Browsing by Author "Bravo Morales, Sebastián Ignacio"

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    Beta-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 Alejandro
    Different 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.
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    Clinical characteristics, anticoagulation therapy, and short-term outcomes of neonatal cerebral sinovenous thrombosis: a cross-sectional study from a Chilean center
    (2023) Duk Fonseca, Nasser Andrés; Hernández Chávez, Marta Isabel; Bravo Morales, Sebastián Ignacio; López Espejo, Mauricio Alejandro
    Purpose: Cerebral sinovenous thrombosis (SVT) is a rare but severe condition, with neonates having the highest incidence among pediatric patients. The underlying conditions contributing to SVT are heterogeneous, and although anticoagulation therapy (ACT) is safe and potentially beneficial, the evidence supporting its effectiveness on neurological outcomes is lacking. This study analyzed the association of clinical-demographic characteristics and ACT in the acute setting with vital-neurological outcomes at discharge in neonates with SVT. Methodology: This cross-sectional study utilized secondary data from 30 neonates with SVT confirmed by MRI/MRV at a single center in Chile between 2005 and 2021. Penalized maximum likelihood logistic regression models were conducted to calculate adjusted odds ratios. Results: The median gestational age, weight, and age of diagnostic were 38 weeks (IQR 37–39), 3141 grams (IQR 2579–3478), and 15 days (IQR 8.7–27.5), respectively. All patients had diffuse neurological signs. Acute seizures and focal deficits were detected in 12 (40%) and 1 (3.3%) cases. At discharge, 15 (50%) patients had a neurological deficit, and 7 (23.3%) died. The frequency of ACT use was higher between 2013 and 2021 than between 2005 and 2012 (8% vs. 2%, Fisher's exact test, p 0.05). Adjusted for demographic and clinical variables, ACT was negatively associated with adverse vital or neurological outcomes (OR 0.18, 95% CI 0.03–1.00). Conclusions: ACT increased its use over time. Our results suggest that ACT in neonates with SVT is associated with better neurological outcomes at discharge and lower in-hospital case fatality. Further follow-up is needed to establish long-term associations.
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    Long-term mortality of coronavirus disease 2019 critically ill patients that required percutaneous tracheostomy in Chile: A multicenter cohort study
    (Wolters Kluwer Health, Inc., 2024) Ulloa Morrison, Rodrigo; Escalona, José; Navarrete, Pablo; Espinoza, Javiera; Bravo Morales, Sebastián Ignacio; Pastore Thomson, Antonia; Reyes, Sebastián; Bozinovic, Milan; Abbott, Francisco; Pairumani, Ronald; Noguera, Roselyn; Vera Alarcón, María Magdalena; González, Felipe; Valle, Felipe; Bakker, Jan; Bugedo Tarraza, Guillermo; Kattan Tala, Eduardo José
    Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to mechanical ventilation (MV) in approximately 20% of hospitalized patients. Tracheostomy expedites weaning of respiratory support. Moreover, there is a paucity of data regarding long-term outcomes of tracheostomized coronavirus disease 2019 (COVID-19) patients. The objective of this study was to describe 1-year mortality in a cohort of COVID-19 critically ill patients who required percutaneous tracheostomy in Chile and to assess the impact of age on outcomes. Methods: A multicenter prospective observational study was conducted in 4 hospitals in Chile between March 2020 and July 2021. Patients with confirmed SARS-CoV-2 infection connected to MV and required percutaneous tracheostomy were included. Baseline data, relevant perioperative and long-term outcomes, such as 1-year mortality, MV duration, intensive care unit (ICU), and hospital length of stay were registered. Patients were dichotomized according to age group (< and ≥ 70 years). Univariate and multivariate logistic regressions were performed to identify predictors of 1-year mortality. Results: Of 1319 COVID-19 ventilated critically ill patients, 23% (304) required a percutaneous tracheostomy. One-year mortality of the study group was 25% (20.2%-30.3%). ICU and hospital length of stay (LOS) were of 37 (27-49) and 52 (40-72) days. One-year mortality was higher in patients ≥ 70 years (36.9% vs. 21.2%, P = 0.012). Multivariate analysis confirmed age and baseline sequential organ failure assessment (SOFA) score as independent predictors, while time from intubation to tracheostomy was not. Conclusion: In COVID-19 critically ill patients who required percutaneous tracheostomy in Chile, the 1-year mortality rate was 25%, with a relevant impact of age on outcomes. An appropriate patient selection likely accounted for the low mortality rate. Future studies should confirm these results.