Browsing by Author "Mercado, Marcelo"

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    Mini bronchoalveolar lavage in patients with severe respiratory failure
    (SOC MEDICA SANTIAGO, 2011) Andresen, Max; Mercado, Marcelo; Zapata, Marcelo; Bustamante, Andrea; Regueira, Tomas
    Background: To recognize the etiological agent responsible for severe acute respiratory failure (ARF) in patients in mechanical ventilation (MV) is important to determine their treatment and prognosis, and to avoid the excessive use of antibiotics. Mini bronchoalveolar lavage (mini BAL) is a blind, non bronschoscopic procedure, used to obtain samples from the lower respiratory tract from patients on mechanical ventilation (MV). Aim: To assess the feasibility, complications and preliminary results of mini BAL among patients with severe ARF on MV Material and Methods: Prospective study in 17 patients with acute lung injury (ALI) or acute respiratory distess syndrome (ARDS) on MV and with negative conventional microbiological studies. Mini BAL was performed using standardized protocols. Hemodynamic and respiratory parameters where measured before and after the procedure. Samples obtained were sent to quantitative cultures. Results: At baseline: APACHE II score of 22 +/- 6,7, P(a)O(2)/F(i)O(2) ratio was 176.6 +/- 48.6 and the oxygenation index was 9.74 +/- 3.78. All procedures were performed by an ICU resident. Thirty five percent of the procedures had positive cultures and no complications related to the procedures were reported. The procedure lasted an average of 12 minutes and the instilled and rescued volume were 60 ml and 19.6 ml, respectively There were no significant differences between hemodynamic and respiratory variables before and after the procedure. Conclusions: Mini BAL is a safe, fast and easy technique for obtaining samples from the inferior airway in patients with ALI or ARDS on MV (Rev Med Chile 2011; 139: 1292-1297).
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    Natriuretic peptide type-B can be a marker of reperfusion in patients with pulmonary thromboembolism subjected to invasive treatment
    (2012) Andresen, Max; Gonzalez, Alejandro; Mercado, Marcelo; Diaz, Orlando; Meneses, Luis; Fava, Mario; Cordova, Samuel; Castro, Ricardo
    This study was intended to investigate changes in cardiac biomarkers and pulmonary hemodynamic effects of invasive treatment in patients with intermediate-risk (hemodynamic stability with evidence of right ventricle dysfunction and/or myocardial injury) pulmonary embolism. Also, to also evaluate if natriuretic peptide type-B (NT-proBNP) plasma levels are associated with right ventricle function and pulmonary arterial pressures. Interventional study: Fourteen normotensive adult patients with acute and radiologically massive pulmonary embolism plus positive biomarkers and evidences of right ventricle dysfunction underwent invasive pulmonary angiography for invasive treatment consisting on mechanical thrombus fragmentation and catheter-directed intrathrombus thrombolysis. Angiography was repeated after 12-24 h to reevaluate perfusion status. Plasma biomarkers were monitored before and 8-h after intervention. Biomarkers were initially elevated in all patients. Eleven patients (78.6%) exhibited significant angiographic reperfusion. NT-proBNP and mean pulmonary arterial pressure decreased significantly in all of them [3693 (1803, 8862) to 1951 (1309, 7918) pg/ml; P = 0.008) and 40.0 (24.0, 46.0) to 22.0 (14.0, 27.0) mmHg; P = 0.003, respectively]. No significant variation was observed in troponin-T levels. In patients with high-risk pulmonary embolism, NT-proBNP plasma levels experience rapid and significant reduction after successful invasive treatment. In pulmonary embolism, serial measurements of NT-proBNP could be useful as a tracking tool to assess the success or failure of the thrombolytic treatment.