A5084524782- Cardiac Arrest and Resuscitation
- Respiratory Support and Mechanisms
- Sepsis Diagnosis and Treatment
- Hemodynamic Monitoring and Therapy
- Intensive Care Unit Cognitive Disorders
- Mechanical Circulatory Support Devices
- Liver Disease and Transplantation
- Liver Disease Diagnosis and Treatment
- Organ Transplantation Techniques and Outcomes
- Renal function and acid-base balance
- Antibiotics Pharmacokinetics and Efficacy
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Family and Patient Care in Intensive Care Units
- Pneumonia and Respiratory Infections
- Sleep and related disorders
- Intracerebral and Subarachnoid Hemorrhage Research
- Healthcare cost, quality, practices
- Advanced Statistical Modeling Techniques
- Religion, Spirituality, and Psychology
- Traumatic Brain Injury and Neurovascular Disturbances
- Infant Development and Preterm Care
- Resilience and Mental Health
- Rheology and Fluid Dynamics Studies
- Neurosurgical Procedures and Complications
- Ultrasound in Clinical Applications
Pontificia Universidad Católica de Chile
2016-2025
Hospital Clínico de la Universidad de Chile
2020
European Society of Cardiology
2020
New York State College of Veterinary Medicine
2020
Committee on Publication Ethics
2020
Universidad Andrés Bello
2020
Universidad de La Frontera
2020
Cornell University
2020
Yahoo (United Kingdom)
2020
University of Concepción
2020
Abnormal peripheral perfusion after septic shock resuscitation has been associated with organ dysfunction and mortality. The potential role of the clinical assessment as a target during in early not established.To determine if perfusion-targeted adults is more effective than lactate level-targeted for reducing mortality.Multicenter, randomized trial conducted at 28 intensive care units 5 countries. Four-hundred twenty-four patients were included between March 2017 2018. last date follow-up...
There is wide variability in mechanical ventilation settings during extracorporeal membrane oxygenation (ECMO) patients with acute respiratory distress syndrome. Although lung rest recommended to prevent further injury, there no evidence support it.To determine whether near-apneic decreases injury a pig model of syndrome supported ECMO.Pigs (26-36 kg; n = 24) were anesthetized and connected ventilation. In 18 animals was induced by double-hit consisting repeated saline lavages followed 2...
Septic shock is a highly lethal condition. Early recognition of tissue hypoperfusion and its reversion are key factors for limiting progression to multiple organ dysfunction death. Lactate-targeted resuscitation the gold-standard under current guidelines, although it has several pitfalls including that non-hypoxic sources lactate might predominate in an unknown proportion patients. Peripheral perfusion-targeted provide real-time response increases flow could lead more timely decision stop...
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...
Latin America bears an important burden of critical care disease, yet the information about it is scarce. Our objective was to describe structure, organization, processes care, and research activities in Latin-American ICUs.Web-based survey submitted ICU directors.ICUs located nine countries.Individual ICUs.None.Two hundred fifty-seven 498 (52%) surveys responded: 51% from Brazil, 17% Chile, 13% Argentina, 6% Ecuador, 5% Uruguay, 3% Colombia, between Mexico, Peru, Paraguay. Seventy-nine...
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....
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 have been reported, there scarce evidence about the feasibility and safety of such approach. We analyzed a continuous prolonged strategy implemented nationwide, large cohort COVID-19 Chile.Retrospective study mechanically ventilated with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted 15 Intensive Care...
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...
Introduction A significant number of critically ill patients who survive their illness will experience new sequelae or a worsening baseline health status following discharge from the hospital. These consequences may be physical, cognitive and/or psychological and have been labelled postintensive care syndrome (PICS). Prior research has demonstrated that spiritual aligned with specific creed during hospitalisation in intensive unit (ICU), as part comprehensive plan, an effective strategy for...
Intensive care medicine is a relatively young discipline that has rapidly grown into full-fledged medical subspecialty. Intensivists are responsible for managing an ever-increasing number of patients with complex, life-threatening diseases. Several factors may influence their performance, including age, training, experience, workload, and socioeconomic context. The aim this study was to examine individual- work-related aspects the Latin American intensivist workforce, mainly academic...
Abstract Background Prophylactic high-flow nasal cannula (HFNC) oxygen therapy can decrease the risk of extubation failure. It is frequently used in postextubation phase alone or combination with noninvasive ventilation. However, its physiological effects this setting have not been thoroughly investigated. The aim study was to determine comprehensively HFNC applied after on respiratory effort, diaphragm activity, gas exchange, ventilation distribution, and cardiovascular biomarkers. Methods...
Introduction: The use of antibiotics is mandatory in patients during extracorporeal membrane oxygenation (ECMO) support. Clinical studies have shown high variability the antibiotic concentrations, as well sequestration them by ECMO circuit, suggesting that doses and/or interval administration used may not be adequate. Thus, a fast response sensor to estimate concentrations this setting would contribute improve dose adjustments. biosensor PenP has been dynamic range, sensitivity and...
ANDROMEDA-SHOCK is an international, multicenter, randomized controlled trial comparing peripheral perfusion-targeted resuscitation to lactate-targeted in patients with septic shock order test the hypothesis that targeting perfusion will be associated lower morbidity and mortality.To report statistical analysis plan for trial.We describe design, primary secondary objectives, patients, methods of randomization, interventions, outcomes, sample size. We our planned primary, tertiary outcomes....
Background The spontaneous breathing trial (SBT) assesses the risk of weaning failure by evaluating some physiological responses to massive venous return increase imposed discontinuing positive pressure ventilation. This can be very demanding for critically ill patients, inducing excessive physical and cardiovascular stress, including muscle fatigue, heart ischemia eventually cardiac dysfunction. Extubation with emergency reintubation is a serious adverse consequence failed process. Some...
Background A lung rest strategy is recommended during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome (ARDS). However, spontaneous breathing modes are frequently used this context. The impact of approach may depend on the intensity efforts. authors aimed to determine whether a low effort increases injury, compared controlled near-apneic ventilation, porcine ARDS model assisted by oxygenation. Methods Twelve female pigs were subjected injury repeated lavages,...
Introduction In critically ill patients, sleep and circadian rhythms are greatly altered. These disturbances have been associated with adverse consequences, including increased mortality. Factors the ICU environment, such as exposure to inadequate light noise levels during day night or inflexible schedules of daily care activities, described playing an essential role in disturbances. The main objective this study is evaluate impact use a multifaceted environmental control intervention on...
Assessment of tissue hypoxia at the bedside has yet to be translated into daily clinical practice in septic shock patients. Perfusion markers are surrogates deeper physiological phenomena. Lactate-to-pyruvate ratio (LPR) and between veno-arterial PCO2 difference Ca-vO2 (ΔPCO2/Ca-vO2) have been proposed as hypoxia, but they not compared scenario. We studied acute patients under resuscitation. wanted evaluate relationship these with biochemical hypoperfusion during resuscitation.Secondary...
Recently, Wong et al. have successfully developed a fluorescent biosensor based on the PenPC β -lactamase which changes its intrinsic fluorescence in presence of -lactam antibiotics (BLAs). Here, we studied systematically this correlation among change and concentration different BLAs aimed at developing novel method for estimating wide range BLAs. This showed high precision specificity very low interference from clinically relevant samples. We were able to monitor pharmacokinetics meropenem...