Manejo de la presión del cuff en usuarios adultos con vía aérea artificial por profesionales de salud en Chile

There are different international recommendations on the cuff pressure range for the management of adult patients with an artificial airway. Some Chilean health institutions have developed their own airway management protocols based on these recommendations due to the lack of a national guide. A literature review was undertaken at the University of Southampton, U.K., to determine the appropriate cuff pressure range. Results found that this is between 20-30 cmH2O. Afterwards, a valid and reliable online questionnaire was developed in Spanish at the University of Southampton for application in Chile. The aim of this study is to analyse the cuff pressure management of adult patients with an artificial airway performed by non-medical health professionals in Chile. An analytical, observational and cross-sectional study was performed. A database which contained the responses of nurses, physiotherapists and speech therapists with experience attending adult patients with an artificial airway in Chile was analysed. Results show that 58% of the participants used exclusively the objective technique whilst 7% only used subjective techniques. The minimum and maximum pressures used were 25 and 34 cmH2O respectively, which were higher than the recommended range. 38% of the participants declared that there was an existing protocol at their workplace. There was a significant difference between the maximum pressures used by the clinicians and the pressures recommended on the protocols (p = .029). In conclusion, the participants showed a poor manage of the cuff pressure which could create risks linked with over-inflated or under-inflated cuffs. It is suggested to develop a national guide.Existen diferentes recomendaciones internacionales sobre el rango de presión del cuff para utilizar en usuarios adultos con vía aérea artificial. Algunas instituciones de salud chilenas han creado sus protocolos de vía aérea basadas en dichas recomendaciones, ya que no existe una guía nacional. Se desarrolló una revisión bibliográfica en la Universidad de Southampton, Reino Unido, para determinar el rango adecuado de presión del cuff siendo entre 20-30 cmH2O. Posteriormente, se creó un cuestionario online válido y confiable en español en la Universidad de Southampton, Reino Unido, para ser aplicado en Chile. El objetivo de este estudio es analizar las respuestas emanadas de los profesionales de salud en Chile sobre el manejo de la presión del cuff en pacientes adultos con vía aérea artificial. Es un estudio analítico, observacional y transversal. Consistió en analizar las respuestas de enfermeros, kinesiólogos y fonoaudiólogos con experiencia en pacientes con vía aérea artificial tras aplicar el cuestionario. Los resultados muestran que la técnica objetiva fue ampliamente utilizada de forma aislada (58%) en comparación al uso exclusivo de subjetivas (7%). La presión mínima fue de 25 cmH2O mientras que la máxima fue de 34 cmH2O, rango mayor a lo reportado por la evidencia. Solo un 38% declaró la existencia de protocolo en su trabajo. Hubo diferencia estadísticamente significativa entre las presiones máximas usadas y las recomendadas en dichos protocolos (p=0,029). Se concluye que los participantes en Chile mostraron un manejo poco seguro de la presión del cuff en pacientes adultos con vía aérea artificial que puede generar riesgos asociados a cuffs sobre o sub insuflados. Se sugiere desarrollar una guía Ministerial

Revisión literaria del rango apropiado de la presión del cuff para el manejo de usuarios adultos con vía aérea artificial

Existen diferentes recomendaciones internacionales del rango de presión del “cuff” a utilizar para el manejo de usuarios adultos con vía aérea artificial. En Chile no existe una guía clínica en el tema, por lo que algunas instituciones han creado sus propios protocolos recomendando distintas presiones referenciando literatura internacional. El objetivo de este trabajo es conocer el rango seguro de insuflación del “cuff” de cánulas de traqueostomía y tubos endotraqueales. Se realizó una revisión literaria con enfoque cualitativo de artículos publicados en inglés y de sus referencias primarias, con criterios de inclusión de estudios experimentales y observacionales, con acceso completo, con recomendaciones de presiones a utilizar, en población humana mayor a 18 años y animales, y con procedimientos médicos-científicos. En animales los rangos recomendados a utilizar difieren según la especie. En humanos los rangos recomendados también son diversos. Parte de la literatura actual sobre las presiones a utilizar en pacientes han sido basadas en estudios llevados a cabo en animales. Por ello, no se debe generalizar recomendaciones en base a investigaciones con muestras no humanas debido a los resultados encontrados. Considerando exclusivamente estudios en humanos con resultados analizados estadísticamente, la presión mínima a utilizar para evitar el riesgo de aspiración es de 20 cm H2O y la presión máxima para evitar el daño traqueal es de 30 cm H2O. Se precisan nuevas investigaciones con tecnología reciente en población exclusivamente humana. Los protocolos internos de cada institución chilena necesitan ser revisados para analizar los artículos primarios de sus referencias.There are different international recommendations in relation to the use of cuff pressure ranges for the management of adult patients with an artificial airway. In Chile there are no clinical guidelines on this topic. Due to this, some institutions have created their own protocols, in which different cuff pressures are recommended. The goal of this research is to find a safe pressure range to insufflate the cuff of tracheostomy tubes and endotracheal tubes. A literature review was performed with a qualitative approach of: full access articles published in English and their primary references, experimental and observational research, human population over 18 years or animals, cuff pressure recommendations and medical-scientific procedures were included. Cuff pressure range recommendations vary according to the animals studied. In human population, the ranges recommended are also different. Some current literature relating to cuff pressure values to use in patients have been based upon research performed on animals. Due to this, cuff pressure range recommendations should be based on research carried out on humans. Considering exclusively human studies with scientific statistical results, the minimum pressure to avoid the risk of aspiration is 20 cm H2O, whilst the maximum pressure to avoid the risk of tracheal damage is 30 cm H2O. New research, with recent technology used exclusively on human population, is required. The protocols used by Chilean institutions need to be revised

Early determinants of acute kidney injury during experimental intra-abdominal sepsis

Indexación: Web of Science; Scielo.Background: Sepsis-induced acute kidney injury (AKI) is an early and frequent organ dysfunction, associated with increased mortality. Aim: To evaluate the impact of macrohemodynamic and microcirculatory changes on renal function and histology during an experimental model of intra-abdominal sepsis. Material and Methods: In 18 anaesthetized pigs, catheters were installed to measure hemodynamic parameters in the carotid, right renal and pulmonary arteries. After baseline assessment and stabilization, animals were randomly divided to receive and intra-abdominal infusion of autologous feces or saline. Animals were observed for 18 hours thereafter. Results: In all septic animals, serum lactate levels increased, but only eight developed AKI (66%). These animals had higher creatinine and interleukin-6 levels, lower inulin and paraaminohippurate clearance (decreased glomerular filtration and renal plasma flow), and a negative lactate uptake. Septic animals with AKI had lower values of mean end arterial pressure, renal blood flow and kidney perfusion pressure, with an associated increase in kidney oxygen extraction. No tubular necrosis was observed in kidney histology. Conclusions: The reduction in renal blood flow and renal perfusion pressure were the main mechanisms associated with AKI, but were not associated with necrosis. Probably other mechanisms, such as microcirculatory vasoconstriction and inflammation also contributes to AKI development. (Rev Med Chile 2014; 142: 551-558) Key words: Acute kidney injury; Renal circulation; Sepsis

Acute kidney injury and extrarenal organ dysfunction - A randomized experimental study

Indexación: Web of Science; ScieloIntroducción: La insuficiencia renal aguda (IRA) es una enfermedad grave y causante de disfunciones de órganos distantes que incrementan su mortalidad. Objetivo: Identificar disfunción hemodinámica y respiratoria gatillada por IRA en un modelo pediátrico animal de isquemia-reperfusión renal. Método: Doce cerdos anestesiados (11,9 ± 1,0 kg). En seis animales se indujo lesión renal bilateral por isquemia-reperfusión: 45 min de isquemia y 240 min de reperfusión, mientras que los seis animales restantes fueron grupo control. En condiciones basales y posterior a lesión renal se realizó monitorización hemodinámica convencional y termodilución transpulmonar. Paralelamente se midió gasometría arterial y análisis de mecánica pulmonar. Resultados: Hubo un incremento de la precarga volumétrica en 29% (221 ± 22 ml/m2 vs 286 ± 16 ml/m2, p = 0,04) y de la presión arterial media en 58% (71 ± 6 mmHg vs 112 ± 17 mmHg, p = 0,04) respecto a controles, sin cambios en frecuencia cardíaca, presión venosa central ni gasto cardíaco. Además ocurrió un aumento del agua extravascular pulmonar en 86% (7,6 ± 0,6 ml/kg vs 14,1 ± 1,4 ml/kg, p = 0,02), sin cambios en intercambio gaseoso ni mecánica pulmonar. Simultáneamente hubo un leve deterioro de la creatinina sérica (1,12 ± 0,07 mg/dL vs 1,45 ± 0,10 mg/dL, p = 0,03). Discusión: En este modelo experimental se pudo apreciar el desarrollo temprano de disfunción hemodinámica y pulmonar. Se evidenció un aumento de la precarga volumétrica y de la presión arterial, asociado a un incremento substancial del agua extravascular pulmonar. Creemos que es fundamental monitorizar de forma seriada la función hemodinámica y respiratoria en sujetos con una lesión renal aguda, aún sin una IRA urémica.Acute kidney injury (AKI) is a serious disease that can cause distant organ injuries and is associated with high mortality rates. Objective: To identify the hemodynamic and respiratory dysfunction triggered by AKI, in an animal model of renal ischemia-reperfusion. Method: Twelve anesthetized juvenile pigs (11.9 ± 1.0 kg). Six animals underwent ischemia/reperfusion-induced AKI: 45 min of ischemia and 240 minutes of reperfusion, while the remaining six animals were the control group. In basal conditions and after AKI, a conventional hemodynamic monitoring and transpulmonary thermodilution were performed. At the same time, arterial blood gases and lung mechanics were measured. Results: There was a 29% increase in volumetric preload (221 ± 22 ml/m2 vs 286 ± 16 ml/m2, p = 0.04) and a 58% mean arterial pressure increase (71 ± 6 mmHg vs 112 ± 17 mmHg, p = 0.04) compared to controls, without changes in heart rate, central venous pressure and cardiac output. In addition, an increase of 86% in extravascular lung water (7.6 ± 0.6 ml/kg vs 14.1 ± 1.4 ml/ kg, p = 0.02) was reported, without changes in gas exchange and lung mechanics. Simultaneously, a slight increase in serum creatinine (1.12 ± 0.07 mg/dl vs 1.45 ± 0.10 mg/dl, p = 0.03) was described. Discussion: An early development of hemodynamic and pulmonary dysfunction was observed in this experimental reperfusion model. An increase in volumetric preload and blood pressure associated with a substantial increase in the extravascular lung water were also reported. It is essential serially monitor the hemodynamic and respiratory functions in AKI, including nonuremic subjects.http://www.scielo.cl/pdf/rcp/v84n3/art04.pd

La complementariedad de métodos para estudiar la sensibilidad intercultural en estudiantes del área de negocios en Chile

La globalización ha dispuesto un nuevo orden en los factores económicos mundiales, así las personas tratan de adaptar y tomar lo mejor del proceso globalizador con el fin de mejorar la calidad de vida y, por otro lado, las empresas se transnacionalizan buscando nuevas oportunidades de negocio que permitan lograr los objetivos de sus planes comerciales. Este proceso obliga a las personas a un encuentro cultural no voluntario, pero necesario para sus intereses. Pone a prueba la capacidad de comunicarse con personas culturalmente diversas. Zapata (2014) explicando el origen del concepto indica que lo intercultural proviene de lo multicultural. Sin embargo, no existe una clara delimitación, más bien es posible deducir desde la literatura que lo multicultural está relacionado con la existencia de grupos sociales diversos que están juntos en un lugar geográfico determinado, pero ello no implica que convivan, se comuniquen y se demuestren afectividad recíprocamente. La actitud y comportamientos que un individuo asume al entrar en contacto, voluntario u obligatorio, con otro de distinta cultura está comprendido en el constructo de la competencia comunicativa intercultural.Facultad de Humanidades y Ciencias de la Educació

Changes in the ankle muscles co-activation pattern after 5 years following total ankle joint replacement

© 2018 Elsevier Ltd Background: The Hintegra® arthroplasty provides inversion-eversion stability, permits axial rotation, ankle flexion-extension, and improvements of the gait patterns are expected up to 12 months of rehabilitation. However, sensorimotor impairments are observed in ankle flexors/extensors muscles after rehabilitation, with potential negative effects on locomotion. Here we determined the timing and amplitude of co-activation of the tibialis anterior and medial gastrocnemius muscles during gait by assessing non-operated and operated legs of patients with total ankle replacement, 5 years after surgery. Methods: Twenty-nine patients (age: 58 [5.5] years, height: 156.4 [6.5] cm, body mass: 72.9 [6.5] kg, 10 men, and 19 women) that underwent Hintegra® ankle arthroplasty were included. Inclusion criteria included 5 years prosthesis survivorship. The onset and offset of muscle activation (timing), as well as the amplitude of activation, were determined during barefoot walkin

Identification of grapevine clones via high-throughput amplicon sequencing: a proof-of-concept study

Wine cultivars are available to growers in multiple clonal selections with agronomic and enological differences. Phenotypic differences between clones originated from somatic mutations that accrued over thousands of asexual propagation cycles. Genetic diversity between grape cultivars remains unexplored, and tools to discriminate unequivocally clones have been lacking. This study aimed to uncover genetic variations among a group of clonal selections of 4 important Vitis vinifera cultivars: Cabernet sauvignon, Sauvignon blanc, Chardonnay, and Merlot, and use this information to develop genetic markers to discriminate the clones of these cultivars. We sequenced with short-read sequencing technology the genomes of 18 clones, including biological replicates for a total of 46 genomes. Sequences were aligned to their respective cultivar's reference genome for variant calling. We used reference genomes of Cabernet sauvignon, Chardonnay, and Merlot and developed a de novo genome assembly of Sauvignon blanc using long-read sequencing. On average, 4 million variants were detected for each clone, with 74.2% being single nucleotide variants and 25.8% being small insertions or deletions (InDel). The frequency of these variants was consistent across all clones. From these variants, we validated 46 clonal markers using high-throughput amplicon sequencing for 77.7% of the evaluated clones, most of them small InDel. These results represent an advance in grapevine genotyping strategies and will benefit the viticulture industry for the characterization and identification of the plant material

Functional consequences of the variable stoichiometry of the Kv1.3-KCNE4 complex

The voltage-gated potassium channel Kv1.3 plays a crucial role during the immune response. The channel forms oligomeric complexes by associating with several modulatory subunits. KCNE4, one of the five members of the KCNE family, binds to Kv1.3, altering channel activity and membrane expression. The association of KCNEs with Kv channels is the subject of numerous studies, and the stoichiometry of such associations has led to an ongoing debate. The number of KCNE4 subunits that can interact and modulate Kv1.3 is unknown. KCNE4 transfers important elements to the Kv1.3 channelosome that negatively regulate channel function, thereby fine-tuning leukocyte physiology. The aim of this study was to determine the stoichiometry of the functional Kv1.3-KCNE4 complex. We demonstrate that as many as four KCNE4 subunits can bind to the same Kv1.3 channel, indicating a variable Kv1.3-KCNE4 stoichiometry. While increasing the number of KCNE4 subunits steadily slowed the activation of the channel and decreased the abundance of Kv1.3 at the cell surface, the presence of a single KCNE4 peptide was suffcient for the cooperative enhancement of the inactivating function of the channel. This variable architecture, which depends on KCNE4 availability, differentially affects Kv1.3 function. Therefore, our data indicate that the physiological remodeling of KCNE4 triggers functional consequences for Kv1.3, thus affecting cell physiology

Money, Age and Happiness: Association of Subjective Wellbeing with Socio-Demographic Variables

The relationship between happiness and socio-demographic variables (age, sex, socioeconomic status, educational level) was examinated, this with a Latin American sample and its association with Subjective wellbeing given the controversial empirical evidence of their relationship. We surveyed a total of 520 people (300 women and 220 men) between the ages of 18 and 29 with an average of 21.26 years and a standard deviation of 2.47 to answer the subjective happiness scale. The happiness variable was categorized, and the subjects were reorganized in happy and non-happy groups. From the use of main component analysis and logistic regressions, the main results show that variables which best characterize the happiness levels are age and socioeconomic status. Specifically, the results indicate that higher age within the sample, predicts lower levels of happiness. On the other side, at a higher socioeconomic level, people are happier. In addition, there are no differences between genders