Browsing by Author "Bravo, Sebastian"
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- ItemCharacteristics and evolution of patients admitted to a public hospital intensive care unit(SOC MEDICA SANTIAGO, 2016) Ruiz, Carolina; Angel Diaz, Miguel; Marcelo Zapata, Juan; Bravo, Sebastian; Panay, Sergio; Escobar, Cristina; Godoy, Jorge; Andresen, Max; Castro, RicardoBackground: The epidemiology of critical patients in Chile could differ from that reported in international studies. Aim: To describe the causes of admission and evolution of patients who were admitted to the ICU (Intensive Care Unit) of a general hospital in Chile in a two-year period (2012-2013). Patients and Methods: A retrospective study was carried out using the ICU database. The following variables were registered: admission diagnosis, APACHE II (Acute Physiology and Chronic Health Evaluation), days of mechanical ventilation (MV), ICU length of stay and ICU and hospital survival. Results: We analyzed data from 1075 aged 54 +/- 18 years (55% males), representing 75% of the admissions during the study period. The median ICU and MV lengths were 5 and 3 days respectively (92% of patients required MV). APACHE II was 20.5 +/- 8.2. The ICU and hospital mortality rate were 19.4% and 31%, respectively. Critical neurological diseases were the most common diagnoses requiring ICU, representing 26.8% of the admissions. No differences were found between 2012 and 2013 in age, APACHE II, ICU or hospital survival. A longer post ICU length of stay was found during 2013, both for patients who survived and those who died at the hospital. Conclusions: This study highlights the high percentage of patients that required MV and the high percentage critical neurological conditions requiring ICU admission. The characteristics and evolution of patients admitted to the ICU did not differ during 2012 and 2013.
- ItemCharacteristics of trauma patients admitted to the intensive care unit of a general hospital in Chile(SOC MEDICA SANTIAGO, 2013) Ruiz, Carolina; Mimica, Ximena; Luisa Lisbona, Maria; Donoso, Javiera; Arriagada, Paula; Roa, Macarena; Bravo, Sebastian; Godoy, JorgeBackground: Trauma is an important cause of death among young adults. Aim: To determine the characteristics, treatments and evolution of trauma patients admitted to an intensive care unit (ICU) of a public hospital in Santiago, Chile. Material and Methods: All polytrauma (PT) and severely traumatized (ST) patients admitted to ICU were included. We recorded the type of trauma along with demographic and hemodynamic variables, treatments and complications. The evolution and treatments received by PT and ST patients were compared. Results: We recorded data from 72 patients aged 43 +/- 21 years (93% males). Sixty two percent were PT and 24% had penetrating injuries. TBI (Trauma Brain Injury) was the most common trauma. On admission, acute Physiology and Chronic Health Evaluation II (APACHE II) score was 18.7 + 7.3, and Injury Severity Score (ISS) was 32.8 + 20.1. ICU stay was 7.8 + 6 days. Sixty seven per cent of patients required surgery and 58% received blood transfusions. No differences were found between PT and ST ICU and hospital mortality rates were 15 and 25% respectively. Conclusions: The characteristics and evolution of PT and ST of this series of patients are similar to those described abroad. Mortality was in agreement with ISS and APACHE II scores.
- ItemEvolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A clinical-physiologic study(W B SAUNDERS CO-ELSEVIER INC, 2012) Hernandez, Glenn; Pedreros, Cesar; Veas, Enrique; Bruhn, Alejandro; Romero, Carlos; Rovegno, Maximiliano; Neira, Rodolfo; Bravo, Sebastian; Castro, Ricardo; Kattan, Eduardo; Ince, CanPurpose: Perfusion assessment during septic shock resuscitation is difficult and usually complex determinations. Capillary refill time (CRT) and central-to-toe temperature difference (Tc-toe) have been proposed as objective reproducible parameters to evaluate peripheral perfusion. The comparative evolution of peripheral vs metabolic perfusion parameters in septic shock resuscitation has not been studied. We conducted a prospective observational clinical-physiologic study to address this subject.
- ItemExpanding ICU facilities in a pandemic scenario(SOC MEDICA SANTIAGO, 2020) Andresen, Max; Born, Pablo; Kattan, Eduardo; Vera, Magdalena; Cataldo, Alejandro; Ruiz, Carolina; Bravo, SebastianOur country is suffering the effects of the ongoing pandemic of coronavirus disease (COVID-19). Because the vulnerability of healthcare systems, especially the intensive care areas they can rapidly be overloaded. That challenge the ICUs simultaneously on multiple fronts making urgent to increase the number of beds, without lowering the standards of care. The purpose of this article is to discuss some aspects of the national situation and to provide recommendations on the organizational management of intensive care units such as isolation protocols, surge in ICU bed capacity, ensure adequate supplies, protect and train healthcare workers maintaining quality clinical management.
- ItemHypoxia-related parameters during septic shock resuscitation: Pathophysiological determinants and potential clinical implications(AME PUBL CO, 2020) Pavez, Nicolas; Kattan, Eduardo; Vera, Magdalena; Ferri, Giorgio; Daniel Valenzuela, Emilio; Alegria, Leyla; Bravo, Sebastian; Pairumani, Ronald; Santis, Cesar; Oviedo, Vanessa; Soto, Dagoberto; Ospina Tascon, Gustavo; Bakker, Jan; Hernandez, Glenn; Castro, RicardoBackground: Assessment of tissue hypoxia at the bedside has yet to be translated into daily clinical practice in septic shock patients. Perfusion markers are surrogates of deeper physiological phenomena. Lactate-to-pyruvate ratio ( LPR) and the ratio between veno-arterial PCO2 difference and Ca-vO(2) (Delta PCO2/Ca-vO(2)) have been proposed as markers of tissue hypoxia, but they have not been compared in the clinical scenario. We studied acute septic shock patients under resuscitation. We wanted to evaluate the relationship of these hypoxia markers with clinical and biochemical markers of hypoperfusion during septic shock resuscitation.
- ItemProcess-oriented metrics to provide feedback and assess the performance of students who are learning surgical procedures: The percutaneous dilatational tracheostomy case(TAYLOR & FRANCIS LTD, 2022) Jose Martinez, Juan; Galvez-Yanjari, Victor; de la Fuente, Rene; Kychenthal, Catalina; Kattan, Eduardo; Bravo, Sebastian; Munoz-Gama, Jorge; Sepulveda, MarcosPurpose Assessing competency in surgical procedures is key for instructors to distinguish whether a resident is qualified to perform them on patients. Currently, assessment techniques do not always focus on providing feedback about the order in which the activities need to be performed. In this research, using a Process Mining approach, process-oriented metrics are proposed to assess the training of residents in a Percutaneous Dilatational Tracheostomy (PDT) simulator, identifying the critical points in the execution of the surgical process. Materials and methods A reference process model of the procedure was defined, and video recordings of student training sessions in the PDT simulator were collected and tagged to generate event logs. Three process-oriented metrics were proposed to assess the performance of the residents in training. Results Although the students were proficient in classic metrics, they did not reach the optimum in process-oriented metrics. Only in 25% of the stages the optimum was achieved in the last session. In these stages, the four more challenging activities were also identified, which account for 32% of the process-oriented metrics errors. Conclusions Process-oriented metrics offer a new perspective on surgical procedures performance, providing a more granular perspective, which enables a more specific and actionable feedback for both students and instructors.