Browsing by Author "Bruhn A."

Now showing 1 - 4 of 4
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    Cardiac function in critically ill patients with severe COVID: A prospective cross-sectional study in mechanically ventilated patients
    (W.B. Saunders, 2022) Valenzuela E.D.; Gonzalez A.; Rovegno M.; Ramirez J.; Hernandez G.; Bruhn A.; Bakker J.; Mercado P.; Aguilera J.; Pairumani R.; Petruska E.; Morales F.; Araya C.; Medel J.N.; Ugalde D.; Eisen D.; Montoya J.; Slama M.
    © 2022 Elsevier Inc.Purpose: To evaluate cardiac function in mechanically ventilated patients with COVID-19. Materials and methods: Prospective, cross-sectional multicenter study in four university-affiliated hospitals in Chile. All consecutive patients with COVID-19 ARDS requiring mechanical ventilation admitted between April and July 2020 were included. We performed systematic transthoracic echocardiography assessing right and left ventricular function within 24 h of intubation. Results: 140 patients aged 57 ± 11, 29% female were included. Cardiac output was 5.1 L/min [IQR 4.5–6.2] and 86% of the patients required norepinephrine. ICU mortality was 29% (40 patients). Fifty-four patients (39%) exhibited right ventricle dilation out of whom 20 patients (14%) exhibited acute cor pulmonale (ACP). Eight out of the twenty patients with ACP exhibited pulmonary embolism (40%). Thirteen patients (9%) exhibited left ventricular systolic dysfunction (ejection fraction <45%). In the multivariate analysis acute cor pulmonale and PaO2/FiO2 ratio were independent predictors of ICU mortality. Conclusions: Right ventricular dilation is highly prevalent in mechanically ventilated patients with COVID-19 ARDS. Acute cor pulmonale was associated with reduced pulmonary function and, in only 40% of patients, with co-existing pulmonary embolism. Acute cor pulmonale is an independent risk factor for ICU mortality.
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    Patient-ventilator dyssynchronies: Are they all the same? A clinical classification to guide actions
    (W.B. Saunders, 2020) Damiani L.F.; Damiani L.F.; Bruhn A.; Retamal J.; Bugedo G.
    © 2020 Elsevier Inc.Patient ventilatory dyssynchrony (PVD) is a mismatch between the respiratory drive of the patient and ventilatory assistance. It is a complex event seen in almost all ventilated patients and at any ventilator mode, with uncertain significance and prognosis. Due to its different pathophysiological mechanisms, there is still not consensual classification to guide us in selecting the best treatment. In the present review we aimed to summarize some clinical data on PVD, and to propose a clinical classification based on the type of PVD, from potentially innocuous to clearly harmful PVD, which could help clinicians in the decision-making process from adjusting ventilator settings to deeply sedate or paralyze the patient. Clearly, further studies are needed addressing risk factors, physiologic mechanisms and direct consequences of PVD in order to help clinicians to design effective and proven strategies at the bedside.
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    Physiological and inflammatory consequences of high and low respiratory rate in acute respiratory distress syndrome
    (John Wiley and Sons Inc, 2021) Retamal J.; Damiani L.F.; Basoalto R.; Bruhn A.; Bugedo G.; Damiani L.F.; Benites M.H.; Larsson A.
    © 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons LtdUsing protective mechanical ventilation strategies with low tidal volume is usually accompanied by an increment of respiratory rate to maintain adequate alveolar ventilation. However, there is no robust data that support the safety of a high respiratory rate concerning ventilator-induced lung injury. Several experimental animal studies have explored the effects of respiratory rate over lung physiology, using a wide range of frequencies and different models. Clinical evidence is scarce and restricted to the physiological impact of increased respiratory rate. Undoubtedly, the respiratory rate can influence respiratory mechanics in various ways as a factor of multiplication of the power of ventilation, and gas exchange, and also on alveolar dynamics. In this narrative review, we present our point of view over the main experimental and clinical evidence available regarding the effect of respiratory rate on ventilator-induced lung injury development.
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    Recommendations for the management of patients with COVID-19 with therapeutic indication for mechanical ventilation that are eventually connected to anesthesia machinesRecomendaciones para el manejo de pacientes con COVID-19 con indicación terapéutica de ventilación mecánica que eventualmente son conectados a máquinas de anestesia
    (Sociedad de Anestesiologia de Chile, 2020) Aranda F.; Cabrera M.C.; Aliste J.; Egaña J.I.; González R.; Penna A.; Altermatt Couratier, Fernando René; Bruhn A.; De La Fuente R.; Lacassie H.J.; Bruhn A.; Bernucci F.; Carrasco E.; Castillo R.; Díaz R.; Honorato T.; López M.; Pizarro F.; Rocco C.; Regueira T.; Merino W.; Torres D.; Alvarez J.P.; Acuña D.