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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      9Scopus© Citations 9
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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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    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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    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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    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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    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, Epistemónikos, 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
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    Mechanical ventilatory parameters guided by the low flow pressure-volume curve in patients with acute lung injury/acute respiratory distress syndrome
    (2007-03-01)
    Tomicic Flores, Vinko
    ;
    Molina B, Jorge
    ;
    GRAF SANTOS, JERÓNIMO  
    ;
    Espinoza R, Mauricio
    ;
    Antúnez R, Miguel
    Background: Mechanical ventilation may contribute to lung injury and then enhance systemic inflammation. Optimal ventilatory parameters such as tidal volume (VT) and positive end expiratory pressure (PEEP) can be determined using different methods. Low flow pressure volume (P/V-LF) curve is a useful tool to assess the respiratory system mechanics and set ventilatory parameters. Aim: To set VT and PEEP according P/V-LF curve analysis and evaluate its effects on gas exchange and hemodynamic parameters. Materials and methods: Twenty seven patients underwent P/V-LF within the first 72 hours of acute lung injury/acute respiratory distress syndrome (ALI/ARDS). P/V-LF curves were obtained from the ventilator and both lower and upper inflexion points determined. Gas exchange and hemodynamic parameters were measured before and after modifying ventilator settings guided by P/V-LF curves. Results: Ventilatory parameters set according P/V-LF curve, led to a rise of PEEP and reduction of VT: 11.6 ±2.8 to 14.1±2.1 cm H 2O, and 9.7±2.4 to 8.8±2.2 mL/kg (p<0.01). Arterial to inspired oxygen fraction ratio increased from 158.0±66 to 188.5±68.5 (p <0.01), and oxygenation index was reduced, 13.7±8.2 to 12.3±7.2 (p <0.05). Cardiac output and oxygen delivery index (IDO2) were not modified. Demographic data, gas exchange improvement and respiratory system mechanics showed no significant difference between patients with extra-pulmonary and pulmonary ALI/ARDS. There was no evidence of significant adverse events related with this technique. Conclusion: P/V-LF curves information allowed us to adjust ventilatory parameters and optimize gas exchange without detrimental effects on oxygen delivery in mechanically ventilated ALI/ARDS patients.
    Scopus© Citations 2  2
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