Efficiency of a mechanical device in controlling tracheal cuff pressure in intubated critically ill patients : a randomized controlled study

Cuff pressure (P ) control is mandatory to avoid leakage of oral secretions passing the tracheal tube and tracheal ischemia. The aim of the present trial was to determine the efficacy of a mechanical device (PressureEasy®) in the continuous control of P in patients intubated with polyvinyl chloride (PVC)-cuffed tracheal tubes, compared with routine care using a manometer. This is a prospective, randomized, controlled, cross-over study. All patients requiring intubation with a predicted duration of mechanical ventilation ≥48 h were eligible. Eighteen patients randomly received continuous control of P with PressureEasy® device for 24 h, followed by discontinuous control (every 4 h) with a manual manometer for 24 h, or vice versa. P and airway pressure were continuously recorded. P target was 25 cmHO during the two periods. The percentage of time spent with P 20-30 cmHO (median (IQR) 34 % (17-57) versus 50 % (35-64), p = 0.184) and the percentage of time spent with P 30 cmHO was significantly higher during continuous control compared with routine care of tracheal cuff (26 % (14-39) versus 7 % (1-18), p = 0.002). No significant difference was found in P (25 (18-28) versus 21 (18-26), p = 0.17), mean airway pressure (14 (10-17) versus 14 (11-16), p = 0.679), or coefficient of variation of P (19 % (11-26) versus 20 % (11-25), p = 0.679) during continuous control compared with routine care of tracheal cuff, respectively. PressureEasy® did not demonstrate a better control of P between 20 and 30 cmHO, compared with routine care using a manometer. Moreover, the device use resulted in significantly higher time spent with overinflation of tracheal cuff, which might increase the risk for tracheal ischemic lesions

Abdominal adiposity increases lordosis and doubles the risk of low back pain

Vertebral disorders have significant health and economic impacts, and due to aging and current lifestyle habits, there is a trend toward their increase. Obesity and the alignment of vertebral curvatures can be associated with back pain. Objective: This study aims to analyze whether general and abdominal obesity are associated with cervical, dorsal, and lumbar vertebral pain as well as increased or decreased values of cervical, dorsal, and lumbar vertebral curvatures. Methodology: Body composition, degree of vertebral curvature, and the perception of cervical, dorsal, and lumbar pain were evaluated in a study population of 301 people (>18 years old). Linear and logistic regression analyses were performed to evaluate the influence of several variables of body composition on vertebral angles and cervical, dorsal, and lumbar pain. Results: Lumbar pain was the most prevalent (66.1%), mainly affecting women (70.9%). They were also shown to have greater lumbar angles (p < 0.001). The degrees of lumbar curvature increased, as did the BMI, waist circumference, and waist-to-height ratio. Cervical and dorsal curvatures were increased by all the variables of adiposity and abdominal adiposity. It was found that people with abdominal obesity carried twice the risk of lower back pain than those without abdominal obesity (OR = 2.172, p < 0.05). In addition, an increased lumbar angle was related to an increased risk of low back pain (OR = 1.031, p < 0.05). Cervical pain, on the other hand, was associated with the waist-height index (OR = 0.948, p <0.01). Conclusions: This study shows that increased lumbar curvature and abdominal obesity may be risk factors for lower back pain. In addition, it shows an association between the amount of body and abdominal fat in relation to the degree of curvature of the spine in the sagittal plane. Investigating the effect of obesity on vertebral morphology and musculoskeletal disorders makes it possible to prescribe interventions and therapeutic strategie

Evaluación de la utilidad de la diferencia venosa-arterial de dióxido de carbono en el proceso de la resucitación hemodinámica del shock séptico

El shock es un estado de disoxia tisular, donde el desequilibrio entre el aporte y el consumo de oxígeno genera disfunción tisular, fracaso multiorgánico y finalmente la muerte. Por todo ello supone una urgencia médica. Actualmente las recomendaciones a la hora de resucitar a un paciente en shock abogan por la optimización de la presión arterial media (PAM) y la búsqueda de la normalización de los valores de la saturación venosa central de oxígenos (SvcO2) y lactato. No obstante, estos parámetros macrohemodinámicos, parecen ser insuficientes. En los últimos años, se ha demostrado el valor pronóstico de la presión venosa central a arterial de dióxido de carbono (PcvaCO2) en distintas condiciones, lo que ha generado que sea propuesto como marcador adicional de la adecuación en la perfusión tisular. Existen numerosos trabajos que muestran la asociación entre PcvaCO2 y gasto cardíaco, y su capacidad discriminativa a pesar de niveles normales de SvcO2, por lo que desde hace años ha sido introducido como un objetivo más en el proceso de la resucitación hemodinámica. No obstante, el PcvaCO2 no se ha explorado de forma prospectiva, y podría ser una variable más compleja de lo pensado inicialmente. Además, el PcvaCO2, no parece ser tan bueno a la hora de detectar estados de anaerobiosis, y algunos autores han propuesto la utilización del PcvaCO2 corregido por el contenido arterio-venoso de O2 (CavO2), cálculo aproximativo del coeficiente respiratorio. Este supone la corrección de la producción global de CO2 (VCO2) por el consumo global de oxígeno (VO2). De acuerdo con la ecuación de Fick, el coeficiente respiratorio es equivalente al contenido venoso central a arterial de dióxido de carbono (CcvaCO2) dividido por el CavO2. Atendiendo que el valor fisiológico del contenido de dióxido de carbono incluye la presión parcial, se atribuye una relación lineal de ambas variables, siendo aceptada la utilizando el PcvaCO2 como un subrogado del CcvaCO2. No obstante la intercambiabilidad de dichas variables es un tema de debate. En el presente trabajo de tesis doctoral se ha pretendido dar respuesta a diferentes aspectos clínicos en relación a las variables derivadas del dióxido de carbono (CO2) como son el PcvaCO2 y el PcvaCO2/CavO2. Fundamentalmente, se ha analizado su asociación con la presencia de metabolismo anaerobio, la interacción de diversos parámetros en la relación entre contenido y presión de CO2, así como su valor pronostico en las fases precoces del paciente en shock séptico.Shock is a state of tissue disoxia, where the imbalance between transport and oxygen consumption generates tissue dysfunction, multiorgan failure and finally death. This is why it implies a medical emergency. Currently the recommendations when resuscitating a patient in shock, advocate to the optimization of mean arterial pressure (PAM) and the search for the normalization of the values ​​of central venous oxygen saturation (SvcO2) and lactate. However, those macrohemodynamic parameters seem to be insufficient. In recent years, the prognostic value of the central venous-to-arterial carbon dioxide difference (PcvaCO2) gap has been demonstrated in different conditions, which has led to its being proposed as an additional marker of adequacy in tissue perfusion. There are numerous studies that show the association between PcvaCO2 and cardiac output and its discriminative capacity despite normal levels of SvcO2, thus, few years ago it has been introduced as another objective in the process of hemodynamic resuscitation. However, PcvaCO2 has not been explored prospectively, and could be a more complex variable than originally thought. In addition, PcvaCO2 does not seem to be as good at detecting anaerobic states, and some authors have proposed the use of PcvaCO2 corrected for the arterial-venous O2 content (CavO2). This parameter supposes an approximate calculation of the respiratory coefficient. This supposes the correction of the global production of CO2 (VCO2) by the global consumption of oxygen (VO2). According to the Fick equation, the respiratory coefficient equivalent to central venous-to-arterial carbon dioxide content (CcvaCO2) corrected by CavO2. Considering that the physiological value of the carbon dioxide content (CCO2) includes partial pressure (PCO2), a linear relationship of both variables is attributed, being accepted using PcvaCO2 as a surrogate of CcvaCO2. However, the equivalence of these variables is a matter of debate. In the present work of doctoral thesis has sought to respond to different clinical aspects in relation to the variables derived from carbon dioxide (CO2) such as PcvaCO2 and PcvaCO2/CavO2. Basically, its association with the presence of anaerobic metabolism, the interaction of various parameters in the relationship between content and CO2 pressure, as well as its prognostic value in the early phases of the patient in septic shock has been analyzed

Riñas numéricas

This paper shows one of the tales presented to the contest about tales with mathematical content organized by the Innovation Educative Group “Mathematical Thinking” in 2015. The tale introduces the integer numbers in a funny way.En este artículo se muestra uno de los cuentos presentados al concurso de relatos con contenido matemático organizado por el GIE Pensamiento matemático en 2015 para alumnos de la ESO, Bachillerato y universitarios. En él se introducen los números enteros de una forma divertida

Evaluación de la utilidad de la diferencia venosa-arterial de dióxido de carbono en el proceso de la resucitación hemodinámica del shock séptico

El shock es un estado de disoxia tisular, donde el desequilibrio entre el aporte y el consumo de oxígeno genera disfunción tisular, fracaso multiorgánico y finalmente la muerte. Por todo ello supone una urgencia médica. Actualmente las recomendaciones a la hora de resucitar a un paciente en shock abogan por la optimización de la presión arterial media (PAM) y la búsqueda de la normalización de los valores de la saturación venosa central de oxígenos (SvcO2) y lactato. No obstante, estos parámetros macrohemodinámicos, parecen ser insuficientes. En los últimos años, se ha demostrado el valor pronóstico de la presión venosa central a arterial de dióxido de carbono (PcvaCO2) en distintas condiciones, lo que ha generado que sea propuesto como marcador adicional de la adecuación en la perfusión tisular. Existen numerosos trabajos que muestran la asociación entre PcvaCO2 y gasto cardíaco, y su capacidad discriminativa a pesar de niveles normales de SvcO2, por lo que desde hace años ha sido introducido como un objetivo más en el proceso de la resucitación hemodinámica. No obstante, el PcvaCO2 no se ha explorado de forma prospectiva, y podría ser una variable más compleja de lo pensado inicialmente. Además, el PcvaCO2, no parece ser tan bueno a la hora de detectar estados de anaerobiosis, y algunos autores han propuesto la utilización del PcvaCO2 corregido por el contenido arterio-venoso de O2 (CavO2), cálculo aproximativo del coeficiente respiratorio. Este supone la corrección de la producción global de CO2 (VCO2) por el consumo global de oxígeno (VO2). De acuerdo con la ecuación de Fick, el coeficiente respiratorio es equivalente al contenido venoso central a arterial de dióxido de carbono (CcvaCO2) dividido por el CavO2. Atendiendo que el valor fisiológico del contenido de dióxido de carbono incluye la presión parcial, se atribuye una relación lineal de ambas variables, siendo aceptada la utilizando el PcvaCO2 como un subrogado del CcvaCO2. No obstante la intercambiabilidad de dichas variables es un tema de debate. En el presente trabajo de tesis doctoral se ha pretendido dar respuesta a diferentes aspectos clínicos en relación a las variables derivadas del dióxido de carbono (CO2) como son el PcvaCO2 y el PcvaCO2/CavO2. Fundamentalmente, se ha analizado su asociación con la presencia de metabolismo anaerobio, la interacción de diversos parámetros en la relación entre contenido y presión de CO2, así como su valor pronostico en las fases precoces del paciente en shock séptico.Shock is a state of tissue disoxia, where the imbalance between transport and oxygen consumption generates tissue dysfunction, multiorgan failure and finally death. This is why it implies a medical emergency. Currently the recommendations when resuscitating a patient in shock, advocate to the optimization of mean arterial pressure (PAM) and the search for the normalization of the values ​​of central venous oxygen saturation (SvcO2) and lactate. However, those macrohemodynamic parameters seem to be insufficient. In recent years, the prognostic value of the central venous-to-arterial carbon dioxide difference (PcvaCO2) gap has been demonstrated in different conditions, which has led to its being proposed as an additional marker of adequacy in tissue perfusion. There are numerous studies that show the association between PcvaCO2 and cardiac output and its discriminative capacity despite normal levels of SvcO2, thus, few years ago it has been introduced as another objective in the process of hemodynamic resuscitation. However, PcvaCO2 has not been explored prospectively, and could be a more complex variable than originally thought. In addition, PcvaCO2 does not seem to be as good at detecting anaerobic states, and some authors have proposed the use of PcvaCO2 corrected for the arterial-venous O2 content (CavO2). This parameter supposes an approximate calculation of the respiratory coefficient. This supposes the correction of the global production of CO2 (VCO2) by the global consumption of oxygen (VO2). According to the Fick equation, the respiratory coefficient equivalent to central venous-to-arterial carbon dioxide content (CcvaCO2) corrected by CavO2. Considering that the physiological value of the carbon dioxide content (CCO2) includes partial pressure (PCO2), a linear relationship of both variables is attributed, being accepted using PcvaCO2 as a surrogate of CcvaCO2. However, the equivalence of these variables is a matter of debate. In the present work of doctoral thesis has sought to respond to different clinical aspects in relation to the variables derived from carbon dioxide (CO2) such as PcvaCO2 and PcvaCO2/CavO2. Basically, its association with the presence of anaerobic metabolism, the interaction of various parameters in the relationship between content and CO2 pressure, as well as its prognostic value in the early phases of the patient in septic shock has been analyzed

Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference is associated with lactate evolution in the hemodynamic resuscitation process in early septic shock

Since normal or high central venous oxygen saturation (ScvO) values cannot discriminate if tissue perfusion is adequate, integrating other markers of tissue hypoxia, such as central venous-to-arterial carbon dioxide difference (PCO gap) has been proposed. In the present study, we aimed to evaluate the ability of the PCO gap and the PCO/arterial-venous oxygen content difference ratio (PCO/CO) to predict lactate evolution in septic shock. Observational study. Septic shock patients within the first 24 hours of ICU admission. After restoration of mean arterial pressure, and central venous oxygen saturation, the PCO gap and the PCO/CO ratio were calculated. Consecutive arterial and central venous blood samples were obtained for each patient within 24 hours. Lactate improvement was defined as the decrease ≥ 10% of the previous lactate value. Thirty-five septic shock patients were studied. At inclusion, the PCO gap was 5.6 ± 2.1 mmHg, and the PCO/CO ratio was 1.6 ± 0.7 mmHg · dL/mL O. Those patients whose lactate values did not decrease had higher PCO/CO ratio values at inclusion (1.8 ± 0.8vs. 1.4 ± 0.5, p 0.02). During the follow-up, 97 paired blood samples were obtained. No-improvement in lactate values was associated to higher PCO/CO ratio values in the previous control. The ROC analysis showed an AUC 0.82 (p < 0.001), and a PCO/CO ratio cut-off value of 1.4 mmHg · dL/mL O showed sensitivity 0.80 and specificity 0.75 for lactate improvement prediction. The odds ratio of an adequate lactate clearance was 0.10 (p < 0.001) in those patients with an elevated PCO/CO ratio (≥1.4). In a population of septic shock patients with normalized MAP and SO, the presence of elevated PCO/CO ratio significantly reduced the odds of adequate lactate clearance during the following hours

Evaluación de la utilidad de la diferencia venosa-arterial de dióxido de carbono en el proceso de la resucitación hemodinámica del shock séptico /

El shock es un estado de disoxia tisular, donde el desequilibrio entre el aporte y el consumo de oxígeno genera disfunción tisular, fracaso multiorgánico y finalmente la muerte. Por todo ello supone una urgencia médica. Actualmente las recomendaciones a la hora de resucitar a un paciente en shock abogan por la optimización de la presión arterial media (PAM) y la búsqueda de la normalización de los valores de la saturación venosa central de oxígenos (SvcO2) y lactato. No obstante, estos parámetros macrohemodinámicos, parecen ser insuficientes. En los últimos años, se ha demostrado el valor pronóstico de la presión venosa central a arterial de dióxido de carbono (PcvaCO2) en distintas condiciones, lo que ha generado que sea propuesto como marcador adicional de la adecuación en la perfusión tisular. Existen numerosos trabajos que muestran la asociación entre PcvaCO2 y gasto cardíaco, y su capacidad discriminativa a pesar de niveles normales de SvcO2, por lo que desde hace años ha sido introducido como un objetivo más en el proceso de la resucitación hemodinámica. No obstante, el PcvaCO2 no se ha explorado de forma prospectiva, y podría ser una variable más compleja de lo pensado inicialmente. Además, el PcvaCO2, no parece ser tan bueno a la hora de detectar estados de anaerobiosis, y algunos autores han propuesto la utilización del PcvaCO2 corregido por el contenido arterio-venoso de O2 (CavO2), cálculo aproximativo del coeficiente respiratorio. Este supone la corrección de la producción global de CO2 (VCO2) por el consumo global de oxígeno (VO2). De acuerdo con la ecuación de Fick, el coeficiente respiratorio es equivalente al contenido venoso central a arterial de dióxido de carbono (CcvaCO2) dividido por el CavO2. Atendiendo que el valor fisiológico del contenido de dióxido de carbono incluye la presión parcial, se atribuye una relación lineal de ambas variables, siendo aceptada la utilizando el PcvaCO2 como un subrogado del CcvaCO2. No obstante la intercambiabilidad de dichas variables es un tema de debate. En el presente trabajo de tesis doctoral se ha pretendido dar respuesta a diferentes aspectos clínicos en relación a las variables derivadas del dióxido de carbono (CO2) como son el PcvaCO2 y el PcvaCO2/CavO2. Fundamentalmente, se ha analizado su asociación con la presencia de metabolismo anaerobio, la interacción de diversos parámetros en la relación entre contenido y presión de CO2, así como su valor pronostico en las fases precoces del paciente en shock séptico.Shock is a state of tissue disoxia, where the imbalance between transport and oxygen consumption generates tissue dysfunction, multiorgan failure and finally death. This is why it implies a medical emergency. Currently the recommendations when resuscitating a patient in shock, advocate to the optimization of mean arterial pressure (PAM) and the search for the normalization of the values ​​of central venous oxygen saturation (SvcO2) and lactate. However, those macrohemodynamic parameters seem to be insufficient. In recent years, the prognostic value of the central venous-to-arterial carbon dioxide difference (PcvaCO2) gap has been demonstrated in different conditions, which has led to its being proposed as an additional marker of adequacy in tissue perfusion. There are numerous studies that show the association between PcvaCO2 and cardiac output and its discriminative capacity despite normal levels of SvcO2, thus, few years ago it has been introduced as another objective in the process of hemodynamic resuscitation. However, PcvaCO2 has not been explored prospectively, and could be a more complex variable than originally thought. In addition, PcvaCO2 does not seem to be as good at detecting anaerobic states, and some authors have proposed the use of PcvaCO2 corrected for the arterial-venous O2 content (CavO2). This parameter supposes an approximate calculation of the respiratory coefficient. This supposes the correction of the global production of CO2 (VCO2) by the global consumption of oxygen (VO2). According to the Fick equation, the respiratory coefficient equivalent to central venous-to-arterial carbon dioxide content (CcvaCO2) corrected by CavO2. Considering that the physiological value of the carbon dioxide content (CCO2) includes partial pressure (PCO2), a linear relationship of both variables is attributed, being accepted using PcvaCO2 as a surrogate of CcvaCO2. However, the equivalence of these variables is a matter of debate. In the present work of doctoral thesis has sought to respond to different clinical aspects in relation to the variables derived from carbon dioxide (CO2) such as PcvaCO2 and PcvaCO2/CavO2. Basically, its association with the presence of anaerobic metabolism, the interaction of various parameters in the relationship between content and CO2 pressure, as well as its prognostic value in the early phases of the patient in septic shock has been analyzed

Abdominal Adiposity Increases Lordosis and Doubles the Risk of Low Back Pain

Vertebral disorders have significant health and economic impacts, and due to aging and current lifestyle habits, there is a trend toward their increase. Obesity and the alignment of vertebral curvatures can be associated with back pain. Objective: This study aims to analyze whether general and abdominal obesity are associated with cervical, dorsal, and lumbar vertebral pain as well as increased or decreased values of cervical, dorsal, and lumbar vertebral curvatures. Methodology: Body composition, degree of vertebral curvature, and the perception of cervical, dorsal, and lumbar pain were evaluated in a study population of 301 people (&gt;18 years old). Linear and logistic regression analyses were performed to evaluate the influence of several variables of body composition on vertebral angles and cervical, dorsal, and lumbar pain. Results: Lumbar pain was the most prevalent (66.1%), mainly affecting women (70.9%). They were also shown to have greater lumbar angles (p &lt; 0.001). The degrees of lumbar curvature increased, as did the BMI, waist circumference, and waist-to-height ratio. Cervical and dorsal curvatures were increased by all the variables of adiposity and abdominal adiposity. It was found that people with abdominal obesity carried twice the risk of lower back pain than those without abdominal obesity (OR = 2.172, p &lt; 0.05). In addition, an increased lumbar angle was related to an increased risk of low back pain (OR = 1.031, p &lt; 0.05). Cervical pain, on the other hand, was associated with the waist-height index (OR = 0.948, p &lt;0.01). Conclusions: This study shows that increased lumbar curvature and abdominal obesity may be risk factors for lower back pain. In addition, it shows an association between the amount of body and abdominal fat in relation to the degree of curvature of the spine in the sagittal plane. Investigating the effect of obesity on vertebral morphology and musculoskeletal disorders makes it possible to prescribe interventions and therapeutic strategies

Abdominal Adiposity Increases Lordosis and Doubles the Risk of Low Back Pain

Vertebral disorders have significant health and economic impacts, and due to aging and current lifestyle habits, there is a trend toward their increase. Obesity and the alignment of vertebral curvatures can be associated with back pain. Objective: This study aims to analyze whether general and abdominal obesity are associated with cervical, dorsal, and lumbar vertebral pain as well as increased or decreased values of cervical, dorsal, and lumbar vertebral curvatures. Methodology: Body composition, degree of vertebral curvature, and the perception of cervical, dorsal, and lumbar pain were evaluated in a study population of 301 people (>18 years old). Linear and logistic regression analyses were performed to evaluate the influence of several variables of body composition on vertebral angles and cervical, dorsal, and lumbar pain. Results: Lumbar pain was the most prevalent (66.1%), mainly affecting women (70.9%). They were also shown to have greater lumbar angles (p < 0.001). The degrees of lumbar curvature increased, as did the BMI, waist circumference, and waist-to-height ratio. Cervical and dorsal curvatures were increased by all the variables of adiposity and abdominal adiposity. It was found that people with abdominal obesity carried twice the risk of lower back pain than those without abdominal obesity (OR = 2.172, p < 0.05). In addition, an increased lumbar angle was related to an increased risk of low back pain (OR = 1.031, p < 0.05). Cervical pain, on the other hand, was associated with the waist-height index (OR = 0.948, p <0.01). Conclusions: This study shows that increased lumbar curvature and abdominal obesity may be risk factors for lower back pain. In addition, it shows an association between the amount of body and abdominal fat in relation to the degree of curvature of the spine in the sagittal plane. Investigating the effect of obesity on vertebral morphology and musculoskeletal disorders makes it possible to prescribe interventions and therapeutic strategies.Sección Deptal. de Radiología, Rehabilitación y Fisioterapia (Enfermería)Fac. de Enfermería, Fisioterapia y PodologíaTRUEpu