Papers by Gerardo Aguilar
Etic@net. Revista científica electrónica de Educación y Comunicación en la Sociedad del Conocimiento, 2011
En esta investigación trata del uso de las TIC como herramienta didáctica, para la especialidad d... more En esta investigación trata del uso de las TIC como herramienta didáctica, para la especialidad de Administración de la UNESR, Núcleo Maracay, en sus 03 menciones durante el P. A. 2008-II, toda vez que se cuenta con la tecnología pero no se posee la dotación suficiente para satisfacer los requerimientos académicos e investigativos de la comunidad educativa. Es un estudio de campo con carácter descriptivo y evaluativo, no experimental transaccional. La población de docentes y estudiantes se estratificó y los datos fueron obtenidos con 02 cuestionarios y 01 lista de chequeo. Se concluye que la población posee debilidades en cuanto a preparación en el uso de las TIC, lo que conlleva a que posean una actitud desfavorable hacia su uso aunque no niegan la utilidad que tienen las TIC como herramienta didáctica a nivel universitario. Se recomendó mejorar el nivel de difusión de las TIC con la dotación de laboratorios y, la aplicación de planes de formación permanente.
Scientia et Technica, 2020
Using the Intermediate Value Theorem we demonstrate the rules of Trapeze and Simpson's. Demon... more Using the Intermediate Value Theorem we demonstrate the rules of Trapeze and Simpson's. Demonstrations with this approach and its generalization to new formulas are less laborious than those resulting from methods such as polynomial interpolation or Gaussian quadrature. In addition, we extend the theory of approximate integration by finding new approximate integration formulas. The methodology we used to obtain this generalization was to use the definition of the integral defined by Riemann sums. Each Riemann sum provides an approximation of the result of an integral. With the help of the Intermediate Value Theorem and a detailed analysis of the Middle Point, Trapezoidal and Simpson Rules we note that these rules of numerical integration are Riemann sums. The results we obtain with this analysis allowed us to generalize each of the rules mentioned above and obtain new rules of approximation of integrals. Since each of the rules we obtained uses a point in the interval we have ca...
Critical Care, 2020
In accordance with the recommendations of, amongst others, the Surviving Sepsis Campaign and the ... more In accordance with the recommendations of, amongst others, the Surviving Sepsis Campaign and the recently published European treatment guidelines for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), in the event of a patient with such infections, empirical antibiotic treatment must be appropriate and administered as early as possible. The aim of this manuscript is to update treatment protocols by reviewing recently published studies on the treatment of nosocomial pneumonia in the critically ill patients that require invasive respiratory support and patients with HAP from hospital wards that require invasive mechanical ventilation. An interdisciplinary group of experts, comprising specialists in anaesthesia and resuscitation and in intensive care medicine, updated the epidemiology and antimicrobial resistance and established clinical management priorities based on patients’ risk factors. Implementation of rapid diagnostic microbiological techniques availab...
Intensive Care Medicine, 2020
The main characteristics of mechanically ventilated ARDS patients affected with COVID-19, and the... more The main characteristics of mechanically ventilated ARDS patients affected with COVID-19, and the adherence to lung-protective ventilation strategies are not well known. We describe characteristics and outcomes of confirmed ARDS in COVID-19 patients managed with invasive mechanical ventilation (MV). Methods: This is a multicenter, prospective, observational study in consecutive, mechanically ventilated patients with ARDS (as defined by the Berlin criteria) affected with with COVID-19 (confirmed SARS-CoV-2 infection in nasal or pharyngeal swab specimens), admitted to a network of 36 Spanish and Andorran intensive care units (ICUs) between March 12 and June 1, 2020. We examined the clinical features, ventilatory management, and clinical outcomes of COVID-19 ARDS patients, and compared some results with other relevant studies in non-COVID-19 ARDS patients. Results: A total of 742 patients were analysed with complete 28-day outcome data: 128 (17.1%) with mild, 331 (44.6%) with moderate, and 283 (38.1%) with severe ARDS. At baseline, defined as the first day on invasive MV, median (IQR) values were: tidal volume 6.9 (6.3-7.8) ml/kg predicted body weight, positive end-expiratory pressure 12 (11-14) cmH 2 O. Values of respiratory system compliance 35 (27-45) ml/cmH 2 O, plateau pressure 25 (22-29) cmH 2 O, and driving pressure 12 (10-16) cmH 2 O were similar to values from non-COVID-19 ARDS patients observed in other studies. Recruitment maneuvers, prone position and neuromuscular blocking agents were used in 79%, 76% and 72% of patients, respectively. The risk of 28-day mortality was lower in mild ARDS [hazard ratio (RR) 0.56 (95% CI 0.33-0.93), p = 0.026] and moderate ARDS [hazard ratio (RR) 0.69 (95% CI 0.47-0.97), p = 0.035] when compared to severe ARDS. The 28-day mortality was similar to other observational studies in non-COVID-19 ARDS patients. Conclusions: In this large series, COVID-19 ARDS patients have features similar to other causes of ARDS, compliance with lung-protective ventilation was high, and the risk of 28-day mortality increased with the degree of ARDS severity.
Intensive Care Medicine, 2019
Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence sug... more Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of daily life in addition to the presence of comorbidity and polypharmacy and to assess their influence on 30-day survival. Methods: Prospective cohort study with 242 ICUs from 22 countries. Patients 80 years or above acutely admitted over a six months period to an ICU between May 2018 and May 2019 were included. In addition to common patients' characteristics and disease severity, we collected information on specific geriatric syndromes as potential predictive factors for 30-day survival, frailty (Clinical Frailty scale) with a CFS > 4 defining frail patients, cognitive impairment (informant questionnaire on cognitive decline in the elderly (IQCODE) with IQCODE ≥ 3.5 defining cognitive decline, and disability (measured the activity of daily life with the Katz index) with ADL ≤ 4 defining disability. A Principal Component Analysis to identify co-linearity between geriatric syndromes was performed and from this a multivariable model was built with all geriatric information or only one: CFS, IQCODE or ADL. Akaike's information criterion across imputations was used to evaluate the goodness of fit of our models. Results: We included 3920 patients with a median age of 84 years (IQR: 81-87), 53.3% males). 80% received at least one organ support. The median ICU length of stay was 3.88 days (IQR: 1.83-8). The ICU and 30-day survival were 72.5% and 61.2% respectively. The geriatric conditions were median (IQR): CFS: 4 (3-6); IQCODE: 3.19 (3-3.69); ADL: 6 (4-6); Comorbidity and Polypharmacy score (CPS): 10 (7-14). CFS, ADL and IQCODE were closely correlated. The multivariable analysis identified predictors of 1-month mortality (HR; 95% CI): Age (per 1 year increase): 1.02 (1.-1.03, p = 0.01), ICU admission diagnosis, sequential organ failure assessment score (SOFA) (per point): 1.15 (1.14-1.17, p < 0.0001) and
Revista Mexicana de Economía y Finanzas, 2005
Este trabajo desarrolla un modelo de equilibrio parcial para valuar productos derivados cuando la... more Este trabajo desarrolla un modelo de equilibrio parcial para valuar productos derivados cuando la volat ilidad del activo subyacente presenta volatilidad estocástica. El modelo considera una economía poblada por agentes racionales (consumidores-inversionistas) que toman decisiones sobre co nsumo e inversión en un a mbiente de riesgo de mercado. E l precio del der ivado y el coefici ente d e riesgo se caracterizan como las soluciones d e un sistema de ecuaciones diferencia les parciales. Varias formas específicas de la función d e ut ilida d son analizadas en el proceso de valuación.
Critical Care, 2019
Ceftolozane-tazobactam (C/T), the combination of a new cephalosporin with a classic β-lactamase i... more Ceftolozane-tazobactam (C/T), the combination of a new cephalosporin with a classic β-lactamase inhibitor, is currently considered the most active betalactam antibiotic against P. aeruginosa [1]. Despite several case reports on C/T pharmacokinetics in critically ill patients during continuous renal replacement therapy (CRRT) [2-4], the optimal dose in this clinical scenario still remains unclear [5]. A 68-year-old patient was admitted to our ICU with septic shock (nosocomial peritonitis) and anuric acute renal failure. Broad-spectrum antimicrobial therapy, including C/T and continuous venovenous hemodiafiltration (CVVHD), was initiated, using a polysulphone hemofilter (Fresenius, Germany) with blood flow, dialysate fluid, and replacement fluid rates of 100 mL/min, 2000 mL/h, and 1000 mL/h. The patient received high C/T doses of C/T 2 g/1 g every 8 h (infused over 1 h) while receiving CVVHD, and became apyrexial 7 days after C/T treatment initiation, remaining fever-free for 14 days without any adverse effects related to this drug.
Bioanalysis, 2018
Aim: A simple, rapid, economical and sensitive HPLC-UV method was developed for the simultaneous ... more Aim: A simple, rapid, economical and sensitive HPLC-UV method was developed for the simultaneous quantification of ceftolozane and tazobactam in plasma samples. Methodology: After deproteinization followed by a liquid–liquid back-extraction, the compounds were separated on a C18 column (150 mm × 4.6 mm, 5 μm) with UV-visible detection at 220 nm. The mobile phase consisted of acetonitrile and potassium dihydrogenphosphate buffer at pH 3.0 (8:92, v/v), delivered isocratically at a flow rate of 1.0 ml/min and at a column oven temperature of 30°C. Cefepime was used as an internal standard. Results: Linearity was achieved in the concentration range of 0.50–100.00 μg/ml for ceftolozane and 0.25–50.00 μg/ml for tazobactam. The intra- and interday precision showed good reproducibility with coefficients of variation of less than 9.26% for ceftolozane and 9.62% for tazobactam. Conclusion: The sample preparation procedure avoids expensive or time-consuming steps used by other previously publis...
Critical care (London, England), Jan 22, 2018
Early appropriate antibiotic treatment is essential in sepsis. We aimed to evaluate the impact of... more Early appropriate antibiotic treatment is essential in sepsis. We aimed to evaluate the impact of a multifaceted educational intervention to improve antibiotic treatment. We hypothesized that the intervention would hasten and improve the appropriateness of empirical antibiotic administration, favor de-escalation, and decrease mortality. We prospectively studied all consecutive patients with sepsis/septic shock admitted to 72 intensive care units (ICUs) throughout Spain in two 4-month periods (before and immediately after the 3-month intervention). We compared process-of-care variables (resuscitation bundle and time-to-initiation, appropriateness, and de-escalation of empirical antibiotic treatment) and outcome variables between the two cohorts. The primary outcome was hospital mortality. We analyzed the intervention's long-term impact in a subset of 50 ICUs. We included 2628 patients (age 64.1 ± 15.2 years; men 64.0%; Acute Physiology and Chronic Health Evaluation (APACHE) II, 2...
The Lancet. Respiratory medicine, Mar 19, 2018
The effects of individualised perioperative lung-protective ventilation (based on the open-lung a... more The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m2. Patients were randomly assigned (1:1:1:1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a l...
Critical care (London, England), Aug 2, 2017
Fig. 1 Concentration-time curve for a schedule treatment of 100 mg/day caspofungin versus 70 mg/d... more Fig. 1 Concentration-time curve for a schedule treatment of 100 mg/day caspofungin versus 70 mg/day in a morbidly obese patient
BMJ open, Jan 31, 2017
Surgical site infection (SSI) is a serious postoperative complication that increases morbidity an... more Surgical site infection (SSI) is a serious postoperative complication that increases morbidity and healthcare costs. SSIs tend to increase as the partial pressure of tissue oxygen decreases: previous trials have focused on trying to reduce them by comparing high versus conventional inspiratory oxygen fractions (FIO2) in the perioperative period but did not use a protocolised ventilatory strategy. The open-lung ventilatory approach restores functional lung volume and improves gas exchange, and therefore it may increase the partial pressure of tissue oxygen for a given FIO2. The trial presented here aims to compare the efficacy of high versus conventional FIO2 in reducing the overall incidence of SSIs in patients by implementing a protocolised and individualised global approach to perioperative open-lung ventilation. This is a comparative, prospective, multicentre, randomised and controlled two-arm trial that will include 756 patients scheduled for abdominal surgery. The patients will...
Critical care (London, England), Jan 30, 2017
Journal of Structural Engineering, 2015
This paper presents the main results obtained from field tests carried out in four sites of three... more This paper presents the main results obtained from field tests carried out in four sites of three recently built elevated viaducts in Mexico City. The main objectives of the tests were to determine and assess the structural response of elements located at representative sections of the viaducts. Focus was given to the identification of main static and dynamic properties, the measurement of the lateral displacement of the column-footing assemblage under monotonically increasing loads, and the study of the soil-structure interaction of the assembly. The field tests ranged from ambient vibration measurements to applying horizontal and vertical loads to the structure by means of pulling cranes and both parked and moving vehicles. The tests were aimed not only at providing experimental evidence to support the general assumptions used by the design firm, and to make the proper adjustments if deemed necessary, but to contribute to the body of knowledge with respect to elevated viaducts built by means of precast posttensioned members.
British Journal of Anaesthesia, 2010
† Transpulmonary thermodilution (TPTD) has been developed as an alternative to invasive haemodyna... more † Transpulmonary thermodilution (TPTD) has been developed as an alternative to invasive haemodynamic monitoring with a pulmonary artery catheter (PAC). † This study examined the type and incidence of complications during the insertion, use, and removal of 514 arterial catheters used for TPTD. † The use of TPTD catheters did not increase the risk of complications when compared with the commonly used short peripheral arterial catheters or PAC. Background. The aim of this study was to evaluate the type and incidence of complications during insertion, maintenance, and withdrawal of central arterial catheters used for transpulmonary thermodilution haemodynamic monitoring (PiCCO TM). Methods. We conducted a prospective, observational, multicentre study in 14 European intensive care units (six countries). A total of 514 consecutive patients in whom haemodynamic monitoring by PiCCO TM was indicated were studied. Results. Five hundred and fourteen PiCCO catheters (475 in femoral, 26 in radial, nine in axillary, and four in brachial arteries) were inserted. Arterial access was obtained on the first attempt in 86.4% of the patients. Minor problems such as oozing after insertion (3.3%) or removal of the catheter (3.5%) were observed, but no episodes of serious bleeding (more than 50 ml) were recorded. Small local haematomas were observed after insertion (4.5%) and after removal (1.2%) of the catheter. These complications were not more frequent in patients with coagulation abnormalities. The incidence of site inflammation and catheter-related infection was 2% and 0.78%, respectively. Other complications such as ischaemia (0.4%), pulse loss (0.4%), or femoral artery thrombosis (0.2%) were rare, transient, and all resolved with catheter removal or embolectomy, respectively. Conclusions. In this series of patients, central arterial catheters used for PiCCO TM monitoring were demonstrated to be a safe alternative for advanced haemodynamic monitoring.
Annals of Intensive Care, 2020
BackgroundThe number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients... more BackgroundThe number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival.ResultsThis prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81–86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, ha...
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Papers by Gerardo Aguilar