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Introducción: La disección de la arteria vertebral (DAV) es una ruptura de su pared interna, lo que conduce ala intrusión de sangre dentro de las capas de la misma con potencial estrechamiento luminal. Puede sucederespontánea o traumáticamente. Su incidencia anual es de 1 a 1,5 por cada 100.000 personas en Estados Unidos, pudiendo ser potencialmente mortal. La evidencia encontrada sobre el manejo kinésico del paciente con DAV es escasa, por lo que nuestro objetivo es describir la evaluación y tratamiento deglutorio de un paciente con DAV en un Hospital General de Agudos basándonos en el cuadro clínico y la literatura disponible.Presentación del caso: Sujeto de 41 años, con mareos, náuseas e inestabilidad de la marcha tras realizar una rotación y extensión del cuello. Evolucionó con paresia facial, mal manejo del lago orofaríngeo y estado febril. Se diagnosticó como infarto cerebeloso secundario a DAV. Luego de su ingreso en sala de internación, comenzó el tratamiento kinésico deglutorio por presentar disfagia severa. A los 5 meses, recibió el alta hospitalaria. Conclusión: Se describió la evaluación y el tratamiento kinésico de las alteraciones deglutorias de un paciente con DAV.

BACKGROUND: Laboratory studies suggest applying positive pressure without endotracheal suction during cuff deflation and extubation. Although some studies reported better physiological outcomes (e.g. arterial blood gases) with this technique, the safety of positive pressure extubation technique has not been well studied. The aim of this study was to determine the safety of the positive-pressure extubation technique compared with the traditional extubation technique in terms of incidence of complications. METHODS: Adult subjects who were critically ill and on invasive mechanical ventilation who met extubation criteria were included. The subjects were randomly assigned to positive-pressure extubation (n = 120) or to traditional extubation (n = 120). Sequential tests for noninferiority and, when appropriate, for superiority were performed. Positive pressure was considered noninferior if the upper limit of the CI for the absolute risk difference did not exceed a threshold of 15% in favor of the traditional group, both in per protocol and intention-to-treat analyses. A P value of RESULTS: A total of 236 subjects were included in the primary analysis (per protocol) (119 in the positive-pressure group and 117 in the traditional group). The incidence of overall major and minor complications, pneumonia, extubation failure, and reintubation was lower in the positive-pressure group than in the traditional group, with statistical significance for noninferiority both in the per protocol (P CONCLUSIONS: Positive pressure was safe and noninferior to traditional extubation methods. Furthermore, positive pressure has shown to be superior in terms of a lower incidence of major complications. (ClinicalTrials.gov registration NCT03174509.)