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Introduction and aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, causing the current pandemic of acute respiratory disease known as COVID-19. Liver injury due to COVID-19 is defined as any liver injury occurring during the course of the disease and treatment of patients with COVID-19, with or without liver disease. The incidence of elevated liver transaminases, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), ranges from 2.5 to 76.3%. The aim of the present study was to describe the hepatic biochemical abnormalities, after a SARS-CoV-2-positive polymerase chain reaction (PCR) test, and the mortality rate in critically ill patients. Materials and methods: A retrospective study was conducted that included 70 patients seen at a private hospital in Mexico City, within the time frame of February-December 2021. Median patient age was 44.5 years (range: 37-57.2) and 43 (61.4%) of the patients were men. Liver function tests were performed on the patients at hospital admission. Results: Gamma glutamyl transferase (GGT) levels were elevated (p = 0.032), as were those of AST (p = 0.011) and ALT (p = 0.021). The patients were stratified into age groups: 18-35, 36-50, and > 50 years of age. The 18 to 35-year-olds had the highest liver enzyme levels and transaminase levels were higher, the younger the patient. Due to the low mortality rate (one patient whose death did not coincide with a hepatic cause), the multivariate analysis showed an R2 association of 0.689, explained by AST, GGT, and C-reactive protein levels. Conclusions: Despite the increase in transaminases in our study population during the course of COVID-19, there was no increase in mortality. Nevertheless, hospitalized patient progression should be continuously followed. Resumen: Introducción y objetivo: La pandemia por coronavirus de 2019 (COVID-19), puede causar El síndrome respiratorio agudo grave (SARS-CoV-2) emergió, causando la pandemia actual de enfermedad respiratoria aguda llamada COVID-19. La lesión hepática por COVID-19 se define como cualquier daño hepático que ocurra durante el curso de la enfermedad y el tratamiento de pacientes con COVID-19, con o sin enfermedad hepática. La incidencia de transaminasas hepáticas elevadas, ALT (alanina aminotransferasa) y AST (aspartato aminotransferasa), va de 2.5% a 76.3%. El objetivo del estudio fue describir las anormalidades bioquímicas hepáticas posterior a la prueba reacción en cadena de la polimerasa (PCR) positiva para SARS-CoV-2 y mortalidad en el paciente crítico. Material y métodos: Es un estudio retrospectivo, se incluyeron 70 pacientes, la mediana de edad 44.5 (rango 37-57.2), siendo del sexo masculino 43 (61.4%), de un hospital privado de la Ciudad de México, se midieron al ingreso hospitalario las pruebas de función hepática. Período de febrero-diciembre 2021. Resultados: Encontrando elevación de gamma-glutamil transferasa (GGT) p 0.032, aspartato aminotransferasa (AST) p 0.011, alanina-aminotransferasa (ALT) p 0.021, los pacientes se estratificaron en grupo de edad, 18-35, 36-50 y > 50 años. La mayor elevación fue de 18-35 años, entre más joven mayor elevación de transaminasas, debido a la baja mortalidad, 1 paciente, que no coincide con causa hepática, el análisis multivariado explicó una asociación R2 .689 p 0.001, explicado por AST, GGT y proteína C reactiva. Conclusiones: A pesar del incremento de transaminasas durante la infección por COVID 19, en nuestra población no aumentó la mortalidad, si bien, debe darse seguimiento continuo durante la evolución hospitalaria.

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Copyright of Argentinian Journal of Respiratory & Physical Therapy (AJRPT) is the property of Asociacion Civil Cientifica de Difusion y Promocion de la Kinesiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La presión transpulmonar (Ptp) es la diferencia entre la presión en la vía aérea (Pva) y la presión pleural (Ppl). La medición de la presión esofágica (Pes), como subrogado de la Ppl, permite el cálculo de la Ptp diferenciando la mecánica pulmonar y de la caja torácica. Para ello, existen dos métodos, el de Talmor y el definido por Gattinoni. Ambos métodos aportan información útil, particularmente en sujetos con síndrome de distrés respiratorio agudo (SDRA) para individualizar la estrategia de protección pulmonar. El objetivo del siguiente paso a paso es describir el cálculo de la Ptp, con ambos métodos, durante la fase de soporte total de la ventilación mecánica invasiva.

El escorpionismo, como se denomina al cuadro clínico producido por la picadura de escorpiones tóxicos en humanos, es un problema de salud pública en áreas urbanas y rurales de la América Tropical, incluyendo Paraguay, asociado a pobreza y a la falta de acceso a antivenenos específicos. Aunque su prevalencia en Paraguay no ha sido aún evaluada, la presencia de especies de reconocida toxicidad que son propias del país junto a otras especies compartidas con los países limítrofes y el registro de envenenamientos severos en niños en el Departamento Central, demandan la revisión de esta patología para su conocimiento por los profesionales de salud y de investigación sobre el tema. En esta revisión, se describen el conocimiento actual sobre esta patología en Paraguay, las alteraciones fisiopatológicas ocasionadas por los componentes tóxicos presentes en el veneno escorpiónico en los principales sistemas fisiológicos que sirven de blanco farmacológico de las toxinas, además de aportar a su diagnóstico diferencial, con el fin de contribuir con el adecuado tratamiento de las víctimas de estos envenenamientos y a la comprensión holística de esta emergente enfermedad desatendida en el país.

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Introducción: la ventilación mecánica artificial es una medida terapéutica de soporte vital aplicada en contextos clínicos como el síndrome de distrés respiratorio agudo. Por lo que es necesario establecer parámetros de seguridad. La presión de distensión alveolar es una variable de interés en la protección pulmonar. Se usa para optimizar el volumen tidal de acuerdo con el tamaño del pulmón disponible durante el intercambio gaseoso. Refleja el grado de estiramiento pulmonar en cada ciclo respiratorio. Objetivo: actualizar contenidos referentes a la presión de distensión alveolar en pacientes ventilados con distrés respiratorio agudo. Método: Se realizó una pesquisa en Google Scholar, PudMed/Medline, SciELO regional entre otros, bajo los términos: ventilación de protección pulmonar / variables, presión de distensión alveolar durante la ventilación / medición, relación de la presión de distensión alveolar y mortalidad en SDRA/ resultados. Se seleccionaron 62 referencias que cumplieron los criterios de inclusión Resultados: la evidencia actual la asocia a la mortalidad en pacientes ventilados con síndrome de distrés respiratorio. Permite identificar el riesgo de daño inducido por la ventilación y complicaciones pulmonares en otros escenarios clínicos, logrando mejoría en los objetivos y metas en la ventilación mecánica artificial. Conclusiones: la presión de distensión alveolar está fuertemente asociada con cambios en la supervivencia y ha demostrado ser el mediador clave en los efectos de la ventilación mecánica sobre los resultados del síndrome de distrés respiratoria agudo.

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Introducción: El uso de ventilación mecánica no invasiva se ha generalizado en el mundo, con un uso extendido incluso en pacientes con fallo respiratorio hipoxémico. Objetivo: Identificar estado actual del uso de la ventilación no invasiva en el síndrome de distrés respiratorio agudo y analizar su aplicación en pacientes con la COVID-19. Desarrollo: La ventilación mecánica no invasiva podría aparecer como un recurso más para dar soporte respiratorio en pacientes con la COVID-19; la escasa evidencia científica sobre su efectividad en el síndrome de distrés respiratorio agudo y el riesgo de contagio por la dispersión de partículas, genera controversia sobre su uso. Conclusiones: En adultos con la COVID-19 e insuficiencia respiratoria hipoxémica aguda, se debe contraindicar el uso de la ventilación mecánica no invasiva; solo valorar su uso en escenarios muy concretos y justificados.

COVID-19 is a newly emerged disease that has become a global public health challenge. Due to a lack of knowledge about the virus, a significant number of potential targets for using a particular drug have been proposed. Five cases with a clinical history of biopolymers in the gluteal region that developed iatrogenic allogenosis (IA) are presented here. The 5 cases were put under colchicine treatment for IA crisis and had non-specific symptoms (headache, cough without dyspnea, and arthralgias) with a positive SARS-CoV-2 test. Their close contacts had mild to severe symptoms and three of them died. In the SARS-CoV-2 infection different inflammatory pathways are altered where colchicine reduces cytokine levels as well as the activation of macrophages, neutrophils, and the inflammasome. The possible mechanisms that colchicine may use to prevent acute respiratory distress syndrome (ARDS) in patients with COVID-19 infection are also reviewed in this article. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

El desenlace de la infección por SARS-CoV-2 (COVID-19) afecta fundamentalmente al campo pulmonar, ocasionando un cuadro de síndrome de distrés respiratorio agudo (SDRA). Este proceso es un cuadro inflamatorio protagonizado por una cascada de citocinas bajo el amparo del inflamasoma NLRP3, responsable principal de la destrucción alveolar. De entre todas las citocinas que se desencadenan en este cuadro destaca la IL-1ß. Anakinra es un potente fármaco biológico, capaz de bloquear esta IL-1ß. Proponemos su uso, de cara a controlar el SDRA secundario a la infección por COVID-19. The outcome of the SARS-CoV-2 (COVID-19) infection fundamentally affects the lung field, causing acute respiratory distress syndrome (ARDS). This process is an inflammatory picture, involving an NLRP3 inflamosome-triggered cytokine storm, the main player in alveolar destruction. IL-1 beta stands out among the cytokines that are triggered in this picture. Anakinra is a potent biological drug, capable of blocking this IL-1ß. We propose its use in controlling ARDS secondary to COVID-19 infection. [ABSTRACT FROM AUTHOR]

El edema por reexpansión pulmonar es un edema agudo de causa no cardiogénica producido por la rápida reexpansión de un pulmón colapsado. Es una complicación iatrogénica poco frecuente, pero potencialmente mortal, debida al drena- je artificial de las cavidades pleurales mediante toracocentesis terapéutica, principalmente para derrame pleural y neumotórax, o debida a cirugías cardiotorácicas. La reexpansión pulmonar permite la reperfusión sanguínea en lugares de hipoxia tisular, generando aumento de la presión hidrostática capilar y, mediante la coexistencia de mecanismos com- plejos celulares y humorales inherentes del pulmón, se despliega un estado de hiperinflamación local y sistémico que produce un aumento de la permeabilidad de la vasculatura pulmonar, dando paso a fuga plasmática por extravasación hacia el espacio alveolo-capilar y produciendo un edema de mecanismo mixto, lo que explica sus síntomas y potencia- les complicaciones como el síndrome de distrés respiratorio.

Introduction: The use of systemic corticosteroids in severely ill patients with coronavirus disease 2019 (COVID-19) is controversial. We aimed to evaluate the efficacy and safety of corticosteroid pulses in patients with COVID-19 pneumonia. Methods: A quasi-experimental study, before and after, was performed in a tertiary referral hospital, including admitted patients showing COVID-19-associated pneumonia. The standard treatment protocol included targeted COVID-19 antiviral therapy from 23rd March 2020, and additionally pulses of methylprednisolone from 30th March 2020. The primary outcome was a composite endpoint combining oro-tracheal intubation (OTI) and death within 7 days. Results: A total of 24 patients were included. Standard of care (SOC) (before intervention) was prescribed in 14 patients, while 10 received SOC plus pulses of methylprednisolone (after intervention). The median age of patients was 64.5 years and 83.3% of the patients were men. The primary composite endpoint occurred in 13 patients (92.9%) who received SOC vs. 2 patients (20%) that received pulses of methylprednisolone (odds ratio, 0.02; 95% confidence interval, 0.001 to 0.25; p = 0.019). Length of hospitalization in survivors was shorter in the corticosteroids group (median, 14.5 [8.5–21.8] days vs. 29 [23–31] days, p = 0.003). There were no differences in the development of infections between both groups. There were 3 deaths, none of them in the corticosteroids group. Conclusions: In patients with severe pneumonia due to COVID-19, the administration of methylprednisolone pulses was associated with a lower rate of OTI and/or death and a shorter hospitalization episode. Resumen: Introducción: El uso de corticosteroides sistémicos en pacientes gravemente enfermos por enfermedad coronavírica de 2019 (covid-19) es controvertido. Nuestro objetivo fue evaluar la eficacia y la seguridad de los pulsos de corticoesteroides en los pacientes con neumonía por covid-19. Métodos: Se realizó un ensayo cuasiexperimental, tipo antes y después, en un hospital terciario de referencia que incluyó a pacientes ingresados por neumonía asociada a covid-19. El protocolo de tratamiento estándar incluía un tratamiento antiviral dirigido contra el virus de la covid-19 desde el 23 de marzo de 2020 y añadió pulsos de metilprednisolona desde el 30 de marzo de 2020. El resultado primario fue un criterio combinado compuesto por la intubación orotraqueal y el fallecimiento durante los siguientes siete días. Resultados: Se incluyó un total de 24 pacientes. El protocolo de tratamiento (antes de la intervención) se prescribió en 14 pacientes, mientras que 10 recibieron el protocolo de tratamiento además de los pulsos de metilprednisolona (después de la intervención). La edad media de los pacientes fue de 64,5 años y el 83,3% de los pacientes eran hombres. El resultado combinado primario tuvo lugar en 13 pacientes (92,9%) que recibieron el protocolo de tratamiento frente a 2 pacientes (20%) que recibieron los pulsos de metilprednisolona (odds ratio = 0,02; intervalo de confianza del 95% = 0,001-0,25; p = 0,019). La duración de la hospitalización en los supervivientes fue más corta en el grupo que recibió corticoesteroides (media = 14,5 [8,5-21,8] días frente a 29 [23-31] días, p = 0,003). No hubo diferencias en el desarrollo de infecciones entre ambos grupos. Hubo tres fallecimientos, ninguno de ellos en el grupo que recibió corticoesteroides. Conclusiones: En los pacientes con neumonía grave por covid-19, la administración de pulsos de metilprednisolona se asoció a unas tasas menores de intubación orotraqueal y/o muerte y a episodios de hospitalización más cortos.

Acute lung injury (ALI) is a frequent entity in intensive care units, with a high incidence and mortality, and constitutes the center of the pathophysiology of acute respiratory distress syndrome. This involves an acute and inflammatory lung damage, which causes an increase in pulmonary vascular permeability, with increased lung weight and loss of aerated lung tissue, accompanied by hypoxemia, decreased lung elasticity, and increased physiologic dead space. Nevertheless, the pathogeny underlying this phenomenon has not been clarified in detail. The events occurring in ALI may be divided in those that occur locally--such as the increase in lung capillary permeability, surfactant dysfunction, alveolar edema, and alveolar mechanic disorders--and generalized and systemic phenomena affecting the lungs, among which inflammation is notorious. In ensemble, these elements act additively and in synergy, finalizing in a significant decrease of residual functional capacity, as well as a heterogeneous or patchy collapse of airspaces. Revision and feedback from the molecular basics of pathophysiology is necessary to closely examine this condition, with the objective of proposing novel and promising modalities and strategies for treatment. This is fertile terrain for future research, with ample space for innovation based on potential discoveries. This article offers a molecular vision of the pathogeny of ALI. [ABSTRACT FROM AUTHOR]

Objective: To explore combined non-invasive-respiratory-support (NIRS) patterns, reasons for NIRS switching, and their potential impact on clinical outcomes in acute-hypoxemic-respiratory-failure (AHRF) patients., Design: Retrospective, single-center observational study., Setting: Intensive Care Medicine., Patients: AHRF patients (cardiac origin and respiratory acidosis excluded) underwent combined NIRS therapies such as non-invasive-ventilation (NIV) and High-Flow-Nasal-Cannula (HFNC)., Interventions: Patients were classified based on the first NIRS switch performed (HFNC-to-NIV or NIV-to-HFNC), and further specific NIRS switching strategies (NIV trial-like vs. Non-NIV trial-like and single vs. multiples switches) were independently evaluated., Main Variables of Interest: Reasons for switching, NIRS failure and mortality rates., Results: A total of 63 patients with AHRF were included, receiving combined NIRS, 58.7% classified in the HFNC-to-NIV group and 41.3% in the NIV-to-HFNC group. Reason for switching from HFNC to NIV was AHRF worsening (100%), while from NIV to HFNC was respiratory improvement (76.9%). NIRS failure rates were higher in the HFNC-to-NIV than in NIV-to-HFNC group (81% vs. 35%, p < 0.001). Among HFNC-to-NIV patients, there was no difference in the failure rate between the NIV trial-like and non-NIV trial-like groups (86% vs. 78%, p = 0.575) but the mortality rate was significantly lower in NIV trial-like group (14% vs. 52%, p = 0.02). Among NIV to HFNC patients, NIV failure was lower in the single switch group compared to the multiple switches group (15% vs. 53%, p = 0.039), with a shorter length of stay (5 [2-8] vs. 12 [8-30] days, p = 0.001)., Conclusions: NIRS combination is used in real life and both switches' strategies, HFNC to NIV and NIV to HFNC, are common in AHRF management. Transitioning from HFNC to NIV is suggested as a therapeutic escalation and in this context performance of a NIV-trial could be beneficial. Conversely, switching from NIV to HFNC is suggested as a de-escalation strategy that is deemed safe if there is no NIRS failure., (Copyright © 2023 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)

Mechanical ventilation is a therapeutic measure frequently used in intensive care which, although highly useful, can cause important damage to lung tissue. Ventilation-induced lung injury (VILI) is also frequent, and has been associated with a significant increase in mortality in patients with acute respiratory distress syndrome. Nevertheless, this has notoriously decreased in recent decades, which has been especially ascribed to reductions in the tidal volume selected for patients on ventilation, in independent association with increased survival. These advances have arisen greatly due to advances on the knowledge of these entities' pathogeny. Classically, the pathophysiology of VILI has been systematized into four main elements: volutrauma, barotrauma, atelectrauma, and biotrauma. Novel observations have led to the inclusion of new factors, such as regional heterogeneity in mechanical dysfunction within the lung, alteration in local vascular flow and permeability, and the amplifying effect on these processes mediated by the inflammatory response. This article explores the pathophysiology of VILI with emphasis on the possible clinical correlates. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) is an important procedure because it provides assistance to patients suffering from some type of cardiac and/or respiratory condition that prevents them from proper blood circulation. There are mainly two types of ECMO, veno-venous and venoarterial, the first being used in patients with purely respiratory problems. With regard to its evolution, numerous advances have shown an increase in its efficiency in relation to the riskbenefit of the affected, as well as its application in people with acute respiratory diseases such as Acute Respiratory Distress Syndrome (ARDS), which cannot be solved through regular techniques. Basically it is a procedure that is carried out to prevent the cardiopulmonary system from failing, after complications that can make this condition intractable through traditional methods. In relation to ECMO therapy, ARDS is one of the situations that has most led to studies due to its complications that endanger the life of the individual, several analyzes show that this technique is indeed effective as evidenced by the CESAR test, improving the survival of the patient and in general refining the mortality rates. The results of this method have been encouraging, implying a great improvement against mechanical ventilation, however, not everything is positive because it also has difficulties linked to bleeding and nosocomial infection. In general, it is concluded that this technique seeks and in a significant proportion of cases it manages to optimize the condition of life of the person. [ABSTRACT FROM AUTHOR]

Objective: To determine if potential predictors for invasive mechanical ventilation (IMV) are also determinants for mortality in COVID-19-associated acute respiratory distress syndrome (C-ARDS)., Design: Single center highly detailed longitudinal observational study., Setting: Tertiary hospital ICU: two first COVID-19 pandemic waves, Madrid, Spain., Patients or Participants: 280 patients with C-ARDS, not requiring IMV on admission., Interventions: None., Main Variables of Interest: Target: endotracheal intubation and IMV, mortality., Predictors: demographics, hourly evolution of oxygenation, clinical data, and laboratory results., Results: The time between symptom onset and ICU admission, the APACHE II score, the ROX index, and procalcitonin levels in blood were potential predictors related to both IMV and mortality. The ROX index was the most significant predictor associated with IMV, while APACHE II, LDH, and DaysSympICU were the most with mortality., Conclusions: According to the results of the analysis, there are significant predictors linked with IMV and mortality in C-ARDS patients, including the time between symptom onset and ICU admission, the severity of the COVID-19 waves, and several clinical and laboratory measures. These findings may help clinicians to better identify patients at risk for IMV and mortality and improve their management., (Copyright © 2023 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)

Introduction and Aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, causing the current pandemic of acute respiratory disease known as COVID-19. Liver injury due to COVID-19 is defined as any liver injury occurring during the course of the disease and treatment of patients with COVID-19, with or without liver disease. The incidence of elevated liver transaminases, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), ranges from 2.5 to 76.3%. The aim of the present study was to describe the hepatic biochemical abnormalities, after a SARS-CoV-2-positive polymerase chain reaction (PCR) test, and the mortality rate in critically ill patients., Materials and Methods: A retrospective study was conducted that included 70 patients seen at a private hospital in Mexico City, within the time frame of February-December 2021. Median patient age was 44.5 years (range: 37-57.2) and 43 (61.4%) of the patients were men. Liver function tests were performed on the patients at hospital admission., Results: Gamma glutamyl transferase (GGT) levels were elevated (p = 0.032), as were those of AST (p = 0.011) and ALT (p = 0.021). The patients were stratified into age groups: 18-35, 36-50, and > 50 years of age. The 18 to 35-year-olds had the highest liver enzyme levels and transaminase levels were higher, the younger the patient. Due to the low mortality rate (one patient whose death did not coincide with a hepatic cause), the multivariate analysis showed an R 2 association of 0.689, explained by AST, GGT, and C-reactive protein levels., Conclusions: Despite the increase in transaminases in our study population during the course of COVID-19, there was no increase in mortality. Nevertheless, hospitalized patient progression should be continuously followed., (Copyright © 2023. Published by Masson Doyma México S.A.)

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Lemierre's syndrome is a clinical triad of acute oropharyngeal infection, secondary local invasion and vein thrombosis often involving the internal jugular vein, along with evidence of systemic septic embolism. Usually affecting otherwise healthy adolescents and young adults, anaerobic Fusobacterium spp. are often implicated. Other bacterial species are sometimes found. While being a rare disease with a reported 14.4 cases per million person-years, it carries a mortality rate of 5 to 9%. Clinical presentation can be severe owing to septic shock, multiorgan dysfunction, septic embolization and acute respiratory distress syndrome requiring ICU admission. Treatment involves antibiotic therapy with anaerobic coverage and supportive care. Anticoagulation use is controversial and surgical treatment may be needed to control focus of infection. There is few quality evidence available regarding the clinical management of this syndrome. We report a case of Lemierre syndrome caused by Streptococcus hemolyticus group C, complicated with pulmonary septic embolism, necrotizing pneumonia, empyema and acute respiratory distress syndrome with a degree of severity that required the use of extracorporeal membrane oxygenation to support the patient. [ABSTRACT FROM AUTHOR]

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Objective: To describe the characteristics of patients with acute respiratory distress syndrome (ARDS) due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV), and to analyze the effect of prone position >24 h (prolonged) (PPP) compared to prone decubitus <24 h (PP)., Design: A retrospective observational descriptive study was carried out, with uni- and bivariate analyses., Setting: Department of Intensive Care Medicine. Hospital General Universitario de Elche (Elche, Alicante, Spain)., Participants: Patients with SARS-CoV-2 pneumonia (2020-2021) on IMV due to moderate-severe ARDS, ventilated in prone position (PP)., Interventions: IMV. PP maneuvers., Main Variables of Interest: Sociodemographic characteristics, analgo-sedation, neuromuscular blockade (NMB), PD duration, ICU stay and mortality, days of IMV, non-infectious complications, healthcare associated infections., Results: Fifty-one patients required PP, and of these, 31 (69.78%) required PPP. No differences were observed in terms of patient characteristics (gender, age, comorbidities, initial severity, antiviral and antiinflammatory treatment received). Patients on PPP had poorer tolerance to supine ventilation (61.29% vs 89.47%, p = 0.031), longer hospital stay (41 vs 30 days, p = 0.023), more days of IMV (32 vs 20 days, p = 0.032), longer duration of NMB (10.5 vs 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39% vs 15%, p = 0.014)., Conclusions: PPP was associated with greater resource use and complications in patients with moderate-severe ARDS due to COVID-19., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To determine which method of Positive End-expiratory Pressure (PEEP) titration is more useful, and to establish an evidence base for the clinical impact of Electrical Impedance Tomography (EIT) based individual PEEP setting which appears to be a promising method to optimize PEEP in Acute Respiratory Distress Syndrome (ARDS) patients., Design: A systematic review and meta-analysis., Setting: 4 databases (PUBMED, EMBASE, Web Of Science, and the Cochrane Library) from 1980 to December 2020 were performed., Participants: Randomized clinical trials patients with ARDS., Main Variables: PaO 2 /FiO 2 -ratio and respiratory system compliance., Intervension: The quality of the studies was assessed with the Cochrane risk and bias tool., Results: 8 trials, including a total of 222 participants, were eligible for analysis. Meta-analysis demonstrates a significantly EIT-based individual PEEP setting for patients receiving higher PaO 2 /FiO 2 ratio as compared to other PEEP titration strategies [5 trials, 202 patients, SMD 0.636, (95% CI 0.364-0.908)]. EIT-drived PEEP titration strategy did not significantly increase respiratory system compliance when compared to other peep titration strategies, [7 trials, 202 patients, SMD -0.085, (95% CI -0.342 to 0.172)]., Conclusions: The benefits of PEEP titration with EIT on clinical outcomes of ARDS in placebo-controlled trials probably result from the visible regional ventilation of EIT. These findings offer clinicians and stakeholders a comprehensive assessment and high-quality evidence for the safety and efficacy of the EIT-based individual PEEP setting as a superior option for patients who undergo ARDS., (Copyright © 2022 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)

El SDRA severo es un síndrome clínico de relativa frecuencia en la unidades críticas y de elevada morbi-mortalidad, la que no ha sido modificada significativamente a pesar de los avances en la investigación clínica. Un conocimiento profundo de su fisiopatología y las condiciones particulares de cada caso permiten un manejo adecuado. Un número importante de estrategias de manejo han sido investigadas, con variable resultado, pero es improbable que una sola de ellas conduzca a resultados clínicos exitosos. Al revés, una combinación juiciosa e informada de las diferentes alternativas terapéuticas disponibles es la única opción conocida hoy día para el manejo de estos pacientes. La transferencia precoz de estos casos a centros de referencia con experiencia y equipamiento en el manejo de esta patología puede salvar vidas.

Introduction: This bibliographic review is carried out in order to obtain answers about aspects related to techniques and treatments, as well as care associated with the critically ill patient diagnosed with Covid-19., Objective: To analyze the available scientific evidence on the effectiveness of the use of invasive mechanical ventilation together with other adjuvant techniques, in reducing the mortality rate in patients with Acute Respiratory Distress Syndrome and clinical trial of Covid-19 treated in intensive care units., Methodology: A systematized bibliographic review was carried out in the Pubmed, Cuiden, Lilacs, Medline, Cinahl and Google Scholar databases, using MeSH terms (Adult Respiratory Distress Syndrome, Mechanical Ventilation, Prone Position, Nitric Oxide, Extracorporeal Membrane Oxygenation, Nursing Care) and the corresponding Boolean operators. The selected studies underwent a critical reading carried out between December 6, 2020 and March 27, 2021 using the Critical Appraisal Skills Program tool in Spanish and a cross-sectional epidemiological studies evaluation instrument., Results: A total of 85 articles were selected. After performing the critical reading, a total of 7 articles were included in the review, 6 being descriptive studies and 1 cohort study. After analyzing these studies, it appears that the technique that has obtained the best results is ECMO, with the care provided by qualified and trained nursing staff being very important., Conclusion: Mortality from Covid-19 increases in patients treated with invasive mechanical ventilation compared to patients treated with extracorporeal membrane oxygenation. Nursing care and specialization can have an impact on improving patient outcomes., (Copyright © 2022 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes., Methods: Retrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression., Results: A total of 139 proning cycles were performed. The mean number of cycles were 2 [1-3] and the mean duration per cycle was of 22h [15-24]. The prevalence of adverse events this population was 84.9 %, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin <21mg/dl, the number of proning cycles and severe disease. We observed a significant increase in the PaO 2 /FiO 2 at different time points during the prone positioning, and a significant decrease after it., Conclusions: There is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients., (Copyright © 2022 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Immune tolerance and pregnancy changes associate to an increased risk of infection, including community pneumonia, influenza pneumonia and varicella zoster pneumonitis, sometimes also with acute respiratory distress syndrome. The objective is expose an acute respiratory distress syndrome case during puerperium, successfully discharged. Case report: 22 year-old patient, last partum 14 days before, admitted to Adult Critical Care Unit because of progressive dyspnea, hypoxemia and chest X-ray with bilateral opacifications disseminated mainly in basal posterior regions, obstetrical sepsis origin is ruled out, airway pressure release ventilation is performed in prone position, methylprednisolone administration and oseltamivir, at 72 hours oxygenation improves and at the 6th day is extubated, with vesicular eruption in intercostal layers. Discussion: During pregnancy a cellular immune suppression, protection associated to Th2 cytokines and HLA-G expression is found, the reversion of this situation during puerperium results in clinical manifestations of latent infections known as «immune reconstitution inflammatory syndrome», treatable with steroids. It becomes indispensable to consider dyspnea and hypoxemia causes during puerperium. The conduct assumed in this case avoided an indirect maternal death case. [ABSTRACT FROM AUTHOR]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Noninvasive ventilation (NIV) failure it has been associated to worst clinical outcomes due to a delay in intubation and initiation of invasive mechanical ventilation (IMV). There is a lack of evidence in pediatric patients regarding this topic. The objective was to deter-mine the association between duration of IMV and length of stay, with duration of NIV prior tointubation/IMV in pediatric patients., Design: A prospective cohort study since January 2015 to October 2019., Setting: A pediatric intensive care unit., Patients: Children under 15 years with acute respiratory failure who failed to noninvasive ventilation., Interventions: None., Main Variables of Interest: Demographic variables, pediatric index of mortality (PIM2), pediatric acute respiratory distress syndrome (PARDS) diagnosis, IMV and NIV duration, PICU LOS were registered and intrahospital mortality., Results: A total of 109 patients with a median (IQR) age of 7 (3-14) months were included. The main diagnosis was pneumonia (89.9%). PARDS was diagnosed in 37.6% of the sample. No association was found between NIV duration and duration of IMV after Kaplan-Meier analysis (Log rank P = .479). There was no significant difference between PICU LOS (P = .253) or hospital LOS (P = 0.669), when categorized by NIV duration before intubation. PARDS diagnosis was associated to an increased length of invasive ventilation (HR: 0.64 [95% IC: 0.42-0.99])., Conclusions: No association was found between NIV duration prior to intubation and duration of invasive ventilation in critical pediatric patients with acute respiratory failure., (Copyright © 2021 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)

Copyright of Revista Chilena de Pediatría is the property of Revista Chilena de Pediatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)