Browsing by Author "Kattan, Eduardo"

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    Anestesia obstétrica en Chad. Volviendo a los orígenes
    (Sociedad de Anestesiologia de Chile, 2022) Ghiringhelli, Juan Pablo; López, Rodrigo; Catalán, Cynthia; Kattan, Eduardo; Urzúa, Miguel; Cruzat, Francisco
    © 2022 Authors. All rights reserved.Background: Most maternal deaths occur in low- and middle-income countries, with Chad being one of the countries with the most alarming figures. There aren't many reports of anesthetic management for cesarean delivery in these countries. Aim: To report the obstetrical anesthetic experience in a hospital in Chad, Africa in the context of an international cooperation project to reduce the global shortage of anesthesiologists. Material and Methods: Case series of pregnant woman who were admitted to the ward of the Good Samaritan University Hospital Complex. Results: Thirty-two cesarean sections were performed, all using spinal anesthesia. The median age was 22 years, seven of them being adolescents. In two cases sedation with ketamine was used due to insufficient level and in one case general anesthesia with halothane was converted due to total spinal diagnosis. In twelve patients the interruption was due to immediate maternal/fetal vital risk (emergency cesarean section), the main causes being fetal bradycardia and placental abruption. Three patients presented uterine inertia refractory to medical treatment and resolved with the B-Lynch technique. Two patients decided to have immediate skin-to-skin contact. Three neonates had to be resuscitated with positive pressure ventilation, one of them died. No operative deaths were reported in the patients who underwent c-section, but there was one maternal death due to severe preeclampsia and postpartum hemorrhage after vaginal delivery. No epidural analgesia was requested for labor. Conclusions: This individual report provides insight into a particular reality with very limited staff and resources.
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    Capillary refill time response to a fluid challenge or a vasopressor test: an observational, proof-of-concept study
    (2024) Hernández, Glenn; Valenzuela, Emilio Daniel; Kattan, Eduardo; Castro, Ricardo; Guzmán, Camila; Kraemer, Alicia Elzo; Sarzosa, Nicolás; Alegria, Leyla; Contreras, Roberto; Oviedo, Vanessa; Bravo, Sebastián; Soto, Dagoberto; Sáez, Claudia; Ait-Oufella, Hafid; Ospina Tascón, Gustavo; Bakker, Jan
    Background: Several studies have validated capillary refill time (CRT) as a marker of tissue hypoperfusion, and recent guidelines recommend CRT monitoring during septic shock resuscitation. Therefore, it is relevant to further explore its kinetics of response to short-term hemodynamic interventions with fluids or vasopressors. A couple of previous studies explored the impact of a fluid bolus on CRT, but little is known about the impact of norepinephrine on CRT when aiming at a higher mean arterial pressure (MAP) target in septic shock. We designed this observational study to further evaluate the effect of a fluid challenge (FC) and a vasopressor test (VPT) on CRT in septic shock patients with abnormal CRT after initial resuscitation. Our purpose was to determine the effects of a FC in fluid-responsive patients, and of a VPT aimed at a higher MAP target in chronically hypertensive fluid-unresponsive patients on the direction and magnitude of CRT response. Methods Thirty-four septic shock patients were included. Fluid responsiveness was assessed at baseline, and a FC (500 ml/30 mins) was administered in 9 fluid-responsive patients. A VPT was performed in 25 patients by increasing norepinephrine dose to reach a MAP to 80–85 mmHg for 30 min. Patients shared a multimodal perfusion and hemodynamic monitoring protocol with assessments at at least two time-points (baseline, and at the end of interventions). Results CRT decreased significantly with both tests (from 5 [3.5–7.6] to 4 [2.4–5.1] sec, p = 0.008 after the FC; and from 4.0 [3.3–5.6] to 3 [2.6 -5] sec, p = 0.03 after the VPT. A CRT-response was observed in 7/9 patients after the FC, and in 14/25 pts after the VPT, but CRT deteriorated in 4 patients on this latter group, all of them receiving a concomitant low-dose vasopressin. Conclusions Our findings support that fluid boluses may improve CRT or produce neutral effects in fluid-responsive septic shock patients with persistent hypoperfusion. Conversely, raising NE doses to target a higher MAP in previously hypertensive patients elicits a more heterogeneous response, improving CRT in the majority, but deteriorating skin perfusion in some patients, a fact that deserves further research.
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    Drug diluent and efficacy of methylene blue in septic shock: authors’ reply
    (2023) Ibarra Estrada, Miguel; Kattan, Eduardo; Aguirre Avalos, Guadalupe; Hernández P., Glenn
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    Evolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A clinical-physiologic study
    (W B SAUNDERS CO-ELSEVIER INC, 2012) Hernandez, Glenn; Pedreros, Cesar; Veas, Enrique; Bruhn, Alejandro; Romero, Carlos; Rovegno, Maximiliano; Neira, Rodolfo; Bravo, Sebastian; Castro, Ricardo; Kattan, Eduardo; Ince, Can
    Purpose: Perfusion assessment during septic shock resuscitation is difficult and usually complex determinations. Capillary refill time (CRT) and central-to-toe temperature difference (Tc-toe) have been proposed as objective reproducible parameters to evaluate peripheral perfusion. The comparative evolution of peripheral vs metabolic perfusion parameters in septic shock resuscitation has not been studied. We conducted a prospective observational clinical-physiologic study to address this subject.
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    Expanding ICU facilities in a pandemic scenario
    (SOC MEDICA SANTIAGO, 2020) Andresen, Max; Born, Pablo; Kattan, Eduardo; Vera, Magdalena; Cataldo, Alejandro; Ruiz, Carolina; Bravo, Sebastian
    Our country is suffering the effects of the ongoing pandemic of coronavirus disease (COVID-19). Because the vulnerability of healthcare systems, especially the intensive care areas they can rapidly be overloaded. That challenge the ICUs simultaneously on multiple fronts making urgent to increase the number of beds, without lowering the standards of care. The purpose of this article is to discuss some aspects of the national situation and to provide recommendations on the organizational management of intensive care units such as isolation protocols, surge in ICU bed capacity, ensure adequate supplies, protect and train healthcare workers maintaining quality clinical management.
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    Hypoxia-related parameters during septic shock resuscitation: Pathophysiological determinants and potential clinical implications
    (AME PUBL CO, 2020) Pavez, Nicolas; Kattan, Eduardo; Vera, Magdalena; Ferri, Giorgio; Daniel Valenzuela, Emilio; Alegria, Leyla; Bravo, Sebastian; Pairumani, Ronald; Santis, Cesar; Oviedo, Vanessa; Soto, Dagoberto; Ospina Tascon, Gustavo; Bakker, Jan; Hernandez, Glenn; Castro, Ricardo
    Background: Assessment of tissue hypoxia at the bedside has yet to be translated into daily clinical practice in septic shock patients. Perfusion markers are surrogates of deeper physiological phenomena. Lactate-to-pyruvate ratio ( LPR) and the ratio between veno-arterial PCO2 difference and Ca-vO(2) (Delta PCO2/Ca-vO(2)) have been proposed as markers of tissue hypoxia, but they have not been compared in the clinical scenario. We studied acute septic shock patients under resuscitation. We wanted to evaluate the relationship of these hypoxia markers with clinical and biochemical markers of hypoperfusion during septic shock resuscitation.
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    Implementation of Distance-Based Simulation Training Programs for Healthcare Professionals Breaking Barriers During COVID-19 Pandemic
    (LIPPINCOTT WILLIAMS & WILKINS, 2021) Vera, Magdalena; Kattan, Eduardo; Cerda, Tomas; Niklitshek, Jessie; Montana, Rodrigo; Varas, Julian; Corvetto, Marcia A.
    A Summary Statement: The sudden rise of critically ill patients secondary to the SARS-CoV-2 pandemic has triggered a surge in healthcare response. This project's goal was to provide essential cognitive and technical skills to healthcare professionals returning to the workforce or reassigned to critical care clinical duties during the COVID-19 pandemic. The plan included the implementation of 4 distance-based simulation training programs, with asynchronous personalized feedback. The courses allowed the acquisition of skills for the complete critical care patient management chain: use of personal protection equipment, use of a high-flow nasal cannula, endotracheal intubation, and prone positioning. Participants logged into the platform, reviewed material, practiced while recording the session, and uploaded the video through the training platform. The expert tutor remotely delivered asynchronous feedback. Participants trained remotely until achieving course approval. Remote-based simulation seems a feasible and attractive alternative to provide adequate educational solutions, especially for remote and rural areas.
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    Optimal target in septic shock resuscitation
    (2020) Kattan, Eduardo; Castro, Ricardo; Vera Alarcón, María Magdalena; Hernández, Glenn
    Septic shock presents a high risk of morbidity and mortality. Through therapeutic strategies, such as fluid administration and vasoactive agents, clinicians intend to rapidly restore tissue perfusion. Nonetheless, these interventions have narrow therapeutic margins. Adequate perfusion monitoring is paramount to avoid progressive hypoperfusion or detrimental over-resuscitation. During early stages of septic shock, macrohemodynamic derangements, such as hypovolemia and decreased cardiac output (CO) tend to predominate. However, during late septic shock, endothelial and coagulation dysfunction induce severe alterations of the microcirculation, making it more difficult to achieve tissue reperfusion. Multiple perfusion variables have been described in the literature, from bedside clinical examination to complex laboratory tests. Moreover, all of them present inherent flaws and limitations. After the ANDROMEDA-SHOCK trial, there is evidence that capillary refill time (CRT) is an interesting resuscitation target, due to its rapid kinetics and correlation with deep hypoperfusion markers. New concepts such as hemodynamic coherence and flow responsiveness may be used at the bedside to select the best treatment strategies at any time-point. A multimodal perfusion monitoring and an integrated analysis with macrohemodynamic parameters is mandatory to optimize the resuscitation of septic shock patients.
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    Process-oriented metrics to provide feedback and assess the performance of students who are learning surgical procedures: The percutaneous dilatational tracheostomy case
    (TAYLOR & FRANCIS LTD, 2022) Jose Martinez, Juan; Galvez-Yanjari, Victor; de la Fuente, Rene; Kychenthal, Catalina; Kattan, Eduardo; Bravo, Sebastian; Munoz-Gama, Jorge; Sepulveda, Marcos
    Purpose Assessing competency in surgical procedures is key for instructors to distinguish whether a resident is qualified to perform them on patients. Currently, assessment techniques do not always focus on providing feedback about the order in which the activities need to be performed. In this research, using a Process Mining approach, process-oriented metrics are proposed to assess the training of residents in a Percutaneous Dilatational Tracheostomy (PDT) simulator, identifying the critical points in the execution of the surgical process. Materials and methods A reference process model of the procedure was defined, and video recordings of student training sessions in the PDT simulator were collected and tagged to generate event logs. Three process-oriented metrics were proposed to assess the performance of the residents in training. Results Although the students were proficient in classic metrics, they did not reach the optimum in process-oriented metrics. Only in 25% of the stages the optimum was achieved in the last session. In these stages, the four more challenging activities were also identified, which account for 32% of the process-oriented metrics errors. Conclusions Process-oriented metrics offer a new perspective on surgical procedures performance, providing a more granular perspective, which enables a more specific and actionable feedback for both students and instructors.
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    ProDeM: A Process-Oriented Delphi Method for systematic asynchronous and consensual surgical process modelling
    (ELSEVIER, 2023) Gonzalez-Lopez, Fernanda; Martin, Niels; de la Fuente, Rene; Galvez-Yanjari, Victor; Guzman, Javiera; Kattan, Eduardo; Sepulveda, Marcos; Muñoz Gama, Jorge
    Surgical process models support improving healthcare provision by facilitating communication and reasoning about processes in the medical domain. Modelling surgical processes is challenging as it requires integrating information that might be fragmented, scattered, and not process-oriented. These challenges can be faced by involving healthcare domain experts during process modelling. This paper presents ProDeM: a novel ProcessOriented Delphi Method for the systematic, asynchronous, and consensual modelling of surgical processes. ProDeM is an adaptable and flexible method that acknowledges that: (i) domain experts have busy calendars and might be geographically dispersed, and (ii) various elements of the process model need to be assessed to ensure model quality. The contribution of the paper is twofold as it outlines ProDeM, but also demonstrates its operationalisation in the context of a well-known surgical process. Besides showing the method's feasibility in practice, we also present an evaluation of the method by the experts involved in the demonstration.
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    The impact of norepinephrine dose reporting heterogeneity on mortality prediction in septic shock patients
    (2024-07-03) Morales, Sebastian; Wendel-Garcia, Pedro D.; Ibarra-Estrada, Miguel; Jung, Christian; Castro, Ricardo; Retamal, Jaime; Cortinez, Luis I.; Severino, Nicolás; Kiavialaitis, Greta E.; Ospina-Tascón, Gustavo; Bakker, Jan; Hernández, Glenn; Kattan, Eduardo
    Background: Norepinephrine (NE) is a cornerstone drug in the management of septic shock, with its dose being used clinically as a marker of disease severity and as mortality predictor. However, variations in NE dose reporting either as salt formulations or base molecule may lead to misinterpretation of mortality risks and hinder the process of care. Methods: We conducted a retrospective analysis of the MIMIC-IV database to assess the impact of NE dose reporting heterogeneity on mortality prediction in a cohort of septic shock patients. NE doses were converted from the base molecule to equivalent salt doses, and their ability to predict 28-day mortality at common severity dose cut-offs was compared. Results: 4086 eligible patients with septic shock were identified, with a median age of 68 [57–78] years, an admission SOFA score of 7 [6–10], and lactate at diagnosis of 3.2 [2.4–5.1] mmol/L. Median peak NE dose at day 1 was 0.24 [0.12–0.42] μg/kg/min, with a 28-day mortality of 39.3%. The NE dose showed significant heterogeneity in mortality prediction depending on which formulation was reported, with doses reported as bitartrate and tartrate presenting 65 (95% CI 79–43)% and 67 (95% CI 80–47)% lower ORs than base molecule, respectively. This divergence in prediction widened at increasing NE doses. When using a 1 μg/kg/min threshold, predicted mortality was 54 (95% CI 52–56)% and 83 (95% CI 80–87)% for tartrate formulation and base molecule, respectively. Conclusions: Heterogeneous reporting of NE doses significantly affects mortality prediction in septic shock. Standardizing NE dose reporting as base molecule could enhance risk stratification and improve processes of care. These findings underscore the importance of consistent NE dose reporting practices in critical care settings.
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    The seven Ts of capillary refill time: more than a clinical sign for septic shock patients
    (LIPPINCOTT WILLIAMS & WILKINS, 2020) Vera, Magdalena; Kattan, Eduardo; Castro, Ricardo; Hernandez, Glenn