Browsing by Author "Tomicic, Vinko"
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- ItemAcute effect of dobutamine and amrinone on hemodynamics and splanchnic perfusion in septic shock patients(1999) Hernández, P. Glenn; Gigoux Muller, Jorge Alberto; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis Benito; Bruhn Cruz, Alejandro Rodrigo; Tomicic, Vinko; Dagnino Sepúlveda, Jorge ÁlvaroBackground: Vasoactive drugs used in the reanimation of septic patients, can modify splanchnic perfusion. Aim: To compare the effects of dobutamine and amrinone on gastric intramucosal pH (pHi), lactate levels and hemodynamics in surgical patients with compensated septic shock. Patients and methods: Fourteen postoperative patients with abdominal sepsis and compensated septic shock (pHi < 7.32 or lactate > 2.5 mmol/l) were studied in a prospective, randomized, unblinded study. Patients were randomized to receive (Group 1, n = 7) dobutamine at 5 micrograms/Kg/min or (Group 2, n = 7) amrinone at 5 micrograms/Kg/min. Hemodynamic data, arterial lactate and pHi were measured before and 30, 60 and 120 minutes after starting drug infusion. Results: Both drugs were associated with a decrease in lactate levels. Dobutamine infusion, but not amrinone, increased gastric pHi, as well as cardiac index and oxygen delivery. Conclusions: An improvement in gastric pHi associated with an increase in oxygen delivery, was observed with dobutamine. Amrinone showed no effect at the fixed, low dose used in the study.
- ItemContinuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile(2022) Cornejo, Rodrigo A.; Montoya, Jorge; Gajardo, Abraham I. J.; Graf, Jerónimo; Alegría Vargas, Leyla; Baghetti, Romyna; Irarrázaval, Anita; Santis, César; Pavez, Nicolás; Leighton, Sofía; Tomicic, Vinko; Morales, Daniel; Ruiz Balart, Carolina; Navarrete, Pablo; Vargas, Patricio; Gálvez, Roberto; Espinosa, Victoria; Lazo, Marioli; Pérez-Araos, Rodrigo A.; Garay, Osvaldo; Sepúlveda, Patrick; Martinez, Edgardo; Bruhn, Alejandro; The SOCHIMI Prone-COVID-19 Group; Pontificia Universidad Católica de Chile. Escuela de MedicinaBackground Prone positioning is currently applied in time-limited daily sessions up to 24 h which determines that most patients require several sessions. Although longer prone sessions have been reported, there is scarce evidence about the feasibility and safety of such approach. We analyzed feasibility and safety of a continuous prolonged prone positioning strategy implemented nationwide, in a large cohort of COVID-19 patients in Chile. Methods: Retrospective cohort study of mechanically ventilated COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted in 15 Intensive Care Units, which adhered to a national protocol of continuous prone sessions ≥ 48 h and until PaO2:FiO2 increased above 200 mm Hg. The number and extension of prone sessions were registered, along with relevant physiologic data and adverse events related to prone positioning. The cohort was stratified according to the first prone session duration: Group A, 2–3 days; Group B, 4–5 days; and Group C, > 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety. Results: We included 417 patients who required a first prone session of 4 (3–5) days of whom 318 (76.3%) received only one session. During the first prone session the main adverse event was grade 1–2 pressure sores in 97 (23.9%) patients; severe adverse events were infrequent with 17 non-scheduled extubations (4.2%). 90-day mortality was 36.2%. Ninety-eight patients (24%) were classified as group C; they exhibited a more severe ARDS at baseline, as reflected by lower PaO2:FiO2 ratio and higher ventilatory ratio, and had a higher rate of pressure sores (44%) and higher 90-day mortality (48%). However, after adjustment for severity and several relevant confounders, prone session duration was not associated with mortality or pressure sores. Conclusions: Nationwide implementation of a continuous prolonged prone positioning strategy for COVID-19 ARDS patients was feasible. Minor pressure sores were frequent but within the ranges previously described, while severe adverse events were infrequent. The duration of prone session did not have an adverse effect on safety.
- ItemImpacto 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 EstebanBedside 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.
- 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