Browsing by Autor "Osman Arteaga Iriarte"

Now showing 1 - 7 of 7

Bilateral Subdural Empyema, secondary to odontogenic infectious process. Case Report
(2024) Edwin Cruz Choquetopa; Jhossmar Cristians Auza-Santiváñez; Mildred Ericka Kubatz La Madrid; Blas Apaza-Huanca; Yenifer Zelaya-Espinoza; Maribel Zambrana-Mejia; F Salazar; Osman Arteaga Iriarte
Introduction: Subdural empyema (ESD) is a collection of pus between the dura mater and arachnoid, and constitutes a medical emergency due to its rapid progression and high mortality rate. Although ENT infections are the main causes, odontogenic infections can also lead to ESD. Early diagnosis, intravenous antibiotic therapy and surgical intervention are essential to reduce mortality.Clinical case: A 32-year-old male patient presented with a month-long picture of swelling and pain on the left side of the face, recently aggravated by fever, headache, vomiting and generalised tonic-clonic convulsions. He had a history of alcoholism and recurrent dental infections. Imaging revealed a bilateral subdural empyema with left-sided predominance. Urgent antibiotic treatment was initiated, followed by bilateral craniotomy and drainage of purulent material. In addition, a brain abscess and a subgaleal haematoma were managed. Cultures identified Streptococcus viridans and coagulase-negative Staphylococcus, with good response to targeted therapy. The patient progressed favourably and was discharged in good condition.Conclusions: In regions like Bolivia, the prevalence of odontogenic infections due to cultural and economic factors increases the risk of severe complications such as SDE. A multidisciplinary approach, including early diagnosis, broad-spectrum antibiotics, and surgical intervention, is essential to improve outcomes and reduce mortality in these patients
Diaphragmatic muscle dysfunction associated with artificial mechanical ventilation: a narrative review of the literature
(2024) Arian Jesús Cuba Naranjo; Ariel Sosa Remón; Jhossmar Cristians Auza-Santiváñez; Ana Esperanza Jeréz Álvarez; Yudiel Pérez Yero; Héctor R. Díaz Águila; Osman Arteaga Iriarte
Mechanical ventilation is a respiratory support therapy that can cause diaphragm muscle injury and induce dysfunction, which is associated with prolonged ventilation, weaning failure and mortality. Protecting the diaphragm during ventilation requires the use of tools to monitor diaphragmatic effort. The aim of this review was to address current and relevant elements about the pathophysiology of diaphragmatic function in ventilated patients. For this purpose, a narrative review of the literature available in Google Scholar, Pumed/Medline, regional SciELO, and academic Google was carried out under the terms: diaphragmatic function-diaphragmatic function in ventilated patients/diaphragmatic ultrasound in ventilated patients pathophysiology/ diaphragmatic function and others. Fundamental theoretical contents on the clinic of diaphragmatic muscle dysfunction, its relationship with artificial ventilation and related structures, such as the lung, are addressed. It is concluded that the diaphragm represents the main muscle involved in respiration and diaphragmatic muscle dysfunction represents a frequent complication in critically ill patients. Diaphragmatic ultrasound is a tool that aids decision making on artificial ventilation, potentially reduces the duration of respiratory support and associated complications
Early prediction of acute kidney injury in neurocritical patients: relevance of renal resistance index and intrarenal venous Doppler as diagnostic tools
(2023) Jorge Márquez-Molina; Jhossmar Cristians Auza-Santiváñez; Edwin Cruz Choquetopa; José Bernardo Antezana-Muñoz; Osman Arteaga Iriarte; Helen Fernández Burgoa
Introduction: Implementing renal POCUS in critical care is a valuable tool complementing the physical examination of critical patients. As it is noninvasive, accessible, innocuous, and economical, it makes it possible to assess, at the bedside of patients, renal perfusion via ultrasound measurements such as the renal resistance index (RRI) and intrarenal venous Doppler (IRVD), which are considered early predictors of the acute renal lesion. Goals: Determine the relationship between the renal resistance index (RRI) and the degree of acute renal lesion according to KDIGO in neurocritical patients. Correlate the alterations to intrarenal venous Doppler (IRVD) flow with the degree of the acute renal lesion, according to KDIGO. Methods: An observational, analytical, prospective, longitudinal study was carried out in an ICU with an influx of neurocritical patients. Forty-three (43) patients participated. Their renal resistance index (RRI) and intrarenal venous Doppler (IRVD) were measured upon admission, 72 hours later, and 7 days after admission. Which of these tools better predicts acute renal lesions according to KDIGO was assessed. Results: In the study with 43 critical patients, no significant correlation was found between the RRI value and the acute renal lesion, according to KDIGO. On the contrary, a significant relation was found between intrarenal venous Doppler (IRVD) upon admission, 72 hours later, and 7 days after admission with the acute renal lesion according to KDIGO, with a value of r: 43=0.95 (P=0.54); 0.49 (P=0.001); 0.58 (P=0.000). When analyzing via the classification tree, it was determined that the variables better predicting the risk of suffering from an acute renal lesion before its occurrence are the measurement of intrarenal venous Doppler (IRVD) 7 days after admission and the value of the accumulated water balance. Conclusions: There is a positive and significant correlation between intrarenal venous Doppler (IRVD) and the acute renal lesion. Intrarenal venous Doppler (IRVD) and the accumulated water balance better predict the risk of suffering from an acute renal lesion in critical patients. In contrast, the renal resistance index (RRI) was unrelated to the acute renal lesion in the studied population
Extubation based on predictive scales in the management of neurocritical patients: Narrative review and update
(2025) Jhossmar Cristians Auza-Santiváñez; Edwin Cruz Choquetopa; José Bernardo Antezana-Muñoz; Osman Arteaga Iriarte; Sara Milca Robles-Nina; Blas Apaza-Huanca; Rodrigo Stalin Torrico-Araúz; David Oliver Aguirre-Soliz
Introduction: Invasive mechanical ventilation (IMV) is essential in neurocritical patients to ensure oxygenation, control ventilation and prevent secondary brain damage, although its prolonged use is associated with complications such as ventilator-associated pneumonia (VAP) and increased mortality. Extubation in this population faces failure rates of up to 40%, highlighting the need for specific strategies. Methodology: A narrative review was conducted based on original articles, case series and open access systematic reviews, consulted in SciELO, LILACS, Scopus, PubMed-Medline, Google Scholar and ClinicalKey. DeCS descriptors and Boolean operators were used, excluding letters to the editor and conference proceedings to prioritise quality evidence. Development: Extubation in neurocritical patients is compromised by neurological (altered level of consciousness, reflex dysfunction), respiratory (secretions, weak cough) and systemic (prolonged IMV) factors. Scales such as VISAGE, AIRWAY SCORE and ENIO integrate key variables to predict success, although they lack universal validation. Tracheostomy reduces duration of IMV, but not VAPV or mortality, while physiotherapy shows unconfirmed potential. Conclusion: Predictive scales offer valuable tools, but their standardisation is limited. Level of consciousness does not consistently predict success, prioritising airway protection. Prospective studies are needed to develop specific protocols and improve outcomes in neurocritical patients.
Mechanical power and mortality: analysis of a prospective cohort of ventilated patients
(2025) Yudiel Pérez Yero; Ariel Sosa Remón; Jhossmar Cristians Auza-Santiváñez; Arian Jesús Cuba Naranjo; Dasha María García Arias; Ana Esperanza Jeréz Álvarez; Mileydys Saborit García; Osman Arteaga Iriarte; José Bernardo Antezana-Muñoz
Introduction: Mechanical power establishes the amount of energy per unit time transferred from the ventilator to the respiratory system. Its usefulness as a predictor of death has been demonstrated in COVID-19 or acute respiratory distress syndrome. However, its prognostic value in ventilated patients without these conditions is unknown. Objective: to determine the association of mechanical power with the incidence of mortality in patients with invasive artificial ventilation in the Intensive Care Unit. Methods: a prospective cohort study in 52 patients ventilated invasively in an Intensive Care Unit of a Cuban hospital. The final variable of interest was mortality. Sociodemographic and ventilatory variables were studied. The level of significance was found according to p value ≤ 0.05 through hypothesis testing of differences in means and proportions and the the area under the ROC curve. Results: mortality predominated in female patients, with a mean age of 51.76 ± 21.76 years. The main causes of ventilation were respiratory. High APACHE II score, SOFA and a mean mechanical power value of 14.82 ± 1.67 J/min were associated with mortality. On analysis of the area under the ROC curve, mechanical power yielded adequate discriminative ability for mortality (AROC: 0.993; 95 % CI: 0.979 - 1; p = 0.000). Conclusions: In this series of ventilated patients the mechanical power value proved to be a factor associated with mortality.
Prognostic scale for death in critically ill cancer patients due to neurological complications
(2025) Ariel Sosa Remón; Freddy Ednildon Bautista-Vanegas; José Bernardo Antezana-Muñoz; Osman Arteaga Iriarte; Yudiel Pérez-Yero; Arian Jesús Cuba Naranjo; Miguel Emilio García Rodríguez; Jhossmar Cristians Auza-Santiváñez; Ana Esperanza Jeréz Álvarez; J. Triana
Introduction: The scales used to predict death in cancer patients are scarce and have not been adequately validated in populations with neurological complications. Objective: To design a prognostic scale for death in critically ill cancer patients due to neurological complications. Method: An observational, prospective cohort study was conducted from January 2017 to 2024 in the Oncology Intensive Care Unit of the Institute of Oncology and Radiobiology in Havana, Cuba. The study population consisted of 265 patients. Clinical, oncological, laboratory, and life support variables were studied. Binary logistic regression analysis was used to determine the variables with the best prognostic power for the model. The final variable was mortality in the Intensive Care Unit. Results: The final model consisted of the following variables: ECOG III (OR: 3.62; 95% CI: 1.05 - 12.46; p= 0.041), absence of pupillary reflex (OR: 9.35; 95% CI: 2.24 - 38.99; p= 0.002), intracranial hypertension (OR: 17.91; 95% CI: 3.02 - 105.91; p= 0.001), hyperglycemia (OR: 5.85; 95% CI: 2.07 - 16.49; p= 0.001), hypoxemia (OR: 19.09; 95% CI: 2.91 - 61.67; p= 0.000) and artificial mechanical ventilation (OR: 9.59; 95% CI: 2.59 – 35.51; p = 0.001).Conclusions: The prognostic score classified mortality into 3 risk groups: low (0 to 2 points), moderate (3 to 6 points), and high (7 to 13 points). Mortality was higher in patients with higher scores. Internal validation showed excellent calibration and discrimination.
Utility of POCUS in estimating blood volume in neurocritical patients with hyponatremia, in the Polyvalent Intensive Care Unit of the Viedma Clinical Hospital
(2024) Edwin Cruz Choquetopa; Jhossmar Cristians Auza-Santiváñez; José Bernardo Antezana-Muñoz; Jorge Márquez-Molina; F Salazar; Osman Arteaga Iriarte; Daniel Victor Arraya Borges; Eloy Paycho Anagua
Introduction: Hyponatremia is one of the most common hydroelectrolytic disorders in patients with neurocritical pathology. Estimating blood volume in critically ill patients with hyponatremia is a challenge, and this is where point-of-care ultrasound (POCUS) becomes relevant.Methods: An observational, analytical, prospective, and longitudinal study was conducted in an ICU with a high influx of neurocritical patients. Thirty-one neurocritical patients who developed acute hyponatremia participated. They were evaluated clinically, analytically, and underwent ultrasound measurements at the bedside of the patients. It was determined which of the variables (clinical, analytical, and ultrasound) achieved the greatest sensitivity and specificity when determining blood volume. Results: More than half developed hyponatremia during their stay in the ICU, the predominant gender was male with more than 61% and more than 77% had a diagnosis of head trauma. The ROC curve was able to show that the ultrasound variables presented a sensitivity of 93% and specificity of 94% with an area under the curve (AUC) of 0.93. And of these (ITV, GC, Echo-pulmonary, VEXUS and IVC indices) were the ones that best predict blood volume. In our survival analysis (Kaplan Meier) we found a mean survival of 37.5 days (36.4 - 38.49) in the group (Hypovolemic = CPS), compared to a mean survival of 27.7 days (25.4 - 29.9) in the group (Normo-hypervolemic = SIADH) (CI 95% P: 0.078), which expresses higher mortality in those neurocritical patients who developed acute hyponatremia (Normo-hypervolemic = CPS).Conclusions:More than half of the neurocritical patients developed hyponatremia during their stay in the ICU, the mean age of the patients was 44 for the hypovolemic group and 35 for the normo-hypervolemic group, the predominant gender was male and most had a diagnosis of head trauma. POCUS (LUS, VEXUS, FoCUS) showed higher sensitivity and specificity in predicting blood volume in neurocritical patients with acute hyponatremia. The time to resolution of hyponatremia after starting treatment was a median of 3 days in the hypovolemic group, in contrast to the normo-hypervolemic group, which required more time, and no cases of overcorrection were reported in either group. Neurocritical patients with acute hyponatremia (Hypovolemic = CPS) would have more days of survival compared to neurocritical patients with acute hyponatremia (Normo-hypervolemic = SIADH)