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

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Examinando Artículos de Revistas por Materia "Acute respiratory distress syndrome"

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    Association of Ventilatory Ratio with Acute Cor Pulmonale and Mortality in COVID-19 ARDS: A Cohort Study
    (Sage Publications, 2025-09-08) Benites, Martín Hernán; Battiato, Romina; Mercado, Pablo; Pairumani, Ronald; Medel, Juan Nicolás; Petruska, Edward; Ugalde, Diego; Morales, Felipe; Eisen, Daniela; Araya, Carla; Montoya, Jorge; Retamal, Jaime; Kattan, Eduardo; Basoalto, Roque; Bugedo, Guillermo; Valenzuela, Emilio Daniel
    Purpose: An elevated ventilatory ratio (VR) and acute cor pulmonale (ACP) are associated with mortality in ARDS patients. The primary aim of this study was to assess the association between VR and ACP in patients with COVID-19-related ARDS (CARDS). The secondary objectives were to analyze the association between VR and ICU mortality, describe VR temporal behavior in survivors and non-survivors, and evaluate the association between VR and pulmonary embolism. Materials and Methods: We studied a cohort of patients with C-ARDS. The VR was calculated using a validated formula. Echocardiography was used to diagnose ACP, and CT pulmonary angiography was performed to identify PE. To evaluate the associations between VR and ACP, mortality, and PE, a generalized logistic regression model was used. Results: Of the 140 subjects, 60 (43%) had a VR < 2, while 80 (57%) had a VR ≥ 2. Patients with a VR ≥2 had a higher risk of developing ACP than those with a VR <2 (Odds Ratio (OR), 3.77; 95% CI: 1.30 - 8.72). The ICU mortality rate was 29%. Of the 40 patients who died, 30 (75%) had a VR ≥ 2. Mortality was significantly associated with VR ≥ 2 and driving pressure ≥ 15 cm H2O. In non-survivor patients with a VR < 2 at ICU admission, a significant increase in VR was observed over the 7-day observation period. No significant association was observed between PE and VR (p = .118). Conclusion: Elevated VR was associated with ACP in patients with C-ARDS. VR ≥ 2 combined with driving pressure ≥ 15 cm H2O significantly improved the ability to identify patients at risk for ACP. Additionally, at ICU admission, elevated VR values and initially low values that increased over the first week were associated with higher ICU mortality
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    Critical asthma in infancy and toddlers: how can we mechanically discriminate from critical bronchiolitis?
    (Wiley, 2024-11-06) Cruces, Pablo; Alcántar, Valentina; Caviedes, Paola; Díaz, Franco
    Asthma in infancy and toddlers has been increasingly recognized, referring to recurrent episodes of wheezing, also in mechanically ventilated children [1]. We analyzed the working pressures of the respiratory system under static conditions in a cohort of infants and toddlers with a discharge diagnosis of critical asthma. Also, we compare them with critical bronchiolitis cohort and anesthetized children without respiratory disease (normal physiology). Finally, we aimed to identify consistent thresholds in lung mechanics to discriminate between these conditions.
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    Physiological and clinical effects of trunk inclination adjustment in patients with respiratory failure: a scoping review and narrative synthesis
    (BMC, 2024-07-09) Benites, Martín Hernán; Zapata‑Canivilo, Marcelo; Poblete, Fabian; Labbe, Francisco; Battiato, Romina; Ferre, Andrés; Dreyse, Jorge; Bugedo, Guillermo; Bruhn, Alejandro; Costa, Eduardo L. V.; Retamal, Jaime
    Background Adjusting trunk inclination from a semirecumbent position to a supinefat position or vice versa in patients with respiratory failure signifcantly afects numerous aspects of respiratory physiology including respiratory mechanics, oxygenation, endexpiratory lung volume, and ventilatory efciency. Despite these observed efects, the current clinical evidence regarding this positioning manoeuvre is limited. This study undertakes a scoping review of patients with respiratory failure undergoing mechanical ventilation to assess the efect of trunk inclination on physiological lung parameters. Methods The PubMed, Cochrane, and Scopus databases were systematically searched from 2003 to 2023. Interventions: Changes in trunk inclination. Measurements: Four domains were evaluated in this study: 1) respiratory mechanics, 2) ventilation distribution, 3) oxygenation, and 4) ventilatory efciency. Results After searching the three databases and removing duplicates, 220 studies were screened. Of these, 37 were assessed in detail, and 13 were included in the fnal analysis, comprising 274 patients. All selected studies were experimental, and assessed respiratory mechanics, ventilation distribution, oxygenation, and ventilatory efciency, primarily within 60 min post postural change. Conclusion In patients with acute respiratory failure, transitioning from a supine to a semirecumbent position leads to decreased respiratory system compliance and increased airway driving pressure. Additionally, CARDS patients experienced an improvement in ventilatory efciency, which resulted in lower PaCO2 levels. Improvements in oxygenation were observed in a few patients and only in those who exhibited an increase in EELV upon moving to a semi recumbent position. Therefore, the trunk inclination angle must be accurately reported in patients with respiratory failure under mechanical ventilation
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    Ventilatory load reduction by combined mild hypothermia and ultraprotective mechanical ventilation strategy in severe COVID-19-related acute respiratory distress syndrome: A physiological study.
    (The Emergency Medicine Association of Turkey, 2024-04) Cruces, Pablo; Moreno, Diego; Reveco, Sonia; Ramírez, Yenny; Díaz, Franco
    We report the feasibility of a combined approach of very low low tidal volume (VT) and mild therapeutic hypothermia (MTH) to decrease the ventilatory load in a severe COVID-19-related acute respiratory distress syndrome (ARDS) cohort. Inclusion criteria was patients ≥18 years old, severe COVID 19 related ARDS, driving pressure ∆P >15 cmH2 O despite low-VT strategy, and extracorporea therapies not available. MTH was induced with a surface cooling device aiming at 34°C. MTH was maintained for 72 h, followed by rewarming of 1°C per day. Data were shown in median (interquartile range, 25%–75%). Mixed effects analysis and Dunnett’s test were used for comparisons. Seven patients were reported. Ventilatory load decreased during the first 24 h, minute ventilation (VE) decreased from 173 (170–192) to 152 (137–170) mL/kg/min (P = 0.007), and mechanical power (MP) decreased from 37 (31–40) to 29 (26–34) J/min (P = 0.03). At the end of the MTH period, the VT, P, and plateau pressure remained consistently close to 3.9 mL/kg predicted body weight, 12 and 26 cmH2 O, respectively. A combined strategy of MTH and ultraprotective mechanical ventilation (MV) decreased VE and MP in severe COVID-19-related ARDS. The decreasing of ventilatory load may allow maintaining MV within safety thresholds.