Browsing by Author "Dreyse, Jorge"
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- ItemA hypoperfusion context may aid to interpret hyperlactatemia in sepsis-3 septic shock patients : a proof-of-concept study(2017) Alegría, Leyla.; Vera, Magdalena.; Dreyse, Jorge; Castro, Ricardo; Carpio Cordero, David; Henríquez, Carolina.; Gajardo, Daniela.; Bravo-Grau, Sebastian.; Araneda, Felipe.; Hernández P., GlennAbstract Background Persistent hyperlactatemia is particularly difficult to interpret in septic shock. Besides hypoperfusion, adrenergic-driven lactate production and impaired lactate clearance are important contributors. However, clinical recognition of different sources of hyperlactatemia is unfortunately not a common practice and patients are treated with the same strategy despite the risk of over-resuscitation in some. Indeed, pursuing additional resuscitation in non-hypoperfusion-related cases might lead to the toxicity of fluid overload and vasoactive drugs. We hypothesized that two different clinical patterns can be recognized in septic shock patients through a multimodal perfusion monitoring. Hyperlactatemic patients with a hypoperfusion context probably represent a more severe acute circulatory dysfunction, and the absence of a hypoperfusion context is eventually associated with a good outcome. We performed a retrospective analysis of a database of septic shock patients with persistent hyperlactatemia after initial resuscitation. Results We defined hypoperfusion context by the presence of a ScvO2 < 70%, or a P(cv-a)CO2 ≥6 mmHg, or a CRT ≥4 s together with hyperlactatemia. Ninety patients were included, of whom seventy exhibited a hypoperfusion-related pattern and 20 did not. Although lactate values were comparable at baseline (4.8 ± 2.8 vs. 4.7 ± 3.7 mmol/L), patients with a hypoperfusion context exhibited a more severe circulatory dysfunction with higher vasopressor requirements, and a trend to longer mechanical ventilation days, ICU stay, and more rescue therapies. Only one of the 20 hyperlactatemic patients without a hypoperfusion context died (5%) compared to 11 of the 70 with hypoperfusion-related hyperlactatemia (16%). Conclusions Two different clinical patterns among hyperlactatemic septic shock patients may be identified according to hypoperfusion context. Patients with hyperlactatemia plus low ScvO2, or high P(cv-a)CO2, or high CRT values exhibited a more severe circulatory dysfunction. This provides a starting point to launch further prospective studies to confirm if this approach can lead to a more selective resuscitation strategy.
- ItemBehavior of Quality of Life (SGRQ) in COPD Patients According to BODE Scores. Comportamiento de la calidad de vida (SGRQ) en pacientes con EPOC según las puntuaciones BODE(2015) Nonato, Nívia L.; Díaz Patiño, Orlando; Nascimento, Oliver A.; Dreyse, Jorge; Jardim, José R.; Lisboa Basualto, Carmen
- ItemComportamiento de la calidad de vida (SGRQ) en pacientes con EPOC según las puntuaciones BODE(2015) Nonato, Nívia L.; Díaz Patiño, Orlando; Nascimento, Oliver A.; Dreyse, Jorge; Jardim, José R.; Lisboa Basualto, Carmen
- ItemCPAP in patients with obstructive sleep apnea and type 2 diabetes mellitus: Systematic review and meta-analysis(2018) Labarca, Gonzalo; Reyes, Tomas; Jorquera, Jorge; Dreyse, Jorge; Drake, Lauren
- ItemDifferences between manual and automatic analysis in determining the severity of obstructive sleep apnea using home sleep apnea testing(2018) Labarca, Gonzalo; Dreyse, Jorge; Salas, Constanza; Contreras, Andrea; Nazar, Gonzalo; Gaete, Maria I.; Jorquera, Jorge
- ItemDificultades en la elección de una ecuación de referencia para la interpretación de los resultados de capacidad de difusión de monóxido de carbono(2013) Briceño Villafane, Catalina Paz; Dreyse, Jorge; Mendoza L., Laura; Díaz Patiño, Orlando; Mercado M., Gesma; Borzone, Gisella
- ItemDo frequent moderate exacerbations contribute to progression of chronic obstructive pulmonary disease in patients who are ex-smokers?(2015) Dreyse, Jorge; Díaz Patiño, Orlando; Repetto Lisboa, Paula Beatriz; Morales, Arturo; Saldías Peñafiel, Fernando; Lisboa Basualto, Carmen; Dreyse, Jorge; Díaz Patiño, Orlando; Repetto Lisboa, Paula Beatriz; Morales, Arturo; Saldías Peñafiel, Fernando; Lisboa Basualto, Carmen
- ItemEffects of changes in trunk inclination on ventilatory efficiency in ARDS patients: quasi-experimental study(2023) Benites, Martín H.; Torres, David; Poblete, Fabián; Labbé, Francisco; Bachmann, María C.; Regueira, Tomas E.; Soto, Leonardo; Ferre, Andrés; Dreyse, Jorge; Retamal Montes, JaimeTrunk inclination from semirecumbent head-upright to supine-flat positioning reduces driving pressure and increases respiratory system compliance in patients with acute respiratory distress syndrome (ARDS). These effects are associated with an improved ventilatory ratio and reduction in the partial pressure of carbon dioxide (PaCO2). However, these physiological effects have not been completely studied, and their mechanisms have not yet been elucidated. Therefore, this study aimed to evaluate the effects of a change in trunk inclination from semirecumbent (45°) to supine-flat (10°) on physiological dead space and ventilation distribution in different lung regions. Results: twenty-two ARDS patients on pressure-controlled ventilation underwent three 60-min steps in which trunk inclination was changed from 45° (baseline) to 10° (intervention) and back to 45° (control) in the last step. Tunk inclination from a semirecumbent (45°) to a supine-flat (10°) position resulted in a higher tidal volume [371 (± 76) vs. 433 (± 84) mL (P < 0.001)] and respiratory system compliance [34 (± 10) to 41 (± 12) mL/cmH2O (P < 0.001)]. The CO2 exhaled per minute improved from 191 mL/min (± 34) to 227 mL/min (± 38) (P < 0.001). Accordingly, Bohr’s dead space ratio decreased from 0.49 (± 0.07) to 0.41 (± 0.06) (p < 0.001), and PaCO2 decreased from 43 (± 5) to 36 (± 4) mmHg (p < 0.001). In addition, the impedance ratio, which divides the ventilation activity of the ventral region by the dorsal region ventilation activity in tidal images, dropped from 1.27 (0.83–1.78) to 0.86 (0.51–1.33) (p < 0.001). These results, calculated from functional EIT images, indicated further ventilation activity in the dorsal lung regions. These effects rapidly reversed once the patient was repositioned at 45°. Conclusions: a change in trunk inclination from a semirecumbent (45 degrees) to a supine-flat position (10 degrees) improved Bohr’s dead space ratio and reduced PaCO2 in patients with ARDS. This effect is associated with an increase in tidal volume and respiratory system compliance, along with further favourable impedance ventilation distribution toward the dorsal lung regions. This study highlights the importance of considering trunk inclination as a modifiable determinant of physiological parameters. The angle of trunk inclination is essential information that must be reported in ARDS patients.
- ItemEtiology of community-acquired pneumonia in hospitalized patients in Chile - The increasing prevalence of respiratory viruses among classic pathogens(ELSEVIER SCIENCE BV, 2007) Diaz, Alejandro; Barria, Paulina; Niederman, Michael; Restrepo, Marcos I.; Dreyse, Jorge; Fuentes, Gino; Couble, Bernardita; Saldias, FernandoBackground and study objectives: The range and relative impact of microbial pathogens, particularly viral pathogens, as a cause of community-acquired pneumonia (CAP) in hospitalized adults has not received much attention. The aim of this study was to determine the microbial etiology of CAP in adults and to identify the risk factors for various specific pathogens.
- ItemHipertensión pulmonar en pacientes con fibrosis pulmonar y sobrevida post-trasplante pulmonar(2016) Briceño Villafane, Catalina Paz; Sepúlveda, Claudia; Melo T., Joel; Linacre S., Virginia; Dreyse, Jorge
- ItemPhysiological and clinical effects of trunk inclination adjustment in patients with respiratory failure: a scoping review and narrative synthesis(2024) Benites, Martín H.; Zapata Canivilo, Marcelo; Poblete, Fabian; Labbe, Francisco; Battiato, Romina; Ferre, Andrés; Dreyse, Jorge; Bugedo, Guillermo; Bruhn, Alejandro; Costa, Eduardo L. V.; Retamal, JaimeBackground Adjusting trunk inclination from a semi-recumbent position to a supine-flat position or vice versa in patients with respiratory failure significantly affects numerous aspects of respiratory physiology including respiratory mechanics, oxygenation, end-expiratory lung volume, and ventilatory efficiency. Despite these observed effects, the current clinical evidence regarding this positioning manoeuvre is limited. This study undertakes a scoping review of patients with respiratory failure undergoing mechanical ventilation to assess the effect of trunk inclination on physiological lung parameters. Methods The PubMed, Cochrane, and Scopus databases were systematically searched from 2003 to 2023. Interventions: Changes in trunk inclination. Measurements: Four domains were evaluated in this study: 1) respiratory mechanics, 2) ventilation distribution, 3) oxygenation, and 4) ventilatory efficiency. Results After searching the three databases and removing duplicates, 220 studies were screened. Of these, 37 were assessed in detail, and 13 were included in the final analysis, comprising 274 patients. All selected studies were experimental, and assessed respiratory mechanics, ventilation distribution, oxygenation, and ventilatory efficiency, primarily within 60 min post postural change. Conclusion In patients with acute respiratory failure, transitioning from a supine to a semi-recumbent position leads to decreased respiratory system compliance and increased airway driving pressure. Additionally, C-ARDS patients experienced an improvement in ventilatory efficiency, which resulted in lower PaCO2 levels. Improvements in oxygenation were observed in a few patients and only in those who exhibited an increase in EELV upon moving to a semi-recumbent position. Therefore, the trunk inclination angle must be accurately reported in patients with respiratory failure under mechanical ventilation.