Browsing by Author "Soto, L"

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    Clinical features of Wegener granulomatosis and microscopic polyangiitis in Chilean patients
    (SOC MEDICA SANTIAGO, 2005) Cisternas, M; Soto, L; Jacobelli, S; Marinovic, MA; Vargas, A; Sobarzo, E; Saavedra, J; Chauan, K; Melendez, G; Foster, C; Pacheco, D; Wainstein, E; Sociedad Chilena de Reumatologia
    Background Systemic vasculitis are a group of heterogeneous diseases characterized by inflammation and necrosis of blood vessel walls. The etiology is not known, but geographic and environmental, factors are implicated. Aim: To describe the clinical features of microscopic polyangiitis (MPA) and Wegener's granulomatosis (WG) in a Chilean cohort of patients. Patients and methods: Retrospective review of the medical records of 123 patients with the diagnosis of systemic vasculitis (65 MPA and 58 WG), seen from 1990 to 2001. The diagnosis were made based on the American College of Rheumatology and Chapel Hill criteria. Results: The mean follow-up for MPA was 15 months (1-120) and for WG, 20 months (1-120). The median age (years) at diagnosis for MPA was 61 (19-82) and WG 50 (20-82). Gender distribution was similar in both groups (male: 68% and 57% respectively). The main clinical features in the MPA group were renal involvement (68%), peripheral nervous system involvement (57%), pulmonary hemorrhage (28%), and skin disease (32%). In the WG group were alveolar hemorrhage (62%), renal involvement (78%); paranasal sinus involvement (57%); and ocular disease (26%). In both, creatinine levels above 2.0 mg/dl were associated with a higher mortality (p < 0.01). ANCA by immunofluorescence was performed in 56 MPA patients (75% had pANCA, 4% had cANCA and 21% were ANCA negative) and in 55 WG patients (17%, had pANCA, 79% had cANCA and 4% were ANCA negative). Global mortality was 18% and 17% respectively, and the most causes of death were infections. Conclusions: The clinical features of our patients are similar to other-published data. In our WG and MPA patients the main predictor for death was a serum creatinine above 2 mg/dl.
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    How is mechanical ventilation employed in the intensive care unit? An international utilization review
    (AMER THORACIC SOC, 2000) Esteban, A; Anzueto, A; Alia, I; Gordo, F; Apezteguia, C; Palizas, F; Cide, D; Goldwaser, R; Soto, L; Bugedo, G; Rodrigo, C; Pimentel, J; Raimondi, G; Tobin, MJ; Mech Ventilation Int Study Grp
    A 1-d point-prevalence study was performed with the aim of describing the characteristics of conventional mechanical ventilation in intensive care units ICUs from North America, South America Spain, and Portugal. The study involved 412 medical-surgical ICUs and 1,638 patients receiving mechanical ventilation at the moment of the study. The main outcome measures were characterization of the indications for initiation of mechanical ventilation, the artificial airways used to deliver mechanical ventilation, the ventilator modes and settings, and the methods of weaning. The median age of the study patients was 67 yr, and the median duration of mechanical ventilation at the time of the study was 7 d. Common indications for the initiation of mechanical ventilation included acute respiratory failure (66%), acute exacerbation of chronic obstructive pulmonary disease (13%), coma (10%), and neuromuscular disorders (10%). Mechanical ventilation was delivered via an endotracheal tube in 75% of patients, a tracheostomy in 24%, and a facial mask in 1%. Ventilator modes consisted of assist/control ventilation in 47% of patients and 46% were ventilated with synchronized intermittent mandatory ventilation, pressure support, or the combination of both. The median tidal volume setting was 9 ml/kg in patients receiving assist/control and the median setting of pressure support was 18 cm H2O. Positive end-expiratory pressure was not employed in 31% of patients. Method of weaning varied considerably from country to country, and even within a country several methods were in use. We conclude that the primary indications for mechanical ventilation and the ventilator settings were remarkably similar across countries, but the selection of modes of mechanical ventilation and methods of weaning varied considerably from country to country.