[Lung-brain interaction in the mechanically ventilated patient]. / Interacción pulmón-cerebro en el paciente ventilado mecánicamente.

Patients with acute lung injury or acute respiratory distress syndrome (ARDS) admitted to the ICU present neuropsychological alterations, which in most cases extend beyond the acute phase and have an important adverse effect upon quality of life. The aim of this review is to deepen in the analysis of the complex interaction between lung and brain in critically ill patients subjected to mechanical ventilation. This update first describes the neuropsychological alterations occurring both during the acute phase of ICU stay and at discharge, followed by an analysis of lung-brain interactions during mechanical ventilation, and finally explores the etiology and mechanisms leading to the neurological disorders observed in these patients. The management of critical patients requires an integral approach focused on minimizing the deleterious effects over the short, middle or long term.

[Interpretation of ventilator curves in patients with acute respiratory failure]. / Interpretación de las curvas del respirador en pacientes con insuficiencia respiratoria aguda.

Mechanical ventilation is a therapeutic intervention involving the temporary replacement of ventilatory function with the purpose of improving symptoms in patients with acute respiratory failure. Technological advances have facilitated the development of sophisticated ventilators for viewing and recording the respiratory waveforms, which are a valuable source of information for the clinician. The correct interpretation of these curves is crucial for the correct diagnosis and early detection of anomalies, and for understanding physiological aspects related to mechanical ventilation and patient-ventilator interaction. The present study offers a guide for the interpretation of the airway pressure and flow and volume curves of the ventilator, through the analysis of different clinical scenarios.

Changing patterns in tobacco consumption among Spanish military personnel under stressful conditions.

OBJECTIVE: A study is made to determine the prevalence of smoking and its variation over time in a group of Spanish military personnel (MP) under stressful conditions. METHODS: A questionnaire specifically designed for this study was administered to the entire MP contingent assigned to Banghis province (Afghanistan) between July and October 2009. A descriptive analysis was made (p < 0.05, 95%CI). RESULTS: The study sample comprised 254 MP (males 239; mean age 32 years (SD 9)). A total of 39.8% (95%CI; 33.7 - 45.8) were smokers, while 3.1% (95%CI; 1.0 - 5.3%) were former smokers. Regarding smoking habit before and at the end of deployment, one-half (50.5%) of the smokers declared that they smoked the same as before, 20.8% more than before, and 18.8% less than before. In turn, 5.9% of the smokers claimed to have started to smoke in the course of deployment, while 4% of the former smokers declared that they had quit smoking. The MP who quit smoking were younger than those who began to smoke (24 +/- 5 vs 39 +/- 9 years, p = 0.038). Moreover, the heavy smokers (> or = 15 cigarettes/day) reduced tobacco consumption, while the less heavy smokers increased the habit (p < 0.0001). CONCLUSIONS: The prevalence of daily smokers is high among MP. The majority of smokers smoke the same at the end of deployment. Those who quit smoking during the mission are significantly younger than those who begin to smoke. In turn, heavy smokers reduced their habit, while less heavy smokers increased smoking.

Noncoding RNAs as potential biomarkers for DIPG diagnosis and prognosis: XIST and XIST-210 involvement.

PURPOSE: Diffuse intrinsic pontine gliomas (DIPGs) are the most fatal primary brainstem tumors in pediatric patients. The identification of new molecular features, mediating their formation and progression, as non-coding RNAs (ncRNAs), would be of great importance for the development of effective treatments. METHODS: We analyzed the DIPGs transcriptome with the HTA2.0 array and it was compared with pediatric non-brainstem astrocytoma expression profiles (GSE72269). RESULTS: More than 50% of the differentially expressed transcripts were ncRNAs and based on this, we proposed a DIPGs ncRNA signature. LncRNAs XIST and XIST-210, and the HBII-52 and HBII-85 snoRNA clusters were markedly downregulated in DIPGs. qPCR assays demonstrated XIST downregulation in all non-brainstem astrocytomas, in a gender, age, and brain location-independent manner, as well as in DIPGs affecting boys; however, DIPGs affecting girls showed both downregulation and upregulation of XIST. Girls' with longer survival positively correlated with XIST expression. CONCLUSIONS: The involvement of ncRNAs in DIPGs is imminent and their expression profile is useful to differentiate them from non-neoplastic tissues and non-brain stem astrocytomas, which suggests their potential use as DIPG biomarkers. In fact, XIST and XIST-210 are potential DIPG prognostic biomarkers.

Do sedation and analgesia contribute to long-term cognitive dysfunction in critical care survivors?

Deep sedation during stay in the Intensive Care Unit (ICU) may have deleterious effects upon the clinical and cognitive outcomes of critically ill patients undergoing mechanical ventilation. Over the last decade a vast body of literature has been generated regarding different sedation strategies, with the aim of reducing the levels of sedation in critically ill patients. There has also been a growing interest in acute brain dysfunction, or delirium, in the ICU. However, the effect of sedation during ICU stay upon long-term cognitive deficits in ICU survivors remains unclear. Strategies for reducing sedation levels in the ICU do not seem to be associated with worse cognitive and psychological status among ICU survivors. Sedation strategy and management efforts therefore should seek to secure the best possible state in the mechanically ventilated patient and lower the prevalence of delirium, in order to prevent long-term cognitive alterations.

Relación entre respuestas físico-fisiológicas y psicológicas en árbitros de fútbol amateur / Relationship Between Physical-Physiological and Psychological Responses in Amateur Soccer Referees

The soccer referee confronts stressful situations during the sports competition while performing physical actions of great demand to be close to the play that entails a high physiological demand. The aims of this study are to know the different physical, physiological and psychological responses and their interrelations in real competition in amateur soccer referees and to analyze the effect of the refereed category with the psychological characteristics related to performance. Fifteen referees belonging to the Andalusian Committee of Soccer Referees participated and data were collected in 21 matches of their respective leagues during the 2016-2017 season. The results indicated that the referees have a minor physiological response in the second part of the match, have greater somatic anxiety and lower self-confidence, stress control, motivation, mental ability and team cohesion in competitive matches compared to the baseline sample (p < .05). There are several psycho-physiological correlations between stress control with heart rate less than 80% (positive) and heart rate greater than 80% (negative) (p < .05). In conclusion, the amateur soccer referee is exposed to stress situations, which, the control of it, is related to the physiological responses produced in competition, so that referees with less stress control develop more physiological responses in competition, which can cause decisions with a high degree of fatigue. These findings may advise the soccer referee to supplement training with psychological intervention programs to increase stress control.(AU)

Relación Entre Respuestas Físico-Fisiológicas Y Psicológicas En Árbitros De Fútbol Amateur / Relação Entre Respostas Físico-Fisiológicas E Psicológicas Em Árbitros De Futebol Amador / Relationship Between Physical-Physiological and Psychological Responses in Amateur Football Referees

El árbitro de fútbol se enfrenta a situaciones estresantes durante la competición deportiva mientras que lleva a cabo acciones físicas de gran exigencia para estar cerca de la jugada que conlleva una demanda fisiológica elevada. Los objetivos de este estudio son conocer las diferentes respuestas físicas, fisiológicas y psicológicas y sus interrelaciones en competición real en árbitros de fútbol amateurs y analizar el efecto de la categoría arbitrada con las características psicológicas relacionadas con el rendimiento. Participaron 15 árbitros pertenecientes al Comité Andaluz de Árbitros de Fútbol y se recogieron datos en 21 partidos de sus correspondientes ligas durante la temporada 2016-2017. Los resultados indicaron que los árbitros tienen una respuesta fisiológica menor en la segunda parte del partido, poseen mayor ansiedad somática y menor autoconfianza, control del estrés, motivación, habilidad mental y cohesión de equipo en los partidos de competición en comparación con la muestra basal (p < .05). Existen diversas correlaciones psico-fisiológicas entre el control del estrés con frecuencia cardíaca menor al 80% (positiva) y con frecuencia cardíaca superior al 80% (negativa) (p < .05). Como conclusión, el árbitro de fútbol amateur se expone a situaciones de estrés, el cual, el control de ésta, guarda relación con las respuestas fisiológicas producidas en competición, de forma que los árbitros con menor control del estrés desarrollan más respuestas fisiológicas en competición, lo que puede provocar tomar decisiones con un grado elevado de fatiga. Estos hallazgos pueden aconsejar al árbitro de fútbol complementar los entrenamientos con programas de intervención psicológicos para aumentar el control del estrés.(AU)

O árbitro de futebol enfrenta situações estressantes durante a competição esportiva enquanto realiza ações físicas de grande exigência para estar perto do jogo que implica uma demanda fisiológica elevada. Os objetivos deste estudo são conhecer as diferentes respostas físicas, fisiológicas e psicológicas e suas inter-relações em competição real em árbitros de futebol amadores e analisar o efeito da categoria arbitrada com as características psicológicas relacionadas com o desempenho. Participaram 15 árbitros pertencentes ao Comité Andaluz de Árbitros de Futebol e foram recolhidos dados em 21 jogos das suas ligas durante a temporada 2016-2017. Os resultados indicaram que os árbitros têm uma resposta fisiológica menor na segunda parte do partido, possuem maior ansiedade somática e menor autoconfiança, controle do estresse, motivação, capacidade mental e coesão de equipa nos jogos de competição em comparação com a amostra basal (p < .05). Existem diversas correlações psico-fisiológicas entre o controle do estresse com freqüência cardíaca inferior a 80% (positiva) e com freqüência cardíaca superior a 80% (negativa) (p < .05). Em conclusão, o árbitro de futebol amador expõe-se a situações de stress que, sob o seu controlo, estão relacionadas com as respostas fisiológicas produzidas em competição, de forma que os árbitros com menor controle do estresse desenvolvem mais respostas fisiológicas em competição, o que pode provocar decisões com um elevado grau de fadiga. Estes achados podem aconselhar o árbitro de futebol a complementar os treinos com programas de intervenção psicológicos para aumentar o controle do estresse.(AU)

The football referee faces stressful situations during the sports competition while performing physical actions of great demand to be close to the play that entails a high physiological demand. The objectives of this study are to know the different physical responses, physiological and psychological and their interrelationships in real competition in amateur football referees and analyze the effect of the referee category with the psychological characteristics related to performance. 15 referees from the Andalusian Committee of Football Referees participated and data were collected in 21 matches of their respective leagues during the 2016-2017 season. The results indicated that the referees have a lower physiological response in the second part of the game, have greater somatic anxiety and lower self-confidence, stress control, motivation, mental ability and team cohesion in competition matches compared to baseline (p < .05). There are several psycho-physiological correlations between stress control with heart rate less than 80% (positive) and heart rate greater than 80% (negative) (p < .05). In conclusion, the amateur football referee is exposed to situations of stress, which, control of this, is related to physiological responses produced in competition, so that referees with less stress control develop more physiological responses in competition, which can lead to decisions with a high degree of fatigue. These findings may advise the football referee to supplement training with psychological intervention programs to increase stress control.(AU)

Frequency characteristics of lung tissue strip during passive stretch and induced pneumoconstriction.

To investigate the frequency-dependent changes of lung tissue mechanics during pneumoconstriction, we studied guinea pig subpleural lung strips submitted to a multisinusoidal deformation composed of five equal-amplitude discrete frequencies ranging between 0.2 and 3.1 Hz. Strips were submitted to graded step stretch changes (SS) and to graded histamine stimulation (HS) in organ bath. Elastance, resistance, and hysteresivity were calculated at each frequency. The model accounting for the relationship between the complex Young's modulus and the angular frequency showed that the constant-phase hypothesis was satisfied in SS condition. However, HS modified all parameters in the model, and the constant-phase hypothesis could be rejected for HS of 10(-5) and 10(-3) M. The hysteresivity time course changed with angular frequency, but differently in the HS and SS conditions. Our results agree with a serial disposition of the connective matrix and contractile system in lung tissue. We conclude that pneumoconstriction induced significant structural changes at the level of the connective matrix.

Parallel airways inhomogeneity and lung tissue mechanics in transition to constricted state in rabbits.

To investigate whether changes of tissue resistance (Rti) during methacholine (MCh)-induced constriction correspond to an intrinsic mechanism or are an artifact of increased airways inhomogeneity, rabbits were studied after exposure to air (n = 7) or 1.5 parts/million O3 (n = 6). Animals were anesthetized and mechanically ventilated. Tracheal flow and pressure (Ptr) and four alveolar capsule pressures (Pcap) were measured during 3 min after administration of an intrajugular bolus of 0.8 mg/ml MCh. By adjustment of the equation of motion [P(t) = E . V(t) + R . dV(t)/dt + P0] [where P(t), V(t), and dV(t)/dt are pressure, volume, and flow as a function of time, respectively, E is elastance, R is resistance, and P0 is end-expiratory pressure] to Ptr, lung resistance (RL) and dynamic elastance (EL) were determined breath by breath. Rti and airways resistance (Raw) were determined from Pcap in phase with rate of change of pulmonary expansion. Hysteresivity (eta) was calculated. Parallel inhomogeneity was estimated from the coefficients of variation (CV) of every Pcap at end inspiration and end expiration. Increase in CV significantly lagged Rti, RL, and eta. A linear relationship between EL and Raw was observed. Our results suggest that changes in tissue mechanics during the transition to the constricted state are not artifactual.

Do sedation and analgesia contribute to long-term cognitive dysfunction in critical care survivors? / ¿Contribuye la sedación y la analgesia a la disfunción cognitiva en supervivientes de una enfermedad crítica?

Deep sedation during stay in the Intensive Care Unit (ICU) may have deleterious effects upon the clinical and cognitive outcomes of critically ill patients undergoing mechanical ventilation. Over the last decade a vast body of literature has been generated regarding different sedation strategies, with the aim of reducing the levels of sedation in critically ill patients. There has also been a growing interest in acute brain dysfunction, or delirium, in the ICU. However, the effect of sedation during ICU stay upon long-term cognitive deficits in ICU survivors remains unclear. Strategies for reducing sedation levels in the ICU do not seem to be associated with worse cognitive and psychological status among ICU survivors. Sedation strategy and management efforts therefore should seek to secure the best possible state in the mechanically ventilated patient and lower the prevalence of delirium, in order to prevent long-term cognitive alterations (AU)

La sedación profunda durante la estancia en una Unidad de Cuidados Intensivos (UCI) puede afectar negativamente al estado clínico y cognitivo de los pacientes críticos sometidos a ventilación mecánica. En la última década ha aparecido gran cantidad de literatura sobre diferentes estrategias dirigidas a reducir los niveles de sedación en el paciente crítico. Además, ha aumentado el interés sobre la disfunción cerebral aguda o delirium. Sin embargo, el efecto de la sedación sobre los déficits cognitivos a largo plazo continúa siendo poco conocido. Las estrategias centradas en reducir los niveles de sedación en UCI no parecen estar asociadas con un peor estado cognitivo y psicológico de los supervivientes. Por lo tanto, las estrategias de manejo de la sedación en UCI deberían focalizarse en mejorar el estado del paciente ventilado, así como en disminuir el delirium, con el fin de prevenir las alteraciones cognitivas a largo plazo (AU)

Noncoding RNAs as potential biomarkers for DIPG diagnosis and prognosis: XIST and XIST-210 involvement

Purpose Diffuse intrinsic pontine gliomas (DIPGs) are the most fatal primary brainstem tumors in pediatric patients. The identification of new molecular features, mediating their formation and progression, as non-coding RNAs (ncRNAs), would be of great importance for the development of effective treatments. Methods We analyzed the DIPGs transcriptome with the HTA2.0 array and it was compared with pediatric non-brainstem astrocytoma expression profiles (GSE72269). Results More than 50% of the differentially expressed transcripts were ncRNAs and based on this, we proposed a DIPGs ncRNA signature. LncRNAs XIST and XIST-210, and the HBII-52 and HBII-85 snoRNA clusters were markedly downregulated in DIPGs. qPCR assays demonstrated XIST downregulation in all non-brainstem astrocytomas, in a gender, age, and brain location-independent manner, as well as in DIPGs affecting boys; however, DIPGs affecting girls showed both downregulation and upregulation of XIST. Girls’ with longer survival positively correlated with XIST expression. Conclusions The involvement of ncRNAs in DIPGs is imminent and their expression profile is useful to differentiate them from non-neoplastic tissues and non-brain stem astrocytomas, which suggests their potential use as DIPG biomarkers. In fact, XIST and XIST-210 are potential DIPG prognostic biomarkers (AU)

Double and multiple cycling in mechanical ventilation: Complex events with varying clinical effects / Doble y múltiples ciclados en ventilación mecánica: eventos complejos con diferentes significado clínico

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[Utility of recruitment maneuvers (con)]. / Utilidad de las maniobras de reclutamiento (contra).

A reduction in both total lung volume and in lung parenchyma useful for gas exchange has been observed in ARDS patients. Applying an appropriate ventilatory pattern that includes PEEP can open up collapsed areas of the lung to aeration, thus ensuring a more homogeneous distribution of air in the lung. However, the heterogeneous patterns observed in patients with ARDS vary widely in their response to ventilation with PEEP. Recruitment maneuvers (RM) have been proposed as an adjuvant treatment to mechanical ventilation to re-expand collapsed lung tissue in ARDS. Nevertheless, it is unclear whether RM are useful when patients are ventilated with high PEEP or when they have fibrosis, stiff chest wall, or hypovolemia, among other conditions. Likewise, decisions about RM must take into account not only their short- and long-term efficacy and reversibility, but also possible adverse effects derived from the high pressures reached during RM, including barotrauma, hemodynamic alterations, reduced systolic volume and aortic flow, and difficulties in venous return, as well as the possibility of bacterial translocation to the bloodstream or other organs. This article review the effects of RM as adjuvant treatment to mechanical ventilation in ARDS patients and discuss its efficacy and potential benefits as well as the different interactions that RM can have with the diverse conditions that can be associated to ARDS.

[Molecular and biophysical mechanisms and modulation of ventilator-induced lung injury]. / Mecanismos biofísicos, celulares y modulación de la lesión pulmonar inducida por la ventilación mecánica.

Ventilator-induced lung injury (VILI) is associated to a high rate of mortality with an important social impact. Mechanical ventilation induces structural and ultrastructural alterations in all cell types of the lung and can derive in the transduction of intracellular signals, as well as in changes in the expression of genes, a process known as mechanotransduction. Some of the conditions involved, such as inflammation and/or coagulation, apoptosis/necrosis can lead to the propagation of the injury outside the lung, resulting in multiorganic failure. VILI can be modulated by means of diverse interventions as the use of protective ventilatory modes, therapeutic approaches based on vasoactive and antioxidative drugs, and more recently treatments based on the use of repairing substances of the surfactant like poloxamers among others. Knowledge of the mechanisms involved in VILI is definitive for a better approach to this condition.

Interpretación de las curvas del respirador en pacientes con insuficiencia respiratoria aguda / Interpretation of ventilator curves in patients with acute respiratory failure

La ventilación mecánica es una intervención terapéutica de sustitución temporal de la función ventilatoria enfocada a mejorar los síntomas en los pacientes que sufren insuficiencia respiratoria aguda. Los avances tecnológicos han facilitado el desarrollo de ventiladores sofisticados que permiten visualizar y registrar las ondas respiratorias, lo que constituye una fuente de información muy valiosa para el clínico. La correcta interpretación de los trazados es de vital importancia tanto para el correcto diagnóstico como para la detección precoz de anomalías y para comprender aspectos de la fisiología relacionados con la ventilación mecánica y con la interacción paciente-ventilador. El presente trabajo da una orientación de cómo interpretar las curvas del ventilador mediante el análisis de trazados de presión en la vía aérea, flujo aéreo y volumen en distintas situaciones clínicas (AU)

Mechanical ventilation is a therapeutic intervention involving the temporary replacement of ventilatory function with the purpose of improving symptoms inpatients with acute respiratory failure. Technological advances have facilitated the development of sophisticated ventilators for viewing and recording the respiratory waveforms, which are a valuable source of information for the clinician. The correct interpretation of these curves is crucial for the correct diagnosis and early detection of anomalies, and for understanding physiological aspects related to mechanical ventilation and patient-ventilator interaction. The present study offers a guide for the interpretation of the airway pressure and flow and volume curves of the ventilator, through the analysis of different clinical scenarios (AU)