Browsing by Author "Romero Patiño, Carlos"

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    Fisiopatología de la lesión neurológica aguda
    (Médica Panamericana, 2024) Fisher Prato, Danilo; Rovegno Echavarria David Maximiliano; Romero Patiño, Carlos
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    Impacto hemodinámico de la presión positiva de fin de espiración (PEEP) durante la falla respiratoria grave: Visión actual
    (2002) Tomicic, Vinko; Andresen M, M.; Romero Patiño, Carlos; Mercado Flores, Marcelo Esteban
    Bedside evaluation of pulmonary mechanics and thoracic computed axial tomography have changed the ventilatory management of patients suffering an acute respiratory failure caused by adult respiratory distress syndrome (ARDS). Mortality has been reduced limiting tidal volumes, which avoids alveolar overdistention and by the use of positive end expiratory pressure (PEEP), that reduces the damage caused by cyclical alveolar collapse-reopening. Nowadays, it is well known that inappropriate mechanical ventilation enhances lung damage caused by the underlying disease. However, the optimal adjustment of PEEP is not yet established. Usually, it is not easy to achieve an equilibrium between an optimal lung recruitment without producing alveolar overdistention and hemodynamic adverse effects such as hypotension and reduction of cardiac output. This paper reviews the interactions between heart and lung.
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    Implementation of a norepinephrine-based protocol for management of septic shock: a pilot feasibility study
    (2006) Hernández P., Glenn; Bruhn, Alejandro; Romero Patiño, Carlos; Larrondo Gálvez, Francisco Andrés; De la Fuente Sanhueza, René; Cornejo, Rodrigo; Castillo Fuenzalida, Luis Benito; Bugedo Tarraza, Guillermo
    Background: The subject of the best vasopressor for hemodynamic management of septic shock (SS) is controversial. One of the difficulties in planning such studies is that physicians are reluctant to use one vasopressor exclusively, and there is considerable variation in practice. The aim of this study was to test the feasibility of implementing a single pressor-based algorithm (in this case, norepinephrine [NE]). Methods: A NE-based algorithm was applied prospectively to 100 consecutive SS patients. A formal training program was implemented before starting the protocol and applied to 72 physicians and nurses involved in intensive care unit (ICU) patient care. Compliance, protocol violations, probable adverse effects, and outcome were evaluated on a daily basis by an independent group of fellows and a research nurse. Results: In 100 patients, there were 7,139 hours of algorithm use. Only 13 protocol violations were observed, mostly in the timing of inotropic drugs. Senior staff physicians or busy night shifts accounted for most of these violations. ICU mortality was 33%, which is comparable to that predicted by Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. Adverse events probably related to NE were not observed. Conclusions: The present algorithm, applied after a strict training program, obtained an overall good acceptance and compliance with very few protocol violations in more than 7,000 hours of use. Safety was demonstrated by a global mortality comparable to that predicted by severity scores and absence of specific drugrelated morbidity. The implementation of a single pressor-based algorithm for SS is feasible and safe.
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    Infarto agudo al miocardio con supradesnivel del ST y terapias de reperfusión
    (Mediterráneo, 2015) Castro Galvez, Pablo Federico; Paredes Cardenas, Freddy Alejandro; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis; Romero Patiño, Carlos