Browsing by Author "Mercado Flores, Marcelo Esteban"

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    Comparacion de tres metodos de manejo del dolor en pacientes sometidos a revascularizacion miocardica candidatos a tránsito rapido
    (2008) Carvajal F., Claudia; Lema F., Guillermo; Canessa, Roberto; Aeschlimann del Río, Nicolás Alejandro; Merino, Waldo; Mercado Flores, Marcelo Esteban; Muñoz, Rodrigo
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    Determinación 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, Alberto
    Cardiac 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.
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    Determinantes precoces en el desarrollo de injuria renal aguda durante la sepsis abdominal experimental
    (2014) Regueira Heskia, Tomás; Andresen Hernández, Max; Mercado Flores, Marcelo Esteban; Lillo, F.; Soto, D.
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    Impacto hemodinámico de la presión positiva de fin de espiración (PEEP) durante la falla respiratoria grave: Visión actual
    (2002) Tomicic, Vinko; Andresen M, M.; Romero Patiño, Carlos; Mercado Flores, Marcelo Esteban
    Bedside evaluation of pulmonary mechanics and thoracic computed axial tomography have changed the ventilatory management of patients suffering an acute respiratory failure caused by adult respiratory distress syndrome (ARDS). Mortality has been reduced limiting tidal volumes, which avoids alveolar overdistention and by the use of positive end expiratory pressure (PEEP), that reduces the damage caused by cyclical alveolar collapse-reopening. Nowadays, it is well known that inappropriate mechanical ventilation enhances lung damage caused by the underlying disease. However, the optimal adjustment of PEEP is not yet established. Usually, it is not easy to achieve an equilibrium between an optimal lung recruitment without producing alveolar overdistention and hemodynamic adverse effects such as hypotension and reduction of cardiac output. This paper reviews the interactions between heart and lung.
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    Prevalencia 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 Benito
    Background: 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.
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    Pro- 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 Alfonso
    Purpose: 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.
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    Síndrome 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, Alberto
    We 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