Browsing by Author "Morales, Sebastian"

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    Bariatric Surgery in Cirrhotic Patients: a Matched Case-Control Study
    (2020) Quezada, Nicolas; Maturana, Gregorio; Irarrazaval, Maria Jesus; Munoz, Rodrigo; Morales, Sebastian; Achurra, Pablo; Azocar, Cristobal; Crovari, Fernando
    Introduction Laparoscopic bariatric surgery (LBS) in liver end-stage organ disease has been proven to improve organ function and patients' symptoms. A series of LBS in patients with cirrhosis have shown good results in weight loss, but increased risk of complications. Current literature is based on clinical series. This paper aims to compare LBS (69% gastric bypass) between patients with cirrhosis and without cirrhosis. Methods We conducted a retrospective 1:3 matched case-control study including bariatric patients with cirrhosis and without cirrhosis. Demographics, operative variables, postoperative complications, long-term weight loss, and comorbidity resolution were compared between groups. Results Sixteen Child A patients were included in the patients with cirrhosis (PC) group and 48 in patients without cirrhosis (control) group. Mean age was 50 years; preoperative BMI was 39 +/- 6.8 kg/m(2). Laparoscopic gastric bypass and laparoscopic sleeve gastrectomy were performed in 69% and 31%, respectively. Follow-up was 81% at 2 years for both groups. PC group had a higher rate of overall (31% vs. 6%;p < 0.05) and severe (Clavien-Dindo >= III; 13% vs. 0%;p = 0.013) complications than that of the control group. Mean %EWL of PC at 2 years of follow-up was 84.9%, without differences compared with that of the control group (83.1%). Comorbidity remission in PC was 14%, 50%, and 85% for hypertension, type 2 diabetes, and dyslipidemia, respectively. Patients without cirrhosis had a higher resolution rate of hypertension (65% vs. 14%,p = 0.03). Conclusion LBS is effective for weight loss and comorbidity resolution in patients with obesity and Child A liver cirrhosis. However, these results are accompanied by significantly increased risk of complications.
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    Exploring the relationship between capillary refill time, skin blood flow and microcirculatory reactivity during early resuscitation of patients with septic shock: a pilot study
    (2023) Contreras, Roberto; Hernandez, Glenn; Daniel Valenzuela, Emilio; Gonzalez, Cecilia; Ulloa, Rodrigo; Soto, Dagoberto; Castro, Ricardo; Guzman, Camila; Oviedo, Vanessa; Alegria, Leyla; Vidal, Diego; Morales, Sebastian; Adolfo Ospina-Tascon, Gustavo; Bakker, Jan; Kattan, Eduardo
    Capillary refill time (CRT), a costless and widely available tool, has emerged as a promising target to guide septic shock resuscitation. However, it has yet to gain universal acceptance due to its potential inter-observer variability. Standardization of CRT assessment may minimize this problem, but few studies have compared this approach with techniques that directly assess skin blood flow (SBF). Our objective was to determine if an abnormal CRT is associated with impaired SBF and microvascular reactivity in early septic shock patients. Twelve septic shock patients were subjected to multimodal perfusion and hemodynamic monitoring for 24 h. Three time-points (0, 1, and 24 h) were registered for each patient. SBF was measured by laser doppler. We performed a baseline SBF measurement and two microvascular reactivity tests: one with a thermal challenge at 44 & DEG;C and other with a vascular occlusion test. Ten healthy volunteers were evaluated to obtain reference values. The patients (median age 70 years) exhibited a 28-day mortality of 50%. Baseline CRT was 3.3 [2.7-7.3] seconds. In pooled data analysis, abnormal CRT presented a significantly lower SBF when compared to normal CRT [44 (13.3-80.3) vs 193.2 (99.4-285) APU, p = 0.0001]. CRT was strongly associated with SBF (R-2 0.76, p < 0.0001). An abnormal CRT also was associated with impaired thermal challenge and vascular occlusion tests. Abnormal CRT values observed during early septic shock resuscitation are associated with impaired skin blood flow, and abnormal skin microvascular reactivity. Future studies should confirm these results.
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    The impact of norepinephrine dose reporting heterogeneity on mortality prediction in septic shock patients
    (2024-07-03) Morales, Sebastian; Wendel-Garcia, Pedro D.; Ibarra-Estrada, Miguel; Jung, Christian; Castro, Ricardo; Retamal, Jaime; Cortinez, Luis I.; Severino, Nicolás; Kiavialaitis, Greta E.; Ospina-Tascón, Gustavo; Bakker, Jan; Hernández, Glenn; Kattan, Eduardo
    Background: Norepinephrine (NE) is a cornerstone drug in the management of septic shock, with its dose being used clinically as a marker of disease severity and as mortality predictor. However, variations in NE dose reporting either as salt formulations or base molecule may lead to misinterpretation of mortality risks and hinder the process of care. Methods: We conducted a retrospective analysis of the MIMIC-IV database to assess the impact of NE dose reporting heterogeneity on mortality prediction in a cohort of septic shock patients. NE doses were converted from the base molecule to equivalent salt doses, and their ability to predict 28-day mortality at common severity dose cut-offs was compared. Results: 4086 eligible patients with septic shock were identified, with a median age of 68 [57–78] years, an admission SOFA score of 7 [6–10], and lactate at diagnosis of 3.2 [2.4–5.1] mmol/L. Median peak NE dose at day 1 was 0.24 [0.12–0.42] μg/kg/min, with a 28-day mortality of 39.3%. The NE dose showed significant heterogeneity in mortality prediction depending on which formulation was reported, with doses reported as bitartrate and tartrate presenting 65 (95% CI 79–43)% and 67 (95% CI 80–47)% lower ORs than base molecule, respectively. This divergence in prediction widened at increasing NE doses. When using a 1 μg/kg/min threshold, predicted mortality was 54 (95% CI 52–56)% and 83 (95% CI 80–87)% for tartrate formulation and base molecule, respectively. Conclusions: Heterogeneous reporting of NE doses significantly affects mortality prediction in septic shock. Standardizing NE dose reporting as base molecule could enhance risk stratification and improve processes of care. These findings underscore the importance of consistent NE dose reporting practices in critical care settings.