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Pablo Rodriguez

Publications and source records attributed to Pablo Rodriguez.

7 recordsLinked to original sources
PubMed2006

Patient-ventilator asynchrony during assisted mechanical ventilation.

OBJECTIVE: The incidence, pathophysiology, and consequences of patient-ventilator asynchrony are poorly known. We assessed the incidence of patient-ventilator asynchrony during assisted mechanical ventilation and we identified associated factors. METHODS: Sixty-two consecutive patients requiring mechanical ventilation for more than 24 h were included prospectively as soon as they triggered all ventilator breaths: assist-control ventilation (ACV) in 11 and pressure-support ventilation (PSV) in 51. MEASUREMENTS: Gross asynchrony detected visually on 30-min recordings of flow and airway pressure was quantified using an asynchrony index. RESULTS: Fifteen patients (24%) had an asynchrony index greater than 10% of respiratory efforts. Ineffective triggering and double-triggering were the two main asynchrony patterns. Asynchrony existed during both ACV and PSV, with a median number of episodes per patient of 72 (range 13-215) vs. 16 (4-47) in 30 min, respectively (p=0.04). Double-triggering was more common during ACV than during PSV, but no difference was found for ineffective triggering. Ineffective triggering was associated with a less sensitive inspiratory trigger, higher level of pressure support (15 cmH(2)O, IQR 12-16, vs. 17.5, IQR 16-20), higher tidal volume, and higher pH. A high incidence of asynchrony was also associated with a longer duration of mechanical ventilation (7.5 days, IQR 3-20, vs. 25.5, IQR 9.5-42.5). CONCLUSIONS: One-fourth of patients exhibit a high incidence of asynchrony during assisted ventilation. Such a high incidence is associated with a prolonged duration of mechanical ventilation. Patients with frequent ineffective triggering may receive excessive levels of ventilatory support.

Aged↗
PubMed2006

A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation.

RATIONALE AND OBJECTIVES: Duration of weaning from mechanical ventilation may be reduced by the use of a systematic approach. We assessed whether a closed-loop knowledge-based algorithm introduced in a ventilator to act as a computer-driven weaning protocol can improve patient outcomes as compared with usual care. METHODS AND MEASUREMENTS: We conducted a multicenter randomized controlled study with concealed allocation to compare usual care for weaning with computer-driven weaning. The computerized protocol included an automatic gradual reduction in pressure support, automatic performance of spontaneous breathing trials (SBT), and generation of an incentive message when an SBT was successfully passed. One hundred forty-four patients were enrolled before weaning initiation. They were randomly allocated to computer-driven weaning or to physician-controlled weaning according to local guidelines. Weaning duration until successful extubation and total duration of ventilation were the primary endpoints. MAIN RESULTS: Weaning duration was reduced in the computer-driven group from a median of 5 to 3 d (p=0.01) and total duration of mechanical ventilation from 12 to 7.5 d (p=0.003). Reintubation rate did not differ (23 vs. 16%, p=0.40). Computer-driven weaning also decreased median intensive care unit (ICU) stay duration from 15.5 to 12 d (p=0.02) and caused no adverse events. The amount of sedation did not differ between groups. In the usual care group, compliance to recommended modes and to SBT was estimated, respectively, at 96 and 51%. CONCLUSIONS: The specific computer-driven system used in this study can reduce mechanical ventilation duration and ICU length of stay, as compared with a physician-controlled weaning process.

Aged↗
PubMed2006

Transcutaneous arterial carbon dioxide pressure monitoring in critically ill adult patients.

OBJECTIVE: To evaluate the accuracy of transcutaneous PCO(2) (PtcCO(2)) as a surrogate for arterial PCO(2) (PaCO(2)) in a cohort of adult critically ill patients in a medical intensive care unit (ICU). DESIGN: Prospective observational study comparing paired measures of transcutaneous and arterial PCO(2). SETTING: A 26-bed medical ICU. PATIENTS: Fifty ICU patients monitored with a SenTec Digital Monitor placed at the ear lobe over prolonged periods. RESULTS: A total of 189 paired PCO(2) measures were obtained. Twenty-one were excluded from analysis, because profound skin vasoconstriction was present (PCO(2) bias =-10.8+/-21.8 mmHg). Finally, 168 were analysed, including 137 obtained during mechanical ventilation and 82 under catecholamine treatment. Body temperature was below 36 degrees C for 27 measurements. Mean duration of monitoring was 17+/-17 h. The mean difference between PaCO(2) and PtcCO(2) was -0.2+/-4.6 mmHg with a tight correlation (R(2)=0.92, p>0.01). PCO(2) bias did not significantly change among three successive measurements. Changes in PaCO(2) and in PtcCO(2) between two blood samples were well correlated (R(2)=0.78, p>0.01). Variations of more than 8 mmHg in PtcCO(2) had 86% sensitivity and 80% specificity to correctly predict similar changes in PaCO(2) in the same direction. Catecholamine dose or respiratory support did not affect PtcCO(2) accuracy. Hypothermia has only a small effect on accuracy. No complication related to a prolonged use of the sensor was observed CONCLUSION: Transcutaneous PCO(2) provides a safe and reliable trend-monitoring tool, provided there is no major vasoconstriction.

Adult↗
PubMed2004

L-arginine promotes capacitation and acrosome reaction in cryopreserved bovine spermatozoa.

Sperm capacitation and acrosome reaction are essential for fertilization and they are considered as part of an oxidative process involving superoxide and hydrogen peroxide. In human spermatozoa, the amino acid L-arginine is a substrate for the nitric oxide synthase (NOS) producing nitric oxide (NO*), a reactive molecule that participates in capacitation as well as in acrosome reaction. L-arginine plays an important role in the physiology of spermatozoa and has been shown to enhance their metabolism and maintain their motility. Moreover, L-arginine has a protective effect on spermatozoa against the sperm plasma membrane lipid peroxidation. In this paper, we have presented, for the first time, the effect of L-arginine on cryopreserved bovine sperm capacitation and acrosome reaction and the possible participation of NOS in both processes. Frozen-thawed bovine spermatozoa have been incubated in TALP medium with different concentrations of L-arginine and the percentages of capacitated and acrosome reacted spermatozoa have been determined. L-arginine induced both capacitation and acrosome reaction. NO* produced by L-arginine has been inhibited or inactivated using NOS inhibitors or NO* scavengers in the incubation medium, respectively. Thus, the effect of NOS inhibitors and NO* scavengers in capacitated and non-capacitated spermatozoa treated with L-arginine has also been monitored. The data presented suggest the participation of NO*, produced by a sperm NOS, in cryopreseved bovine sperm capacitation and acrosome reaction.

Acrosome Reaction↗