Maniobrabilidad de buques: pruebas a escala real del Buque Patrullero de Apoyo Fluvial de la Armada de Colombia

Methodology and results of full scale maneuvering trials for Riverine Support Patrol Vessel “RSPV”, built by COTECMAR for the Colombian Navy are presented. This ship is equipped with a “Pump – Jet” propulsion system and the hull corresponds to a wide-hull with a high Beam – Draft ratio (B/T=9.5). Tests were based on the results of simulation of turning diameters obtained from TRIBON M3˝ design software, applying techniques of Design of Experiments “DOE”, to rationalize the number of runs in different conditions of water depth, ship speed, and rudder angle. Results validate the excellent performance of this class of ship and show that turning diameter and other maneuvering characteristics improve with decreasing water depth.En el presente trabajo se presenta la metodología y los resultados de las pruebas de maniobrabilidad a escala real del Buque Patrullero de Apoyo Fluvial Pesado “PAF-P”, construido por COTECMAR para la Armada Nacional de Colombia. El buque está equipado con un sistema de propulsión de bomba de agua tipo “Pump – Jet” y su casco corresponde a un casco con una relación Manga – Calado muy alta (B/T = 9.5). Las pruebas se basaron en los resultados de simulación de círculos evolutivos obtenidos en el software de Diseño TRIBON M3©, aplicando técnicas de Diseño de Experimentos “DOE”, para racionalizar el número de corridas en diferentes condiciones de profundidad, velocidad y ángulo de timón. Los resultados validan el excelente desempeño de esta clase de buques y muestran que el diámetro de giro y otras características de maniobrabilidad mejoran con la disminución de la profundidad

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Ship maneuverability: full-scale trials of colombian Navy Riverine Support Patrol Vessel

Methodology and results of full scale maneuvering trials for Riverine Support Patrol Vessel “RSPV”, built by COTECMAR for the Colombian Navy are presented. This ship is equipped with a “Pump – Jet” propulsion system and the hull corresponds to a wide-hull with a high Beam – Draft ratio (B/T=9.5). Tests were based on the results of simulation of turning diameters obtained from TRIBON M3˝ design software, applying techniques of Design of Experiments “DOE”, to rationalize the number of runs in different conditions of water depth, ship speed, and rudder angle. Results validate the excellent performance of this class of ship and show that turning diameter and other maneuvering characteristics improve with decreasing water depth.En el presente trabajo se presenta la metodología y los resultados de las pruebas de maniobrabilidad a escala real del Buque Patrullero de Apoyo Fluvial Pesado “PAF-P”, construido por COTECMAR para la Armada Nacional de Colombia. El buque está equipado con un sistema de propulsión de bomba de agua tipo “Pump – Jet” y su casco corresponde a un casco con una relación Manga – Calado muy alta (B/T = 9.5). Las pruebas se basaron en los resultados de simulación de círculos evolutivos obtenidos en el software de Diseño TRIBON M3©, aplicando técnicas de Diseño de Experimentos “DOE”, para racionalizar el número de corridas en diferentes condiciones de profundidad, velocidad y ángulo de timón. Los resultados validan el excelente desempeño de esta clase de buques y muestran que el diámetro de giro y otras características de maniobrabilidad mejoran con la disminución de la profundidad

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Compilación de Proyectos de Investigacion de 1984-2002

Instituto Politecnico Nacional. UPIICS

ESICM LIVES 2016: part two : Milan, Italy. 1-5 October 2016.

Meeting abstrac

Death in hospital following ICU discharge: insights from the LUNG SAFE study

ackground: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations. Results: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors

Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study

Background: Current incidence and outcome of patients with acute hypoxaemic respiratory failure requiring mechanical ventilation in the intensive care unit (ICU) are unknown, especially for patients not meeting criteria for acute respiratory distress syndrome (ARDS). Methods: An international, multicentre, prospective cohort study of patients presenting with hypoxaemia early in the course of mechanical ventilation, conducted during four consecutive weeks in the winter of 2014 in 459 ICUs from 50 countries (LUNG SAFE). Patients were enrolled with arterial oxygen tension/inspiratory oxygen fraction ratio ≤300 mmHg, new pulmonary infiltrates and need for mechanical ventilation with a positive end-expiratory pressure of ≥5 cmH2O. ICU prevalence, causes of hypoxaemia, hospital survival and factors associated with hospital mortality were measured. Patients with unilateral versus bilateral opacities were compared. Findings: 12 906 critically ill patients received mechanical ventilation and 34.9% with hypoxaemia and new infiltrates were enrolled, separated into ARDS (69.0%), unilateral infiltrate (22.7%) and congestive heart failure (CHF; 8.2%). The global hospital mortality was 38.6%. CHF patients had a mortality comparable to ARDS (44.1% versus 40.4%). Patients with unilateral-infiltrate had lower unadjusted mortality, but similar adjusted mortality compared to those with ARDS. The number of quadrants on chest imaging was associated with an increased risk of death. There was no difference in mortality comparing patients with unilateral-infiltrate and ARDS with only two quadrants involved. Interpretation: More than one-third of patients receiving mechanical ventilation have hypoxaemia and new infiltrates with a hospital mortality of 38.6%. Survival is dependent on the degree of pulmonary involvement whether or not ARDS criteria are reached