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https://repositorio.uft.cl/handle/20.500.12254/2464

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Examinando Artículos de Revistas por Materia "Acute respiratory distress syndrome"

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    Physiological and clinical effects of trunk inclination adjustment in patients with respiratory failure: a scoping review and narrative synthesis
    (BMC, 2024-07-09) Benites, Martín Hernán; Zapata‑Canivilo, Marcelo; Poblete, Fabian; Labbe, Francisco; Battiato, Romina; Ferre, Andrés; Dreyse, Jorge; Bugedo, Guillermo; Bruhn, Alejandro; Costa, Eduardo L. V.; Retamal, Jaime
    Background Adjusting trunk inclination from a semirecumbent position to a supinefat position or vice versa in patients with respiratory failure signifcantly afects numerous aspects of respiratory physiology including respiratory mechanics, oxygenation, endexpiratory lung volume, and ventilatory efciency. Despite these observed efects, the current clinical evidence regarding this positioning manoeuvre is limited. This study undertakes a scoping review of patients with respiratory failure undergoing mechanical ventilation to assess the efect of trunk inclination on physiological lung parameters. Methods The PubMed, Cochrane, and Scopus databases were systematically searched from 2003 to 2023. Interventions: Changes in trunk inclination. Measurements: Four domains were evaluated in this study: 1) respiratory mechanics, 2) ventilation distribution, 3) oxygenation, and 4) ventilatory efciency. Results After searching the three databases and removing duplicates, 220 studies were screened. Of these, 37 were assessed in detail, and 13 were included in the fnal analysis, comprising 274 patients. All selected studies were experimental, and assessed respiratory mechanics, ventilation distribution, oxygenation, and ventilatory efciency, primarily within 60 min post postural change. Conclusion In patients with acute respiratory failure, transitioning from a supine to a semirecumbent position leads to decreased respiratory system compliance and increased airway driving pressure. Additionally, CARDS patients experienced an improvement in ventilatory efciency, which resulted in lower PaCO2 levels. Improvements in oxygenation were observed in a few patients and only in those who exhibited an increase in EELV upon moving to a semi recumbent position. Therefore, the trunk inclination angle must be accurately reported in patients with respiratory failure under mechanical ventilation
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    Ventilatory load reduction by combined mild hypothermia and ultraprotective mechanical ventilation strategy in severe COVID-19-related acute respiratory distress syndrome: A physiological study.
    (The Emergency Medicine Association of Turkey, 2024-04) Cruces, Pablo; Moreno, Diego; Reveco, Sonia; Ramírez, Yenny; Díaz, Franco
    We report the feasibility of a combined approach of very low low tidal volume (VT) and mild therapeutic hypothermia (MTH) to decrease the ventilatory load in a severe COVID-19-related acute respiratory distress syndrome (ARDS) cohort. Inclusion criteria was patients ≥18 years old, severe COVID 19 related ARDS, driving pressure ∆P >15 cmH2 O despite low-VT strategy, and extracorporea therapies not available. MTH was induced with a surface cooling device aiming at 34°C. MTH was maintained for 72 h, followed by rewarming of 1°C per day. Data were shown in median (interquartile range, 25%–75%). Mixed effects analysis and Dunnett’s test were used for comparisons. Seven patients were reported. Ventilatory load decreased during the first 24 h, minute ventilation (VE) decreased from 173 (170–192) to 152 (137–170) mL/kg/min (P = 0.007), and mechanical power (MP) decreased from 37 (31–40) to 29 (26–34) J/min (P = 0.03). At the end of the MTH period, the VT, P, and plateau pressure remained consistently close to 3.9 mL/kg predicted body weight, 12 and 26 cmH2 O, respectively. A combined strategy of MTH and ultraprotective mechanical ventilation (MV) decreased VE and MP in severe COVID-19-related ARDS. The decreasing of ventilatory load may allow maintaining MV within safety thresholds.