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Association of Ventilatory Ratio with Acute Cor Pulmonale and Mortality in COVID-19 ARDS: A Cohort Study
(SAGE Publications, 2025-09-08)
Martín H. Benites
;
Romina Battiato
;
Pablo Mercado
;
Ronald Pairumani
;
Juan Nicolás Medel
Purpose : An elevated ventilatory ratio (VR) and acute cor pulmonale (ACP) are associated with mortality in ARDS patients. The primary aim of this study was to assess the association between VR and ACP in patients with COVID-19-related ARDS (C-ARDS). The secondary objectives were to analyze the association between VR and ICU mortality, describe VR temporal behavior in survivors and non-survivors, and evaluate the association between VR and pulmonary embolism. Materials and Methods : We studied a cohort of patients with C-ARDS. The VR was calculated using a validated formula. Echocardiography was used to diagnose ACP, and CT pulmonary angiography was performed to identify PE. To evaluate the associations between VR and ACP, mortality, and PE, a generalized logistic regression model was used. Results : Of the 140 subjects, 60 (43%) had a VR < 2, while 80 (57%) had a VR >= 2. Patients with a VR >= 2 had a higher risk of developing ACP than those with a VR <2 (Odds Ratio (OR), 3.77; 95% CI: 1.30 - 8.72). The ICU mortality rate was 29%. Of the 40 patients who died, 30 (75%) had a VR >= 2. Mortality was significantly associated with VR >= 2 and driving pressure >= 15 cm H2O. In non-survivor patients with a VR < 2 at ICU admission, a significant increase in VR was observed over the 7-day observation period. No significant association was observed between PE and VR (p = .118). Conclusion : Elevated VR was associated with ACP in patients with C-ARDS. VR >= 2 combined with driving pressure >= 15 cm H2O significantly improved the ability to identify patients at risk for ACP. Additionally, at ICU admission, elevated VR values and initially low values that increased over the first week were associated with higher ICU mortality.
Scopus© Citations 1 1
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Progression of regional lung strain and heterogeneity in lung injury: assessing the evolution under spontaneous breathing and mechanical ventilation
(2020)
Daniel E. Hurtado
;
Benjamín Erranz
;
Felipe Lillo
;
Mauricio Sarabia-Vallejos
;
Pablo Iturrieta
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Protective mechanical ventilation (MV) aims at limiting global lung deformation and has been associated with better clinical outcomes in acute respiratory distress syndrome (ARDS) patients. In ARDS lungs without MV support, the mechanisms and evolution of lung tissue deformation remain understudied. In this work, we quantify the progression and heterogeneity of regional strain in injured lungs under spontaneous breathing and under MV.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Lung injury was induced by lung lavage in murine subjects, followed by 3 h of spontaneous breathing (SB-group) or 3 h of low <jats:italic>V</jats:italic><jats:sub>t</jats:sub> mechanical ventilation (MV-group). Micro-CT images were acquired in all subjects at the beginning and at the end of the ventilation stage following induction of lung injury. Regional strain, strain progression and strain heterogeneity were computed from image-based biomechanical analysis. Three-dimensional regional strain maps were constructed, from which a region-of-interest (ROI) analysis was performed for the regional strain, the strain progression, and the strain heterogeneity.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>After 3 h of ventilation, regional strain levels were significantly higher in 43.7% of the ROIs in the SB-group. Significant increase in regional strain was found in 1.2% of the ROIs in the MV-group. Progression of regional strain was found in 100% of the ROIs in the SB-group, whereas the MV-group displayed strain progression in 1.2% of the ROIs. Progression in regional strain heterogeneity was found in 23.4% of the ROIs in the SB-group, while the MV-group resulted in 4.7% of the ROIs showing significant changes. Deformation progression is concurrent with an increase of non-aerated compartment in SB-group (from 13.3% ± 1.6% to 37.5% ± 3.1%), being higher in ventral regions of the lung.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Spontaneous breathing in lung injury promotes regional strain and strain heterogeneity progression. In contrast, low <jats:italic>V</jats:italic><jats:sub>t</jats:sub> MV prevents regional strain and heterogeneity progression in injured lungs.</jats:p> </jats:sec>
Scopus© Citations 43 1
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Cardiac function in critically ill patients with severe COVID: A prospective cross-sectional study in mechanically ventilated patients
(2022)
Emilio Daniel Valenzuela
;
Pablo Mercado
;
Ronald Pairumani
;
Juan Nicolás Medel
;
Edward Petruska
Scopus© Citations 6 64
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Critical care echocardiography in prone position patients during COVID-19 pandemic: a feasibility study
(2022)
Diego Ugalde
;
Juan Nicolas Medel
;
Pablo Mercado
;
Ronald Pairumani
;
Daniela Eisen
Scopus© Citations 5 1
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Risk Factors for Adult Depression: Adverse Childhood Experiences and Personality Functioning
(2020)
Paula Dagnino
;
María José Ugarte
;
Felipe Morales
;
Sofia González
;
Daniela Saralegui Fernández
<jats:p><jats:bold>Background:</jats:bold> Depressive disorder is one of the main health problems worldwide. Many risk factors have been associated with this pathology. However, while the association between risks factors and adult depression is well established, the mechanisms behind its impact remains poorly understood. A possible, yet untested explanation is the mediating impact of levels of personality functioning, i.e., impairments with regard to self and interpersonal.</jats:p><jats:p><jats:bold>Method:</jats:bold> Around 162 patients were assessed at the beginning of their therapy, with regard to risk factors, such as sociodemographic, physical, hereditary (Information Form), and adverse childhood experiences (ACE; CTQ). Depressive symptoms (Beck Depression Inventory, BDI) and personality functioning (OPD-SQ) were also measured. Associations between the related variables as well as other possible covariates were examined by means of zero-order correlations and bootstrapping-based mediation analysis.</jats:p><jats:p><jats:bold>Results:</jats:bold> Of all the risk factors taken into account, level of education and physical illness were associated with depression. On the other hand, the most significant predictor of depressive symptomatology was ACE, and this relationship was mediated by personality functioning. This indicates that patients presenting adverse childhood experiences are more likely to develop deficiencies in personality functioning, which in turn increases their likelihood of developing depressive symptomatology.</jats:p><jats:p><jats:bold>Conclusion:</jats:bold> These results reaffirm the importance of incorporating risk and vulnerability factors such as personality functioning in understanding depression.</jats:p>
Scopus© Citations 53 1
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Mapping regional strain in anesthetised healthy subjects during spontaneous ventilation
(2019)
Pablo Cruces
;
Benjamín Erranz
;
Felipe Lillo
;
Mauricio A Sarabia-Vallejos
;
Pablo Iturrieta
<jats:sec><jats:title>Introduction</jats:title><jats:p>Breathing produces a phenomenon of cyclic deformation throughout life. Biomechanically, deformation of the lung is measured as strain. Regional strain recently started to be recognised as a tool in the study of lung pathophysiology, but regional lung strain has not been studied in healthy subjects breathing spontaneously without voluntary or pharmacological control of ventilation. Our aim is to generate three-dimensional (3D) regional strain and heterogeneity maps of healthy rat lungs and describe their changes over time.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Micro-CT and image-based biomechanical analysis by finite element approach were carried out in six anaesthetised rats under spontaneous breathing in two different states, at the beginning of the experiment and after 3 hours of observation. 3D regional strain maps were constructed and divided into 10 isovolumetric region-of-interest (ROI) in three directions (apex to base, dorsal to ventral and costal to mediastinal), allowing to regionally analyse the volumetric strain, the strain progression and the strain heterogeneity. To describe in depth these parameters, and systematise their report, we defined <jats:italic>regional strain heterogeneity index</jats:italic> [1+strain SD ROI(x)]/[1+strain mean ROI(x)] and <jats:italic>regional strain progression index</jats:italic> [ROI(x)−mean of final strain/ROI(x)−mean of initial strain].</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We were able to generate 3D regional strain maps of the lung in subjects without respiratory support, showing significant differences among the three analysed axes. We observed a significantly lower regional volumetric strain in the apex sector compared with the base, with no significant anatomical systematic differences in the other directions. This heterogeneity could not be identified with physiological or standard CT methods. There was no progression of the analysed regional volumetric strain when the two time-points were compared.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>It is possible to map the regional volumetric strain in the lung for healthy subjects during spontaneous breathing. Regional strain heterogeneity and changes over time can be measured using a CT image-based numerical analysis applying a finite element approach. These results support that healthy lung might have significant regional strain and its spatial distribution is highly heterogeneous. This protocol for CT image acquisition and analysis could be a useful tool for helping to understand the mechanobiology of the lung in many diseases.</jats:p></jats:sec>
Scopus© Citations 11 3

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