Browsing by Author "De la Fuente Sanhueza, René"

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    Design and Evaluation of a Low-Cost Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Simulator
    (2019) Kattan Tala, Eduardo José; Vera Alarcón, María Magdalena; Putz de la Fuente, Francisca Carolina; Corvetto Aqueveque, Marcia Antonia; De la Fuente Sanhueza, René; Bravo Grau, Sebastián
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    Implementation of a norepinephrine-based protocol for management of septic shock: a pilot feasibility study
    (2006) Hernández P., Glenn; Bruhn, Alejandro; Romero Patiño, Carlos; Larrondo Gálvez, Francisco Andrés; De la Fuente Sanhueza, René; Cornejo, Rodrigo; Castillo Fuenzalida, Luis Benito; Bugedo Tarraza, Guillermo
    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 drugrelated morbidity. The implementation of a single pressor-based algorithm for SS is feasible and safe.
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    Simulation-based mastery learning of bronchoscopy-guided percutaneous dilatational tracheostomy competency acquisition and skills transfer to a cadaveric model
    (2021) Kattan Tala, Eduardo José; De la Fuente Sanhueza, René; Putz de la Fuente, Francisca Carolina; Vera Alarcón, María Magdalena; Corvetto Aqueveque, Marcia Antonia; Inzunza, Oscar; Achurra Tirado, Pablo; Inzunza Agüero, Martín Alejandro; Muñoz Gama, Jorge; Sepúlveda Fernández, Marcos Ernesto; Gálvez Yanjarí, Víctor Andrés; Pavez, Nicolás; Retamal Montes, Jaime; Bravo Morales, Sebastián
    Introduction: Although simulation-based training has demonstrated improvement of procedural skills and clinical outcomes in different procedures, there are no published training protocols for bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT). The objective of this study was to assess the acquisition of BG-PDT procedural competency with a simulation-based mastery learning training program, and skills transfer into cadaveric models. Methods: Using a prospective interventional design, 8 trainees naive to the procedure were trained in a simulation-based mastery learning BG-PDT program. Students were assessed using a multimodal approach, including blind global rating scale (GRS) scores of video-recorded executions, total procedural time, and hand-motion tracking–derived parameters. The BG-PDT mastery was defined as proficient tracheostomy (successful procedural performance, with less than 3 puncture attempts, and no complications) with GRS scores higher than 21 points (of 25). After mastery was achieved in the simulator, residents performed 1 BG-PDT execution in a cadaveric model. Results: Compared with baseline, in the final training session, residents presented a higher procedural proficiency (0% vs. 100%, P < 0.001), with higher GRS scores [8 (6–8) vs. 25 (24–25), P = 0.01] performed in less time [563 (408–600) vs. 246 (214–267), P = 0.01] and with higher movement economy. Procedural skills were further transferred to the cadaveric model. Conclusions: Residents successfully acquired BG-PDT procedural skills with a simulation-based mastery learning training program, and skills were effectively transferred to a cadaveric model. This easily replicable program is the first simulation-based BG-PDT training experience reported in the literature, enhancing safe competency acquisition, to further improve patient care.