Comparison of Two Extubation Techniques in Critically Ill Adult Subjects: The ExtubAR Randomized Clinical Trial.

BACKGROUND: Two orotracheal extubation techniques are described in the literature: the traditional technique and the positive-pressure technique. Although prior studies reported better clinical outcomes with the positive-pressure extubation technique, its superiority has not been extensively studied yet. This study was to determine whether the positive-pressure orotracheal extubation technique, compared with the traditional orotracheal extubation technique, reduces the incidence of major postextubation complications (up to 60 min) in critically ill adult subjects. METHODS: This was a multi-center randomized clinical trial. Subjects age > 18 y, requiring invasive mechanical ventilation through an endotracheal tube, who met the orotracheal extubation criteria were included and randomized to traditional extubation group (removing the endotracheal tube by applying continuous endotracheal suctioning during the entire procedure) or positive-pressure group (application of pressure support mode at 15/10 cm H2O during cuff deflation and extubation). The primary measure was postextubation major complications, defined as the clinical evidence of at least one of the following: desaturation, upper-airway obstruction, or vomiting. RESULTS: A total of 725 subjects was randomly assigned to the traditional extubation group (n = 358) and positive-pressure group (n = 367). Seventeen subjects were eliminated and not included in the per-protocol analysis. Of 708 subjects, 185 (26.1%) developed at least one major complication. The incidence was 27.8% (96/345) in the traditional group compared with 24.5% (89/363) in the positive-pressure group. No statistically significant differences were observed between the 2 groups (absolute risk 3% [95 CI -3 to 10]; relative risk, 0.88 [95 CI 0.69-1.13], P = .32). CONCLUSIONS: Despite the trend toward the positive-pressure group, no statistically significant differences were observed. Our findings agree with the literature in that positive-pressure extubation is a safe procedure; therefore, both techniques may be used during extubation in critically ill adult patients.

Encuesta sobre el procedimiento de extubación en las unidades de cuidados intensivos de Buenos Aires, Argentina / Survey on the extubation procedure in intensive care units in Buenos Aires, Argentina

RESUMEN Objetivo: Conocer la práctica habitual del manejo de la vía aérea durante el procedimiento de extubación mediante una encuesta online a profesionales de las unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos, Argentina. Métodos: Estudio descriptivo transversal de tipo encuesta online del 11 de febrero al 11 de marzo de 2013. Se envió por correo electrónico una invitación voluntaria y anónima para acceder a la encuesta a 500 participantes a partir de una base de datos confeccionada por los investigadores de este estudio. Resultados: De un total de 500 participantes, 217 (44%) respondieron la encuesta. El 59,4% son kinesiólogos. Ciento noventa y cinco (89,9%) profesionales se desempeñan en atención de adultos. Con respecto al procedimiento de desinflado del balón y extubación, 203 (93,5%) realizan aspiración endotraqueal y 27 (12,5%) emplean presión positiva. El 53,5% de los participantes informó haber tenido en los últimos 3 meses complicaciones inmediatas a este procedimiento. Se informaron un total de 163 complicaciones, siendo el estridor el más prevalente (52,7%). Conclusión: La mayoría de los profesionales de unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos Aires, Argentina, emplea aspiración endotraqueal sin aplicar presión positiva durante el procedimiento de extubación.

ABSTRACT Objective: To examine the usual practice of airway management during the extubation procedure through an online survey to professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina. Methods: A cross-sectional descriptive study online survey was conducted from February 11 to March 11, 2013. A database was generated, and a voluntary and anonymous invitation to access the survey was sent by email to 500 participants. Results: Out of a total of 500 participants, 217 (44%) responded to the survey, of whom 59.4% were physical therapists. One hundred ninety-five (89.9%) professionals were working in adult care. Regarding the cuff deflation procedure and extubation, 203 (93.5%) performe endotracheal suctioning, and 27 (12.5%) use positive pressure. Approximately 53.5% of participants reported having experienced immediate complications with this procedure in the last three months. In all, 163 complications were reported, and stridor was the most prevalent (52.7%). Conclusion: Most professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina, use endotracheal suctioning without applying positive pressure during extubation.

Survey on the extubation procedure in intensive care units in Buenos Aires, Argentina. / Encuesta sobre el procedimiento de extubación en las unidades de cuidados intensivos de Buenos Aires, Argentina.

OBJECTIVE: To examine the usual practice of airway management during the extubation procedure through an online survey to professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina. METHODS: A cross-sectional descriptive study online survey was conducted from February 11 to March 11, 2013. A database was generated, and a voluntary and anonymous invitation to access the survey was sent by email to 500 participants. RESULTS: Out of a total of 500 participants, 217 (44%) responded to the survey, of whom 59.4% were physical therapists. One hundred ninety-five (89.9%) professionals were working in adult care. Regarding the cuff deflation procedure and extubation, 203 (93.5%) performe endotracheal suctioning, and 27 (12.5%) use positive pressure. Approximately 53.5% of participants reported having experienced immediate complications with this procedure in the last three months. In all, 163 complications were reported, and stridor was the most prevalent (52.7%). CONCLUSION: Most professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina, use endotracheal suctioning without applying positive pressure during extubation.

OBJETIVO: Conocer la práctica habitual del manejo de la vía aérea durante el procedimiento de extubación mediante una encuesta online a profesionales de las unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos, Argentina. MÉTODOS: Estudio descriptivo transversal de tipo encuesta online del 11 de febrero al 11 de marzo de 2013. Se envió por correo electrónico una invitación voluntaria y anónima para acceder a la encuesta a 500 participantes a partir de una base de datos confeccionada por los investigadores de este estudio. RESULTADOS: De un total de 500 participantes, 217 (44%) respondieron la encuesta. El 59,4% son kinesiólogos. Ciento noventa y cinco (89,9%) profesionales se desempeñan en atención de adultos. Con respecto al procedimiento de desinflado del balón y extubación, 203 (93,5%) realizan aspiración endotraqueal y 27 (12,5%) emplean presión positiva. El 53,5% de los participantes informó haber tenido en los últimos 3 meses complicaciones inmediatas a este procedimiento. Se informaron un total de 163 complicaciones, siendo el estridor el más prevalente (52,7%). CONCLUSIÓN: La mayoría de los profesionales de unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos Aires, Argentina, emplea aspiración endotraqueal sin aplicar presión positiva durante el procedimiento de extubación.

Chemical Composition and Antimicrobial Activity of Ageratina deltoidea.

The chemical study of Ageratina deltoidea afforded grandiflorenic acid (1), ent-kaurenoic acid (2), and eight benzylbenzoates (3 - 10), two of them, 3,5-dimethoxybenzyl 2,3,6-trimethoxybenzoate (5) and 4-(ß-d-glucopyranosyloxy)-3-hydroxybenzyl 2,6-dimethoxybenzoate (9), described for the first time. In addition, the new sesquiterpene lactone deltoidin C (13), together with the known 11 and 12, the phenolic compounds: ayanin, 2,6-dimethoxybenzoic acid, methyl 3,4-dihydroxycinnamate, chlorogenic acid, and 3,5-dicaffeoylquinic acid were also isolated. The structures of these compounds were determined by spectroscopic methods and chemical reactions. The antibacterial and antifungal activities of compounds 1 - 12 were evaluated on Staphylococcus aureus, Escherichia coli, and Candida albicans. Deltoidin A (11) was the most active antibacterial agent (MIC 16.0 µg ml-1 ) against E. coli, and the ent-kaurenoid derivatives (1 - 2) showed activity (MIC 31.0 µg ml-1 ) against S. aureus.

[Cultural adaptation and Argentine validation of the Northwick Park Neck Pain Questionnaire in the hospitals of the Autonomous City of Buenos Aires]. / Adaptación cultural y validación argentina del cuestionario Northwick park de dolor cervical en el ámbito hospitalario de la ciudad autónoma de Buenos Aires.

OBJECTIVE: [corrected] To make cultural adaptation and validation of the Northwick Park Neck Pain Questionnaire (NPQ) in Argentina, determining its psychometric properties in patients with neck pain of mechanical origin referred to the physiotherapy Service at D. F. Santojanni Hospital. MATERIALS AND METHODS: autorization of original author of the NPQ was requested. Then we make the linguistic adaptation and pilot study. Psychometric analyses included test-retest reliability (intraclass correlation coefficient), validity (Pearson correlation coefficient NPQ-Visual Analog Scale, VAS), internal consistency (Cronbach Coefficient Alpha) and sensibility to change (paired t test). Sixty patients were inclueed from September 2007 to February 2009 with mechanical neck pain. The variables percentage of disability (NPQ) and pain (VAS) were measured on the day of admission, 24 hours later and when the patient was discharged. RESULTS: Twenty six patients completed the study, 4 were eliminated and 30 did not complete the 3rd measurement. We get a good test-retest reliability (CCI 0,8979) and a high internal consistency (Cronbach Coefficient Alpha 0,86). Validity obtained a good correlation (r=0,678). Sensitivity to change was good (r=0,661). CONCLUSION: The NPQ is a valid, reliable and sensitive instrument to assess disability associated with neck pain of mechanical origin in patients treated at the hospitals of the Autonomous City of Buenos Aires.

Objetivo: realizar la adaptación cultural y validación del Cuestionario Northwick Park (NPQ) en Argentina, determinando sus propiedades psicométricas, en pacientes con dolor cervical de origen mecánico derivados al Servicio de Kinesiología del Hospital D. F. Santojanni. Materiales y Métodos: Se solicitó la autorización del autor original del NPQ, luego se realizó la adaptación lingüística y prueba piloto. Las propiedades psicométricas incluyeron: confiabilidad test-retest (coeficiente de correlación intraclase, CCI), validez (coeficiente de correlación de Pearson NPQ-Escala Análoga Visual, EVA), consistencia interna (alfa de Cronbach) y sensibilidad al cambio (prueba T para pruebas pareadas NPQ-EVA). Se incluyeron consecutivamente 60 pacientes de septiembre de 2007 a febrero de 2009 con dolor cervical mecánico. Se midieron las variables porcentaje de discapacidad (NPQ) y dolor (EVA) al día del ingreso, a las 24 horas y al alta. Resultados: Veintiséis pacientes completaron el estudio, 4 fueron eliminados y 30 no completaron la 3° medición. Se obtuvo una buena confiabilidad test-retest (ICC 0.8979) y una alta consistencia interna (alfa de Cronbach 0.86). La validez mostró una buena correlación (r= 0,678). La sensibilidad al cambio fue buena (r=0.661). Conclusión: El NPQ es un instrumento válido, confiable y sensible para evaluar la discapacidad asociada al dolor cervical de origen mecánico en pacientes atendidos en el ámbito hospitalario de la Ciudad Autónoma de Buenos Aires.

Adaptación cultural y validación argentina del cuestionario Northwick park de dolor cervical en el ámbito hospitalario de la ciudad autónoma de Buenos Aires / [Cultural adaptation and Argentine validation of the Northwick Park Neck Pain Questionnaire in the hospitals of the Autonomous City of Buenos Aires].

OBJECTIVE: [corrected] To make cultural adaptation and validation of the Northwick Park Neck Pain Questionnaire (NPQ) in Argentina, determining its psychometric properties in patients with neck pain of mechanical origin referred to the physiotherapy Service at D. F. Santojanni Hospital. MATERIALS AND METHODS: autorization of original author of the NPQ was requested. Then we make the linguistic adaptation and pilot study. Psychometric analyses included test-retest reliability (intraclass correlation coefficient), validity (Pearson correlation coefficient NPQ-Visual Analog Scale, VAS), internal consistency (Cronbach Coefficient Alpha) and sensibility to change (paired t test). Sixty patients were inclueed from September 2007 to February 2009 with mechanical neck pain. The variables percentage of disability (NPQ) and pain (VAS) were measured on the day of admission, 24 hours later and when the patient was discharged. RESULTS: Twenty six patients completed the study, 4 were eliminated and 30 did not complete the 3rd measurement. We get a good test-retest reliability (CCI 0,8979) and a high internal consistency (Cronbach Coefficient Alpha 0,86). Validity obtained a good correlation (r=0,678). Sensitivity to change was good (r=0,661). CONCLUSION: The NPQ is a valid, reliable and sensitive instrument to assess disability associated with neck pain of mechanical origin in patients treated at the hospitals of the Autonomous City of Buenos Aires.