Browsing by Author "Bravo Morales, Sebastián"

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    Características y evolución de los pacientes que ingresan a una unidad de cuidados intensivos de un hospital público
    (2016) Ruiz, C.; Díaz, Marco A.; Zapata, J.; Bravo Morales, Sebastián; Panay, S.; Escobar, C.; Godoy, J.; Andresen Hernández, Max; Castro López, Ricardo
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    Development of a comprehensive Percutaneous Dilatational Tracheostomy process model for procedural training: A Delphi-based experts consensus
    (2021) Fuente Sanhueza, René Francisco de la; Kattan Tala, Eduardo José; Muñoz Gama, Jorge; Puente, Ignacio; Navarrete, Matías; Kychenthal, Catalina; Fuentes, Ricardo; Bravo Morales, Sebastián; Gálvez Yanjari, Víctor Andrés; Sepúlveda Cárdenas, Marcos Daniel
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    Effects of capillary refill time-vs. lactate-targeted fluid resuscitation on regional, microcirculatory and hypoxia-related perfusion parameters in septic shock: a randomized controlled trial
    (2020) Castro López, Ricardo; Kattan Tala, Eduardo José; Valenzuela, Emilio Daniel; Alegría, Leyla; Oviedo, Vanessa; Soto, Dagoberto; Vera Alarcón, María Magdalena; Bravo Morales, Sebastián; Bakker, Jan; Hernández P., Glenn
    Abstract Background Persistent hyperlactatemia has been considered as a signal of tissue hypoperfusion in septic shock patients, but multiple non-hypoperfusion-related pathogenic mechanisms could be involved. Therefore, pursuing lactate normalization may lead to the risk of fluid overload. Peripheral perfusion, assessed by the capillary refill time (CRT), could be an effective alternative resuscitation target as recently demonstrated by the ANDROMEDA-SHOCK trial. We designed the present randomized controlled trial to address the impact of a CRT-targeted (CRT-T) vs. a lactate-targeted (LAC-T) fluid resuscitation strategy on fluid balances within 24 h of septic shock diagnosis. In addition, we compared the effects of both strategies on organ dysfunction, regional and microcirculatory flow, and tissue hypoxia surrogates. Results Forty-two fluid-responsive septic shock patients were randomized into CRT-T or LAC-T groups. Fluids were administered until target achievement during the 6 h intervention period, or until safety criteria were met. CRT-T was aimed at CRT normalization (≤ 3 s), whereas in LAC-T the goal was lactate normalization (≤ 2 mmol/L) or a 20% decrease every 2 h. Multimodal perfusion monitoring included sublingual microcirculatory assessment; plasma-disappearance rate of indocyanine green; muscle oxygen saturation; central venous-arterial pCO2 gradient/ arterial-venous O2 content difference ratio; and lactate/pyruvate ratio. There was no difference between CRT-T vs. LAC-T in 6 h-fluid boluses (875 [375–2625] vs. 1500 [1000–2000], p = 0.3), or balances (982[249–2833] vs. 15,800 [740–6587, p = 0.2]). CRT-T was associated with a higher achievement of the predefined perfusion target (62 vs. 24, p = 0.03). No significant differences in perfusion-related variables or hypoxia surrogates were observed. Conclusions CRT-targeted fluid resuscitation was not superior to a lactate-targeted one on fluid administration or balances. However, it was associated with comparable effects on regional and microcirculatory flow parameters and hypoxia surrogates, and a faster achievement of the predefined resuscitation target. Our data suggest that stopping fluids in patients with CRT ≤ 3 s appears as safe in terms of tissue perfusion. Clinical Trials: ClinicalTrials.gov Identifier: NCT03762005 (Retrospectively registered on December 3rd 2018)
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    Extracorporeal membrane oxygenation for tuberculosis-related acute respiratory distress syndrome: An international multicentre retrospective cohort study
    (2024) Ait Hssain, Ali; Petit, Matthieu; Wiest, Clemens; Simon, Laura; Al-Fares, Abdulrahman A.; Hany, Ahmed; Garcia-Gomez, Dafna I.; Besa, Santiago; Nseir, Saad; Guervilly, Christophe; Alqassem, Wael; Lesouhaitier, Mathieu; Chelaru, Adrian; Sin, Simon W.; Roncon-Albuquerque, Roberto; Giani, Marco; Lepper, Philipp M.; Lavillegrand, Jean-Rémi; Park, Sunghoon; Schellongowski, Peter; Fawzy Hassan, Ibrahim; Combes, Alain; Sonneville, Romain; Schmidt, Matthieu; Salas Villarroel, Patricio; Bravo Morales, Sebastián
    Abstract Objective To report the outcomes of patients with severe tuberculosis (TB)-related acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO), including predictors of 90-day mortality and associated complications. Methods An international multicenter retrospective study was conducted in 20 ECMO centers across 13 countries between 2002 and 2022. Results We collected demographic data, clinical details, ECMO-related complications, and 90-day survival status for 79 patients (median APACHE II score of 20 [25th to 75th percentile, 16 to 28], median age 39 [28 to 48] years, PaO2/FiO2 ratio of 69 [55 to 82] mmHg before ECMO) who met the inclusion criteria. Thoracic computed tomography showed that 61 patients (77%) had cavitary TB, while 18 patients (23%) had miliary TB. ECMO-related complications included major bleeding (23%), ventilator-associated pneumonia (41%), and bloodstream infections (32%). The overall 90-day survival rate was 51%, with a median ECMO duration of 20 days [10 to 34] and a median ICU stay of 42 days [24 to 65]. Among patients on VV ECMO, those with miliary TB had a higher 90-day survival rate than those with cavitary TB (90-day survival rates of 81% vs. 46%, respectively; log-rank P = 0.02). Multivariable analyses identified older age, drug-resistant TB, and pre-ECMO SOFA scores as independent predictors of 90-day mortality. Conclusion The use of ECMO for TB-related ARDS appears to be justifiable. Patients with miliary TB have a much better prognosis compared to those with cavitary TB on VV ECMO.
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    Manejo del potencial donante cadáver
    (2014) Bugedo Tarraza, Guillermo; Bravo Morales, Sebastián; Romero, C.; Castro López, Ricardo
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    Simulation-based mastery learning of bronchoscopy-guided percutaneous dilatational tracheostomy competency acquisition and skills transfer to a cadaveric model
    (2021) Kattan Tala, Eduardo José; De la Fuente Sanhueza, René; Putz de la Fuente, Francisca Carolina; Vera Alarcón, María Magdalena; Corvetto Aqueveque, Marcia Antonia; Inzunza, Oscar; Achurra Tirado, Pablo; Inzunza Agüero, Martín Alejandro; Muñoz Gama, Jorge; Sepúlveda Fernández, Marcos Ernesto; Gálvez Yanjarí, Víctor Andrés; Pavez, Nicolás; Retamal Montes, Jaime; Bravo Morales, Sebastián
    Introduction: Although simulation-based training has demonstrated improvement of procedural skills and clinical outcomes in different procedures, there are no published training protocols for bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT). The objective of this study was to assess the acquisition of BG-PDT procedural competency with a simulation-based mastery learning training program, and skills transfer into cadaveric models. Methods: Using a prospective interventional design, 8 trainees naive to the procedure were trained in a simulation-based mastery learning BG-PDT program. Students were assessed using a multimodal approach, including blind global rating scale (GRS) scores of video-recorded executions, total procedural time, and hand-motion tracking–derived parameters. The BG-PDT mastery was defined as proficient tracheostomy (successful procedural performance, with less than 3 puncture attempts, and no complications) with GRS scores higher than 21 points (of 25). After mastery was achieved in the simulator, residents performed 1 BG-PDT execution in a cadaveric model. Results: Compared with baseline, in the final training session, residents presented a higher procedural proficiency (0% vs. 100%, P < 0.001), with higher GRS scores [8 (6–8) vs. 25 (24–25), P = 0.01] performed in less time [563 (408–600) vs. 246 (214–267), P = 0.01] and with higher movement economy. Procedural skills were further transferred to the cadaveric model. Conclusions: Residents successfully acquired BG-PDT procedural skills with a simulation-based mastery learning training program, and skills were effectively transferred to a cadaveric model. This easily replicable program is the first simulation-based BG-PDT training experience reported in the literature, enhancing safe competency acquisition, to further improve patient care.