GRAF SANTOS, JERÓNIMO
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GRAF SANTOS, JERÓNIMO
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jgraf@udd.cl
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7102778326

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2024 2024 2023 2023 2022 2022 2021 2021 2020 2020 2019 2019 2018 2018 2017 2017 2016 2016 2015 2015 0.0 0.0 1.0 1.0 2.0 2.0 3.0 3.0 4.0 4.0 5.0 5.0

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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 , Aldo Barrera , Carlos Palma , Gonzalo Barriga Pinto , Analia Cuiza , Leonila Ferreira , María Luisa Rioseco , Mario Calvo , Ricardo Fritz , Sebastián Bravo , Alejandro Bruhn , Jerónimo Graf , Alvaro Llancaqueo , Gonzalo Rivera , Carolina Cerda , Nicole Tischler , Francisca Valdivieso , VIAL CLARO, PABLO AGUSTIN , Gregory Mertz , VIAL COX, MARIA CECILIA , Nicole Le Corre

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Transpulmonary pressure targets for open lung and protective ventilation: one size does not fit all

2012 , GRAF SANTOS, JERÓNIMO

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Comment on Tusman et al.: Validation of Bohr dead space measured by volumetric capnography

2011 , GRAF SANTOS, JERÓNIMO

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Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution

2019 , LOPEZ HERNANDEZ, RENE RAMON , Rodrigo Pérez-Araos , Álvaro Salazar , Ana L. Ulloa , VIAL COX, MARIA CECILIA , VIAL CLARO, PABLO AGUSTIN , GRAF SANTOS, JERÓNIMO

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.

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Extracorporeal Membrane Oxygenation for COVID-19–associated Severe Acute Respiratory Distress Syndrome in Chile: A Nationwide Incidence and Cohort Study

2021 , Rodrigo A. Diaz , GRAF SANTOS, JERÓNIMO , José M. Zambrano , Carolina Ruiz , Juan A. Espinoza , Sebastian I. Bravo , Pablo A. Salazar , Juan C. Bahamondes , Luis B. Castillo , Abraham I. J. Gajardo , Andrés Kursbaum , Leonila L. Ferreira , Josefa Valenzuela , Roberto E. Castillo , Rodrigo A. Pérez-Araos , Marcela Bravo , Andrés F. Aquevedo , Mauricio G. González , Rodrigo Pereira , Leandro Ortega , César Santis , Paula A. Fernández , Vilma Cortés , Rodrigo A. Cornejo

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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 , Rodrigo Pérez‐Araos , Álvaro Salazar , Mauricio Espinoza , Analia Cuiza , VIAL COX, MARIA CECILIA , VIAL CLARO, PABLO AGUSTIN , GRAF SANTOS, JERÓNIMO

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Increased respiratory dead space could associate with coagulation activation and poor outcomes in COVID-19 ARDS

2022 , GRAF SANTOS, JERÓNIMO , Rodrigo Pérez , René López

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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 , Romyna Baghetti , Anita Irarrázaval , César Santis , Nicolás Pavez , Sofía Leighton , Vinko Tomicic , Daniel Morales , Carolina Ruiz , Pablo Navarrete , Patricio Vargas , Roberto Gálvez , Victoria Espinosa , Marioli Lazo , Rodrigo A. Pérez-Araos , Osvaldo Garay , Patrick Sepúlveda , Edgardo Martinez , Alejandro Bruhn , Nicole Rossel , María José Martin , Juan Nicolás Medel , Vanessa Oviedo , Magdalena Vera , Vicente Torres , José Miguel Montes , Álvaro Salazar , Carla Muñoz , Francisca Tala , Mariana Migueles , Claudia Ortiz , Felipe Gómez , Luis Contreras , Itzia Daviu , Yurimar Rodriguez , Carol Ortiz , Andrés Aquevedo , Rodrigo Parada , Cristián Vargas , Miguel Gatica , Dalia Guerrero , Araceli Valenzuela , Diego Torrejón

Abstract Background 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. Methods 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 PaO2:FiO2 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, > 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety. Results 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 PaO2:FiO2 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. Conclusions 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.

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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 , GRAF SANTOS, JERÓNIMO

Objectives: 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. Data Sources: Eight electronic databases were searched from inception to February 2021, using a predefined search strategy. Study Selection: 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. Data Extraction: Four physiotherapists extracted relevant information using a prespecified template. Data Synthesis: 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 (n = 11) and assist-control (n = 9). Adjustment of variables and modes were identified in only seven documents (20%). The most frequent respiratory variable was the Fio 2, 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 (n = 21) or safety (n = 13). Monitored variables were mostly respiratory rate (n = 26), pulse oximetry (n = 22), and oxygen consumption (n = 9). Remarkably, no study assessed the work of breathing or effort during mobilization. Conclusions: 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.

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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 , Alvaro Salazar , Jeronimo Graf

PURPOSE 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. PATIENTS AND METHODS 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. RESULTS 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. CONCLUSION 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.

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