CRIS

Permanent URI for this communityhttps://investigadores.udd.cl/handle/123456789/1

Browse

Search Results

Now showing 1 - 8 of 8

Some of the metrics are blocked by your
consent settings
Driving Pressure and Normalized Energy Transmission Calculations in Mechanically Ventilated Children Without Lung Disease and Pediatric Acute Respiratory Distress Syndrome*
(2021)
Franco Díaz
;
Sebastián González-Dambrauskas
;
Federico Cristiani
;
Daniel R. Casanova
;
Pablo Cruces
Scopus© Citations 21 15
Some of the metrics are blocked by your
consent settings
Effect of positive end-expiratory pressure on lung injury and haemodynamics during experimental acute respiratory distress syndrome treated with extracorporeal membrane oxygenation and near-apnoeic ventilation
(2021)
Joaquin Araos
;
Leyla Alegria
;
Aline Garcia
;
Pablo Cruces
;
Dagoberto Soto
Scopus© Citations 11 1
Some of the metrics are blocked by your
consent settings
Successful use of mild therapeutic hypothermia as compassionate treatment for severe refractory hypoxemia in COVID-19
(2021)
Pablo Cruces
;
Camila Cores
;
Daniel Casanova
;
Federico Pizarro
;
Franco Díaz
2Scopus© Citations 13
Some of the metrics are blocked by your
consent settings
Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis
(2020)
Jesús Alberto Serra
;
Sebastián González-Dambrauskas
;
Pablo Vásquez Hoyos
;
CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL
;
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
Some of the metrics are blocked by your
consent settings
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
Some of the metrics are blocked by your
consent settings
Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study
(2022)
Anoopindar K. Bhalla
;
Margaret J. Klein
;
Vicent Modesto I Alapont
;
Guillaume Emeriaud
;
Martin C. J. Kneyber
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Mechanical power is a composite variable for energy transmitted to the respiratory system over time that may better capture risk for ventilator-induced lung injury than individual ventilator management components. We sought to evaluate if mechanical ventilation management with a high mechanical power is associated with fewer ventilator-free days (VFD) in children with pediatric acute respiratory distress syndrome (PARDS).</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective analysis of a prospective observational international cohort study.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>There were 306 children from 55 pediatric intensive care units included. High mechanical power was associated with younger age, higher oxygenation index, a comorbid condition of bronchopulmonary dysplasia, higher tidal volume, higher delta pressure (peak inspiratory pressure—positive end-expiratory pressure), and higher respiratory rate. Higher mechanical power was associated with fewer 28-day VFD after controlling for confounding variables (per 0.1 J·min<jats:sup>−1</jats:sup>·Kg<jats:sup>−1</jats:sup> Subdistribution Hazard Ratio (SHR) 0.93 (0.87, 0.98), <jats:italic>p</jats:italic> = 0.013). Higher mechanical power was not associated with higher intensive care unit mortality in multivariable analysis in the entire cohort (per 0.1 J·min<jats:sup>−1</jats:sup>·Kg<jats:sup>−1</jats:sup> OR 1.12 [0.94, 1.32], <jats:italic>p</jats:italic> = 0.20). But was associated with higher mortality when excluding children who died due to neurologic reasons (per 0.1 J·min<jats:sup>−1</jats:sup>·Kg<jats:sup>−1</jats:sup> OR 1.22 [1.01, 1.46], <jats:italic>p</jats:italic> = 0.036). In subgroup analyses by age, the association between higher mechanical power and fewer 28-day VFD remained only in children < 2-years-old (per 0.1 J·min<jats:sup>−1</jats:sup>·Kg<jats:sup>−1</jats:sup> SHR 0.89 (0.82, 0.96), <jats:italic>p</jats:italic> = 0.005). Younger children were managed with lower tidal volume, higher delta pressure, higher respiratory rate, lower positive end-expiratory pressure, and higher PCO<jats:sub>2</jats:sub> than older children. No individual ventilator management component mediated the effect of mechanical power on 28-day VFD.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Higher mechanical power is associated with fewer 28-day VFDs in children with PARDS. This association is strongest in children < 2-years-old in whom there are notable differences in mechanical ventilation management. While further validation is needed, these data highlight that ventilator management is associated with outcome in children with PARDS, and there may be subgroups of children with higher potential benefit from strategies to improve lung-protective ventilation.</jats:p> <jats:p><jats:bold>Take Home Message</jats:bold>: Higher mechanical power is associated with fewer 28-day ventilator-free days in children with pediatric acute respiratory distress syndrome. This association is strongest in children <2-years-old in whom there are notable differences in mechanical ventilation management.</jats:p> </jats:sec>
7Scopus© Citations 23
Some of the metrics are blocked by your
consent settings
A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection
(2020)
Pablo Cruces
;
Jaime Retamal
;
Daniel E. Hurtado
;
Benjamín Erranz
;
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
Some of the metrics are blocked by your
consent settings
Near-Apneic Ventilation Decreases Lung Injury and Fibroproliferation in an ARDS Model with ECMO
(2019)
Joaquin Araos
;
Leyla Alegria
;
Patricio Garcia
;
Pablo Cruces
;
Dagoberto Soto
13Scopus© Citations 96

CRIS

Browse

Filters

Settings

Sort By

Results per page

Search Results