[Obstructive sleep apnoea syndrome]. / Síndrome de apneas-hipopneas durante el sueño.

INTRODUCTION: Obstructive sleep apnoea (OSA) is highly prevalent in children and a major public health problem. An attempt is made to determine the clinical and polysomnographic presentation of paediatric OSA in our area. PATIENTS AND METHODS: Retrospective descriptive study of sleep tests conducted on children up to 14 years-old from 1999 to 2012 in the Sleep Unit of the University Hospital of Albacete. Age, gender, anthropometric, clinical data, indication and variables of sleep study, treatment, and outcomes were collected. RESULTS: The study included 234 children. OSA was found in 71.8%, with 42.3% moderate and 44.6% severe. The majority were male (60.7%) and the mean age 5 was years, of whom 78% were pre-school or school age. There was overweight/obesity in 44%, with 93.4% snoring, apnoea 84.5%, and 5.4% daytime sleepiness. There were 23 polysomnographies and 145 polygraphies, with a median apnoea/hypopnoea index (AHI) of 10, Sat.O2 minimum 84%, desaturation index 8, and mean sleep supine 53.65% and supine events 57.61%. Treatment was lifestyle modifications 29.2%, CPAP 6%, and surgery 42.9%. Improved snoring and/or apnoea 69.4%, and weight 32.4% of overweight/obesity children. CONCLUSIONS: Most of the studied children had a pathological AHI. Almost half were overweight/obese, and a high percentage had moderate-severe OSA. Most frequent treatment was surgery. The clinical outcome was favourable in almost 70%. Less than a third with OSA and overweight/obesity improved weight.

Inhaled nitric oxide in adult patients with acute respiratory distress syndrome.

In some patients, acute respiratory distress syndrome (ARDS) leads to life-threatening refractory hypoxemia developing. Physicians may consider hypoxemic rescue therapies in an attempt to improve oxygenation in these patients while on conventional mechanical ventilation support. Use of inhaled nitric oxide (iNO) in ARDS is one of the most widely-studied pharmacological interventions over the past two decades. Its efficacy was examined in several randomized clinical trials and has undergone meta-analyses. Although iNO treatment was associated with improved oxygenation, researchers unfortunately never demonstrated a concomitant decrease in mortality or any improved outcome. Hence the current evidence suggests that iNO should not be routinely used in patients with ARDS however may be considered as adjunct therapy to tentatively improve oxygenation while other therapies are being considered in patients with severely hypoxemic ARDS.This review focuses on the therapeutic use of iNO in adult ARDS patients. We set out some recommendations for its use as rescue therapy against refractory hypoxemia.

En algunos pacientes, el síndrome de distrés respiratorio agudo (SDRA) provoca el desarrollo de una hipoxemia refractaria que compromete la vida. En este contexto pueden considerarse terapias de rescate en un intento de mejorar la oxigenación mientras los pacientes permanecen en ventilación mecánica. El uso de óxido nítrico inhalado (NOi) en el SDRA ha sido una de las terapias farmacológicas más estudiadas en las últimas dos décadas. Diversos ensayos clínicos y metaanálisis han evaluado su eficacia, y aunque se ha demostrado un aumento en la oxigenación, no se ha podido demostrar un descenso en la mortalidad o una mejora en el pronóstico. La evidencia actual sugiere que aunque el NOi no debe usarse de forma rutinaria en pacientes con SDRA, puede considerarse su uso para mejorar la oxigenación en pacientes severamente hipoxémicos.Esta revisión examina la aplicación terapéutica del NOi en pacientes adultos con SDRA. Se propone un esquema con diversas recomendaciones para su uso como terapia de rescate frente a la hipoxemia refractaria.

Generic-type hierarchical multi digital signal processor system for hard-field tomography.

This article introduces the design and implementation of a hierarchical multi digital signal processor system aimed to perform parallel multichannel measurements and data processing of the type widely used in hard-field tomography. Details are presented of a complete tomography system with modular and expandable architecture, capable of accommodating a variety of data processing modalities, configured by software. The configuration of the acquisition and processing circuits and the management of the data flow allow a data frame rate of up to 250 kHz. Results of a case study, guided path tomography for temperature mapping, are shown as a direct demonstration of the system's capabilities. Digital lock-in detection is employed for data processing to extract the information from ac measurements of the temperature-induced resistance changes in an array of 32 noninteracting transducers, which is further exported for visualization.