LOPEZ HERNANDEZ, RENE RAMON

Preferred name

Main Affiliation

Facultad de Medicina Clínica Alemana Universidad del Desarrollo

lrene@udd.cl

ORCID

0000-0003-4026-6367

Scopus Author ID

57194425118

Now showing 1 - 10 of 21

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Dataset - Hantavirus cardiopulmonary syndrome: organ support requirements and outcomes from a national Chilean cohort
(FONASA, 2026)
GABRIELA CONSTANZA ANDREA MEZA FUENTES
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DELGADO BECERRA, OROZIMBA IRIS
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VIAL CLARO, PABLO AGUSTIN
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LOPEZ HERNANDEZ, RENE RAMON
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Switching Stable Kidney Transplant Recipients to a Generic Tacrolimus Is Feasible and Safe, but It Must Be Monitored
(2017)
Fernando González
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Elizabeth Arriagada
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René López
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René Carrasco
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NATALIA BERNARDITA GALLARDO CHAPARRO
<jats:p><jats:italic>Background</jats:italic>. Tacrolimus is the primary immunosuppressive drug used in kidney transplant patients. Replacing brand name products with generics is a controversial issue that we studied after a Chilean Ministry of Health mandate to implement such a switch.<jats:italic>Methods</jats:italic>. Forty-one stable Prograf (Astellas) receiving kidney transplant patients were switched to a generic tacrolimus (Sandoz) in a 1 : 1 dose ratio and were followed up for up to 8 months. All other drugs were maintained as per normal practice.<jats:italic>Results</jats:italic>. Neither tacrolimus doses nor their trough blood levels changed significantly after the switch, but serum creatinine did:<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mn fontstyle="italic">1.62</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">0.90</mml:mn></mml:math>versus<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mn fontstyle="italic">1.75</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">0.92</mml:mn></mml:math> mg/dL (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mi>p</mml:mi><mml:mo><</mml:mo><mml:mn fontstyle="italic">0.001</mml:mn></mml:math>). At the same time, five graft biopsies were performed, and two of them showed cellular acute rejection. There were nine infectious episodes treated satisfactorily with proper therapies. No patient or graft was lost during the follow-up time period.<jats:italic>Conclusion</jats:italic>. Switching from brand name tacrolimus to a generic tacrolimus (Sandoz) is feasible and appears to be safe, but it must be monitored carefully by treating physicians.</jats:p>
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Critical care management of hantavirus cardiopulmonary syndrome. A narrative review
(2024)
Rodrigo Ulloa-Morrison
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Nicolas Pavez
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Esteban Parra
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LOPEZ HERNANDEZ, RENE RAMON
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Roberto Mondaca
Scopus© Citations 14 20
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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
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Suraj Rajesh Samtani
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Jose Miguel Montes
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PEREZ ARAOS, RODRIGO ALEJANDRO
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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 < .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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Fluid removal improves muscle performance and weakness in critically ill patients: a pilot study
(Springer Science and Business Media LLC, 2025-11-24)
Nicolás Arancibia
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LOPEZ HERNANDEZ, RENE RAMON
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Fluid overload in critically ill patients has been associated with muscle edema, decreased tissue quality, and the development of intensive care unit-acquired weakness (ICU-AW). Continuous renal replacement therapy (CRRT) with ultrafiltration (UF) contributes to removing excess extracellular fluid. This study aimed to evaluate whether UF is associated with changes in muscle ultrasound parameters and strength in critically ill patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Critically ill patients with resolved hypoperfusion undergoing CRRT with fluid removal via UF were prospectively enrolled and compared with a control group without UF. Muscle ultrasound assessments included rectus femoris and vastus intermedius thickness, echogenicity, and subcutaneous tissue. Global muscle strength was assessed using the Medical Research Council Sum Score (MRC-SS). Assessments were performed at CRRT initiation (T1) and again 36 h later (T2).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p> Twenty-eight patients were enrolled, 18 in the UF group and 10 patients in the control group. All ultrasonographic variables measured were different between the UF and control groups. In the UF group, median rectus femoris thickness decreased from 1.74 to 1.57 cm ( <jats:italic>p</jats:italic> = 0.03), vastus intermedius from 1.14 to 0.95 cm ( <jats:italic>p</jats:italic> < 0.01), echogenicity from 91.7 to 78.3 grayscale units ( <jats:italic>p</jats:italic> < 0.01), and subcutaneous tissue thickness from 1.98 to 1.79 cm ( <jats:italic>p</jats:italic> < 0.01). MRC-SS increased from 45.0 to 49.0 points ( <jats:italic>p</jats:italic> = 0.05). A positive correlation was found between UF volume (mL/kg) and MRC-SS at T2 ( <jats:italic>ρ</jats:italic> = 0.71, <jats:italic>p</jats:italic> < 0.01), and a negative correlation between UF volume and change in muscle echogenicity ( <jats:italic>ρ</jats:italic> = − 0.49, <jats:italic>p</jats:italic> = 0.039). ROC curve analysis identified that a UF volume ≥ 82 mL/kg was associated with MRC-SS > 48 points obtaining an AUC of 0.982 (95% CI: 0.928–1.000), sensitivity 92.9%, and specificity 100%. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Ultrafiltration was associated with changes in muscle echogenicity and subcutaneous tissue as well as an increase in MRC scoring at follow-up. These results suggest a potential relationship between fluid balance and muscle ultrasound parameters. No causal inferences can be drawn; therefore, further studies are needed.</jats:p> </jats:sec>
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Increased respiratory dead space could associate with coagulation activation and poor outcomes in COVID-19 ARDS
(2022)
GRAF SANTOS, JERÓNIMO
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Rodrigo Pérez
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René López
9Scopus© Citations 9
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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
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Natalia Dreyse
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LOPEZ HERNANDEZ, RENE RAMON
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Marcelo Cano-Cappellacci
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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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Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution
(2019)
LOPEZ HERNANDEZ, RENE RAMON
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Rodrigo Pérez-Araos
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Álvaro Salazar
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Ana L. Ulloa
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VIAL COX, MARIA CECILIA
<jats:p>Hantavirus cardiopulmonary syndrome (HCPS) is characterized by capillary leak, pulmonary edema (PE), and shock, which leads to death in up to 40% of patients. Treatment is supportive, including mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO). Hemodynamic monitoring is critical to titrate therapy and to decide ECMO support. Transpulmonary thermodilution (TPTD) provides hemodynamic and PE data that have not been systematically used to understand HCPS pathophysiology. We identified 11 HCPS patients monitored with TPTD: eight on MV, three required ECMO. We analyzed 133 measurements to describe the hemodynamic pattern and its association with PE. The main findings were reduced stroke volume, global ejection fraction (GEF), and preload parameters associated with increased extravascular lung water and pulmonary vascular permeability compatible with hypovolemia, myocardial dysfunction, and increased permeability PE. Lung water correlated positively with heart rate (HR, r = 0.20) and negatively with mean arterial pressure (r = −0.27) and GEF (r = −0.36), suggesting that PE is linked to hemodynamic impairment. Pulmonary vascular permeability correlated positively with HR (r = 0.31) and negatively with cardiac index (r = −0.49), end-diastolic volume (r = −0.48), and GEF (r = −0.40), suggesting that capillary leak contributes to hypovolemia and systolic dysfunction. In conclusion, TPTD data suggest that in HCPS patients, increased permeability leads to PE, hypovolemia, and circulatory impairment.</jats:p>
Scopus© Citations 7 1
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Platelet Count in Patients with Mild Disease at Admission is Associated with Progression to Severe Hantavirus Cardiopulmonary Syndrome
(2019)
LOPEZ HERNANDEZ, RENE RAMON
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Mario Calvo
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VIAL COX, MARIA CECILIA
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Marcela Ferrés
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GRAF SANTOS, JERÓNIMO
<jats:p>Background: Hantavirus cardiopulmonary syndrome (HCPS) has a mortality up to 35–40% and its treatment is mainly supportive. A variable to predict progression from mild to severe disease is unavailable. This study was performed in patients with documented infection by Andes orthohantavirus, and the aim was to find a simple variable to predict progression to moderate/severe HCPS in patients with mild disease at admission. Methods: We performed a retrospective analysis of 175 patients between 2001 and 2018. Patients were categorized into mild, moderate, and severe disease according to organ failure and advanced support need at hospital admission (e.g., mechanical ventilation, vasopressors). Progression to moderate/severe disease was defined accordingly. Clinical and laboratory variables associated with progression were explored. Results: Forty patients with mild disease were identified; 14 of them progressed to moderate/severe disease. Only platelet count was different between those who progressed versus those that did not (37 (34–58) vs. 83 (64–177) K/mm3, p < 0.001). A ROC curve analysis showed an AUC = 0.889 (0.78–1.0) p < 0.001, with a platelet count greater than 115K /mm3 ruling out progression to moderate/severe disease. Conclusions: In patients with mild disease at presentation, platelet count could help to define priority of evacuation to tertiary care centers.</jats:p>
Scopus© Citations 10 4
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Machine learning-based identification of efficient and restrictive physiological subphenotypes in acute respiratory distress syndrome
(Springer Science and Business Media LLC, 2025-03-01)
Gabriela Meza-Fuentes
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DELGADO BECERRA, OROZIMBA IRIS
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Mario Barbé
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Ignacio Sánchez
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RETAMAL LUCERO, MAURICIO ANTONIO
Acute respiratory distress syndrome (ARDS) is a severe condition with high morbidity and mortality, characterized by significant clinical heterogeneity. This heterogeneity complicates treatment selection and patient inclusion in clinical trials. Therefore, the objective of this study is to identify physiological subphenotypes of ARDS using machine learning, and to determine ventilatory variables that can effectively discriminate between these subphenotypes in a bedside setting with high performance, highlighting potential utility for future clinical stratification approaches.</jats:p> Methodology A retrospective cohort study was conducted using data from our ICU, covering admissions from 2017 to 2021. The study included 224 patients over 18 years of age diagnosed with ARDS according to the Berlin criteria and undergoing invasive mechanical ventilation (IMV). Data on physiological and ventilatory variables were collected during the first 24 h IMV. We applied machine learning techniques to categorize subphenotypes in ARDS patients. Initially, we employed the unsupervised Gaussian Mixture Classification Model approach to group patients into subphenotypes. Subsequently, we applied supervised models such as XGBoost to perform root cause analysis, evaluate the classification of patients into these subgroups, and measure their performance.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Our models identified two ARDS subphenotypes with significant clinical differences and significant outcomes. Subphenotype Efficient (<jats:italic>n</jats:italic> = 172) was characterized by lower mortality, lower clinical severity and presented a less restrictive pattern with better gas exchange compared to Subphenotype Restrictive (<jats:italic>n</jats:italic> = 52), which showed the opposite. The models demonstrated high performance with an area under the ROC curve of 0.94, sensitivity of 94.2% and specificity of 87.5%, in addition to an F1 score of 0.85. The most influential variables in the discrimination of subphenotypes were distension pressure, respiratory frequency and exhaled carbon dioxide volume.Conclusion This study presents an approach to improve subphenotype categorization in ARDS. The generation of clustering and prediction models by machine learning involving clinical, ventilatory mechanics, and gas exchange variables allowed for more accurate stratification of patients. These findings have the potential to optimize individualized treatment selection and improve clinical outcomes in patients with ARDS.</jats:p> Graphical Abstract
Scopus© Citations 2 5

LOPEZ HERNANDEZ, RENE RAMON

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