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Browsing by Author "Andresen, Max"

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C-Reactive protein levels in patients with chronic obstructive pulmonary disease
(SOC MEDICA SANTIAGO, 2012) Diaz, Orlando; Parada, Alejandra; Ramos, Cristobal; Klaassen, Julieta; Carlos Diaz, Juan; Andresen, Max; Lisboa, Carmen; Saldias, Fernando
Background: Patients with chronic obstructive pulmonary disease (COPD) have elevated serum levels of ultrasensitive C reactive protein (CRPus). This raise may be related directly to COPD and its associated systemic inflammation or secondary to other factors such as smoking status, disease severity, acute exacerbations, or associated complications. Aim: To evaluate the potential causes of raised levels of CRPus in stable COPD patients. Patients and Methods: Cohorts of 133 mild-to-very severe COPD patients (41 current smokers), 31 never-smokers, and 33 current smoker controls were compared. Clinical assessments included body mass index (BMA fat (FM) and fat-free mass (FFM) measurement by DEXA, forced expiratory volume in one second (FEV1), arterial oxygen tension (PaO2), six-minute walking test (SMWT), emphysema (EMPH) and right thigh muscle cross-sectional area (TMCSA), both quantified by high resolution computed tomography. Results: Serum CRPus levels were significantly higher in COPD patients than in controls (7 +/- 4.2 and 3.7 +/- 2.7 mg/L, respectively; p < 0.0001). Being smoker did not influence CRPus levels. These levels were significantly correlated with FM (r = 0.30), BMI (r = 0.21), FEV1 (r = -0.21), number of acute exacerbations of the disease in the last year (r = 0.28), and PaO2 (r = -0.27). Using multivariate analysis FM, PaO2, and number of acute exacerbations of the disease in the last year had the strongest association with CRPus levels. Conclusions: CRPus is elevated in COPD patients, independent of smoking status. It is weakly associated with fat mass, arterial oxygen tension and frequency of exacerbations. (Rev Med Chile 2012; 140: 569-578).
Characteristics and evolution of patients admitted to a public hospital intensive care unit
(SOC MEDICA SANTIAGO, 2016) Ruiz, Carolina; Angel Diaz, Miguel; Marcelo Zapata, Juan; Bravo, Sebastian; Panay, Sergio; Escobar, Cristina; Godoy, Jorge; Andresen, Max; Castro, Ricardo
Background: The epidemiology of critical patients in Chile could differ from that reported in international studies. Aim: To describe the causes of admission and evolution of patients who were admitted to the ICU (Intensive Care Unit) of a general hospital in Chile in a two-year period (2012-2013). Patients and Methods: A retrospective study was carried out using the ICU database. The following variables were registered: admission diagnosis, APACHE II (Acute Physiology and Chronic Health Evaluation), days of mechanical ventilation (MV), ICU length of stay and ICU and hospital survival. Results: We analyzed data from 1075 aged 54 +/- 18 years (55% males), representing 75% of the admissions during the study period. The median ICU and MV lengths were 5 and 3 days respectively (92% of patients required MV). APACHE II was 20.5 +/- 8.2. The ICU and hospital mortality rate were 19.4% and 31%, respectively. Critical neurological diseases were the most common diagnoses requiring ICU, representing 26.8% of the admissions. No differences were found between 2012 and 2013 in age, APACHE II, ICU or hospital survival. A longer post ICU length of stay was found during 2013, both for patients who survived and those who died at the hospital. Conclusions: This study highlights the high percentage of patients that required MV and the high percentage critical neurological conditions requiring ICU admission. The characteristics and evolution of patients admitted to the ICU did not differ during 2012 and 2013.
Expanding ICU facilities in a pandemic scenario
(SOC MEDICA SANTIAGO, 2020) Andresen, Max; Born, Pablo; Kattan, Eduardo; Vera, Magdalena; Cataldo, Alejandro; Ruiz, Carolina; Bravo, Sebastian
Our country is suffering the effects of the ongoing pandemic of coronavirus disease (COVID-19). Because the vulnerability of healthcare systems, especially the intensive care areas they can rapidly be overloaded. That challenge the ICUs simultaneously on multiple fronts making urgent to increase the number of beds, without lowering the standards of care. The purpose of this article is to discuss some aspects of the national situation and to provide recommendations on the organizational management of intensive care units such as isolation protocols, surge in ICU bed capacity, ensure adequate supplies, protect and train healthcare workers maintaining quality clinical management.
Hipotermia intravascular prolongada en un paciente con hipertensión endocraneana refractaria
(SOC MEDICA SANTIAGO, 2012) Rovegno, Maximiliano; Luis Valenzuela, Jose; Mellado, Patricio; Andresen, Max
The use of hypothermia after cardiac arrest caused by ventricular fibrillation is a standard clinical practice, however its use for neuroprotection has been extended to other conditions. We report a 23-year-old male with intracranial hypertension secondary to a parenchymal hematoma associated to acute hydrocephalus. An arterial malformation was found and embolized. Due to persistent intracranial hypertension, moderate hypothermia with a target temperature of 33 degrees C was started. After 12 hours of hypothermia, intracranial pressure was controlled. After 13 days of hypothermia a definitive control of intracranial pressure was achieved. The patient was discharged 40 days after admission, remains with a mild hemiparesia and is reassuming his university studies. (Rev Med Chile 2012; 140: 219-224).
INTESTINAL PERFORATION SECONDARY TO BLUNT INGUINAL TRAUMA IN A SOCCER PLAYER: A CASE REPORT
(ELSEVIER SCIENCE INC, 2012) Vucetich, Nevenka; Andresen, Max; Hasbun, Pablo; Regueira, Tomas; Ibanez, Luis; Gonzalez, Alejandro
Background: Intestinal perforation caused by blunt trauma to an inguinal hernia is a very uncommon event. Case Report: We present the case of a 55-year old man who suffered trauma to the inguinal area while playing soccer and later developed intense abdominal pain with no categorical signs of peritoneal irritation. Computed tomography scan at arrival showed a right inguinal hernia, with partial protrusion of the ileum, inflammatory changes of the mesenteric fat tissue inside the hernial sac, and free intraperitoneal fluid. Several hours later he developed hypotension and fever. An emergency laparotomy was performed, revealing ileum perforation with peritonitis. Intestinal perforation was repaired without intestinal resection. After surgery, the patient developed severe septic shock with multiple organ failure. He recovered without sequelae and was discharged 3 weeks later. Conclusion: This case emphasizes the potential clinical complications associated with this condition. (C) 2012 Elsevier Inc.
Mini bronchoalveolar lavage in patients with severe respiratory failure
(SOC MEDICA SANTIAGO, 2011) Andresen, Max; Mercado, Marcelo; Zapata, Marcelo; Bustamante, Andrea; Regueira, Tomas
Background: To recognize the etiological agent responsible for severe acute respiratory failure (ARF) in patients in mechanical ventilation (MV) is important to determine their treatment and prognosis, and to avoid the excessive use of antibiotics. Mini bronchoalveolar lavage (mini BAL) is a blind, non bronschoscopic procedure, used to obtain samples from the lower respiratory tract from patients on mechanical ventilation (MV). Aim: To assess the feasibility, complications and preliminary results of mini BAL among patients with severe ARF on MV Material and Methods: Prospective study in 17 patients with acute lung injury (ALI) or acute respiratory distess syndrome (ARDS) on MV and with negative conventional microbiological studies. Mini BAL was performed using standardized protocols. Hemodynamic and respiratory parameters where measured before and after the procedure. Samples obtained were sent to quantitative cultures. Results: At baseline: APACHE II score of 22 +/- 6,7, P(a)O(2)/F(i)O(2) ratio was 176.6 +/- 48.6 and the oxygenation index was 9.74 +/- 3.78. All procedures were performed by an ICU resident. Thirty five percent of the procedures had positive cultures and no complications related to the procedures were reported. The procedure lasted an average of 12 minutes and the instilled and rescued volume were 60 ml and 19.6 ml, respectively There were no significant differences between hemodynamic and respiratory variables before and after the procedure. Conclusions: Mini BAL is a safe, fast and easy technique for obtaining samples from the inferior airway in patients with ALI or ARDS on MV (Rev Med Chile 2011; 139: 1292-1297).
Reanimación cardiopulmonar básica: conocimiento teórico, desempeño práctico y efectividad de las maniobras en médicos generales
(SOC MEDICA SANTIAGO, 2012) Rojas, Luis; Aizman, Andres; Pablo Arab, Juan; Utili, Franco; Andresen, Max
Background: General physicians should be adequately trained to deliver effective resuscitation during ventricular fibrillation (VF). Aim: To assess the degree of knowledge, skills and practical effectiveness in cardiopulmonary resuscitation (CPR) of Chilean general physicians. Materials and Methods: Forty eight general physicians starting Anesthesiology or Internal Medicine residency programs were evaluated. They answered a modified American Heart Association Basic Life Support Course written test and individually participated in a witnessed VF cardiac arrest simulated scenario. Execution of resuscitation tasks in the correct order, the quality of the maneuvers and the use of defibrillator were registered. Results: All participants acknowledged the importance of uninterrupted CPR and early defibrillation. Seventy five percent knew the correct frequency of chest compressions, but only 6.25% knew all the effective chest compression characteristics. Ninety eight percent knew the recommended number of breaths per cycle. In practice, 58% performed effective ventilations, 33% performed uninterrupted compressions, 14% did them with adequate frequency and only 8% performed chest compressions adequately. Forty four percent requested a defibrillator within 30 seconds and 31% delivered the first defibrillation within 30 seconds of defibrillator arrival. Airway, breathing, circulation and defibrillation sequence was correctly performed by 12% of participants and 80% acknowledged that their medical training was inadequate or insufficient for managing a cardiac arrest. Conclusions: Despite an elevated degree of knowledge about key aspects of CPR, this group of Chilean physicians displayed suboptimal practical skills while performing CPR in a simulated scenario, specially delivering effective chest compressions and promptly asking for and using the defibrillator. (Rev Med Chile 2012; 140: 73-77).
The impact of a better coordination between emergency and intensive care units in the care of critically ill patients
(SOC MEDICA SANTIAGO, 2016) Lara, Barbara A.; Cataldo, Alejandro; Castro, Ricardo; Aguilera, Pablo R.; Ruiz, Carolina; Andresen, Max
The need for critical care services is increasing in Chile. Critical care beds and specialists in this area are scarce. In this article we discuss some aspects that hamper the care of critically ill patients from their arrival to the emergency department to their transfer to the ICU. Special emphasis is given to system saturation and its multiple causes. The benefits of an integrative approach between emergency medicine and critical care specialists are highlighted and some solutions are proposed to strengthen this partnership.
Therapeutic monitoring of antibiotics. New methodologies: biosensors
(SOC MEDICA SANTIAGO, 2015) Soto, Dagoberto; Silva, Camila; Andresen, Max, V; Soto, Natalia; Wong, Kwok Yin; Andresen, Max
The pharmacokinetics of antibiotics, especially in severely ill patients, may be profoundly altered due to multiple pathophysiological changes. Recent studies have shown that empiric dosing recommendations for ICU patients are inadequate to effectively treat a broad range of susceptible organisms and need to be reconsidered. Therapeutic drug monitoring (TDM) is an important mean for optimizing drug utilization and doses for the purpose of improving the clinical effectiveness. However, it is very challenging to quantify plasma antibiotic concentrations in clinical situations as a routine practice, because of the high costs and complexities associated with advanced instrumental techniques. Currently there are not routine and low cost methods to determine the presence and concentration of beta-lactam antibiotics in plasma patients in a clinical setup. Indeed, such analytical methods are based on chromatographic techniques mainly used in research. Here we describe and comment different techniques, focusing on our preliminary experience using biosensors.

Browsing by Author "Andresen, Max"

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