Browsing by Author "Vera Alarcón, María Magdalena"

Now showing 1 - 20 of 21
  • Thumbnail Image
    Item
    Acute kidney injury caused by rhabdomyolysis as a SARS-CoV-2 infection manifestation. Report of one case
    (Sociedad Médica de Santiago, 2021) Pérez, Javier; Sánchez, Sebastián; Sepúlveda Arcos, Rodrigo Antonio; Vera Alarcón, María Magdalena; Mery Ponce, Pablo Agustín; Garayar Pulgar, Bernardita; Jalil Milad, Roberto Daniel
    SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.
  • Thumbnail Image
    Item
    Corticosteroids use and risk of respiratory coinfections in mechanically ventilated patients with COVID-19
    (2021) Ceballos, María Elena; Núñez Palma, Carolina Verónica; Uribe, Javier; Vera Alarcón, María Magdalena; Castro López, Ricardo; García C., Patricia; Arriata, Gabriel; Gándara, Vicente; Vargas, Camila; Domínguez De Landa, María Angélica; Cerón, Inés; Born, Pablo; Espíndola, Eduardo
    Background: To describe respiratory coinfections, predictive factors and outcomes in patients requiring mechanical ventilation (MV) with COVID-19. Methods: Cohort study, carried out in a Chilean single tertiary Hospital. All patients with COVID-19 admitted to ICU that required MV were included between 1 June and 31 July 2020 Results: 175 patients were admitted to ICU and required MV. Of these, 71 patients developed at least one respiratory coinfection (40.6 %). Early coinfections and late coinfections were diagnosed in 1.7% and 31.4% of all patients admitted to ICU respectively. Within late coinfections, 88% were bacterial, 10% were fungal, and 2% were viral coinfections. One third of isolated bacteria were multidrug-resistant. Multivariate analysis showed that the risk for coinfection was 7.7 times higher for patients with history of corticosteroids (adOR = 7.65, CI 95%: 1.04-56.2, p=0,046) and 2.7 times higher for patients that received dexamethasone during hospitalization (adOR=2.69; CI 95%: 1.14-6.35, p=0,024) than patients that were not exposed. For each additional day in MV, the risk of coinfection increases 1.1 times (adOR=1.06; CI 95%: 1.01-1.11, p=0,025)
  • Thumbnail Image
    Item
    Creencias del personal del servicio de urgencia y de la Unidad de Cuidados Intensivos respecto de su rol en la detección de potenciales donantes: un estudio desde el modelo de la conducta planificada.
    (2019) Maldonado Sánchez, Laura; Repetto Lisboa, Paula Beatriz; Bernales, Margarita; Vera Alarcón, María Magdalena; Pontificia Universidad Católica de Chile. Escuela de Psicología
    Introducción: La escasez de órganos es un problema a nivel mundial. Chile no está ajeno a esta situación, con una tasa de donación menor a la que se reporta en países desarrollados. Lo anterior se podría explicar por un interés más bajo por donar y por una falta de detección y aviso de potenciales donantes por parte de los profesionales de la salud de las Unidades de Cuidados Intensivos y en el Servicio de Urgencia. Sabemos menos respecto de factores que explican esta falta detección de donantes por parte de los equipos de salud. Este estudio tuvo como objetivo explorar las creencias que tienen miembros del personal de la Unidad de Cuidados Intensivos y Urgencias , desde el modelo de la conducta planificada, que influyen en la intención de detectar potenciales donantes y de comunicarlos a los equipos de procuramiento. Material y Método: Se utilizó una metodología cualitativa y se realizó un estudio exploratorio, con un diseño de estudio de caso. Se realizaron entrevistas semiestructuradas, tanto individuales y grupales a 38 personas que trabajan en estos servicios en el Hospital Clínico UC. Resultados: Se realizó un análisis temático donde los resultados fueron agrupados en 5 categorías; (1) creencias acerca del rol en la detección de potenciales donantes, (2) conocimientos acerca del proceso de detección, (3) actitudes del personal con respecto a la la detección de potenciales donantes, (4) normas subjetivas del personal a la detección de potenciales donantes y (5) percepción de control del personal a la detección de potenciales donantes. Conclusiones: Los resultados de este estudio muestran que las creencias de estos equipos son relevantes para explicar la detección o no de potenciales donantes, las cuales deberían ser abordadas para contribuir a aumentar la tasa de donantes en los miembros de equipos de salud que tienen ese rol.Introducción: La escasez de órganos es un problema a nivel mundial. Chile no está ajeno a esta situación, con una tasa de donación menor a la que se reporta en países desarrollados. Lo anterior se podría explicar por un interés más bajo por donar y por una falta de detección y aviso de potenciales donantes por parte de los profesionales de la salud de las Unidades de Cuidados Intensivos y en el Servicio de Urgencia. Sabemos menos respecto de factores que explican esta falta detección de donantes por parte de los equipos de salud. Este estudio tuvo como objetivo explorar las creencias que tienen miembros del personal de la Unidad de Cuidados Intensivos y Urgencias , desde el modelo de la conducta planificada, que influyen en la intención de detectar potenciales donantes y de comunicarlos a los equipos de procuramiento. Material y Método: Se utilizó una metodología cualitativa y se realizó un estudio exploratorio, con un diseño de estudio de caso. Se realizaron entrevistas semiestructuradas, tanto individuales y grupales a 38 personas que trabajan en estos servicios en el Hospital Clínico UC. Resultados: Se realizó un análisis temático donde los resultados fueron agrupados en 5 categorías; (1) creencias acerca del rol en la detección de potenciales donantes, (2) conocimientos acerca del proceso de detección, (3) actitudes del personal con respecto a la la detección de potenciales donantes, (4) normas subjetivas del personal a la detección de potenciales donantes y (5) percepción de control del personal a la detección de potenciales donantes. Conclusiones: Los resultados de este estudio muestran que las creencias de estos equipos son relevantes para explicar la detección o no de potenciales donantes, las cuales deberían ser abordadas para contribuir a aumentar la tasa de donantes en los miembros de equipos de salud que tienen ese rol.
  • Thumbnail Image
    Item
    Current concepts in acute liver failure
    (2019) Rovegno Echavarria, Maxiliano; Vera Alarcón, María Magdalena; Ruiz, A.; Benítez, Carlos
  • Thumbnail Image
    Item
    Design and Evaluation of a Low-Cost Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Simulator
    (2019) Kattan Tala, Eduardo José; Vera Alarcón, María Magdalena; Putz de la Fuente, Francisca Carolina; Corvetto Aqueveque, Marcia Antonia; De la Fuente Sanhueza, René; Bravo Grau, Sebastián
  • Thumbnail Image
    Item
    Diseño de un taller para identificar posibles donantes de órganos para transplante, dirigido a estudiantes de pregrado de Medicina
    (2022) Vera Alarcón, María Magdalena; Bitrán Carreño, Marcela; Pontificia Universidad Católica de Chile. Escuela de Medicina
    El trasplante de órganos es la única opción terapéutica para un paciente con una insuficiencia terminal de un órgano. Sin embargo, la posibilidad de trasplantar se relaciona fuertemente con una escasez de órganos que es multifactorial y no descansa únicamente de la voluntad de la población, sino que también de los profesionales médicos. Para obtener un donante, los médicos tienen que identificar a un posible donante, este es un paciente que podría evolucionar a muerte encefálica y así transformarse en un donante. La falta de identificación es un factor relacionado con la escasez de órganos y se atribuye al desconocimiento de los profesionales médicos y que les impide enfrentar el proceso de donación de órganos y no les permite acercarse y responder las preguntas o inquietudes de la familia. Esta propuesta educativa consiste en diseñar un taller para los estudiantes de medicina, en el internado de la rotación de Medicina Intensiva, cuyo propósito es contribuir a formar médicos recién egresados con los conocimientos y actitudes necesarios para identificar un posible donante de órganos. La metodología será a partir del modelo de diseño curricular de 6 etapas de Kern. Considerará una revisión de la literatura y una encuesta a los estudiantes de medicina y el fundamento teórico se hará basándonos en Knowles y las teorías de aprendizaje experiencial y transformacional. Se espera que esta estrategia educacional permita entregar durante el desarrollo de los futuros profesionales médicos, los conocimientos relacionados con la identificación de un posible donante y de esta forma contribuir a dar solución a un problema de salud publica global.
  • Thumbnail Image
    Item
    Disparities Affecting Organ Donation Rates in Chile
    (2024) Pérez Castro, Pablo; Muñoz, Delia; González, María Trinidad; Vera Alarcón, María Magdalena; Muñoz, Ana María
  • No Thumbnail Available
    Item
    Disparities Affecting Organ Donation Rates in Chile
    (Wiley, 2024) Pérez Castro, Pablo; Muñoz, Delia; González, María Trinidad; Vera Alarcón, María Magdalena; Muñoz, Ana María
  • Thumbnail Image
    Item
    Donación y trasplante de órganos : análisis y propuestas para avanzar hacia una cultura de donación
    (Centro de Políticas Públicas UC, 2019) Vera Alarcón, María Magdalena
  • Thumbnail Image
    Item
    Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS : a propensity score analysis
    (2022) Li Bassi, Gianluigi; Gibbons, Kristen; Suen, Jacky Y.; Dalton, Heidi J.; White, Nicole; Corley, Amanda; Shrapnel, Sally; Hinton, Samuel; Forsyth, Simon; Vera Alarcón, María Magdalena; Fan, Eddy; Fanning, Jonathon P.; Panigada, Mauro; Bartlett, Robert; Brodie, Daniel; Burrell, Aidan; Chiumello, Davide; Elhazmi, Alyaa; Esperatti, Mariano; Grasselli, Giacomo; Hodgson, Carol; Ichiba, Shingo; Luna, Carlos; Marwali, Eva; Merson, Laura; Murthy, Srinivas; Nichol, Alistair; Ogino, Mark; Pelosi, Paolo; Torres, Antoni; Ng, Pauline Y.; Fraser, John F.; Laffey, John G.
    Background: The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis. Methods: We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 h from commencement of IMV were compared with subjects who did not receive NMBAs or only upon commencement of IMV (control). The primary objective in the PS-matched cohort was comparison between groups in 90-day in-hospital mortality, assessed through Cox proportional hazard modeling. Secondary objectives were comparisons in the numbers of ventilator-free days (VFD) between day 1 and day 28 and between day 1 and 90 through competing risk regression. Results: Data from 1953 patients were included. After propensity score matching, 210 cases from each group were well matched. In the PS-matched cohort, mean (± SD) age was 60.3 ± 13.2 years and 296 (70.5%) were male and the most common comorbidities were hypertension (56.9%), obesity (41.1%), and diabetes (30.0%). The unadjusted hazard ratio (HR) for death at 90 days in the NMBA treatment vs control group was 1.12 (95% CI 0.79, 1.59, p = 0.534). After adjustment for smoking habit and critical therapeutic covariates, the HR was 1.07 (95% CI 0.72, 1.61, p = 0.729). At 28 days, VFD were 16 (IQR 0–25) and 25 (IQR 7–26) in the NMBA treatment and control groups, respectively (sub-hazard ratio 0.82, 95% CI 0.67, 1.00, p = 0.055). At 90 days, VFD were 77 (IQR 0–87) and 87 (IQR 0–88) (sub-hazard ratio 0.86 (95% CI 0.69, 1.07; p = 0.177). Conclusions: In patients with COVID-19 and moderate-to-severe ARDS, short course of NMBA treatment, applied early, did not significantly improve 90-day mortality and VFD. In the absence of definitive data from clinical trials, NMBAs should be indicated cautiously in this setting.
  • Thumbnail Image
    Item
    Effect of positive end expiratory pressure on lung injury and haemodynamics during experimental acute respiratory distress syndrome treated with extracorporeal membrane oxygenation and near-apnoeic ventilation
    (2021) Araos, Joaquin; Alegría Vargas, Leyla; Garcia, Aline; Cruces, Pablo; Soto Muñoz, Dagoberto Igor; Erranz, Benjamín; Salomon, Tatiana; Medina, Tania; García Valdes, Patricio Hernán; Dubo, Sebastian; Bachmann Barron, María Consuelo; Basoalto Escobar, Roque Ignacio; Valenzuela, Emilio Daniel; Rovegno Echavarría, Maximiliano David; Vera Alarcón, María Magdalena; Retamal Montes, Jaime; Cornejo Rosas, Rodrigo Alfredo; Bugedo Tarraza, Guillermo; Bruhn, Alejandro
    Background: Lung rest has been recommended during extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS). Whether positive end-expiratory pressure (PEEP) confers lung protection during ECMO for severe ARDS is unclear. We compared the effects of three different PEEP levels whilst applying near-apnoeic ventilation in a model of severe ARDS treated with ECMO. Methods: Acute respiratory distress syndrome was induced in anaesthetised adult male pigs by repeated saline lavage and injurious ventilation for 1.5 h. After ECMO was commenced, the pigs received standardised near-apnoeic ventilation for 24 h to maintain similar driving pressures and were randomly assigned to PEEP of 0, 10, or 20 cm H2O (n¼7 per group). Respiratory and haemodynamic data were collected throughout the study. Histological injury was assessed by a pathologist masked to PEEP allocation. Lung oedema was estimated by wet-to-dry-weight ratio. Results: All pigs developed severe ARDS. Oxygenation on ECMO improved with PEEP of 10 or 20 cm H2O, but did not in pigs allocated to PEEP of 0 cm H2O. Haemodynamic collapse refractory to norepinephrine (n¼4) and early death (n¼3) occurred after PEEP 20 cm H2O. The severity of lung injury was lowest after PEEP of 10 cm H2O in both dependent and non-dependent lung regions, compared with PEEP of 0 or 20 cm H2O. A higher wet-to-dry-weight ratio, indicating worse lung injury, was observed with PEEP of 0 cmH2O. Histological assessment suggested that lung injury was minimised with PEEP of 10 cm H2O. Conclusions: During near-apnoeic ventilation and ECMO in experimental severe ARDS, 10 cm H2O PEEP minimised lung injury and improved gas exchange without compromising haemodynamic stability.
  • Thumbnail Image
    Item
    Effects of capillary refill time-vs. lactate-targeted fluid resuscitation on regional, microcirculatory and hypoxia-related perfusion parameters in septic shock: a randomized controlled trial
    (2020) Castro López, Ricardo; Kattan Tala, Eduardo José; Valenzuela, Emilio Daniel; Alegría, Leyla; Oviedo, Vanessa; Soto, Dagoberto; Vera Alarcón, María Magdalena; Bravo Morales, Sebastián; Bakker, Jan; Hernández P., Glenn
    Abstract Background Persistent hyperlactatemia has been considered as a signal of tissue hypoperfusion in septic shock patients, but multiple non-hypoperfusion-related pathogenic mechanisms could be involved. Therefore, pursuing lactate normalization may lead to the risk of fluid overload. Peripheral perfusion, assessed by the capillary refill time (CRT), could be an effective alternative resuscitation target as recently demonstrated by the ANDROMEDA-SHOCK trial. We designed the present randomized controlled trial to address the impact of a CRT-targeted (CRT-T) vs. a lactate-targeted (LAC-T) fluid resuscitation strategy on fluid balances within 24 h of septic shock diagnosis. In addition, we compared the effects of both strategies on organ dysfunction, regional and microcirculatory flow, and tissue hypoxia surrogates. Results Forty-two fluid-responsive septic shock patients were randomized into CRT-T or LAC-T groups. Fluids were administered until target achievement during the 6 h intervention period, or until safety criteria were met. CRT-T was aimed at CRT normalization (≤ 3 s), whereas in LAC-T the goal was lactate normalization (≤ 2 mmol/L) or a 20% decrease every 2 h. Multimodal perfusion monitoring included sublingual microcirculatory assessment; plasma-disappearance rate of indocyanine green; muscle oxygen saturation; central venous-arterial pCO2 gradient/ arterial-venous O2 content difference ratio; and lactate/pyruvate ratio. There was no difference between CRT-T vs. LAC-T in 6 h-fluid boluses (875 [375–2625] vs. 1500 [1000–2000], p = 0.3), or balances (982[249–2833] vs. 15,800 [740–6587, p = 0.2]). CRT-T was associated with a higher achievement of the predefined perfusion target (62 vs. 24, p = 0.03). No significant differences in perfusion-related variables or hypoxia surrogates were observed. Conclusions CRT-targeted fluid resuscitation was not superior to a lactate-targeted one on fluid administration or balances. However, it was associated with comparable effects on regional and microcirculatory flow parameters and hypoxia surrogates, and a faster achievement of the predefined resuscitation target. Our data suggest that stopping fluids in patients with CRT ≤ 3 s appears as safe in terms of tissue perfusion. Clinical Trials: ClinicalTrials.gov Identifier: NCT03762005 (Retrospectively registered on December 3rd 2018)
  • Thumbnail Image
    Item
    Fluid and electrolyte management in neurosurgical critical care
    (2020) Bugedo Tarraza, Guillermo; Vera Alarcón, María Magdalena; Brambrink, Ansgar M.; Kirsch, Jeffrey R.
  • No Thumbnail Available
    Item
    Insuficiencia renal aguda secundaria a rabdomiolisis como manifestación de infección por SARS-CoV-2
    (2021) Pérez, Javier; Sánchez, Sebastián; Sepúlveda Arcos, Rodrigo Antonio; Vera Alarcón, María Magdalena; Mery Ponce, Pablo Agustín; Garayar Pulgar, Bernardita; Jalil Milad, Roberto Daniel
    SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.
  • Thumbnail Image
    Item
    Intubation timing as determinant of outcome in patients with acute respiratory distress syndrome by SARS-CoV-2 infection
    (2021) Vera Alarcón, María Magdalena; Kattan Tala, Eduardo José; Born, Pablo; Rivas, E.; Amthauer, M.; Nesvadba, A.; Lara, Bárbara; Rao, I.; Espíndola, Eduardo; Rojas Orellana, Luis; Hernández Poblete, Glenn; Bugedo Tarraza, Guillermo; Castro López, Ricardo
    Background: SARS-CoV-2 infection presents in many cases with pneumonia and respiratory failure. It is not clear whether the time of intubation and connection to mechanical ventilation (MV) in this condition is associated with an increase in mortality or represents the natural course of the disease. We conducted an observational, prospective, single-center study to describe the characteristics and outcomes of acute respiratory distress syndrome (ARDS) patients with confirmed COVID-19 and treated with invasive MV to determine whether the time-to-intubation following hospital admission is associated with worse outcomes. Methods: We prospectively included consecutive patients with SARS-CoV-2 infection and moderate to severe ARDS, admitted to an intensive care unit (ICU) and connected to MV between March 17 and July 31, 2020. We examined their general characteristics, ventilatory management, and clinical outcomes. Time of intubation was defined as the time from hospital admission to endotracheal intubation and was categorized as early (<72 hours) or late (≥72 hours). Mann-Whitney U, Kruskal Wallis, chi-square, and Fisher’s exact, were used when appropriate. Uni and multivariate analyses between main outcome and explanatory variables were performed. Results: A total of 183 consecutive patients were included, 28% (51/183) were female, and their median age was 62 years [54-70]. One hundred (55%) patients were subjected to early and 83 (45%) to late intubation. Patients intubated after 72 hours were older and presented more comorbidities. Mortality was higher in the group of patients with late intubation (41% versus 21%; p= 0.002), a PaO2/FiO2 ratio <100 mmHg at admission (p= 0.029), and that were older than 60 years (p= 0.008). Conclusions: In acute COVID-19 patients with moderate to severe ARDS, intubation after 72 hours following hospital admission, age >60 years-old and a PaO2/FiO2 ratio <100 at admission may appear to be associated with increased ICU mortality. Further studies are required to confirm our findings and establish the best timing for intubation in COVID-19 patients admitted to the ICU with respiratory failure.
  • Thumbnail Image
    Item
    La criticidad de las Unidades de Intensivo : ampliando las Unidades en tiempos de pandemia
    (2020) Andresen Hernández, Max; Born, P.; Kattan Tala, Eduardo José; Vera Alarcón, María Magdalena; Cataldo Cornejo, Alejandro; Ruiz Balart, Carolina; Bravo, S.
  • No Thumbnail Available
    Item
    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.
  • Thumbnail Image
    Item
    Role of Prolonged Intubation in Vocal Fold Motion Impairment in Critically Ill Patients
    (2024) Cabrera López, José María; Lagos Villaseca, Antonia Elisa; Fuentes López, Eduardo; Rosenbaum Fuentes, Andrés Ricardo; Willson Easton, Matías Iñigo; Palma Rojas, Soledad De Los Ángeles; Kattan Tala, Eduardo José; Vera Alarcón, María Magdalena; Aquevedo Salazar, Andrés Fernando; Napolitano Valenzuela, Carla Andrea; Cabello Estay, Pablo Andrés
    Summary: Objective. COVID-19 upsurge in orotracheal intubation (OTI) has opened a new opportunity for studying associated complications. Vocal fold motion impairment (VFMI) is a known complication of OTI. The present study sought to determine the impact of OTI and prolonged OTI on the risk of developing VFMI; to identify both risk and protective factors associated with it. Study design. Retrospective cohort study. Setting. Multicenter. Methods. Medical charts were reviewed for all patients that received invasive mechanical ventilation with a subsequent flexible laryngoscopic assessment between March 2020 and March 2022. The main outcomes were the presence of VFMI, including immobility (VFI) and hypomobility (VFH). Results. A total of 155 patients were included, 119 (76.8%) COVID-19 and 36 (23.2%) non-COVID-19 patients; overall 82 (52.9%) were diagnosed with VFMI. Eighty (52.3%) patients underwent a tracheostomy. The median (IQR) intubation duration was 18 (11–24.25) days, while the median (IQR) time to tracheostomy was 22 (16–29). In the adjusted model, we observed there was a 68% increased risk for VFMI from day 21 of intubation (RR: 1.68; 95% CI 1.07–2.65; P = 0.025). Conclusions. VFMI is a frequent complication in severely ill patients that undergo intubation. A prolonged OTI was associated with an increased risk of VFMI, highlighting the importance of timely tracheostomy. Further research is needed to confirm these findings in other subsets of critically ill patients.
  • Thumbnail Image
    Item
    Secondary respiratory early and late infections in mechanically ventilated patients with COVID-19
    (2022) Ceballos, María Elena; Nuñez, Ingrid; Uribe, Javier; Vera Alarcón, María Magdalena; Castro López, Ricardo; García C., Patricia; Arriata, Gabriel; Gándara, Vicente; Vargas Muñoz, Camila; Domínguez De Landa, María Angélica; Cerón, Inés; Born, Pablo; Espíndola, Eduardo
    Background: Patients with COVID-19 receiving mechanical ventilation may become aggravated with a secondary respiratory infection. The aim of this study was to describe secondary respiratory infections, their predictive factors, and outcomes in patients with COVID-19 requiring mechanical ventilation. Methods: A cohort study was carried out in a single tertiary hospital in Santiago, Chile, from 1st June to 31st July 2020. All patients with COVID-19 admitted to the intensive care unit that required mechanical ventilation were included. Results: A total of 175 patients were enrolled, of which 71 (40.6%) developed at least one secondary respiratory infection during follow-up. Early and late secondary infections were diagnosed in 1.7% and 31.4% respectively. Within late secondary infections, 88% were bacterial, 10% were fungal, and 2% were of viral origin. One-third of isolated bacteria were multidrug-resistant. Bivariate analysis showed that the history of corticosteroids used before admission and the use of dexamethasone during hospitalization were associated with a higher risk of secondary infections (p = 0.041 and p = 0.019 respectively). Multivariate analysis showed that for each additional day of mechanical ventilation, the risk of secondary infection increases 1.1 times (adOR = 1.07; 95% CI 1.02–1.13, p = 0.008) Conclusions: Patients with COVID-19 admitted to the intensive care unit and requiring mechanical ventilation had a high rate of secondary infections during their hospital stay. The number of days on MV was a risk factor for acquiring secondary respiratory infections.
  • Thumbnail Image
    Item
    Simulation-based mastery learning of bronchoscopy-guided percutaneous dilatational tracheostomy competency acquisition and skills transfer to a cadaveric model
    (2021) Kattan Tala, Eduardo José; De la Fuente Sanhueza, René; Putz de la Fuente, Francisca Carolina; Vera Alarcón, María Magdalena; Corvetto Aqueveque, Marcia Antonia; Inzunza, Oscar; Achurra Tirado, Pablo; Inzunza Agüero, Martín Alejandro; Muñoz Gama, Jorge; Sepúlveda Fernández, Marcos Ernesto; Gálvez Yanjarí, Víctor Andrés; Pavez, Nicolás; Retamal Montes, Jaime; Bravo Morales, Sebastián
    Introduction: Although simulation-based training has demonstrated improvement of procedural skills and clinical outcomes in different procedures, there are no published training protocols for bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT). The objective of this study was to assess the acquisition of BG-PDT procedural competency with a simulation-based mastery learning training program, and skills transfer into cadaveric models. Methods: Using a prospective interventional design, 8 trainees naive to the procedure were trained in a simulation-based mastery learning BG-PDT program. Students were assessed using a multimodal approach, including blind global rating scale (GRS) scores of video-recorded executions, total procedural time, and hand-motion tracking–derived parameters. The BG-PDT mastery was defined as proficient tracheostomy (successful procedural performance, with less than 3 puncture attempts, and no complications) with GRS scores higher than 21 points (of 25). After mastery was achieved in the simulator, residents performed 1 BG-PDT execution in a cadaveric model. Results: Compared with baseline, in the final training session, residents presented a higher procedural proficiency (0% vs. 100%, P < 0.001), with higher GRS scores [8 (6–8) vs. 25 (24–25), P = 0.01] performed in less time [563 (408–600) vs. 246 (214–267), P = 0.01] and with higher movement economy. Procedural skills were further transferred to the cadaveric model. Conclusions: Residents successfully acquired BG-PDT procedural skills with a simulation-based mastery learning training program, and skills were effectively transferred to a cadaveric model. This easily replicable program is the first simulation-based BG-PDT training experience reported in the literature, enhancing safe competency acquisition, to further improve patient care.