Browsing by Author "Reyes, Luis Felipe"

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    Adherence to low tidal volume in the transition to spontaneous ventilation in patients with acute respiratory failure in intensive care units in Latin America (SPIRAL): a study protocol
    (Associacao de Medicina Intensiva Brasileira - AMIB, 2024) Diniz-Silva, Fabia; Pinheiro, Bruno Valle; Reyes, Luis Felipe; Cavalcanti, Alexandre Biasi; Figueredo, Belinda; Rios, Fernando; Machado, Flávia Ribeiro; Preda, Gabriel; Bugedo Tarraza, Guillermo Jaime; Maia, Israel Silva; da Silveira, Leda Tomiko Yamada; Herrera, Luis; Jibaja, Manuel; Ibarra-Estrada, Miguel; Cestari, Mino; Nin, Nicolás; Roldan, Rollin; Dos Santos, Tiago Mendonça; Veiga, Viviane Cordeiro; Bruhn Cruz, Alejandro Rodrigo; Ferreira, Juliana Carvalho
    © 2024, Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.Objective: Patients with acute respiratory failure often require mechanical ventilation to reduce the work of breathing and improve gas exchange; however, this may exacerbate lung injury. Protective ventilation strategies, characterized by low tidal volumes (≤ 8mL/kg of predicted body weight) and limited plateau pressure below 30cmH2O, have shown improved outcomes in patients with acute respiratory distress syndrome. However, in the transition to spontaneous ventilation, it can be challenging to maintain tidal volume within protective levels, and it is unclear whether low tidal volumes during spontaneous ventilation impact patient outcomes. We developed a study protocol to estimate the prevalence of low tidal volume ventilation in the first 24 hours of spontaneous ventilation in patients with hypoxemic acute respiratory failure and its association with ventilator-free days and survival. Methods: We designed a multicenter, multinational, cohort study with a 28-day follow-up that will include patients with acute respiratory failure, defined as a partial oxygen pressure/ fraction of inspired oxygen ratio < 300mmHg, in transition to spontaneous ventilation in intensive care units in Latin America. Results: We plan to include 422 patients in ten countries. The primary outcomes are the prevalence of low tidal volume in the first 24 hours of spontaneous ventilation and ventilator-free days on day 28. The secondary outcomes are intensive care unit and hospital mortality, incidence of asynchrony and return to controlled ventilation and sedation. Conclusion: In this study, we will assess the prevalence of low tidal volume during spontaneous ventilation and its association with clinical outcomes, which can inform clinical practice and future clinical trials.
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    Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study
    (NATURE PORTFOLIO, 2023) Reyes, Luis Felipe; Rodriguez, Alejandro; Fuentes, Yuli V.; Duque, Sara; Garcia-Gallo, Esteban; Bastidas, Alirio; Serrano-Mayorga, Cristian C.; Ibanez-Prada, Elsa D.; Moreno, Gerard; Ramirez-Valbuena, Paula C.; Ospina-Tascon, Gustavo; Hernandez, Glenn; Silva, Edwin; Diaz, Ana Maria; Jibaja, Manuel; Vera-Alarcon, Magdalena; Diaz, Emili; Bodi, Maria; Sole-Violan, Jordi; Ferrer, Ricard; Albaya-Moreno, Antonio; Socias, Lorenzo; Figueroa, William; Lozano-Villanueva, Jose L.; Varon-Vega, Fabio; Estella, Angel; Loza-Vazquez, Ana; Jorge-Garcia, Ruth; Sancho, Isabel; Shankar-Hari, Manu; Martin-Loeches, Ignacio
    Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40-2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98-1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes.