Browsing by Author "Cornejo, Rodrigo A."

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    Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile
    (2022) Cornejo, Rodrigo A.; Montoya, Jorge; Gajardo, Abraham I. J.; Graf, Jerónimo; Alegría Vargas, Leyla; Baghetti, Romyna; Irarrázaval, Anita; Santis, César; Pavez, Nicolás; Leighton, Sofía; Tomicic, Vinko; Morales, Daniel; Ruiz Balart, Carolina; Navarrete, Pablo; Vargas, Patricio; Gálvez, Roberto; Espinosa, Victoria; Lazo, Marioli; Pérez-Araos, Rodrigo A.; Garay, Osvaldo; Sepúlveda, Patrick; Martinez, Edgardo; Bruhn, Alejandro; The SOCHIMI Prone-COVID-19 Group; Pontificia Universidad Católica de Chile. Escuela de Medicina
    Background Prone positioning is currently applied in time-limited daily sessions up to 24 h which determines that most patients require several sessions. Although longer prone sessions have been reported, there is scarce evidence about the feasibility and safety of such approach. We analyzed feasibility and safety of a continuous prolonged prone positioning strategy implemented nationwide, in a large cohort of COVID-19 patients in Chile. Methods: Retrospective cohort study of mechanically ventilated COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted in 15 Intensive Care Units, which adhered to a national protocol of continuous prone sessions  ≥ 48 h and until PaO2:FiO2 increased above 200 mm Hg. The number and extension of prone sessions were registered, along with relevant physiologic data and adverse events related to prone positioning. The cohort was stratified according to the first prone session duration: Group A, 2–3 days; Group B, 4–5 days; and Group C, > 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety. Results: We included 417 patients who required a first prone session of 4 (3–5) days of whom 318 (76.3%) received only one session. During the first prone session the main adverse event was grade 1–2 pressure sores in 97 (23.9%) patients; severe adverse events were infrequent with 17 non-scheduled extubations (4.2%). 90-day mortality was 36.2%. Ninety-eight patients (24%) were classified as group C; they exhibited a more severe ARDS at baseline, as reflected by lower PaO2:FiO2 ratio and higher ventilatory ratio, and had a higher rate of pressure sores (44%) and higher 90-day mortality (48%). However, after adjustment for severity and several relevant confounders, prone session duration was not associated with mortality or pressure sores. Conclusions: Nationwide implementation of a continuous prolonged prone positioning strategy for COVID-19 ARDS patients was feasible. Minor pressure sores were frequent but within the ranges previously described, while severe adverse events were infrequent. The duration of prone session did not have an adverse effect on safety.
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    Effects of Prone Positioning on Lung Protection in Patients with Acute Respiratory Distress Syndrome
    (2013) Cornejo, Rodrigo A.; Díaz, Juan C.; Tobar, Eduardo A.; Bruhn, Alejandro; Ramos, Cristóbal A.; González, Roberto A.; Repetto, Claudia A.; Romero, Carlos M.; Gálvez, Luis R.; Llanos, Osvaldo; Arellano, Daniel H.; Neira, Wilson R.; Díaz Ulloa, Gonzalo Alberto; Zamorano, Aníbal J.; Pereira, Gonzalo L.
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    Pendelluft in hypoxemic patients resuming spontaneous breathing: proportional modes versus pressure support ventilation
    (2023) Arellano, Daniel H.; Brito, Roberto; Morais, Caio C. A.; Ruiz-Rudolph, Pablo; Gajardo, Abraham I. J.; Guiñez, Dannette V.; Lazo, Marioli T.; Ramirez, Ivan; Rojas, Verónica A.; Bruhn, Alejandro; Cerda, María A.; Medel, Juan N.; Illanes, Victor; Estuardo, Nivia R.; Brochard, Laurent J.; Amato, Marcelo B. P.; Cornejo, Rodrigo A.
    Background: Internal redistribution of gas, referred to as pendelluft, is a new potential mechanism of effort-dependent lung injury. Neurally-adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV +) follow the patient’s respiratory effort and improve synchrony compared with pressure support ventilation (PSV). Whether these modes could prevent the development of pendelluft compared with PSV is unknown. We aimed to compare pendelluft magnitude during PAV + and NAVA versus PSV in patients with resolving acute respiratory distress syndrome (ARDS). Methods: Patients received either NAVA, PAV + , or PSV in a crossover trial for 20-min using comparable assistance levels after controlled ventilation (> 72 h). We assessed pendelluft (the percentage of lost volume from the non-dependent lung region displaced to the dependent region during inspiration), drive (as the delta esophageal swing of the first 100 ms [ΔPes 100 ms]) and inspiratory effort (as the esophageal pressure–time product per minute [PTPmin]). We performed repeated measures analysis with post-hoc tests and mixed-effects models. Results: Twenty patients mechanically ventilated for 9 [5–14] days were monitored. Despite matching for a similar tidal volume, respiratory drive and inspiratory effort were slightly higher with NAVA and PAV + compared with PSV (ΔPes 100 ms of –2.8 [−3.8–−1.9] cm H2O, −3.6 [−3.9–−2.4] cm H2O and −2.1 [−2.5–−1.1] cm H2O, respectively, p < 0.001 for both comparisons; PTPmin of 155 [118–209] cm H2O s/min, 197 [145–269] cm H2O s/min, and 134 [93–169] cm H2O s/min, respectively, p < 0.001 for both comparisons). Pendelluft magnitude was higher in NAVA (12 ± 7%) and PAV + (13 ± 7%) compared with PSV (8 ± 6%), p < 0.001. Pendelluft magnitude was strongly associated with respiratory drive (β = -2.771, p-value < 0.001) and inspiratory effort (β = 0.026, p  < 0.001), independent of the ventilatory mode. A higher magnitude of pendelluft in proportional modes compared with PSV existed after adjusting for PTPmin (β = 2.606, p = 0.010 for NAVA, and β = 3.360, p = 0.004 for PAV +), and only for PAV + when adjusted for respiratory drive (β = 2.643, p = 0.009 for PAV +). Conclusions: Pendelluft magnitude is associated with respiratory drive and inspiratory effort. Proportional modes do not prevent its occurrence in resolving ARDS compared with PSV.