Technological advances and interprofessional teamwork have significantly improved survival rates of critically ill patients. However, this progress has also introduced new challenges, such as intensive care unit-acquired weakness, which can contribute to postintensive care syndrome. Both conditions are associated with increased morbidity and mortality, prolonged length of hospital stay, higher social and health care […] ABSTRACT Technological advances and interprofessional teamwork have significantly improved survival rates of critically ill patients. However, this progress has also introduced new challenges, such as intensive care unit-acquired weakness, which can contribute to postintensive care syndrome. Both conditions are associated with increased morbidity and mortality, prolonged length of hospital stay, higher social and health care […]

Background: This study analyzed weaning characteristics and assessed the association of clinical and ultrasonographic indices—maximum inspiratory pressure (MIP), rapid shallow breathing index (RSBI), peak flow expiratory (PFE), diaphragm-thickening fraction (DTF), diaphragm thickness (DT), diaphragm excursion (DE), diaphragm-RSBI (D-RSBI), and lung ultrasound (LUS) patterns—with weaning failure. Methods: This retrospective cohort study included critically ill COVID-19 patients aged 18 and older who had been on invasive mechanical ventilation for at least 48 h and undergoing weaning. Exclusion criteria included absence of ultrasound assessments, neuromuscular diseases, and chronic cardio-respiratory dysfunction. Results: Among 61 patients, 44.3% experienced weaning failure, 27.9% failed the spontaneous breathing trial (SBT), 16.4% were re-intubated within 48 h, and 28% required tracheostomy. Weaning failure was associated with prolonged ventilation (29 vs. 7 days, p < 0.001), extended oxygen therapy, longer ICU stays, and higher ICU mortality. These patients had higher pressure support, lower oxygenation levels, a higher RSBI, and a lower MIP. While PEF, DTF, DE, and D-RSBI showed no significant differences, both right and left diaphragm thicknesses and the inspiratory thickness of the left diaphragm were reduced in failure cases. LUS scores were significantly higher before and after SBT in the failure group. Bivariate analysis identified RSBI [OR = 1.04 (95% CI = 1.01–1.07), p = 0.010], MIP [OR = 0.92 (95% CI = 0.86–0.99), p = 0.018], and LUS [OR = 1.15 (95% CI = 0.98–1.35), p = 0.025] as predictors of weaning failure; however, these associations were not confirmed in multivariate analysis. Conclusions: Ultrasound provides supplementary information during weaning, but no definitive association between ultrasound indices and weaning failure was confirmed in this study.

La Fibrosis Quística (FQ) es una enfermedad autosómica recesiva y se produce por una mutación del gen que codifica para la proteína reguladora de la conductancia transmembrana (CFTR); siendo el sistema respiratorio, cardiovascular y musculo esquelético afectados por esta mutación. La repercusión multisistémica de la enfermedad, causa alteración en el rendimiento físico, expresado en caídas en el VO2 peak; el que está directamente correlacio­nado con la sobrevida del paciente portador de FQ. En este contexto la rehabilitación respiratoria (RR), a través del ejercicio aeróbico, anaeróbico, entrenamiento muscular respiratorio y general; ha demostrado ser métodos seguros y efectivos, en la reversión del deterioro funcional causado por la mutación de la CFTR. En la presente trabajo se hace una revisión de la literatura sobre los aspectos más importantes vinculados a la fisiopatología del ejercicio, y el impacto del entrenamiento sobre variables fisiológicas y clínicas en pacientes con FQ, con el fin de proporcionar una mirada integral acerca de los beneficios que potencialmente puede generar el ejercicio en el curso de esta enfermedad.

To evaluate the impact of an ascending positive end-expiratory pressure titration strategy on respiratory mechanics and mechanical power in patients without lung injury. An incremental positive end-expiratory pressure titration was performed in 4cmH2O steps, starting from zero end-expiratory pressure and progressing to 16cmH2O. Differences (Δ) in respiratory system static compliance, plateau pressure, driving pressure, and mechanical power were assessed during lung-protective ventilation. Mechanical power formulas proposed by Gattinoni et al. and Costa et al. were used. Analyses were also performed on the static elastic components, dynamic elastic components, total elastic power, and resistive components. Increasing positive end-expiratory pressure levels were associated with a progressive rise in mechanical power, plateau pressure, total and static elastic power, and a decline in compliance. Mechanical power showed strong positive correlations with: ΔPplat (p < 0.001); Δelastic dynamic power (p < 0.001); Δdriving pressure (p < 0.001); and Δtotal elastic power (p < 0.001). Δmechanical power correlated strongly with Δresistive power (p < 0.001), but not with other mechanical power components or mechanics. Progressive positive end-expiratory pressure increase in patients without lung disease significantly raises total mechanical power and its elastic components, particularly static elastic power. These changes may occur silently and without significant alterations in driving pressure or compliance.

Although early mobilization is a cornerstone of modern critical care for reducing intensive care unit-acquired weakness, the duration of mechanical ventilation, and length of stay, its implementation remains highly variable due to the absence of standardized laboratory criteria to guide clinical decision-making. Therefore, this study aimed to generate safety recommendations regarding laboratory and blood […] Abstract Although early mobilization is a cornerstone of modern critical care for reducing intensive care unit-acquired weakness, the duration of mechanical ventilation, and length of stay, its implementation remains highly variable due to the absence of standardized laboratory criteria to guide clinical decision-making. Therefore, this study aimed to generate safety recommendations regarding laboratory and blood […]

Introducción: La decanulación en pacientes con daño neurológico representa un hito clínico y funcional relevante, cuya decisión continúa siendo compleja y heterogénea. En este contexto, la eficacia de la tos ha emergido como un factor clave para la protección de la vía aérea y el éxito del proceso.Objetivo: Analizar la relevancia clínica de la tos eficaz como factor asociado al éxito de la decanulación en pacientes con daño neurológico.Metodología: Se realizó una revisión narrativa de la literatura mediante búsqueda en bases de datos científicas, seleccionando estudios relacionados con fisiología de la tos, control neurológico, métodos de evaluación clínica y objetiva, y modelos predictivos de decanulación en población neurológica. Se priorizaron estudios publicados en los últimos 10 años, con énfasis en revisiones sistemáticas, estudios observacionales y ensayos clínicos relevantes en población neurológica.Resultados: La evidencia identifica a la tos eficaz, especialmente cuando es evaluada de forma objetiva mediante flujo de tos, como un predictor consistente del éxito de la decanulación, integrándose en modelos multivariados junto a variables neurológicas y deglutorias.Conclusión: La evaluación sistemática de la tos constituye un componente central para optimizar la toma de decisiones y la seguridad del proceso de decanulación en pacientes con daño neurológico.