Browsing by Author "Bugedo G."

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    Development of mechanical ventilators in Chile. Chronicle of the initiative “Un Respiro para Chile”Desarrollo de ventiladores mecánicos en Chile. Crónica de la iniciativa “Un Respiro para Chile”, durante la primera ola de la pandemia COVID-19
    (2022) Bugedo G.; Tobar E.; Alegria L.; Oviedo V.; Arellano D.; Basoalto R.; Enberg L.; Suarez P.; Bitran E.; Chabert S.; Bruhn A.
    © 2022 Sociedad Medica de Santiago. All rights reserved.At the beginning of the COVID-19 pandemic in Chile, in March 2020, a projection indicated that a significant group of patients with pneumonia would require admission to an Intensive Care Unit and connection to a mechanical ventilator. Therefore, a paucity of these devices and other supplies was predicted. The initiative “Un respiro para Chile” brought together many people and institutions, public and private. In the course of three months, it allowed the design and building of several ventilatory assistance devices, which could be used in critically ill patients.
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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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    Respiratory support of the COVID-19 critically ill patient: 18 months since the pandemic started in ChileSoporte ventilatorio en pacientes críticos con COVID-19: A 18 meses de la pandemia en Chile
    (2021) Ulloa R.; Born P.; Kattan E.; Bugedo G.
    © 2021 Sociedad de Anestesiologia de Chile. All rights reserved.After 18 months from the beginning of the pandemic, we have increased our knowledge about different aspects of respiratory care of critically ill patients with SARS-CoV-2 pneumonia. In this review, we analyze the available evidence regarding physiopathology and clinical course of COVID-19 pneumonia; the pillars of respiratory support (both non-invasive and invasive); pharmacological therapy, and the challenges derived from the chronic critically ill COVID-19 patient. Even though there are still many questions left to be answered, as long as we keep learning from this new disease and its’ impact on our organism, we will opportunely adapt our care strategies.