Browsing by Author "González Seguel, Felipe"
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Publication 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, PamelaIntroduction 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 methodologyPublication 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.Publication 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 CristinaIntroduction 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.Item 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, JaimeAntecedentes: 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.Publication Early Mobilization Dose Reporting in Randomized Clinical Trials With Patients Who Were Mechanically Ventilated: A Scoping Review(2024) González Seguel, Felipe; Letelier, RenatoObjective: 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.Publication 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, CamiloBackground: 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.Item 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, FelipeObjetivo: 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.Item 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, JaimePurpose: 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.Item 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, FelipeIntroducción: 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.Publication 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 groupIntroduction: 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%).Publication 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, PamelaRationale: 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.