Advanced airway management: a descriptive analysis of complications and factors associated with first-attempt intubation failure in prehospital emergency care

7 p.Objetivos. Analizar las características del manejo de la vía aérea (VA) en emergencias prehospitalarias, sus complicaciones y establecer factores predictores de fracaso en el primer intento de intubación orotraqueal (FIPI). Método. Estudio observacional de cohortes retrospectivo de pacientes que precisaron intubación orotraqueal por el servicio de emergencias prehospitalarias de Castilla La Mancha, desde el 01-06-2017 hasta el 01-01-2021. Se analizaron características de los pacientes, del procedimiento y sus complicaciones, se realizó una regresión logística para detectar factores predictores de FIPI. Resultados. Se incluyeron 425 pacientes, 417 (98,1%) fueron intubados con éxito y 326 (76,7%) en el primer intento. Se registraron 183 complicaciones en 94 pacientes (22,1%). Los factores predictores de FIPI fueron la edad > 55 años (OR = 1,94; IC 95% 1,10-4,23), índice de masa corporal > 30 (OR = 9,14; IC 95% 4,40-19,00); saturación de oxígeno < 90% (OR = 3,33; IC 95% 1,06-10,58); puntuación en la Glasgow Coma Scale entre 9 y 13 (OR = 1,58; IC 95% 1,28-6,9); intubación realizada en vía pública (OR = 2,99; IC 95% 1,42-6,29); posición distinta a la bipedestación (OR = 2,09; IC 95% 1,08-7,25); laringoscopia directa (OR = 2,39; IC 95% 1,20-6,55); uso de estilete (OR = 1,80; IC 95% 1,40-3,78); y clasificación Cormack-Lehane $ 2 (OR = 6,50; IC 95% 3,96-30,68). Conclusiones. El procedimiento de intubación se realizó de forma habitual en el primer intento. Existen factores asociados a FIPI que permiten individualizar el manejo de la VA

Damage-driven strain localisation in networks of fibres: A computational homogenisation approach

In many applications, such as textiles, fibreglass, paper and several kinds of biological fibrous tissues, the main load-bearing constituents at the micro-scale are arranged as a fibre network. In these materials, rupture is usually driven by micro-mechanical failure mechanisms, and strain localisation due to progressive damage evolution in the fibres is the main cause of macro-scale instability. We propose a strain-driven computational homogenisation formulationbased on Representative Volume Element (RVE), within a framework in which micro-scale fibre damage can lead to macro-scale localisation phenomena. The mechanical stiffness considered here for the fibrous structure system is due to: i) an intra-fibre mechanism in which each fibre is axially stretched, and as a result, it can suffer damage; ii) an inter-fibre mechanism in which the stiffness results from the variation of the relative angle between pairs of fibres. The homogenised tangent tensor, which comes from the contribution of these two mechanisms, is required to detect the so-called bifurcation point at the macro-scale, through the spectral analysis of the acoustic tensor. This analysis can precisely determine the instant at which the macro-scale problem becomes ill-posed. At such a point, the spectral analysis provides information about the macro-scale failure pattern (unit normal and crack-opening vectors). Special attention is devoted to present the theoretical fundamentals rigorously in the light of variational formulations for multi-scale models. Also, the impact of a recent derived more general boundary condition for fibre networks is assessed in the context of materials undergoing softening. Numerical examples showing the suitability of the present methodology are also shown and discussed

Altered Ecology of the Respiratory Tract Microbiome and Nosocomial Pneumonia

10 p.Nosocomial pneumonia is one of the most frequent infections in critical patients. It is primarily associated with mechanical ventilation leading to severe illness, high mortality, and prolonged hospitalization. The risk of mortality has increased over time due to the rise in multidrug-resistant (MDR) bacterial infections, which represent a global public health threat. Respiratory tract microbiome (RTM) research is growing, and recent studies suggest that a healthy RTM positively stimulates the immune system and, like the gut microbiome, can protect against pathogen infection through colonization resistance (CR). Physiological conditions of critical patients and interventions as antibiotics administration and mechanical ventilation dramatically alter the RTM, leading to dysbiosis. The dysbiosis of the RTM of ICU patients favors the colonization by opportunistic and resistant pathogens that can be part of the microbiota or acquired from the hospital environments (biotic or built ones). Despite recent evidence demonstrating the significance of RTM in nosocomial infections, most of the host-RTM interactions remain unknown. In this context, we present our perspective regarding research in RTM altered ecology in the clinical environment, particularly as a risk for acquisition of nosocomial pneumonia. We also reflect on the gaps in the field and suggest future research directions. Moreover, expected microbiome-based interventions together with the tools to study the RTM highlighting the "omics" approaches are discussed.Comunidad de MadridFundación Ramón ArecesInstituto de Salud Carlos IIIFondo Europeo de Desarrollo RegionalCIBERON

The Method of Multiscale Virtual Power for the derivation of a second order mechanical model

A multi-scale model, based on the concept of Representative Volume Element (RVE), is proposed linking a classical continuum at RVE level to a macro-scale strain-gradient theory. The multi-scale model accounts for the effect of body forces and inertia phenomena occurring at the micro-scale. The Method of Multiscale Virtual Power recently proposed by the authors drives the construction of the model. In this context, the coupling between the macro- and micro-scale kinematical descriptors is defined by means of kinematical insertion and homogenisation operators, carefully postulated to ensure kinematical conservation in the scale transition. Micro-scale equilibrium equations as well as formulae for the homogenised (macro-scale) force- and stress-like quantities are naturally derived from the Principle of Multiscale Virtual Power - a variational extension of the Hill-Mandel Principle that enforces the balance of the virtual powers of both scales. As an additional contribution, further insight into the theory is gained with the enforcement of the RVE kinematical constraints by means of Lagrange multipliers. This approach unveils the reactive nature of homogenised force- and stress-like quantities and allows the characterisation of the homogenised stress-like quantities exclusively in terms of RVE boundary data in a straightforward manner.Fil: Blanco, Pablo Javier. Ministério da Ciência, Tecnologia, Inovações e Comunicações. Laboratório Nacional de Computação Científica; BrasilFil: Sánchez, Pablo Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Centro de Investigaciones en Métodos Computacionales. Universidad Nacional del Litoral. Centro de Investigaciones en Métodos Computacionales; ArgentinaFil: De Souza Neto, Eduardo Alberto. Swansea University; Reino UnidoFil: Feijóo, Raúl Antonino. Ministério da Ciência, Tecnologia, Inovações e Comunicações. Laboratório Nacional de Computação Científica; Brasi

Pulmonary vascular proliferation in patients with severe COVID-19: an autopsy study

3 p.Diffuse alveolar damage and thrombi are the most common lung histopathological lesions reported in patients with severe COVID-19. Although some studies have suggested increased pulmonary angiogenesis, the presence of vascular proliferation in COVID-19 lungs has not been well characterised. Glomeruloid-like microscopic foci and/or coalescent vascular proliferations measuring up to 2 cm were present in the lung of 14 out of 16 autopsied patients. These lesions expressed CD31, CD34 and vascular endothelial cadherin. Platelet-derived growth factor receptor-? immunohistochemistry and dual immunostaining for CD34/smooth muscle actin demonstrated the presence of pericytes. These vascular alterations may contribute to the severe and refractory hypoxaemia that is common in patients with severe COVID-19.Instituto de Salud Carlos IIICIBERONCInstituto Ramón y Cajal de Investigación Sanitaria Intramural COVID1

High-Flow Oxygen with Capping or Suctioning for Tracheostomy Decannulation

9 p.BACKGROUND When patients with a tracheostomy tube reach a stage in their care at which decannulation appears to be possible, it is common practice to cap the tracheostomy tube for 24 hours to see whether they can breathe on their own. Whether this approach to establishing patient readiness for decannulation leads to better outcomes than one based on the frequency of airway suctioning is unclear. METHODS In five intensive care units (ICUs), we enrolled conscious, critically ill adults who had a tracheostomy tube; patients were eligible after weaning from mechanical ventilation. In this unblinded trial, patients were randomly assigned either to undergo a 24-hour capping trial plus intermittent high-flow oxygen therapy (control group) or to receive continuous high-flow oxygen therapy with frequency of suctioning being the indicator of readiness for decannulation (intervention group). The primary outcome was the time to decannulation, compared by means of the log-rank test. Secondary outcomes included decannulation failure, weaning failure, respiratory infections, sepsis, multiorgan failure, durations of stay in the ICU and hospital, and deaths in the ICU and hospital. RESULTS The trial included 330 patients; the mean (±SD) age of the patients was 58.3±15.1 years, and 68.2% of the patients were men. A total of 161 patients were assigned to the control group and 169 to the intervention group. The time to decannulation was shorter in the intervention group than in the control group (median, 6 days [interquartile range, 5 to 7] vs. 13 days [interquartile range, 11 to 14]; absolute difference, 7 days [95% confidence interval, 5 to 9]). The incidence of pneumonia and tracheobronchitis was lower, and the duration of stay in the hospital shorter, in the intervention group than in the control group. Other secondary outcomes were similar in the two groups. CONCLUSIONS Basing the decision to decannulate on suctioning frequency plus continuous highflow oxygen therapy rather than on 24-hour capping trials plus intermittent highflow oxygen therapy reduced the time to decannulation, with no evidence of a between-group difference in the incidence of decannulation failure. (REDECAP ClinicalTrials.gov number, NCT02512744.

Evaluación de biofertilizantes en el desarrollo de lima rangpur (Citrus limonia Osbeck) en vivero

El presente trabajo se realizó con el objetivo de evaluar cuatro biofertilizantes en el crecimiento vegetativo del porta-injerto Lima Rangpur (Citrus limonia Osbeck) en vivero. El experimento se   implementó en el vivero de la Facultad de Ciencias Biológicas y Agropecuarias en la Universidad Veracruzana, de febrero a agosto del 2019. El diseño experimental utilizado fue completamente al azar con cinco tratamientos y con diez repeticiones. Los tratamientos fueron los siguiente: T1, como testigo, T2 super magro, T3 microrganismos de montaña, T4 aminoácidos, T5 lixiviado de humus de lombriz. Las variables de respuestas evaluadas fueron: número de hoja, altura de planta, grosor de tallo, el contenido de clorofila, tamaño de raíz, peso de materia seca. En las variables número de hojas, grosor de tallo y altura de planta no se encontraron diferencias significativas. En cambio, en la variable clorofila se comprobó de que los tratamientos T3 (microrganismo de montaña) y el tratamiento T4 (aminoácidos), obtuvieron los mayores resultados obtenidos,  en cuanto al tamaño de raíz los tratamientos en los cuales hubo diferencia significativa fueron los tratamientos T3 (microrganismo de montaña) y el tratamiento T5 (lixiviado de humus) y por último la variable el cual era peso de planta en seco el tratamiento más efectivo fue el T3 (microrganismo de montaña) fue el mejor por encima del tratamiento T2 (super-magro) y del tratamiento T5 (lixiviado de humus)

Caracterización morfológica de aislados de Colletotrichum asociados a antracnosis en cítricos en Tuxpan Veracruz

El objetivo  de este  trabajo  fue  aislar  y caracterizar morfológicamente  aislados  de  Colletotrichum responsables de antracnosis en cítricos en Tuxpan Ver. Se utilizaron muestras de tejidos vegetales con síntomas de antracnosis  para obtener aislados de Colletotrichum, una vez obtenidos se codificaron y se hicieron bioensayos arreglados en un diseño completamente al azar con 6 tratamientos y 4 repeticiones para observar el desarrollo de cada aislado. Cada uno de los aislados obtenidos fue considerado como un tratamiento   Las variables analizadas fueron tasa de crecimiento, caracterización de colonias y de apresorios. Los resultados mostraron que existieron diferencias significativas entre los tratamientos: en cuanto a su crecimiento el aislado UVA1 fue el que mostró la menor tasa de crecimiento de 6.5 mm por día, su desarrollo de micelio fue blanco casi transparente sin presencia de masas conidiales y en los otros aislados el crecimientos casi siempre fue similar con rangos de la tasa de crecimiento por día entre 8.1 a 9.0 mm por día; en cuanto a la caracterización de colonias fueron casi similares ya que el micelio en la myoría fue abundante con masa conidiales de color salmón y masas de esclerocios de color negro. La formación de apresorios ocurrió entre 24 y 72 h