Browsing by Author "Hernandez G."

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    A microcirculation-guided trial: never trying is worse than failing
    (Springer, 2023) Bruno R.R.; Hernandez G.; Thiele H.; Kattan E.; Jung C.; CEDEUS (Chile)
    © 2022 European Mathematical Society.Let G be the topological fundamental group of a given nonsingular complex projective surface. We prove that the Chern slopes c12(S)/c2(S) of minimal nonsingular surfaces of general type S with π1(S) ≃ G are dense in the interval [1; 3].
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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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    Correction: Direct assessment of microcirculation in shock: a randomized-controlled multicenter study (Intensive Care Medicine, (2023), 49, 6, (645-655), 10.1007/s00134-023-07098-5)
    (2023) Bruno R.R.; Wollborn J.; Fengler K.; Flick M.; Wunder C.; Allgauer S.; Thiele H.; Schemmelmann M.; Hornemann J.; Moecke H.M.E.; Demirtas F.; Palici L.; Franz M.; Saugel B.; Kattan E.; De Backer D.; Bakker J.; Hernandez G.; Kelm M.; Jung C.
    © 2023, The Author(s).In this article the author Marcus Franz has been mistakenly affiliated with the Erasmus MC University Medical Center, Rotterdam, The Netherlands. He is only affiliated with the “Department of Internal Medicine I, University Hospital Jena, Jena, Germany”. The original article has been corrected. The Authors apologize for this mistake.
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    Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol
    (2022) Kattan E.; Castro R.; Hernandez G.; Bakker J.; Estenssoro E.; Ospina-Tascon G.A.; Cavalcanti A.B.; De Backer D.; Vieillard-Baron A.; Teboul J.-L.
    © 2022 Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.Background: Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock. Methods: The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy. Conclusions: If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.
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    Microcirculation information in clinical decision making: Rome wasn't built in a day
    (Springer International Publishing, 2023) Bruno R.R.; Hernandez G.; Wollborn J.; Saugel B.; Jung C.
    © 2023 by the authors.Young men aged 20–29 present the highest rates of HIV in Chile, yet little is known about their experiences after diagnosis. This study sheds light on the meaning of living with HIV for young gay Chilean males. Qualitative analysis of 11 in-depth interviews, employing Heidegger’s hermeneutical approach, resulted in a depiction of feelings of loneliness and sadness, encounters with discrimination, and a lack of social support. Participants also offer recommendations on utilizing peer support as an essential component for programs targeting young gay men living with HIV in the capital of Chile. Additionally, they suggest that health care providers play a crucial role in supporting the process of accepting the condition. Conclusions: It is imperative to enhance psychological support by integrating it into the HIV program for all clients and families facing crisis situations. The establishment of support groups within hospitals that are part of the national program providers is recommended. Education on comprehensive sexuality should be provided in educational institutions, alongside visible campaigns across all media platforms to dismantle the stigma linked to the disease. Lastly, improvements in care duration and support from health services can be achieved through the provision of comprehensive care founded on unconditional acceptance.