Browsing by Author "Bravo, Sebastian"
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- ItemCharacteristics 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, RicardoBackground: 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.
- ItemCharacteristics of trauma patients admitted to the intensive care unit of a general hospital in Chile(SOC MEDICA SANTIAGO, 2013) Ruiz, Carolina; Mimica, Ximena; Luisa Lisbona, Maria; Donoso, Javiera; Arriagada, Paula; Roa, Macarena; Bravo, Sebastian; Godoy, JorgeBackground: Trauma is an important cause of death among young adults. Aim: To determine the characteristics, treatments and evolution of trauma patients admitted to an intensive care unit (ICU) of a public hospital in Santiago, Chile. Material and Methods: All polytrauma (PT) and severely traumatized (ST) patients admitted to ICU were included. We recorded the type of trauma along with demographic and hemodynamic variables, treatments and complications. The evolution and treatments received by PT and ST patients were compared. Results: We recorded data from 72 patients aged 43 +/- 21 years (93% males). Sixty two percent were PT and 24% had penetrating injuries. TBI (Trauma Brain Injury) was the most common trauma. On admission, acute Physiology and Chronic Health Evaluation II (APACHE II) score was 18.7 + 7.3, and Injury Severity Score (ISS) was 32.8 + 20.1. ICU stay was 7.8 + 6 days. Sixty seven per cent of patients required surgery and 58% received blood transfusions. No differences were found between PT and ST ICU and hospital mortality rates were 15 and 25% respectively. Conclusions: The characteristics and evolution of PT and ST of this series of patients are similar to those described abroad. Mortality was in agreement with ISS and APACHE II scores.
- ItemCOVID-19-Associated Mold Infection in Critically Ill Patients, Chile(2021) Rabagliati, Ricardo; Rodriguez, Nicolas; Nunez, Carolina; Huete, Alvaro; Bravo, Sebastian; Garcia, PatriciaPatients with severe coronavirus disease (COVID-19) may have COVID-19-associated invasive mold infection (CAIMI) develop. We report 16 cases of CAIMI among 146 nonimmunocompromised patients with severe COVID-19 at an academic hospital in Santiago, Chile. These rates correspond to a CAIMI incidence of 11%; the mortality rate for these patients was 31.2%.
- ItemEvolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A clinical-physiologic study(W B SAUNDERS CO-ELSEVIER INC, 2012) Hernandez, Glenn; Pedreros, Cesar; Veas, Enrique; Bruhn, Alejandro; Romero, Carlos; Rovegno, Maximiliano; Neira, Rodolfo; Bravo, Sebastian; Castro, Ricardo; Kattan, Eduardo; Ince, CanPurpose: Perfusion assessment during septic shock resuscitation is difficult and usually complex determinations. Capillary refill time (CRT) and central-to-toe temperature difference (Tc-toe) have been proposed as objective reproducible parameters to evaluate peripheral perfusion. The comparative evolution of peripheral vs metabolic perfusion parameters in septic shock resuscitation has not been studied. We conducted a prospective observational clinical-physiologic study to address this subject.
- ItemExpanding ICU facilities in a pandemic scenario(SOC MEDICA SANTIAGO, 2020) Andresen, Max; Born, Pablo; Kattan, Eduardo; Vera, Magdalena; Cataldo, Alejandro; Ruiz, Carolina; Bravo, SebastianOur 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.
- ItemHypoxia-related parameters during septic shock resuscitation: Pathophysiological determinants and potential clinical implications(AME PUBL CO, 2020) Pavez, Nicolas; Kattan, Eduardo; Vera, Magdalena; Ferri, Giorgio; Daniel Valenzuela, Emilio; Alegria, Leyla; Bravo, Sebastian; Pairumani, Ronald; Santis, Cesar; Oviedo, Vanessa; Soto, Dagoberto; Ospina Tascon, Gustavo; Bakker, Jan; Hernandez, Glenn; Castro, RicardoBackground: Assessment of tissue hypoxia at the bedside has yet to be translated into daily clinical practice in septic shock patients. Perfusion markers are surrogates of deeper physiological phenomena. Lactate-to-pyruvate ratio ( LPR) and the ratio between veno-arterial PCO2 difference and Ca-vO(2) (Delta PCO2/Ca-vO(2)) have been proposed as markers of tissue hypoxia, but they have not been compared in the clinical scenario. We studied acute septic shock patients under resuscitation. We wanted to evaluate the relationship of these hypoxia markers with clinical and biochemical markers of hypoperfusion during septic shock resuscitation.
- ItemPreload responsiveness-guided fluid removal in mechanically ventilated patients with fluid overload: A comprehensive clinical-physiological study(2024) Castro, Ricardo; Born, Pablo; Roessler, Eric; Labra, Christian; McNab, Paul; Bravo, Sebastian; Soto, Dagoberto; Kattan, Eduardo; Hernandez, Glenn; Bakker, JanThis study investigated fluid removal strategies for critically ill patients with fluid overload on mechanical ventilation. Traditionally, a negative fluid balance (FB) is aimed for. However, this approach can have drawbacks. Here, we compared a new approach, namely removing fluids until patients become fluid responsive (FR) to the traditional empiric negative balance approach. Twelve patients were placed in each group (n = 24). FR assessment was performed using passive leg raising (PLR). Both groups maintained stable blood pressure and heart function during fluid management. Notably, the FR group weaned from the ventilator significantly faster than negative FB group (both for a spontaneous breathing trial (14 h vs. 36 h, p = 0.031) and extubation (26 h vs. 57 h, p = 0.007); the difference in total ventilator time wasn't statistically significant (49 h vs. 62 h, p = 0.065). Additionally, FR group avoided metabolic problems like secondary alkalosis and potential hypokalemia seen in the negative FB group. FR-guided fluid-removal in fluid overloaded mechanically ventilated patients was a feasible, safe, and maybe superior strategy in facilitating weaning and disconnection from mechanical ventilation than negative FB-driven fluid removal. FR is a safe endpoint for optimizing cardiac function and preventing adverse consequences during fluid removal.
- ItemProcess-oriented metrics to provide feedback and assess the performance of students who are learning surgical procedures: The percutaneous dilatational tracheostomy case(TAYLOR & FRANCIS LTD, 2022) Jose Martinez, Juan; Galvez-Yanjari, Victor; de la Fuente, Rene; Kychenthal, Catalina; Kattan, Eduardo; Bravo, Sebastian; Munoz-Gama, Jorge; Sepulveda, MarcosPurpose Assessing competency in surgical procedures is key for instructors to distinguish whether a resident is qualified to perform them on patients. Currently, assessment techniques do not always focus on providing feedback about the order in which the activities need to be performed. In this research, using a Process Mining approach, process-oriented metrics are proposed to assess the training of residents in a Percutaneous Dilatational Tracheostomy (PDT) simulator, identifying the critical points in the execution of the surgical process. Materials and methods A reference process model of the procedure was defined, and video recordings of student training sessions in the PDT simulator were collected and tagged to generate event logs. Three process-oriented metrics were proposed to assess the performance of the residents in training. Results Although the students were proficient in classic metrics, they did not reach the optimum in process-oriented metrics. Only in 25% of the stages the optimum was achieved in the last session. In these stages, the four more challenging activities were also identified, which account for 32% of the process-oriented metrics errors. Conclusions Process-oriented metrics offer a new perspective on surgical procedures performance, providing a more granular perspective, which enables a more specific and actionable feedback for both students and instructors.
- ItemViral shedding and viraemia of Andes virus during acute hantavirus infection: a prospective study(2024) Ferres, Marcela; Martinez-Valdebenito, Constanza; Henriquez, Carolina; Marco, Claudia; Angulo, Jenniffer; Barrera, Aldo; Palma, Carlos; Pinto, Gonzalo Barriga; Cuiza, Analia; Ferreira, Leonila; Rioseco, Maria Luisa; Calvo, Mario; Fritz, Ricardo; Bravo, Sebastian; Bruhn, Alejandro; Graf, Jeronimo; Llancaqueo, Alvaro; Rivera, Gonzalo; Cerda, Carolina; Tischler, Nicole; Valdivieso, Francisca; Vial, Pablo; Mertz, Gregory; Vial, Cecilia; Le Corre, NicoleBackground Andes virus (ANDV) is a zoonotic Orthohantavirus leading to hantavirus cardiopulmonary syndrome. Although most transmissions occur through environmental exposure to rodent faeces and urine, rare person -toperson transmission has been documented, mainly for close contacts. This study investigates the presence and infectivity of ANDV in body fluids from confirmed cases and the duration of viraemia. Methods In this prospective study, 131 participants with confirmed ANDV infection were enrolled in Chile in a prospective study between 2008 and 2022. Clinical samples (buffy coat, plasma, gingival crevicular fluid [GCF], saliva, nasopharyngeal swabs [NPS], and urine) were collected weekly for 3 weeks together with clinical and epidemiological data. Samples were categorised as acute or convalescent (up to and after 16 days following onset of symptoms). Infectivity of positive fluids was assessed after the culture of samples on Vero E6 cells and use of flow cytometry assays to determine the production of ANDV nucleoprotein. Findings ANDV RNA was detected in 100% of buffy coats during acute phase, declining to 95% by day 17, and to 93% between days 23-29. ANDV RNA in GCF and saliva decreased from 30% and 12%, respectively, during the acute phase, to 12% and 11% during the convalescent phase. Successful infectivity assays of RT-qPCR-positive fluids, including GCF, saliva, NPS, and urine, were observed in 18 (42%) of 43 samples obtained during the acute phase of infection. After re -culture, the capacity to infect Vero E6 cells was maintained in 16 (89%) of 18 samples. Severity was associated with the presence of ANDV RNA in one or more fluids besides blood (odds ratio 258 [95% CI 142-518]). Interpretation ANDV infection is a systemic and viraemic infection, that affects various organs. The presence of infectious particles in body fluids contributes to our understanding of potential mechanisms for person -to -person transmission, supporting the development of preventive strategies. Detection of ANDV RNA in additional fluids at hospital admission is a predictor of disease severity. Funding National Institutes of Health and Agencia de Investigaci & oacute;n y Desarrollo. Copyright (c) 2024 Elsevier Ltd. All rights reserved.