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Editorial: Immune response to gram-negative bacteria in the lungs
(2024)
Agnes Jara-Collao
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POLI HARLOWE, MARIA CECILIA BERTA
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William Bain
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Hernán F. Peñaloza
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Six-month post-intensive care outcomes during high and low bed occupancy due to the COVID-19 pandemic: A multicenter prospective cohort study
(2023)
CASTRO AVILA, ANA CRISTINA
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Catalina Merino-Osorio
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GONZALEZ SEGUEL, FELIPE ANDRES
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CAMUS MOLINA, AGUSTIN
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Felipe Muñoz-Muñoz
<jats:sec id="sec001"> <jats:title>Introduction</jats:title> <jats:p>The COVID-19 pandemic can be seen as a natural experiment to test how bed occupancy affects post-intensive care unit (ICU) patient’s functional outcomes. To compare by bed occupancy the frequency of mental, physical, and cognitive impairments in patients admitted to ICU during the COVID-19 pandemic.</jats:p> </jats:sec> <jats:sec id="sec002"> <jats:title>Methods</jats:title> <jats:p>Prospective cohort of adults mechanically ventilated >48 hours in 19 ICUs from seven Chilean public and private hospitals. Ninety percent of nationwide beds occupied was the cut-off for low versus high bed occupancy. At ICU discharge, 3- and 6-month follow-up, we assessed disability using the World Health Organization Disability Assessment Schedule 2.0. Quality of life, mental, physical, and cognitive outcomes were also evaluated following the core outcome set for acute respiratory failure.</jats:p> </jats:sec> <jats:sec id="sec003"> <jats:title>Results</jats:title> <jats:p>We enrolled 252 participants, 103 (41%) during low and 149 (59%) during high bed occupancy. Patients treated during high occupancy were younger (P<jats:sub>50</jats:sub> [P<jats:sub>25</jats:sub>-P<jats:sub>75</jats:sub>]: 55 [44–63] vs 61 [51–71]; p<0.001), more likely to be admitted due to COVID-19 (126 [85%] vs 65 [63%]; p<0.001), and have higher education qualification (94 [63%] vs 48 [47%]; p = 0.03). No differences were found in the frequency of at least one mental, physical or cognitive impairment by bed occupancy at ICU discharge (low vs high: 93% vs 91%; p = 0.6), 3-month (74% vs 63%; p = 0.2) and 6-month (57% vs 57%; p = 0.9) follow-up.</jats:p> </jats:sec> <jats:sec id="sec004"> <jats:title>Conclusions</jats:title> <jats:p>There were no differences in post-ICU outcomes between high and low bed occupancy. Most patients (>90%) had at least one mental, physical or cognitive impairment at ICU discharge, which remained high at 6-month follow-up (57%).</jats:p> </jats:sec> <jats:sec id="sec005"> <jats:title>Clinical trial registration</jats:title> <jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT04979897" xlink:type="simple">NCT04979897</jats:ext-link> (clinicaltrials.gov).</jats:p> </jats:sec>
3Scopus© Citations 3
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Ventilación mecánica invasiva. Puesta al día para el médico pediatra
(2013)
Alejandro Donoso
3Scopus© Citations 2
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Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis
(2020)
Jesús Alberto Serra
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Sebastián González-Dambrauskas
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Pablo Vásquez Hoyos
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CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL
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Alejandro Donoso
<jats:p>Objetivo: describir las terapias utilizadas en lactantes con bronquiolitis aguda admitidos en 20 Unidades de Cuidados Intensivos (UCI) pediátricos miembros de LARed en 5 países latinoamericanos.Pacientes y Método: Estudio observacional retrospectivo, multicéntrico, de datos del Registro Latinoamericano de Falla Respiratoria Aguda Pediátrica. Se incluyeron niños menores de 2 años ingresados a UCI pediátrica por bronquiolitis aguda comunitaria entre mayo-septiembre 2017. Se recolectaron datos demográficos, clínicos, soporte respiratorio, terapias utilizadas y resultados clínicos. Se realizó análisis de subgrupos según ubicación geográfica, tipo financiación y presencia de academia.Resultados: Ingresaron al registro 1.155 pacientes con falla respiratoria aguda. Seis casos fueron excluidos por no tener formulario completo. De los 1.147 pacientes, 908 eran menores de 2 años. De ellos, 467 tuvieron diagnóstico de bronquiolitis aguda, correspondiendo a la principal causa de ingreso a UCI pediátrica por falla respiratoria aguda (51,4%). Las características demográficas y de gravedad entre los centros fueron similares. El soporte máximo respiratorio más frecuente fue cánula nasal de alto flujo (47%), seguido por ventilación mecánica no invasiva (26%) y ventilación mecánica invasiva (17%), con un coeficiente de variación (CV) amplio entre los centros. Hubo una gran dispersión en uso de terapias, siendo frecuente el uso de broncodilatadores, antibióticos y corticoides, con CV hasta 400%. El análisis de subgrupos mostró diferencias significativas en soporte respiratorio y tratamientos utilizados. Un paciente falleció en esta cohorte.Conclusión: Detectamos gran variabilidad en el soporte respiratorio y tratamientos entre UCI pediátricas latinoamericanas. Esta variabilidad no es explicada por disparidades demográficas ni clínicas. Esta heterogeneidad de tratamientos debería promover iniciativas colaborativas para disminuir la brecha entre la evidencia científica y la práctica asistencial.</jats:p>
3Scopus© Citations 11
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Reduced PICU respiratory admissions during COVID-19
(2020)
Pablo Vásquez-Hoyos
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Franco Diaz-Rubio
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Nicolas Monteverde-Fernandez
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Juan Camilo Jaramillo-Bustamante
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CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL
<jats:sec><jats:title>Background</jats:title><jats:p>The COVID-19 pandemic reached the Southern Hemisphere in the autumn of 2020, thus coinciding with its expected annual viral respiratory season. The potential impact of national strategies aimed at mitigating COVID-19 during the pandemic on the incidence of other critical viral lower respiratory tract infections (LRTIs) in children is unknown.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We analysed admission data for LRTIs from 22 paediatric intensive care units (PICUs) in four countries, part of a large international Latin American registry of children with acute respiratory failure (Red Colaborativa Pediátrica de Latinoamérica [LARed Network]).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Between January and August, there were 83% fewer PICU admissions for LRTIs in 2020 compared to the 2018/2019 average over the same period. Similar decreases were noted for PICU admissions due to respiratory syncytial virus and influenza (92% and 78%, respectively).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>We observed a striking reduction in PICU admissions due to viral LRTIs over winter, during the COVID-19 pandemic in South America.</jats:p></jats:sec>
Scopus© Citations 59 1
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Coronavirus disease 2019 in patients with inborn errors of immunity: An international study
(2021)
Isabelle Meyts
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Giorgia Bucciol
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Isabella Quinti
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Bénédicte Neven
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Alain Fischer
Scopus© Citations 309 3
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Targeted high volume hemofiltration could avoid extracorporeal membrane oxygenation in some patients with severe Hantavirus cardiopulmonary syndrome
(2021)
LOPEZ HERNANDEZ, RENE RAMON
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Rodrigo Pérez‐Araos
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Álvaro Salazar
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Mauricio Espinoza
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Analia Cuiza
Scopus© Citations 10 1
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High Flow Nasal Cannula as Support in Immunocompromised Patients with Acute Respiratory Failure: A Retrospective Study
(2021)
Claudia Giugliano-Jaramillo
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Josefina León
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Cristobal Enriquez
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Juan E. Keymer
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Rodrigo Pérez-Araos
<jats:sec> <jats:title>Introduction:</jats:title> <jats:p>High Flow Nasal Cannula (HFNC) is a novel technique for respiratory support that improves oxygenation. In some patients, it may reduce the work of breathing. In immunocompromised patients with Acute Respiratory Failure (ARF), Non-Invasive Ventilation (NIV) is the main support recommended strategy, since invasive mechanical ventilation could increase mortality rates. NIV used for more than 48 hours may be associated with increased in-hospital mortality and hospital length of stay. Therefore HFNC seems like a respiratory support alternative.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective:</jats:title> <jats:p>To describe clinical outcomes of immunocompromised patients with ARF HFNC-supported.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>Retrospective study in patients admitted with ARF and HFNC-supported. 25 adult patients were included, 21 pharmacologically and 4 non- pharmacologically immunosuppressed. Median age of the patients was 64 [60-76] years, APACHE II 15 [11-19], and PaO2:FiO2 218 [165-248]. Demographic information, origin of immunosuppression, Respiratory Rate (RR), Heart Rate (HR), Mean Arterial Pressure (MAP), oxygen saturation (SpO<jats:sub>2</jats:sub>) and PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> ratio were extracted from clinical records of our HFNC local protocol. Data acquisition was performed before and after the first 24 hours of connection. In addition, the need for greater ventilatory support after HFNC, orotracheal intubation, in-hospital mortality and 90 days out-patients’ mortality was recorded.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Mean RR before the connection was 25±22 breaths/min and 22±4 breaths/min after the first 24 hours of HFNC use (95% CI; p=0.02). HR mean before connection to HFNC was 96±22 beats/min, and after, it was 86±15 beats/min (95%CI; p=0.008). Previous mean MAP was 86±15 mmHg, and after HFNC, it was 80±12 mmHg (95%CI; p=0.09); mean SpO<jats:sub>2</jats:sub> after was 93±5% and before it was 95±4% (95% CI; p=0.13); and previous PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> mean was 219±66, and after it was 324±110 (95%CI; p=0.52). In-hospital mortality was 28% and 90 days out-patients’ mortality was 32%.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>HFNC in immunosuppressed ARF subjects significantly decreases HR and RR, being apparently an effective alternative to decrease work of breathing. In-hospital mortality in ARF immunosuppressed patients was high even though respiratory support was used. Better studies are needed to define the role of HFNC-support in ARF.</jats:p> </jats:sec>
11
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Tracheostomy
(2019)
Macarena R. Vial
;
Joseph L. Nates
12
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A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection
(2020)
Pablo Cruces
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Jaime Retamal
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Daniel E. Hurtado
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Benjamín Erranz
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Pablo Iturrieta
<jats:title>Abstract</jats:title><jats:p>Deterioration of lung function during the first week of COVID-19 has been observed when patients remain with insufficient respiratory support. Patient self-inflicted lung injury (P-SILI) is theorized as the responsible, but there is not robust experimental and clinical data to support it. Given the limited understanding of P-SILI, we describe the physiological basis of P-SILI and we show experimental data to comprehend the role of regional strain and heterogeneity in lung injury due to increased work of breathing.</jats:p><jats:p>In addition, we discuss the current approach to respiratory support for COVID-19 under this point of view.</jats:p>
8Scopus© Citations 103

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