Asynchronies during mechanical ventilation are associated with mortality

This study aimed to assess the prevalence and time course of asynchronies during mechanical ventilation (MV). Prospective, noninterventional observational study of 50 patients admitted to intensive care unit (ICU) beds equipped with Better Care (TM) software throughout MV. The software distinguished ventilatory modes and detected ineffective inspiratory efforts during expiration (IEE), double-triggering, aborted inspirations, and short and prolonged cycling to compute the asynchrony index (AI) for each hour. We analyzed 7,027 h of MV comprising 8,731,981 breaths. Asynchronies were detected in all patients and in all ventilator modes. The median AI was 3.41 % [IQR 1.95-5.77]; the most common asynchrony overall and in each mode was IEE [2.38 % (IQR 1.36-3.61)]. Asynchronies were less frequent from 12 pm to 6 am [1.69 % (IQR 0.47-4.78)]. In the hours where more than 90 % of breaths were machine-triggered, the median AI decreased, but asynchronies were still present. When we compared patients with AI > 10 vs AI a parts per thousand currency sign 10 %, we found similar reintubation and tracheostomy rates but higher ICU and hospital mortality and a trend toward longer duration of MV in patients with an AI above the cutoff. Asynchronies are common throughout MV, occurring in all MV modes, and more frequently during the daytime. Further studies should determine whether asynchronies are a marker for or a cause of mortality

Interpretación de las curvas del respirador en pacientes con insuficiencia respiratoria aguda

La ventilación mecánica es una intervención terapéutica de sustitución temporal de la función ventilatoria enfocada a mejorar los síntomas en los pacientes que sufren insuficiencia respiratoria aguda. Los avances tecnológicos han facilitado el desarrollo de ventiladores sofisticados que permiten visualizar y registrar las ondas respiratorias, lo que constituye una fuente de información muy valiosa para el clínico. La correcta interpretación de los trazados es de vital importancia tanto para el correcto diagnóstico como para la detección precoz de anomalías y para comprender aspectos de la fisiología relacionados con la ventilación mecánica y con la interacción paciente-ventilador. El presente trabajo da una orientación de cómo interpretar las curvas del ventilador mediante el análisis de trazados de presión en la vía aérea, flujo aéreo y volumen en distintas situaciones clínicas.Facultad de Ciencias Médica

El diseño para la deconstrucción, una metodología Lean

Postprint (published version

Microwaves as a synthetic route for preparing electrochemically active TiO2 nanoparticles

Nanocrystalline anatase was synthesized, using both domestic and laboratory microwave ovens, from different precursors. Nanoparticulate anatase was obtained after microwave irradiation of tetra-butyl orthotitanate solution in benzyl alcohol. As-synthesized samples have orange color due to the presence of organics that were eliminated after annealing at 500 degrees C, whereas the size of small anatase nanocrystals (around 8 nm) was preserved. Other nanocrystalline anatase samples were obtained from hexafluorotitanate-organic salt ionic liquid-like precursors. In this case, use of a domestic microwave oven and very short processing times (1-3 min irradiation time) were involved. Good specific capacity values and capacity retention at high C rates for insertion/deinsertion of Li+ were recorded when testing such nanoparticles as electrode material in lithium cells. The electrochemical performances were found be strongly dependent on the phase composition, which in turn could be tuned through the synthetic procedure