A5052604366- Hemodynamic Monitoring and Therapy
- Sepsis Diagnosis and Treatment
- Cardiac Arrest and Resuscitation
- Respiratory Support and Mechanisms
- Cardiac, Anesthesia and Surgical Outcomes
- Renal function and acid-base balance
- Airway Management and Intubation Techniques
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Tracheal and airway disorders
- Traumatic Brain Injury and Neurovascular Disturbances
- Simulation-Based Education in Healthcare
- Intensive Care Unit Cognitive Disorders
- Anesthesia and Pain Management
- Non-Invasive Vital Sign Monitoring
- Anesthesia and Sedative Agents
- Ultrasound in Clinical Applications
- Family and Patient Care in Intensive Care Units
- Surgical Simulation and Training
- Disaster Response and Management
- Cardiovascular Syncope and Autonomic Disorders
- Thermoregulation and physiological responses
- Patient Safety and Medication Errors
- Innovations in Medical Education
- Business, Innovation, and Economy
- Global Health and Surgery
Pontificia Universidad Católica de Chile
2015-2025
Medicina
2024
University of Chile
2021
Anna Needs Neuroblastoma Answers
2021
Sociedade Brasileira de Anestesiologia
2017
Weatherford College
2016
Methylene blue (MB) has been tested as a rescue therapy for patients with refractory septic shock. However, there is lack of evidence on MB an adjuvant therapy, its' optimal timing, dosing and safety profile. We aimed to assess whether early adjunctive can reduce time vasopressor discontinuation in shock.In this single-center randomized controlled trial, we assigned shock according Sepsis-3 criteria or placebo. Primary outcome was at 28 days. Secondary outcomes included vasopressor-free days...
Abstract Background Current recommendations support guiding fluid resuscitation through the assessment of responsiveness. Recently, concept tolerance and prevention venous congestion (VC) have emerged as relevant aspects to be considered avoid potentially deleterious side effects resuscitation. However, there is paucity data on relationship responsiveness VC. This study aims compare prevalence in responsive unresponsive critically ill patients after intensive care (ICU) admission. Methods...
Acute circulatory dysfunction in patients with sepsis can evolve rapidly into a progressive stage associated high mortality. Early recognition and adequate resuscitation could improve outcome. However, since the spectrum of clinical presentation is quite variable, signs hypoperfusion are frequently unrecognized just admitted to emergency department (ED). Hyperlactatemia considered key parameter disclose tissue hypoxia but it not universally available getting timely results be challenging low...
The decision of when to stop septic shock resuscitation is a critical but yet relatively unexplored aspect care. This especially relevant since the risks over-resuscitation with fluid overload or inotropes have been highlighted in recent years. A guideline has proposed normalization central venous oxygen saturation and/or lactate as therapeutic end-points, assuming that these variables are equivalent interchangeable. However, physiological determinants both totally different, it legitimate...
Abstract Background Fluid boluses are administered to septic shock patients with the purpose of increasing cardiac output as a means restore tissue perfusion. Unfortunately, fluid therapy has narrow therapeutic index, and therefore, several approaches increase safety have been proposed. responsiveness (FR) assessment might predict which will effectively after bolus (FR+), thus preventing potentially harmful administration in non-fluid responsive (FR−) patients. However, there scarce data on...
Shock is a life-threatening condition characterized by substantial alterations in the microcirculation. This study tests hypothesis that considering sublingual microcirculatory perfusion variables therapeutic management reduces 30-day mortality patients admitted to intensive care unit (ICU) with shock. randomized, prospective clinical multicenter trial-recruited an arterial lactate value above two mmol/L, requiring vasopressors despite adequate fluid resuscitation, regardless of cause All...
Capillary refill time (CRT) may improve more rapidly than lactate in response to increments systemic flow. Therefore, it can be assessed frequently during septic shock (SS) resuscitation. Hyperlactatemia, contrast, exhibits a slower recovery SS survivors, probably explained by the delayed resolution of non-hypoperfusion-related sources. Thus, targeting normalization associated with impaired outcomes. The ANDROMEDA-SHOCK trial compared CRT- versus lactate-targeted resuscitation early SS....
Persistent hyperlactatemia is particularly difficult to interpret in septic shock. Besides hypoperfusion, adrenergic-driven lactate production and impaired clearance are important contributors. However, clinical recognition of different sources unfortunately not a common practice patients treated with the same strategy despite risk over-resuscitation some. Indeed, pursuing additional resuscitation non-hypoperfusion-related cases might lead toxicity fluid overload vasoactive drugs. We...
Abstract Introduction Although the prognostic value of persistent hyperlactatemia in septic shock is unequivocal, its physiological determinants are controversial. Particularly, role impaired hepatic clearance has been underestimated and only considered relevant patients with liver ischemia or cirrhosis. Our objectives were to establish whether endotoxemia impairs whole body net lactate clearance, explore a potential for total hypoperfusion during early phase shock. Methods After anesthesia,...
Persistent hyperlactatemia during septic shock is multifactorial. Hypoperfusion-related anaerobic production and adrenergic-driven aerobic generation together with impaired lactate clearance have been implicated. An excessive adrenergic response could contribute to persistent modulation might be beneficial. We assessed the effects of dexmedetomidine esmolol on hemodynamics, generation, exogenous endotoxin-induced shock.Eighteen anesthetized mechanically ventilated sheep were subjected a...
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 fluid overload. Peripheral perfusion, assessed by capillary refill time (CRT), an effective alternative resuscitation target recently demonstrated ANDROMEDA-SHOCK trial. We designed present randomized controlled trial...
Introduction Venous congestion is a pathophysiological state where high venous pressures cause organ oedema and dysfunction. associated with worse outcomes, particularly acute kidney injury (AKI), for critically ill patients. can be measured by Doppler ultrasound at the bedside through interrogation of inferior vena cava (IVC), hepatic vein (HV), portal (PV) intrarenal veins (IRV). The objective this study to quantify association between identified need renal replacement therapy (RRT) or...
Abstract 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 response short-term hemodynamic interventions with fluids or vasopressors. A couple previous explored the impact fluid bolus on CRT, but little known about norepinephrine when aiming at higher mean arterial pressure (MAP) target in shock....
ANDROMEDA-SHOCK 2 is an international, multicenter, randomized controlled trial comparing hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock to standard care test the hypothesis that former associated with lower morbidity and mortality terms of hierarchal analysis outcomes. To report statistical plan for ANDROMEDA--SHOCK clinical trial. We briefly describe design, patients, methods randomization, interventions, outcomes, sample size. portray our...