GRAF SANTOS, JERÓNIMO

Preferred name
GRAF SANTOS, JERÓNIMO
Main Affiliation
Email
jgraf@udd.cl
ORCID
0000-0001-5657-7616
Scopus Author ID
7102778326

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    Survival of Critically Ill Oncologic Patients Requiring Invasive Ventilatory Support: A Prospective Comparative Cohort Study With Nononcologic Patients
    (2019)
    Rene López  
    ;
    Suraj Rajesh Samtani
    ;
    Jose Miguel Montes
    ;
    PEREZ ARAOS, RODRIGO ALEJANDRO  
    ;
    Maria Jose Martin
    <jats:sec><jats:title>PURPOSE</jats:title><jats:p> Cancer is in the process of changing to become a chronic disease; therefore, an increasing number of oncologic patients (OPs) are being admitted to intensive care units (ICUs) for supportive care of disease or therapy-related complications. We compare the short- and long-term outcomes of critically ill mechanically ventilated OPs with those of their nononcologic counterparts. </jats:p></jats:sec><jats:sec><jats:title>PATIENTS AND METHODS</jats:title><jats:p> We performed a prospective study of patients admitted to our ICU between October 2017 and February 2019. Demographic, physiologic, laboratory, clinical, and treatment data were obtained. The primary outcome was survival at 28 days and at the end of the follow-up period. Secondary outcomes were survival according to acute severity scoring (Acute Physiology and Chronic Health Evaluation II score), Eastern Cooperative Oncology Group (ECOG) performance status, and Charlson comorbidity index. </jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p> A total of 1,490 patients were admitted during the study period; 358 patients (24%) were OPs, and 100 of these OPs were supported with mechanical ventilation. Seventy-three percent of OPs had an ECOG performances status of 0 or 1, and 90% had solid tumors. Reason for admission to the ICU was postoperative admission in 44 patients and neutropenic infection in 10 patients. The follow-up period was 148 days (range, 42 to 363 days). Survival at 28 days was similar between OPs and nononcologic patients and associated with the Acute Physiology and Chronic Health Evaluation II score. However, long-term survival was lower in OPs compared with nononcologic patients (52% v 76%, respectively; P &lt; .001) and associated with poor ECOG performance status. </jats:p></jats:sec><jats:sec><jats:title>CONCLUSION</jats:title><jats:p> Short-term survival of critically ill, mechanically ventilated OPs is similar to that of their nononcologic counterparts and is determined by the severity of the critical illness. </jats:p></jats:sec>
    Scopus© Citations 2  2
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      9Scopus© Citations 9
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    Respiratory Support Adjustments and Monitoring of Mechanically Ventilated Patients Performing Early Mobilization: A Scoping Review
    (2021)
    GONZALEZ SEGUEL, FELIPE ANDRES  
    ;
    CAMUS MOLINA, AGUSTIN  
    ;
    Anita Jasmén
    ;
    Jorge Molina
    ;
    PEREZ ARAOS, RODRIGO ALEJANDRO  
    <jats:sec> <jats:title>Objectives:</jats:title> <jats:p>This scoping review is aimed to summarize current knowledge on respiratory support adjustments and monitoring of metabolic and respiratory variables in mechanically ventilated adult patients performing early mobilization.</jats:p> </jats:sec> <jats:sec> <jats:title>Data Sources:</jats:title> <jats:p>Eight electronic databases were searched from inception to February 2021, using a predefined search strategy.</jats:p> </jats:sec> <jats:sec> <jats:title>Study Selection:</jats:title> <jats:p>Two blinded reviewers performed document selection by title, abstract, and full text according to the following criteria: mechanically ventilated adult patients performing any mobilization intervention, respiratory support adjustments, and/or monitoring of metabolic/respiratory real-time variables.</jats:p> </jats:sec> <jats:sec> <jats:title>Data Extraction:</jats:title> <jats:p>Four physiotherapists extracted relevant information using a prespecified template.</jats:p> </jats:sec> <jats:sec> <jats:title>Data Synthesis:</jats:title> <jats:p>From 1,208 references screened, 35 documents were selected for analysis, where 20 (57%) were published between 2016 and 2020. Respiratory support settings (ventilatory modes or respiratory variables) were reported in 21 documents (60%). Reported modes were assisted (<jats:italic toggle="yes">n</jats:italic> = 11) and assist-control (<jats:italic toggle="yes">n</jats:italic> = 9). Adjustment of variables and modes were identified in only seven documents (20%). The most frequent respiratory variable was the F<jats:sc>io</jats:sc> <jats:sub>2</jats:sub>, and only four studies modified the level of ventilatory support. Mechanical ventilator brand/model used was not specified in 26 documents (74%). Monitoring of respiratory, metabolic, and both variables were reported in 22 documents (63%), four documents (11%) and 10 documents (29%), respectively. These variables were reported to assess the physiologic response (<jats:italic toggle="yes">n</jats:italic> = 21) or safety (<jats:italic toggle="yes">n</jats:italic> = 13). Monitored variables were mostly respiratory rate (<jats:italic toggle="yes">n</jats:italic> = 26), pulse oximetry (<jats:italic toggle="yes">n</jats:italic> = 22), and oxygen consumption (<jats:italic toggle="yes">n</jats:italic> = 9). Remarkably, no study assessed the work of breathing or effort during mobilization.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Little information on respiratory support adjustments during mobilization of mechanically ventilated patients was identified. Monitoring of metabolic and respiratory variables is also scant. More studies on the effects of adjustments of the level/mode of ventilatory support on exercise performance and respiratory muscle activity monitoring for safe and efficient implementation of early mobilization in mechanically ventilated patients are needed.</jats:p> </jats:sec>
    Scopus© Citations 9  2
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    Viral shedding and viraemia of Andes virus during acute hantavirus infection: a prospective study
    (2024)
    Marcela Ferrés
    ;
    Constanza Martínez-Valdebenito
    ;
    Carolina Henriquez
    ;
    Claudia Marco
    ;
    Jenniffer Angulo
      10Scopus© Citations 29
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    Association between phase angle and daily creatinine excretion changes in critically ill patients: an approach to muscle mass
    (Frontiers Media SA, 2025-01-07)
    Patricio Vargas-Errázuriz
    ;
    Natalia Dreyse
    ;
    LOPEZ HERNANDEZ, RENE RAMON  
    ;
    Marcelo Cano-Cappellacci
    ;
    Julia Guerrero
    Assessing muscle mass in critically ill patients remains challenging. This retrospective cohort study explores the potential of phase angle (PA°) derived from bioelectrical impedance analysis (BIA) as a surrogate marker for muscle mass monitoring by associating it with daily creatinine excretion (DCE), a structural and metabolic muscle mass marker. In 20 ICU patients, we observed a linear relationship between PA° and DCE at initial (S1) and follow-up (S2) points, with Rho values of 0.78 and 0.65, respectively, as well as between their percentage changes (Rho = 0.80). Multivariate analysis confirmed a strong association between changes in PA° and DCE (adjusted R<jats:sup>2</jats:sup> of 0.73), while changes in the extracellular water to total body water (ECW/TBW) ratio showed no significant association. This study establishes a relationship between a BIA-derived independent-weight parameter and DCE, highlighting the potential of PA° for muscle mass monitoring during acute changes, such as those seen in ICU settings. Integrating PA° into clinical practice could provide a non-invasive and reliable tool to enhance muscle assessment and support targeted interventions in critically ill patients.
    Scopus© Citations 1  1
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    Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile
    (2022)
    Rodrigo A. Cornejo
    ;
    Jorge Montoya
    ;
    Abraham I. J. Gajardo
    ;
    GRAF SANTOS, JERÓNIMO  
    ;
    Leyla Alegría
    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Prone positioning is currently applied in time-limited daily sessions up to 24 h which determines that most patients require several sessions. Although longer prone sessions have been reported, there is scarce evidence about the feasibility and safety of such approach. We analyzed feasibility and safety of a continuous prolonged prone positioning strategy implemented nationwide, in a large cohort of COVID-19 patients in Chile.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective cohort study of mechanically ventilated COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted in 15 Intensive Care Units, which adhered to a national protocol of continuous prone sessions  ≥ 48 h and until PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> increased above 200 mm Hg. The number and extension of prone sessions were registered, along with relevant physiologic data and adverse events related to prone positioning. The cohort was stratified according to the first prone session duration: Group A, 2–3 days; Group B, 4–5 days; and Group C, &gt; 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>We included 417 patients who required a first prone session of 4 (3–5) days, of whom 318 (76.3%) received only one session. During the first prone session the main adverse event was grade 1–2 pressure sores in 97 (23.9%) patients; severe adverse events were infrequent with 17 non-scheduled extubations (4.2%). 90-day mortality was 36.2%. Ninety-eight patients (24%) were classified as group C; they exhibited a more severe ARDS at baseline, as reflected by lower PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> ratio and higher ventilatory ratio, and had a higher rate of pressure sores (44%) and higher 90-day mortality (48%). However, after adjustment for severity and several relevant confounders, prone session duration was not associated with mortality or pressure sores.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Nationwide implementation of a continuous prolonged prone positioning strategy for COVID-19 ARDS patients was feasible. Minor pressure sores were frequent but within the ranges previously described, while severe adverse events were infrequent. The duration of prone session did not have an adverse effect on safety.</jats:p> </jats:sec>
    Scopus© Citations 17  1
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    Intrathoracic blood volume versus pulmonary artery occlusion pressure as estimators of cardiac preload in critically ill patients
    (2005-01-01)
    Tomicic F, Vinko
    ;
    GRAF SANTOS, JERÓNIMO  
    ;
    Echevarría O, Ghislaine
    ;
    Espinoza R, Mauricio
    ;
    Abarca Z, Juan
    Background: Monitoring of cardiac preload by determination of pulmonary artery occlusion pressure (PAOP) has been traditionally used to guide fluid therapy to optimize cardiac output (CO). Since factors such as intrathoracic pressure and ventricular compliance may modify PAOP, volumetric estimators of preload have been developed. The PiCCO system is able to measure CO and intrathoracic blood volume (ITBV) by transpulmonary thermodilution. Aim: To compare a volumetric (ITBV) versus a pressure (PAOP) determination to accurately estimate cardiac preload in severely ill patients. Patients and Methods: From June 2001 to October 2003, 22 mechanically ventilated patients with hemodynamic instability underwent hemodynamic monitoring with pulmonary artery catheter (PAC) and PiCCO system. ITBV index (ITBVI), PAOP and CI were measured simultaneously by both methods. One hundred thirty eight deltas (Δ) were obtained from the difference of ITBVI, PAOP, CI-PAC and CI-PiCCO between 6-12 am and 6-12 pm. Linear regression analysis of Δ ITBVI versus Δ CI-PiCCO and Δ PAOP versus Δ CI-PAC were made. Results: Mean age of patients was 60.8 ± 19.4 years. APACHE II was 23.9 ± 7. Fifteen patients met criteria for acute respiratory distress syndrome (ARDS). Delta ITBVI significantly correlated with Δ CI-PiCCO (r=0.54; 95% confidence interval = 0.41-0.65; p <0.01). There was no correlation between Δ PAOP and Δ CI-PAC. Conclusion: ITBVI correlated better with CI than PAOP, and therefore it seems to be a more accurate estimator of preload in unstable, mechanically ventilated patients.
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    A non-randomized multicentre trial of human immune plasma for treatment of hantavirus cardiopulmonary syndrome caused by Andes virus
    (2015)
    VIAL CLARO, PABLO AGUSTIN  
    ;
    Francisca Valdivieso
    ;
    Mario Calvo
    ;
    M Luisa Rioseco
    ;
    Raul Riquelme
    <jats:sec><jats:title>Background</jats:title><jats:p> In Chile, Andes virus (ANDV) is the sole aetiological agent of hantavirus cardiopulmonary syndrome (HCPS) with mean annual incidence of 55 cases, 32% case fatality rate (CFR) and no specific treatment. Neutralizing antibody (NAb) titres at hospital admission correlate inversely with HCPS severity. We designed an open trial to explore safety and efficacy and evaluate pharmacokinetics of immune plasma as a treatment strategy for this disease. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We performed plasmapheresis on donors at least 6 months after HCPS and measured NAb titres through a focus-reduction neutralization test. Subjects admitted to 10 study sites with suspected/confirmed HCPS were eligible for treatment with immune plasma by intravenous infusion at an ANDV NAb dose of 5,000 U/kg. HCPS was confirmed through immunoglobulin M serology or reverse transcriptase-PCR. The main outcome was mortality within 30 days. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> From 2008–2012, we enrolled and treated 32 cases and confirmed HCPS in 29. CFR of hantavirus plasma-treated cases was 4/29 (14%); CFR of non-treated cases in the same period in Chile was 63/199 (32%; P=0.049, OR=0.35, CI=0.12, 0.99); CFR of non-treated cases at the same study sites between 2005–2012 was 18/66 (27%; ( P=0.15, OR=0.43, CI=0.14, 1.34) and CFR in a previous methylprednisolone treatment study was 20/60 (33%; P=0.052, OR=0.32, CI=0.10, 1.00). We detected no serious adverse events associated to plasma infusion. Plasma NAb titres reached in recipients were variable and viral load remained stable. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Human ANDV immune plasma infusion appears safe for HCPS. We observed a decrease in CFR in treated cases with borderline significance that will require further studies for confirmation. </jats:p></jats:sec>
    Scopus© Citations 56  2