Browsing by Author "Molina, Jorge"
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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 Ecografía muscular en la unidad de cuidados intensivos: valores basales y tasa de cambio de la masa muscular diafragmática: un estudio observacional descriptivo longitudinal(Universidad del Desarrollo. Facultad de Medicina, 2025) Araya Bustamante, Aline Catalina; Molina, Jorge; González, FelipeIntroducción: La inmovilidad en UCI y la ventilación mecánica provocan pérdida acelerada de masa muscular, afectando especialmente al diafragma. La ecografía musculoesquelética permite evaluar estos cambios de forma no invasiva y sin cooperación del paciente. Sin embargo, la falta de estandarización limita su aplicación clínica. Este estudio busca describir los valores ecográficos del diafragma durante la primera semana de hospitalización en UCI, aportando información útil para el contexto chileno. Objetivo: Determinar valores basales e identificar la tasa de cambio de la masa muscular diafragmática durante la primera semana en adultos hospitalizados en UCI. Método: Se realizó un estudio descriptivo longitudinal de cohorte en dos centros de UCI en Santiago de Chile. Se incluyeron adultos hospitalizados con posibilidad de evaluación ecográfica en las primeras 48 horas, excluyéndose pacientes con antecedentes neuromusculares o condiciones que impidieran las mediciones. Se midieron variables clínicas y sociodemográficas, y se realizaron ecografías diafragmáticas por kinesiólogos capacitados. Las imágenes fueron analizadas con ImageJ y los datos procesados con STATA 15.0. Se utilizó estadística descriptiva, prueba de Wilcoxon y regresión lineal múltiple, considerando un nivel de significancia del 5%. Resultados: De 155 pacientes evaluados, 60 cumplieron los criterios. Se realizaron 151 mediciones, generando 1.819 imágenes. La mediana de edad fue 53,7 años; 70% eran hombres. El grosor diafragmático disminuyó 8,9%, la excursión 15% y la fracción de engrosamiento 24,5%. La ecointensidad aumentó 19,8% (todas con p < 0,001). Se observaron asociaciones diferenciales entre centros, especialmente entre IMC y grosor, y entre días en VM y excursión. Conclusiones: La ecografía evidenció deterioro progresivo de la masa muscular diafragmática durante la primera semana de hospitalización. Se confirma su utilidad como herramienta sensible y reproducible para el monitoreo temprano en pacientes críticos. Se recomienda estandarizar los protocolos y ampliar la muestra para mejorar la validez externa de futuros estudios.Item Respiratory drive, inspiratory effort, and work of breathing: review of definitions and non-invasive monitoring tools for intensive care ventilators during pandemic times(2022) Ríos, Francisco; González, Felipe; Molina, JorgeTechnological advances in mechanical ventilation have been essential to increasing the survival rate in intensive care units. Usually, patients needing mechanical ventilation use controlled ventilation to override the patients respiratory muscles and favor lung protection. Weaning from mechanical ventilation implies a transition towards spontaneous breathing, mainly using assisted mechanical ventilation. In this transition, the challenge for clinicians is to avoid under and over assistance and minimize excessive respiratory effort and iatrogenic diaphragmatic and lung damage. Esophageal balloon monitoring allows objective measurements of respiratory muscle activity in real time, but there are still limitations to its routine application in intensive care unit patients using mechanical ventilation. Like the esophageal balloon, respiratory muscle electromyography and diaphragmatic ultrasound are minimally invasive tools requiring specific training that monitor respiratory muscle activity. Particularly during the coronavirus disease pandemic, non invasive tools available on mechanical ventilators to monitor respiratory drive, inspiratory effort, and work of breathing have been extended to individualize mechanical ventilation based on patients needs. This review aims to identify the conceptual definitions of respiratory drive, inspiratory effort, and work of breathing and to identify non invasive maneuvers available on intensive care ventilators to measure these parameters. The literature highlights that although respiratory drive, inspiratory effort, and work of breathing are intuitive concepts, even distinguished authors disagree on their definitions.Item Respiratory Support Adjustments and Monitoring of Mechanically Ventilated Patients Performing Early Mobilization: A Scoping Review(2021) González, Felipe; Camus, Agustín; Jasmén, Anita; Molina, Jorge; Pérez-Araos, Rodrigo; Graf, JerónimoThis scoping review is aimed to summarize current knowledge on respiratory support adjustments and monitoring of metabolic and respiratory variables in mechanically ventilated adult patients performing early mobilization. Data sources: Eight electronic databases were searched from inception to February 2021, using a predefined search strategy. Study selection: Two blinded reviewers performed document selection by title, abstract, and full text according to the following criteria: mechanically ventilated adult patients performing any mobilization intervention, respiratory support adjustments, and/or monitoring of metabolic/respiratory real-time variables. Data extraction: Four physiotherapists extracted relevant information using a prespecified template.Item Revista Confluencia Volumen 5, número 2, 2022 (Edición completa)(2022) Facultad de Medicina, Clínica Alemana de Santiago - Universidad del Desarrollo; Ronco, Ricardo; Jadue, Liliana; Pérez, Claudia; López, María Angélica; Molina, Jorge; Castillo, Marcela; Ratner, Rinat; Mayol, Mimy; Ocaranza, Danilo; Parra, María Adriana; Villarroel, Vivian; Fuentes, Daniela; Lizana, MarceloItem Revista Confluencia Volumen 6, número 1, 2023 (Edición completa)(2023) Facultad de Medicina, Clínica Alemana de Santiago - Universidad del Desarrollo; Castillo, Marcela; Jadue, Liliana; Pérez, Claudia; López, María Angélica; Molina, Jorge; Jadue, Mariana; Ratner, Rinat; Mayol, Mimy; Ocaranza, Danilo; Parra, María Adriana; Villarroel, Vivian; Fuentes, Daniela; Lizana, MarceloItem Revista Confluencia Volumen 6, número 2, 2023 (Edición completa)(2023) Castillo, Marcela; Jadue, Liliana; Pérez, Claudia; López, María Angélica; Molina, Jorge; Jadue, Mariana; Ratner, Rinat; Mayol, Mimy; Ocaranza, Danilo; Parra, María Adriana; Villarroel, Vivian; Fuentes, Daniela; Ovalle, Marcelo; Facultad de Medicina, Clínica Alemana de Santiago - Universidad del DesarrolloItem Settings and monitoring of mechanical ventilation during physical therapy in adult critically ill patients: protocol for a scoping review(2019) González-Seguel, Felipe; Camus-Molina, Agustín; Jasmén, Anita; Pérez-Araos, Rodrigo; Molina, Jorge; Graf, JerónimoIntroduction Early mobilisation has been extensively advocated to improve functional outcomes in critically ill patients, even though consistent evidence of its benefits has remained elusive. These conflicting results could be explained by a lack of knowledge on the optimal dosage of physical therapy and a mismatch between ventilatory support and exercise-induced patient ventilatory demand. Modern mechanical ventilators provide realtime monitoring of respiratory/metabolic variables and ventilatory setting that could be used for physical therapy dosage or ventilatory support titration, allowing individualised interventions in these patients. The aim of this review is to comprehensively map and summarise current knowledge on adjustments of respiratory support and respiratory or metabolic monitoring during physical therapy in adult critically ill mechanically ventilated patients. Methods and analysis This is a scoping review protocol based on the methodology of the Joanna-Briggs-Institute. The search strategy will be conducted from inception to 30 June 2019 as a cut-off date in PubMed, CINAHL, Rehabilitation & Sport Medicine, Scielo Citation Index, Epistemónikos, Clinical Trials, PEDro and Cochrane Library, performed by a biomedical librarian and two critical care physiotherapists. All types of articles will be selected, including conference abstracts, clinical practice guidelines and expert recommendations. Bibliometric variables, patient characteristics, physical therapy interventions, ventilator settings and respiratory or metabolic monitoring will be extracted. The identified literature will be analysed by four critical care physiotherapists and reviewed by a senior critical care physician. Ethics and dissemination Ethical approval is not required. The knowledge-translation of the results will be carried out based on the End-of-Grant strategies: diffusion, issemination and application. The results will be published in a peer-review journal, presentations will be disseminated in relevant congresses, and recommendations based on the results will be developed through training for mechanical ventilation and physical therapy takeholders.Item Valores de masa muscular basal en cuidados intensivos y su asociación con el funcionamiento físico previo(Universidad del Desarrollo. Facultad de Medicina, 2025) Loch Franco, Matías Nicolás; Molina, Jorge; González, FelipeIntroducción: En pacientes críticamente enfermos, la pérdida de masa muscular ocurre tempranamente y se asocia con deterioro funcional. Aún se desconocen en gran medida los valores basales de masa muscular en la UCI y su relación con el funcionamiento físico previo. Esta información puede ser clave para el manejo terapéutico y decisiones clínicas tempranas. Objetivo: Determinar valores basales de masa muscular del cuádriceps y tibial anterior al ingreso a la UCI, los cambios durante la primera semana y su asociación con el funcionamiento físico previo. Métodos: Estudio observacional prospectivo. Se evaluaron pacientes al ingreso a la UCI y en el día 7. Se midió el grosor muscular, el área de sección transversal y la ecointensidad del recto femoral, vasto intermedio y tibial anterior mediante ecografía. La relación con variables demográficas y funcionamiento físico previo se analizó con Spearman Rho y Chi². Los cambios musculares en el tiempo se evaluaron con Wilcoxon. Resultados: Al ingreso, el grosor muscular tuvo una mediana de 1.76 cm (RIQ: 1.20–3.10) en el cuádriceps y 1.71 cm (RIQ: 1.30–2.53) en el tibial anterior. El área de sección transversal del recto femoral fue 2.38 cm² (RIQ: 1.14–6.35) y del tibial anterior 3.89 cm² (RIQ: 2.32–6.72). La ecointensidad inicial fue 94 (RIQ: 73–116) para el recto femoral y 95 (RIQ: 80–116) para el tibial anterior. Los hombres presentaron mayor grosor muscular y área de sección transversal. La edad se asoció negativamente con la masa muscular, mientras que peso y talla se correlacionaron positivamente. La pérdida muscular general fue del 4-24% en 7 días. Se observo una correlación moderada entre la masa muscular basal y la independencia previa en AIVD. Conclusión: Estos resultados destacan la ecografía como una herramienta objetiva y accesible para monitorear la masa muscular basal en pacientes críticos.