Browsing by Author "Dougnac Labatut, Alberto"
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- ItemAn 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., GlennBackground. 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.
- ItemClinical epidemiologic study of patients admitted to the intensive care unit, according to age.(1997) Dougnac Labatut, Alberto; Andresen, M.; Giacaman, P.; Díaz, O.; Letelier Saavedra, Luz María; Arriagada, D.Introducción: Últimamente hemos observado un aumento en el ingreso a unidades de cuidados intensivos de pacientes mayores de 65 años, probablemente debido al aumento de la esperanza de vida que se está presentando en Chile. Objetivo: Comparar la frecuencia de ingresos a unidades de cuidados intensivos en pacientes mayores de 65 años, sus diagnósticos, su gravedad y evolución hospitalaria, con la de pacientes más jóvenes. Pacientes y métodos: Se revisaron los prontuarios de todos los pacientes ingresados en una unidad de cuidados intensivos de un Hospital Universitario, durante un año. El diagnóstico que motivó el ingreso fue considerado como enfermedad principal. La gravedad en el momento del ingreso se evaluó mediante el puntaje de Apache. Resultados: Un total de 777 pacientes ingresaron durante el período de estudio. Veinte tuvieron que ser excluidos debido a la falta de datos confiables. Cuatrocientos treinta y dos (57%) tenían más de 65 años. Las enfermedades cardiovasculares fueron la principal causa de ingreso en pacientes jóvenes y ancianos. La mortalidad fue del 14,8% de los pacientes mayores de 65 años y del 18,7% en los más jóvenes. Las principales causas de muerte fueron paro cardíaco, shock cardiogénico, sepsis y enfermedad cerebrovascular. No se observaron diferencias en las causas de muerte entre pacientes jóvenes y ancianos. Conclusiones: Los pacientes mayores de 65 años ingresados en unidades de cuidados intensivos son muy similares a sus contrapartes más jóvenes en su pronóstico y causas de ingreso.
- ItemCytokine kinetics in severe sepsis. Its relationship with mortality and organic dysfunction(SOC MEDICA SANTIAGO, 2001) Dougnac Labatut, Alberto; Riquelme Pérez, Arnoldo; Calvo Arellano, Mario; Andresen Hernández, Max; Magedzo N., Amiran; Eugenin Arce, Eliseo Alberto; Marshall Rivera, Guillermo; Gutiérrez Torres, Miguel Alejandro
- ItemDeterminación y análisis comparativo de gasto cardíaco en enfermos críticos mediante Doppler transesofágico y termodilución en bolos. Experiencia preliminar(2005) Andresen Hernández, Max; Henríquez Valenzuela, Mauricio; Mercado Flores, Marcelo Esteban; Farías Gontupil, Gonzalo; Castillo Sepúlveda, Carmen; Benítez Gajardo, Carlos Esteban; Dougnac Labatut, AlbertoCardiac output can be measured non invasively by transesophageal Doppler. This is an alternative to measure it by thermodilution with a catheter in the pulmonary artery. Aim: To compare both methods of cardiac output measurement. Material and methods: Simultaneous measurement of cardiac output by transesophageal Doppler and thermodilution with a catheter in the pulmonary artery in four male critical patients, aged 60±12 years, hospitalized in a University Hospital. The Bland and Altman method to compare the concordance between two measurements, was used. Results: Forty measurements were performed. The results of both methods had a correlation coefficient of 0.98. According to the Bland and Altman method, the difference between both methods was -0.5 L with a precision of 0.52 L/min (95% confidence interval -1.51 to 0.52 L/min). Considering that a change between two sequential measurements is considered significant when the difference is more than 15%, both measurements agreed in 83% of cases, that there was a change in cardiac output. Conclusions: Transesophageal Doppler is a promising non invasive technique to measure cardiac output in critical care patients. It becomes a valid alternative to the thermodilution technique.
- ItemEstudio de la supervivencia de pacientes ancianos en unidades de cuidados intensivos. ¿Deberían ser admitidos en estas unidades?(1997) Dougnac Labatut, Alberto; Giacaman, P.; Andresen, M.; Díaz, O.; Letelier, L.M.Background: An important increase in health care costs has occurred lately, determined in part by the expenses of intensive care units. An important proportion of beds in these units are occupied by elders, with high costs and dubious results. Aim: To study the survival of elderly patients in intensive care units to shed light on the question if these patients should be admitted to these facilities. Material and methods: We retrospectively analyzed the mortality of 443 patients older than 65 years old, admitted to an intensive care unit between 1993 and 1994. The mortality was compared with that of 334 younger patients admitted in the same period. Severity of disease was determined using admission APACHE II score. Results: Older patients had a higher admission APACHE score than younger subjects (18.4 +/- 8.4 and 14.5 +/- 8.7 respectively, p < 0.01). Mortality during the intensive care unit stay was similar in older and younger patients (18.5 and 14.4%, respectively). Hospital mortality was also similar (22.4 and 25.9%, respectively). Older patients had a higher frequency of chronic diseases and degree of functional impairment. Mortality rates for different diseases were also similar in older and younger patients. Conclusions: Older age was not associated with a higher mortality during intensive care unit stay. Prognosis is determined by the admission severity score and the number of concomitant chronic diseases.
- ItemHigh-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
- ItemLipoperoxidation and protein oxidative damage exhibit different kinetics during septic shock(HINDAWI LTD, 2008) Andresen Hernández, Max; Regueira Heskia, Tomás; Bruhn, Alejandro; Pérez Pons, Druso Diego; Strobel Lobos, Pablo Alberto; Dougnac Labatut, Alberto; Marshall Rivera, Guillermo; Leighton Puga, Federico
- ItemPrevalencia de sepsis grave en las Unidades de Cuidado Intensivo. Primer estudio nacional multicéntrico(2007) Dougnac Labatut, Alberto; Mercado Flores, Marcelo Esteban; Cornejo Rosas, Rodrigo Alfredo; Cariaga Vergara, Mario Alberto; Hernández P., Glenn; Andresen Hernández, Max Alfonso; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis BenitoBackground: Severe sepsis (SS) is the leading cause of death in the Intensive Care Units (ICU). Aim: To study the prevalence of SS in Chilean ICUs. Material and methods: An observational, cross-sectional study using a predesigned written survey was done in all ICUs of Chile on April 21st, 2004. General hospital and ICU data and the number of hospitalized patients in the hospital and in the ICU at the survey day, were recorded. Patients were followed for 28 days. Results: Ninety four percent of ICUs participated in the survey. The ICU occupation index was 66%. Mean age of patients was 57.7+18 years and 59% were male, APACHE II score was 15+7.5 and SOFA score was 6+4. SS was the admission diagnosis of 94 of the 283 patients (33%) and 38 patients presented SS after admission. On the survey day, 112 patients fulfilled SS criteria (40%). APACHE II and SOFA scores were significantly higher in SS patients than in non SS patients. Global case-fatality ratio at 28 days was 15.9% (45/283). Case-fatality ratio in patients with or without SS at the moment of the survey was 26.7% (30/112) and 8.7% (17/171), respectively p <0.05. Thirteen percent of patients who developed SS after admission, died. Case-fatality ratios for patients with SS from Santiago and the other cities were similar, but APACHE II score was significantly higher in patients from Santiago. In SS patients, the independent predictors of mortality were SS as cause of hospital admission, APACHE II and SOFA scores. Ninety nine percent of SS patients had a known sepsis focus (48% respiratory and 30% abdominal). Eighty five patients that presented SS after admission, had a respiratory focus. Conclusions: SS is highly prevalent in Chilean ICUs and represents the leading diagnosis at admission. SS as cause of hospitalization, APA CHE II and SOFA scores were independent predictors of mortality.
- ItemPro- and anti-inflammatory balance of septic patients is associated with severity and outcome(2007) Dougnac Labatut, Alberto; Castro López, Ricardo; Riquelme, Arnoldo; Calvo, M.; Eugenin, E.; Arellano, M.; Pattillo, A.; Regueira Heskia, Tomás; Mercado Flores, Marcelo Esteban; Andresen Hernández, Max AlfonsoPurpose: To study infl ammatory profi le in patients with sepsis, severe sepsis and septic shock with regards to organ dysfunction and outcome, and to identify a pattern associated with more catastrophic course of illness, organ failure and risk of death. Material and methods: Twenty-nine consecutive patients with sepsis admitted to a medical Intensive Care Unit of a tertiary university hospital (November 2002-December 2003). Plasmatic levels of interleukin-6 (IL-6) and interleukin-10 (IL10) as pro-infl ammatory and anti-infl ammatory markers were measured at baseline, 12, 24 and 48 hours of evolution. Results: There is a positive association between higher levels of IL-6 and severity of the septic process, organ dysfunctions and risk of death, statistically signifi cant at anytime (at baseline, 12, 24 and 48 hours, p <0.05). Higher IL-6/IL-10 ratios associate signifi cantly with risk of death at 24 hours (RR=1.45 if higher or equal to the median). Conclusions: Plasmatic biomarkers measurement during the initial phase of sepsis may help to individualize therapy. An evaluation at 24 h based on IL-6/IL-10 ratio may anticipate a more aggressive infl ammatory profi le. These patients would specially benefi t from immunomodulating therapies to improve survival.
- ItemSíndrome cardiopulmonar por Hantavirus: Utilidad de la monitorización con el sistema PiCCO(2003) Romero Patino; Carlos Miguel; Andresen Hernández, Max Alfonso; Díaz Patiño, Orlando; Tomicic, Vinko; Baraona Reyes, Fernando Exequiel; Mercado Flores, Marcelo Esteban; Pérez C., Carlos; Downey, Patricio; Dougnac Labatut, AlbertoWe report a 68 years old man, farmer from the metropolitan region, admitted with a Hantavirus Cardiopulmonary Syndrome. The diagnosis was made using serologic test and was later confirmed by the Public Health Institute. He evolved to an early multiple organ failure, requiring high concentrations of oxygen and invasive ventilatory assistance, vasopressor drugs and renal replacement therapy. Swan Ganz and PiCCO were used simultaneously for hemodynamic monitoring. Treatment consisted in global support therapy, antimicrobial therapy and systemic corticosteroids. Intrathoracic blood volume was a more reliable parameter than pulmonary capillary wedge pressure for the assessment of preload. As expected in situations of increased vascular permeability, there was an increase in extravascular lung water. There was a good correlation between extravascular lung water and oxygenation parameters (PaO2/FiO2 and oxygenation index). PiCCO system may become a helpful tool in the management of patients with Hantavirus Cardiopulmonary Syndrome
- ItemSíndrome de respuesta inflamatoria sistémica severa: ¿Es comparable a la sepsis severa?(1999) Hernández P., Glenn; Dougnac Labatut, Alberto; Castro O, J.; Labarca M, E.; Ojeda M, M.; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis Benito; Andresen Hernández, Max; Bruhn, Alejandro; Huidobro M, L.F.; Huidobro M, R.; Caballero G, M.T.; Hernández M, A.Background: In 1992, a consensus conference defined the terms systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock. Since then, numerous reports have validated the prognostic usefulness of these operative definitions. Aim: To evaluate if sepsis severity criteria, as defined by the Consensus Conference, can be applied to noninfectious SIRS. Patients and methods: Five hundred eighteen patients admitted to 5 intensive care units (ICU) from 4 hospitals were prospectively evaluated during a 3 months period. Patients that met at least one severity criteria were included. SIRS etiology, organ dysfunction and evolution were recorded in each patient. Results: One hundred two patients were included: 79 with sepsis (group I) and 23 with noninfectious SIRS (group II). ICU and hospital mortality were comparable (43 and 48% in sepsis compared to 43 and 51% in non infectious SIRS). The most common sources of sepsis were pneumonia and peritonitis. Group II patients had a wide variety of diseases. ICU stay, APACHE score and number of organs with dysfunction were not different among groups. Only the incidence of renal dysfunction was higher in the septic group. Conclusions: The Consensus sepsis severity criteria can be applied to noninfectious SIRS, defining a population subset with similar high mortality and organ dysfunction incidence, although with greatly heterogeneous etiologies.