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Search Results: 1 - 10 of 227522 matches for " Alejandro Bruhn C "
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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)
Evaluación de la microcirculación sublingual en un paciente en shock séptico refractario tratado con hemofiltración de alto volumen
Ruiz B,Carolina; Bruhn C,Alejandro; Hernández P,Glenn; Andresen H,Max;
Revista médica de Chile , 2008, DOI: 10.4067/S0034-98872008000900013
Abstract: microcirculation is severely compromised in sepsis, with a reduction of capillary density and flow impairment. these alterations have important prognostic implications, being more severe in non-survivors to septic shock. today microcirculation may be assessed bedside, non-invasively usingpolarized light videomicroscopy a technique known as sdf (side dark field). we report a 54 year-old man with an extramembranous nephropathy that developed a necrotizing fascitis associated to septic shock, in whom microcirculation was periodically assessed during his management. the patient was treated with buids, vasoactive drugs, antibiotics and was operated for exploration and debridement. as the patient persisted in refractory shock despite treatment, high-volume hemofiltration was started. before hemofiltration the patient had severe microcirculatory alterations that improved during and after the procedure. physiologic endpoints of high-volume hemofiltration in septic shock remain unknown, but it has the capacity to clear in?ammatory mediators. since microcirculatory alterations are in part secondary to these mediators, their removal is beneficia! like other authors, we found no relation between microcirculation and other haemodynamic and perfusión variables.
Cateterización venosa suprahepática en cuatro casos de shock séptico severo: Report of four cases Suprahepatic vein oxygen saturation monitoring and gastric tonometry in the management of severe septic shock
Carlos Inzunza P,Matías Cornu A,Alejandro Bruhn C,Luis Castillo F
Revista médica de Chile , 2001,
Abstract: Splanchnic hypoperfusion, with pathogenic implications for multiple organ failure, can occur during septic shock. We report four patients with septic shock in whom regional hepatosplenic splanchnic perfusion was monitored through suprahepatic vein catheterization and gastric tonometry. Suprahepatic lactate and oxygen saturation showed splanchnic hypoperfusion in all patients. These parameters improved only in the patient that survived. Gastric tonometry was more inconsistent. We conclude that suprahepatic vein catheterization could have a role in the management of septic shock. ( Rev Méd Chile 2001; 129: 552-5)
Evaluación de la microcirculación sublingual en un paciente en shock séptico refractario tratado con hemofiltración de alto volumen Evaluation of sublingual microcirculation in septic shock. Report of one patient treated with high volume hemofiltration
Carolina Ruiz B,Alejandro Bruhn C,Glenn Hernández P,Max Andresen H
Revista médica de Chile , 2008,
Abstract: Microcirculation is severely compromised in sepsis, with a reduction of capillary density and flow impairment. These alterations have important prognostic implications, being more severe in non-survivors to septic shock. Today microcirculation may be assessed bedside, non-invasively usingpolarized light videomicroscopy a technique known as SDF (side dark field). We report a 54 year-old man with an extramembranous nephropathy that developed a necrotizing fascitis associated to septic shock, in whom microcirculation was periodically assessed during his management. The patient was treated with Buids, vasoactive drugs, antibiotics and was operated for exploration and debridement. As the patient persisted in refractory shock despite treatment, high-volume hemofiltration was started. Before hemofiltration the patient had severe microcirculatory alterations that improved during and after the procedure. Physiologic endpoints of high-volume hemofiltration in septic shock remain unknown, but it has the capacity to clear in ammatory mediators. Since microcirculatory alterations are in part secondary to these mediators, their removal is beneficia! Like other authors, we found no relation between microcirculation and other haemodynamic and perfusión variables.
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)
Cateterización venosa suprahepática en cuatro casos de shock séptico severo: Report of four cases
Inzunza P,Carlos; Cornu A,Matías; Bruhn C,Alejandro; Castillo F,Luis; Bugedo T,Guillermo; Acu?a C,Darwin; Medeiros U,Sebastián; Hernández P,Glenn;
Revista médica de Chile , 2001, DOI: 10.4067/S0034-98872001000500012
Abstract: splanchnic hypoperfusion, with pathogenic implications for multiple organ failure, can occur during septic shock. we report four patients with septic shock in whom regional hepatosplenic splanchnic perfusion was monitored through suprahepatic vein catheterization and gastric tonometry. suprahepatic lactate and oxygen saturation showed splanchnic hypoperfusion in all patients. these parameters improved only in the patient that survived. gastric tonometry was more inconsistent. we conclude that suprahepatic vein catheterization could have a role in the management of septic shock. ( rev méd chile 2001; 129: 552-5)
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.
Síndrome de respuesta inflamatoria sistémica severa: ?Es comparable a la sepsis severa?
Hernández P,Glenn; Dougnac L,Alberto; Castro O,José; Labarca M,Eduardo; Ojeda M,Mario; Bugedo T,Guillermo; Castillo F,Luis; Andresen H,Max; Bruhn C,Alejandro; Huidobro M,Luis Felipe; Huidobro M,Rodrigo; Caballero G,María Teresa; Hernández M,Antonio;
Revista médica de Chile , 1999, DOI: 10.4067/S0034-98871999001100007
Abstract: background: in 1992, a consensus conference defined the terms systemic inflammatory response syndrome (sirs), sepsis, severe sepsis and septic shock. since then, numerous reports have validated the prognostic usefulness of these operative definitions. aim: to evaluate if sepsis severity criteria, as defined by the consensus conference, can be applied to noninfectious sirs. patients and methods: five hundred eighteen patients admitted to 5 intensive care units (icu) from 4 hospitals were prospectively evaluated during a 3 months period. patients that met at least one severity criteria were included. sirs etiology, organ dysfunction and evolution were recorded in each patient. results: one hundred two patients were included: 79 with sepsis (group i) and 23 with noninfectious sirs (group ii). icu and hospital mortality were comparable (43 and 48% in sepsis compared to 43 and 51% in non infectious sirs). the most common sources of sepsis were pneumonia and peritonitis. group ii patients had a wide variety of diseases. icu stay, apache score and number of organs with dysfunction were not different among groups. only the incidence of renal dysfunction was higher in the septic group. conclusions: the consensus sepsis severity criteria can be applied to noninfectious sirs, defining a population subset with similar high mortality and organ dysfunction incidence, although with greatly heterogeneous etiologies.
Lipoperoxidation and Protein Oxidative Damage Exhibit Different Kinetics During Septic Shock
Max Andresen,Tomas Regueira,Alejandro Bruhn,Druso Perez,Pablo Strobel,Alberto Dougnac,Guillermo Marshall,Federico Leighton
Mediators of Inflammation , 2008, DOI: 10.1155/2008/168652
Abstract: Septic shock (SS)-related multiorgan dysfunction has been associated with oxidative damage, but little is known about the temporal damage profile and its relationship to severity. The present work investigated prospectively 21 SS patients. Blood samples were obtained at diagnosis, 24, 72 hours, day 7, and at 3 months. At admission, thiobarbituric acid reactive substances (TBARSs), plasma protein carbonyls, plasma protein methionine sulfoxide (MS), ferric/reducing antioxidant power (FRAP), total red blood cell glutathione (RBCG), uric acid (UA), and bilirrubin levels were increased (<.05). Total radical—trapping antioxidant potential (TRAP) and vitamin-E were similar to controls, and vitamin-C was decreased (<.05). During evolution, TBARS and RBCG increased (<.001), vitamin-E levels remained stable, whereas plasma protein carbonyls and MS, TRAP, vitamin-C, reduced glutathione, and UA levels decreased (<.006). After 3 months, plasma protein carbonyls and MS persisted elevated. More severe patients exhibited higher TBARS, TRAP, FRAP, vitamin-C, UA, and bilirrubin levels. Our results suggest early and persistent oxidative stress during septic shock and a correlation between increasing levels of lipoperoxidation and sepsis severity.
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