Browsing by Author "Damiani Rebolledo, Luis Felipe"

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    Acute lung injury secondary to hydrochloric acid instillation induces small airway hyperresponsiveness
    (2021) Basoalto Escobar, Roque Ignacio; Damiani Rebolledo, Luis Felipe; Bachmann Barron, María Consuelo; Fonseca, Marcelo; Barros, Marisol; Soto Muñoz, Dagoberto Igor; Araos, Joaquin; Jalil Contreras, Yorschua Frederick; Dubo, Sebastian; Retamal, Jaime; Bugedo Tarraza, Guillermo Jaime; Henriquez, Mauricio; Bruhn Cruz, Alejandro Rodrigo
    Background: Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure characterized by altered lung mechanics and poor oxygenation. Bronchial hyperresponsiveness has been reported in ARDS survivors and animal models of acute lung injury. Whether this hyperreactivity occurs at the small airways or not is unknown. Objective: To determine ex-vivo small airway reactivity in a rat model of acute lung injury (ALI) by hydrochloric acid (HCl) instillation. Methods: Twelve anesthetized rats were connected to mechanical ventilation for 4-hour, and randomly allocated to either ALI group (HCl intratracheal instillation; n=6) or Sham (intratracheal instillation of 0.9% NaCl; n=6). Oxygenation was assessed by arterial blood gases. After euthanasia, tissue samples from the right lung were harvested for histologic analysis and wet-dry weight ratio assessment. Precision cut lung slice technique (100-200 pm diameter) was applied in the left lung to evaluate ex vivo small airway constriction in response to histamine and carbachol stimulation, using phase-contrast video microscopy. Results: Rats from the ALI group exhibited hypoxemia, worse histologic lung injury, and increased lung wet-dry weight ratio as compared with the sham group. The bronchoconstrictor responsiveness was significantly higher in the ALI group, both for carbachol (maximal contraction of 84.5 +/- 2.5% versus 61.4 +/- 4.2% in the Sham group, P<0.05), and for histamine (maximal contraction of 78.6 +/- 5.3% versus 49.6 +/- 5.3% in the Sham group, P<0.05). Conclusion: In an animal model of acute lung injury secondary to HCL instillation, small airway hyperresponsiveness to carbachol and histamine is present. These results may provide further insight into the pathophysiologi of ARDS.
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    Disfunción Diafragmática en Ventilación Mecánica: Evaluación e Implicancias Clínicas
    (2020) Damiani Rebolledo, Luis Felipe; Jalil Contreras, Yorschua Frederick; Dubó, Sebastián
    La debilidad diafragmática es un problema relevante en pacientes admitidos a la unidad de cuidados intensivos (UCI). Su presencia ha sido asociada a mayor tiempo en ventilación mecánica, weaning dificultoso, mayor riesgo de readmisión hospitalaria y mayor mortalidad. Las causas de esta debilidad son múltiples incluyendo factores relacionados a la severidad de la enfermedad, las intervenciones en la UCI y el uso de ventilación mecánica, termino conocido como miotrauma. Se han propuesto cuatro diferentes mecanismos de miotrauma relacionados a la sobre asistencia ventilatoria, baja asistencia ventilatoria, ocurrencia de contracciones diafragmáticas excéntricas y efecto de la presión espiratoria al final de espiración. Una adecuada evaluación y monitoreo de la función diafragmática es, por lo tanto, un aspecto clave que debe ser realizado al lado de la cama del paciente. La prueba de referencia para medir la función del diafragma es la presión transdiafragmática calculada como la diferencia entre la presión gástrica y presión esofágica. Adicionalmente, otras técnicas disponibles para la evaluación de la función del diafragma corresponden a la ecografía y la medición de la actividad eléctrica. Desde un punto de vista clínico, basado en la evidencia sobre disfunción diafragmática en los pacientes ventilados mecánicamente, uno de los principales desafíos actuales es poder buscar estrategias ventilatorias que incorporen protección diafragmática mientras se mantiene una ventilación protectora pulmonar. En este sentido, favorecer un nivel de esfuerzo inspiratorio adecuado junto con optimizar la interacción entre el paciente y el ventilador constituyen los principales objetivos de una ventilación diafragmática protectora.
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    Effects of the First Spontaneous Breathing Trial in Children With Tracheostomy and Long-Term Mechanical Ventilation
    (NLM (Medline), 2023) Villarroel-Silva, Gregory; Jalil Contreras, Yorschua Frederick; Moya-Gallardo, E.; Oyarzun Aguirre, Ignacio Javier; Moscoso Altamira, Gonzalo Andrés; Astudillo Maggio, Claudia Ester; Damiani Rebolledo, Luis Felipe
    Copyright © 2023 by Daedalus Enterprises.BACKGROUND: Weaning and liberation from mechanical ventilation in pediatric patients with tracheostomy and long-term mechanical ventilation constitute a challenging process due to diagnosis heterogeneity and significant variability in the clinical condition. We aimed to evaluate the physiological response during the first attempt of a spontaneous breathing trial (SBT) and to compare variables in subjects who failed or passed the SBT. METHODS: This was a prospective observational study in tracheostomized children with long-term mechanical ventilation admitted to the Hospital Josefina Martinez, Santiago, Chile, between 2014-2020. Cardiorespiratory variables such as breathing pattern, use of accessory respiratory muscles, heart rate, breathing frequency, and oxygen saturation were registered at baseline and throughout a 2-h SBT with or without positive pressure depending on an SBT protocol. Comparison of demographic and ventilatory variables between groups (SBT failure and success) was performed. RESULTS: A total of 48 subjects were analyzed (median [IQR] age of 20.5 [17.0-35.0] months, 60% male). Chronic lung disease was the primary diagnosis in 60% of subjects. Eleven (23%) total subjects failed the SBT (< 2 h), with an average failure time of 69 ± 29 min. Subjects who failed the SBT had a significantly higher breathing frequency, heart rate, and end-tidal CO2 than subjects who succeeded (P < .001). In addition, subjects who failed the SBT had significantly shorter duration of mechanical ventilation before the SBT, higher proportion unassisted SBT, and higher rate of deviation SBT protocol in comparison with subjects who succeeded. CONCLUSIONS: Conducting an SBT to evaluate the tolerance and cardiorespiratory response in tracheostomized children with long-term mechanical ventilation is feasible. Time on mechanical ventilation before the first attempt and type of SBT (with or without positive pressure) could be associated with SBT failure.
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    Impact of Decreasing Respiratory Rate While Tolerating Moderate Hypercapnia on Lung Injury Markers in Patients with Covid-19 Related Acute Respiratory Distress Syndrome
    (2021) Damiani Rebolledo, Luis Felipe; Oviedo Álvarez, Vanessa Andrea; Alegria Aguirre, Luz Katiushka; Basoalto Escobar, Roque Ignacio; Bachmann Barron, María Consuelo; Jalil Contreras, Yorschua Frederick; Bruhn Cruz, Alejandro Rodrigo; Retamal Montes, A.; Santis Fuentes, César Antonio; Vera, M.; Bugedo Tarraza, Guillermo Jaime
    Rationale: Acute respiratory distress syndrome (ARDS) secondary to SARS-CoV-2 pneumonia is associated with a high mortality rate. Protective ventilationstrategies, by decreasing ventilator induced lung injury (VILI), have reduced mortality in patients with ARDS. However, the role of respiratory rate (RR), a centraldeterminant of the energy applied to the lung parenchyma remains uncertain. Objective: To evaluate the role of respiratory rate on systemic pro-inflammatory mediators, as markers of VILI, in patients with Covid-19-associated ARDS (CARDS) Methods: Prospective, randomized crossover trial in patients with CARDS,PaO2:FIO2 ratio less than 200 mmHg, and requiring deep sedation and neuromuscular blockade. All patients were ventilated with a tidal volume of 6 ml/kg IBW,and PEEP and FiO2 according to the ARDSNet table. If PaO2:FIO2 ratio was less than 150 mmHg, patients were positioned in the prone position.Two 12 hoursperiods with a low RR and a high RR, randomly selected, was conducted. Low RR and high RR periods were set to obtain an 8-10 breaths/min difference betweengroups while maintaining pH and PaCO2 within recommended limits. I:E ratio was held constant during the study.Hemodynamic and respiratory mechanics wereregistered, and arterial blood samples drawn for gas exchange and quantification of inflammatory biomarkers at baseline and repeated at 12 and 24 hours. Results: We enrolled 11 patients (10 males, median age 54 [51-66] years, PaO2:FIO2 108 [86-132]), and all of them were in prone position. The low RR (20 [16-23]) vs the high RR (28 [26-32]) was associated with a significantly lower energy applied to the lung (16 [12-19] vs 23 [20-32] J / min, respectively). PaCO2 and pH were kept within the recommended limits (pH 7.30 [7.25-7.35] vs 7.46 [7.43-7.50]; PaCO2 48 (45-63) vs 36 (32-38) mmHg for low and high RR, respectively).There were no significant changes in any of the respiratory mechanics parameters.The change in RR did not induce differences in any inflammatory marker (IL-6,IL-8, TNF-R1) or in the markers of epithelial (receptor for advanced glycation end products, s-RAGE; Surfactant protein D, SP-D), endothelial damage (Angiopoietin2) or the marker of profibrotic activity (transforming growth factor ß, TGF-ß) (table 1). Conclusion: These preliminary results reveal that a decrease in respiratoryrate, tolerating moderate hypercapnia, does not modify the biomarkers of lung damage compared to a strategy of high respiratory rate in patients with CARDS.
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    Kinesiólogos frente a la pandemia de COVID-19: ¿Cuál es su rol?
    (2021) Damiani Rebolledo, Luis Felipe; Jalil Contreras, Yorschua Frederick; Basoalto Escobar, Roque Ignacio; Villarroel Silva, Gregory; Garcia Valdes, Patricio Hernan
    El impacto de la pandemia por COVID-19 a nivel social, económico y sanitario no tiene precedentes. Sólo en Chile hasta el mes de julio de 2020, más de 340.000 personas han contraído la enfermedad y alrededor de 9.000 han fallecido por esta causa. Esta crisis sanitaria ha llevado a una adaptación en todo el sistema de salud y toma de medidas extraordinarias para poder cubrir dichas necesidades. El kinesiólogo como profesional de la salud constituye una pieza fundamental en la atención de estos pacientes. Su rol se ha visto reflejado en las distintas etapas de la enfermedad desde la atención primaria y urgencia hasta la atención de pacientes en la unidad de cuidados intensivos y posterior al alta hospitalaria. Además de su rol clínico asistencial, el kinesiólogo es capaz de contribuir en áreas de educación, promoción, gestión en salud e investigación científica, aspectos que podrían ser esenciales en el manejo de la pandemia. Es deber del kinesiólogo considerar esta oportunidad y asumir los múltiples desafíos derivados de la pandemia para comprometerse y otorgar respuestas a las necesidades sanitarias actuales.
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    Physiologic Effects of High Flow Nasal Cannula Compared to Conventional Oxygen Therapy Postextubation: A Randomized Crossover Study
    (2022) Basoalto Escobar, Roque Ignacio; Damiani Rebolledo, Luis Felipe; Jalil Contreras, Yorschua Frederick; Garcia, P.; Carpio Cordero, David Bernardo; Bachmann Barron, María Consuelo; Alegria Aguirre, Luz Katiushka; Oviedo Álvarez, Vanessa Andrea; Bugedo Tarraza, Guillermo Jaime; Retamal, J.; Bruhn Cruz, Alejandro Rodrigo
    Rationale: High flow nasal cannula (HFNC) has been shown to generate several physiological which would be responsible forreducing weaning failure rates. However, there are not many physiological studies focused on the post-extubationstage.Objective: To determine the physiological effects of HFNC in the post-extubation period.Methods:Prospective randomizedcrossover study in the post-extubation period of patients with acute respiratory failure (ARF), which was approved by the HealthSciences Scientific Ethics Committee of Pontificia Universidad Católica de Chile. Critically ill patients connected to mechanicalventilation (MV) more than 48 hours, with PaO2/FiO2 <300 mmHg, and in whom the physician planned to perform a spontaneousventilation test (SBT) were included. After obtaining consent informed a catheter with an esophageal and gastric balloon andelectrodes to record the electrical activity of the diaphragm (EAdi) were installed. Moreover, an electrical impedance tomography(EIT) around the chest was connected, arterial and venous blood gases were recorded, in addition to the usual clinical signs.After extubation, the patients were connected to HFNC set at 50 L/min for one hour and conventional oxygen therapy (venturimask) for one hour in a random sequence.Results:Nine patients (6 men) aged 60.7 ± 10.0 years were included. Patients wereconnected to MV for 6.6 ± 3.2 days. Compared with conventional oxygen therapy, HFNC significantly reduces the respiratoryeffort observed by a reduction of esophageal pressure swings (ΔPes)(p= 0.006) and pressure-time product (PTPes) (p= 0.047)of 30% and 27%, respectively. In the HFNC period, the end-expiratory lung impedance (p< 0.001) and dynamic lung compliance(VT/ΔPes) (p= 0.041) was significantly higher. However, no differences were observed in tidal volume (p= 0.255), electricalactivity of the diaphragm (ΔEAdi) (p= 0.104), Neuro-ventilatory efficiency (p= 0.262), and respiratory rate (RR) (p= 0.299)compared to the period of conventional oxygen therapy. Finally, the PaO2 / FiO2 ratio was also higher in the HFNC period (p =0.029).Conclusion:The use of HFNC in the post-extubation period in patients with acute respiratory failure reduces work ofbreathing and is capable of increasing end-expiratory lung volume, dynamic compliance, and gas exchange.
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    Physiological effects of high-flow nasal cannula during sustained high-intensity exercise in healthy volunteers: a randomised crossover trial
    (2024) Moya Gallardo, Eduardo Sebastián; García Valdés, Patricio Hernán; Marambio Coloma, Consuelo Belén; Gutiérrez Escobar, Constanza Isidora; Hernández Vargas, Betsabeth Scarlet; Muñoz Castro, Carolina Andrea; Riquelme Sánchez, Santiago Martin; Moo-Millán, Joel; Basoalto Escobar, Roque Ignacio; Bruhn Cruz, Alejandro Rodrigo; Díaz Patino, Orlando Alberto; Damiani Rebolledo, Luis Felipe
    IntroductionHigh-flow nasal cannula (HFNC) has increased exercise capacity in patients with chronic respiratory diseases. However, it remains unknown whether HFNC impacts respiratory physiological variables during exercise. This study aimed to evaluate the effect of HFNC on respiratory physiological variables during sustained high-intensity exercise in healthy volunteers.MethodsWe performed a single-center, open-label, and randomised crossover trial to compare HFNC (60 L·min−1) and Sham-HFNC (2 L·min−1) interventions during a constant work-rate exercise (CWRET) through randomised order. The primary outcome was ΔPes, and the secondary outcomes were other variables of inspiratory effort, ventilation distribution, ventilatory variables, and clinical assessment. We evaluated volunteers at seven-time points (Baseline= T0; CWRET= T1-T2-T3 (minutes: 1′, 4′ and 6′); Cooldown-period= T4-T5-T6 (minutes: 1′; 6′;10′)) in both interventions.ResultsFourteen healthy volunteers (50% women; age: 22 [21–27] years) were enrolled. Mean differences in ΔPes decreased to favor the HFNC intervention compared to Sham-HFNC at T2 (−2.8 cmH2O; 95%CI −5.3 to −0.3), as well as the sPTPmin at T2 (−86.1 cmH2O×s·min−1;95%CI −146.2 to −26.1), and T3 (−79.9 cmH2O×s·min−1;95%CI −142.3 to −17.6). The standard deviation of the regional ventilation delay index was also lower with HFNC compared to Sham-HFNC (T1: −1.38; 95%CI −1.93 to −0.83; T2: −0.71; 95%CI −1.27 to −0.16). There was decreased dyspnea to favor the HFNC, but sPTP-per-breath, spatial distribution ventilation indexes, ventilatory variables, and clinical assessments were nonsignificant between interventions.ConclusionHFNC intervention reduces respiratory effort, dyspnea and improves temporal ventilation distribution in healthy volunteers during CWRET.