Browsing by Author "Bugedo Tarraza, Guillermo"

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    Effects of positive end-expiratory pressure on gastric mucosal perfusion in acute respiratory distress syndrome
    (2004) Bruhn, Alejandro; Hernández P., Glenn; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis
    Abstract Introduction Positive end-expiratory pressure (PEEP) improves oxygenation and can prevent ventilator-induced lung injury in patients with acute respiratory distress syndrome (ARDS). Nevertheless, PEEP can also induce detrimental effects by its influence on the cardiovascular system. The purpose of this study was to assess the effects of PEEP on gastric mucosal perfusion while applying a protective ventilatory strategy in patients with ARDS. Methods Eight patients were included. A pressure–volume curve was traced and ideal PEEP, defined as lower inflection point + 2 cmH2O, was determined. Gastric tonometry was measured continuously (Tonocap). After baseline measurements, 10, 15 and 20 cmH2O PEEP and ideal PEEP were applied for 30 min each. By the end of each period, hemodynamic, CO2 gap (gastric minus arterial partial pressures), and ventilatory measurements were performed. Results PEEP had no effect on CO2 gap (median [range], baseline: 19 [2–30] mmHg; PEEP 10: 19 [0–40] mmHg; PEEP 15: 18 [0–39] mmHg; PEEP 20: 17 [4–39] mmHg; ideal PEEP: 19 [9–39] mmHg; P = 0.18). Cardiac index also remained unchanged (baseline: 4.6 [2.5–6.3] l min-1 m-2; PEEP 10: 4.5 [2.5–6.9] l min-1 m-2; PEEP 15: 4.3 [2–6.8] l min-1 m-2; PEEP 20: 4.7 [2.4–6.2] l min-1 m-2; ideal PEEP: 5.1 [2.1–6.3] l min-1 m-2; P = 0.08). One patient did not complete the protocol because of hypotension. Conclusion PEEP of 10–20 cmH2O does not affect gastric mucosal perfusion and is hemodynamically well tolerated in most patients with ARDS, including those receiving adrenergic drugs.
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    Hipotermia intravascular inducida en el manejo de la hipertensión intracraneana en insuficiencia hepática aguda. Caso clínico
    (2009) Castillo Fuenzalida, Luis Benito; Pérez Ríos, Cristián; Ruiz B., C.; Bugedo Tarraza, Guillermo; Hernández P., Glenn; Martínez Castillo, Jorge; Jarufe Cassis, Nicolás; Pérez Ayuso, Rosa María; Mellado T., Patricio; Domínguez, P.
    Acute liver failure has a mortality rate in excess of 80%. Most deaths are attributed to brain edema with intracranial hypertension and herniation of structures, where ammonium plays a major role in its generation. We report an 18 year-old female with a fulminant hepatic failure caused by virus A infection. The patient developed a profound sopor and required mechanical ventilation. A CT scan showed the presence of brain edema and intracranial hypertension. A Raudemic® catheter was inserted to measure intracranial pressure and brain temperature. Intracranial hypertension became refractory and intravascular hypothermia was started, reducing brain temperature to 33oC. Seventy two hours later, a liver transplantation was performed. After testing graft perfusion, rewarming was started, completing 122 hours of hypothermia at 33oC. The patient was discharged in good conditions after 69 days of hospitalization (Rev Méd Chile 2009; 137: 801-6).
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    Infarto agudo al miocardio con supradesnivel del ST y terapias de reperfusión
    (Mediterráneo, 2015) Castro Galvez, Pablo Federico; Paredes Cardenas, Freddy Alejandro; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis; Romero Patiño, Carlos
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    Ondansetron and droperidol in the prevention of postoperative nausea and vomiting
    (1999) Bugedo Tarraza, Guillermo; González Sotomayor, Julio; Asenjo, C.; Cuadra F., Juan Carlos de la; Gajardo, A.; Castillo Fuenzalida, Luis; Muñoz L., Hernán; Dagnino Sepúlveda, Jorge
    We have performed a prospective, randomized, double-blind clinical study to assess the efficacy of ondansetron, droperidol, or both, in preventing postoperative emesis. We studied 242 patients undergoing biliary or gynaecological surgery under general anaesthesia. Shortly before induction of anaesthesia, patients received: saline i.v. (group 1, n=62); droperidol 2.5 mg i.v. (group 2, n=60); ondansetron 4 mg i.v. (group 3, n=57); or droperidol 2.5 mg with ondansetron 4 mg i.v. (group 4, n=63). Nausea occurred in 45%, 37%, 32% and 29% (P=0.234) and vomiting in 23%, 17%, 9% and 5% (P=0.016) of patients in groups 1, 2, 3 and 4, respectively, during the first 24 h. Groups 2 and 4 had greater sedation scores than group 1 during the first 3 h (P<0.01). We conclude that both droperidol and ondansetron showed a significant antiemetic effect, ondansetron was not significantly better than droperidol, and the combination of droperidol and ondansetron was better than droperidol but no better than ondansetron alone.
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    Síndrome de respuesta inflamatoria sistémica severa: ¿Es comparable a la sepsis severa?
    (1999) Hernández P., Glenn; Dougnac Labatut, Alberto; Castro O, J.; Labarca M, E.; Ojeda M, M.; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis Benito; Andresen Hernández, Max; Bruhn, Alejandro; Huidobro M, L.F.; Huidobro M, R.; Caballero G, M.T.; Hernández M, A.
    Background: In 1992, a consensus conference defined the terms systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock. Since then, numerous reports have validated the prognostic usefulness of these operative definitions. Aim: To evaluate if sepsis severity criteria, as defined by the Consensus Conference, can be applied to noninfectious SIRS. Patients and methods: Five hundred eighteen patients admitted to 5 intensive care units (ICU) from 4 hospitals were prospectively evaluated during a 3 months period. Patients that met at least one severity criteria were included. SIRS etiology, organ dysfunction and evolution were recorded in each patient. Results: One hundred two patients were included: 79 with sepsis (group I) and 23 with noninfectious SIRS (group II). ICU and hospital mortality were comparable (43 and 48% in sepsis compared to 43 and 51% in non infectious SIRS). The most common sources of sepsis were pneumonia and peritonitis. Group II patients had a wide variety of diseases. ICU stay, APACHE score and number of organs with dysfunction were not different among groups. Only the incidence of renal dysfunction was higher in the septic group. Conclusions: The Consensus sepsis severity criteria can be applied to noninfectious SIRS, defining a population subset with similar high mortality and organ dysfunction incidence, although with greatly heterogeneous etiologies.