GONZALEZ SEGUEL, FELIPE ANDRES

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GONZALEZ SEGUEL, FELIPE ANDRES
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fgonzalez@udd.cl
ORCID
0000-0001-9099-2389
Scopus Author ID
57209215584
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    Scopus© Citations 24  2
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    Muscle Dysfunction and Physical Recovery After Critical Illness
    (SAGE Publications, 2025-02-04)
    Matthew F. Mart
    ;
    Joshua I. Gordon
    ;
    GONZALEZ SEGUEL, FELIPE ANDRES  
    ;
    Kirby P. Mayer
    ;
    Nathan Brummel
    During critical illness, patients experience significant and rapid onsets of muscle wasting and dysfunction with loss of strength, mass, and power. These deficits often persist long after the ICU, leading to impairments in physical function including reduced exercise capacity and increased frailty and disability. While there are numerous studies describing the epidemiology of impaired muscle and physical function in the ICU, there are significantly fewer data investigating mechanisms of prolonged and persistent impairments in ICU survivors. Additionally, while several potential clinical risk factors associated with poor physical recovery have been identified, there remains a dearth of interventions that have effectively improved outcomes long-term among survivors. In this article, we aim to provide a thorough, evidence-based review of the current state of knowledge regarding muscle dysfunction and physical function after critical illness with a focus on post-ICU and post-hospitalization phase of recovery.
    Scopus© Citations 14  2
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    Intensive Care Unit–Acquired Weakness in Patients With Acute Kidney Injury: A Contemporary Review
    (2023)
    J. Pedro Teixeira
    ;
    Kirby P. Mayer
    ;
    Benjamin R. Griffin
    ;
    Naomi George
    ;
    Nathaniel Jenkins
    Scopus© Citations 11  6
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    Concurrent nutrition and physical rehabilitation interventions for patients with critical illness
    (Ovid Technologies (Wolters Kluwer Health), 2024-12-16)
    GONZALEZ SEGUEL, FELIPE ANDRES  
    ;
    Kirby P. Mayer
    ;
    Renee D. Stapleton
    The effects of either physical rehabilitation or nutrition on outcomes in patients with critical illness are variable and remain unclear. The potential for the combination of exercise and nutritional delivered concurrently to provide benefit is provocative, but data are only emerging. Herein, we provide a summary of evidence from 2023 and 2024 on combined physical rehabilitation and nutrition during and following critical illness. Recent findings While latest trials on physical rehabilitation alone reported conflicting findings, recent nutrition trials found no difference between higher and lower protein delivery and even suggested harm in patients with acute kidney injury. In 2023 and 2024, we identified four studies (one randomized controlled trial) combining physical rehabilitation and nutrition (mainly protein supplementation) within the ICU setting. Overall, these suggested benefits, including reduction of muscle size loss, ICU acquired weakness, delirium, and improved mobility levels, although these benefits did not extend to mortality and hospital length of stay. No recent trials combining physical rehabilitation and nutrition for patients after ICU were identified.</jats:p>
    Scopus© Citations 6  1
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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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    Trajectories of Recovery after ACutE and cRitical illness (TRACER): a prospective observational study protocol
    (BMJ, 2025-11)
    GONZALEZ SEGUEL, FELIPE ANDRES  
    ;
    Louisa A Summers
    ;
    Lindsey E Fresenko
    ;
    Douglas E Long
    ;
    Logan N Scott
    <jats:sec> <jats:title>Introduction</jats:title> <jats:p>Patients who survive admission to intensive care unit (ICU) for critical illness are at high risk of developing muscle atrophy and weakness, commonly diagnosed as ICU-acquired weakness (ICUAW). The development of ICUAW is closely linked to long-term symptoms and impairments known as post-intensive care syndrome (PICS). Despite heightened recognition of impairments, there is limited research supporting effective interventions to improve muscle and physical outcomes after hospital discharge. Prior to developing and testing interventions for ICU survivors, it is imperative to understand the trajectory of muscle and physical function recovery following an ICU stay. The purpose of this study is to longitudinally investigate skeletal muscle health and physical function outcomes after ICU admission.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and analysis</jats:title> <jats:p>This protocol describes a single site, prospective, observational study in adult patients who have survived a critical illness (ie, sepsis or acute respiratory failure). Patients will participate in a battery of testing including primary outcomes: muscle power and physical function; and secondary outcomes: muscle strength, muscle size, endurance and physical activity (by accelerometry) at hospital discharge and 3, 6, and 12 months post-discharge. A subset of patients will participate in muscle biopsy and venipuncture. To examine if the trajectory of recovery predicts primary outcomes, we will perform multivariate linear regression models in 150 evaluable patients. To examine differences in molecular and cellular outcomes in plasma and muscle tissue, a control group of community-dwelling adults without history of an ICU stay will be enrolled as a comparator group. Enrolment started on 18 October 2022 with an estimated completion date of 1 August 2027.</jats:p> </jats:sec> <jats:sec> <jats:title>Ethics and dissemination</jats:title> <jats:p>This protocol was approved by the University of Kentucky Office of Research Integrity Medical Internal Review Board (# 77407), with patients providing informed written consent. We anticipate our findings to establish recovery trajectories, improving the classification of patients who experience sustained physical disability. Improved identification of recovery trajectories of muscle and physical function enables future studies to employ an individually targeted rehabilitation approach, that is, precision medicine, with the goal of improving patient outcomes. The cellular findings will support the development of novel interventions specifically designed for detecting underlying mechanisms. We intend to disseminate findings to patients, healthcare professionals, the public and other relevant groups via conference presentations and manuscripts without publication restrictions.</jats:p> </jats:sec> <jats:sec> <jats:title>Trial registration number</jats:title> <jats:p> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="clintrialgov" xlink:href="NCT05537298">NCT05537298</jats:ext-link> . </jats:p> </jats:sec>
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      2Scopus© Citations 12
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    Settings and monitoring of mechanical ventilation during physical therapy in adult critically ill patients: protocol for a scoping review
    (2019)
    GONZALEZ SEGUEL, FELIPE ANDRES  
    ;
    CAMUS MOLINA, AGUSTIN  
    ;
    Anita Jasmén Sepúlveda
    ;
    PEREZ ARAOS, RODRIGO ALEJANDRO  
    ;
    Jorge Molina Blamey
    <jats:sec><jats:title>Introduction</jats:title><jats:p>Early mobilisation has been extensively advocated to improve functional outcomes in critically ill patients, even though consistent evidence of its benefits has remained elusive. These conflicting results could be explained by a lack of knowledge on the optimal dosage of physical therapy and a mismatch between ventilatory support and exercise-induced patient ventilatory demand. Modern mechanical ventilators provide real-time monitoring of respiratory/metabolic variables and ventilatory setting that could be used for physical therapy dosage or ventilatory support titration, allowing individualised interventions in these patients. The aim of this review is to comprehensively map and summarise current knowledge on adjustments of respiratory support and respiratory or metabolic monitoring during physical therapy in adult critically ill mechanically ventilated patients.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>This is a scoping review protocol based on the methodology of the Joanna-Briggs-Institute. The search strategy will be conducted from inception to 30 June 2019 as a cut-off date in PubMed, CINAHL, Rehabilitation &amp; Sport Medicine, Scielo Citation Index, EpistemĂłnikos, Clinical Trials, PEDro and Cochrane Library, performed by a biomedical librarian and two critical care physiotherapists. All types of articles will be selected, including conference abstracts, clinical practice guidelines and expert recommendations. Bibliometric variables, patient characteristics, physical therapy interventions, ventilator settings and respiratory or metabolic monitoring will be extracted. The identified literature will be analysed by four critical care physiotherapists and reviewed by a senior critical care physician.</jats:p></jats:sec><jats:sec><jats:title>Ethics and dissemination</jats:title><jats:p>Ethical approval is not required. The knowledge-translation of the results will be carried out based on the End-of-Grant strategies: diffusion, dissemination and application. The results will be published in a peer-review journal, presentations will be disseminated in relevant congresses, and recommendations based on the results will be developed through training for mechanical ventilation and physical therapy stakeholders.</jats:p></jats:sec>
      5  1Scopus© Citations 5