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Search Results: 1 - 10 of 6000 matches for " Guillermo Bugedo "
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Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome
Alejandro Bruhn, Glenn Hernandez, Guillermo Bugedo, Luis Castillo
Critical Care , 2004, DOI: 10.1186/cc2905
Abstract: Eight patients were included. A pressure–volume curve was traced and ideal PEEP, defined as lower inflection point + 2 cmH2O, was determined. Gastric tonometry was measured continuously (Tonocap). After baseline measurements, 10, 15 and 20 cmH2O PEEP and ideal PEEP were applied for 30 min each. By the end of each period, hemodynamic, CO2 gap (gastric minus arterial partial pressures), and ventilatory measurements were performed.PEEP had no effect on CO2 gap (median [range], baseline: 19 [2–30] mmHg; PEEP 10: 19 [0–40] mmHg; PEEP 15: 18 [0–39] mmHg; PEEP 20: 17 [4–39] mmHg; ideal PEEP: 19 [9–39] mmHg; P = 0.18). Cardiac index also remained unchanged (baseline: 4.6 [2.5–6.3] l min-1 m-2; PEEP 10: 4.5 [2.5–6.9] l min-1 m-2; PEEP 15: 4.3 [2–6.8] l min-1 m-2; PEEP 20: 4.7 [2.4–6.2] l min-1 m-2; ideal PEEP: 5.1 [2.1–6.3] l min-1 m-2; P = 0.08). One patient did not complete the protocol because of hypotension.PEEP of 10–20 cmH2O does not affect gastric mucosal perfusion and is hemodynamically well tolerated in most patients with ARDS, including those receiving adrenergic drugs.Recent studies have shown that lung protective strategies using low tidal volumes and high levels of positive end-expiratory pressure (PEEP) reduce mortality and are becoming standard practice in patients with acute respiratory distress syndrome (ARDS) [1,2].Although PEEP improves arterial oxygenation, it can adversely affect systemic hemodynamics, reducing venous return and cardiac output. These effects are proportional to the PEEP level. Regional perfusion can also be affected by PEEP, independently of cardiac output changes. The splanchnic perfusion is particularly sensitive, and any reduction can compromise its barrier function, promote bacterial translocation, and contribute to the development of multiple organ failure [3]. In experimental models, PEEP has markedly decreased mesenteric and portal blood flow, despite only moderate reductions in cardiac output [4-8]. Similar results have been repo
Encuesta sobre humidificación de la vía aérea en unidades de cuidados intensivos de adultos de Chile Airway humidification practices in Chilean intensive care units
Jaime Retamal,Juan Castillo,Guillermo Bugedo,Alejandro Bruhn
Revista médica de Chile , 2012,
Abstract: Background: In patients with an artificial airway, inspired gases can be humidified and heated using a passive (heat and moisture exchange filter - HMEF), or an active system (heated humidifier). Aim: To assess how humidification is carried out and what is the usual clinical practice in this field in Chilean intensive care units (ICUs). Material and Methods: A specific survey to evaluate humidification system features as well as caregivers' preferences regarding humidification systems, was carried out on the same day in all Chilean ICUs. Results: Fifty-five ICUs were contacted and 44 of them completed the survey. From a total of 367 patients, 254 (69%) required humidification because they were breathing through an artificial airway. A heated humidifier was employed only in 12 patients (5%). Forty-three ICUs (98%) used HMEF as their routine humidification system. In 52% of surveyed ICUs, heated humidifiers were not available. Conclusions: In Chile the main method to humidify and heat inspired gases in patients with an artificial airway is the HMEF. Although there are clear indications for the use of heated humidifiers, they are seldom employed.
Preliminary study of ventilation with 4 ml/kg tidal volume in acute respiratory distress syndrome: feasibility and effects on cyclic recruitment - derecruitment and hyperinflation
Jaime Retamal, Javiera Libuy, Magdalena Jiménez, Matías Delgado, Cecilia Besa, Guillermo Bugedo, Alejandro Bruhn
Critical Care , 2013, DOI: 10.1186/cc12487
Abstract: Patients with pulmonary acute respiratory distress syndrome (ARDS) were included in a cross-over study with two Vt levels: 6 and 4 ml/kg. The protocol had two parts: one bedside and other at the CT room. To avoid severe hypercapnia in the 4 ml/kg arm, we replaced the heat and moisture exchange filter by a heated humidifier, and respiratory rate was increased to keep minute ventilation constant. Data on lung mechanics and gas exchange were taken at baseline and after 30 minutes at each Vt (bedside). Thereafter, a dynamic CT (4 images/sec for 8 sec) was taken at each Vt at a fix transverse region between the middle and lower third of the lungs. Afterwards, CT images were analyzed and cyclic recruitment-derecruitment was determined as non aerated tissue variation between inspiration and expiration, and hyperinflation as maximal hyperinflated tissue at end-inspiration, expressed as % of lung tissue weight.We analyzed 10 patients. Decreasing Vt from 6 to 4 ml/kg consistently decreased cyclic recruitment-derecruitment from 3.6 (2.5-5.7) % to 2.9 (0.9-4.7) % (p<0.01) and end-inspiratory hyperinflation from 0.7 (0.3 - 2.2) to 0.6 (0.2 - 1.7) % (p=0.01). No patient developed severe respiratory acidosis or severe hypercapnia when decreasing Vt to 4 ml/kg (pH 7.29 (7.21-7.46); PaCO2 48 (26 - 51) mmHg).Decreasing Vt from 6 to 4 ml/kg reduces cyclic recruitment-derecruitment and hyperinflation. Severe respiratory acidosis may be effectively prevented by decreasing instrumental dead space and by increasing respiratory rate.
Press?o expiratória final positiva aumenta o estiramento em pacientes com LPA/SDRA
Bugedo, Guillermo;Bruhn, Alejandro;Regueira, Tomás;Romero, Carlos;Retamal, Jaime;Hernández, Glenn;
Revista Brasileira de Terapia Intensiva , 2012, DOI: 10.1590/S0103-507X2012000100007
Abstract: objective: the objective of this study was to assess the effects of positive end-expiratory pressure on recruitment, cyclic recruitment and derecruitment and strain in patients with acute lung injury and acute respiratory distress syndrome using lung computed tomography. methods: this is an open, controlled, non-randomized interventional study of ten patients with acute lung injury and acute respiratory distress syndrome. using computed tomography, single, basal slices of the lung were obtained during inspiratory and expiratory pauses at a tidal volume of 6 ml/kg and a positive end-expiratory pressure of 5, 10, 15 and 20 cmh2o. the densities of the lung parenchyma were measured in hounsfield units. the values for positive end-expiratory pressure-induced recruitment, cyclic recruitment and derecruitment and strain were then calculated. results: increasing levels of positive end-expiratory pressure were correlated with increased recruitment and global strain (p < 0.01), which was significantly correlated with plateau pressure (r2 = 0.97, p < 0.01). in addition, increasing levels of positive end-expiratory pressure systematically increased strain along the sternovertebral axis. conclusion: while strain is an adverse effect of positive end-expiratory pressure, the decision use positive end-expiratory pressure with any patient should be balanced against the potential benefits of recruitment. due to the small number of patients in this study, the present data should be treated as hypothesis generating and is not intended to limit the clinical application of a high level of positive end-expiratory pressure in patients with severe hypoxemia.
Prevención de infecciones asociadas a catéteres vasculares centrales Prevention of catheter related infections
Pola Brenner F.,Guillermo Bugedo T.,Dolores Calleja R.,Gladys Del Valle M.
Revista chilena de infectología , 2003,
Abstract:
Hemicraniectomía descompresiva en dos pacientes con infarto maligno de la arteria cerebral media Decompressive hemicraniectomy for malignant middle cerebral artery infarction. Report of two cases
Patricio Mellado T,Luis Castillo F,Manuel Campos P,Guillermo Bugedo T
Revista médica de Chile , 2005,
Abstract: Malignant middle cerebral territory infarction represents 5 to 10% of all brain infarctions. Its mortality is 80%, due to brain herniation and it is not reduced by medical treatment. Decompressive hemicraniectomy reduces mortality to 12%, and the subsequent quality of life of patients is acceptable. We report two male patients aged 61 and 54 years, with a malignant middle cerebral territory infarction who were treated with decompressive hemicraniectomy. After two years of follow up, both patients are self-sufficient and live at home with their families
Ventilación diferencial en el manejo del síndrome de distress respiratorio agudo secundario a mediastinitis necrotizante descendente: Rol de la tomografía axial computarizada dinámica de pulmón Use of dinamic lung computed tomography to orient mechanical ventilation in adult respiratory distress syndrome: Report of one case with acute mediastinitis
Guillermo Bugedo T,Alejandro Bruhn C,Glenn Hernández P,Gonzalo Rojas C
Revista médica de Chile , 2003,
Abstract: Lung computed tomography (CT) is being used increasingly to assess lung morphology in patients on mechanical ventilation. Lung CT under known levels of airway pressure (dynamic CT) can also assess the response of lung parenchyma to ventilatory therapy. We report a patient with acute respiratory distress syndrome secondary to descending necrotizing mediastinitis, in whom lung dynamic CT oriented ventilatory management. Independent lung ventilation improved gas exchange and helped patient recovery (Rev Méd Chile 2003; 131: 200-8)
Hipotermia intravascular inducida en el manejo de la hipertensión intracraneana en insuficiencia hepática aguda: Caso clínico Intravascular hypothermia for the management of Intracranial hypertension in acute liver failure: Case report
Luis Castillo F,Cristian Pérez R,Carolina Ruiz B,Guillermo Bugedo T
Revista médica de Chile , 2009,
Abstract: Acute liver failure has a mortality rate in excess of 80%. Most deaths are attributed to brain edema with intracranial hypertension and herniation of structures, where ammonium plays a major role in its generation. We report an 18 year-old female with a fulminant hepatic failure caused by virus A infection. The patient developed a profound sopor and required mechanical ventilation. A CT scan showed the presence of brain edema and intracranial hypertension. A Raudemic catheter was inserted to measure intracranial pressure and brain temperature. Intracranial hypertension became refractory and intravascular hypothermia was started, reducing brain temperature to 33°C. Seventy two hours later, a liver transplantation was performed. After testing graft perfusion, rewarming was started, completing 122 hours of hypothermia at 33°C. The patient was discharged in good conditions after 69 days of hospitalization.
Ventilación diferencial en el manejo del síndrome de distress respiratorio agudo secundario a mediastinitis necrotizante descendente: Rol de la tomografía axial computarizada dinámica de pulmón
Bugedo T,Guillermo; Bruhn C,Alejandro; Hernández P,Glenn; Rojas C,Gonzalo; Aparicio R,Rodrigo; Castillo F,Luis;
Revista médica de Chile , 2003, DOI: 10.4067/S0034-98872003000200011
Abstract: lung computed tomography (ct) is being used increasingly to assess lung morphology in patients on mechanical ventilation. lung ct under known levels of airway pressure (dynamic ct) can also assess the response of lung parenchyma to ventilatory therapy. we report a patient with acute respiratory distress syndrome secondary to descending necrotizing mediastinitis, in whom lung dynamic ct oriented ventilatory management. independent lung ventilation improved gas exchange and helped patient recovery (rev méd chile 2003; 131: 200-8)
Hemicraniectomía descompresiva en dos pacientes con infarto maligno de la arteria cerebral media
Mellado T,Patricio; Castillo F,Luis; Campos P,Manuel; Bugedo T,Guillermo; Dougnac L,Alberto; Andresen H,Max;
Revista médica de Chile , 2005, DOI: 10.4067/S0034-98872005000400008
Abstract: malignant middle cerebral territory infarction represents 5 to 10% of all brain infarctions. its mortality is 80%, due to brain herniation and it is not reduced by medical treatment. decompressive hemicraniectomy reduces mortality to 12%, and the subsequent quality of life of patients is acceptable. we report two male patients aged 61 and 54 years, with a malignant middle cerebral territory infarction who were treated with decompressive hemicraniectomy. after two years of follow up, both patients are self-sufficient and live at home with their families
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