Artículos de Revistas

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https://repositorio.uft.cl/handle/20.500.12254/2464

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Examinando Artículos de Revistas por Materia "ARDS"

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    Ítem
    Clinical and organizational framework of repurposing pediatric intensive care unit to adult critical care in a resource-limited setting: Lessons from the response of an urban general hospital to the COVID-19 pandemic
    (Elsevier, 2022) Díaz, Franco; Kehr, Juan; Cores, Camila; Rubilar, Patricia; Medina, Tania; Vargas, Caroline; Cruces, Pablo
    Purpose We aim to describe the action plan and clinical results of a COVID-19 unit for adult patient care in units intended for critically ill children, proposing a clinical/administrative framework. Methods We reviewed the preparedness of the PICU team before the surge of cases of COVID-19 and the organizational/administrative issues to increase critical beds in a six-bed PICU allocated to adult critical care in a government-funded general hospital in Latin America. We analyzed the prospectively collected administrative/clinical data of severe COVID-19 cases admitted to PICU during the peak of the first wave of the pandemic. Results We describe a 6-step preparedness plan: recruitment and education, admission criteria, children diversion, team hierarchy, and general and respiratory equipment. The 6-bed PICU was allocated to adult care for 20 weeks, progressively increasing capacity to a 23-bed dedicated COVID-19 unit managed by the PICU team. A six-block bed organizational units were implemented, and personnel increased from 40 to 125 healthcare workers in 24 h shifts. COVID-19 incidence in personnel was 0.5/1000 workdays. One hundred thirty-six patients were admitted, median age 59 (51,65) years old, 68% were male, and 63% had P/F ≤ 100. In addition, 48% received mechanical ventilation, the median length of stay was 7 (3,17), and in-hospital mortality was 15%. Conclusions We propose an organizational framework for the role of PICU in the hospital action plan to increase adult critical beds. The cohort of patients admitted to a PICU repurposed as a COVID-19 ICU had good outcomes. These data are valuable to plan coordinated actions of the healthcare system for future scenarios.
  • Miniatura
    Ítem
    Morphological differences between patient self-inflicted and ventilator-induced lung injury: an experimental study
    (American Thoracic Society, 2023-03) Díaz, Franco
    The role of supraphysiological airway pressure and VT in lung damage during mechanical ventilation (MV) has been studied in-depth, the phenomenon called ventilator-induced lung injury (VILI). Following the same principles, strenuous pontaneous breathing can also be harmful, and the concept of patient self-inflicted lung injury (P-SILI) is proposed (1). However, establishing P-SILI as a pathological entity in acute patients is challenging. There are few P-SILI models focusing on the respiratory effort during MV, showing histological damage in animals with intense respiratory effort (2–4). On the contrary, data regarding strong unassisted spontaneous breathing without MV is lacking. Therefore, we aimed to compare the histopathological findings in animals with acute lung injury (ALI) treated without ventilatory support, injurious MV, and protective MV.