Papers by Guillermo Montiel
Respirar
La ventilación mecánica no invasiva (VMNi) y la cánula nasal de alto-flujo (CNAF) se utilizan cad... more La ventilación mecánica no invasiva (VMNi) y la cánula nasal de alto-flujo (CNAF) se utilizan cada vez más en los pacientes con insuficiencia respiratoria aguda y crónica exacerbada. Algunos pacientes que reciben estas terapias también podrían beneficiarse de la administración de fármacos inhalados. Por lo tanto, resulta atractivo combinar el tratamiento con aerosoles y soportes respiratorios no invasivos (SR-NI). Los dispositivos para realizar aerosolterapia que pueden adaptarse en línea con los SRNI son los inhaladores de dosis medida presurizados (IDMp) y los nebulizadores. En el subgrupo de los nebulizadores se encuentran tres tipos: nebulizadores tipo jet (NJ), nebulizadores ultrasónicos (NUs) y los nebulizadores de malla vibrante (NMV). La administración de aerosolterapia en línea con la CNAF parece una combinación novedosa y de gran aplicabilidad en pacientes seleccionados. En función de la evidencia disponible, parece oportuna la combinación de brindar VMNi y terapia de aerosoles en pacientes con obstrucción al flujo aéreo sin interrumpir el tratamiento respiratorio. El objetivo de este artículo es revisar la bibliografía disponible sobre la aerosolterapia durante los SRNI. Además, ofrecer recomendaciones basadas en la evidencia disponible. Palabras clave: aerosolterapia; cánula nasal de alto-flujo, ventilación no invasiva; nebulizador; inhaladores; nebulizador de malla vibrante.
Chest
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Medicina-buenos Aires, Jan 12, 2020
Rev. am. med. respir, 2020
The severe chronic hypoxemia is defined as an arterial partial oxygen pressure measuring less tha... more The severe chronic hypoxemia is defined as an arterial partial oxygen pressure measuring less than 60 mmHg. Oxygen therapy is defined as the therapeutic use ...
Respirar, Sep 13, 2022
Nebulización con malla vibratoria de broncodilatadores a través de CNAF en exacerbación de EPOC
![Research paper thumbnail of [Preliminary results of a non-invasive ventilatory support unit in SARS-COVID-2]](https://a.academia-assets.com/images/blank-paper.jpg)
Medicina, 2020
The use of non-invasive respiratory support in the context of the COVID-19 pandemic is controvers... more The use of non-invasive respiratory support in the context of the COVID-19 pandemic is controversial. The aim of this observational study was to show the experience of the first month since the creation of a Non-invasive Ventilatory Support Unit (NIVSU) at Hospital Fernández. We describe the creation of the NIVSU, the health professional-patient ratio, the type of room, the modified personal protection equipment; diagnostic, monitoring and ventilatory support equipment for treatment, as well as the inclusion criteria and the treatment algorithm. Twenty five (63%) of patients were referred from the Internal Medicine Ward, 10 (25%)) from Shock Room, and 5 (13%) from Emergency Ward. National Early Warning Score, Acute Physiology and Chronic Health Disease Classification System II and Sequential Organ Failure Assessment, were calculated on admission, with a median of 12, 8, and 2 points, respectively. The Lung Ultrasonography Score was taken to quantify lung ultrasound findings. All pat...
Presentamos un paciente masculino de 68 anos, obeso morbido con antecedentes de sindrome de apnea... more Presentamos un paciente masculino de 68 anos, obeso morbido con antecedentes de sindrome de apneas del sueno, que ingresa a la unidad de terapia Intensiva con insuficiencia respiratoria aguda hipercapnica y es tratado con ventilacion mecanica no invasiva (VMNI). A pesar de lograr una buena adaptacion a la interfaz, el menor valor de PaCO2 fue de 68mmHg. Se decide colocar un balon esofagico con el objetivo de determinar en que medida el componente toraco abdominal estaba afectando el esfuerzo de musculos inspiratorios y el intercambio gaseoso. Luego de la medicion, los valores de presion positiva al final de espiracion (PEEP) se incrementaron, obteniendose una presion transpulmonar telespiratoria (PLesp) cercana a 0 cmH2O, una y una mejoria en el valor de PaCO2. El paciente no presento ninguna complicacion asociada a la titulacion con manometria esofagica y fue dado de alta de la terapia intensiva a las 72 horas.
Respiratory Care, 2021
Background: The role of high-flow nasal cannula (HFNC) and CPAP in COVID-19 are controversial. Th... more Background: The role of high-flow nasal cannula (HFNC) and CPAP in COVID-19 are controversial. The objective of the study was to evaluate the impact of the application of a non-invasive respiratory support (NIRS) algorithm on clinical outcomes in COVID-19 subjects with acute respiratory failure (ARF).Methods: We performed a single center prospective observational study of subjects with respiratory failure from COVID-19 managed with high-flow nasal cannula (HFNC) and CPAP+HFNC (combined therapy). The main outcome was the intubation rate, which defined failure of therapy. We also analyzed the role of the ROX index ([SpO2/FiO2]/respiratory rate) to predict the need for intubation.Results: From June to December 2020, 113 subjects with COVID-19 respiratory failure were admitted to our respiratory intermediate care unit (RICU). HFNC was applied in 65 subjects (57.52%) and combined therapy in 48 (42.47%). A total of 83 subjects (73.45%) were successfully treated with NIRS. The intubation rate was 26.54 %, and overall mortality was 14.15%. Mortality rate in intubated subjects was 55.2%. ROX index of 6.28 at 12 hours predicted NIRS failure, with 97.6% of sensitivity and 51.8% of specificity.Conclusions: Data from our cohort managed on RICU showed that combined NIRS are feasible with favorable outcomes. Further prospective studies are required.
Pulmonology, 2021
High flow nasal cannula (HFNC) is used to treat acute hypoxemic respiratory failure (AHRF) even o... more High flow nasal cannula (HFNC) is used to treat acute hypoxemic respiratory failure (AHRF) even outside the ICU and the ROX index (pulse oximetry/fraction of inspired oxygen/respiratory rate) may predict HFNC failure. Objective: The purpose of this investigation was therefore to verify whether the ROX index is an accurate predictor of HFNC failure for COVID-19 patients treated outside the intensive care unit (ICU) and to evaluate the validity of the previously suggested threshold. Design: Multicenter study. Retrospective observational analysis of prospectively collected data. Setting: 3 centres specialized in non-invasive respiratory support (Buenos Aires, Argentina; Bolzano and Treviso, Italy). Patients treated outside the ICU were analysed Measurements: The variables to calculate the ROX index were collected during the first day of therapy at 2, 6, 12 and 24 hours and then recorded every 24 hours. HFNC failure was defined as escalation of respiratory support to invasive mechanical ventilation (IMV) or death. Main results: A total of 35 (29%) patients failed HFNC and required intubation. ROC analysis identified the 12-hour ROX index as the best predictor of intubation with an AUC of 0.7916[CI KEYWORDS
Revista Chilena De Enfermedades Respiratorias, 2008
Revista chilena de enfermedades respiratorias, 2008
Respiratory Medicine, 1999
The aim of this study was to define the most useful index of expressing bronchodilator response a... more The aim of this study was to define the most useful index of expressing bronchodilator response and to distinguish between asthma and COPD. A prospective study was carried out of bronchodilator response in 142 asthmatics and 58 COPD patients in a university hospital. Reversibility was expressed as: 1. absolute change (dabs); 2. % of initial (A %init); 3. % of predicted (A %pred) and 4. % of maximum possible response (A %max). Dependence on forced expirations volume in 1 set (FEV,) as % of predicted and sensitivity and specificity for diagnosis of asthma were established. A relationship between dabs and initial FEVl was not found in asthma (dabs vs. % initial FEV1. r= 0.07) or COPD (I = 0.02). A%pred did not show a correlation in asthma (v=O.lO) or COPD (u= 0.06). A?/oinit was dependent on the baseline value in asthma (r=0.38 , Pi 0,001) but not in COPD (r=O.lS , P=n.s.). dmax was dependent in both. The combination of best sensitivity and specificity to separate asthma and COPD was obtaiced with dabs (70.4 or 70.6%). The worst specificity for asthma diagnosis was obtained with A% init (50%). The best likelihood ratios were obtained with dabs and A%pred and the worst likelihood ratio with A%init A%init is not recommended as an index for differential diagnosis between asthma and COPD; 2) A%init overscores bronchodilator response in patients with low FEV,. The independence of each bronchodilator response index should be verified in clinical trials for each selected sample.
MEDICINA ( …, 1998
MEDICINA - Volumen 58 - Nº 3, 1998. MEDICINA (Buenos Aires) 1998; 58:303-306. VENTILACION MECANIC... more MEDICINA - Volumen 58 - Nº 3, 1998. MEDICINA (Buenos Aires) 1998; 58:303-306. VENTILACION MECANICA NO INVASIVA EN PACIENTE HIV.+ VENTILACION MECANICA NO INVASIVA COMO TRATAMIENTO DE LA NEUMONIA ...
Medicina (Buenos Aires), 2005
La ventilación no invasiva (VNI) ha alcanzado notable difusión en los últimos años. El ahorro de ... more La ventilación no invasiva (VNI) ha alcanzado notable difusión en los últimos años. El ahorro de las complicaciones causadas por la intubación traqueal la hace especialmente atractiva en pacientes que presentan insuficiencia respiratoria aguda (IRA) no muy grave y que conservan cierta autonomía respiratoria. También se han descripto efectos terapéuticos en pacientes con insuficiencia respiratoria crónica de etiologías diversas. No obstante, los resultados obtenidos son variables según las circunstancias que motivan su aplicación. A fin de revisar la evidencia a favor de su uso se elaboró este Consenso referido particularmente a la VNI a presión positiva. Se describen su fundamento fisiopatológico, esencial para su correcta aplicación, y el equipamiento necesario para implementarla. La evidencia existente en la literatura establece definida utilidad de la VNI en la exacerbación de la EPOC y en el edema agudo de pulmón cardiogénico (Recomendación A). Su beneficio es aún incierto en pa...
Medicina, 1997
Resumo: La influencia de la incisión quirúrgica, anestesia y condiciones específicas de la cirugí... more Resumo: La influencia de la incisión quirúrgica, anestesia y condiciones específicas de la cirugía cardíaca sobre las alteraciones de la función pulmonar es analizada. La hipoxemia (presente aún en los post-operatorios no complicados) puede adjudicar-se a ...
Respiratory Medicine, Aug 1, 1999
The purpose of this study was to determine the impact upon classification of patients of the choi... more The purpose of this study was to determine the impact upon classification of patients of the choice of reference equation and the criterion defining the lower limit of the normal range in clinical practice.
Medicina Clínica
Noninvasive ventilation (NIV) utilization has experienced an exponential growth in the last 25 ye... more Noninvasive ventilation (NIV) utilization has experienced an exponential growth in the last 25 years immediately after the introduction of the positive pressure and the nasal mask. Patients with acute, chronic and acute on chronic respiratory failure are candidates to be treated by this therapeutic modality. Its utilization inside the hospital is very heterogeneous being indicated for diverse patients by different levels of complexity and severity levels. We have scientific evidence of the maximum level for certain problems such as COPD exacerbations with respiratory acidosis, acute pulmonary edema, or patients with solid and hematologic transplantation, although its utilization has been generalized to many other clinical scenes using minor levels of evidence. NIV is also used successfully in patients of advanced age, patients with do not intubate orders or even patients with severe comorbidities. Finally, NIV could be used as a palliative tool. The continuous technological evolutio...
![Research paper thumbnail of [Argentine consensus of non-invasive ventilation]](https://attachments.academia-assets.com/42813437/thumbnails/1.jpg)
Medicina, 2005
Non-invasive ventilation (NIV) is nowadays increasingly used. The significant decrease in trachea... more Non-invasive ventilation (NIV) is nowadays increasingly used. The significant decrease in tracheal intubation related complications makes it particularly attractive in patients with moderately acute respiratory failure (ARF) who still have some degree of respiratory autonomy. It has also been used to support patients with chronic respiratory failure. However, final outcomes are variable according to the conditions which determined its application. This Consensus was performed in order to review the evidence supporting the use of positive pressure NIV. The patho-physiological background of NIV and the equipment required technology are described. Available evidence clearly suggests benefits of NIV in acute exacerbation of chronic obstructive pulmonary disease (COPD) and in cardiogenic pulmonary edema (Recommendation A). When considering ARF in the setting of acute respiratory distress syndrome results are uncertain, unless dealing with immunosupressed patients (Recommendation B). Posi...
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Papers by Guillermo Montiel