Browsing by Author "Jalil Contreras, Yorschua Frederick"

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    A deep look into the rib cage compression technique in mechanically ventilated patients: a narrative review
    (2022) Jalil Contreras, Yorschua Frederick; Damiani, L. Felipe; Basoalto, Roque; Bachmman, María Consuelo; Bruhn, Alejandro
    Defective management of secretions is one of the most frequent complications in invasive mechanically ventilated patients. Clearance of secretions through chest physiotherapy is a critical aspect of the treatment of these patients. Manual rib cage compression is one of the most practiced chest physiotherapy techniques in ventilated patients; however, its impact on clinical outcomes remains controversial due to methodological issues and poor understanding of its action. In this review, we present a detailed analysis of the physical principles involved in rib cage compression technique performance, as well as the physiological effects observed in experimental and clinical studies, which show that the use of brief and vigorous rib cage compression, based on increased expiratory flows (expiratory-inspiratory airflow difference of > 33L/minute), can improve mucus movement toward the glottis. On the other hand, the use of soft and gradual rib cage compression throughout the whole expiratory phase does not impact the expiratory flows, resulting in ineffective or undesired effects in some cases. More physiological studies are needed to understand the principles of the rib cage compression technique in ventilated humans. However, according to the evidence, rib cage compression has more potential benefits than risks, so its implementation should be promoted.
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    Acute lung injury secondary to hydrochloric acid instillation induces small airway hyperresponsiveness
    (2021) Basoalto Escobar, Roque Ignacio; Damiani Rebolledo, Luis Felipe; Bachmann Barron, María Consuelo; Fonseca, Marcelo; Barros, Marisol; Soto Muñoz, Dagoberto Igor; Araos, Joaquin; Jalil Contreras, Yorschua Frederick; Dubo, Sebastian; Retamal, Jaime; Bugedo Tarraza, Guillermo Jaime; Henriquez, Mauricio; Bruhn Cruz, Alejandro Rodrigo
    Background: Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure characterized by altered lung mechanics and poor oxygenation. Bronchial hyperresponsiveness has been reported in ARDS survivors and animal models of acute lung injury. Whether this hyperreactivity occurs at the small airways or not is unknown. Objective: To determine ex-vivo small airway reactivity in a rat model of acute lung injury (ALI) by hydrochloric acid (HCl) instillation. Methods: Twelve anesthetized rats were connected to mechanical ventilation for 4-hour, and randomly allocated to either ALI group (HCl intratracheal instillation; n=6) or Sham (intratracheal instillation of 0.9% NaCl; n=6). Oxygenation was assessed by arterial blood gases. After euthanasia, tissue samples from the right lung were harvested for histologic analysis and wet-dry weight ratio assessment. Precision cut lung slice technique (100-200 pm diameter) was applied in the left lung to evaluate ex vivo small airway constriction in response to histamine and carbachol stimulation, using phase-contrast video microscopy. Results: Rats from the ALI group exhibited hypoxemia, worse histologic lung injury, and increased lung wet-dry weight ratio as compared with the sham group. The bronchoconstrictor responsiveness was significantly higher in the ALI group, both for carbachol (maximal contraction of 84.5 +/- 2.5% versus 61.4 +/- 4.2% in the Sham group, P<0.05), and for histamine (maximal contraction of 78.6 +/- 5.3% versus 49.6 +/- 5.3% in the Sham group, P<0.05). Conclusion: In an animal model of acute lung injury secondary to HCL instillation, small airway hyperresponsiveness to carbachol and histamine is present. These results may provide further insight into the pathophysiologi of ARDS.
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    Cambios demográficos y clínicos de pacientes hospitalizados por cuadros graves de COVID-19 entre la primera y segunda ola: experiencia de una UCI reconvertida
    (Sociedad de Anestesiologia de Chile, 2023) Ramírez, José I.; Revollo García, Shirley Olivia; Farías, Jorge; García, Renato; Jalil Contreras, Yorschua Frederick
    Introducción: El COVID-19 es un virus respiratorio con un espectro amplio de infección que va desde presentarse de manera asintomática hasta provocar falla respiratoria y muerte. En nuestro país se han registrado dos grandes olas de contagios teniendo que reconvertir unidades con el fin de responder a la alta demanda hospitalaria, por lo que nos parece relevante poder observar y comparar las características demográficas y clínicas de los pacientes ingresados a una unidad reconvertida en este período. Método: Es un estudio observacional retrospectivo, en el cual se analizaron datos demográficos y clínicos de dos olas diferentes. Resultados: Se incluyeron en el estudio un total de 36 pacientes (17 y 19 respectivamente), durante la segunda ola fueron significativamente más jóvenes que los de la primera (50 ± 12 vs 60± 10 años; p = 0,015), también se vio una disminución en los días de VM (9 ± 6 vs 19 ± 9 días respectivamente; p = 0,003) y en la estancia hospitalaria (19 ± 9 vs 38 ± 20 días respectivamente; p = 0,007). Conclusiones: Los pacientes ingresados a una UCI reconvertida durante la pandemia, en el período correspondiente a la segunda ola eran sujetos más jóvenes, los cuales requirieron menos días de VMI y menor estancia hospitalaria. Lo que puede reflejar un mejor manejo por parte del equipo de salud, sin embargo, no se observaron diferencias respecto a la mortalidad entre ambos grupos.
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    Disfunción Diafragmática en Ventilación Mecánica: Evaluación e Implicancias Clínicas
    (2020) Damiani Rebolledo, Luis Felipe; Jalil Contreras, Yorschua Frederick; Dubó, Sebastián
    La debilidad diafragmática es un problema relevante en pacientes admitidos a la unidad de cuidados intensivos (UCI). Su presencia ha sido asociada a mayor tiempo en ventilación mecánica, weaning dificultoso, mayor riesgo de readmisión hospitalaria y mayor mortalidad. Las causas de esta debilidad son múltiples incluyendo factores relacionados a la severidad de la enfermedad, las intervenciones en la UCI y el uso de ventilación mecánica, termino conocido como miotrauma. Se han propuesto cuatro diferentes mecanismos de miotrauma relacionados a la sobre asistencia ventilatoria, baja asistencia ventilatoria, ocurrencia de contracciones diafragmáticas excéntricas y efecto de la presión espiratoria al final de espiración. Una adecuada evaluación y monitoreo de la función diafragmática es, por lo tanto, un aspecto clave que debe ser realizado al lado de la cama del paciente. La prueba de referencia para medir la función del diafragma es la presión transdiafragmática calculada como la diferencia entre la presión gástrica y presión esofágica. Adicionalmente, otras técnicas disponibles para la evaluación de la función del diafragma corresponden a la ecografía y la medición de la actividad eléctrica. Desde un punto de vista clínico, basado en la evidencia sobre disfunción diafragmática en los pacientes ventilados mecánicamente, uno de los principales desafíos actuales es poder buscar estrategias ventilatorias que incorporen protección diafragmática mientras se mantiene una ventilación protectora pulmonar. En este sentido, favorecer un nivel de esfuerzo inspiratorio adecuado junto con optimizar la interacción entre el paciente y el ventilador constituyen los principales objetivos de una ventilación diafragmática protectora.
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    Eccentric Contractions of the Diaphragm During Mechanical Ventilation
    (2023) García Valdés, Patricio Hernán; Fernandez Mincone, Tiziana Rita; Jalil Contreras, Yorschua Frederick; Peñailillo, Luis; Damiani Rebolledo, L. Felipe
    Diaphragm dysfunction is a highly prevalent phenomenon in patients receiving mechanical ventilation, mainly due to ventilatory over-assistance and the development of diaphragm disuse atrophy. Promoting diaphragm activation whenever possible and facilitating an adequate interaction between the patient and the ventilator is encouraged at the bedside to avoid myotrauma and further lung injury. Eccentric contractions of the diaphragm are defined as muscle activation while muscle fibers are lengthening within the exhalation phase. There is recent evidence that suggests that eccentric activation of the diaphragm is very frequent and may occur during post-inspiratory activity or under different types of patient-ventilator asynchronies, which include ineffective efforts, premature cycling, and reverse triggering. The consequences of this eccentric contraction of the diaphragm may have opposite effects, depending on the level of breathing effort. For instance, during high or excessive effort, eccentric contractions can result in diaphragm dysfunction and injured muscle fibers. Conversely, when eccentric contractions of the diaphragm occur along with low breathing effort, a preserved diaphragm function, better oxygenation, and more aerated lung tissue are observed. Despite this controversial evidence, evaluating the level of breathing effort at the bedside seems crucial and is highly recommended to optimize ventilatory therapy. The impact of eccentric contractions of the diaphragm on the patient's outcome remains to be elucidated.
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    Efectos fisiologicos de las terapias de soporte respiratorio no invasivo y su potencial rol postextubación
    (2021) Basoalto Escobar, Roque Ignacio; Jalil Contreras, Yorschua Frederick; Díaz Patino, Orlando Alberto; Bruhn Cruz, Alejandro Rodrigo
    Posterior a una extubación programada existe un porcentaje de pacientes que fracasa y requiere reintubación (~20%), este evento es conocido como fracaso de extubación, el cual se asocia con mayor morbimortalidad. Para prevenir el fracaso de extubación se han propuesto terapias como la ventilación no invasiva (VNI) y la cánula nasal de alto flujo (CNAF). Estas terapias son capaces de entregar soporte respiratorio postextubación y justifican su uso en los efectos fisiológicos que son capaces de inducir, en dónde el impacto sobre el esfuerzo respiratorio e intercambio de gases sería fundamental. Con esta racionalidad fisiológica se han desarrollado diversos estudios en diferentes contextos clínicos, esto con el fin de dilucidar cuál terapia es la mejor alternativa. En esta revisión narrativa pretendemos describir y analizar los diversos efectos fisiológicos que induce la VNI y la CNAF
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    Effectiveness of neuromuscular electrostimulation in COPD subjects on mechanical ventilation. A systematic review and meta-analysis
    (2022) Gutierrez-Arias, Ruvistay; Jalil Contreras, Yorschua Frederick; Fuentes-Aspe, Rocío; Seron, Pamela
    OBJECTIVE: To estimate the effectiveness of Neuromuscular Electrostimulation (NMES) in adults with COPD undergoing MV. METHOD: A sensitive search was performed in MEDLINE, Embase, CENTRAL, CINAHL and other resources. Randomized Controlled Clinical Trials (RCTs) or non-RCTs that enrolled adults with COPD on MV due to an exacerbation of their disease were included. Two independent reviewers screened, extracted information, and assessed the risk of bias (RoB 2 tool) and the certainty of evidence (GRADE approach) from the included studies. RESULTS: Four RCTs (144 participants) were included. Subjects who underwent NMES were able to move from bed to chair independently in less time (MD = 4.98 days less; 95% CI -8.55 to -1.47; 2 RCTs; low certainty of the evidence) and they were fewer days on MV (MD = 2.89 days less; 95% CI -4.58 to -1.21); 3 RCTs; low certainty of the evidence) than the control group. However, the effect of NMES on muscle strength is unclear (very low certainty of the evidence). CONCLUSIONS: NMES may improve functional independence and decrease MV time in adults with COPD; however, its effectiveness on muscle strength is uncertain. More and better RCTs are needed to determine with greater certainty the effectiveness of NMES in this population.
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    Effectiveness of telerehabilitation in physical therapy: A rapid overview.
    (2021) Seron, Pamela; Oliveros,, María-Jose; Gutierrez-Arias, Ruvistay; Fuentes-Aspe, Rocío; Torres-Castro, Rodrigo C.; Merino-Osorio, Catalina; Nahuelhual, Paula; Inostroza, Jacqueline; Jalil Contreras, Yorschua Frederick; Solano, Ricardo; Marzuca-Nassr, Gabriel N.; Aguilera-Eguía, Raul; Lavados-Romo, Pamela; Soto-Rodríguez, Francisco J.; Sabelle, Cecilia; Villarroel Silva, Gregory; Gomolán, Patricio; Huaiquilaf, Sayen; Sanchez, Paulina
    Objective: The purpose of this article was to summarize the available evidence from systematic reviews on telerehabilitation in physical therapy.Methods: We searched Medline/PubMed, EMBASE, and Cochrane Library databases. In addition, the records in PROSPERO and Epistemonikos and PEDro were consulted. Systematic reviews of different conditions, populations, and contexts-where the intervention to be evaluated is telerehabilitation by physical therapy-were included. The outcomes were clinical effectiveness depending on specific condition, functionality, quality of life, satisfaction, adherence, and safety. Data extraction and risk of bias assessment were carried out by a reviewer with non-independent verification by a second reviewer. The findings are reported qualitatively in the tables and figures.Results: Fifty-three systematic reviews were included, of which 17 were assessed as having low risk of bias. Fifteen reviews were on cardiorespiratory rehabilitation, 14 on musculoskeletal conditions, and 13 on neurorehabilitation. The other 11 reviews addressed other types of conditions and rehabilitation. Thirteen reviews evaluated with low risk of bias showed results in favor of telerehabilitation versus in-person rehabilitation or no rehabilitation, while 17 reported no differences between the groups. Thirty-five reviews with unclear or high risk of bias showed mixed results.Conclusions: Despite the contradictory results, telerehabilitation in physical therapy could be comparable with in-person rehabilitation or better than no rehabilitation for conditions such as osteoarthritis, low-back pain, hip and knee replacement, and multiple sclerosis and also in the context of cardiac and pulmonary rehabilitation. It is imperative to conduct better quality clinical trials and systematic reviews.Impact: Providing the best available evidence on the effectiveness of telerehabilitation to professionals, mainly physical therapists, will impact the decision-making process and therefore yield better clinical outcomes for patients, both in these times of the COVID-19 pandemic and in the future. The identification of research gaps will also contribute to the generation of relevant and novel research questions.
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    Effects of the First Spontaneous Breathing Trial in Children With Tracheostomy and Long-Term Mechanical Ventilation
    (NLM (Medline), 2023) Villarroel-Silva, Gregory; Jalil Contreras, Yorschua Frederick; Moya-Gallardo, E.; Oyarzun Aguirre, Ignacio Javier; Moscoso Altamira, Gonzalo Andrés; Astudillo Maggio, Claudia Ester; Damiani Rebolledo, Luis Felipe
    Copyright © 2023 by Daedalus Enterprises.BACKGROUND: Weaning and liberation from mechanical ventilation in pediatric patients with tracheostomy and long-term mechanical ventilation constitute a challenging process due to diagnosis heterogeneity and significant variability in the clinical condition. We aimed to evaluate the physiological response during the first attempt of a spontaneous breathing trial (SBT) and to compare variables in subjects who failed or passed the SBT. METHODS: This was a prospective observational study in tracheostomized children with long-term mechanical ventilation admitted to the Hospital Josefina Martinez, Santiago, Chile, between 2014-2020. Cardiorespiratory variables such as breathing pattern, use of accessory respiratory muscles, heart rate, breathing frequency, and oxygen saturation were registered at baseline and throughout a 2-h SBT with or without positive pressure depending on an SBT protocol. Comparison of demographic and ventilatory variables between groups (SBT failure and success) was performed. RESULTS: A total of 48 subjects were analyzed (median [IQR] age of 20.5 [17.0-35.0] months, 60% male). Chronic lung disease was the primary diagnosis in 60% of subjects. Eleven (23%) total subjects failed the SBT (< 2 h), with an average failure time of 69 ± 29 min. Subjects who failed the SBT had a significantly higher breathing frequency, heart rate, and end-tidal CO2 than subjects who succeeded (P < .001). In addition, subjects who failed the SBT had significantly shorter duration of mechanical ventilation before the SBT, higher proportion unassisted SBT, and higher rate of deviation SBT protocol in comparison with subjects who succeeded. CONCLUSIONS: Conducting an SBT to evaluate the tolerance and cardiorespiratory response in tracheostomized children with long-term mechanical ventilation is feasible. Time on mechanical ventilation before the first attempt and type of SBT (with or without positive pressure) could be associated with SBT failure.
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    El movimiento del sistema ventilatorio en la funcióndisfunción humana. Fundamentos de especialidad.
    (Ediciones Universidad Católica del Maule, 2017) Muñoz Cofré, Rodrigo.; Maureira Pareja, Hernán Antonio; Medina González, Paul; Pinochet Urzúa, Ramón; Villarroel Silva, Gregory; Jalil Contreras, Yorschua Frederick; Santander C., Rafael; Escobar C., Máximo
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    Estimulación eléctrica neuromuscular en el paciente crítico. Una revisión narrativa
    (2022) Gutiérrez-Arias, Ruvistay; Jalil Contreras, Yorschua Frederick
    Los avances en el tratamiento de pacientes críticamente enfermos han llevado a una mayor tasa de supervivencia. Sin embargo, los sobrevivientes a menudo experimentan consecuencias significativas asociadas al modelo convencional de atención, en el cual los pacientes tienden a permanecer inactivos, particularmente durante el tratamiento con ventilación mecánica (VM) y uso prolongado de sedación. Esto puede determinar trastornos mentales, psicológicos, del habla y deglución, y/o secuelas físicas, entre las que destacan la debilidad muscular y la consecuente discapacidad física, la que en muchos casos persisten tras el alta. La evidencia actual sugiere que la estimulación eléctrica neuromuscular tiene un efecto positivo sobre la masa y fuerza de los músculos estimulados, pudiendo además inducir efectos sistémicos pro-miogénicos, antiinflamatorios y regenerativos, que podrían influir en una disminución del tiempo de VM entre otros beneficios. Estos efectos podrían impactar desenlaces relevantes para los tomadores de decisiones, como la disminución de la estadía en unidades de cuidados intensivos y el tiempo de hospitalización total
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    Factors Associated With Accidental Decannulation in Tracheostomized Children
    (2023) Villarroel Silva, Gregory; Oyarzun, I.J.; Baranao Garces, Patricio; Mendez Raggi, Mireya Patricia; Faundez, M.; Jalil Contreras, Yorschua Frederick; Fernandez, T.R.; Munoz, S.R.
    BACKGROUND: Tracheostomy has many benefits for pediatric patients in the ICU, but it is also associated with complications. Accidental decannulation (AD) is a frequent complication and cause of mortality in this population. Our study aimed to determine the factors associated with AD in tracheostomized pediatric subjects. METHODS: This was a case-control study with 1:2 allocation ratio. Participants were tracheostomized children hospitalized in a prolonged mechanical ventilation hospital between 2013–2018. Each child who experienced decannulation during the study period was included as a case at the time of the event. Controls were obtained from the same population and were defined as subjects without an AD event during the same period. RESULTS: One hundred forty patients were hospitalized at Josefina Martinez Hospital at the time, of whom 41 were selected as cases and 82 as controls. Median (interquartile range) age was 20 (12–36) months, being 60% male. The median time from tracheostomy placement to AD event was 364 (167–731) d. Eighty-four percent of subjects were mechanically ventilated. AD mainly occurred by self-decannulation (53.7%). The risk of AD was higher in children who reached the midline in a sitting position (odds ratio 9.5 [95% CI 1.59-53.90]), inner di-ameter (ID) tracheostomy tube size ? 4.0 mm (odds ratio 5.18 [95% CI 1.41-19.06]), and who had been hospitalized in hospital rooms with a low ratio of nursing staff for each subject (1 nurse to 4 subjects) (odds ratio 4.48 [95% CI 1.19-16.80]). CONCLUSIONS: Factors associated with a higher risk of AD in tracheostomized children included the ability to reach the midline in a sitting position, the use of a smaller tracheostomy tube (? 4.0 mm ID), and lower supervision from staff.
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    Impact of a Noninvasive Ventilation Protocol in Hospitalized Children With Acute Respiratory Failure
    (2017) Jalil Contreras, Yorschua Frederick; Damiani Rebolledo, L. Felipe; Astudillo, C.; Villarroel S, G.; Barañao Garcés, Patricio; Bustos, E.; Silva, A.; Méndez Lesser, Manuel
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    Impact of Awake Prone Positioning on Inspiratory Effort and Work of Breathing. A Physiological Study in Healthy Subjects
    (American Thoracic Society, 2022) Damiani Rebolledo, L. Felipe; Basoalto Escobar, Roque Ignacio; Bachmann Barrón, María Consuelo; Jalil Contreras, Yorschua Frederick; Acuña, V.; Díaz, G.; Mella, J.; García Valdés, Patricio Hernán; Moya Gallardo, Eduardo Sebastián; Villarroel, G.; Retamal Montes, Jaime; Bugedo Tarraza, Guillermo; Bruhn, Alejandro
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    Kinesiólogos frente a la pandemia de COVID-19: ¿Cuál es su rol?
    (2021) Damiani Rebolledo, Luis Felipe; Jalil Contreras, Yorschua Frederick; Basoalto Escobar, Roque Ignacio; Villarroel Silva, Gregory; Garcia Valdes, Patricio Hernan
    El impacto de la pandemia por COVID-19 a nivel social, económico y sanitario no tiene precedentes. Sólo en Chile hasta el mes de julio de 2020, más de 340.000 personas han contraído la enfermedad y alrededor de 9.000 han fallecido por esta causa. Esta crisis sanitaria ha llevado a una adaptación en todo el sistema de salud y toma de medidas extraordinarias para poder cubrir dichas necesidades. El kinesiólogo como profesional de la salud constituye una pieza fundamental en la atención de estos pacientes. Su rol se ha visto reflejado en las distintas etapas de la enfermedad desde la atención primaria y urgencia hasta la atención de pacientes en la unidad de cuidados intensivos y posterior al alta hospitalaria. Además de su rol clínico asistencial, el kinesiólogo es capaz de contribuir en áreas de educación, promoción, gestión en salud e investigación científica, aspectos que podrían ser esenciales en el manejo de la pandemia. Es deber del kinesiólogo considerar esta oportunidad y asumir los múltiples desafíos derivados de la pandemia para comprometerse y otorgar respuestas a las necesidades sanitarias actuales.
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    Lung aeration estimated by chest electrical impedance tomography and lung ultrasound during extubation
    (2023) Joussellin, Vincent; Bonny, Vincent; Spadaro, Savino; Clerc, Sébastien; Parfait, Mélodie; Ferioli, Martina; Sieye, Antonin; Jalil Contreras, Yorschua Frederick; Janiak, Vincent; Pinna, Andrea; Dres, Martin
    Abstract: Background: This study hypothesized that patients with extubation failure exhibit a loss of lung aeration and heterogeneity in air distribution, which could be monitored by chest EIT and lung ultrasound. Patients at risk of extubation failure were included after a successful spontaneous breathing trial. Lung ultrasound [with calculation of lung ultrasound score (LUS)] and chest EIT [with calculation of the global inhomogeneity index, frontback center of ventilation (CoV), regional ventilation delay (RVD) and surface available for ventilation] were performed before extubation during pressure support ventilation (H0) and two hours after extubation during spontaneous breathing (H2). EIT was then repeated 6 h (H6) after extubation. EIT derived indices and LUS were compared between patients successfully extubated and patients with extubation failure. Results: 40 patients were included, of whom 12 (30%) failed extubation. Before extubation, when compared with patients with successful extubation, patients who failed extubation had a higher LUS (19 vs 10, p = 0.003) and a smaller surface available for ventilation (352 vs 406 pixels, p = 0.042). After extubation, GI index and LUS were higher in the extubation failure group, whereas the surface available for ventilation was lower. The RVD and the CoV were not different between groups. Conclusion: Before extubation, a loss of lung aeration was observed in patients who developed extubation failure afterwards. After extubation, this loss of lung aeration persisted and was associated with regional lung ventilation heterogeneity. Trial registration Clinical trials, NCT04180410, Registered 27 November 2019—prospectively registered. https://clinicaltrials.gov/ct2/show/NCT04180410
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    Myokines secretion and their role in critically ill patients. A scoping review protocol
    (2021) Jalil Contreras, Yorschua Frederick; Gutiérrez, Ruvistay
    Review question / Objective: 1-How and by which means stimulated muscle from critically ill patients can liberate myokines?, 2-Which are the main characteristics of the critically ill population studied and if some of these influenced myokine´s secretion?, 5-Can myokines exert local or distant effects in critically ill patients?, 5-Which are the potential effects of myokines in critically ill patients?
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    Pediatric tracheostomy tube change
    (2020) Jalil Contreras, Yorschua Frederick; Villarroel Silva, Gregory; Baranao, Patricio G.; Briceño, Lilian L.; Lara, Andres P.; Mendez Raggi, Mireya
    Changing the tracheostomy tube in children is a key procedure, however, some of its aspects remain unclear. Objective: To characterize the tracheostomy tube change in children from a long-stay health institution. Patients and Method: Retrospective observational analytical study based on the 2-year clinical record of hospitalized children who underwent tracheostomy. The variables evaluated were the reason for tracheostomy tube change, size and brand of the tube, operator and participants (assistants/spectators) of the procedure, complications, and education. Results: We analyzed 630 tracheostomy tube changes. The most frequent operators were relatives (33.7%). The main reason for the change was routine (83.3%). 10.7% of the changes presented some complications, where the most frequent was peristomal bleeding (47.37%) and the first failed attempt (34.21%). There was no association between the presence of balloon and complications (p = 0.24), nor with the use of Mechanical Ventilation (p = 0.8) or the operator (p = 0.74). Conclusion: The routine change of the tracheostomy tube in children with prolonged artificial airway use is a safe procedure, which can be performed by both health professionals and properly trained family members.
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    Physiological effects of high-flow nasal cannula oxygen therapy after extubation: a randomized crossover study
    (Springer Open, 2023) Basoalto Escobar, Roque Ignacio; Damiani Rebolledo, L. Felipe; Jalil Contreras, Yorschua Frederick; Bachmann Barrón, Maria Consuelo; Oviedo, Vanessa; Alegria Vargas, Leyla; Valenzuela Espinoza Emilio Daniel; Rovegno Echavarria, David Maximiliano; Ruiz-Rudolph, Pablo; Cornejo, Rodrigo; Retamal Montes, Jaime; Bugedo Tarraza, Guillermo; Thille, Arnaud W.; Bruhn, Alejandro
    Background: Prophylactic high-flow nasal cannula (HFNC) oxygen therapy can decrease the risk of extubation failure. It is frequently used in the postextubation phase alone or in combination with noninvasive ventilation. However, its physiological effects in this setting have not been thoroughly investigated. The aim of this study was to determine comprehensively the effects of HFNC applied after extubation on respiratory effort, diaphragm activity, gas exchange, ventilation distribution, and cardiovascular biomarkers. Methods: This was a prospective randomized crossover physiological study in critically ill patients comparing 1 h of HFNC versus 1 h of standard oxygen after extubation. The main inclusion criteria were mechanical ventilation for at least 48 h due to acute respiratory failure, and extubation after a successful spontaneous breathing trial (SBT). We measured respiratory effort through esophageal/transdiaphragmatic pressures, and diaphragm electrical activity (ΔEAdi). Lung volumes and ventilation distribution were estimated by electrical impedance tomography. Arterial and central venous blood gases were analyzed, as well as cardiac stress biomarkers. Results: We enrolled 22 patients (age 59 ± 17 years; 9 women) who had been intubated for 8 ± 6 days before extubation. Respiratory effort was significantly lower with HFNC than with standard oxygen therapy, as evidenced by esophageal pressure swings (5.3 [4.2–7.1] vs. 7.2 [5.6–10.3] cmH2O; p < 0.001), pressure–time product (85 [67–140] vs. 156 [114–238] cmH2O*s/min; p < 0.001) and ΔEAdi (10 [7–13] vs. 14 [9–16] µV; p = 0.022). In addition, HFNC induced increases in end-expiratory lung volume and PaO2/FiO2 ratio, decreases in respiratory rate and ventilatory ratio, while no changes were observed in systemic hemodynamics, Troponin T, or in amino-terminal pro-B-type natriuretic peptide. Conclusions: Prophylactic application of HFNC after extubation provides substantial respiratory support and unloads respiratory muscles. Trial registration January 15, 2021. NCT04711759.
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    Reduction of Respiratory Rate in COVID-19-Associated ARDS
    (2022) Damiani, L. Felipe; Oviedo, Vanessa; Alegria, Leyla; Soto, Dagoberto; Basoalto, Roque; Consuelo Bachmann, M.; Jalil Contreras, Yorschua Frederick; Santis, Cesar; Vera, Magdalena; Retamal, Jaime; Bruhn, Alejandro; Bugedo, Guillermo