Browsing by Author "Vargas, Patricio"
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Publication Continuous prolonged prone positioning in COVID‑19‑related ARDS: a multicenter cohort study from Chile(2022) Cornejo, Rodrigo; Montoya, Jorge; Gajardo, Abraham; Graf, Jerónimo; Alegría, Leyla; Baghetti, Romyna; Irarrázaval, Anita; Santis, César; Pavez, Nicolás; Leighton, Sofía; Tomicic, Vinko; Morales, Daniel; Ruiz, Carolina; Navarrete, Pablo; Vargas, Patricio; Gálvez, Roberto; Espinosa, Victoria; Lazo, Marioli; Pérez Araos, Rodrigo; Garay, Osvaldo; Sepúlveda, Patrick; Martínez, Edgardo; Bruhn, Alejandro; SOCHIMI Prone-COVID-19 GroupBackground: Prone positioning is currently applied in time-limited daily sessions up to 24 h which determines that most patients require several sessions. Although longer prone sessions have been reported, there is scarce evidence about the feasibility and safety of such approach. We analyzed feasibility and safety of a continuous prolonged prone positioning strategy implemented nationwide, in a large cohort of COVID-19 patients in Chile. Methods: Retrospective cohort study of mechanically ventilated COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted in 15 Intensive Care Units, which adhered to a national protocol of continuous prone sessions ≥ 48 h and until PaO2:FiO2 increased above 200 mm Hg. The number and extension of prone sessions were registered, along with relevant physiologic data and adverse events related to prone positioning. The cohort was stratified according to the first prone session duration: Group A, 2-3 days; Group B, 4-5 days; and Group C, > 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety. Results: We included 417 patients who required a first prone session of 4 (3-5) days, of whom 318 (76.3%) received only one session. During the first prone session the main adverse event was grade 1-2 pressure sores in 97 (23.9%) patients; severe adverse events were infrequent with 17 non-scheduled extubations (4.2%). 90-day mortality was 36.2%. Ninety-eight patients (24%) were classified as group C; they exhibited a more severe ARDS at baseline, as reflected by lower PaO2:FiO2 ratio and higher ventilatory ratio, and had a higher rate of pressure sores (44%) and higher 90-day mortality (48%). However, after adjustment for severity and several relevant confounders, prone session duration was not associated with mortality or pressure sores. Conclusions: Nationwide implementation of a continuous prolonged prone positioning strategy for COVID-19 ARDS patients was feasible. Minor pressure sores were frequent but within the ranges previously described, while severe adverse events were infrequent. The duration of prone session did not have an adverse effect on safety.Item Dexmedetomidine Improves Cardiovascular and Ventilatory Outcomes in Critically Ill Patients: Basic and Clinical Approaches(2020-02) Castillo, Rodrigo L.; Ibacache, Mauricio; Carrasco-Pozo, Catalina; Cortínez, Ignacio; Farías, Jorge G.; Carrasco, Rodrigo A.; Ramos, Daniel; Benavente, Rafael; Henríquez Torres, Daniela; Méndez, Aníbal; Vargas, PatricioDexmedetomidine (DEX) is a highly selective α2-adrenergic agonist with sedative and analgesic properties, with minimal respiratory effects. It is used as a sedative in the intensive care unit and the operating room. The opioid-sparing effect and the absence of respiratory effects make dexmedetomidine an attractive adjuvant drug for anesthesia in obese patients who are at an increased risk for postoperative respiratory complications. The pharmacodynamic effects on the cardiovascular system are known; however the mechanisms that induce cardioprotection are still under study. Regarding the pharmacokinetics properties, this drug is extensively metabolized in the liver by the uridine diphosphate glucuronosyltransferases. It has a relatively high hepatic extraction ratio, and therefore, its metabolism is dependent on liver blood flow. This review shows, from a basic clinical approach, the evidence supporting the use of dexmedetomidine in different settings, from its use in animal models of ischemia-reperfusion, and cardioprotective signaling pathways. In addition, pharmacokinetics and pharmacodynamics studies in obese subjects and the management of patients subjected to mechanical ventilation are described. Moreover, the clinical efficacy of delirium incidence in patients with indication of non-invasive ventilation is shown. Finally, the available evidence from DEX is described by a group of Chilean pharmacologists and clinicians who have worked for more than 10 years on DEX.Item Embolización selectiva de arterias uterinas en la resolución de patologías ginecológicas y emergencias obstétricas(2011) Guzmán Rojas, Rodrigo; Vargas, Patricio; Astudillo, Julio; Riveros, Rodrigo; Yamamoto, MasamiAntecedentes: La embolización de arterias uterinas es un procedimiento que permite manejar patologías hemorrágicas ginecológicas y obstétricas de manera conservadora y mínimamente invasiva. Métodos: Revisión retrospectiva de casos tratados con embolización selectiva en nuestro Servicio desde su inicio en octubre de 2007. Objetivo: Conocer las indicaciones y resultados de esta técnica. Resultados: Seis casos por patología ginecológica y 7 de causa obstétrica fueron tratados con este procedimiento. El procedimiento fue factible y libre de complicaciones en todos los casos, siendo terapéutico en primera instancia en 12 de los 13 casos. En ningún caso se requirió un tratamiento complementario quirúrgico para cumplir el objetivo terapéutico planificado. Conclusiones: La embolización de arterias uterinas representa una excelente herramienta para tratar cuadros hemorrágicos graves del puerperio, deteniendo hemorragias activas con manejo conservador del útero. En casos de patología ginecológica, el resultado inmediato resulta adecuado, consiguiendo buen control de la hemorragia. Este procedimiento debe ser considerado como alternativa posible en el manejo de la patología hemorrágica obstétrica y ginecológica.Item Grosor íntima media carotídeo y asociación con factores de riesgo cardiovascular tradicionales y metabólicos(2013) Varleta, Paola; Concepción, Roberto; Vargas, Patricio; Casanova, HéctorBackground: Carotid intima-media thickness (IMT) is a surrogate marker of subclinical atherosderosis and is associated with cardiovascular risk factors (CVRF) Aim: To analyze the association of CVRF and metabolic factors (MF) with IMT, and if the clustering of these factors modify IMT. Material and Methods: Cross sectional study in 187 participants aged 46±10years (53% male) without CV disease. Weight, height, waist circumference (WC), blood pressure, fasting plasma glucose and lipid profile were measured. Abdominal obesity (AOb) was defined by ATP III criteria. Mean carotid IMT was measured at the farwall of the common carotid artery. The cutoff point for an abnormally high IMT was set at the 75th IMT percentile of the sample. Results: The 75th IMT percentile of the sample was 0.67 mm. In a multivariate analysis four factors were significantly related with a high IMT: age (odds ratio (OR): 5.3, confidence intervals (CI): 2.2-12.9), dyslipidemia (OR: 6.4 CI: 2.3-17.9), systolic blood pressure (OR: 2.9, CI: 1.2-7.1) and AOb (OR: 2.9 (IC: 1.1-7.2). The presence of Oto 4 of these factors was associated with an IMT increment from 0.54 to 0.71 mm (p < 0,001). Conclusions: In this sample dyslipidemia, systolic blood pressure and abdominal obesity were the main predictors of a high IMT.Item Hemoperitoneo en el post parto secundario a la rotura aneurismática de la arteria ovárica: Caso Clínico(2019) Horwitz, Benjamín; Vargas, Patricio; Vicentela, Andrés; Vega, Ricardo; Zamboni, Gian PaoloEl hallazgo de hemoperitoneo en el post parto secundario a la rotura aneurismática de la arteria ovárica es una situación clínica extremadamente rara que presenta un cuadro clínico inespecífico y puede poner en riesgo la vida del paciente. El ultrasonido es una modalidad segura y rápida para la detección de líquido libre intraperitoneal. (1) . La tomografía computada es la herramienta de elección para un diagnóstico rápido y seguro (2) ; y la angiografía con embolización durante el mismo procedimiento es una alternativa útil y altamente efectiva para la resolución del cuadro. (3). Presentamos el caso de una multípara puérpera de 34 años que consulta en el servicio de urgencia por intenso dolor abdominal. La paciente se encontraba hemodinámicamente estable y afebril. La tomografía computada demostró un hematoma retroperitoneal y hemoperitoneo asociado a un aneurisma de la arteria ovárica derecha. Fue evaluada por el servicio de radiología intervencional y se trasladó de emergencia al pabellón angiográfico donde se realizó la embolización de la lesión mediante la cateterización vascular supra selectiva. La paciente evolucionó de manera favorable y fue dada de alta una semana después. Es necesario tener un alto índice de sospecha en pacientes de riesgo para lograr un diagnóstico y tratamiento oportuno.Item Inferior vena cava thrombosis related to hypothermia catheter: Report of 20 consecutive cases(Neurocritical Care Society wiith Springer International Publishing AG, 2015) Reccius, Andrés; Mercado, Pablo; Vargas, Patricio; Canals, Claudio; Montes, JoséBACKGROUND: Temperature management using endovascular catheters is an established therapy in neurointensive care. Nonetheless, several case series have reported a high rate of thrombosis related to the use of endovascular hypothermia catheters. METHODS: As a result of a pulmonary embolism that developed in a patient after removing an inferior vena cava hypothermia catheter, we designed a clinical protocol for managing and removing these devices. First, an invasive cavography was performed before the removal of the catheter. If there was a thrombus, a cava vein filter was inserted through jugular access. After that, the catheter was removed. RESULTS: The venography found inferior vena cava thrombi in 18 of 20 consecutive patients. A concomitant ultrasonography study showed vena cava thrombosis in only three patients. A vena cava filter was inserted in all patients where thrombi were found, without any significant complication. Anticoagulation was started in all patients. No symptomatic pulmonary embolism was diagnosed until the time of discharge. CONCLUSIONS: The frequency of thrombosis related to temperature management catheters is extremely high (90 %). Furthermore, ultrasonography has a very low sensibility to detect cava vein thrombosis (16.7 %). The real meaning of our findings is unknown, but other temperature control systems could be a safer option. More studies are needed to confirm our findings.Publication Interventional solutions for post-surgical problems: a lymphatic leaks review(2024) Gómez, Fernando M.; Baetens, Tarik R.; Santos, Ernestos; Rocha, Leon; Horwitz, Benjamín; Lojo-Lendoiro, Sara; Vargas, Patricio; Patel, Premal; Beets-Tan, Regina; Martinez-Rodrigo, José J.; Marti Bonmati, LuisThe lymphatic circulation plays a crucial role in maintaining fluid balance and supporting immune responses by returning serum proteins and lipids to the systemic circulation. Lymphatic leaks, though rare, pose significant challenges post-radical neck surgery, oesophagectomy, and thoracic or retroperitoneal oncological resections, leading to heightened morbidity and mortality. Managing lymphatic leaks necessitates consideration of aetiology, severity, and volume of leakage. Traditionally, treatment involved conservative measures such as dietary restrictions, drainage, and medical management, with surgical intervention reserved for severe cases, albeit with variable outcomes and extended recovery periods. Lymphography, introduced in the 1950s, initially served as a diagnostic tool for lymphoedema, lymphoma, tumour staging, and monitoring chemotherapy response. However, its widespread adoption was impeded by alternative techniques like Computed Tomography, learning curves, and its associated complications. Contemporary lymphatic interventions have evolved, favouring nodal lymphangiography over pedal lymphangiography for its technical simplicity and reduced complexity. Effective management of chylous leaks mandates a multimodal approach encompassing clinical evaluation and imaging techniques. In cases where conservative management proves ineffective, embolization through conventional lymphangiography by bipedal dissection or intranodal injection emerges as a viable option. This review underscores the importance of a comprehensive approach to diagnosing and treating lymphatic leaks, highlighting advancements in imaging and therapeutic interventions that enhance patient outcomes.Publication Intranodal Ultrasound-Guided Percutaneous Methylene Blue Injection for the Identification of Leakage Point during Laparoscopic Repair of Refractory Chylous Ascites after Laparoscopic Lymphadenectomy for Kidney Cancer(2022) Otaola, Hugo; Vargas, Patricio; Hasson, Daniel; Orvieto, Marcelo; Niño, Carmen; Bermúdez, HugoChylous ascites is an uncommon complication after surgery that can result in malnutrition and immunodeficiency. Therefore, surgical interventions are reserved for refractory patients, and the primary success factor for these interventions is locating the point of leakage, which is often tricky. We describe a case of a 56-year-old male with chylous ascites after laparoscopic radical nephrectomy and lumbo-aortic lymphadenectomy for kidney cancer. The patient was initially managed with dietary modifications and drainage placement. Afterward, lymphography with Lipiodol, percutaneous embolization of the leakage point, and total parenteral nutrition were established. Finally, the patient underwent laparoscopic repair after identifying the leakage point by injecting methylene blue through an inguinal node. Complete resolution was achieved, and no complications related to the procedure were recorded. Intranodal methylene blue injection can be an invaluable tool to identify the point of leakage in selected patients to improve the outcomes of surgical repair of refractory chylous ascites.Item New Use of Rapamycin Stent in Non-Responding Facial Lymphatic Malformation(Biomedical Journal of Scientific, 2019) Vargas, Patricio; Whittle, Carolina; Recule, Francisca; Fajre, XimenaIntroduction: Vascular anomalies represent a diagnostic and therapeutic difficulty. A lymphatic malformation (LM) corresponds to a low-flow vascular malformation. Sclerotherapy is the preferred treatment. Recently, angiogenesis inhibitors such as Rapamycin have been used with promising results. Case Report: A pediatric patient presented with a large facial LM and poor response to Sildenafil and sclerotherapy. After a persistent enlargement of the lesion, with painful ocular occlusion a new sclerotherapy was performed obtaining partial improvement. As a rescue treatment an IRS was installed. The patient achieved a rapid and evident response, with better ocular aperture and pain control. Discussion: LM correspond to vasculogenesis disorders with persistent growth over time. They can present high morbidity. The complications in the facial area are infection, hemorrhage, exophthalmos, and amblyopia. Rapamycin is a potent angiogenesis inhibitor. Rapamycin stents have been safely used in cardiology. They provide local concentration with less adverse effects. There are no reports on their use in lymphatic malformation. The patient had a favorable and persistent response. Conclusion: IRS should be considered as a therapeutic alternative in severe nonresponding lymphatic malformation. The necessity of a multidisciplinary approach is fundamentalPublication The Management of Chylous Ascites: Description of a New Technique Regarding a Clinical Case(2023) Otaola, Hugo; Vargas, Patricio; Orvieto, Marcelo; Niño, Carmen; Bermúdez, HugoChylous ascites (CA) is a rare postoperative complication that can lead to malnutrition and immunodeficiency. As a result, surgical interventions are reserved for patients who are refractory, and the primary success factor for these interventions is locating the point of leakage, which is frequently difficult. Most CA cases were managed conservatively in the literature, with a minority treated with surgical intervention. We present the case of a 56-year-old man who developed chylous ascites following a laparoscopic radical nephrectomy and lumbo-aortic lymphadenectomy for kidney cancer. At first, the patient was managed with dietary changes and drainage placement. Following that, lipiodol lymphography, percutaneous embolisation of the leakage point, and total parenteral nutrition were established. Ultimately, after identifying the leakage point with methylene blue injection through an inguinal node, the patient underwent laparoscopic repair. The procedure was completed successfully, and no complications were reported. To improve the results of surgical repair of refractory chylous ascites in a subset of patients, intranodal methylene blue injection can be a beneficial technique for pinpointing the source of leakage.