Browsing by Author "Merino, Catalina"
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Item 24/7 Physical Therapy Intervention With Adult Patients in a Chilean Intensive Care Unit: A Cost-Benefit Analysis in a Developing Country(2020) Merino, Catalina; Velásquez, Mónica; Marmolejo, José Ignacio; Fu, CarolinaObjectives: Physiotherapy in an adult intensive care unit (ICU) affects health outcome. To justify the investment in ICU physical therapy, the cost savings associated with its benefits need to be established. The main objective of this study is to evaluate the potential cost savings of implementing 24-hour, 7-days-per-week physiotherapist (24/7-PT) in a Chilean public high-complex specialized ICU. Methods: Using clinical data from a literature review and a micro-costing technique, we conducted a cost-benefit analysis in the National Institute of Thorax in Chile. Our example scenario involves 697 theoretical admissions of adult patients with cardiovascular or respiratory diseases, and the costs and benefits by reduction of length of stay in ICU, days of mechanical ventilation, and days with respiratory infections during the first year and 5 years of admissions. A sensitivity analysis was considered according to the variability in total costs, production income, and clinical benefits. Results: Net cost savings generated in our example scenario demonstrate that the implementation of 24/7-PT produces a minimum saving for the institution of $16 242 during the first year and $69 351 over a 5-year interval considering individual income production. Out of the 30 scenarios included in the sensitivity analyses, 26 (87%) demonstrated net savings. Conclusions: A financial model, based on literature review and actual cost data, projects that 24/7-PT intervention is a costbenefit alternative in adult ICU patients with cardiovascular or respiratory diseases in Chile. It is necessary a scenario of at least 3 sessions per day with insurance payment for individual treatments to support the long-term implementation of a 24/7-PT program.Item Análisis de sobrevida de pacientes adultos hospitalizados en una unidad de cuidados intensivos: un estudio de seguimiento(Universidad del Desarrollo. Facultad de Medicina, 2020) Barzaga Molina, Arianne; Merino, CatalinaLos pacientes en unidades de cuidados intensivos (UCI) presentan factores intrínsecos y extrínsecos que pueden determinar los desenlaces en salud. Sin embargo, y posterior al crecimiento de UCI Clínica Vespucio, se carece de información respecto de las características clínicas, manejo terapéutico y evolución como posibles factores determinantes de la sobrevida de los pacientes en la unidad. Conocer las condiciones basales y progresión de los usuarios hospitalizados permite tomar desiciones clínico administrativas y generar intervenciones protocolizadas enfocadas a cada paciente. Objetivo: Analizar la sobrevida de adultos hospitalizados en una UCI, en relación con sus características clínicas de ingreso, manejo terapéutico y evolución clínica. Metodología: Estudio observacional analítico de cohorte prospectiva. Se reclutaron pacientes adultos que ingresaron a UCI Clínica Vespucio durante junio a diciembre de 2019. Se realizó análisis descriptivo e inferencial de las características clínicas de ingreso, manejo terapéutico y evolución clínica, con el estado vital al alta. Además de un análisis de sobrevida presentado en curva de Kaplan-Meier, y un análisis exploratorio de factores de riesgo de mortalidad mediante regresión logística múltiple. Resultados: Se reclutaron 120 pacientes con edad promedio de 57,6 (+17,9) años y mediana de Apache II de 17(14-23) puntos, provenientes principalmente desde urgencia (40%). La mediana de estadía en UCI fue de 7(4-17) días, y el 12,5% de los pacientes fallecieron. La estadía en UCI >7 días (OR 7,14 IC95%[1,53-33,25]), Apache II de ingreso >20 puntos (OR 3,67 IC95%[1,16-11,55]), y el “shock” como diagnóstico inicial (OR 12,08 IC95%[2,05-71,11]) fueron significativos por sí mismos para el estado vital al alta de UCI. Conclusión: El diagnóstico y gravedad de ingreso como características clínicas, junto con la estadía en UCI como evolución, resultaron ser factores de riesgo independientes de mortalidad en la unidad. Futuros análisis debieran orientarse a los factores determinantes de la evolución clínica de estos pacientes.Item Breaking the breach in Latin America: A pilot study of mechanical thrombectomy in the public healthcare system in Chile(2021) Rivera, Rodrigo; Amudio, Cristian; Brunetti, Enzo; Catalan, Pascual; Sordo, Juan Gabriel; Badilla, Lautaro; Echeverria, Daniel; Cruz, Juan Pablo; Ojeda, Hector; Bravo, Loreto; Bravo, Fabian; González, Walter; Orellana, Maria Luisa; Pinto, Camila; Merino, Catalina; Oportus, Monica; Salazar, AlejandroBackground: Mechanical Thrombectomy (MT) is the standard of care for treatment of large vessel occlusion stroke. Until the beginning of 2020 MT was not funded nor widely implemented at the public healthcare level in Chile. Objective: To describe the results of a pilot program created to provide access to public MT in Santiago - Chile. Methods: Analysis from a prospectively collected database of MT cases performed between September 2017 and September 2019 in one center. A stroke network was developed with a single MT capable stroke center and five primary stroke centers. The primary efficacy endpoint was the rate of functional independence (mRS 0-2) at 90 days. Successful reperfusion was defined as 2 b-3 according to the thrombolysis in cerebral infarction scale. Safety outcomes include the rates of symptomatic intracranial hemorrhage and 90-day mortality. Results: A total of 100 patients were treated over the study period. Their mean age was 62.8 11.8 years and median baseline National Institute of Health Stroke Scale (NIHSS) measurement was 17. Seventy-seven percent of the patients received intra venous thrombolysis. Successful reperfusion was achieved in 95% of the cases. NIHSS at 24 hours showed a median drop of 7 points from baseline (p < 0.00001) and 50% of the follow-up patients were functionally independent at 90 days. Symptomatic Intracerebral hemorrhage occurred in 5% of the patients and 90-day all case mortality was 11%. Conclusions: We demonstrated the feasibility of a publicly funded MT program in Chile, with similar results as other international randomized control trials.Item Characteristics of physiotherapy staffing levels and caseload: a cross-sectional survey of Chilean adult Intensive Care Units(2019) Aranis, Nadine; Molina, Jorge; Leppe, Jaime; Castro, Ana; Fu, Carolina; Merino, CatalinaIntroduction: The European Society of Intensive Care Medicine recommends the presence of a specialist physiotherapist, available every five beds, seven days a week in the high complexity Intensive Care Unit. However, in Chile the adherence of adult Intensive Care Units to this recommendation is unknown. Objective: To describe the organizational characteristics and the physiotherapist availability in adult Intensive Care Units in Chile, and according to the adherence to international recommendations, inform health decision-makers. Methods: Observational study based on a telephone survey. All adult Intensive Care Units institutions of high complexity, private hospitals and teaching health centers in Chile were eligible (n = 74). The primary outcome measures were the proportion of institutions with physiotherapist availability 24 hours a day and seven days a week (24/7 physiotherapist), a maximum caseload per physiotherapist of five patients and the presence of a specialist physiotherapist. Results: Response rate was 86.5%, with 59% of responding units being public and 83% offering level III care. 70% of the adult Intensive Care Units in Chile have 24/7 physiotherapist (87% of the public and 46% of the private sector). 41% of the centers had a maximum caseload per physiotherapist of five patients during the day on weekdays. This number decreased on weekends and during night shifts. 23% of the Intensive Care Units had a specialist physiotherapist, being more common in the private sector (31%). Conclusions: In Chilean adult ICU, 24/7 physiotherapist availability is high, the prevalence of physiotherapists with specialist training is low. Future efforts should focus on promoting the uptake of specialist training.Item Descripción de los cambios en la velocidad media de flujo sanguíneo cerebral en posición supino y sedente, en pacientes con hemorragia subaracnoidea aneurismática con vasoespasmo asintomático o sin vasoespasmo. Serie de casos(Sociedad Médica de Santiago, 2014) Merino, Catalina; Heap, Pía; Vergara, Valentina; Yáñez, Alonso; Rivera, RodrigoEarly mobilization in intensive care units (ICU) provides respiratory, neurological and cardiovascular benefits in hospitalized patients. However, the orthostatic effects of changing from a supine to a sitting position may interfere with cerebral hemodynamics of patients with aneurysmal subarachnoid hemorrhage (aSAH). Aim: To describe the changes in mean cerebral blood flow velocity (MCBFV) in supine and sitting position, in adult patients with aSAH, with asymptomatic vasospasm (AVS) or without vasospasm (VS) at a neurosurgical ICU. Material and Methods: Descriptive case series study in 21 patients with aSAH, both with and without VS. They were positioned in a supine 30° position and then seated at the edge of bed for six minutes. MCBFV was measured by transcranial Doppler (TCD), and hemodynamic variables in both positions were registered. After this basal assessment and for 21 days after the episode of SAH, patients were seated once a day and signs of VS were recorded. Results: No significant changes in MCBFV or hemodynamic variables were detected during position changes, except for an increase in heart rate in the sitting position. No patient with AVS at the onset, had symptomatic VS during the 21 days of follow up when patients were seated. Among patients with a normal MCBFV at baseline, five patients (24%) had VS at a mean of three days after the first time that they were seated on the edge of bed. Conclusions: Sitting patients at the edge of the bed is a safe mobilization alternative for patients who suffered aSAH who did not have VS or had AVS.Item Effects of 24-hours/day versus business hours physical therapy intervention in adult intensive care unit patients: a systematic review care unit patients(2018) Merino, Catalina; Castro-Ávila, Ana Cristina; Gutiérrez-Arias, Ruvistay; Arriagada, María Jesús; Villanueva, Catalina; Leppe, Jaime; Fu, CarolinaBackground: Some evidence suggests that higher doses of mobilization could have benefits on functional status. However, the impact of increasing the availability of Physical Therapist in the intensive care unit to provide critical care for these conditions is unclear. Objective: to determine the effect of physical therapy 24-hour/7days on the length of stay, index of respiratory system infection, days of mechanical ventilation, mortality and quality of life, in adult patients admitted to an intensive care unit. Methods and design: The databases EMBASE, MEDLINE, PUBMED, and reference lists of previous reviews were searched for clinical trials and observational studies, without restriction on language or publication date. Four reviewers independently screened articles for eligibility, and included studies were appraised using the ROBINS-I risk of bias tool for non-randomised studies. Results: 4509 records were screened. Two prospective cohorts were included in the review. Both studies reported significant improvements in length of intensive care unit stay and days of mechanical ventilation, while the index of respiratory system infection and mortality had unclear improvement. No studies reported quality of life in patients. Conclusion: There was insufficient robust data to conclude that increasing availability of physical therapy beyond business hours could shorten the length of ICU stay and days of mechanical ventilation. Further studies are required to increase certainty about the effectiveness of Physical Therapist intervention 24-hours/7 days in intensive care unit.Item Encuesta sobre implementación de investigación en centros educacionales en Chile: cumplimientos de aspectos regulatorios éticos y legales(Centro Interdisciplinario de Estudios en Bioética, Universidad de Chile, 2017) Merino, Catalina; Mattar, Gustavo; Leppe, Jaime; Bahamondes, Paz; Lecaros, Juan AlbertoBackground: Research in educational centers is a frequent source of social and health related studies. Objective: To determine the knowledge and adherence to the current legal and ethical regulations to research performed on children at educational institutions. Methodology: Cross-sectional study online survey-type. The level of knowledge and adherence to the ethical regulation and legislation in Chile, to conduct research with minors was consulted. Results: 126 educational institutions responded the survey; 69% belonged to urban centers; 60% corresponded to those under the Municipality umbrella and 34% to charter schools. Research was performed in 31,8% of the consulted institutions, 41% of the research was on health issues and 30,8% on education. The 27,5% answered that they had the approval of ethical-scientific committee, 82% answered that they neither received nor had any awareness of regulatory aspects on research. Conclusion: There is low knowledge and adherence to ethical and legal regulation to research performed with children in educational centers. A journey for dissemination of results was performed and a flow chart was created by experts and proposed to the school directors to contribute to the adherence of ethical and regulatory aspects of research in educational centers.Item Impact on Mental, Physical and Cognitive functioning of a Critical care sTay during the COVID-19 pandemic (IMPACCT COVID-19): protocol for a prospective, multicentre, mixed-methods cohort study(2021) Castro, Ana; Merino, Catalina; González, Felipe; Camus, Agustín; Leppe, Jaime; IMPACCT COVID-19 study groupIntroduction The ongoing pandemic could affect the duration, variety and severity of the mental, physical, and cognitive impairments intensive care unit (ICU) survivors and their families frequently present. We aim to determine the impact of the COVID-19 pandemic on the mental, physical, and cognitive health of survivors, the experience of their families and their treating healthcare professionals.Item International Classification of Functioning, Disability, and Health Domains of 60 Physical Functioning Measurement Instruments Used During the Adult Intensive Care Unit Stay: A Scoping Review.(2019) González-Seguel, Felipe; Corner, Evelyn; Merino, CatalinaBACKGROUND: There has been a recent surge in the creation and adaptation of instruments to measure physical functioning (PF) in the intensive care unit (ICU). Selecting the right measurement instrument depends on understanding the core constructs that it measures in terms of the International Classification of Functioning, Disability and Health (ICF) domains. PURPOSE: The purpose of this study was to map systematically the ICF domains and subdomains included in the PF measurement instruments used for adult patients during the ICU stay. DATA SOURCES: A systematic search was carried out in Cochrane CENTRAL, PubMed, CINAHL, and LILACS as well as a hand search up to May 17, 2017. STUDY SELECTION: Study selection included all types of research articles that used at least 1 PF measurement instrument in adult patients within the ICU. DATA EXTRACTION: Study design, year of publication, study population, and the measurement instruments reported were recorded. A consensus of experts analyzed the ICF domains included in each instrument. DATA SYNTHESIS: We found 181 articles containing 60 PF measurement instruments used during the ICU stay. Twenty-six ICF domains were identified, 38 instruments included Mobility, and 13 included Muscle function. LIMITATIONS: Studies not written in English or Spanish were excluded. CONCLUSIONS: There are numerous PF measurement instruments used in adult patients in the ICU. The most frequent ICF domain measured is Mobility. This study highlights the ICF domains contained in the instruments that can be used clinically, providing a complete database of instruments that could facilitate selection of the most appropriate measure based on the patients' needs.Item Intervenciones terapéuticas y criterios de decisión utilizados por kinesiólogos en las unidades de cuidados intensivos adultos de Chile: una caracterización a nivel nacional(Universidad del Desarrollo. Facultad de Medicina, 2020) Periale Bravo, José Ignacio; Merino, CatalinaAntecedentes: Las intervenciones kinésicas en Unidades de Cuidados Intensivos (UCI) han demostrado efectividad disminuyendo, entre otros aspectos, los días de hospitalización y días de ventilación mecánica. Para ello, los kinesiólogos deben guiar su accionar mediante criterios de decisión para iniciar, progresar, monitorizar y detener el ejercicio. Sin embargo, se desconoce si los kinesiólogos de las UCI adultos en Chile realizan intervenciones similares a las reportadas como efectivas en la literatura, y si consideran los criterios recomendados para orientar las diferentes etapas de intervención kinésicas. Objetivo general: Describir las intervenciones terapéuticas y los criterios de decisión utilizados por los kinesiólogos en las Unidades de Cuidados Intensivos adulto de Chile. Metodología: Análisis secundario de datos, proveniente de la encuesta de un estudio original previo que describe intervenciones terapéuticas y criterios de decisión para las intervenciones utilizados por los kinesiólogos. La población contempla 64 Unidades de Cuidados Intensivos adultos de Chile. Los datos se representaron mediante estadística descriptiva. Resultados: las intervenciones respiratorias más realizadas son los ejercicios respiratorios con volúmenes pulmonares y técnicas de remoción de secreciones en un 100% (n=64), y la menos realizada es la fijación de vía aérea artificial, con un 52% (n=33) de día y 39% (n=25) de noche. Las intervenciones motoras en horario diurno menos realizadas son el uso de bicicleta/cicloergómetro (27%, n=17), tilt-table (25%, n=16) y treadmill (2%, n=1), siendo la razón principal por falta de insumo. El razonamiento clínico es el principal criterio para la realización de la sesión kinésica en un 100% (n=64). Conclusión: las intervenciones kinésicas respiratorias y motoras, como los criterios de decisión, concuerdan con la evidencia internacional para una mejor atención y seguridad del paciente en UCI.Item Liderazgo de estrategias para potenciar el desarrollo científico en el pregrado: Experiencia Semana i UDD(Facultad de Medicina. Clínica Alemana Universidad del Desarrollo, 2019) Rojas, Julissa; López, Constanza; Dattwyler, Daniela; Cruzat, Antonia; Merino, Catalina; Muñoz, BárbaraIntroducción: La Semana i de Universidad del Desarrollo es una actividad en la que estudiantes de pregrado de diversas carreras asumen desafíos académicos propuestos por sus docentes, con el objetivo de fortalecer el desarrollo de competencias a través de la interdisciplina. Objetivo: Describir el desarrollo científico y la innovación basada en ciencias a partir de la participación de estudiantes en Semana i. Metodología: Estudio cualitativo, tipo fenomenológico, con muestreo por conveniencia. Luego de firmar consentimiento informado y cautelar requisitos éticos, se realizaron entrevistas semiestructuradas a egresados UDD de 4 carreras de la Salud, Ingeniería, Publicidad y Arquitectura. Las entrevistas fueron grabadas, transcritas, codificadas y presentadas como esquema, desde la interdisciplina. Resultados: Se identificaron diversas oportunidades y necesidades para potenciar el desarrollo científico en los estudiantes. Se menciona la importancia de aumentar la visibilidad del área de investigación en las diversas carreras de pregrado UDD. Se releva el valor del aprendizaje basado en experiencia como una estrategia optimizable y necesaria de difundir. Discusión: El tiempo estimado para transcribir las entrevistas fue excesivo y se requiere de alta experticia para realizarla. Los resultados difieren sobre difusión del desarrollo científico en la UDD, en comparación con información existente sobre universidades extranjeras. Conclusiones: Existen falencias a nivel universitario en el ámbito de impulsar, guiar y difundir el desarrollo científico. La innovación basada en ciencia se percibe como necesaria y útil para el futuro laboral.Item Medidas de resultado de intervenciones fisioterapéuticas en pacientes adultos de unidades de cuidados intensivos: Un mapa de la evidencia(Universidad del Desarrollo. Facultad de Medicina, 2021-01) Galleguillos, Fernanda; Merino, CatalinaAntecedentes: Los avances tecnológicos en Unidades de Cuidados Intensivos (UCI) permitieron aumentar la sobrevida de pacientes, como consecuencia la discapacidad y con ello el reporte de literatura científica en fisioterapia. En UCI, la investigación de resultados se utiliza para obtener evidencia sobre intervenciones y guiar la práctica fisioterapéutica, por lo que es esencial una elección adecuada de medidas de resultado. Sin embargo, creemos que no se ha prestado suficiente atención a los resultados fisioterapéuticos, dificultando la utilización de la literatura científica y desperdiciando el reporte de investigación. Objetivo: Describir las medidas de resultado que involucran intervenciones de Terapia Física realizadas en pacientes adultos de UCI, reportadas en artículos científicos en los últimos 15 años. Método: Mapeo de evidencia utilizando palabras claves asociadas a “Physical Therapy” e “Intensive Care Unit”, en las bases de datos Web of Science, CINAHL, MEDLINE (mediante Pubmed y EBSCO-Host) y PEDro. Se seleccionaron artículos publicados entre 01.01.2004 y 31.12.2018, en humanos y sin límite de idioma. Se aplicaron criterios de elegibilidad utilizando el software Covidence© en el filtro por título, resumen y texto completo -realizado por dos investigadores independientes y un tercero para resolver discrepancias- y se clasificaron los resultados según Williamson/Clarke. Resultados: Fueron identificados 2730 artículos, eliminándose 1146 duplicados y 1340 no cumplieron con los criterios de elegibilidad. Se incluyeron 244 artículos, identificándose 1232 medidas de resultado principalmente fisiológicas o clínicas (45,9%), seguidos por medidas de impacto en la vida (22%), y en menor medida mortalidad (4,1%). El uso de recurso hospitalario y reporte de eventos adversos aumentó en los últimos 5 años. Conclusión: La cantidad de publicaciones y reporte de resultados en estudios de terapia física en UCI ha aumentado en los últimos 15 años, prevaleciendo los resultados fisiológicos, y destacando una tendencia al aumento en los resultados referentes a impacto en la vida.Item Modificaciones en las Prácticas de los Kinesiólogos de Cuidados Críticos durante y después de la Pandemia COVID-19 en Chile: Protocolo de una Encuesta Nacional(2020) González, Felipe; Adasme, Rodrigo; Henríquez, Loreto; Sufán, José; Merino, CatalinaAntecedentes: El 11 de marzo de 2020, la Organización Mundial de la Salud declaró la enfermedad por coronavirus (COVID-19) como pandemia, cuyos casos y gravedad en Chile han sido elevados. Internacionalmente, los profesionales de la salud han debido adaptar sus actividades laborales hacia pacientes mecánicamente ventilados por agravamiento de los síntomas respiratorios. La terapia respiratoria y terapia física que realizan los kinesiólogos en la unidad de cuidados intensivos (UCI) es fundamental, y existe la urgencia por agrupar datos nacionales que permitan describir la situación y así prepararse para futuros aumentos de la carga asistencial en UCI. Objetivo: Describir las modificaciones institucionales, laborales y asistenciales experimentadas por kinesiólogos que se desempeñan en UCI durante y después de la pandemia COVID-19 en Chile. Metodos: Este es el protocolo de un estudio observacional analítico transversal, el cual recopilará información desde el inicio hasta un año iniciada la pandemia. Se incluirán todas las UCI adulto existentes y las creadas por contingencia COVID-19. Se excluirán aquellas que no hayan recibido pacientes en UCI con COVID-19 confirmado. Se aplicará una encuesta online (REDCap®) al kinesiólogo representante de cada centro, la cual recopilará la información anonimizada principalmente a través de selección múltiple y escala Likert. Resultados esperados: Se espera identificar un alto porcentaje de modificaciones institucionales en las UCI de Chile, y kinesiólogos que se vieron en la necesidad de cambiar sus condiciones laborales y asistenciales durante la pandemia, en comparación al período pre-pandemia; cambios que en un menor porcentaje se mantuvieron en el tiempoItem Necesidades y oportunidades para la investigación e innovación basada en ciencias según kinesiólogos egresados de la Universidad del Desarrollo.(Universidad del Desarrollo. Facultad de Medicina. Escuela de Kinesiología, 2019) Cruzat, Antonia; Dättwyler, Daniela; López, Constanza; Rojas, Julissa; Cruzat, Antonia; Dättwyler, Daniela; López, Constanza; Rojas, Julissa; Muñoz, Bárbara; Merino, Catalina; Muñoz, Bárbara; Merino, CatalinaObjetivo: Indagar necesidades y oportunidades para el progreso de la innovación e investigación basada en ciencias en la formación en pregrado, a partir de la percepción de la aplicabilidad de las herramientas de desarrollo científico obtenidas durante el pregrado, en Kinesiólogos egresados en 2017 y 2018 del campus Santiago de la Universidad del Desarrollo (UDD). Metodología: Estudio cualitativo fenomenológico mediante una entrevista semi-estructurada a Kinesiólogos egresados 2017 y 2018 de la UDD reclutados mediante un muestreo por bola de nieve. Se recolectaron datos como estatus laboral, vinculación del trabajo actual con el desarrollo científico, percepción de aplicabilidad de herramientas de pregrado en desarrollo científico y, necesidades y oportunidades para innovar basado en ciencias. Finalizó con codificación abierta y triangulación de investigador de los datos obtenidos. Resultados: Hay baja visualización sobre aplicabilidad de herramientas obtenidas en pregrado. Se identificó la necesidad de un enfoque concreto dentro las asignaturas de investigación, potenciar las posibilidades para desarrollo científico y mayor difusión. Como oportunidades se identificó el desarrollo de investigación dentro del trabajo profesional e interdisciplinario. Conclusión: La principal necesidad es la difusión del desarrollo científico y como oportunidad, mayor colaboración interdisciplinar factible de realizar durante el pregrado.Item Quantitative evaluation of arteriovenous malformation hemodynamic changes after endovascular treatment using parametric color coding: A case series study.(Sage Publications, 2017) Rivera, Rodrigo; Sordo, Juan; Echeverria, Daniel; Badilla, Lautaro; Pinto, Camila; Merino, CatalinaBackground Brain arteriovenous malformations (AVMs) are complex vascular lesions. Endovascular treatment results are usually measured by calculating the volume reduction of the lesions. Nevertheless, vascular flow quantification seems a more physiologically accurate way of measuring endovascular results. We evaluated the use of parametric color coding (PCC) with digital subtraction angiography (DSA), in order to determine the feasibility of PCC to detect and measure the impact of AVM endovascular treatment-induced changes using real-time hemodynamic parameters. Methods and results Supratentorial brain AVM treatment was evaluated in 29 patients over the course of 38 sessions. Using regions of interest (ROIs) at the carotid siphon, arterial feeder, drainage vein and venous sinus, we found significant increase in time to peak (TTP) values at the arterial feeder, drainage vein and venous sinus. We compared TTP in four different embolization volume groups: I (0-25%), II (26-50%), III (51-75%) and IV (76-100%). We found significant differences between groups and a moderate correlation between embolization percentages, as well as an increase in TTP at the main vein ROI; but not in the arterial side or sinus. Conclusions Brain AVM endovascular treatment results can be quantified in vivo with PCC. PCC is capable of detecting hemodynamic changes after brain AVM endovascular treatment, that may reflect flow drop, and it is correlated with volume embolization.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%).Item Therapeutic strategies performed by physiotherapists in three intensive care units (ICUS) in Santiago, Chile: pilot study(Elsevier, 2015) Castro, A; Merino, Catalina; Leppe, JaimeBackground: To date, there are four systematic reviews suggesting positive effects of rehabilitation and chest physiotherapy during ICU stay. However, in Chile there is no information about the therapeutic strategies used by physiotherapists (PTs) working in this environment. A better understanding of the interventions they perform would shed light on possible areas of improvement. Purpose: To describe the duration and therapeutic strategies used by PTs working at three Level 3 ICUs in Santiago, Chile. Methods: A cross sectional study carried out in three level 3 ICUs in Santiago: a private hospital, a public hospital and a national reference centre for cardiothoracic disorders. PTs were observed in each unit for 24 hours over the course of 8 days, using a structured observation template. Data were collected on time spent on different activities (reading of charts and test results, assessment of patient, intervention, reassessment, writing on patients’ charts, change-of-shift report and administrative work) and therapeutic strategies performed with patients. Frequency of use is presented for the most common activities and the median (P25-P75) of their duration. Chi-squared was used to compare frequencies according to ward. P-value <0.05 were considered statistically significant. Results: 32 PTs were observed for 960 hours during 1131 visits. 121 patients received care from PTs during this period with a median (P25-P75) APACHE II of 13 (9–19). 41 patients (33.9%) were on invasive or non-invasive mechanical ventilation. 88% of the PTs’ working time was spent on activities related to patients’ care and 12% in administrative tasks or clinical meetings with members of staff. The median (P25-P75) duration of a visit was 20 (12–28) min including 3 (1–4) different therapeutic strategies. The most commonly used were: mucus clearance techniques (49%), ribcage compressiondecompression (48%), active-assisted range of motion (ROM) (21%), sitting on edge of bed (SEB) (19%), mechanical ventilator parameters adjustment (16%) and assisted walking (16%). Neuromuscular electric stimulation or training with cycloergometer, steps or treadmill were not used. Passive ROM was more frequent in the ICUs than High Dependency Units (HDUs) (20% vs 12%, p < 0.0001), while SEB (14% vs 23%, p < 0.0006), assisted standing (11% vs 17%, p < 0.044) and assisted walking (10% vs 20%, p < 0.0001) were more common in HDUs than ICUs. Conclusion(s): Chest physiotherapy techniques are the most commonly used techniques despite conflicting evidence on their benefit. It is noteworthy that some forms of early mobilisation are also frequently performed, although they were more common in HDUs than ICUs. Beliefs about safety of exercise, lack of skills, knowledge or human resources, might be preventing the use of more active ways of rehabilitation. This should be explored in the future in order to increase the quality of care provided. Implications: This pilot study will help to develop a self-report questionnaire. With it, we aim to survey PTs across Chile in order to establish the current therapeutic strategies used and human resources in the ICU. This information would help to develop policies in relation to the minimum number of PTs and standard of care in the ICU.