Cecilia Loudet - Academia.edu (original) (raw)
Papers by Cecilia Loudet
BMJ open quality, Jun 1, 2024
Journal of Critical Care, Oct 1, 2019
Intensive Care Medicine, Feb 6, 2017
Journal of Critical Care
Purpose To identify determinants of oxygenation over time in patients with COVID-19 acute respira... more Purpose To identify determinants of oxygenation over time in patients with COVID-19 acute respiratory distress syndrome (ARDS); and to analyze their characteristics according to Berlin definition categories. Materials and methods Prospective cohort study including consecutive mechanically ventilated patients admitted between 3/20/2020–10/31/2020 with ARDS. Epidemiological and clinical data on admission; outcomes; ventilation, respiratory mechanics and oxygenation variables were registered on days 1, 3 and 7 for the entire population and for ARDS categories. Results 1525 patients aged 61 ± 13, 69% male, met ARDS criteria; most frequent comorbidities were obesity, hypertension, diabetes and respiratory disease. On admission, 331(21%), 849(56%) and 345(23%) patients had mild, moderate and severe ARDS; all received lung-protective ventilation (mean tidal volumes between 6.3 and 6.7 mL/kg PBW) and intermediate PEEP levels (10–11 cmH2O). PaO2/FiO2, plateau pressure, static compliance, driving pressure, ventilation ratio, pH and D-dimer >2 mg/L remained significantly different among the ARDS categories over time. In-hospital mortality was, respectively, 55%, 58% and 70% (p < 0.000). Independent predictors of changes of PaO2/FiO2 over time were BMI; preexistent respiratory disease; D-dimer >2 mg/L; day 1-PEEP, and day 1-ventilatory ratio. Conclusion Hypoxemia in patients with COVID-19-related ARDS is associated with comorbidities, deadspace and activated coagulation markers, and disease severity—reflected by the PEEP level required.
Medicina, 2022
During the SARS-CoV-2 pandemic, there was a marked requirement for critical care beds, supplies a... more During the SARS-CoV-2 pandemic, there was a marked requirement for critical care beds, supplies and trained professionals to assist patients with severe respiratory failure. The Argentine Society of Intensive Care (SATI) designed a study to characterize these aspects in intensive care units (ICUs). Multicenter, prospective cohort study; the participating ICUs completed a form at the end of the study (31/10/2020) on hospital characteristics, number of beds in pre- and intra-pandemic critical areas, incorporation of professionals, technological resources, and workload. Fifty-eight ICUs participated; 28(48%) were located in Buenos Aires Province, 22(38%) in Buenos Aires Autonomous City and 10 (17%) in other provinces; 31 (53%) of UCIs belonged to the public sector; 23 (47%) to the private-social security. In 35/58 (60%) of the hospitals critical care beds increased from 902 to 1575 (75%), 37% in ICU and 63% mainly in Coronary Care Unit and Emergency-shock room. In 41/55 (75%) UCIs, staff were incorporated: 27(49%) physicians (70% intensivists), 36 (65%) nurses, 28 (51%) respiratory therapists, 20(36%) cleaning staff, and 1(2%) others. A 96% of the ICUS reported having sufficient ventilators and 95% enough supplies and PPE. Of all patients on invasive mechanical ventilation, 55% [43-64] had COVID-19. Oxygen therapy was required as noninvasive support in 14% [8-24] of COVID-19 admissions. There was a significant expansion of critical operational areas, secondary to the increase in beds, staff, and adequate availability of ventilators and essential supplies. The burden of critical illness from COVID-19 was intense, with more than half of patients on mechanical ventilation.
Additional file 1. Table S1. Epidemiological and hemodynamic data in the entire cohort, and in su... more Additional file 1. Table S1. Epidemiological and hemodynamic data in the entire cohort, and in survivors and nonsurvivors. Table S2. Independent determinants of mortality according to a mixed-effect model, in which hospitals (centers) were added as the random term. Figure S1. Frequency of the variables utilized as a guide for the additional administration of fluids after the initial bolus. Figure S2. Vasopressors and/or inotropes used in the resuscitation of septic patients. Figure S3. Type of solution used for the initial fluid bolus of 30 mL/kg. Tests used for the dynamic assessment of fluid responsiveness.
Table S1. Characteristics of the participating hospitals. Table S2. Localization of the sites of ... more Table S1. Characteristics of the participating hospitals. Table S2. Localization of the sites of infection in patients in public and private hospitals. Table S3. Bivariable analysis for mortality. Table S4. Full multivariable logistic regression model 1 after multiple imputation. Table S5. Full multivariable logistic regression model 2 after multiple imputation. (DOCX 24 kb)
Supplemental material, sj-pdf-1-gqn-10.1177_23333936211015660 for Theory-driven, rapid formative ... more Supplemental material, sj-pdf-1-gqn-10.1177_23333936211015660 for Theory-driven, rapid formative research on quality improvement intervention for critical care of patients with COVID-19 in Argentina by Javier Roberti, Facundo Jorro, Viviana Rodríguez, María Belizán, Pilar Arias, María Elena Ratto, Rosa Reina, Natalí Ini, Cecilia Loudet and Ezequiel García-Elorrio in Global Qualitative Nursing Research
Global Qualitative Nursing Research, 2021
The challenges of implementing interventions in healthcare settings have been more apparent durin... more The challenges of implementing interventions in healthcare settings have been more apparent during the COVID-19 pandemic. This pre-implementation evaluation used a rapid qualitative approach to explore barriers and facilitators to an intervention in intensive care units in Argentina, aimed to promote the use of personal protection equipment, provide emotional support for professionals, and achieve patient flow goals. Data were collected using semi-structured interviews with health professionals of 15 public hospitals in Argentina. Normalization Process Theory was used to guide content analysis of the data. Participants identified potential barriers such as the incorporation of non-specialist staff, shortage of resources, lack of communication between groups and shifts. Potential facilitators were also identified: regular feedback and communication related to implementation, adequate training for new and non-specialist staff, and incentives (e.g., scholarships). The immediacy of the ...
La vancomicina (vanco) sufre variaciones en su concentracion plasmatica (dosaje) segun dosis admi... more La vancomicina (vanco) sufre variaciones en su concentracion plasmatica (dosaje) segun dosis administradas y clearance de creatinina (ClCr), entre otros factores. Varios autores demostraron que dosis fijas de 2 g/dia y sin dosis de carga podrian no ser adecuadas para alcanzar dosaje terapeutico de 20-30 mg/L, por aumento (hiperfiltracion) o disminucion (insuficiencia renal) del ClCr durante el tratamiento, sugiriendo administrar dosis de carga y de mantenimiento, y medir dosajes para ajustar a una dosis efectiva.
Introducción Recomendaciones actuales sugieren manejar sedoanalgesia (SA) ligera y guiada por obj... more Introducción Recomendaciones actuales sugieren manejar sedoanalgesia (SA) ligera y guiada por objetivos en pacientes en ventilación mecánica (VM). Datos previos de nuestra UCI (2010) de evaluación del estado de alerta con escala de RASS, indicaron un nivel de sedación profunda. La indicación se realizaba según el criterio de cada médico tratante. Surge la iniciativa del diseño e implementación de un protocolo de SA en etapas, para hacer frente a este problema
En los ultimos anos se han producido grandes cambios en el manejo de la pancreatitis aguda. Las r... more En los ultimos anos se han producido grandes cambios en el manejo de la pancreatitis aguda. Las razones son multiples: conocemos en detalle la fisiopatologia, existen mas y mejores herramientas para tratar a los pacientes criticos en forma general, hay avances en cuanto al soporte nutricional, mayor conocimiento sobre la prevencion y tratamiento de las infecciones pancreaticas, y sin dudas un cambio radical en las diferentes tecnicas quirurgicas.El objetivo de este articulo es revisar dichas recomendaciones y actualizarlas, unificar criterios para el manejo integral de la pancreatitis aguda potencialmente grave que ingresa a los cuidados intensivos. Han participado de la confeccion de este texto, medicos intensivistas y cirujanos expertos en el manejo de esta patologia. Posteriormente dicho documento se ha discutido y consensuado en el grupo de Patologias digestivas Criticas de la Sociedad Argentina de Terapia Intensiva.
Hypertension in Pregnancy, 2021
ABSTRACT Objectives To explore variables associated with adverse maternal/fetal/neonatal outcomes... more ABSTRACT Objectives To explore variables associated with adverse maternal/fetal/neonatal outcomes among pregnant/postpartum patients admitted to ICU for hypertensive disorders of pregnancy (HDP). Methods Multicenter, prospective, national cohort study. Results Variables independently associated with maternal/fetal/neonatal mortality among 172 patients were as follows: Acute Physiology and Chronic Health Evaluation-II (APACHE-II)(OR1.20[1.06–1.35]), gestational age (OR0.698[0.59–0.82]) and aspartate aminotransferase (AST)(OR1.004[1.001–1.006]). Positive likelihood ratio for headache, epigastric pain, and visual disturbances to predict composite adverse outcomes were 1.23(1.16–1.30), 0.76(0.59–1.02), and 1.1(0.98–1.2), respectively. Conclusions Maternal/fetal mortality due to HDP was independently associated with severity of illness on admission, gestational age, and elevated AST. Accuracy of clinical symptoms to predict composite adverse outcomes was low.
Annals of Intensive Care, 2020
Background Resuscitation of septic patients regarding goals, monitoring aspects and therapy is hi... more Background Resuscitation of septic patients regarding goals, monitoring aspects and therapy is highly variable. Our aim was to characterize cardiovascular and fluid management of sepsis in Argentina, a low and middle-income country (LMIC). Furthermore, we sought to test whether the utilization of dynamic tests of fluid responsiveness, as a guide for fluid therapy after initial resuscitation in patients with persistent or recurrent hypoperfusion, was associated with decreased mortality. Methods Secondary analysis of a national, multicenter prospective cohort study (n = 787) fulfilling Sepsis-3 definitions. Epidemiological characteristics, hemodynamic management data, type of fluids and vasopressors administered, physiological variables denoting hypoperfusion, use of tests of fluid responsiveness, and outcomes, were registered. Independent predictors of mortality were identified with logistic regression analysis. Results Initially, 584 of 787 patients (74%) had mean arterial pressure ...
Journal of Critical Care, 2020
Critical care medicine, Jan 8, 2018
The new Sepsis-3 definitions have been scarcely assessed in low- and middle-income countries; bes... more The new Sepsis-3 definitions have been scarcely assessed in low- and middle-income countries; besides, regional information of sepsis outcomes is sparse. Our objective was to evaluate Sepsis-3 definition performance in Argentina. Cohort study of 3-month duration beginning on July 1, 2016. Forty-nine ICUs. Consecutive patients admitted to the ICU with suspected infection that triggered blood cultures and antibiotic administration. None. Patients were classified as having infection, sepsis (infection + change in Sequential Organ Failure Assessment ≥ 2 points), and septic shock (vasopressors + lactate > 2 mmol/L). Patients on vasopressors and lactate less than or equal to 2 mmol/L (cardiovascular dysfunction) were analyzed separately, as those on vasopressors without serum lactate measurement. Systemic inflammatory response syndrome was also recorded. Main outcome was hospital mortality. Of 809 patients, 6% had infection, 29% sepsis, 20% cardiovascular dysfunction, 40% septic shock,...
BMJ open quality, Jun 1, 2024
Journal of Critical Care, Oct 1, 2019
Intensive Care Medicine, Feb 6, 2017
Journal of Critical Care
Purpose To identify determinants of oxygenation over time in patients with COVID-19 acute respira... more Purpose To identify determinants of oxygenation over time in patients with COVID-19 acute respiratory distress syndrome (ARDS); and to analyze their characteristics according to Berlin definition categories. Materials and methods Prospective cohort study including consecutive mechanically ventilated patients admitted between 3/20/2020–10/31/2020 with ARDS. Epidemiological and clinical data on admission; outcomes; ventilation, respiratory mechanics and oxygenation variables were registered on days 1, 3 and 7 for the entire population and for ARDS categories. Results 1525 patients aged 61 ± 13, 69% male, met ARDS criteria; most frequent comorbidities were obesity, hypertension, diabetes and respiratory disease. On admission, 331(21%), 849(56%) and 345(23%) patients had mild, moderate and severe ARDS; all received lung-protective ventilation (mean tidal volumes between 6.3 and 6.7 mL/kg PBW) and intermediate PEEP levels (10–11 cmH2O). PaO2/FiO2, plateau pressure, static compliance, driving pressure, ventilation ratio, pH and D-dimer >2 mg/L remained significantly different among the ARDS categories over time. In-hospital mortality was, respectively, 55%, 58% and 70% (p < 0.000). Independent predictors of changes of PaO2/FiO2 over time were BMI; preexistent respiratory disease; D-dimer >2 mg/L; day 1-PEEP, and day 1-ventilatory ratio. Conclusion Hypoxemia in patients with COVID-19-related ARDS is associated with comorbidities, deadspace and activated coagulation markers, and disease severity—reflected by the PEEP level required.
Medicina, 2022
During the SARS-CoV-2 pandemic, there was a marked requirement for critical care beds, supplies a... more During the SARS-CoV-2 pandemic, there was a marked requirement for critical care beds, supplies and trained professionals to assist patients with severe respiratory failure. The Argentine Society of Intensive Care (SATI) designed a study to characterize these aspects in intensive care units (ICUs). Multicenter, prospective cohort study; the participating ICUs completed a form at the end of the study (31/10/2020) on hospital characteristics, number of beds in pre- and intra-pandemic critical areas, incorporation of professionals, technological resources, and workload. Fifty-eight ICUs participated; 28(48%) were located in Buenos Aires Province, 22(38%) in Buenos Aires Autonomous City and 10 (17%) in other provinces; 31 (53%) of UCIs belonged to the public sector; 23 (47%) to the private-social security. In 35/58 (60%) of the hospitals critical care beds increased from 902 to 1575 (75%), 37% in ICU and 63% mainly in Coronary Care Unit and Emergency-shock room. In 41/55 (75%) UCIs, staff were incorporated: 27(49%) physicians (70% intensivists), 36 (65%) nurses, 28 (51%) respiratory therapists, 20(36%) cleaning staff, and 1(2%) others. A 96% of the ICUS reported having sufficient ventilators and 95% enough supplies and PPE. Of all patients on invasive mechanical ventilation, 55% [43-64] had COVID-19. Oxygen therapy was required as noninvasive support in 14% [8-24] of COVID-19 admissions. There was a significant expansion of critical operational areas, secondary to the increase in beds, staff, and adequate availability of ventilators and essential supplies. The burden of critical illness from COVID-19 was intense, with more than half of patients on mechanical ventilation.
Additional file 1. Table S1. Epidemiological and hemodynamic data in the entire cohort, and in su... more Additional file 1. Table S1. Epidemiological and hemodynamic data in the entire cohort, and in survivors and nonsurvivors. Table S2. Independent determinants of mortality according to a mixed-effect model, in which hospitals (centers) were added as the random term. Figure S1. Frequency of the variables utilized as a guide for the additional administration of fluids after the initial bolus. Figure S2. Vasopressors and/or inotropes used in the resuscitation of septic patients. Figure S3. Type of solution used for the initial fluid bolus of 30 mL/kg. Tests used for the dynamic assessment of fluid responsiveness.
Table S1. Characteristics of the participating hospitals. Table S2. Localization of the sites of ... more Table S1. Characteristics of the participating hospitals. Table S2. Localization of the sites of infection in patients in public and private hospitals. Table S3. Bivariable analysis for mortality. Table S4. Full multivariable logistic regression model 1 after multiple imputation. Table S5. Full multivariable logistic regression model 2 after multiple imputation. (DOCX 24 kb)
Supplemental material, sj-pdf-1-gqn-10.1177_23333936211015660 for Theory-driven, rapid formative ... more Supplemental material, sj-pdf-1-gqn-10.1177_23333936211015660 for Theory-driven, rapid formative research on quality improvement intervention for critical care of patients with COVID-19 in Argentina by Javier Roberti, Facundo Jorro, Viviana Rodríguez, María Belizán, Pilar Arias, María Elena Ratto, Rosa Reina, Natalí Ini, Cecilia Loudet and Ezequiel García-Elorrio in Global Qualitative Nursing Research
Global Qualitative Nursing Research, 2021
The challenges of implementing interventions in healthcare settings have been more apparent durin... more The challenges of implementing interventions in healthcare settings have been more apparent during the COVID-19 pandemic. This pre-implementation evaluation used a rapid qualitative approach to explore barriers and facilitators to an intervention in intensive care units in Argentina, aimed to promote the use of personal protection equipment, provide emotional support for professionals, and achieve patient flow goals. Data were collected using semi-structured interviews with health professionals of 15 public hospitals in Argentina. Normalization Process Theory was used to guide content analysis of the data. Participants identified potential barriers such as the incorporation of non-specialist staff, shortage of resources, lack of communication between groups and shifts. Potential facilitators were also identified: regular feedback and communication related to implementation, adequate training for new and non-specialist staff, and incentives (e.g., scholarships). The immediacy of the ...
La vancomicina (vanco) sufre variaciones en su concentracion plasmatica (dosaje) segun dosis admi... more La vancomicina (vanco) sufre variaciones en su concentracion plasmatica (dosaje) segun dosis administradas y clearance de creatinina (ClCr), entre otros factores. Varios autores demostraron que dosis fijas de 2 g/dia y sin dosis de carga podrian no ser adecuadas para alcanzar dosaje terapeutico de 20-30 mg/L, por aumento (hiperfiltracion) o disminucion (insuficiencia renal) del ClCr durante el tratamiento, sugiriendo administrar dosis de carga y de mantenimiento, y medir dosajes para ajustar a una dosis efectiva.
Introducción Recomendaciones actuales sugieren manejar sedoanalgesia (SA) ligera y guiada por obj... more Introducción Recomendaciones actuales sugieren manejar sedoanalgesia (SA) ligera y guiada por objetivos en pacientes en ventilación mecánica (VM). Datos previos de nuestra UCI (2010) de evaluación del estado de alerta con escala de RASS, indicaron un nivel de sedación profunda. La indicación se realizaba según el criterio de cada médico tratante. Surge la iniciativa del diseño e implementación de un protocolo de SA en etapas, para hacer frente a este problema
En los ultimos anos se han producido grandes cambios en el manejo de la pancreatitis aguda. Las r... more En los ultimos anos se han producido grandes cambios en el manejo de la pancreatitis aguda. Las razones son multiples: conocemos en detalle la fisiopatologia, existen mas y mejores herramientas para tratar a los pacientes criticos en forma general, hay avances en cuanto al soporte nutricional, mayor conocimiento sobre la prevencion y tratamiento de las infecciones pancreaticas, y sin dudas un cambio radical en las diferentes tecnicas quirurgicas.El objetivo de este articulo es revisar dichas recomendaciones y actualizarlas, unificar criterios para el manejo integral de la pancreatitis aguda potencialmente grave que ingresa a los cuidados intensivos. Han participado de la confeccion de este texto, medicos intensivistas y cirujanos expertos en el manejo de esta patologia. Posteriormente dicho documento se ha discutido y consensuado en el grupo de Patologias digestivas Criticas de la Sociedad Argentina de Terapia Intensiva.
Hypertension in Pregnancy, 2021
ABSTRACT Objectives To explore variables associated with adverse maternal/fetal/neonatal outcomes... more ABSTRACT Objectives To explore variables associated with adverse maternal/fetal/neonatal outcomes among pregnant/postpartum patients admitted to ICU for hypertensive disorders of pregnancy (HDP). Methods Multicenter, prospective, national cohort study. Results Variables independently associated with maternal/fetal/neonatal mortality among 172 patients were as follows: Acute Physiology and Chronic Health Evaluation-II (APACHE-II)(OR1.20[1.06–1.35]), gestational age (OR0.698[0.59–0.82]) and aspartate aminotransferase (AST)(OR1.004[1.001–1.006]). Positive likelihood ratio for headache, epigastric pain, and visual disturbances to predict composite adverse outcomes were 1.23(1.16–1.30), 0.76(0.59–1.02), and 1.1(0.98–1.2), respectively. Conclusions Maternal/fetal mortality due to HDP was independently associated with severity of illness on admission, gestational age, and elevated AST. Accuracy of clinical symptoms to predict composite adverse outcomes was low.
Annals of Intensive Care, 2020
Background Resuscitation of septic patients regarding goals, monitoring aspects and therapy is hi... more Background Resuscitation of septic patients regarding goals, monitoring aspects and therapy is highly variable. Our aim was to characterize cardiovascular and fluid management of sepsis in Argentina, a low and middle-income country (LMIC). Furthermore, we sought to test whether the utilization of dynamic tests of fluid responsiveness, as a guide for fluid therapy after initial resuscitation in patients with persistent or recurrent hypoperfusion, was associated with decreased mortality. Methods Secondary analysis of a national, multicenter prospective cohort study (n = 787) fulfilling Sepsis-3 definitions. Epidemiological characteristics, hemodynamic management data, type of fluids and vasopressors administered, physiological variables denoting hypoperfusion, use of tests of fluid responsiveness, and outcomes, were registered. Independent predictors of mortality were identified with logistic regression analysis. Results Initially, 584 of 787 patients (74%) had mean arterial pressure ...
Journal of Critical Care, 2020
Critical care medicine, Jan 8, 2018
The new Sepsis-3 definitions have been scarcely assessed in low- and middle-income countries; bes... more The new Sepsis-3 definitions have been scarcely assessed in low- and middle-income countries; besides, regional information of sepsis outcomes is sparse. Our objective was to evaluate Sepsis-3 definition performance in Argentina. Cohort study of 3-month duration beginning on July 1, 2016. Forty-nine ICUs. Consecutive patients admitted to the ICU with suspected infection that triggered blood cultures and antibiotic administration. None. Patients were classified as having infection, sepsis (infection + change in Sequential Organ Failure Assessment ≥ 2 points), and septic shock (vasopressors + lactate > 2 mmol/L). Patients on vasopressors and lactate less than or equal to 2 mmol/L (cardiovascular dysfunction) were analyzed separately, as those on vasopressors without serum lactate measurement. Systemic inflammatory response syndrome was also recorded. Main outcome was hospital mortality. Of 809 patients, 6% had infection, 29% sepsis, 20% cardiovascular dysfunction, 40% septic shock,...