Browsing by Author "Bugedo Tarraza, Guillermo Jaime"
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- ItemAcute lung injury secondary to hydrochloric acid instillation induces small airway hyperresponsiveness(2021) Basoalto Escobar, Roque Ignacio; Damiani Rebolledo, Luis Felipe; Bachmann Barron, María Consuelo; Fonseca, Marcelo; Barros, Marisol; Soto Muñoz, Dagoberto Igor; Araos, Joaquin; Jalil Contreras, Yorschua Frederick; Dubo, Sebastian; Retamal, Jaime; Bugedo Tarraza, Guillermo Jaime; Henriquez, Mauricio; Bruhn Cruz, Alejandro RodrigoBackground: Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure characterized by altered lung mechanics and poor oxygenation. Bronchial hyperresponsiveness has been reported in ARDS survivors and animal models of acute lung injury. Whether this hyperreactivity occurs at the small airways or not is unknown. Objective: To determine ex-vivo small airway reactivity in a rat model of acute lung injury (ALI) by hydrochloric acid (HCl) instillation. Methods: Twelve anesthetized rats were connected to mechanical ventilation for 4-hour, and randomly allocated to either ALI group (HCl intratracheal instillation; n=6) or Sham (intratracheal instillation of 0.9% NaCl; n=6). Oxygenation was assessed by arterial blood gases. After euthanasia, tissue samples from the right lung were harvested for histologic analysis and wet-dry weight ratio assessment. Precision cut lung slice technique (100-200 pm diameter) was applied in the left lung to evaluate ex vivo small airway constriction in response to histamine and carbachol stimulation, using phase-contrast video microscopy. Results: Rats from the ALI group exhibited hypoxemia, worse histologic lung injury, and increased lung wet-dry weight ratio as compared with the sham group. The bronchoconstrictor responsiveness was significantly higher in the ALI group, both for carbachol (maximal contraction of 84.5 +/- 2.5% versus 61.4 +/- 4.2% in the Sham group, P<0.05), and for histamine (maximal contraction of 78.6 +/- 5.3% versus 49.6 +/- 5.3% in the Sham group, P<0.05). Conclusion: In an animal model of acute lung injury secondary to HCL instillation, small airway hyperresponsiveness to carbachol and histamine is present. These results may provide further insight into the pathophysiologi of ARDS.
- ItemAdherence to low tidal volume in the transition to spontaneous ventilation in patients with acute respiratory failure in intensive care units in Latin America (SPIRAL): a study protocol(Associacao de Medicina Intensiva Brasileira - AMIB, 2024) Diniz-Silva, Fabia; Pinheiro, Bruno Valle; Reyes, Luis Felipe; Cavalcanti, Alexandre Biasi; Figueredo, Belinda; Rios, Fernando; Machado, Flávia Ribeiro; Preda, Gabriel; Bugedo Tarraza, Guillermo Jaime; Maia, Israel Silva; da Silveira, Leda Tomiko Yamada; Herrera, Luis; Jibaja, Manuel; Ibarra-Estrada, Miguel; Cestari, Mino; Nin, Nicolás; Roldan, Rollin; Dos Santos, Tiago Mendonça; Veiga, Viviane Cordeiro; Bruhn Cruz, Alejandro Rodrigo; Ferreira, Juliana Carvalho© 2024, Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.Objective: Patients with acute respiratory failure often require mechanical ventilation to reduce the work of breathing and improve gas exchange; however, this may exacerbate lung injury. Protective ventilation strategies, characterized by low tidal volumes (≤ 8mL/kg of predicted body weight) and limited plateau pressure below 30cmH2O, have shown improved outcomes in patients with acute respiratory distress syndrome. However, in the transition to spontaneous ventilation, it can be challenging to maintain tidal volume within protective levels, and it is unclear whether low tidal volumes during spontaneous ventilation impact patient outcomes. We developed a study protocol to estimate the prevalence of low tidal volume ventilation in the first 24 hours of spontaneous ventilation in patients with hypoxemic acute respiratory failure and its association with ventilator-free days and survival. Methods: We designed a multicenter, multinational, cohort study with a 28-day follow-up that will include patients with acute respiratory failure, defined as a partial oxygen pressure/ fraction of inspired oxygen ratio < 300mmHg, in transition to spontaneous ventilation in intensive care units in Latin America. Results: We plan to include 422 patients in ten countries. The primary outcomes are the prevalence of low tidal volume in the first 24 hours of spontaneous ventilation and ventilator-free days on day 28. The secondary outcomes are intensive care unit and hospital mortality, incidence of asynchrony and return to controlled ventilation and sedation. Conclusion: In this study, we will assess the prevalence of low tidal volume during spontaneous ventilation and its association with clinical outcomes, which can inform clinical practice and future clinical trials.
- ItemBeta-Lactam Antibiotics Can Be Measured in the Exhaled Breath Condensate in Mechanically Ventilated Patients: a Pilot Study(2023) Escalona Solari, José Antonio; Soto Muñoz, Dagoberto Igor; Oviedo Álvarez, Vanessa Andrea; Rivas Garrido, Elizabeth Alexis; Severino, Nicolás; Kattan Tala, Eduardo José; Andresen Hernández, Max Alfonso; Bravo Morales, Sebastián Ignacio; Basoalto Escobar, Roque Ignacio; Bachmann Barron, María Consuelo; Kwok-Yin, Wong; Pavez, Nicolás; Bruhn Cruz, Alejandro Rodrigo; Bugedo Tarraza, Guillermo Jaime; Retamal Montes, Jaime AlejandroDifferent techniques have been proposed to measure antibiotic levels within the lung parenchyma; however, their use is limited because they are invasive and associated with adverse effects. We explore whether beta-lactam antibiotics could be measured in exhaled breath condensate collected from heat and moisture exchange filters (HMEFs) and correlated with the concentration of antibiotics measured from bronchoalveolar lavage (BAL). We designed an observational study in patients undergoing mechanical ventilation, which required a BAL to confirm or discard the diagnosis of pneumonia. We measured and correlated the concentration of beta-lactam antibiotics in plasma, epithelial lining fluid (ELF), and exhaled breath condensate collected from HMEFs. We studied 12 patients, and we detected the presence of antibiotics in plasma, ELF, and HMEFs from every patient studied. The concentrations of antibiotics were very heterogeneous over the population studied. The mean antibiotic concentration was 293.5 (715) ng/mL in plasma, 12.3 (31) ng/mL in ELF, and 0.5 (0.9) ng/mL in HMEF. We found no significant correlation between the concentration of antibiotics in plasma and ELF (R2 = 0.02, p = 0.64), between plasma and HMEF (R2 = 0.02, p = 0.63), or between ELF and HMEF (R2 = 0.02, p = 0.66). We conclude that beta-lactam antibiotics can be detected and measured from the exhaled breath condensate accumulated in the HMEF from mechanically ventilated patients. However, no correlations were observed between the antibiotic concentrations in HMEF with either plasma or ELF.
- ItemIntensive care challenges for the next pandemic(2024) Vera Alarcón, María Magdalena; Alegría Vargas, Leyla; Avendaño Jara, Stefany Fernanda; Amthauer Rojas, Macarena Paz; Castro López, Ricardo Adolfo; Bugedo Tarraza, Guillermo JaimeExperience during the COVID-19 pandemic has highlighted the need for crisis preparedness, particularly in intensive care units (ICUs). Addressing key challenges is vital for improving readiness and response, as well as ensuring better protection for vulnerable populations. Our review focuses on the recent literature examining the challenges in acute care settings during the pandemic. We aimed to identify lessons that could improve our ability to handle similar situations. Studies have highlighted the critical role of intensive care, responsiveness, and preparedness. The key challenges identified include a shortage of trained personnel to meet high demand without compromising care quality or overburdening healthcare workers. Resource scarcity during the pandemic emphasizes the importance of reasonable resource allocation to ensure sufficient care provision. Additionally, addressing post-ICU syndrome and early rehabilitation is crucial, as ICU treatment can lead to long-term physical, psychological, and cognitive issues that can affect patients' quality of life. Finally, fostering a culture of data sharing and research collaboration is essential for knowledge exchange and improving crisis management across healthcare centers.
- ItemMechanical Power of Ventilation: From Computer to Clinical Implications(2023) Damiani Rebolledo, L. Felipe; Basoalto Escobar, Roque Ignacio; Retamal Montes, Jaime Alejandro; Bruhn Cruz, Alejandro Rodrigo; Bugedo Tarraza, Guillermo JaimeMechanical ventilation is a lifesaving intervention that may also induce further lung injury by exerting excessive mechanical forces on susceptible lung tissue, a phenomenon termed ventilator-induced lung injury (VILI). The concept of mechanical power (MP) aims to unify in one single variable the contribution of the different ventilatory parameters that could induce VILI by measuring the energy transfer to the lung over time. Despite an increasing amount of evidence demonstrating that high MP values can be associated with VILI development in experimental studies, the evidence regarding the association of MP and clinical outcomes remains controversial. In the present review, we describe the different determinants of VILI, the concept and computation of MP, and discuss the experimental and clinical studies related to MP. Currently, due to different limitations, the clinical application of MP is debatable. Further clinical studies are required to enhance our understanding of the relationship between MP and the development of VILI, as well as its potential impact on clinical outcomes.
- ItemReflections on a Respiratory Therapy Postgraduate Certificate Program in Chile(American Thoracic Society, 2024) Kattan Tala, Eduardo José; Basoalto Escobar, Roque Ignacio; Retamal Montes, Jaime Alejandro; Oviedo Álvarez, Vanessa Andrea; Bruhn Cruz, Alejandro Rodrigo; Bugedo Tarraza, Guillermo JaimeChile is a South American country that spans 4,300 km from north to south. Population density and access to critical care are highly concentrated in Santiago’s metropolitan region. After the educational challenges posed by the 2009 H1N1 influenza pandemic, our critical care department at the Pontificia Universidad Catolica de Chile in Santiago created the Respiratory Therapy Postgraduate Certificate as an educational intervention to address the shortage of healthcare professionals with knowledge and skills in performing respiratory support in critically ill patients. Throughout this Perspective, we aim to delineate the program design, major educational results, implementation of educational innovations that allowed us to adapt to the geographical challenges of the country and those imposed by the coronavirus disease (COVID-19) pandemic, and future challenges identified for the next decade.