Browsing by Author "Bugedo Tarraza, Guillermo"

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    Acute effect of dobutamine and amrinone on hemodynamics and splanchnic perfusion in septic shock patients
    (1999) Hernández, P. Glenn; Gigoux Muller, Jorge Alberto; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis Benito; Bruhn Cruz, Alejandro Rodrigo; Tomicic, Vinko; Dagnino Sepúlveda, Jorge Álvaro
    Background: Vasoactive drugs used in the reanimation of septic patients, can modify splanchnic perfusion. Aim: To compare the effects of dobutamine and amrinone on gastric intramucosal pH (pHi), lactate levels and hemodynamics in surgical patients with compensated septic shock. Patients and methods: Fourteen postoperative patients with abdominal sepsis and compensated septic shock (pHi < 7.32 or lactate > 2.5 mmol/l) were studied in a prospective, randomized, unblinded study. Patients were randomized to receive (Group 1, n = 7) dobutamine at 5 micrograms/Kg/min or (Group 2, n = 7) amrinone at 5 micrograms/Kg/min. Hemodynamic data, arterial lactate and pHi were measured before and 30, 60 and 120 minutes after starting drug infusion. Results: Both drugs were associated with a decrease in lactate levels. Dobutamine infusion, but not amrinone, increased gastric pHi, as well as cardiac index and oxygen delivery. Conclusions: An improvement in gastric pHi associated with an increase in oxygen delivery, was observed with dobutamine. Amrinone showed no effect at the fixed, low dose used in the study.
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    An evidence-based resuscitation algorithm applied from the emergency room to the ICU improves survival of severe septic shock
    (2008) Castro López, Ricardo; Regueira Heskia, Tomás; Aguirre Zúniga, Marcia Lorena; Llanos Valdés, Osvaldo Pablo; Bruhn, Alejandro; Bugedo Tarraza, Guillermo; Dougnac Labatut, Alberto; Castillo Fuenzalida, Luis Benito; Andresen Hernández, Max; Hernández P., Glenn
    Background. Septic shock is highly lethal. We recently implemented an algorithm (advanced resuscitation algorithm for septic shock, ARAS 1) with a global survival of 67%, but with a very high mortality (72%) in severe cases [norepinephrine (NE) requirements >0.3 µg/kg/min for mean arterial pressure ≥70 mmHg]. As new therapies with different levels of evidence were proposed [steroids, drotrecogin alpha, high-volume hemofiltration (HVHF)], we incorporated them according to severity (NE requirements; algorithm ARAS-2), and constructed a multidisciplinary team to manage these patients from the emergency room (ER) to the ICU. The aim of this study was to compare the outcome of severe septic shock patients under both protocols. Methods. Adult patients with severe septic shock were enrolled consecutively and managed prospectively with ARAS1 (1999-2001), and ARAS-2 (2002-05). ARAS-2 incorporates HVHF for intractable shock. Results. Thirty-three patients were managed with each protocol, without statistical differences in baseline demographics, APACHE II (22.2 vs 23.8), SOFA (11.4 vs 12.7) and NE peak levels (0.62 vs 0.8 µg/kg/min). The 28-day mortality and epinephrine use were higher with ARAS-1 (72.7% vs 48.5%; 87.9% vs 18.2 %); and low-dose steroids (35.9% vs 72.7%), drotrecogin (0 vs 15 %) and HVHF use (3.0% vs 39.4%) were higher for ARAS-2 (P<0.05 for all). Conclusion. Management of severe septic shock with a multidisciplinary team and an updated protocol (according to the best current evidence), with precise entry criteria for every intervention at different stages of severity, may improve survival in these patients. Multidisciplinary management, rationalization of the use of vasoactives and rescue therapy based on HVHF instead of epinephrine may have contributed to these results. Management of severe septic shock with these kinds of algorithms is feasible and should be encouraged.
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    Características e impacto de la sedación, la analgesia y el bloqueo neuromuscular en los pacientes críticos que recibieron ventilación mecánica prolongada
    (2009) Tobar, E.; Bugedo Tarraza, Guillermo; Andresen Hernández, Max; Aguirre, M.; Lira, M. T.; Godoy, J.; González, H.; Hernández, A.; Tomicic, V.; Castro, J.; Jara, J.; Ugarte, H.
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    Catastrophic respiratory failure from tuberculosis pneumonia: Survival after prolonged extracorporeal membrane oxygenation support
    (2013) Andresen Hernández, Max; Tapia, P.; Mercado, M.; Bugedo Tarraza, Guillermo; Bravo, S.; Regueira Heskia, Tomás
    Tuberculosis (TB) is an uncommon cause of severe respiratory failure, even in highly endemic regions. Mortality in cases requiring mechanical ventilation (MV) varies between 60 and 90%. The use of extracorporeal membrane oxygenation (ECMO) is not frequently needed in TB. We report the case of a 24 year old woman diagnosed with bilateral pneumonia that required MV and intensive care, patient was managed with prone ventilation for 48 h, but persisted in refractory hypoxemia. Etiological study was only positive for mycobacterium tuberculosis. As a rescue therapy arterio-venous extracorporeal CO2 removal was started and lased for 4 days, but fails to support the patient due to greater impairment of oxygenation. Veno-venous ECMO was then initiated, thus normalizes gas exchanged and allows lungs to rest. ECMO was maintained for 36 days, with two episodes of serious complication treated successfully. Given the absence of clinical improvement and the lack of nosocomial infection, at 42-day of ICU stay methylprednisolone 250 mg daily for 4 days was started, since secondary organizing pneumonia associated with TB was suspected. Thereafter progressive improvement in pulmonary mechanics and reduction of pulmonary opacities was observed, allowing the final withdrawal of ECMO. Percutaneous tracheostomy was performed and the patient remained connected until her transfer to her base hospital at day 59 of admission to our unit. The tracheostomy was removed prior to hospital discharge, and the patient is today at home. Prolonged ECMO support is a useful and potentially successful tool in catastrophic respiratory failure caused by TB.
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    Cateterización venosa suprahepática en cuatro casos de shock séptico severo
    (2001) Inzunza Pérez, Carlos; Cornu A., M.; Bruhn, Alejandro; Castillo Fuenzalida, Luis Benito; Bugedo Tarraza, Guillermo; Acuña C., D.; Medeiros U., S.; Hernández P., Glenn
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    Confusion assessment method for diagnosing delirium in ICU patients (CAM-ICU): Cultural adaptation and validation of the Spanish version
    (2010) Tobar, E.; Romero, C.; Galleguillos, T.; Fuentes, P.; Cornejo, R.; Lira, M. T.; de la Barrera, L.; Sánchez, J. E.; Bozán, F.; Bugedo Tarraza, Guillermo; Morandi, A.; Wesley E, E.
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    Does Regional Lung Strain Correlate With Regional Inflammation in Acute Respiratory Distress Syndrome During Nonprotective Ventilation? An Experimental Porcine Study
    (2018) Retamal Montes, Jaime; Hurtado Sepúlveda, Daniel; Villarroel, Nicolás; Bruhn, Alejandro; Bugedo Tarraza, Guillermo; Amato, Marcelo; Costa, Eduardo L. V.; Hedenstierna, Goran; Larsson, Anders; Borges, Joäo Batista
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    Does the use of high PEEP levels prevent ventilator-induced lung injury?
    (2017) Bugedo Tarraza, Guillermo; Retamal Montes, Jaime; Bruhn, Alejandro
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    Driving pressure : a marker of severity, a safety limit, or a goal for mechanical ventilation?
    (2017) Bugedo Tarraza, Guillermo; Retamal Montes, Jaime; Bruhn, Alejandro
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    Effect of a lung rest strategy during ECMO in a porcine acute lung injury model
    (2015) Araos, J.; Tapia, Pablo; Alegría, Leyla; García Cañete, Patricia; Rodríguez, F.; Amthauer, M.; Castro, G.; Soto, Dagoberto; Damiani Rebolledo, L. Felipe; Bugedo Tarraza, Guillermo; Bruhn, Alejandro; Cruces, Pablo; Salomon, Tatiana; Erranz, B.; Carreño, P.; Medina, T.
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    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
    (2021) Araos, Joaquin; Alegría Vargas, Leyla; Garcia, Aline; Cruces, Pablo; Soto Muñoz, Dagoberto Igor; Erranz, Benjamín; Salomon, Tatiana; Medina, Tania; García Valdes, Patricio Hernán; Dubo, Sebastian; Bachmann Barron, María Consuelo; Basoalto Escobar, Roque Ignacio; Valenzuela, Emilio Daniel; Rovegno Echavarría, Maximiliano David; Vera Alarcón, María Magdalena; Retamal Montes, Jaime; Cornejo Rosas, Rodrigo Alfredo; Bugedo Tarraza, Guillermo; Bruhn, Alejandro
    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 (n¼7 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 (n¼4) and early death (n¼3) 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 cmH2O. 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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    Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome
    (2004) Bruhn, Alejandro; Hernández P., Glenn; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis
    Abstract Introduction Positive end-expiratory pressure (PEEP) improves oxygenation and can prevent ventilator-induced lung injury in patients with acute respiratory distress syndrome (ARDS). Nevertheless, PEEP can also induce detrimental effects by its influence on the cardiovascular system. The purpose of this study was to assess the effects of PEEP on gastric mucosal perfusion while applying a protective ventilatory strategy in patients with ARDS. Methods Eight patients were included. A pressure–volume curve was traced and ideal PEEP, defined as lower inflection point + 2 cmH2O, was determined. Gastric tonometry was measured continuously (Tonocap). After baseline measurements, 10, 15 and 20 cmH2O PEEP and ideal PEEP were applied for 30 min each. By the end of each period, hemodynamic, CO2 gap (gastric minus arterial partial pressures), and ventilatory measurements were performed. Results PEEP had no effect on CO2 gap (median [range], baseline: 19 [2–30] mmHg; PEEP 10: 19 [0–40] mmHg; PEEP 15: 18 [0–39] mmHg; PEEP 20: 17 [4–39] mmHg; ideal PEEP: 19 [9–39] mmHg; P = 0.18). Cardiac index also remained unchanged (baseline: 4.6 [2.5–6.3] l min-1 m-2; PEEP 10: 4.5 [2.5–6.9] l min-1 m-2; PEEP 15: 4.3 [2–6.8] l min-1 m-2; PEEP 20: 4.7 [2.4–6.2] l min-1 m-2; ideal PEEP: 5.1 [2.1–6.3] l min-1 m-2; P = 0.08). One patient did not complete the protocol because of hypotension. Conclusion PEEP of 10–20 cmH2O does not affect gastric mucosal perfusion and is hemodynamically well tolerated in most patients with ARDS, including those receiving adrenergic drugs.
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    Electrical impedance tomography in acute respiratory distress syndrome
    (2018) Bachmann, María Consuelo; Bugedo Tarraza, Guillermo; Bruhn, Alejandro; Morales, Arturo; Retamal Montes, Jaime; Morais, Caio; Borges, João B.; Costa, Eduardo
    Abstract Acute respiratory distress syndrome (ARDS) is a clinical entity that acutely affects the lung parenchyma, and is characterized by diffuse alveolar damage and increased pulmonary vascular permeability. Currently, computed tomography (CT) is commonly used for classifying and prognosticating ARDS. However, performing this examination in critically ill patients is complex, due to the need to transfer these patients to the CT room. Fortunately, new technologies have been developed that allow the monitoring of patients at the bedside. Electrical impedance tomography (EIT) is a monitoring tool that allows one to evaluate at the bedside the distribution of pulmonary ventilation continuously, in real time, and which has proven to be useful in optimizing mechanical ventilation parameters in critically ill patients. Several clinical applications of EIT have been developed during the last years and the technique has been generating increasing interest among researchers. However, among clinicians, there is still a lack of knowledge regarding the technical principles of EIT and potential applications in ARDS patients. The aim of this review is to present the characteristics, technical concepts, and clinical applications of EIT, which may allow better monitoring of lung function during ARDS.
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    Experiencia preliminar del tratamiento con dexmedetomidina del estado confusional e hiperadrenergia en la unidad de cuidados intensivos.
    (2002) Romero Patino, Carlos Miguel; Bugedo Tarraza, Guillermo; Bruhn, Alejandro; Mellado T., Patricio; Hernández P., Glenn; Castillo Fuenzalida, Luis Benito
    Delirium (confusion) is an acute, reversible and fluctuating compromise of awareness and cognitive function, a state that can increase morbidity and mortality. We describe four patients with delirium associated with agitation and hyperadrenergic states refractory to haloperidol but responsive to dexmedetomidine.
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    Extracorporeal membrane oxygenation improves survival in a novel 24-hour pig model of severe acute respiratory distress syndrome
    (2016) Araos, J.; Alegría Aguirre, Luz Katiushka; Garcia, P.; Damiani Rebolledo, L. Felipe; Tapia, P.; Soto, D.; Salomon, T.; Retamal Montes, Jaime; Bugedo Tarraza, Guillermo; Bruhn, Alejandro; Rodriguez, F.; Amthauer, M.; Erranz, B.; Castro, G.; Carreno, P.; Medina, T.; Cruces, P.
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    Fluid and electrolyte management in neurosurgical critical care
    (2020) Bugedo Tarraza, Guillermo; Vera Alarcón, María Magdalena; Brambrink, Ansgar M.; Kirsch, Jeffrey R.
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    Hantavirus cardiopulmonary syndrome successfully treated with high-volume hemofiltration
    (2016) Bugedo Tarraza, Guillermo; Florez, Jorge; Ferrés Garrido, Marcela Viviana; Roessler Barrón, Eric; Bruhn, Alejandro
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    High PEEP levels are associated with overdistension and tidal recruitment/derecruitment in ARDS patients
    (2015) Retamal Montes, Jaime; Bugedo Tarraza, Guillermo; Larsson, A.; Bruhn, Alejandro
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    High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock
    (2006) Cornejo, Rodrigo; Downey Concha, Patricio; Castro López, Ricardo; Romero, Carlos; Regueira Heskia, Tomás Emilio; Vega Stieb, Jorge Enrique; Castillo Fuenzalida, Luis Benito; Andresen Hernández, Max Alfonso; Dougnac Labatut, Alberto; Bugedo Tarraza, Guillermo; Hernández Poblete, Glenn Wilson
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    Hipotermia intravascular inducida en el manejo de la hipertensión intracraneana en insuficiencia hepática aguda. Caso clínico
    (2009) Castillo Fuenzalida, Luis Benito; Pérez Ríos, Cristián; Ruiz B., C.; Bugedo Tarraza, Guillermo; Hernández P., Glenn; Martínez Castillo, Jorge; Jarufe Cassis, Nicolás; Pérez Ayuso, Rosa María; Mellado T., Patricio; Domínguez, P.
    Acute liver failure has a mortality rate in excess of 80%. Most deaths are attributed to brain edema with intracranial hypertension and herniation of structures, where ammonium plays a major role in its generation. We report an 18 year-old female with a fulminant hepatic failure caused by virus A infection. The patient developed a profound sopor and required mechanical ventilation. A CT scan showed the presence of brain edema and intracranial hypertension. A Raudemic® catheter was inserted to measure intracranial pressure and brain temperature. Intracranial hypertension became refractory and intravascular hypothermia was started, reducing brain temperature to 33oC. Seventy two hours later, a liver transplantation was performed. After testing graft perfusion, rewarming was started, completing 122 hours of hypothermia at 33oC. The patient was discharged in good conditions after 69 days of hospitalization (Rev Méd Chile 2009; 137: 801-6).