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Browsing by Author "González Seguel, Felipe"

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Acute skeletal muscle wasting in patients with acute kidney injury requiring continuous kidney replacement therapy: A prospective multicenter study
(2026) Mayer, Kirby; Teixeira, Pedro; González Seguel, Felipe; Tran, Vinh; Gross, Jessica; Horikawa, Arimitsu; Anil, Chaitanya; Shareef, Zan; Puffer, Hayley; Wen, Yuan; Griffin, Benjamin; Neyra, Javier
Purpose: Acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT) has been hypothesized to increase the risk of developing intensive care unit-associated weakness (ICU-AW), but prospective data are lacking. Materials and methods: This prospective observational study evaluated critically ill adults with AKI requiring CKRT at two U.S. academic hospitals. Using ultrasonography (US), we quantified changes in rectus femoris (RF) muscle mass and quality in the first week after CKRT initiation. At hospital discharge, we assessed for ICU-AW, physical function, and frailty. Results: Twenty-three patients with median age 56 [IQR 47-60] years, BMI 29 [26-36] kg/m2, and Charlson Comorbidity Index 3 [1.5-5] were enrolled. The baseline Sequential Organ Failure Assessment (SOFA) score was 9 [7.5-11.5] and CKRT duration was 4 [1-7] days. Six (26 %) patients died in the ICU and one (4 %) transitioned to comfort measures before study completion. Substantial muscle wasting occurred between Day 1 and Day 7: RF muscle thickness (mT) decreased by 10 % [3 %-20 %]; RF cross-sectional area (CSA) decreased by 19 % [12 %-22 %]; and echo intensity (EI) increased (implying worse muscle quality) by 14 % [5 %-25 %]. A significant effect of time within subjects was observed for all three ultrasound measures (CSA: F = 66.2, p < 0.001; mT: F = 27.1, p < 0.001; EI: F = 22.5, p < 0.001). At hospital discharge, 67 % of survivors (n = 10/15) met criteria for ICU-AW. Conclusions: Patients with AKI requiring CKRT experienced significant muscle wasting in the first week following CKRT initiation and had high rate of ICU-AW at hospital discharge. Trial registration: NCT05287204, Registered 20 October 2021.
Assessment of redundancy, methodological and reporting quality, and potential discrepancies of results of systematic reviews of early mobilisation of critically ill adults: a meta- research protocol
(2023) Gutierrez-Arias, Ruvistay; Pieper, Dawid; Nydahl, Peter; González Seguel, Felipe; Jalil, Yorschua; liveros, Maria-José; Torres-Castro, Rodrigo; Seron, Pamela
Introduction Several systematic reviews (SRs) have been conducted to determine the effectiveness of early mobilisation in critically ill adults with heterogeneous methodology and results. Redundancy in conducting SRs, unclear justification when leading new SRs or updating, and discordant results of SRs on the same research question may generate research waste that makes it difficult for clinicians to keep up to date with the best available evidence. This meta- research aims to assess the redundancy, methodological and reporting quality, and potential reasons for discordance in the results reported by SRs conducted to determine the effectiveness of early mobilisation in critically ill adult patients. Methods and analysis A meta- research of early mobilisation SRs in critically ill adult patients will be conducted. A search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos and other search resources will be conducted. Two independent reviewers will perform study selection, data extraction and quality appraisal. Discrepancies will be resolved by consensus or a third reviewer. The redundancy of SRs will be assessed by the degree of overlap of primary studies. In addition, the justification for conducting new SRs will be evaluated with the ‘Evidence- Based Research’ framework. The methodological quality of the SRs will be assessed with the A MeaSurement Tool to Assess systematic Reviews 2 tool, and the quality of the reports through compliance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses statement. To assess the potential reasons for discordance in the results of the SRs considering divergence in results and their interpretation. Ethics and dissemination As meta- research, this study does not involve the participation of people whose rights may be violated. However, this overview will be developed rigorously and systematically to achieve valid and reliable results. The findings of this meta- research study will be presented at conferences and published in a peer-reviewed journal related to rehabilitation, critical care or research methodology
Critical illness myopathy and trajectory of recovery in acute kidney injury requiring continuous renal replacement therapy: a prospective observational trial protocol
(2023) J Pedro Teixeira, J. Pedro; Griffin, Benjamin R.; Pal, Chaitanya Anil; González Seguel, Felipe; Jenkins, Nathanial; Jones, Beth M.; Yoshida, Yuri; George, Naomi; Israel, Hayley Puffer; Ghazi, Lama; Neyra, Javier A.; Mayer, Kirby P.
Introduction Acute kidney injury requiring renal replacement therapy (AKI- RRT) is common in the intensive care unit (ICU) and is associated with significant morbidity and mortality. Continuous RRT (CRRT) non- selectively removes large amounts of amino acids from plasma, lowering serum amino acid concentrations and potentially depleting total- body amino acid stores. Therefore, the morbidity and mortality associated with AKI- RRT may be partly mediated through accelerated skeletal muscle atrophy and resulting muscle weakness. However, the impact of AKI- RRT on skeletal muscle mass and function during and following critical illness remains unknown. We hypothesise that patients with AKI- RRT have higher degrees of acute muscle loss than patients without AKI- RRT and that AKI- RRT survivors are less likely to recover muscle mass and function when compared with other ICU survivors. Methods and analysis This protocol describes a prospective, multicentre, observational trial assessing skeletal muscle size, quality and function in ICU patients with AKI- RRT. We will perform musculoskeletal ultrasound to longitudinally evaluate rectus femoris size and quality at baseline (within 48 hours of CRRT initiation), day 3, day 7 or at ICU discharge, at hospital discharge, and 1–3 months postdischarge. Additional skeletal muscle and physical function tests will be performed at hospital discharge and postdischarge follow- up. We will analyse the effect of AKI- RRT by comparing the findings in enrolled subjects to historical controls of critically ill patients without AKI- RRT using multivariable modelling. Ethics and dissemination We anticipate our study will reveal that AKI- RRT is associated with greater degrees of muscle loss and dysfunction along with impaired postdischarge recovery of physical function. These findings could impact the in- hospital and postdischarge treatment plan for these patients to include focused attention on muscle strength and function. We intend to disseminate findings to participants, healthcare professionals, the public and other relevant groups via conference resentation and publication without any publication restrictions.
Daily compliance of the ABCDEF liberation bundle for patients in the intensive care unit: A retrospective descriptive study
(2024) Muñoz, Felipe; Leppe Zamora, Jaime; González Seguel, Felipe; Castro-Avila, Ana Cristina
Introduction Implementing the ABCDEF bundle has demonstrated improved outcomes in patients with critical illness. This study aims to describe the daily compliance of the ABCDEF bundle in a Chilean intensive care unit. Methods Retrospective observational study of electronic clinical records of nursing, physiotherapy, and medical professionals who cared for patients over 18 years of age, admitted to an intensive care unit for at least 24 hours, with or without mechanical ventilation. Daily bundle compliance was determined by considering the daily records for each element: Assess pain (element A), both spontaneous awakening trials (element B1) and spontaneous breathing trials (element B2), choice of sedation (element C), delirium assessment (element D), early mobilization (element E), and family engagement (element F). Results 4165 registered bundle elements were obtained from nursing (47%), physiotherapy (44%), and physicians (7%), including 1134 patient/days (from 133 patients). Elements E and C showed 67 and 40% compliance, while D, A, and B2 showed 24, 14 and 11%, respectively. For B1 and F, 0% compliance was achieved. Compliance was higher in patients without mechanical ventilation for A and E, while it was similar for D. Conclusions Early mobilization had the highest compliance, while spontaneous awakening trials and family engagement had absolute non-compliance. Future studies should explore the reasons for the different degrees of compliance per bundle element in clinical practice.
Desarrollo de un chatbot para promover el uso de la Functional Status Score for the ICU: un estudio basado en mapeo de intervención
(Universidad del Desarrollo. Facultad de Medicina, 2023) Olave Cerna, Joaquín; González Seguel, Felipe; Leppe Zamora, Jaime
Antecedentes: La Functional Status Score for the ICU (FSS-ICU) es una escala disponible en español que permite evaluar la movilidad en los pacientes de la unidad de cuidados intensivos (UCI), y para su correcto uso se recomienda entrenamiento. Objetivo: Describir el desarrollo de un chatbot de WhatsApp para el uso de la FSS-ICU. Métodos: Como marco teórico se utilizaron las 6 etapas de la metodología Mapeo de Intervención, para facilitar la planificación/diseño de la difusión, implementación y mantenimiento de las intervenciones en la práctica. Medimos usabilidad a través de métricas de 2 de sus 3 atributos: efectividad y satisfacción. Resultados: Se identificaron 3 resultados de desempeño, 4 determinantes y 3 objetivos de desempeño. Tras 6 iteraciones se desarrolló un chatbot de WhatsApp con respuestas automáticas de información necesaria de la FSS-ICU con 7 componentes. Participaron 16 implementadores de 2 UCI chilenas en una pre-prueba del chatbot. Según la frecuencia de mensajes por componente, cada implementador consultó 4(57%) o más componentes siendo considerado un resultado de efectividad. Para la satisfacción se obtuvo una tasa de conversión del 67% y retención del 13%. La encuesta de satisfacción sobre el uso del chatbot mostró que fue fácil de entender, rápida, util y permitió aumento el conocimiento, habilidades. El 92%(n=13) la recomendarían y el 100%(n=14) la reporto como la mejor alternativa disponible para acceder a la información de la FSS-ICU en la clínica. Conclusión: Al evaluar la efectividad y satisfacción de un chatbot automático con información actualizada y basada en la evidencia para el uso clínico de la FSS-ICU se percibió como fácil y rápido de utilizar, permitiendo aumentar los conocimientos y habilidades. Este estudio puede ser precursor de futuros pilotos del chatbot en más centros nacionales.
Development of an artificial intelligence powered software for automated analysis of skeletal muscle ultrasonography
(2025) Calulo, Zoe; González Seguel, Felipe; Horikawa, Arimitsu; Granger, Catherine; Sarwal, Aarti; Dha, Sanjay; Ntoumenopoulos, George; Chen, Jin; Bumgardner, V K; Parry, Selina; Mayer, Kirby; Wen, Yuan
Muscle ultrasound has high utility in clinical practice and research; however, the main challenges are the training and time required for manual analysis to achieve objective quantification of muscle size and quality. We aimed to develop and validate a software tool powered by artificial intelligence (AI) by measuring its consistency and comparability of expert manual analysis quantifying lower limb muscle ultrasound images. Quadriceps complex (QC) and tibialis anterior (TA) muscle images of healthy, intensive care unit, and/or lung cancer participants were captured with portable devices. Manual analyses of muscle size and quality were performed by experienced physiotherapists taking approximately 24 h to analyze all 180 images, while automated analyses were performed using a custom-built deep-learning model (MyoVision-US), taking 247 s (saving time = 99.8%). Consistency between the manual and automated analyses was good to excellent for all QC (ICC = 0.85-0.99) and TA (ICC = 0.93-0.99) measurements, even for critically ill (ICC = 0.91-0.98) and lung cancer (ICC = 0.85-0.99) images. The comparability of MyoVision-US was moderate to strong for QC (adj. R2 = 0.56-0.94) and TA parameters (adj. R2 = 0.81-0.97). The application of AI automating lower limb muscle ultrasound analyses showed excellent consistency and strong comparability compared with human analysis across healthy, acute, and chronic population.
Early Mobilization Dose Reporting in Randomized Clinical Trials With Patients Who Were Mechanically Ventilated: A Scoping Review
(2024) González Seguel, Felipe; Letelier, Renato
Objective: The aim of this scoping review was to investigate the mobilization dose reporting in the randomized clinical trials (RCTs) of patients receiving mechanical ventilation in the intensive care unit. Methods: In this scoping review, RCTs published from inception to December 2022 were searched in relevant electronic databases. Trials that involved adults receiving mechanical ventilation (>48 hours) and any early mobilization modality were analyzed. Two independent authors screened, selected, and extracted data. The mobilization doses of the intervention groups (IGs) and the comparator groups (CGs) were assessed as the proportion of reported items/total applicable from the main items of the Consensus on Exercise Reporting Template (CERT). Results: Twenty-three RCTs comprising 2707 patients (1358 from IG and 1349 from CG) were included, involving studies on neuromuscular electrical stimulation (n = 7), progressive mobility (n = 6), leg cycling (n = 3), tilt table (n = 1), and multicomponent (n = 6) mobilization. The pooled reporting of CERT items was 68% (86% for IG and 50% for CG). The most reported CERT items were type of exercise (100%) and weekly frequency (100%) for IG, whereas the least reported were intensity (4%) and individualization (22%) for CG. Regardless of the group, individualization, progression, and intensity of mobilization were the least reported items. Eight IGs (35%) reported all CERT items, whereas no CGs reported all of them. Conclusions: Deficits in mobilization dose reporting of intensive care unit RCTs were identified, especially for exercise intensity in adults receiving mechanical ventilation. One-third of IG reported all exercise dosing items, whereas no CG reported all of them. Future studies should investigate the details of optimal dosage reporting, particularly for CG. Impact: The lack of dose reporting may partially explain the inconsistency in the meta-analysis results of early mobilization trials, thus limiting the interpretation for clinical practice in the intensive care unit.
Evaluación del funcionamiento físico en cuidados críticos: encuesta nacional en más de 90 centros chilenos durante la pandemia por COVID-19
(2022) González Seguel, Felipe; Cáceres-Parra, Camilo
Background: Physical functioning evaluation in intensive care units (ICUs) identifies rehabilitation requirements and response to interventions. Aim: To identify the usage rate of physical functioning measurement instruments in ICUs during the COVID-19 pandemic in Chile. Material and Methods: Lead physiotherapists representing different national ICUs were invited to answer a National online survey at the onset (T1) and at the first year of COVID-19 pandemic (T2). The usage rate (defined as “always”/“almost always”/“almost never”/“never”) of instruments assessing muscle strength, muscle mass, mobility, and physical performance was surveyed. Also, the reasons for selecting these instruments were requested. Results: We received responses from 94 and 93 ICUs at T1 and T2, respectively, of 111 eligible ICUs (55% public). Compared with T2, the usage rate of instruments was lower at T1, and significant only for Medical Research Sum-Score (MRC-SS) (p = 0.04) and handgrip dynamometry (p = 0.05). Considering the answers “always”, “almost always” and “almost never”, between 89% and 91% of the ICUs reported the use of the MRC-SS; between 70% and 73% reported the use of the Functional Status Score for the Intensive Care Unit; between 5% and 35% of the ICUs reported the use of the rest of mobility scales; and between 44%-45% of ICUs reported that muscle ultrasound was “almost never” used. The main reasons reported for selecting instruments were quick use and clinimetric properties. Conclusions: The usage rate of muscle strength assessments was frequent, while the use of mobility and muscle mass instruments recommended by the literature was poorly reported, which was lower at the onset of the pandemic.
Factores de riesgo de discapacidad tres meses después de cuidados intensivos IMPACCT – Discapacidad.
(Universidad del Desarrollo. Facultad de Medicina, 2024) Ferreira Saavedra, Simón; Molina Blamey, Jorge; González Seguel, Felipe
Objetivo: Determinar la prevalencia y factores de riesgo de sobrevivientes la unidad de cuidados intensivos (UCI).a los 3 meses después del egreso. Método: Realizamos un análisis secundario del estudio IMPACCT-COVID-19, realizado entre octubre del 2020 y abril del 2021. De los 252 pacientes egresados de la UCI, 105 reportaron telefónicamente el grado de discapacidad a los 3 meses usando la World Health Organization Disability Assesment Schedule (WHODAS 2.0), por lo tanto fueron incluidos en este estudio. Se recopilaron variables clínicas (días de ventilación mecánica, ansiedad, diagnóstico de ingreso y otras) y sociodemográficas (edad, sexo, índice de masa corporal y otras) para identificar potenciales factores de riesgo. Éstas se analizaron con regresión logística univariable y multivariable. Resultados: La mediana de edad fue de 57 [47-65] años y el 79% ingreso por COVID-19. La prevalencia de discapacidad a los 3 meses después de la UCI fue del 30%. Tener más de 12 años de educación (OR 0,31 - IC 95% 0,1-0,97) fue un factor protector según la regresión logística simple, mientras que la presencia de depresión (OR 19,2 - IC 95% 5,2-70,7) o ansiedad (OR 5,7 - IC 95% 1,9-17,1) al egreso de la UCI y tener 2 comorbilidades (OR 5,38 - IC 95% 1,5-19,3) fueron factores de riesgo para presentar discapacidad a los 3 meses, según la regresión logística multivariable. Conclusiones: Casi un tercio de los sobrevivientes de la UCI reportaron discapacidad tres meses después de su egreso. Las comorbilidades y la presencia de ansiedad o depresión al egreso de UCI fueron factores de riesgo, mientras que tener más de 12 años de educación fue un factor protector.
Factores de riesgo para el deterioro cognitivo a los 3 meses en sobrevivientes de UCI durante la pandemia por Covid-19
(Universidad del Desarrollo. Facultad de Medicina, 2023) Cantillano Matus, Millaray; González Seguel, Felipe
Objetivo: Determinar los factores de riesgo para presentar deterioro cognitivo a los 3 meses post egreso de la UCI en contexto de pandemia por COVID-19. Pacientes y método: Análisis secundario de una cohorte prospectiva que incluyó a pacientes dados de alta de UCI entre octubre 2020 y abril 2021 de 7 centros (públicos y privados) en Chile. Los pacientes fueron adultos que habían estado en ventilación mecánica (VM) al menos 48 horas y que caminaran de forma independiente al menos 2 semanas antes de su ingreso a UCI. Se consideró deterioro cognitivo un puntaje <18 puntos en el test MOCA-Blind. Se incluyeron como factores de riesgo (FR) la edad, sexo, fragilidad clínica, diagnóstico de ingreso, nivel educacional, comorbilidades y el nivel de ocupación de camas según la demanda sanitaria del momento. El análisis de datos se realizó a través de una regresión logística múltiple ajustada. Los resultados se muestran en Odds Ratio (OR) e intervalo de confianza del 95% (IC95%). Resultados: Se identificaron 1.317 pacientes, 405 fueron elegibles al egreso de la UCI y 252 evaluados al alta, mientras que 103 fueron evaluados a los 3 meses de su egreso de UCI. De estos, 34(33%) correspondía a mujeres, la mediana (p25, p75) de edad fue 56(47,65) años y 40(38%) presentó deterioro cognitivo a los 3 meses. Los pacientes con deterioro cognitivo tenían al menos una comorbilidad (OR 1.9 IC95% 1.0-3.3; p-value =0.024), más probabilidad de tener fragilidad al ingreso (OR 6.8 IC95% 0.74-64; p-value=0.09), menos de 8 años de educación (OR 15 IC95% 2 – 113; p-value <0.009) y haber tenido deterioro cognitivo al alta de la UCI (OR 2.9 IC95% 1.1-7.6; p-value=0.030). La duración de la estadía en UCI, la VM, el diagnóstico de ingreso, tener COVID-19 y el nivel de ocupación de camas no estuvieron asociadas a la probabilidad de deterioro cognitivo a los 3 meses. Conclusión: Menos de 8 años de educación, fragilidad, más de una comorbilidad y deterioro cognitivo al egreso de UCI se asociaron a deterioro cognitivo a los 3 meses. Pacientes con estos factores de riesgo deberían ser priorizados para intervención preventiva antes del alta hospitalaria.
Inter-observer reliability of trained physiotherapists on the Functional Status Score for the Intensive Care Unit Chilean-Spanish version
(2020) González Seguel, Felipe; Camus-Molina, Agustín; Cárcamo, Marcela; Hiser, Stephanie; Needham, Dale M.; Leppe, Jaime
Purpose: Evaluate inter-observer reliability of trained physiotherapists administering the Chilean-Spanish version of the Functional Status Score for the Intensive Care Unit (FSS-ICU).Methods: Six adult patients in a medical-surgical ICU were assessed and video-recorded by 1 of 2 expert physiotherapists. Twelve physiotherapists were then trained using recommended Spanish-language FSS-ICU materials. The 12 physiotherapists independently scored the FSS-ICU for the 6 video-recorded patients. Intraclass Correlation Coefficient (ICC) was used to evaluate the inter-observer reliability, and modified Bland-Altman plots evaluated agreement between the physiotherapists and experts.Results: This study was performed between May and August 2018. The FSS-ICU total score had a median score of 18 (range: 6 to 34) for the 6 patients. The ICC of the total score was 0.96 (95% CI, 0.92 to 1.00), and for each of the 5 individual FSS-ICU tasks, the ICC ranged between 0.87 and 0.92. The modified Bland-Altman plot revealed a mean difference of 0.6 (95% limits of agreement: -3.3 to 4.5).Conclusions: Twelve trained physiotherapists had excellent inter-observer reliability when administering the Chilean-Spanish FSS-ICU using videos of six critically ill patients, and had excellent agreement with an expert, revealing differences within the established minimal important difference. These findings provide new data supporting clinimetric properties of the Chilean-Spanish FSS-ICU.
Modificaciones en las prácticas de los kinesiólogos de unidades de cuidados intensivos durante el primer año de pandemia por Covid-19 en Chile: encuesta nacional. Proyecto DeKUCI COVID-19
(Universidad del Desarrollo. Facultad de Medicina, 2022) Cáceres Parra, Camilo Alonso; González Seguel, Felipe
Introducción: Las unidades de cuidados intensivos (UCI), debieron adaptarse a la demanda sanitaria generada por la pandemia por COVID-19. Con el fin de explorar como se desempeñaron los equipos de kinesiólogos intensivos, este estudio busca describir las modificaciones institucionales, laborales y asistenciales experimentadas por los kinesiólogos de UCI durante el primer año de pandemia. Metodología: Encuesta nacional chilena patrocinada por COLKINE y aprobada por CEC CAS-UDD. Se envió una encuesta a un kinesiólogo representante de cada UCI en Chile Obteniendo información de cuatro periodos: previo 15 de marzo de 2020 (P1), julio de 2020 (P2), octubre de 2020 (P3) y marzo de 2021 (P4). La información se recopiló de manera retrospectiva. Resultados: De 111 UCIs elegibles, se obtuvo información de los cuatro periodos en 84[76%] de los centros; predominando 49[58%] fuera de la región metropolitana, 48[57%] públicos. A nivel institucional, hubo cambios significativos en todos los periodos. En la cantidad de camas UCI (mediana[RIQ] en P1: 10[6-15], P2: 29,5[12-44], P3: 15[10.5-26.5], P4: 24[14-54]), cantidad de kinesiólogos (P1: 2[1-3], P2: 4.5[2-8], P3: 3[2-6], P4: 4[2-8]), 69[82%] incorporaron nuevos kinesiólogos durante P2 y la disponibilidad de kinesiólogo 24/7 aumento (P1: 53[64%], P2: 75[89%], P3: 74[88%] y P4:72[87%]). A nivel laboral, entre P2-P4 se cumplió la recomendación de carga laboral solo en la jornada diurna en día hábil. A nivel asistencial, en P2 hubo mayor uso de ecografía, prono, traslado intrahospitalario y entrega de turno con respecto al periodo P1. En cambio, la docencia clínica y el uso de cicloergómetros disminuyeron desde P1 a P2. Conclusiones: Primer estudio de carácter censal, analítico y trasversal en Chile para la kinesiología intensiva en pandemia. Existieron modificaciones significativas a nivel institucional, laboral y varias de ellas perduran hasta un año desde el inicio de ésta.
Prácticas de implementación de la ecografía muscular orientada al paciente crítico en profesionales entrenados: un estudio mixto
(Universidad del Desarrollo. Facultad de Medicina, 2025) Villablanca Silva, Cecilia Gemita; González Seguel, Felipe
OBJETIVO: Identificar las prácticas de implementación de la ecografía muscular en profesionales de la salud que han recibido entrenamiento en ecografía muscular periférica, incluyendo su utilidad, barreras y facilitadores. MÉTODOS: Estudio mixto, explicatorio y secuencial basado en la metodología de Creswell. Se realizaron dos fases: (1) una fase cuantitativa mediante encuesta en línea y (2) una fase cualitativa con entrevistas semiestructuradas. La encuesta recopiló información en seis dimensiones: (1) características sociodemográficas, (2) evaluación general de la masa muscular, (3) evaluación mediante ecografía, (4) barreras en la práctica, (5) interés en realizar evaluaciones con ecografía y (6) interés en capacitación. En la fase cualitativa, se realizó un análisis temático basado en las recomendaciones de Braun y Clarke para explorar la experiencia y percepciones de los profesionales sobre la implementación de la ecografía en sus centros de trabajo. RESULTADOS: Un total de 43 profesionales respondieron la encuesta (43% mujeres), con una mediana de edad de 33 [30-37] años. El 70% (n=30) reportó utilizar la ecografía como herramienta de evaluación muscular; de estos principalmente se desempeñan en el área clínica (74%, n=32), seguido de la investigación (21%, n=9) y docencia (19%, n=8), pero sólo un 5% (n=2) reportó utilizarla de forma frecuente todos sus días laborales. Las principales barreras identificadas de los hallazgos cuantitativos fueron la carga laboral (88%) y el costo del equipo (72%). En los resultados del análisis cualitativo, los códigos deductivos se derivaron de cinco hallazgos extraídos de la encuesta: entrenamiento insuficiente, costo del equipo, confiabilidad de la herramienta, carga laboral y falta de protocolo. Después del análisis de 15 entrevistas, se identificaron de manera inductiva tres categorías principales en relación con la pregunta de investigación. Las principales dificultades para la implementación de la ecografía en la práctica clínica incluyen la ausencia de protocolos estandarizados, el elevado costo de los equipos y la necesidad de un mayor respaldo institucional. CONCLUSIONES La ecografía muscular fue percibida como una herramienta útil y confiable para la evaluación de pacientes críticos. Sin embargo, se reporta una limitada frecuencia de uso debido a la carga laboral, el costo de los equipos y la falta de formación. Para fomentar su implementación, podría ser necesario mejorar el acceso a equipos, el apoyo institucional, la capacitación continua, la experiencia práctica y la integración en protocolos clínicos estandarizados. La motivación se reportó como un papel clave, actuando tanto como facilitador como barrera, según el contexto. Podrían requerirse estrategias institucionales, programas de formación estructurados y protocolos claros para su integración efectiva en la práctica clínica.
Quiebres de inactividad física de pacientes con ventilación mecánica invasiva: probando el concepto
(Universidad del Desarrollo. Facultad de Medicina, 2023) Leiva Corvalán, Macarena Ignacia; González Seguel, Felipe
Introducción Los pacientes críticos permanecen inactivos la mayor parte del tiempo (entre 92-98%) de la estadía en la unidad de cuidados intensivos (UCI). El objetivo fue describir el comportamiento de la inactividad en pacientes con ventilación mecánica utilizando el concepto de quiebres de inactividad mediante actigrafía. Métodos Análisis secundario de un estudio observacional prospectivo de pacientes críticos adultos mecánicamente ventilados que fueron monitorizados con actigrafía durante toda la estadía en la UCI. De la muestra total (n = 30), se seleccionaron los dos pacientes (A y B) con mayor estadía en UCI (30 y 35 días, respectivamente). Se extrajo información del comportamiento de la inactividad de los primeros diez días desde el despertar, usando el número y duración de quiebres de inactividad (>100 cuentas/minuto). La duración de quiebres de inactividad se presenta en seis intervalos de tiempo acumulados por hora (<1 minuto, 1-4 minutos, 5-9 minutos, 10-14 minutos, 15-29 minutos, y ≥30 minutos). Además, se valoró la movilidad y fuerza muscular al despertar y egreso de UCI. Resultados Ambos pacientes tenían >65 años, ventilación mecánica >10 días y debilidad muscular severa al despertar. El número de quiebres de inactividad de los pacientes A y B fue de 363 y 268, respectivamente. La mediana [RIQ] fue de 35 [33-39] y 25 [22-30] quiebres por día para los pacientes A y B, respectivamente. El paciente B realizó un 52% menos de quiebres de inactividad de ≥30 minutos. Al egreso de UCI, el paciente A tuvo mayor fuerza muscular y movilidad comparado con el paciente B. Conclusiones Fue posible medir los quiebres de inactividad en pacientes mecánicamente ventilados. Futuros estudios podrían confirmar que la información de la cantidad y duración de los quiebres de inactividad es relevante en la toma de decisiones para la movilización de pacientes críticos.
Six-month post-intensive care outcomes during high and low bed occupancy due to the COVID-19 pandemic: A multicenter prospective cohort study
(2023) Castro-Avila, Ana Cristina; Merino, Catalina; González Seguel, Felipe; Camus, Agustín; Muñoz, Felipe; Leppe Zamora, Jaime; IMPACCT COVID-19 study group
Introduction: The COVID-19 pandemic can be seen as a natural experiment to test how bed occupancy affects post-intensive care unit (ICU) patient's functional outcomes. To compare by bed occupancy the frequency of mental, physical, and cognitive impairments in patients admitted to ICU during the COVID-19 pandemic. Methods: Prospective cohort of adults mechanically ventilated >48 hours in 19 ICUs from seven Chilean public and private hospitals. Ninety percent of nationwide beds occupied was the cut-off for low versus high bed occupancy. At ICU discharge, 3- and 6-month follow-up, we assessed disability using the World Health Organization Disability Assessment Schedule 2.0. Quality of life, mental, physical, and cognitive outcomes were also evaluated following the core outcome set for acute respiratory failure. Results: We enrolled 252 participants, 103 (41%) during low and 149 (59%) during high bed occupancy. Patients treated during high occupancy were younger (P50 [P25-P75]: 55 [44-63] vs 61 [51-71]; p<0.001), more likely to be admitted due to COVID-19 (126 [85%] vs 65 [63%]; p<0.001), and have higher education qualification (94 [63%] vs 48 [47%]; p = 0.03). No differences were found in the frequency of at least one mental, physical or cognitive impairment by bed occupancy at ICU discharge (low vs high: 93% vs 91%; p = 0.6), 3-month (74% vs 63%; p = 0.2) and 6-month (57% vs 57%; p = 0.9) follow-up. Conclusions: There were no differences in post-ICU outcomes between high and low bed occupancy. Most patients (>90%) had at least one mental, physical or cognitive impairment at ICU discharge, which remained high at 6-month follow-up (57%).
Trajectories of Recovery after ACutE and cRitical illness (TRACER): a prospective observational study protocol
(González-Seguel F, Summers LA, Fresenko LE, Long DE, Scott LN, Slone SA, Shankara Bhaktula S, Wen Y, Miller BF, Morris PE, Salyer AL, Kalema AG, Montgomery-Yates AA, Dupont-Versteegden EE, Mayer KP; TRACER study group Collaborators. Trajectories of Recovery after ACutE and cRitical illness (TRACER): a prospective observational study protocol, 2025) González Seguel, Felipe; Summers, Louisa; Fresenko, Lindsey; Long, Douglas; Scott, Logan; Slone, Stacey; Shankara, Srushan; Wen, Yuan; Miller, Benjamin; Morris, Peter; Salyer, Amy; Kalema, Anna; Montgomery, Ashley; Dupont, Esther; Mayer, Kirby
Introduction: Patients who survive admission to intensive care unit (ICU) for critical illness are at high risk of developing muscle atrophy and weakness, commonly diagnosed as ICU-acquired weakness (ICUAW). The development of ICUAW is closely linked to long-term symptoms and impairments known as post-intensive care syndrome (PICS). Despite heightened recognition of impairments, there is limited research supporting effective interventions to improve muscle and physical outcomes after hospital discharge. Prior to developing and testing interventions for ICU survivors, it is imperative to understand the trajectory of muscle and physical function recovery following an ICU stay. The purpose of this study is to longitudinally investigate skeletal muscle health and physical function outcomes after ICU admission. Methods and analysis: This protocol describes a single site, prospective, observational study in adult patients who have survived a critical illness (ie, sepsis or acute respiratory failure). Patients will participate in a battery of testing including primary outcomes: muscle power and physical function; and secondary outcomes: muscle strength, muscle size, endurance and physical activity (by accelerometry) at hospital discharge and 3, 6, and 12 months post-discharge. A subset of patients will participate in muscle biopsy and venipuncture. To examine if the trajectory of recovery predicts primary outcomes, we will perform multivariate linear regression models in 150 evaluable patients. To examine differences in molecular and cellular outcomes in plasma and muscle tissue, a control group of community-dwelling adults without history of an ICU stay will be enrolled as a comparator group. Enrolment started on 18 October 2022 with an estimated completion date of 1 August 2027. Ethics and dissemination: This protocol was approved by the University of Kentucky Office of Research Integrity Medical Internal Review Board (# 77407), with patients providing informed written consent. We anticipate our findings to establish recovery trajectories, improving the classification of patients who experience sustained physical disability. Improved identification of recovery trajectories of muscle and physical function enables future studies to employ an individually targeted rehabilitation approach, that is, precision medicine, with the goal of improving patient outcomes. The cellular findings will support the development of novel interventions specifically designed for detecting underlying mechanisms. We intend to disseminate findings to patients, healthcare professionals, the public and other relevant groups via conference presentations and manuscripts without publication restrictions.
Validez de constructo de la versión en español de la "Functional status score for the intensive care unit" (FSS-ICU)
(Universidad del Desarrollo. Facultad de Medicina. Escuela de Kinesiología, 2019) Camus-Molina, Agustín; González Seguel, Felipe; Camus-Molina, Agustín; Gonzalez Seguel, Felipe; Leppe, Jaime
Antecedentes: La Functional Status Score for the Intensive Care Unit (FSS-ICU) es un instrumento válido en su idioma original, recientemente traducido y adaptado al español en Chile. Esto no asegura que la versión adaptada conserve las mismas propiedades psicométricas que la versión original. Objetivo: Evaluar la validez de constructo de la versión en español de la FSS-ICU. Diseño: Estudio observacional prospectivo de evaluación de propiedades psicométricas. Métodos: Se seleccionaron pacientes ventilados mecánicamente de una unidad de cuidados intensivos (UCI) adulto de 12 camas. Se midió movilidad con la FSS-ICU en español, movimiento con acelerometría y fuerza muscular con la Medical Research Council Sum score (MRC-SS) al despertar y egreso de UCI. Se utilizó el coeficiente de Spearman (rho) para evaluar la correlación de las variables. Resultados: Se analizaron veintinueve pacientes con un P50=64 años, 59% mujeres, un Acute Physiology And Chronic Health Evaluation II de P50=16 puntos y un P50 de 2.6 días con ventilación mecánica. El P50 (P25 – P75) del puntaje de la FSS-ICU al despertar y egreso fue de 20 (12–26) y 29 (25–32) puntos, respectivamente. La correlación de la FSS-ICU con el tiempo de inactividad fue negativa al despertar (rho=-0.69, p<0.001) y egreso (rho=-0.77, p<0.001). La FSS-ICU tuvo una correlación positiva con la MRC-SS al despertar (rho=0.63, p<0.001) y egreso (rho=0.69, p<0.001). Limitaciones: La acelerometría es un instrumento de medición no estandarizado para medir el movimiento de los pacientes críticos. Conclusiones: La FSS-ICU tiene moderada a excelente validez de constructo con el tiempo de inactividad durante la estancia en UCI y con la fuerza muscular. La versión en español de la FSS-ICU es válida para medir movilidad en pacientes críticos.
Versión chilena de la functional status score for the intensive care unit(FSS-ICU): Traducción, adaptación transcultural y confiabilidad interobservador
(Universidad del Desarrollo. Facultad de Medicina, 2018) González Seguel, Felipe; Camus Molina, Agustín; Leppe Zamora, Jaime
Introducción: La Functional Status Score for the Intensive Care Unit (FSS-ICU) es una escala válida y confiable para medir movilidad en unidades de cuidados intensivos (UCI). Sin embargo, aún no se ha realizado el proceso recomendado de Traducción y Adaptación Transcultural (TAT) en Chile. Objetivo: Traducir y adaptar transculturalmente la versión original de la FSS-ICU al español de Chile y medir la confiabilidad interobservador. Método: Se realizó la TAT según las recomendaciones de Beaton de seis etapas. El pre-test se realizó a través de entrevistas cognitivas utilizando “pensamiento en voz alta” y “sondeo verbal”. Se realizaron adaptaciones cuando el acuerdo entre los entrevistados fue menor al 80%. Se midió la confiabilidad interobservador en doce kinesiólogos que evaluaron a seis pacientes críticos; dos con puntajes bajos, dos con puntajes medios y dos con puntajes altos. Resultados: La implementación de la TAT tuvo una duración de seis meses. En el pre-test participaron treinta kinesiólogos chilenos, reportando desacuerdos en cinco ítems de instrucciones y encabezados. Los autores originales aprobaron la versión chilena. Se obtuvo buena a excelente confiabilidad interobservador en el puntaje total de la FSSICU (Coeficiente de Correlación Intraclase 0.96 [IC 95%: 0.89-0.99]), y la confiabilidad de los cinco ítems osciló entre 0.87 y 0.92. Conclusiones: La confiabilidad interobservador de la versión chilena de la FSS-ICU fue buena a excelente. Se recomienda el desarrollo y difusión de este tipo de estudios para minimizar las potenciales malas interpretaciones de escalas en la práctica clínica.
Visual attention during non-immersive virtual reality balance training in older adults with mild to moderate cognitive impairment: an eye-tracking study
(2025) Maldonado, Marcos; Jara, Gonzalo; González Seguel, Felipe
Background: Older adults with cognitive impairment often present with balance deficits, reduced walking speed, and attentional difficulties-particularly in executive function. These challenges increase fall risk and complicate traditional rehabilitation approaches. Eye-tracking technology offers an objective way to evaluate attention by analyzing oculomotor behavior during tasks, but its use in clinical rehabilitation contexts is still limited. Objective: The aim of this study is to investigate visual attention using eye-tracking metrics during a non-immersive virtual reality-based balance training program in older adults with mild to moderate cognitive impairment. Methods: This was an exploratory pilot study with a prospective, descriptive cohort, based on a non-controlled, quasi-experimental design of seven older adults with mild to moderate cognitive impairment. Each patient underwent VR-based balance training using RehametricsⓇ software, while their attention was assessed via eye-tracking (Tobii Pro Glasses 2 Refurbished Wireless). Clinical assessments included the Mini-BESTest, Functional Gait Assessment, 6-Minute Walk Test, 4-Meter Walk Test, and Montreal Cognitive Assessment (MoCA). Eye-tracking data focused on fixation patterns, microsaccades, and pupil diameter as indicators of attentional processing. Results: Patients showed a small numerical increase, without reaching statistical significance in task difficulty progression (p = 0.016), lower limb endurance (p = 0.016), and single-leg support time (p = 0.031). Clinical tests revealed a slight increase, though results were not statistically significant in balance and walking speed (p = 0.063). Eye-tracking data indicated increased fixation stability and decreased pupil diameter, suggesting more efficient attention allocation during motor tasks. Conclusions: Eye-tracking provided valuable metrics into attentional behavior during balance training in older adults with cognitive impairment. Its integration into non-immersive virtual reality rehabilitation may help better understand and address cognitive-motor interactions. Further studies with larger samples are needed to confirm these preliminary findings.
Which factors are associated with acquired weakness in the ICU? An overview of systematic reviews and meta-analyses
(2024) Fuentes, Rocío; González Seguel, Felipe; Marzuca, Gabriel; Torres, Rodrigo; Najum, Jasim; Seron, Pamela
Rationale: Intensive care unit-acquired weakness (ICUAW) is common in critically ill patients, characterized by muscle weakness and physical function loss. Determining risk factors for ICUAW poses challenges due to variations in assessment methods and limited generalizability of results from specific populations, the existing literature on these risk factors lacks a clear and comprehensive synthesis. Objective: This overview aimed to synthesize risk factors for ICUAW, categorizing its modifiable and nonmodifiable factors. Methods: An overview of systematic reviews was conducted. Six relevant databases were searched for systematic reviews. Two pairs of reviewers selected reviews following predefined criteria, where bias was evaluated. Results were qualitatively summarized and an overlap analysis was performed for meta-analyses. Results: Eighteen systematic reviews were included, comprising 24 risk factors for ICUAW. Meta-analyses were performed for 15 factors, while remaining reviews provided qualitative syntheses. Twelve reviews had low risk of bias, 4 reviews were unclear, and 2 reviews exhibited high risk of bias. The extent of overlap ranged from 0 to 23% for the corrected covered area index. Nonmodifiable factors, including advanced age, female gender, and multiple organ failure, were consistently associated with ICUAW. Modifiable factors, including neuromuscular blocking agents, hyperglycemia, and corticosteroids, yielded conflicting results. Aminoglycosides, renal replacement therapy, and norepinephrine were associated with ICUAW but with high heterogeneity. Conclusions: Multiple risk factors associated with ICUAW were identified, warranting consideration in prevention and treatment strategies. Some risk factors have produced conflicting results, and several remain underexplored, emphasizing the ongoing need for personalized studies encompassing all potential contributors to ICUAW development.

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