Physical and Physiological Predictors Determining the Maximal Static Apnea Diving Time of Male Freedivers.

This study aimed to investigate what factors determine freedivers' maximal static apnea dive time. We correlated some physical/physiological factors with male freedivers' maximum apnea diving duration. Thirty-six experienced male freedivers participated in this study. The divers participated in two days of the experiments. On the first day, apnea diving time, blood oxygen saturation (SpO2), heart rate (HR), blood pressure (BP), stress index, and blood parameters were measured before, during, and after the apnea diving in the pool. On the second day, body composition, lung capacity, resting and maximal oxygen consumption (VO2max), and the Wingate anaerobic power were measured in the laboratory. The data were analyzed with Pearson's Correlation using the SPSS 22 program. The correlation coefficient (R) of determination was set at 0.4, and the level of significance was set at p <0.05. There were positive correlations of diving experience, maximum SpO2, and lung capacity with the maximum apnea time R>0.4, P<0.05). There were negative correlations of BMI, body fat percentage, body fat mass, minimum SpO2, stress index, and total cholesterol with the maximum apnea diving time (R>-0.4, P<0.05). No correlations of age, height, weight, fat-free mass, skeletal muscle mass, HR, BP, blood glucose, beta- hydroxybutyrate, lactate, and hemoglobin levels with the maximum apnea diving time were observed (R<0.4, P>0.05). It is concluded that more experience in freediving, reduced body fat, extended SpO2 range, and increased lung capacity are the performance predictors and beneficial for freedivers to improve their maximum apnea diving performance.

Acute effects of apnea bouts on hemoglobin concentration and hematocrit: a systematic review and meta-analysis.

Objective: This study aimed to systematically analyze the existing literature and conduct a meta-analysis on the acute effects of apnea on the hematological response by assessing changes in hemoglobin (Hb) concentration and hematocrit (Hct) values. Methods: Searches in Pubmed, The Cochrane Library, and Web of Science were carried out for studies in which the main intervention was voluntary hypoventilation, and Hb and Hct values were measured. Risk of bias and quality assessments were performed. Results: Nine studies with data from 160 participants were included, involving both subjects experienced in breath-hold sports and physically active subjects unrelated to breath-holding activities. The GRADE scale showed a "high" confidence for Hb concentration, with a mean absolute effect of 0.57 g/dL over control interventions. "Moderate" confidence appeared for Hct, where the mean absolute effect was 2.45% higher over control interventions. Hb concentration increased to a greater extent in the apnea group compared to the control group (MD = 0.57 g/dL [95% CI 0.28, 0.86], Z = 3.81, p = 0.0001) as occurred with Hct (MD = 2.45% [95% CI 0.98, 3.93], Z = 3.26, p = 0.001). Conclusions: Apnea bouts lead to a significant increase in the concentration of Hb and Hct with a high and moderate quality of evidence, respectively. Further trials on apnea and its application to different settings are needed.

Exerted force on the face mask in preterm infants at birth is associated with apnoea and bradycardia.

BACKGROUND: During stabilisation of preterm infants at birth, a face mask is used to provide respiratory support. However, application of these masks may activate cutaneous stretch receptors of the trigeminal nerve, causing apnoea and bradycardia. This study investigated the amount of force exerted on the face mask during non-invasive ventilation of preterm infants at birth and whether the amount of exerted force is associated with apnoea and bradycardia. METHODS: A prospective observational study was performed in preterm infants born <32 weeks of gestation who were stabilised at birth. During the first 10 minutes of respiratory support, we measured breathing and heart rate as well as the amount of force exerted on a face mask using a custom-made pressure sensor placed on top of the face mask. RESULTS: Thirty infants were included (median (IQR) gestational age(GA) 28+3 (27+0-30+0) weeks, birthweight 1104 (878-1275) grams). The median exerted force measured was 297 (198-377) grams, ranging from 0 to 1455 grams. Significantly more force was exerted on the face mask during positive pressure ventilation when compared to CPAP (410 (256-556) vs 286 (190-373) grams, p = 0.009). In a binary logistic regression model, higher forces were associated with an increased risk of apnoea (OR = 1.607 (1.556-1.661), p < 0.001) and bradycardia (OR = 1.140 (1.102-1.180), p < 0.001) during the first 10 minutes of respiratory support at birth. CONCLUSION: During mask ventilation, the median exerted force on a face mask was 297 grams with a maximum of 1455 grams. Higher exerted forces were associated apnoea and bradycardia during the first 10 minutes of respiratory support at birth.

Nounat amb apnees a l'hivern: teratoma mediastínic / Neonato con apneas en época invernal: teratoma mediastínico / Newborn with apneic episodes during wintertime: mediastinal teratoma

INTRODUCCIÓ: La causa principal d'insuficiència respiratòria en lactants de menys de 3 mesos és la bronquiolitis, que es pot presentar inicialment en forma d'apnees. En el diagnòstic diferencial d'apnees s'inclouen processos infecciosos, reflux gastroesofàgic, malalties neurològiques, anèmia, hipoxèmia, hipotensió, insuficiència cardíaca, alteracions metabòliques I malformacions de la via aèria, entre altres. Es presenta el cas d'un nounat amb apnees I fracàs respiratori. Durant l'estudi es diagnostica d'apnees obstructives secundàries a una massa extrínseca. CAS CLÍNIC: Nounat portat a Urgències després d'apnea amb cianosi. Inicialment se sospita bronquiolitis. Presenta nova apnea amb repercussió hemodinàmica, per la qual cosa és intubat. A la radiografia destaca atelèctasi massiva de l'hemitòrax dret. S'extuba de forma electiva, però fracassa respiratòriament I requereix nova intubació. En els controls radiològics persisteix una imatge mediastínica, que es confirma per ecografia I per tomografia axial computada toràcica. S'extirpa per cirurgia I es confirma que es tracta d'un teratoma. COMENTARIS: Dins del diagnòstic diferencial d'apnea, una de les possibilitats és una massa mediastínica. La localització de la massa pot orientarne el diagnòstic, però l'anatomia patològica és la que el confirma. En el mediastí anterior es localitzen la meitat de les masses mediastíniques, les més freqüents de les quals són els limfomes T, els tumors de cèl·lules germinals I els timomes. El mediastí és la segona localització més freqüent del teratoma extragonadal. Els teratomes immadurs s'han d'extirpar per confirmar el diagnòstic I prevenir els efectes per compressió, I pel potencial de malignització que tenen. L'alfa-fetoproteïna en els tumors productors pot permetre monitorar-los

INTRODUCCIÓN: La causa principal de insuficiencia respiratoria en lactantes menores de 3 meses es la bronquiolitis, que puede presentarse inicialmente en forma de apneas. El diagnóstico diferencial de apneas incluye procesos infecciosos, reflujo gastroesofágico, enfermedades neurológicas, anemia, hipoxemia, hipotensión, insuficiencia cardíaca, alteraciones metabólicas y malformaciones de la vía aérea, entre otros. Se presenta el caso de un neonato con apneas y fracaso respiratorio. Durante el estudio se diagnostica de apneas obstructivas secundarias a una masa extrínseca. CASO CLÍNICO: Recién nacido llevado a Urgencias después de una apnea con cianosis. Inicialmente se sospecha una bronquiolitis. Presenta nueva apnea con repercusión hemodinámica por lo que es intubado. En la radiografía destaca atelectasia masiva del hemitórax derecho. Se extuba de forma electiva, pero fracasa respiratoriamente y requiere nueva intubación. En los controles radiológicos persiste una imagen mediastínica, que se confirma por ecografía y por tomografía axial computadorizada torácica. Se extirpa por cirugía y se confirma que se trata de un teratoma. COMENTARIOS: Dentro del diagnóstico diferencial de apnea, una de las posibilidades es una masa mediastínica. La localización de la masa puede orientar su diagnóstico, pero la anatomía patológica es la que lo confirma. En el mediastino anterior se localizan la mitad de las masas mediastínicas, siendo más frecuentes los linfomas T, los tumores de células germinales y los timomas. El mediastino es la segunda localización más frecuente del teratoma extragonadal. Los teratomas inmaduros deben ser extirpados para confirmar el diagnóstico y prevenir los efectos por compresión, y por su potencial de malignización. La alfa-fetoproteína en los tumores productores puede permitir monitorizarlos

INTRODUCTION: The main cause of respiratory failure in infants under 3 months is bronchiolitis, which may initially present as apnea. The differential diagnosis of apnea includes infectious processes, gastroesophageal reflux, neurological diseases, anemia, hypoxemia, hypotension, heart failure, metabolic disorders and airway malformations, among others. We present a case of a newborn with apneic episodes and respiratory failure. During the study, obstructive apnea secondary to an extrinsic mass was diagnosed. CASE REPORT: A newborn was taken to the emergency department after an apnea with cyanosis. Bronchiolitis was initially suspected. He presented a new apneic episode with hemodynamic instability requiring intubation. The chest X-ray disclosed massive atelectasis of the right hemithorax. The baby failed an extubation attempt, and additional imaging studies showed a mediastinal mass, confirmed by ultrasound and thoracic computerized axial tomography. The mass was resected, and pathology showed teratoma. COMMENTS: A mediastinal mass should be included in the differential diagnosis of apnea. The location of the mass can guide its diagnosis, although histologic confirmation is required. Half of the mediastinal masses are located in the anterior mediastinum, with T lymphomas, germ cell tumors and thymomas being the most frequent. The mediastinum is the second most frequent location of extragonadal teratoma. Immature teratomas must be removed to confirm the diagnosis, prevent compression effects, and avoid malignant transformation. In secreting tumors, alpha-fetoprotein may facilitate monitoring

Estado epiléptico neonatal no detectado con aEEG monocanal / Neonatal status epilepticus undetected with single-channel aEEG

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Insuficiencia respiratoria aguda como inicio de hemosiderosis pulmonar idiopática en un lactante / Acute respiratory insufficiency as debut of idiopathic pulmonary hemosiderosis in an infant

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Prevalencia del síndrome de apnea obstructiva del sueño en adultos que acuden a la consulta externa de medicina familiar, en Monterrey, México (el SAOS sigue siendo una entidad subdiagnosticada en Latinoamérica) / Prevalence of the syndrome of obstructive sleep apnea in adults who consulting family medicine in Monterrey, Mexico (SAOS continues to be underdiagnosed in Latin America)

El síndrome de apnea obstructiva del sueño (SAOS) es una enfermedad común, caracterizada por episodios recurrentes de obstrucción de la vía aérea superior que ocurren durante el sueño, con descensos en la saturación de oxígeno de la hemoglobina, sueño intranquilo y despertares nocturnos, que se ha asociado a un incremento de morbimortalidad fundamentalmente de origen cardiovascular. Afecta al 2-4% de las mujeres y al 4-6% de los hombres de la población general en edad media de la vida. Objetivo: Determinar la prevalencia del síndrome de apnea obstructiva del sueño en adultos que acuden a la consulta externa de la Clínica Hospital Constitución ISSSTE, Nuevo León. Resultados: La distribución por género fue: 47 hombres (51,1%) y 45 mujeres (48,9%). El índice de masa corporal (IMC) promedio fue de 31,2 (IC 95% 30-32,34). Solo diez personas (11%) presentaron IMC normal (< 25), 35 pacientes (38%) evidenciaron sobrepeso (IMC de 25 a 29) y 47 (51%) demostraron obesidad (IMC mayor de 30). Se analizaron 92 poligrafías respiratorias, y mediante un índice de apneahipopnea (IAH) > 5 se encontró una prevalencia del 77%, de los cuales 42% eran mujeres y 58% hombres, con una edad promedio de 52 años. 41% con grado leve (es decir, IAH 5 a 14), 27% con grado moderado (IAH 15 a 29) y 32% con grado severo (IAH igual o mayor de 30). Las patologías señaladas en el total de las encuestas (n = 92) fueron: ansiedad, 39 pacientes (42,4%); depresión, 22 (24,5%); enfermedades renales, 10 (11%); hipertensión arterial, 32 (35%); diabetes, 17 (18,5%); enfermedades reumáticas, 16 (17,4%); convulsiones, 7 (7,6%); alergias, 24 (26%). Conclusiones: En nuestro estudio encontramos que la prevalencia del síndrome de apnea del sueño es alta, con más frecuencia en el género masculino, que aumenta en mayores de 50 años de edad, y la mayoría de pacientes presentan sobrepeso u obesidad. También se comprobó que hasta el 35% de los hipertensos padecen apnea del sueño. Otro dato importante es la frecuencia de pacientes con apnea del sueño que refirieron ansiedad (42,2%)…

Obstructive Sleep Apnea Syndrome (OSAS) is a common disease characterized by recurrent episodes of obstruction of the upper airway during sleep that occur with decreases in oxygen saturation of hemoglobin, restless sleep and nocturnal awakenings, has been associated with increased cardiovascular morbidity and mortality primarily. It affects 2-4% of women and 4-6% of men in the general population in middle age of life Objective: To determine the prevalence of Obstructive Sleep Apnea Syndrome in adults attending the outpatient clinic of the hospital establishment, ISSSTE, Nuevo Le¨®n. Results: The gender distribution was 47 males (51.1%) and 45 women (48.9%). The average BMI of 31.2 (95% CI 30-32.34). Only 10 people (11%) with normal BMI (BMI <25), overweight (BMI 25 to 29) 35 patients (38%), obese (BMI greater than 30) 47 patients (51%). 92 We analyzed respiratory polygraphs, and employing an apnea hypopnea index (AHI) > 5 found a prevalence of 77%, of which 42% are women and 58% men, with an average age of 52 years old. 41% with mild (ie AHI 5-14), 27% with moderate (AHI 15-29) and 32% with severe (AHI ¡Ý 30). The pathologies identified in the total survey (n = 92) are: anxiety 39 patients (42.4%), depression 22 (24.5%), kidney disease 10 (11%), hypertension 32 (35%), diabetes 17 (18.5%), rheumatic diseases 16 (17.4%), seizures 7 (7.6%), allergy 24 (26%). Conclusions: In our study we found that the prevalence of Obstructive Sleep Apnea Syndrome is high, it is more common in the male gender, increased frequency in patients over 50 years of age, the majorities are overweight or obese. We also found that up to 35% of hypertensive patients with sleep apnea. Another important fact is the frequency of patients with sleep apnea who reported anxiety (42.2%)...

Fatores de risco para raquianestesia em recém-nascidos pré-termo submetidos a herniorrafia inguinal / Risk factors for spinal anesthesia in preterm infants undergoing inguinal hernia repair

OBJETIVOS: Investigar os fatores de risco e a incidência de efeitos adversos perioperatórios advindos da raquianestesia não suplementada em recém-nascidos pré-termo. Também foi avaliado o tempo decorrido até o reinício da alimentação oral e até a alta hospitalar. MÉTODOS: Foram coletados prospectivamente os dados perioperatórios de todos os recém-nascidos prematuros e ex-prematuros submetidos a herniorrafia inguinal com raquianestesia em um centro médico terciário. RESULTADOS: O grupo de estudo consistiu em 144 recém-nascidos com uma idade gestacional mediana de 30 semanas, idade concepcional de 37 semanas, peso de nascimento de 1.420 g, e peso de 2.140 g no momento da cirurgia. No total, seis (4,2%) recém-nascidos apresentaram complicações intraoperatórias, que incluíram apneia (2/1,4%), bradicardia (2/1,4%) e hipoxemia (4/2,8%). Complicações pós-operatórias ocorreram em 15 (10,4%) recém-nascidos, principalmente hipoxemia (3/2,1%), bradicardia (8/5,5%) e apneia (6/4,1%). Os fatores preditivos de desfecho desfavorável (apneia, alimentação oral > 6 h de pós-operatório, ou alta > 30 h de pós-operatório) foram displasia broncopulmonar [razão de chances (OR) = 3,2, intervalo de confiança de 95% (IC95%) 2,8-5,3; p = 0,01] e leucomalácia periventricular (OR = 2,8, IC95% 2,1-4,9; p = 0,03). CONCLUSÕES: A raquianestesia é segura e eficaz na herniorrafia inguinal em recém-nascidos pré-termo, levando a um reinício precoce da alimentação oral e a um menor período de hospitalização. Displasia broncopulmonar e leucomalácia periventricular podem acarretar risco de desfecho desfavorável.

OBJECTIVES: To investigate the risk factors and incidence of perioperative adverse effects from unsupplemented spinal anesthesia in preterm infants. Times to resumption of oral feeding and to home discharge were also evaluated. METHODS: Perioperative data were collected prospectively for all preterm and former preterm infants who underwent inguinal hernia repair with spinal anesthesia at a tertiary medical center. RESULTS: The study group consisted of 144 infants with a median gestational age of 30 weeks, postmenstrual age of 37 weeks, birth weight of 1,420 g, and weight at surgery of 2,140 g. Overall, six (4.2%) infants had intraoperative complications, which included apnea (2/1.4%), bradycardia (2/1.4%), and hypoxemia (4/2.8%). Postoperative complications occurred in 15 (10.4%) infants, mainly hypoxemia (3/2.1%), bradycardia (8/5.5%), and apnea (6/4.1%). Predictive factors of an unfavorable outcome (apnea, resumption of oral feeding > 6 h postoperatively, or discharge > 30 h postoperatively) were bronchopulmonary dysplasia (odds ratio [OR] = 3.2, 95% confidence interval [95%CI] 2.8-5.3; p = 0.01) and periventricular leukomalacia (OR = 2.8, 95%CI 2.1-4.9; p = 0.03). CONCLUSIONS: Spinal anesthesia is safe and effective for inguinal hernia repair in preterm infants, with early resumption of oral feeding and short hospitalization. Bronchopulmonary dysplasia and periventricular leukomalacia may pose risks for an unfavorable outcome.

Apneas e infecciones en lactantes / Apnea and infections in infants

Infections are a frequent cause of apnea in infants, involving both respiratory and extrarrespiratory systems. In the first group we find upper respiratory infections and lower respiratory infections caused by virus or bacteria such as Respiratory Syncytial Virus, Parainfluenza and Bordetella pertussis; in the second group urinary tract infections and severe infections such as meningitis and sepsis are of importance. In this article we analyze different causes of infections attributed to apnea, taking into account existing literature at the time.

Las infecciones son una frecuente causa de apneas en lactantes, pudiendo involucrar tanto el sistema respiratorio como extrarrespiratorio. En el primero encontramos las infecciones respiratorias altas y/o bajas producidas tanto por virus como bacterias, donde destacan Virus Respiratorio Sincicial, Parainfluenza y Bordetella Pertussis; en el segundo grupo son de importancia la infección urinaria e infecciones graves como meningitis y sepsis. En este artículo se analizan estas distintas causas infecciosas atribuidas a eventos de apneas en lactantes, en consideración a la literatura actualmente existente.

A Case Report on 30-Week Premature Twin Babies with Congenital Myotonic Dystrophy Conceived by In Vitro Fertilization

Congenital myotonic dystrophy type 1 (DM1) presents severe generalized weakness, hypotonia, and respiratory compromise after delivery with high mortality and poor prognosis. We presented a congenital DM1 of premature twins in the 30th week of gestation. These twins were conceived by in vitro fertilization (IVF). Both babies presented apnea and hypotonia and had characteristic facial appearance. They were diagnosed DM1 by genetic method. They were complicated by chylothorax and expired at 100 and 215 days of age, respectively. Mother was diagnosed DM1 during the evaluation of babies. This is the first report on congenital DM1 which accompanied the chylothorax. More investigation on the association with chylothorax and congenital DM1 is recommended. With a case of severe neonatal hypotonia, congenital DM1 should be differentiated in any gestational age. Finally, since DM1 is a cause of infertility, we should consider DM1 in infertility clinic with detailed history and physical examination.

Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass

Hypoxemia is a frequent complication after coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB), usually attributed to atelectasis. Using computed tomography (CT), we investigated postoperative pulmonary alterations and their impact on blood oxygenation. Eighteen non-hypoxemic patients (15 men and 3 women) with normal cardiac function scheduled for CABG under CPB were studied. Hemodynamic measurements and blood samples were obtained before surgery, after intubation, after CPB, at admission to the intensive care unit, and 12, 24, and 48 h after surgery. Pre- and postoperative volumetric thoracic CT scans were acquired under apnea conditions after a spontaneous expiration. Data were analyzed by the paired Student t-test and one-way repeated measures analysis of variance. Mean age was 63 ± 9 years. The PaO2/FiO2 ratio was significantly reduced after anesthesia induction, reaching its nadir after CPB and partially improving 12 h after surgery. Compared to preoperative CT, there was a 31 percent postoperative reduction in pulmonary gas volume (P < 0.001) while tissue volume increased by 19 percent (P < 0.001). Non-aerated lung increased by 253 ± 97 g (P < 0.001), from 3 to 27 percent, after surgery and poorly aerated lung by 72 ± 68 g (P < 0.001), from 24 to 27 percent, while normally aerated lung was reduced by 147 ± 119 g (P < 0.001), from 72 to 46 percent. No correlations (Pearson) were observed between PaO2/FiO2 ratio or shunt fraction at 24 h postoperatively and postoperative lung alterations. The data show that lung structure is profoundly modified after CABG with CPB. Taken together, multiple changes occurring in the lungs contribute to postoperative hypoxemia rather than atelectasis alone.

Mulheres e esporte de risco: um mergulho no universo das apneístas / Women and risk sports: diving into the universe of apneístas

Este estudo, de natureza qualitativa propõe-se investigar, sob a ótica do Imaginário Social, os sentidos de limite, risco e corpo para mulheres praticantes de mergulho em apneia, no qual a vivência de uma prática de risco extremo é deliberadamente escolhida pelas informantes. Nossa amostra, intencional, foi composta por oito mulheres que praticam o esporte. O procedimento metodológico utilizado para a interpretação das falas foi a Análise do Discurso proposta por Orlandi (1987, 1993, 1999). Também trabalhamos com a interpretação das palavras que emergem na realização da técnica da Associação de Ideias (ABRIC, 1994). Nove grupos semânticos organizaram-se em torno de um grupo de associações comuns e outro de associações não comuns. As mergulhadoras das grandes profundidades sabem que ao praticarem um esporte de risco extremo desafiam seus limites corporais, e precisam tomar cuidado para não extrapolar esses limites. É preciso estendê-los. A preocupação parece estar presente na vivência deste limiar entre a vida e a morte.

This study of qualitative nature aims at investigating, from a Social Imaginary perspective, the senses of limit, risk and body are for the women who practice apneic diving. The experience of this extreme risk practice is deliberately chosen by informants. Our intentionally selected sample was made up of eight women who practice the sports. The method applied for the interpretation of those speeches was Orlandi's Discourse Analysis (1987, 1993, 1999). We have worked with the interpretation of words that emerge from the Idea Association (ABRIC, 1994) technique. Nine semantic groups were organized around a group of common associations and another group of uncommon associations. The divers who go down great depths know that the practice of that sport of high risks challenges their body limits, and they must be careful not to go beyond those limits. They must extend them. That concern seems to be present in the experience of that boundary between life and death.

Eventos de aparente amenaza a la vida (ALTE): conceptos, etiología y manejo / Apparent life-threatening event (ALTE): concepts of etiology and management

Los Eventos de Aparente Amenaza a la Vida (ALTE) son un desafió para el médico por su diversidad etiológica y el estrés que experimentan los familiares al observar un episodio de muerte inminente. En este artículo se analizan las causas relacionadas con ALTE, se plantean estrategias de estudio y de seguimiento.

Variabilidad de la señal de frecuencia de pulso obtenida mediante pulsioximetría nocturna en pacientes con síndrome de apnea hipopnea del sueño / Variability of pulse signal frequency obtained using nocturnal pulse oximetry in patients with sleep apnoea/hypoapnoea syndrome

IntroducciónLa medida de tendencia central (MTC) es una técnica de análisis no lineal que aplicada a diagramas de diferencias de segundo orden permiten cuantificar el grado de variabilidad de una serie de datos. En el presente estudio, se pretende cuantificar y caracterizar las modificaciones de la frecuencia cardiaca obtenidas por pulsioximetría en pacientes con sospecha clínica de síndrome de apnea hipopnea del sueño (SAHS) mediante la utilización de la MTC y valorar su utilidad diagnóstica.Pacientes y métodosSe incluyen en el estudio 187 pacientes, realizándose un estudio polisomnográfico y pulsioximétrico nocturno. Para la valoración de la variabilidad de la frecuencia cardiaca, se utilizó la MTC aplicada a gráficos de diferencias de segundo orden obtenidos del registro de la frecuencia cardiaca.ResultadosLos pacientes con SAHS presentaron una mayor variabilidad de la frecuencia cardiaca que los pacientes sin SAHS (0,449 vs. 0,666, p<0,001. En el análisis multivariante, la frecuencia cardiaca, la saturación mínima y el índice de desaturación del 4% presentaron una relación independiente con la variabilidad de la frecuencia cardiaca. Como método diagnóstico, la MTC de la frecuencia cardiaca proporcionó una sensibilidad de 69,3%, una especificidad de 77,6% y una precisión diagnóstica de 72,7%ConclusionesLos pacientes con SAHS presentan durante la noche una mayor variabilidad de la frecuencia cardiaca, valorada mediante la aplicación de la medida de tendencia central a diagramas de diferencias de segundo orden de la frecuencia cardiaca. Como método de despistaje, la MTC aplicada a la frecuencia cardiaca presentan una sensibilidad y especificidad moderada(AU)

IntroductionThe measurement of central tendency (MCT) is a non-linear analysis technique which applied to second order differences diagrams enables the degree of variability to be quantified in a data series. In the present study an attempt is made to quantify and characterise the changes in heart rate obtained by pulse oximetry in patients with a clinical suspicion of sleep apnoea/hypoapnoea syndrome (SAHS) using the MCT and to evaluate its diagnostic use.Patients and MethodsA total of 187 patients were included in the study, on whom a nocturnal polysomnographic and pulse oximetry study was performed. To evaluate the variability of the heart rate the MCT applied to graphs of second order differences obtained from the heart rate record.ResultPatients with SAHS had a higher heart rate variablity than patients without SAHS (0.449 vs. 0.666, P<0.001. In the multivariate analysis, the heart rate, the minimum saturation and the desaturation index of 4% were independently associated with the heart rate variability. As a diagnostic method, the MCT of the heart rate gives a sensitivity of 69.3%, a specificity of 77.6% and a diagnostic precision of 72.7%ConclusionsPatients with SAHS have a greater variabilityin heart rate during the night, evaluated by applying the MCT of the heart rate to diagrams of second order differences. As a screening method, the MCT applied to the heart rate has a moderate sensitivity and specificity(AU)

Estudo comparativo da anestesia com propofol ou thionembutal em cães / Comparative study of the anesthesia with propofol or thionembutal in dogs

Os autores compararam o uso de propofol e thionembutal observando as freqüências cardíaca e respiratória e a presença das seguintes intercorrências: apnéia, tremor, bradicardia, taquicardia, taquipnéia e parada cardíaca. Foram randomizados 100 cães para serem anestesiados com propofol ou thionembutal, sendo monitorizados os parâmetros de interesse ao estudo. Foi constatado que existe importância significantemente maior em relação a ocorrência de apnéia e tremor em ambos os grupos, sendo menores com o uso de propofol. O propofol mostrou-se uma droga mais segura para a anestesia em cães do que o thionembutal.

Ventilación mecánica en recién nacidos con infección respiratoria aguda baja por virus respiratorio sincicial / Mechanical ventilation in newborns with lower respiratory tract infection with respiratory syncytial virus

El objetivo de la presente comunicación breve fue determinar la incidencia de recién nacidos (RN) con infección respiratoria aguda baja (IRAB) por virus respiratorio sincicial (VRS) que requirieron ventilación mecánica, las causas que motivaron la VM y algunas características clínicas y epidemiológicas del grupo. De los 150 RN hospitalizados por IRAB por VRS, 11 (7,3 por ciento) requirieron VM, en 10 de la causa de la VM fue apneas a repetición y en 1 insuficiencia respiratoria global más apnea. En promedio la edad de ingreso fue de 18,1 días, siendo los signos más frecuentes: tos (81,8 por ciento) y dificultad respiratoria (54,5 por ciento). Solo un paciente requirió PIM mayor de 35 cm H2O y solo dos requirieron FiO2 mayor de 0,4; el índice de oxigenación promedio fue de 5,5 y la duración de la VM fue de 3,5 ñ 2,8 días (1 a 11 días). La mediana de la duración de la hospitalización fue de 11 días; falleció un solo paciente. Concluimos que la necesidad de VM en RN con IRAB por VRS es de baja frecuencia (7,3 por ciento), siendo la principal causa de conexión los episodios de apnea, requiriendo, en general asistencia ventilatoria por un breve periodo

Alteraciones polisomnográficas en lactantes con reflujo gastroesofágico / Polysomnographic abnormalities in infants with gastroesophageal reflux

BACKGROUND: Infant apnea is a common problem that conveys significant burden to families and physicians. Its temporal relationship with gastroesophageal reflux (GER) is controversial. AIM: To establish whether infants with GER of different magnitude have a higher incidence of respiratory events than children without GER. PATIENTS AND METHODS: 146 consecutive patients were evaluated with polisomnography (PSG) and with an esophageal pH probe. Those infants without GER episodes or with an esophageal pH below 4.0 in less than 5 per cent of total sleep time were considered as physiologic GER (Group I), between 5-10 per cent as mild GER (Group II), and over 10 per cent as severe GER (Group III). These groups were evaluated for demographic and polysomnographic characteristics. RESULTS: There were no differences in the demographic and global PSG characteristics neither in oxymetry, heart rate or electroencephalographic abnormalities. Group III infants had a higher percentage of active sleep compared to infants of Group I (p < 0.05) and higher incidence of central pauses and apneas compared to infants of Group I (p < 0.05). CONCLUSIONS: The presence of severe GER may modify the sleep pattern in infants, increasing the percentage of active sleep. The presence of central pauses and apneas in infants with severe GER suggest an association between the inmaturity of the respiratory centers and the adaptation of the anti-reflux mechanisms.

Apnea severa: signo precoz de neumonía por pneumocystis carinnii en un lactante VIH negativo / Apnea as an early sign of pneumocystis carinii pneumonia in an HIV negative infant

A few reports in the medical literature suggest an association between Pneumocystis caring and apnea in small infants. This patient, a 1 month 20 days old, HIV negative, infant girl weighing 2,000 grams was admitted to hospital after presenting a severe episode of apnea with cyanosis and bradicardia. She progressively developed bronchopneumonia by P. carinii that required prolonged mechanical ventilation with high ventilatory parameters. The clinical course of this patient illustrates that apnea can be an early sign of P. carinii infection in small infants. Early diagnosis and specific therapy might prevent morbidity and mortality and also decrease the length of hospitalization

Relación causal entre apnea y reflujo gastroesofágico / Causal relationships between apnea and gastro-esophageal reflux

Los vómitos, el reflujo gastroesofágico y los episodios de apnea en lactantes son problemas que asustan a los padres y de los cuales deben sier bien informados. En los últimos años se ha logrado estudiar y acotar mejor el diagnóstico de Apparent Life Threatening Event (ALTE) y su escasa relación con el reflujo gastroesofágico.

Comorbilidades del exceso ponderal en el adolescente / No disponible

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