Millan MT, Minwei Z, Mirabella L, Mishra S, Mistraletti G, Mochizuki K, Moerer O, Moghal A, Mojoli F, Molin A, Molnar Z, Montiel R, Montini L, Monza G, Mora Aznar M, Morakul S, Morales M, Moreno Torres D, Morocho Tutillo DR, Motherway C, Mouhssine D, Mouloudi E, Muñoz T, Munoz de Cabo C, Mustafa M, Muthuchellappan R, Muthukrishnan M, Muttini S, Nagata I, Nahar D, Nakanishi M, Nakayama I, Namendys-Silva SA, Nanchal R, Nandakumar S, Nasi A, Nasir K, Navalesi P, Naz Aslam T, Nga Phan T, Nichol A, Niiyama S, Nikolakopoulou S, Nikolic E, Nitta K, Noc M, Nonas S, Nseir S, Nur Soyturk A, Obata Y, Oeckler R, Oguchi M, Ohshimo S, Oikonomou M, Ojados A, Oliveira MT, Oliveira Filho W, Oliveri C, Olmos A, Omura K, Orlandi MC, Orsenigo F, Ortiz-Ruiz De Gordoa L, Ota K, Ovalle Olmos R, Öveges N, Oziemski P, Ozkan Kuscu O, Özyilmaz E, Pachas Alvarado F, Pagella G, Palaniswamy V, Palazon Sanchez EL, Palmese S, Pan G, Pan W, Panka B, Papanikolaou M, Papavasilopoulou T, Parekh A, Parke R, Parrilla FJ, Parrilla D, Pasha T, Pasin L, Patão L, Patel M, Patel G, Pati BK, Patil J, Pattnaik S, Paul D, Pavesi M, Pavlotsky VA, Paz G, Paz E, Pecci E, Pellegrini C, Peña Padilla AG, Perchiazzi G, Pereira T, Pereira V, Perez M, Perez Calvo C, Perez Cheng M, Perez Maita R, Pérez-Araos R, Perez-Teran P, Perez-Torres D, Perkins G, Persona P, Petnak T, Petrova M, Pham T, Philippart F, Picetti E, Pierucci E, Piervincenzi E, Pinciroli R, Pintado MC, Piquilloud L, Piraino T, Piras S, Piras C, Pirompanich P, Pisani L, Platas E, Plotnikow G, Porras W, Porta V, Portilla M, Portugal J, Povoa P, Prat G, Pratto R, Preda G, Prieto I, Prol-Silva E, Pugh R, Qi Y, Qian C, Qin T, Qiu H, Qu H, Quintana T, Quispe Sierra R, Quispe Soto R, Rabbani R, Rabee M, Rabie A, Rahe Pereira MA, Rai A, Raj Ashok S, Rajab M, Ramdhani N, Ramey E, Ranieri M, Rathod D, Ray B, Redwanul Huq SM, Regli A, Reina R, Resano Sarmiento N, Reynaud F, Rialp G, Ricart P, Rice T, Richardson A, Rieder M, Rinket M, Rios F, Rios F, Risso Vazquez A, Rittayamai N, Riva I, Rivette M, Roca O, Roche-Campo F, Rodriguez C, Rodriguez G, Rodriguez Gonzalez D, Rodriguez Tucto XY, Rogers A, Romano ME, Rørtveit L, Rose A, Roux D, Rouze A, Rubatto Birri PN, Ruilan W, Ruiz Robledo A, Ruiz-Aguilar AL, Sadahiro T, Saez I, Sagardia J, Saha R, Saha R, Saiphoklang N, Saito S, Salem M, Sales G, Salgado P, Samavedam S, Sami Mebazaa M, Samuelsson L, San Juan Roman N, Sanchez P, Sanchez-Ballesteros J, Sandoval Y, Sani E, Santos M, Santos C, Sanui M, Saravanabavan L, Sari S, Sarkany A, Sauneuf B, Savioli M, Sazak H, Scano R, Schneider F, Schortgen F, Schultz MJ, Schwarz GL, Seçkin Yücesoy F, Seely A, Seiler F, Seker Tekdos Y, Seok Chan K, Serano L, Serednicki W, Serpa Neto A, Setten M, Shah A, Shah B, Shang Y, Shanmugasundaram P, Shapovalov K, Shebl E, Shiga T, Shime N, Shin P, Short J, Shuhua C, Siddiqui S, Silesky Jimenez JI, Silva D, Silva Sales B, Simons K, Sjøbø BÅ, Slessor D, Smiechowicz J, Smischney N, Smith P, Smith T, Smith M, Snape S, Snyman L, Soetens F, Sook Hong K, Sosa Medellin MÁ, Soto G, Souloy X, Sousa E, Sovatzis S, Sozutek D, Spadaro S, Spagnoli M, Spångfors M, Spittle N, Spivey M, Stapleton A, Stefanovic B, Stephenson L, Stevenson E, Strand K, Strano MT, Straus S, Sun C, Sun R, Sundaram V, SunPark T, Surlemont E, Sutherasan Y, Szabo Z, Szuldrzynski K, Tainter C, Takaba A, Tallott M, Tamasato T, Tang Z, Tangsujaritvijit V, Taniguchi L, Taniguchi D, Tarantino F, Teerapuncharoen K, Temprano S, Terragni P, Terzi N, Thakur A, Theerawit P, Thille AW, Thomas M, Thungtitigul P, Thyrault M, Tilouch N, Timenetsky K, Tirapu J, Todeschini M, Tomas R, Tomaszewski C, Tonetti T, Tonnelier A, Trinder J, Trongtrakul K, Truwit J, Tsuei B, Tulaimat A, Turan S, Turkoglu M, Tyagi S, Ubeda A, Vagginelli F, Valenti MF, Vallverdu I, Van Axel A, van den Hul I, van der Hoeven H, Van Der Meer N, Van Haren F, Vanhoof M, Vargas-Ordoñez M, Vaschetto R, Vascotto E, Vatsik M, Vaz A, Vazquez-Sanchez A, Ventura S, Vermeijden JW, Vidal A, Vieira J, Vilela Costa Pinto B, Villagomez A, Villagra A, Villegas Succar C, Vinorum OG, Vitale G, Vj R, Vochin A, Voiriot G, Volta CA, von Seth M, Wajdi M, Walsh D, Wang S, Wardi G, Ween-Velken NC, Wei BL, Weller D, Welsh D, Welters I, Wert M, Whiteley S, Wilby E, Williams E, Williams K, Wilson A, Wojtas J, Won Huh J, Wrathall D, Wright C, Wu JF, Xi G, Xing ZJ, Xu H, Yamamoto K, Yan J, Yáñez J, Yang X, Yates E, Yazicioglu Mocin O, Ye Z, Yildirim F, Yoshida N, Yoshido HHL, Young Lee B, Yu R, Yu G, Yu T, Yuan B, Yuangtrakul N, Yumoto T, Yun X, Zakalik G, Zaki A, Zalba-Etayo B, Zambon M, Zang B, Zani G, Zarka J, Zerbi SM, Zerman A, Zetterquist H, Zhang J, Zhang H, Zhang W, Zhang G, Zhang W, Zhao H, Zheng J, Zhu B, Zumaran R. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study. Lancet Respir Med 2023; 11:465-476. [PMID: 36693401 DOI: 10.1016/s2213-2600(22)00449-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. METHODS WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. FINDINGS Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. INTERPRETATION In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. FUNDING European Society of Intensive Care Medicine, European Respiratory Society.
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Affiliation(s)
- Tài Pham
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de Recherche CARMAS, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France; Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France
| | - Leo Heunks
- Department of Intensive Care Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - Fabiana Madotto
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Aragao
- Department of Intensive Care Medicine, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Gaëtan Beduneau
- Normandie University, UNIROUEN, UR 3830, CHU Rouen, Department of Medical Intensive Care, F-76000 Rouen, France
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Department of Medicine, Division of Respirology, Toronto General Hospital Research Institute University Health Network, Toronto, Canada
| | - Giacomo Grasselli
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Jon Henrik Laake
- Department of Anaesthesiology and Department of Research and Development, Division of Critical Care and Emergencies, Oslo University Hospital, Oslo, Norway
| | - Jordi Mancebo
- Department of Intensive Care Medicine, Hospital Universitari Sant Pau, Barcelona, Spain
| | - Oscar Peñuelas
- Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain; Centro de Investigación Biomédica en Red, CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
| | - Lise Piquilloud
- Adult Intensive Care Unit, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonio Pesenti
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Hannah Wunsch
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frank van Haren
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Intensive Care Unit, St George Hospital, Sydney, NSW, Australia
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - John G Laffey
- Anaesthesia and Intensive Care Medicine, School of Medicine, Clinical Sciences Institute, Galway University Hospitals, Galway, Ireland; School of Medicine, Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
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Del Sorbo L, Tisminetzky M, Chen L, Brochard L, Arellano D, Brito R, Diaz JC, Cornejo R. Association of lung recruitment and change in recruitment-to-inflation ratio from supine to prone position in acute respiratory distress syndrome. Crit Care 2023; 27:140. [PMID: 37055792 PMCID: PMC10098997 DOI: 10.1186/s13054-023-04428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
Prone positioning is an evidence-based treatment for patients with moderate-to-severe acute respiratory distress syndrome. Lung recruitment has been proposed as one of the mechanisms by which prone positioning reduces mortality in this group of patients. Recruitment-to-inflation ratio (R/I) is a method to measure potential for lung recruitment induced by a change in positive end-expiratory pressure (PEEP) on the ventilator. The association between R/I and potential for lung recruitment in supine and prone position has not been studied with computed tomography (CT) scan imaging. In this secondary analysis, we sought to investigate the correlation between R/I measured in supine and prone position with CT and the potential for lung recruitment as measured by CT scan. Among 23 patients, the median R/I did not significantly change from supine (1.9 IQR 1.6-2.6) to prone position (1.7 IQR 1.3-2.8) (paired t test p = 0.051) but the individual changes correlated with the different response to PEEP. In supine and in prone position, R/I significantly correlated with the proportion of lung tissue recruitment induced by the change of PEEP. Lung tissue recruitment induced by a change of PEEP from 5 to 15 cmH2O was 16% (IQR 11-24%) in supine and 14.3% (IQR 8.4-22.6%) in prone position, as measured by CT scan analysis (paired t test p = 0.56). In this analysis, PEEP-induced recruitability as measured by R/I correlated with PEEP-induced lung recruitment as measured by CT scan, and could help to readjust PEEP in prone position.
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Affiliation(s)
- Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
- Department of Medicine, Division of Respirology, University Health Network/Sinai Health System, University of Toronto, Toronto, Canada.
- Toronto General Hospital, 585 University Avenue, MaRS Centre 9-9021, Toronto, ON, M5G 2N2, Canada.
| | - Manuel Tisminetzky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Division of Respirology, University Health Network/Sinai Health System, University of Toronto, Toronto, Canada
| | - Lu Chen
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Keenan Research Centre and Li Ka Shing Institute, Department of Critical Care, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Keenan Research Centre and Li Ka Shing Institute, Department of Critical Care, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Daniel Arellano
- Unidad de Pacientes Criticos, Departamento de Medicina, Hospital Clinico Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Santiago, Chile
| | - Roberto Brito
- Unidad de Pacientes Criticos, Departamento de Medicina, Hospital Clinico Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Santiago, Chile
| | - Juan C Diaz
- Departamento de Radiología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Rodrigo Cornejo
- Unidad de Pacientes Criticos, Departamento de Medicina, Hospital Clinico Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Santiago, Chile.
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Romero CM, Gajardo AI, Cruz A, Tobar E, Godoy J, Medel N, Zamorano R, Rappoport D, Rojas V, Herrera MC, Cornejo R, Luengo C, Estuardo N. Mortality in patients with severe COVID-19 who underwent tracheostomy due to prolonged mechanical ventilation. Rev Med Chil 2023; 151:151-159. [PMID: 38293850 DOI: 10.4067/s0034-98872023000200151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 12/07/2022] [Indexed: 02/01/2024]
Abstract
BACKGROUND The usefulness of tracheostomy has been questioned in patients with COVID-19 and prolonged invasive mechanical ventilation (IMV). AIM To compare the 90-day mortality rate of patients who underwent a tracheostomy due prolonged IMV with those that did not receive this procedure. MATERIAL AND METHODS We studied a historical cohort of 92 patients with COVID-19 and prolonged IMV (> 10 days). The primary outcome was the 90-day mortality rate. Secondary outcomes included days on IMV, hospital/intensive care unit (ICU) length of stay, frequency of nosocomial infections, and thrombotic complications demonstrated by images. A logistic regression was performed to adjust the effect of tracheostomy by SOFA score and days on IMV. RESULTS Forty six patients aged 54 to 66 years (72% males) underwent tracheostomy. They had a median of two comorbidities, and received the procedure after a median of 20.5 days on IMV (interquartile range: 17-26). 90-day mortality was lower in patients who were tracheostomized than in the control group (6.5% vs. 32.6%, p-value < 0.01). However, after controlling for confounding factors, no differences were found in mortality between both groups (relative risk = 0.303, p-value = 0.233). Healthcare-associated infections and hospital/ICU length of stay were higher in patients with tracheostomy than in controls. Thrombotic complications occurred in 42.4% of the patients, without differences between both groups. No cases of COVID-19 were registered in the healthcare personnel who performed tracheostomies. CONCLUSIONS In patients with COVID-19 undergoing prolonged IMV, performing a tracheostomy is not associated with excess mortality, and it is a safe procedure for healthcare personnel.
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Affiliation(s)
- Carlos-Miguel Romero
- Critical Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Abraham Ij Gajardo
- Critical Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Amalia Cruz
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Eduardo Tobar
- Critical Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Jaime Godoy
- Department of Anesthesiology and Perioperative Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Nicolás Medel
- Critical Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Ricardo Zamorano
- Department of Otorhinolaryngology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Daniel Rappoport
- Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Verónica Rojas
- Critical Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | - Rodrigo Cornejo
- Critical Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Cecilia Luengo
- Critical Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Nivia Estuardo
- Critical Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
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Bachmann MC, Cruces P, Díaz F, Oviedo V, Goich M, Fuenzalida J, Damiani LF, Basoalto R, Jalil Y, Carpio D, Hamidi Vadeghani N, Cornejo R, Rovegno M, Bugedo G, Bruhn A, Retamal J. Spontaneous breathing promotes lung injury in an experimental model of alveolar collapse. Sci Rep 2022; 12:12648. [PMID: 35879511 PMCID: PMC9310356 DOI: 10.1038/s41598-022-16446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Vigorous spontaneous breathing has emerged as a promotor of lung damage in acute lung injury, an entity known as “patient self-inflicted lung injury”. Mechanical ventilation may prevent this second injury by decreasing intrathoracic pressure swings and improving regional air distribution. Therefore, we aimed to determine the effects of spontaneous breathing during the early stage of acute respiratory failure on lung injury and determine whether early and late controlled mechanical ventilation may avoid or revert these harmful effects. A model of partial surfactant depletion and lung collapse was induced in eighteen intubated pigs of 32 ±4 kg. Then, animals were randomized to (1) SB‐group: spontaneous breathing with very low levels of pressure support for the whole experiment (eight hours), (2) Early MV-group: controlled mechanical ventilation for eight hours, or (3) Late MV-group: first half of the experiment on spontaneous breathing (four hours) and the second half on controlled mechanical ventilation (four hours). Respiratory, hemodynamic, and electric impedance tomography data were collected. After the protocol, animals were euthanized, and lungs were extracted for histologic tissue analysis and cytokines quantification. SB-group presented larger esophageal pressure swings, progressive hypoxemia, lung injury, and more dorsal and inhomogeneous ventilation compared to the early MV-group. In the late MV-group switch to controlled mechanical ventilation improved the lung inhomogeneity and esophageal pressure swings but failed to prevent hypoxemia and lung injury. In a lung collapse model, spontaneous breathing is associated to large esophageal pressure swings and lung inhomogeneity, resulting in progressive hypoxemia and lung injury. Mechanical ventilation prevents these mechanisms of patient self-inflicted lung injury if applied early, before spontaneous breathing occurs, but not when applied late.
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Affiliation(s)
- María Consuelo Bachmann
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Cruces
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile.,Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago, Chile
| | - Franco Díaz
- Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago, Chile.,Escuela de Postgrado, Universidad Finis Terrae, Santiago, Chile
| | - Vanessa Oviedo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mariela Goich
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - José Fuenzalida
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Luis Felipe Damiani
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Ciencias de La Salud, Carrera de Kinesiología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roque Basoalto
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yorschua Jalil
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Ciencias de La Salud, Carrera de Kinesiología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David Carpio
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Niki Hamidi Vadeghani
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Cornejo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Maximiliano Rovegno
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Guillermo Bugedo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Bruhn
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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González R, Venegas K, Maldonado F, Cornejo R. Asynchronous differential lung ventilation in a patient with unilateral lung disease undergoing laparoscopic Heller myotomy. Brazilian Journal of Anesthesiology (English Edition) 2022; 72:542-544. [PMID: 35192859 PMCID: PMC9373585 DOI: 10.1016/j.bjane.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022]
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10
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Santa Cruz R, Irrazábal C, Gonzalez L, Geloso A, Nuñez C, Cornejo R. [Analytic review and meta-analysis of awake prone positioning in patients with Covid-19.]. Med Intensiva 2021; 46:580-582. [PMID: 34866727 PMCID: PMC8629725 DOI: 10.1016/j.medin.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- R Santa Cruz
- Department of Intensive Care, Hospital Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina.,Laboratory of Physiology, School of Medicine, University of Magallanes, Punta Arenas, Chile
| | - C Irrazábal
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - L Gonzalez
- Laboratory of Physiology, School of Medicine, University of Magallanes, Punta Arenas, Chile
| | - A Geloso
- Department of Intensive Care, Hospital Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - C Nuñez
- Laboratory of Physiology, School of Medicine, University of Magallanes, Punta Arenas, Chile
| | - R Cornejo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Argentina
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Araos J, Alegria L, Garcia A, Cruces P, Soto D, Erranz B, Salomon T, Medina T, Garcia P, Dubó S, Bachmann MC, Basoalto R, Valenzuela ED, Rovegno M, Vera M, Retamal J, Cornejo R, Bugedo G, Bruhn A. Effect of positive end-expiratory pressure on lung injury and haemodynamics during experimental acute respiratory distress syndrome treated with extracorporeal membrane oxygenation and near-apnoeic ventilation. Br J Anaesth 2021; 127:807-814. [PMID: 34507822 PMCID: PMC8449633 DOI: 10.1016/j.bja.2021.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 01/19/2023] Open
Abstract
Background Lung rest has been recommended during extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS). Whether positive end-expiratory pressure (PEEP) confers lung protection during ECMO for severe ARDS is unclear. We compared the effects of three different PEEP levels whilst applying near-apnoeic ventilation in a model of severe ARDS treated with ECMO. Methods Acute respiratory distress syndrome was induced in anaesthetised adult male pigs by repeated saline lavage and injurious ventilation for 1.5 h. After ECMO was commenced, the pigs received standardised near-apnoeic ventilation for 24 h to maintain similar driving pressures and were randomly assigned to PEEP of 0, 10, or 20 cm H2O (n=7 per group). Respiratory and haemodynamic data were collected throughout the study. Histological injury was assessed by a pathologist masked to PEEP allocation. Lung oedema was estimated by wet-to-dry-weight ratio. Results All pigs developed severe ARDS. Oxygenation on ECMO improved with PEEP of 10 or 20 cm H2O, but did not in pigs allocated to PEEP of 0 cm H2O. Haemodynamic collapse refractory to norepinephrine (n=4) and early death (n=3) occurred after PEEP 20 cm H2O. The severity of lung injury was lowest after PEEP of 10 cm H2O in both dependent and non-dependent lung regions, compared with PEEP of 0 or 20 cm H2O. A higher wet-to-dry-weight ratio, indicating worse lung injury, was observed with PEEP of 0 cm H2O. Histological assessment suggested that lung injury was minimised with PEEP of 10 cm H2O. Conclusions During near-apnoeic ventilation and ECMO in experimental severe ARDS, 10 cm H2O PEEP minimised lung injury and improved gas exchange without compromising haemodynamic stability.
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Affiliation(s)
- Joaquin Araos
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Leyla Alegria
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Aline Garcia
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Cruces
- Center of Acute Respiratory Critical Illness, Santiago, Chile; Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile; Unidad de Pacientes Críticos Pediátrica, Hospital El Carmen Dr Luis Valentín Ferrada, Santiago, Chile
| | - Dagoberto Soto
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Benjamín Erranz
- Centro de Medicina Regenerativa, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tatiana Salomon
- Unidad de Pacientes Críticos Pediátrica, Clínica Alemana, Santiago, Chile
| | - Tania Medina
- Unidad de Pacientes Críticos Pediátrica, Hospital El Carmen Dr Luis Valentín Ferrada, Santiago, Chile
| | - Patricio Garcia
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Dubó
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - María C Bachmann
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roque Basoalto
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Emilio D Valenzuela
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maximiliano Rovegno
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Magdalena Vera
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Center of Acute Respiratory Critical Illness, Santiago, Chile
| | - Rodrigo Cornejo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile; Center of Acute Respiratory Critical Illness, Santiago, Chile
| | - Guillermo Bugedo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Center of Acute Respiratory Critical Illness, Santiago, Chile
| | - Alejandro Bruhn
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Center of Acute Respiratory Critical Illness, Santiago, Chile.
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12
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Gacitúa I, Frías A, Sanhueza ME, Bustamante S, Cornejo R, Salas A, Guajardo X, Torres K, Figueroa Canales E, Tobar E, Navarro R, Romero C. Extracorporeal CO 2 removal and renal replacement therapy in acute severe respiratory failure in COVID-19 pneumonia: Case report. Semin Dial 2021; 34:257-262. [PMID: 33969909 PMCID: PMC8206973 DOI: 10.1111/sdi.12980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/02/2021] [Indexed: 11/26/2022]
Abstract
The COVID‐19 pandemic significates an enormous number of patients with pneumonia that get complicated with severe acute respiratory distress syndrome (ARDS), some of them with refractory hypercapnia and hypoxemia that need mechanical ventilation (MV). Those patients who are not candidate to extracorporeal membrane oxygenation (ECMO), the extracorporeal removal of CO2 (ECCO2R) can allow ultra protective MV to limit the transpulmonary pressures and avoid ventilatory induced lung injury (VILI). We report a first case of prolonged ECCO2R support in 38 year male with severe COVID‐19 pneumonia refractory to conventional support. He was admitted tachypneic and oxygen saturation 71% without supplementary oxygen. The patient's clinical condition worsens with severe respiratory failure, increasing the oxygen requirement and initiating MV in the prone position. After 21 days of protective MV, PaCO2 rise to 96.8 mmHg, making it necessary to connect to an ECCO2R system coupled continuous veno‐venous hemodialysis (CVVHD). However, due to the lack of availability of equipment in the context of the pandemic, a pediatric gas exchange membrane adapted to CVVHD allowed to maintain the removal of CO2 until completing 27 days, being finally disconnected from the system without complications and with a satisfactory evolution.
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Affiliation(s)
- Ignacio Gacitúa
- Department of Nephrology, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Alondra Frías
- Department of Nephrology, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - María E Sanhueza
- Department of Nephrology, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Sergio Bustamante
- Department Cardiovascular, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Rodrigo Cornejo
- Department of Critical Care, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Andrea Salas
- Department Cardiovascular, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Ximena Guajardo
- Department of Nephrology, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Katherine Torres
- Department of Nephrology, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Enzo Figueroa Canales
- Anesthesia and Resuscitation Division, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Eduardo Tobar
- Department of Critical Care, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Rocío Navarro
- Physical Medicine and Rehabilitation Division, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Carlos Romero
- Department of Critical Care, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
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13
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Cornejo R, Iturrieta P, Olegário TMM, Kajiyama C, Arellano D, Guiñez D, Cerda MA, Brito R, Gajardo AIJ, Lazo M, López L, Morais CCA, González S, Zavala M, Rojas V, Medel JN, Hurtado DE, Bruhn A, Ramos C, Estuardo N. Estimation of changes in cyclic lung strain by electrical impedance tomography: Proof-of-concept study. Acta Anaesthesiol Scand 2021; 65:228-235. [PMID: 33037607 DOI: 10.1111/aas.13723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023]
Abstract
RATIONALE Cyclic strain may be a determinant of ventilator-induced lung injury. The standard for strain assessment is the computed tomography (CT), which does not allow continuous monitoring and exposes to radiation. Electrical impedance tomography (EIT) is able to monitor changes in regional lung ventilation. In addition, there is a correlation between mechanical deformation of materials and detectable changes in its electrical impedance, making EIT a potential surrogate for cyclic lung strain measured by CT (StrainCT ). OBJECTIVES To compare the global StrainCT with the change in electrical impedance (ΔZ). METHODS Acute respiratory distress syndrome patients under mechanical ventilation (VT 6 mL/kg ideal body weight with positive end-expiratory pressure 5 [PEEP 5] and best PEEP according to EIT) underwent whole-lung CT at end-inspiration and end-expiration. Biomechanical analysis was used to construct 3D maps and determine StrainCT at different levels of PEEP. CT and EIT acquisitions were performed simultaneously. Multilevel analysis was employed to determine the causal association between StrainCT and ΔZ. Linear regression models were used to predict the change in lung StrainCT between different PEEP levels based on the change in ΔZ. MAIN RESULTS StrainCT was positively and independently associated with ΔZ at global level (P < .01). Furthermore, the change in StrainCT (between PEEP 5 and Best PEEP) was accurately predicted by the change in ΔZ (R2 0.855, P < .001 at global level) with a high agreement between predicted and measured StrainCT . CONCLUSIONS The change in electrical impedance may provide a noninvasive assessment of global cyclic strain, without radiation at bedside.
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Affiliation(s)
- Rodrigo Cornejo
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
- Center of Acute Respiratory Critical Illness (ARCI) Santiago Chile
| | - Pablo Iturrieta
- Department of Structural and Geotechnical Engineering School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | | | | | - Daniel Arellano
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
- Departamento de kinesiología Facultad de Medicina Universidad de Chile Santiago Chile
| | - Dannette Guiñez
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - María A. Cerda
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Roberto Brito
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Abraham I. J. Gajardo
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Marioli Lazo
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Lorena López
- Departamento de Radiología Hospital Clínico Universidad de Chile Santiago Chile
| | - Caio C. A. Morais
- Divisao de Pneumologia Faculdade de Medicina Instituto do Coracao Hospital das Clinicas HCFMUSP Universidade de Sao Paulo Sao Paulo Brazil
| | - Sedric González
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Miguel Zavala
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Verónica Rojas
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Juan N. Medel
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
| | - Daniel E. Hurtado
- Department of Structural and Geotechnical Engineering School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
- Institute for Biological and Medical Engineering School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | - Alejandro Bruhn
- Center of Acute Respiratory Critical Illness (ARCI) Santiago Chile
- Departamento de Medicina Intensiva Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Cristobal Ramos
- Departamento de Radiología Hospital Clínico Universidad de Chile Santiago Chile
| | - Nivia Estuardo
- Unidad de Pacientes Críticos Departamento de Medicina Hospital Clínico Universidad de Chile Santiago Chile
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14
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Tobar E, Cornejo R, Godoy J, Abedrapo M, Cavada G, Tobar D. Effects of intraoperative adrenergic administration on postoperative hyperlactatemia in open colon surgery: an observational study. Braz J Anesthesiol 2020; 71:58-64. [PMID: 33712255 PMCID: PMC9373707 DOI: 10.1016/j.bjane.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/21/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background Postoperative Hyperlactatemia (PO-HL) is a frequent condition associated with poor prognosis. In recent years, there has been growing evidence that adrenergic stimulation may contribute to increased lactate levels. The use of adrenergic agonists for the control of intraoperative hypotension is frequent, and its impact on the development of PO-HL is unknown. Objective To evaluate whether the use of intraoperative adrenergic agents is associated with the occurrence of PO-HL. Methods This was a prospective observational study. The inclusion criteria were undergoing elective open colon surgery, being ≥60 years old and signing informed consent. The exclusion criteria were cognitive impairment, unplanned surgery, and anticipated need for postoperative mechanical ventilation. Baseline and intraoperative variables were collected, and arterial lactate data were collected at baseline and every 6 hours postoperatively for 24 hours. Hyperlactatemia was defined as lactate >2.1 mEq.L-1. Results We studied 28 patients, 61% of whom developed hyperlactatemia. The variables associated with PO-HL in the univariate analysis were anesthetic time, the total dose of intraoperative ephedrine, and lower intraoperative central venous oxygen saturation (ScvO2). Multivariate analysis confirmed the association between the use of ephedrine (p = 0.004), intraoperative hypotension (p = 0.026), and use of phenylephrine (p = 0.001) with PO-HL. Conclusions The use of intraoperative ephedrine, phenylephrine and intraoperative hypotension were independently associated with the development of PO-HL. This finding should lead to new studies in this field, as well as a judicious interpretation of the finding of a postoperative increase in lactate levels.
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Affiliation(s)
- Eduardo Tobar
- Hospital Clínico Universidad de Chile, Unidad de Pacientes Críticos, Departamento Medicina Interna Norte, Santiago, Chile.
| | - Rodrigo Cornejo
- Hospital Clínico Universidad de Chile, Unidad de Pacientes Críticos, Departamento Medicina Interna Norte, Santiago, Chile
| | - Jaime Godoy
- Hospital Clínico Universidad de Chile, Departamento de Anestesiología y Reanimación, Santiago, Chile
| | - Mario Abedrapo
- Hospital Clínico Universidad de Chile, Departamento de Cirugía Norte, Equipo de Coloproctología, Santiago, Chile
| | - Gabriel Cavada
- Facultad de Medicina Universidad de Chile, Escuela de Salud Pública, Santiago, Chile
| | - Daniel Tobar
- Facultad de Medicina Universidad de Chile, Escuela de Pregrado, Santiago, Chile
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15
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Abstract
In recent years there has been substantial progress in the imaging evaluation of patients with lung disease requiring mechanical ventilatory assistance. This has been demonstrated by the inclusion of pulmonary ultrasound, positron emission tomography, electrical impedance tomography (EIT), and magnetic resonance imaging (MRI). The EIT uses electric current to evaluate the distribution of alternating current conductivity within the thoracic cavity. The advantage of the latter is that it is non-invasive, bedside radiation-free functional imaging modality for continuous monitoring of lung ventilation and perfusion. EIT can detect recruitment or derecruitment, overdistension, variation of poorly ventilated lung units (silent spaces), and pendelluft phenomenon in spontaneously breathing patients. In addition, the regional expiratory time constants have been recently explored.
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Affiliation(s)
- Vinko Tomicic
- Jefe Unidad de Cuidados Intensivos Respiratorios, Clínica Indisa, Universidad Andres Bello, Santiago, Chile
| | - Rodrigo Cornejo
- Jefe Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Chile
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16
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Araos J, Alegria L, Garcia P, Cruces P, Soto D, Erranz B, Amthauer M, Salomon T, Medina T, Rodriguez F, Ayala P, Borzone GR, Meneses M, Damiani F, Retamal J, Cornejo R, Bugedo G, Bruhn A. Near-Apneic Ventilation Decreases Lung Injury and Fibroproliferation in an Acute Respiratory Distress Syndrome Model with Extracorporeal Membrane Oxygenation. Am J Respir Crit Care Med 2019; 199:603-612. [DOI: 10.1164/rccm.201805-0869oc] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
| | | | | | - Pablo Cruces
- Center of Acute Respiratory Critical Illness, Santiago, Chile
- Centro de Investigación de Medicina Veterinaria, Escuela de Medicina Veterinaria, Facultad de Ecología y Recursos Naturales, Universidad Andrés Bello, Santiago, Chile
| | | | - Benjamín Erranz
- Centro de Medicina Regenerativa, Facultad de Medicina Clínica Alemana–Universidad del Desarrollo, Santiago, Chile
| | | | - Tatiana Salomon
- Unidad de Pacientes Críticos Pediátrica, Clínica Alemana, Santiago, Chile
| | - Tania Medina
- Escuela de Enfermería, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | | | - Pedro Ayala
- Departamento de Enfermedades Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gisella R. Borzone
- Departamento de Enfermedades Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel Meneses
- Departamento de Anatomía Patológica, Instituto Nacional del Tórax, Santiago, Chile
| | - Felipe Damiani
- Departamento de Medicina Intensiva
- Escuela de Kinesiología, Facultad de Ciencias, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile; and
| | - Jaime Retamal
- Departamento de Medicina Intensiva
- Center of Acute Respiratory Critical Illness, Santiago, Chile
| | - Rodrigo Cornejo
- Center of Acute Respiratory Critical Illness, Santiago, Chile
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Guillermo Bugedo
- Departamento de Medicina Intensiva
- Center of Acute Respiratory Critical Illness, Santiago, Chile
| | - Alejandro Bruhn
- Departamento de Medicina Intensiva
- Center of Acute Respiratory Critical Illness, Santiago, Chile
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17
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Yubini MC, Contreras C, Díaz G, Cerda MA, Guíñez D, Rogers N, Silva F, Cornejo R. [Neisseria meningitidis pneumonia. A case report]. Rev Med Chil 2018; 146:249-253. [PMID: 29999162 DOI: 10.4067/s0034-98872018000200249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 03/05/2018] [Indexed: 11/17/2022]
Abstract
Few cases of bacteremic pneumonia by Neisseria meningitidis (NM) have been described worldwide; mostly in elderly patients or those with comorbidities. They appear clinically indistinguishable from other acute infectious pneumoniae, that do not develope the syndrome of meningococcemia. We report a 17-years-old male, without prior medical history, consulting in the emergency department with a 7-day history of productive cough, right pleural pain, fever and dyspnea. He was admitted to the ICU due to septic shock and respiratory distress. He was managed with vasoactive drugs and prone positioning ventilation for 48 hours. Chest radiography showed a right superior lobe condensation. The electrocardiogram and echocardiogram suggested septic myocarditis. Blood cultures demonstrated the presence of serogroup W135-NM. A lumbar puncture ruled out meningitis, and a 10-day ceftriaxone therapy was completed favorably.
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Affiliation(s)
- María Cecilia Yubini
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Caterina Contreras
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Gonzalo Díaz
- Departamento de Medicina, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | | | - Dannette Guíñez
- Departamento de Medicina, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Nicole Rogers
- Departamento de Neurología Neurocirugía, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Francisco Silva
- Departamento de Medicina, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Rodrigo Cornejo
- Departamento de Medicina, Hospital Clínico, Universidad de Chile, Santiago, Chile
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18
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Guzmán MA, Sepúlveda C, Liberman C, Cornejo R, Roizen G, Cereceda D, Lara MF, Álvarez-Cuesta E. [Successful oral desensitization to levothyroxine. Report of one case]. Rev Med Chil 2018; 146:394-398. [PMID: 29999112 DOI: 10.4067/s0034-98872018000300394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/26/2018] [Indexed: 11/17/2022]
Abstract
We report a 39-year-old female who underwent a total thyroidectomy as treatment for a thyroid papillary cancer. She suffered several episodes of mild angioedema in lips and tongue, after using different commercial Levothyroxine formulations, with and without excipients. Given the need to use this drug, the patient was admitted in our hospital and we proceeded to desensitize her with oral Levothyroxine. The patient fasted throughout the whole procedure, was properly monitored and had an adequate peripheral venous access. On the first day of the procedure, a 15-step protocol was performed, first administering placebo and then, compounded formulations of Levothyroxine starting from 0.01 ug, followed by doubling doses every 15 minutes until the cumulative dose of 111.95 ug was completed, corresponding to the daily dose of Levothyroxine her endocrinologist prescribed (112 ug). The patient was monitored at baseline, between each dose and up to 3 hours after the procedure was completed. There were no incidents such as urticaria, angioedema, or others. On the second day, the patient received a single-full dose of 112 ug on an empty stomach. The medication was successfully tolerated and she was discharged. Thereafter, she tolerates daily Levothyroxine.
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Affiliation(s)
- María Antonieta Guzmán
- Sección Inmunología, VIH y Alergias, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Cecilia Sepúlveda
- Sección Inmunología, VIH y Alergias, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Claudio Liberman
- Sección Endocrinología, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Rodrigo Cornejo
- Unidad de Pacientes Críticos, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Gigia Roizen
- Hospital Clínico, Universidad de Chile, Santiago, Chile
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Abstract
Freud's research on sexuality was, without doubt, a paradigm shift in the temporary conception of childhood experiences in relation to adult life. From those first experiences arise mnemic material which retroactively constitute the place and function of the unconscious. The theory of a psychic temporality that governs mood process, among other things, brings into question the classic model of time in western societies. Freud's relation to these issues is already observable in his first scientific work, where he faces issues related to the sexual differentiation and heterochrony of living beings.
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Affiliation(s)
- Rodrigo Cornejo
- Facultad de Humanidades y Ciencias Sociales, Universidad Andres Bello, Escuela De Psicología, Viña Del Mar, Chile
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Von Seth M, Hillered L, Otterbeck A, Hanslin K, Larsson A, Sjölin J, Lipcsey M, Cove ME, Chew NS, Vu LH, Lim RZ, Puthucheary Z, Hanslin K, Wilske F, Skorup P, Tano E, Sjölin J, Lipcsey M, Derese I, Thiessen S, Derde S, Dufour T, Pauwels L, Bekhuis Y, Van den Berghe G, Vanhorebeek I, Khan M, Dwivedi D, Zhou J, Prat A, Seidah NG, Liaw PC, Fox-Robichaud AE, Von Seth M, Skorup P, Hillered L, Larsson A, Sjölin J, Lipcsey M, Otterbeck A, Hanslin K, Lipcsey M, Larsson A, Von Seth M, Correa T, Pereira J, Takala J, Jakob S, Skorup P, Maudsdotter L, Tano E, Lipcsey M, Castegren M, Larsson A, Sjölin J, Xue M, Xu JY, Liu L, Huang YZ, Guo FM, Yang Y, Qiu HB, Kuzovlev A, Moroz V, Goloubev A, Myazin A, Chumachenko A, Pisarev V, Takeyama N, Tsuda M, Kanou H, Aoki R, Kajita Y, Hashiba M, Terashima T, Tomino A, Davies R, O’Dea KP, Soni S, Ward JK, O’Callaghan DJ, Takata M, Gordon AC, Wilson J, Zhao Y, Singer M, Spencer J, Shankar-Hari M, Genga KR, Lo C, Cirstea MS, Walley KR, Russell JA, Linder A, Boyd JH, Sedlag A, Riedel C, Georgieff M, Barth E, Debain A, Jonckheer J, Moeyersons W, Van zwam K, Puis L, Staessens K, Honoré PM, Spapen HD, De Waele E, de Garibay APR, Bracht H, Ende-Schneider B, Schreiber C, Kreymann B, Bini A, Votino E, Giuliano G, Steinberg I, Vetrugno L, Trunfio D, Sidoti A, Essig A, Brogi E, Forfori F, Conroy M, Marsh B, O’Flynn J, Henne-Bruns D, Gebhard F, Orend K, Halatsch M, Weiss M, Chase M, Freinkman E, Uber A, Liu X, Cocchi MN, Donnino MW, Peetermans M, Liesenborghs L, Claes J, Vanassche T, Hoylaerts M, Jacquemin M, Vanhoorelbeke K, De Meyer S, Verhamme P, Vögeli A, Ottiger M, Meier M, Steuer C, Bernasconi L, Huber A, Christ-Crain M, Henzen C, Hoess C, Thomann R, Zimmerli W, Müller B, Schütz P, Hoppensteadt D, Walborn A, Rondina M, Tsuruta K, Fareed J, Tachyla S, Ikeda T, Ono S, Ueno T, Suda S, Nagura T, Damiani E, Domizi R, Scorcella C, Tondi S, Pierantozzi S, Ciucani S, Mininno N, Adrario E, Pelaia P, Donati A, Andersen MS, Lu S, Lopez G, Lassen AT, Ghiran I, Shapiro NI, Trahtemberg U, Sviri S, Beil M, Agur Z, Van Heerden P, Jahaj E, Vassiliou A, Mastora Z, Orfanos SE, Kotanidou A, Wirz Y, Sager R, Amin D, Amin A, Haubitz S, Hausfater P, Huber A, Kutz A, Mueller B, Schuetz P, Sager RS, Wirz YW, Amin DA, Amin AA, Hausfater PH, Huber AH, Haubitz S, Kutz A, Mueller B, Schuetz P, Gottin L, Dell’amore C, Stringari G, Cogo G, Ceolagraziadei M, Sommavilla M, Soldani F, Polati E, Meier M, Baumgartner T, Zurauskaité G, Gupta S, Mueller B, Devendra A, Schuetz P, Mandaci D, Eren G, Ozturk F, Emir N, Hergunsel O, Azaiez S, Khedher S, Maaoui A, Salem M, Chernevskaya E, Beloborodova N, Bedova A, Sarshor YU, Pautova A, Gusarov V, Öveges N, László I, Forgács M, Kiss T, Hankovszky P, Palágyi P, Bebes A, Gubán B, Földesi I, Araczki Á, Telkes M, Ondrik Z, Helyes Z, Kemény Á, Molnár Z, Spanuth E, Ebelt H, Ivandic B, Thomae R, Werdan K, El-Shafie M, Taema K, El-Hallag M, Kandeel A, Tayeh O, Taema K, Eldesouky M, Omara A, Winkler MS, Holzmann M, Nierhaus A, Mudersbach E, Schwedhelm E, Daum G, Kluge S, Zoellner C, Greiwe G, Sawari H, Schwedhelm E, Nierhaus A, Kluge S, Kubitz J, Jung R, Daum G, Reichenspurner H, Zoellner C, Winkler MS, Groznik M, Ihan A, Andersen LW, Chase M, Holmberg MJ, Wulff A, Cocchi MN, Donnino MW, Balci C, Haliloglu M, Bilgili B, Bilgin H, Kasapoglu U, Sayan I, Süzer M, Mulazımoglu L, Cinel I, Patel V, Shah S, Parulekar P, Minton C, Patel J, Ejimofo C, Choi H, Costa R, Caruso P, Nassar P, Fu J, Jin J, Xu Y, Kong J, Wu D, Yaguchi A, Klonis A, Ganguly S, Kollef M, Burnham C, Fuller B, Mavrommati A, Chatzilia D, Salla E, Papadaki E, Kamariotis S, Christodoulatos S, Stylianakis A, Alamanos G, Simoes M, Trigo E, Silva N, Martins P, Pimentel J, Baily D, Curran LA, Ahmadnia E, Patel BV, Adukauskiene D, Cyziute J, Adukauskaite A, Pentiokiniene D, Righetti F, Colombaroli E, Castellano G, Wilske F, Skorup P, Lipcsey M, Hanslin K, Larsson A, Sjölin J, Man M, Shum HP, Chan YH, Chan KC, Yan WW, Lee RA, Lau SK, Dilokpattanamongkol P, Thirapakpoomanunt P, Anakkamaetee R, Montakantikul P, Tangsujaritvijit V, Sinha S, Pati J, Sahu S, Adukauskiene D, Valanciene D, Dambrauskiene A, Adukauskiene D, Valanciene D, Dambrauskiene A, Hernandez K, Lopez T, Saca D, Bello M, Mahmood W, Hamed K, Al Badi N, AlThawadi S, Al Hosaini S, Salahuddin N, Cilloniz CC, Ceccato AC, Bassi GLL, Ferrer MF, Gabarrus AG, Ranzani OR, Jose ASS, Vidal CGG, de la Bella Casa JPP, Blasi FB, Torres AT, Adukauskiene D, Ciginskiene A, Dambrauskiene A, Simoliuniene R, Giuliano G, Triunfio D, Sozio E, Taddei E, Brogi E, Sbrana F, Ripoli A, Bertolino G, Tascini C, Forfori F, Fleischmann C, Goldfarb D, Schlattmann P, Schlapbach L, Kissoon N, Baykara N, Akalin H, Arslantas MK, Gavrilovic SG, Vukoja MV, Hache MH, Kashyap RK, Dong YD, Gajic OG, Ranzani O, Shankar-Hari M, Harrison D, Rabello L, Rowan K, Salluh J, Soares M, Markota AM, Fluher JF, Kogler DK, Borovšak ZB, Sinkovic AS, László I, Öveges N, Forgács M, Kiss T, Hankovszky P, Palágyi P, Bebes A, Gubán B, Földesi I, Araczki Á, Telkes M, Ondrik Z, Helyes Z, Kemény Á, Molnár Z, Fareed J, Siddiqui Z, Aggarwal P, Iqbal O, Hoppensteadt D, Lewis M, Wasmund R, Abro S, Raghuvir S, Tsuruta K, Barie PS, Fineberg D, Radford A, Tsuruta K, Casazza A, Vilardo A, Bellazzi E, Boschi R, Ciprandi D, Gigliuto C, Preda R, Vanzino R, Vetere M, Carnevale L, Kyriazopoulou E, Pistiki A, Routsi C, Tsangaris I, Giamarellos-Bourboulis E, Kyriazopoulou E, Tsangaris I, Routsi C, Pnevmatikos I, Vlachogiannis G, Antoniadou E, Mandragos K, Armaganidis A, Giamarellos-Bourboulis E, Allan P, Oehmen R, Luo J, Ellis C, Latham P, Newman J, Pritchett C, Pandya D, Cripps A, Harris S, Jadav M, Langford R, Ko B, Park H, Beumer CM, Koch R, Beuningen DV, Oudelashof AM, Vd Veerdonk FL, Kolwijck E, VanderHoeven JG, Bergmans DC, Hoedemaekers C, Brandt JB, Golej J, Burda G, Mostafa G, Schneider A, Vargha R, Hermon M, Levin P, Broyer C, Assous M, Wiener-Well Y, Dahan M, Benenson S, Ben-Chetrit E, Faux A, Sherazi R, Sethi A, Saha S, Kiselevskiy M, Gromova E, Loginov S, Tchikileva I, Dolzhikova Y, Krotenko N, Vlasenko R, Anisimova N, Spadaro S, Fogagnolo A, Remelli F, Alvisi V, Romanello A, Marangoni E, Volta C, Degrassi A, Mearelli F, Casarsa C, Fiotti N, Biolo G, Cariqueo M, Luengo C, Galvez R, Romero C, Cornejo R, Llanos O, Estuardo N, Alarcon P, Magazi B, Khan S, Pasipanodya J, Eriksson M, Strandberg G, Lipsey M, Larsson A, Rajput Z, Hiscock F, Karadag T, Uwagwu J, Jain S, Molokhia A, Barrasa H, Soraluce A, Uson E, Rodriguez A, Isla A, Martin A, Fernández B, Fonseca F, Sánchez-Izquierdo JA, Maynar FJ, Kaffarnik M, Alraish R, Frey O, Roehr A, Stockmann M, Wicha S, Shortridge D, Castanheira M, Sader HS, Streit JM, Flamm RK, Falsetta K, Lam T, Reidt S, Jancik J, Kinoshita T, Yoshimura J, Yamakawa K, Fujimi S, Armaganidis A, Torres A, Zakynthinos S, Mandragos C, Giamarellos-Bourboulis E, Ramirez P, De la Torre-Prados M, Rodriguez A, Dale G, Wach A, Beni L, Hooftman L, Zwingelstein C, François B, Colin G, Dequin PF, Laterre PF, Perez A, Welte R, Lorenz I, Eller P, Joannidis M, Bellmann R, Lim S, Chana S, Patel S, Higuera J, Cabestrero D, Rey L, Narváez G, Blandino A, Aroca M, Saéz S, De Pablo R, Thiessen S, Vanhorebeek I, Derde S, Derese I, Dufour T, Albert CN, Langouche L, Goossens C, Peersman N, Vermeersch P, Vander Perre S, Holst J, Wouters P, Van den Berghe G, Liu X, Uber AU, Holmberg M, Konanki V, McNaughton M, Zhang J, Donnino MW, Demirkiran O, Byelyalov A, Luengo C, Guerrero J, Cariqueo M, Scorcella C, Domizi R, Damiani E, Tondi S, Pierantozzi S, Rossini N, Falanga U, Monaldi V, Adrario E, Pelaia P, Donati A, Cole O, Scawn N, Balciunas M, Blascovics I, Vuylsteke A, Salaunkey K, Omar A, Salama A, Allam M, Alkhulaifi A, Verstraete S, Vanhorebeek I, Van Puffelen E, Derese I, Ingels C, Verbruggen S, Wouters P, Joosten K, Hanot J, Guerra G, Vlasselaers D, Lin J, Van den Berghe G, Haines R, Zolfaghari P, Hewson R, Offiah C, Prowle J, Park H, Ko B, Buter H, Veenstra JA, Koopmans M, Boerma EC, Veenstra JA, Buter H, Koopmans M, Boerma EC, Taha A, Shafie A, Hallaj S, Gharaibeh D, Hon H, Bizrane M, El Khattate AA, Madani N, Abouqal R, Belayachi J, Kongpolprom N, Sanguanwong N, Sanaie S, Mahmoodpoor A, Hamishehkar H, Biderman P, Van Heerden P, Avitzur Y, Solomon S, Iakobishvili Z, Carmi U, Gorfil D, Singer P, Paisley C, Patrick-Heselton J, Mogk M, Humphreys J, Welters I, Pierantozzi S, Scorcella C, Domizi R, Damiani E, Tondi S, Casarotta E, Bolognini S, Adrario E, Pelaia P, Donati A, Holmberg MJ, Moskowitz A, Patel P, Grossestreuer A, Uber A, Andersen LW, Donnino MW, Malinverni S, Goedeme D, Mols P, Langlois PL, Szwec C, D’Aragon F, Heyland DK, Manzanares W, Manzanares W, Szwec C, Langlois P, Aramendi I, Heyland D, Stankovic N, Nadler J, Uber A, Holmberg M, Sanchez L, Wolfe R, Chase M, Donnino M, Cocchi M, Atalan HK, Gucyetmez B, Kavlak ME, Aslan S, Kargi A, Yazici S, Donmez R, Polat KY, Piechota M, Piechota A, Misztal M, Bernas S, Pietraszek-Grzywaczewska I, Saleh M, Hamdy A, Hamdy A, Elhallag M, Atar F, Kundakci A, Gedik E, Sahinturk H, Zeyneloglu P, Pirat A, Popescu M, Tomescu D, Van Gassel R, Baggerman M, Schaap F, Bol M, Nicolaes G, Beurskens D, Damink SO, Van de Poll M, Horibe M, Sasaki M, Sanui M, Iwasaki E, Sawano H, Goto T, Ikeura T, Hamada T, Oda T, Mayumi T, Kanai T, Kjøsen G, Horneland R, Rydenfelt K, Aandahl E, Tønnessen T, Haugaa H, Lockett P, Evans L, Somerset L, Ker-Reid F, Laver S, Courtney E, Dalton S, Georgiou A, Robinson K, Lam T, Haas B, Reidt S, Bartlett K, Jancik J, Bigwood M, Hanley R, Morgan P, Marouli D, Chatzimichali A, Kolyvaki S, Panteli A, Diamantaki E, Pediaditis E, Sirogianni P, Ginos P, Kondili E, Georgopoulos D, Askitopoulou H, Zampieri FG, Liborio AB, Besen BA, Cavalcanti AB, Dominedò C, Dell’Anna AM, Monayer A, Grieco DL, Barelli R, Cutuli SL, Maddalena AI, Picconi E, Sonnino C, Sandroni C, Antonelli M, Gucyetmez B, Atalan HK, Tuzuner F, Cakar N, Jacob M, Sahu S, Singh YP, Mehta Y, Yang KY, Kuo S, Rai V, Cheng T, Ertmer C, Czempik P, Hutchings S, Watts S, Wilson C, Burton C, Kirkman E, Drennan D, O’Prey A, MacKay A, Forrest R, Oglinda A, Ciobanu G, Casian M, Oglinda C, Lun CT, Yuen HJ, Ng G, Leung A, So SO, Chan HS, Lai KY, Sanguanwit P, Charoensuk W, Phakdeekitcharoen B, Batres-Baires G, Kammerzell I, Lahmer T, Mayr U, Schmid R, Huber W, Spanuth E, Bomberg H, Klingele M, Thomae R, Groesdonk H, Bernas S, Piechota M, Mirkiewicz K, Pérez AG, Silva J, Ramos A, Acharta F, Perezlindo M, Lovesio L, Antonelli PG, Dogliotti A, Lovesio C, Baron J, Schiefer J, Baron DM, Faybik P, Shum HP, Yan WW, Chan TM, Marouli D, Chatzimichali A, Kolyvaki S, Panteli A, Diamantaki E, Pediaditis E, Sirogianni P, Ginos P, Kondili E, Georgopoulos D, Askitopoulou H, Vicka V, Gineityte D, Ringaitiene D, Sipylaite J, Pekarskiene J, Beurskens DM, Van Smaalen TC, Hoogland P, Winkens B, Christiaans MH, Reutelingsperger CP, Van Heurn E, Nicolaes GA, Schmitt FS, Salgado ES, Friebe JF, Fleming TF, Zemva JZ, Schmoch TS, Uhle FU, Kihm LK, Morath CM, Nusshag CN, Zeier MZ, Bruckner TB, Mehrabi AM, Nawroth PN, Weigand MW, Hofer SH, Brenner TB, Fotopoulou G, Poularas I, Kokkoris S, Brountzos E, Zakynthinos S, Routsi C, Saleh M, Elghonemi M, Nilsson KF, Sandin J, Gustafsson L, Frithiof R, Skorniakov I, Varaksin A, Vikulova D, Shaikh O, Whiteley C, Ostermann M, Di Lascio G, Anicetti L, Bonizzoli M, Fulceri G, Migliaccio ML, Sentina P, Cozzolino M, Peris A, Khadzhynov D, Halleck F, Staeck O, Lehner L, Budde K, Slowinski T, Slowinski T, Kindgen-Milles D, Khadzhynov D, Huysmans N, Laenen MV, Helmschrodt A, Boer W. 37th International Symposium on Intensive Care and Emergency Medicine (part 3 of 3). Crit Care 2017. [PMCID: PMC5374592 DOI: 10.1186/s13054-017-1629-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Romero CM, Cornejo R, Tobar E, Gálvez R, Luengo C, Estuardo N, Neira R, Navarro JL, Abarca O, Ruiz M, Berasaín MA, Neira W, Arellano D, Llanos O. Fiber optic bronchoscopy-assisted percutaneous tracheostomy: a decade of experience at a university hospital. Rev Bras Ter Intensiva 2016; 27:119-24. [PMID: 26340151 PMCID: PMC4489779 DOI: 10.5935/0103-507x.20150022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/12/2015] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the efficacy and safety of percutaneous tracheostomy by means of
single-step dilation with fiber optic bronchoscopy assistance in critical care
patients under mechanical ventilation. Methods Between the years 2004 and 2014, 512 patients with indication of tracheostomy
according to clinical criteria, were prospectively and consecutively included in
our study. One-third of them were high-risk patients. Demographic variables,
APACHE II score, and days on mechanical ventilation prior to percutaneous
tracheostomy were recorded. The efficacy of the procedure was evaluated according
to an execution success rate and based on the necessity of switching to an open
surgical technique. Safety was evaluated according to post-operative and operative
complication rates. Results The mean age of the group was 64 ± 18 years (203 women and 309 males). The
mean APACHE II score was 21 ± 3. Patients remained an average of 11
± 3 days on mechanical ventilation before percutaneous tracheostomy was
performed. All procedures were successfully completed without the need to switch
to an open surgical technique. Eighteen patients (3.5%) presented procedure
complications. Five patients experienced transient desaturation, 4 presented low
blood pressure related to sedation, and 9 presented minor bleeding, but none
required a transfusion. No serious complications or deaths associated with the
procedure were recorded. Eleven patients (2.1%) presented post-operative
complications. Seven presented minor and transitory bleeding of the percutaneous
tracheostomy stoma, 2 suffered displacement of the tracheostomy cannula, and 2
developed a superficial infection of the stoma. Conclusion Percutaneous tracheostomy using the single-step dilation technique with fiber
optic bronchoscopy assistance seems to be effective and safe in critically ill
patients under mechanical ventilation when performed by experienced intensive care
specialists using a standardized procedure.
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Affiliation(s)
- Carlos M Romero
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Rodrigo Cornejo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Eduardo Tobar
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Ricardo Gálvez
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Cecilia Luengo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Nivia Estuardo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Rodolfo Neira
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - José Luis Navarro
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Osvaldo Abarca
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Mauricio Ruiz
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - María Angélica Berasaín
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Wilson Neira
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Daniel Arellano
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Osvaldo Llanos
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
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Cornejo R, Garrido O, Jaramillo R. Morfometría Nuclear de Hepatocitos Esteatósicos y Esteatósicos Estimulados con Laser Infrarrojo. INT J MORPHOL 2016. [DOI: 10.4067/s0717-95022016000100054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cornejo R, Garrido O, Jaramillo R, Vergara E, Lermanda P, Gatica Y. Poros Nucleares y Función Celular en Epitelio Mamario. INT J MORPHOL 2015. [DOI: 10.4067/s0717-95022015000400012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cornejo R, Romero C, Ugalde D, Bustos P, Diaz G, Galvez R, Llanos O, Tobar E. High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock. Rev Bras Ter Intensiva 2015; 26:193-9. [PMID: 25028955 PMCID: PMC4103947 DOI: 10.5935/0103-507x.20140028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/21/2014] [Indexed: 12/29/2022] Open
Abstract
We report the successful treatment of two patients with aneurismal subarachnoid
hemorrhage complicated by severe respiratory failure and refractory septic shock
using simultaneous prone position ventilation and high-volume hemofiltration. These
rescue therapies allowed the patients to overcome the critical situation without
associated complications and with no detrimental effects on the intracranial and
cerebral perfusion pressures. Prone position ventilation is now an accepted therapy
for severe acute respiratory distress syndrome, and high-volume hemofiltration is a
non-conventional hemodynamic support that has several potential mechanisms for
improving septic shock. In this manuscript, we briefly review these therapies and the
related evidence. When other conventional treatments are insufficient for providing
safe limits of oxygenation and perfusion as part of basic neuroprotective care in
subarachnoid hemorrhage patients, these rescue therapies should be considered on a
case-by-case basis by an experienced critical care team.
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Affiliation(s)
- Rodrigo Cornejo
- Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carlos Romero
- Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Diego Ugalde
- Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Patricio Bustos
- Departamento de Neurologia e Neurocirurgia, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Gonzalo Diaz
- Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Ricardo Galvez
- Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Osvaldo Llanos
- Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Eduardo Tobar
- Unidade de Terapia Intensiva, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
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Cornejo R, Albornoz N, Castañeda L, Palacios D, Etcheberrigaray G, Fernández R, Gómez S, Hidalgo F, Lagos I. Las prescripciones del trabajo docente en el nuevo marco regulatorio de políticas educativas en Chile. Psicoperspectivas 2015. [DOI: 10.5027/psicoperspectivas-vol14-issue2-fulltext-580] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cornejo R, Garrido O, Jaramillo R. Microscopía Electrónica de Nucleos Hepáticos Estimulados con Dosis Crecientes de Laser Infrarrojo. INT J MORPHOL 2015. [DOI: 10.4067/s0717-95022015000100035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bruhn A, Cruces P, Tapia P, Garcia P, Alegria L, Araos J, Soto D, Hurtado D, Rodriguez F, Amthauer M, Salomon T, Rodriguez D, Rucán ME, Castro G, Erranz B, Cornejo R, Bugedo G. 0671. Extended extracorporeal lung support in a porcine acute lung injury model. Feasibility and preliminary data. Intensive Care Med Exp 2014. [PMCID: PMC4796687 DOI: 10.1186/2197-425x-2-s1-p44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Cornejo R, Romero C, Ugalde D, Bustos P, Diaz G, Galvez R, Llanos O, Tobar E. Authors' response. Rev Bras Ter Intensiva 2014; 26:436-437. [PMID: 25764572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Cornejo R, Garrido O, Bustamante C, Muñoz M. El Retículo Endoplasmático Liso en Hepatocitos Estimulados con Distintas Dosis de Láser Infrarrojo. INT J MORPHOL 2014. [DOI: 10.4067/s0717-95022014000300042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Romero CM, Luengo C, Tobar E, Fábrega L, Vial MJ, Cornejo R, Gálvez R, Llanos O. Central venous saturation in septic shock: co-oximetry vs gasometry. Am J Emerg Med 2014; 32:1275-7. [PMID: 25171795 DOI: 10.1016/j.ajem.2014.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 07/26/2014] [Accepted: 07/26/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Central venous oxygen saturation calculated by gasometry (Gaso-Scvo2) is more available than central venous oxygen saturation measured by co-oximetry (Co-oxy-Scvo2) in environments with less resources and underdeveloped countries. Therefore, we aimed to determine the agreement between Co-oxy-Scvo2 and Gaso-Scvo2 and between central venous oxygen tension measured by gasometry (Gaso-Pcvo2) and Co-oxy-Scvo2, respectively. DESIGN AND SETTINGS This is a prospective study in a university hospital's intensive care unit. PATIENTS Sixteen patients were studied during the first 48 hours after diagnosis of septic shock. All patients were intubated, connected to mechanical ventilation, and resuscitated according to the standards of care. MEASUREMENTS AND RESULTS One hundred eleven pairs of central venous blood measurements were analyzed both by conventional gasometry and co-oximetry. Bland and Altman analysis between Co-oxy-Scvo2 and Gaso-Scvo2 showed lack of agreement (1.7 [-10.7, +14.2]). A Gaso-Scvo2 less than 70% had a positive predictive value of 63% in relation to Co-oxy-Scvo2, and its negative predictive value was 90% with 20% false-positives and 5% false-negatives. The area under the receiver operator characteristic curve of Gaso-Pcvo2 to discriminate a Co-oxy-Scvo2 greater than or equal to 70% was 0.87 (confidence interval, 0.80-0.93), and the best cut-off point was a Gaso-Pcvo2 more than 40 mm Hg, (sensitivity, 75%; specificity, 93%). CONCLUSIONS The reliability of Gaso-Scvo2 determination during the resuscitation phase of septic shock is not acceptable. There is a good agreement between a Gaso-Pcvo2 more than 40 mm Hg and a Co-oxy-Scvo2 greater than or equal to 70%. Our results suggest that given these limitations, Gaso-Scvo2 results should be interpreted with caution, helped by Gaso-Pcvo2 measurements and in context with other perfusion parameters.
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Affiliation(s)
- Carlos M Romero
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago Norte, Chile.
| | - Cecilia Luengo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago Norte, Chile
| | - Eduardo Tobar
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago Norte, Chile
| | - Luis Fábrega
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago Norte, Chile
| | - María Jesús Vial
- Laboratorio Central, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago Norte, Chile
| | - Rodrigo Cornejo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago Norte, Chile
| | - Ricardo Gálvez
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago Norte, Chile
| | - Osvaldo Llanos
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago Norte, Chile
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Cornejo R, Garrido O, Sáez L, Bustamante C, Cartes G. Análisis Morfométrico de Hepatoesteatosis Microvesicular Alcohólica de Ratas. INT J MORPHOL 2014. [DOI: 10.4067/s0717-95022014000200019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bustos C, Cornejo R. Sentidos del trabajo en docentes de aulas hospitalarias: Las emociones y el presente como pilares del proceso de trabajo. Psicoperspectivas 2014. [DOI: 10.5027/psicoperspectivas-vol13-issue2-fulltext-365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Matamala F, Cornejo R, Paredes M, Farfán E, Garrido O, Alves N. Análisis Comparativo del Número de Neurofilamentos en Nervios Isquiáticos de Rata Sometidos a Neuropraxia Tratadas con Láser de Baja Intensidad y Ultrasonido Terapéutico. INT J MORPHOL 2014. [DOI: 10.4067/s0717-95022014000100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cornejo R, Garrido O, Matamala F, Silva H, Mardones A, Lagos K, Hueichapan O. Análisis Morfométrico Ultraestructural de Células Normales de Glándula Parótida de Rata. INT J MORPHOL 2013. [DOI: 10.4067/s0717-95022013000400010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cornejo R, Carhuapoma M, Samillán G, Vera M, Cuéllar J, Casquero R. Percepción de docentes y estudiantes acerca de la actividad educativa en la escuela de enfermería de la UNMSM y propuesta co-participativa de planes de mejora. An Fac med 2013. [DOI: 10.15381/anales.v73i1.2235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objetivos: Caracterizar la actividad académica, el cumplimiento de las obligaciones, programa, metodología, materiales, actitud del docente, evaluación, prácticas, satisfacción. Establecer las coincidencias y divergencias de la actividad educativa en Enfermería. Y comprometer a los involucrados a participar en el diseño de propuestas. Diseño: Método descriptivo, transversal, cuantitativo, complementado con técnicas cualitativas. Institución: Departamento Académico Profesional de Enfermería, Facultad de Medicina, UNMSM. Participantes: Estudiantes y docentes. Intervenciones: Se efectuó el estudio en 135 estudiantes y 27 docentes (30% del universo de docentes y estudiantes). La escala fue de 1 a 5, siendo 1 definitivamente negativa y 5 definitivamente positiva. Principales medidas de resultados: Calidad de la actividad académica. Resultados: En estudiantes fue 3,57 y en docentes 3,70, indicando que estamos cercanos al punto medio y lejos de calidad ‘definitivamente positiva’. El menor valor fue la dimensión ‘prácticas’, con un valor de 2,74, con ‘opinión negativa’. El valor más alto estuvo en ‘Programa de Enseñanza’, con 3,91, cerca de ‘opinión positiva’. Conclusiones: Hubo dos categorías de resultados, actitud docente y aptitud docente, señalando que los docentes se mantienen ‘sin interés’, ‘poco comprometidos’ con su labor docente. Falta mejorar la planificación de clases, metodología, supervisión y evaluación; un mejor uso del tiempo, para no afectar la ‘práctica clínica o comunitaria’.
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Cornejo R, Matamala F, Silva H, Garrido O, Jaramillo R, Sáez L, Painemil S, Loncoñanco E. Efecto de Estimulaciones Infrarrojas sobre Hepatoesteatosis Microvesicular Alcohólica de Ratas. INT J MORPHOL 2013. [DOI: 10.4067/s0717-95022013000100048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cornejo R, Matamala F, Silva H, Garrido O, Saéz L. Persistencia de los Efectos del Láser Infrarrojo 6 J/cm² en Hepatocitos de Rata. INT J MORPHOL 2012. [DOI: 10.4067/s0717-95022012000200018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cornejo R, Tobar E, Díaz G, Romero C, Llanos O, Gálvez LR, Zamorano A, Fábrega L, Neira W, Arellano D, Repetto C, Aedo D, Díaz JC, González R. Systematic approach for severe respiratory failure due to novel A (H1N1) influenza. Minerva Anestesiol 2011; 77:510-521. [PMID: 21540806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM In April 2009, a novel influenza A (H1N1) virus appeared in Mexico. It rapidly acquired the characteristics of a pandemic disease. Our objective is to present a case series of mechanically ventilated patients with severe influenza, treated with a systematic approach. METHODS Prospective, observational, single-center study in a University Hospital. A (H1N1) virus was confirmed by rRT-PCR. In this report, we only considered patients that required mechanical ventilation (MV). All patients received antibiotics, steroids and oseltamivir from the time of admission. The main strategies incorporated in the systematic approach were a lung-protective strategy, PEEP adjusted for each patient, protocol-guided sedoanalgesia, restrictive fluid management, weaning protocol, and prolonged prone ventilation and extracorporeal membrane oxygenation (ECMO) as rescue therapies. RESULTS We studied 19 patients: age 41 ± 13 years old, APACHE II 16 ± 7 and SOFA 8 ± 4. All patients presented PaO2/FiO2 ≤ 200 before connection to MV. Their worst values within the first 24 hours for oxygenation index, PaO2/FiO2, and PaCO2 on MV were 21.8 ± 13, 98 ± 39, and 48 ± 16 mmHg, respectively. Sixteen patients achieved ARDS; three exhibited acute lung injury criteria. Ten required a prone position, and two required ECMO (one patient required both therapies). Time on MV was 16 ± 13 days. Length of stay in the ICU and in hospital was 18 ± 12 and 28 ± 17 days, respectively. Mortality was 21%. CONCLUSION Severe hypoxemia and a high rate of rescue therapies were observed among our patients. Nevertheless, mortality was lower than previously reported in comparable populations, which may be related to the management by a critical care team and the use of a systematic approach for ventilatory and non-ventilatory therapeutic strategies.
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Affiliation(s)
- R Cornejo
- Intensive Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile.
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Cornejo R, Venegas P, Goñi D, Salas A, Romero C. Successful response to intravenous immunoglobulin as rescue therapy in a patient with Hashimoto's encephalopathy. BMJ Case Rep 2010; 2010:2010/dec21_1/bcr0920103332. [PMID: 22802479 DOI: 10.1136/bcr.09.2010.3332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors describe the case of a 61-year-old woman who was admitted to our intensive care unit (ICU) due to impaired consciousness associated with generalised seizures. Her cerebrospinal fluid, electrolytes, acid-base analysis, and common laboratory and toxicology tests were normal. An MRI ruled out the presence of stroke or haemorrhage but showed severe leukoencephalopathy. Parkinson's disease, Creuzfeld-Jacob disease, vascular alterations, cancer, and rheumatological and metabolic diseases were evaluated and excluded. In view of her history of hypothyroidism despite adequate hormonal replacement and clinical behaviour, Hashimoto's encephalopathy was considered. Anti-thyroperoxidase levels were above 3000 IU/ml. The patient received 5 g of methylprednisolone followed by prednisone, but after a favourable initial response, returned to a comatose state. However, after administration of intravenous immunoglobulin (IVIG) 2 g/kg, the patient recovered with resolution of neurological symptoms and was discharged from the ICU 4 days after finishing IVIG treatment.
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Affiliation(s)
- Rodrigo Cornejo
- Medicine Department, Critical Care Unit, Clinical Hospital Universidad de Chile, Santiago, Región Metropolitana, Chile.
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Cornejo R, Llanos O, Fernández C, Carlos Díaz J, Cardemil G, Salguero J, Luengo C, Tobar E, Romero C, Gálvez LR. Organizing pneumonia in patients with severe respiratory failure due to novel A (H1N1) influenza. BMJ Case Rep 2010; 2010:bcr0220102708. [PMID: 22767562 PMCID: PMC3027639 DOI: 10.1136/bcr.02.2010.2708] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The authors describe two cases that developed organizing pneumonia (OP) associated with novel influenza A(H1N1) virus. These patients were admitted to intensive care unit (ICU) because of severe respiratory failure. After initial clinical improvement, both patients worsened their condition during their second week of ICU stay, presenting fever, increasing in inflammatory parameters and worsening in oxygen exchange and respiratory mechanics. Chest x-rays and computed tomographies showed an increment on lung infiltrates, given by areas of consolidation and ground glass opacification. Although broad-spectrum antibiotics were administered, patients showed no improvement. All cultures, including bronchoalveolar lavage samples, were negative. In both cases, an open lung biopsy was performed, and histopathological examination of the specimen was compatible with OP. Both patients were successfully treated with high-dose corticoids. The aim of this report is to alert about the possibility of OP associated with novel influenza virus in patients with severe respiratory failure.
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Affiliation(s)
- Rodrigo Cornejo
- Medicine Department, Clinical Hospital Universidad de Chile, Santiago, Chile.
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Romero CM, Marambio A, Larrondo J, Walker K, Lira MT, Tobar E, Cornejo R, Ruiz M. Swallowing dysfunction in nonneurologic critically ill patients who require percutaneous dilatational tracheostomy. Chest 2010; 137:1278-82. [PMID: 20299629 DOI: 10.1378/chest.09-2792] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the incidence of swallowing dysfunction in nonneurologic critically ill patients who require percutaneous dilatational tracheostomy (PDT) for prolonged mechanical ventilation (MV) and to compare the duration of the cannulation period and length of stay in the critical care unit (CCU) in patients with and without swallowing dysfunction. METHODS A total of 40 consecutive patients without neurologic disorders who require PDT for prolonged MV were included. Previous to the tracheostomy decannulation process, an otolaryngologist performed a fiberoptic endoscopic evaluation of swallowing (FEES). We used analysis of variance for the analysis; the results are presented as mean values +/- SD. RESULTS Mean age was 62 +/- 15 years. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were 21 +/- 2 and 9 +/- 1, respectively. Time of MV previous to PDT was 20 +/- 11 days, total MV duration was 38 +/- 16 days, and CCU stay was 63 +/- 27 days. The incidence of swallowing dysfunction in this group of patients was 38% (15/40). No difference was found in the age or time period of MV previous to PDT between groups. The time period between FEES to tracheostomy decannulation process was 19 +/- 11 days in patients with swallowing dysfunction vs 2 +/- 4 days in those patients without dysfunction (P < .001). Patients who developed swallowing dysfunction stayed longer in the CCU (69 +/- 23 vs 47 +/- 19 days, P < .01). CONCLUSIONS Nearly 40% of nonneurologic critically ill patients requiring PDT for prolonged MV presented swallowing dysfunction and experienced a significant delay in their tracheostomy decannulation process.
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Affiliation(s)
- Carlos M Romero
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Facultad de Medicina Universidad de Chile, Santos Dumont 999, Independencia, Santiago Norte, Chile.
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Caironi P, Cressoni M, Chiumello D, Ranieri M, Quintel M, Russo SG, Cornejo R, Bugedo G, Carlesso E, Russo R, Caspani L, Gattinoni L. Lung Opening and Closing during Ventilation of Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2010; 181:578-86. [DOI: 10.1164/rccm.200905-0787oc] [Citation(s) in RCA: 235] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cornejo R, Romero C, Goñi D, Luengas R, Llanos O, Gálvez R, Castro J. Ventilación en posición prono prolongada como alternativa en el tratamiento del síndrome de distrés respiratorio agudo grave posneumonectomía: Caso clínico. Rev Med Chil 2009. [DOI: 10.4067/s0034-98872009001000011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cornejo R, Romero C, Goñi D, Luengas R, Llanos O, Gálvez R, Castro J. [Prolonged prone position ventilation for severe respiratory distress syndrome post-pneumonectomy. Report of one case]. Rev Med Chil 2009; 137:1351-1356. [PMID: 20011943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Management of patients with severe respiratory failure is mainly supportive, and protective mechanical ventilation is the pivotal treatment. When conventional therapy is insufficient to improve oxygenation without deleterious effects, other strategies should be considered. We report a 53 year-old male who presented a severe respiratory failure refractory to conventional management after pneumonectomy. Prone position ventilation was used for 36 hours. Respiratory variables improved and he did not show hemodynamic instability. He was returned to the supine position without worsening of oxygenation parameters. Extended prone position ventilation could be considered in patients presenting with unresponsive severe respiratory failure after pulmonary resection.
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Affiliation(s)
- Rodrigo Cornejo
- Unidad de Pacientes Críticos, Hospital Clínico, Universidad de Chile, Santiago de Chile.
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Cornejo R, Matamala F, Silva H, Garrido O. Análisis Morfométrico del Efecto del Láser Infrarrojo sobre Hepatocitos de Rata. INT J MORPHOL 2009. [DOI: 10.4067/s0717-95022009000300031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hernandez G, Peña H, Cornejo R, Rovegno M, Retamal J, Navarro JL, Aranguiz I, Castro R, Bruhn A. Impact of emergency intubation on central venous oxygen saturation in critically ill patients: a multicenter observational study. Crit Care 2009; 13:R63. [PMID: 19413905 PMCID: PMC2717418 DOI: 10.1186/cc7802] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 04/17/2009] [Accepted: 05/04/2009] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Central venous oxygen saturation (ScvO2) has emerged as an important resuscitation goal for critically ill patients. Nevertheless, growing concerns about its limitations as a perfusion parameter have been expressed recently, including the uncommon finding of low ScvO2 values in patients in the intensive care unit (ICU). Emergency intubation may induce strong and eventually divergent effects on the physiologic determinants of oxygen transport (DO2) and oxygen consumption (VO2) and, thus, on ScvO2. Therefore, we conducted a study to determine the impact of emergency intubation on ScvO2. METHODS In this prospective multicenter observational study, we included 103 septic and non-septic patients with a central venous catheter in place and in whom emergency intubation was required. A common intubation protocol was used and we evaluated several parameters including ScvO2 before and 15 minutes after emergency intubation. Statistical analysis included chi-square test and t test. RESULTS ScvO2 increased from 61.8 +/- 12.6% to 68.9 +/- 12.2%, with no difference between septic and non-septic patients. ScvO2 increased in 84 patients (81.6%) without correlation to changes in arterial oxygen saturation (SaO2). Seventy eight (75.7%) patients were intubated with ScvO2 less than 70% and 21 (26.9%) normalized the parameter after the intervention. Only patients with pre-intubation ScvO2 more than 70% failed to increase the parameter after intubation. CONCLUSIONS ScvO2 increases significantly in response to emergency intubation in the majority of septic and non-septic patients. When interpreting ScvO2 during early resuscitation, it is crucial to consider whether the patient has been recently intubated or is spontaneously breathing.
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Affiliation(s)
- Glenn Hernandez
- Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile.
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Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, Russo S, Patroniti N, Cornejo R, Bugedo G. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 2006; 354:1775-86. [PMID: 16641394 DOI: 10.1056/nejmoa052052] [Citation(s) in RCA: 900] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the acute respiratory distress syndrome (ARDS), positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by keeping lung regions open that otherwise would be collapsed. Since the effects of PEEP probably depend on the recruitability of lung tissue, we conducted a study to examine the relationship between the percentage of potentially recruitable lung, as indicated by computed tomography (CT), and the clinical and physiological effects of PEEP. METHODS Sixty-eight patients with acute lung injury or ARDS underwent whole-lung CT during breath-holding sessions at airway pressures of 5, 15, and 45 cm of water. The percentage of potentially recruitable lung was defined as the proportion of lung tissue in which aeration was restored at airway pressures between 5 and 45 cm of water. RESULTS The percentage of potentially recruitable lung varied widely in the population, accounting for a mean (+/-SD) of 13+/-11 percent of the lung weight, and was highly correlated with the percentage of lung tissue in which aeration was maintained after the application of PEEP (r2=0.72, P<0.001). On average, 24 percent of the lung could not be recruited. Patients with a higher percentage of potentially recruitable lung (greater than the median value of 9 percent) had greater total lung weights (P<0.001), poorer oxygenation (defined as a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen) (P<0.001) and respiratory-system compliance (P=0.002), higher levels of dead space (P=0.002), and higher rates of death (P=0.02) than patients with a lower percentage of potentially recruitable lung. The combined physiological variables predicted, with a sensitivity of 71 percent and a specificity of 59 percent, whether a patient's proportion of potentially recruitable lung was higher or lower than the median. CONCLUSIONS In ARDS, the percentage of potentially recruitable lung is extremely variable and is strongly associated with the response to PEEP.
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Affiliation(s)
- Luciano Gattinoni
- Istituto di Anestesiologia e Rianimazione, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena di Milano, Università degli Studi di Milano, Milan, Italy.
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Cornejo R, Downey P, Castro R, Romero C, Regueira T, Vega J, Castillo L, Andresen M, Dougnac A, Bugedo G, Hernandez G. High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock. Intensive Care Med 2006; 32:713-22. [PMID: 16550372 DOI: 10.1007/s00134-006-0118-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Accepted: 02/15/2006] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the effect of short-term (12-h) high-volume hemofiltration (HVHF) in reversing progressive refractory hypotension and hypoperfusion in patients with severe hyperdynamic septic shock. To evaluate feasibility and tolerance and to compare observed vs. expected hospital mortality. DESIGN AND SETTING Prospective, interventional, nonrandomized study in the surgical-medical intensive care unit of an academic tertiary center. PATIENTS Twenty patients with severe septic shock, previously unresponsive to a multi-intervention approach within a goal-directed, norepinephrine-based algorithm, with increasing norepinephrine (NE) requirements (>0.3 microg kg(-1) min(-1)) and lactic acidosis. INTERVENTIONS Single session of 12-h HVHF. MEASUREMENTS AND RESULTS We measured changes in NE requirements and perfusion parameters every 4h during HVHF and 6h thereafter. Eleven patients showed decreased NE requirements and lactate levels (responders). Nine patients did not fulfill these criteria (nonresponders). The NE dose, lactate levels, and heart rates decreased and arterial pH increased significantly in responders. Hospital mortality (40%) was significantly lower than predicted (60%): 67% (6/9) in nonresponders vs. 18% (2/11) in responders. Of 12 survivors 7 required only a single 12-h HVHF session. On logistic regression analysis the only statistically significant predictor of survival was theresponse to HVHF (odds ratio 9). CONCLUSIONS A single session of HVHF as salvage therapy in the setting of a goal-directed hemodynamic management algorithm may be beneficial in severe refractory hyperdynamic septic-shock patients. This approach may improve hemodynamics and perfusion parameters, acid-base status, and ultimately hospital survival. Moreover, it is feasible, and safe.
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Affiliation(s)
- Rodrigo Cornejo
- Intensive Care Medicine, Catholic University of Chile, Marcoleta 367 Tercer Piso, Santiago Centro, Chile
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Cornejo R. El trabajo docente en la institución escolar. La apropiación-enajenación del proceso de trabajo docente en el contexto de las reformas educativas neoliberales. RevPsicología 2006. [DOI: 10.5354/0719-0581.2006.18390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
El objetivo del presente artículo es analizar el trabajo docente en la institución escolar desde la óptica de los procesos de enajenación y apropiación del trabajo (como proceso y como producto).Para ellos, se hará primero una breve revisión de los conceptos de trabajo y alineación planteados por K. Marx y de los aportes realizados por G. Mendel al problema de la apropiación del acto de trabajo.Posteriormente se analizará el trabajo docente, distinguiendo el producto de éste, su proceso y la institución educativa donde tiene lugar.Para finalizar, se revisará el actual contexto de reformas educativas reoliberales en América Latina y la manera de éstas afectan la labor educativa, el trabajo docente y sus procesos de enajenación y apropiación.
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Hernandez G, Bruhn A, Romero C, Larrondo FJ, De La Fuente R, Cornejo R, Castillo L, Bugedo G. Implementation of a Norepinephrine-based Protocol for Management of Septic Shock: A Pilot Feasibility Study. ACTA ACUST UNITED AC 2006; 60:77-81. [PMID: 16456439 DOI: 10.1097/01.ta.0000202062.49814.f4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The subject of the best vasopressor for hemodynamic management of septic shock (SS) is controversial. One of the difficulties in planning such studies is that physicians are reluctant to use one vasopressor exclusively, and there is considerable variation in practice. The aim of this study was to test the feasibility of implementing a single pressor-based algorithm (in this case, norepinephrine [NE]). METHODS A NE-based algorithm was applied prospectively to 100 consecutive SS patients. A formal training program was implemented before starting the protocol and applied to 72 physicians and nurses involved in intensive care unit (ICU) patient care. Compliance, protocol violations, probable adverse effects, and outcome were evaluated on a daily basis by an independent group of fellows and a research nurse. RESULTS In 100 patients, there were 7,139 hours of algorithm use. Only 13 protocol violations were observed, mostly in the timing of inotropic drugs. Senior staff physicians or busy night shifts accounted for most of these violations. ICU mortality was 33%, which is comparable to that predicted by Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. Adverse events probably related to NE were not observed. CONCLUSIONS The present algorithm, applied after a strict training program, obtained an overall good acceptance and compliance with very few protocol violations in more than 7,000 hours of use. Safety was demonstrated by a global mortality comparable to that predicted by severity scores and absence of specific drug-related morbidity. The implementation of a single pressor-based algorithm for SS is feasible and safe.
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Affiliation(s)
- Glenn Hernandez
- Programa de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367 Tercer Piso Santiago Centro, Santiago, Chile.
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