Browsing by Author "Oyarzun Aguirre, Ignacio Javier"

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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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    Valores de Oximetría de Pulso en Prematuros a las 34-36 semanas post-concepcional
    (2023) Oyarzun Aguirre, Ignacio Javier; Díaz, Marcela; Toso Milos, Paulina Alejandra; Zamorano Wittwer, Alejandra Violeta; Montes, Soledad; Lindemann, Birthe C.; Caussade, Solange
    La oximetría de pulso (SpO2) es fundamental para orientar la oxigenoterapia en prematuros. Existen escasas publicaciones que muestren valores de SpO2 previo al alta. Objetivo: Obtener valores de SpO2 en prematuros asintomáticos a las 34, 35 y 36 semanas post-concepcionales. Sujetos y Método: Estudio longitudinal multicéntrico realizado entre mayo 2018 y mayo 2019, en tres unidades de neonatología de Santiago, Chile (altura 579 m). Se incluyeron recién nacidos ≤ 32 semanas de edad gestacional, clínicamente estables, sin morbilidad respiratoria al momento de la evaluación y hasta el alta. Se analizaron los siguientes parámetros: SpO2 y DS acumulados medios, valor mínimo de SpO2, porcentaje de tiempo de SpO2 < 90%, porcentaje de tiempo de SpO2 < 80%, ID4 e ID80. Se obtuvo SpO2 continua nocturna con oxímetro Masimo Radical-7 o Radical-8 (USA), tiempo válido de registro (TVR) ≥ 6 horas. Resultados: se obtuvieron 101 registros de SpO2: 44, 33 y 24 estudios a las 34, 35 y 36 semanas post-concepcionales respectivamente. Estos pertenecían a 62 prematuros, 28 (45%) varones, mediana (rango) de edad gestacional al nacer 30 (26-32) semanas, mediana (rango) peso al nacer 1480 (785-2700) g. Variables de oximetría: TVR, media (± DE) 8,6 (± 1,5) horas; SpO2 promedio, mediana (rango) 96,9% (93,3-99,3%); SpO2 mínima, mediana (rango) 74% (51-89%); tiempo de SpO2 < 90%, mediana (rango) 2% (0-10,6%); tiempo de SpO2 < 80%, mediana (rango) 0,1% (0-1,3%); evento de desaturación ≥ 4% (ID4) ≥ 10 segundos por hora muestreada, mediana (rango) 15 (3,5–62,5); evento de desaturación < 80% (ID80), mediana (rango) 0,58 (0-10,8). No hubo diferencias entre valores de SpO2 entre las distintas semanas post-concepcionales. Conclusiones: Describimos valores de SpO2 en prematuros extremos asintomáticos a las 34-36 semanas postconcepcionales. Estos valores podrían utilizarse como referencia para orientar oxigenoterapia.