A quantitative evaluation of aerosol generation during cardiopulmonary resuscitation.

It is unclear if cardiopulmonary resuscitation is an aerosol-generating procedure and whether this poses a risk of airborne disease transmission to healthcare workers and bystanders. Use of airborne transmission precautions during cardiopulmonary resuscitation may confer rescuer protection but risks patient harm due to delays in commencing treatment. To quantify the risk of respiratory aerosol generation during cardiopulmonary resuscitation in humans, we conducted an aerosol monitoring study during out-of-hospital cardiac arrests. Exhaled aerosol was recorded using an optical particle sizer spectrometer connected to the breathing system. Aerosol produced during resuscitation was compared with that produced by control participants under general anaesthesia ventilated with an equivalent respiratory pattern to cardiopulmonary resuscitation. A porcine cardiac arrest model was used to determine the independent contributions of ventilatory breaths, chest compressions and external cardiac defibrillation to aerosol generation. Time-series analysis of participants with cardiac arrest (n = 18) demonstrated a repeating waveform of respiratory aerosol that mapped to specific components of resuscitation. Very high peak aerosol concentrations were generated during ventilation of participants with cardiac arrest with median (IQR [range]) 17,926 (5546-59,209 [1523-242,648]) particles.l-1 , which were 24-fold greater than in control participants under general anaesthesia (744 (309-2106 [23-9099]) particles.l-1 , p < 0.001, n = 16). A substantial rise in aerosol also occurred with cardiac defibrillation and chest compressions. In a complimentary porcine model of cardiac arrest, aerosol recordings showed a strikingly similar profile to the human data. Time-averaged aerosol concentrations during ventilation were approximately 270-fold higher than before cardiac arrest (19,410 (2307-41,017 [104-136,025]) vs. 72 (41-136 [23-268]) particles.l-1 , p = 0.008). The porcine model also confirmed that both defibrillation and chest compressions generate high concentrations of aerosol independent of, but synergistic with, ventilation. In conclusion, multiple components of cardiopulmonary resuscitation generate high concentrations of respiratory aerosol. We recommend that airborne transmission precautions are warranted in the setting of high-risk pathogens, until the airway is secured with an airway device and breathing system with a filter.

War and disaster are forcing a major rethink around mass casualty management.

Mass casualty events (MASCAL) do not follow the same rules as typical major incidents. In the West at least, the latter often occur in stable, networked trauma systems, whereas MASCAL are characterised by overwhelming numbers of patients, compounded by protracted scene and transport times, decompensated response systems and significant disruption to infrastructure, command and control.This paper describes the 8Ds approach being taken by the UK Defence Medical Services and the North Atlantic Treaty Organization Emergency Medicine Panel framework to approach MASCAL. The eight domains were derived from literature about management of casualties in the World Wars, and also from approaches taken by civilian health systems as they struggle to manage increasing demand. They are: distribute; decompress; delay; delegate; deliver faster and deliver better; dynamic levels of care; and de-escalate These domains will allow a structured approach to research and innovate around MASCAL, informing better guidelines for their management.

Thyroid dysfunction in pregnancy - a retrospective observational analysis of a Maltese cohort.

BACKGROUND: Thyroid dysfunction is known to adversely affect pregnancy. This study evaluates the prevalence of thyroid disorders and explores their association with pregnancy complications/comorbidities and modes of delivery in the Maltese pregnant population over a ten year period. DESIGN: A population based observational study. METHOD: We analysed data from the National Obstetrics Information Service of the Department of Health Informations and Research (NOIS) for all births delivered in Malta between 2006 and 2016. Cases identified and recorded by NOIS to have had some form of thyroid dysfunction during pregnancy were confirmed by cross-referencing  with laboratory results found in patients' medical records and/or iSOFT® database system. Using the Statistical Package for the Social sciences (SPSS®)  demographic data, past obstetric and medical history and obstetric outcomes were analysed for pregnancies with thyroid dysfunction and compared to data pertaining to pregnancies in euthyroid patients, that is those with no recorded thyroid dysfunction on NOIS. Chi square/Fisher's exact test were used to compare categorical variables while ANOVA/Mann-Whitney U test was used to compare continuous variables. Statistical significance was defined by a two-sided p value <0.05. RESULTS: Data was available for 46,283 women (mean [SD] age = 29.2 [5.4] years). 587 pregnancies (1.3%) suffered from thyroid dysfunction. Of these, 67.3% were hypothyroid, 3.2% had hyperthyroidism, 28.3% had isolated hypothyroxinaemia (IHT) while 1.2% had a history of thyroid carcinoma. Patients with IHT and hypothyroidism were older than euthyroid patients (p < 0.001).  IHT and hypothyroid patients had a statistically significant higher body mass index (BMI) than euthyroid women (p=0.001 for hypothyroid women, p = 0.035 for IHT). Hypothyroid  and IHT women were more likely to have had a previous lower segment caesarean section  (p=0.043,  and 0.006 respectively). Type 1 diabetes and gestational diabetes  p = 0.012) were more common associated comorbidities in hypothyroid pregnancies. Offspring of patients with IHT had a higher birth weight than those born to euthyroid patients (p=0.009). Patients with hyperthyroidism were found to have a significantly increased risk of early preterm delivery before 34 weeks of gestation and were also more likely to have suspected intrauterine growth restriction and low mean birth weight. We report no significant differences in past history of obstetric loss, antenatal complications, mode of delivery, gestational age at delivery and postpartum haemorrhage rates across thyroid categories. CONCLUSIONS: Available evidence suggests that thyroid dysfunction is more likely in the setting of older age, and higher body mass index. Moreover, it impacts on neonatal birth weight, rates of early preterm delivery and intrauterine growth restriction.

Evaluation of an AI system for the detection of diabetic retinopathy from images captured with a handheld portable fundus camera: the MAILOR AI study.

OBJECTIVES: To evaluate the performance of an artificial intelligence (AI) system (Pegasus, Visulytix Ltd., UK*) at the detection of diabetic retinopathy (DR) from images captured by a handheld portable fundus camera. METHODS: A cohort of 6404 patients (~80% with diabetes mellitus) was screened for retinal diseases using a handheld portable fundus camera (Pictor Plus, Volk Optical Inc., USA) at the Mexican Advanced Imaging Laboratory for Ocular Research. The images were graded for DR by specialists according to the Scottish DR grading scheme. The performance of the AI system was evaluated, retrospectively, in assessing referable DR (RDR) and proliferative DR (PDR) and compared with the performance on a publicly available desktop camera benchmark dataset. RESULTS: For RDR detection, Pegasus performed with an 89.4% (95% CI: 88.0-90.7) area under the receiver operating characteristic (AUROC) curve for the MAILOR cohort, compared with an AUROC of 98.5% (95% CI: 97.8-99.2) on the benchmark dataset. This difference was statistically significant. Moreover, no statistically significant difference was found in performance for PDR detection with Pegasus achieving an AUROC of 94.3% (95% CI: 91.0-96.9) on the MAILOR cohort and 92.2% (95% CI: 89.4-94.8) on the benchmark dataset. CONCLUSIONS: Pegasus showed good transferability for the detection of PDR from a curated desktop fundus camera dataset to real-world clinical practice with a handheld portable fundus camera. However, there was a substantial, and statistically significant, decrease in the diagnostic performance for RDR when using the handheld device.

The minimum inhibitory concentration (MIC) assay with Escherichia coli: An early tier in the environmental hazard assessment of nanomaterials?

There are now over a thousand nano-containing products on the market and the antibacterial properties of some nanomaterials has created interest in their use as cleaning agents, biocides and disinfectants. Engineered nanomaterials (ENMs) are being released into the environment and this raises concerns about their effects on microbes in the receiving ecosystems. This study evaluated the bacterial toxicity of a wide range of nanomaterials with different surface coatings on Escherichia coli K-12 MG1655. The minimum inhibitory concentration (MIC) assay, which quantifies the threshold for growth inhibition in suspensions of bacteria, was used to rank the toxicity of silver (Ag), cupric oxide (CuO), cadmium telluride (CdTe) quantum dots, titanium dioxide (TiO2), nanodiamonds and multi-walled carbon nanotubes (MWCNTs). Bacteria were exposed for 12 h at 37 °C to a dilution series of the test suspensions in 96-well plates. The precision and accuracy of the method was good with coefficients of variation < 10%. In terms of the measured MIC values, the toxicity order of the ENMs was as follows: CdTe quantum dots ammonium-coated, 6 mg L-1 > Ag nanoparticles, 12 mg L-1 > CdTe quantum dots carboxylate-coated, 25 mg L-1 > CdTe quantum dots polyethylene glycol-coated, 100 mg L-1. The MIC values were above the highest test concentration used (100 mg L-1) for CuO, TiO2, nanodiamonds and MWCNTs, indicating low toxicity. The MIC assay can be a useful tool for the initial steps of ENMs hazard assessment.

Retraction Note to: L-glutamine supplementation induces insulin resistance in adipose tissue and improves insulin signalling in liver and muscle of rats with diet-induced obesity.

In light of forensic evidence indicating duplication and/or manipulation of western blot images the Editor-in-Chief is retracting the article cited above.

Aryl hydrocarbon receptor (AHR) is a potential tumour suppressor in pituitary adenomas.

Pituitary adenomas (PA) represent the largest group of intracranial neoplasms and yet the molecular mechanisms driving this disease remain largely unknown. The aim of this study was to use a high-throughput screening method to identify molecular pathways that may be playing a significant and consistent role in PA. RNA profiling using microarrays on eight local PAs identified the aryl hydrocarbon receptor (AHR) signalling pathway as a key canonical pathway downregulated in all PA types. This was confirmed by real-time PCR in 31 tumours. The AHR has been shown to regulate cell cycle progression in various cell types; however, its role in pituitary tissue has never been investigated. In order to validate the role of AHR in PA behaviour, further functional studies were undertaken. Over-expression of AHR in GH3 cells revealed a tumour suppressor potential independent of exogenous ligand activation by benzo α-pyrene (BαP). Cell cycle analysis and quantitative PCR of cell cycle regulator genes revealed that both unstimulated and BαP-stimulated AHR reduced E2F-driven transcription and altered expression of cell cycle regulator genes, thus increasing the percentage of cells in G0/G1 phase and slowing the proliferation rate of GH3 cells. Co-immunoprecipitation confirmed the interaction between AHR and retinoblastoma (Rb1) protein supporting this as a functional mechanism for the observed reduction. Endogenous Ahr reduction using silencing RNA confirmed the tumour suppressive function of the Ahr. These data support a mechanistic pathway for the putative tumour suppressive role of AHR specifically in PA, possibly through its role as a cell cycle co-regulator, even in the absence of exogenous ligands.

Immunoexpression of Heat Shock Protein 70, Glypican 3, Glutamine Synthetase, and Beta-Catenin in Hepatocellular Carcinoma After Liver Transplantation: Association Between Positive Glypican 3 and Beta-Catenin With the Presence of Larger Nodules.

BACKGROUND: Hepatocellular carcinoma (HCC) is the 6th leading cause of cancer worldwide. Its recurrence ranges from 6% to 26%. In the literature, many factors are associated with higher risk of recurrence, without a clear definition of the best method that could predict this highly lethal event. OBJECTIVE: The aim of this study was to evaluate the immunoexpression of immunohistochemical markers: HSP70, glypican 3, glutamine synthetase, and beta-catenin, as well as studying their association with tumor characteristics and prognosis of patients undergoing liver transplantation for HCC. METHODS: We studied 90 patients who underwent liver transplantation from 1998 to 2012. Afterwards we evaluated factors related to survival, tumor recurrence, and the correlation of expression of the immunohistochemical markers. RESULTS: Immunohistochemical marker glutamine synthetase showed a positive trend toward better survival. HSP70-positive patients had a higher prevalence of histologic grade III. Patients with positive glypican 3 showed larger lesions and a higher number with AFP >200 ng/mL. Patients with positive beta-catenin showed larger nodules and more with histologic grade III. The association between beta-catenin and glypican 3 showed positive association with larger nodules. CONCLUSIONS: Most of the markers studied had a correlation with at least one of the variables studied, confirming our hypothesis that these markers can indeed assist in assessing the prognosis of patients undergoing liver transplantation for HCC.

Simulador de bajo costo para el entrenamiento en la colocación de accesos vasculares periféricos (AVP) en pediatría / Low-cost simulator for the training of peripheral venous access (PVA) placement in pediatrics

Introducción: El entrenamiento en simuladores permite aprender procedimientos en un marco controlado que protege la seguridad de los pacientes pediátricos y que se integra como una instancia de aprendizaje previa a la realidad con el paciente. En el Centro de Simulación del Hospital de Pediatría Juan P. Garrahan se diseñan y validan simuladores de bajo costo artesanales que permiten contar con recursos propios y de reposición inmediata. Objetivo: Describir el diseño de un simulador de bajo costo para la colocación de accesos vasculares periféricos y reportar la experiencia inicial de validación. Métodos: Se diseñó un simulador artesanal inanimado de punción venosa periférica (parte de miembro superior de un niño de edad aproximada de 8 años) con materiales de bajo costo. En una segunda fase y con el propósito de validarlo, se solicitó la colocación del acceso vascular -en el modelo simulado- a enfermeros del hospital que trabajan en el área de internación (usuarios expertos). Al final de cada experiencia, cada operador reportó su opinión sobre el realismo del modelo y utilidad de la experiencia en forma anónima. Resultados Participaron 43 enfermeros; entre el 75 a 90% de las veces, las repuestas fueron "se parece mucho" o "es igual" a la experiencia real de colocación de un acceso venoso a un niño. El 85% expresó que esta práctica permitía mejorar la destreza, y el 100% que el modelo puede ayudar a enseñarla en forma efectiva. Conclusiones El desarrollo de modelos de simuladores de bajo costo para usos específicos, de baja tecnología, resulta importante para el entrenamiento de habilidades. La aceptación por parte de los usuarios calificados y expertos fue muy buena, encontrando en un alto porcentaje similitud con la realidad (AU)

Introduction: Training on simulators allows for the learning of procedures within a controlled framework that protects the safety of pediatric patients and provides a learning moment previous to working with a real patient. In the Simulation Center at Hospital de Pediatría Juan P. Garrahan low-cost simulators are designed and validated that allow for proper resources and immediate replacement. Aim: To describe the design of a low-cost simulator for the placement of peripheral vascular Access and to report the initial experience with the validation of the device. Methods: An inanimate simulator for peripheral puncture (the upper limb of a child of approximately 8 years of age) was designed using lowcost materials. In a second phase with the purpose of validating the device, nurses of the hospital working in the inpatient area (expert users) were asked to insert a venous catheter in the simulation model. At the end of each procedure, each operator was asked to anonymously give their opinion. Results: 43 nurses participated; between 75 and 90% of times, the answers were "it is very similar "or "it is the same as the experience of placing a real venous catheter in a child. Overall, 85% felt that the training improved their skills and 100% considered that the model may be effective in the teaching process. Conclusions: The development of low-cost, low-technology simulation models is important in the training of skills. Acceptance by qualified users and experts was very good. A high degree of similarity with reality was reported (AU)

Expression of Mcl-1 and Ki-67 in Papillary Thyroid Carcinomas.

UNLABELLED: Studying molecules that are differentially expressed in cancers as well as benign and normal tissues is crucial for identifying novel biomarkers for cancer immunotherapy. This study aimed to investigate the clinical utility of the immunochemical expression of the proliferative cell marker Ki-67 and the apoptotic blocker Mcl-1 in papillary thyroid carcinoma (PTC). METHODS: We built a tissue microarray with 282 thyroid specimens. There were 59 PTCs including 35 classic (CPTC), 3 tall cell (TCPTC) and 21 follicular variants (FVPTC); 79 benign thyroid diseases (22 follicular adenomas; 57 adenomatoid hyperplasia); 33 Hashimoto's thyroiditis (HT) specimens; and 111 normal thyroid tissues. Clinical history and ultrasound data were retrospectively obtained by chart review. RESULTS: Mcl-1 overexpression was evident in 66.7% of the PTC tissues compared to 32% of the benign thyroid diseases. Mcl-1 strong staining distinguished benign from malignant thyroid lesions (sensitivity=61.3%; specificity=72.8%; negative predictive value, NPV=68%; positive predictive value, PPV=66.7% and 67.5% accuracy). Positive nuclear Ki-67 staining was observed in 34% of PTCs vs. 19% of thyroid adenomas (P=0.031). Strong Mcl-1 and Ki-67 co-expression was identified in 57.5% of PTCs with a higher PPV (75.8%). Mcl-1 and Ki-67 expression was not associated with any clinicopathological feature of malignancy. No deaths occurred during the follow-up. CONCLUSIONS: Mcl-1 immunochemical overexpression allowed differentiating low-risk PTC from the benign thyroid lesions. We suggest that Mcl-1 expression may help differentiate follicular patterned thyroid lesions. The influence of the Mcl-1 expression on several features of tumor aggressiveness has to be studied in large series of high-risk thyroid carcinomas.

Four cases of Raoultella planticola conjunctivitis.

AIMS: This brief report of four cases of conjunctivitis caused by Raoultella planticola provides a description of possibly the first documented cases of this eye infection. METHODS: The laboratory database and medical records were used to trace all the R. planticola-positive conjunctival swabs obtained in our institution. Four cases were identified and available relevant information was obtained. RESULTS: This organism causes a non-specific purulent conjunctivitis that seems to have a benign course and tends to be responsive to a topical fluoroquinolone. CONCLUSIONS: The possibility of atypical organisms must be considered when managing infective conjunctivitis. Conjunctival swabs should be obtained and topical treatment switched when initial empirical therapy fails.

Prevalence of obesity in Malta.

BACKGROUND: Obesity is a global epidemic with the Mediterranean island of Malta being no exception. The World Health Organization (WHO) has identified Malta as one of the European countries with the highest obesity prevalence. METHOD: A cross-sectional study was conducted (2014-2016) under the auspices of the University of Malta. The prevalence of overweight-obesity in Malta was calculated and then age stratified for comparisons with previous studies. RESULTS: The study identified 69.75% (95% CI: 68.32-71.18) of the Maltese population to be either overweight or obese. The men overweight/obese prevalence (76.28% 95% CI: 74.41-78.14) was statistically higher than that for women (63.06% 95% CI: 60.92-65.20) (p = 0.0001). Age stratification revealed that both genders had the highest overweight prevalence rates between 55 and 64 years (Men = 23.25% 95% CI: 20.43-26.33; Women = 24.68% 95% CI: 21.44-28.22). Men obesity prevalence rates were highest in the 35 to 44 years group (22.52% 95% CI: 19.65-25.68) while for women it was highest in the 55 to 64 years group (28.90%, 95% CI: 25.44-30.63). CONCLUSION: Over a 35-year period, an overall decrease in the normal and overweight BMI categories occurred with an increase in the prevalence of obesity. An exception was observed in the women, where the prevalence of normal BMI increased over this time period. Also, it appears that while the total population obesity prevalence increased (for 2016), a percentage of the women have shifted from an obese to an overweight status.

Diabetes, pre-diabetes and their risk factors in Malta: a study profile of national cross-sectional prevalence study.

BACKGROUND: Type 2 diabetes mellitus constitutes a global epidemic and a major burden on health care systems across the world. Prevention of this disease is essential, and the development of effective prevention strategies requires validated information on the disease burden and the risk factors. Embarking on a nationally representative cross-sectional study is challenging and costly. Few countries undertake this process regularly, if at all. METHOD: This paper sets out the evidence-based protocol of a recent cross-sectional study that was conducted in Malta. Data collection took place from November 2014 to January 2016. RESULTS: This study presents up-to-date national data on diabetes and its risk factors (such as obesity, smoking, physical activity and alcohol intake) that will soon be publicly available. CONCLUSION: This protocol was compiled so that the study can be replicated in other countries. The protocol contains step-by-step descriptions of the study design, including details on the population sampling, the permissions required and the validated measurement tools used.

Immunohistochemical assessment of PTEN in vulvar cancer: best practices for tissue staining, evaluation, and clinical association.

BACKGROUND: Pten encodes a well-characterized protein that is important in several cancers due to its tumor suppressor function. Yet, the detection and evaluation of PTEN by immunohistochemistry (IHC) for clinical practice have not been standardized. Thus, in this study, we performed a literature review of protocols for PTEN assessment by IHC and the possible differences in evaluation, based on our experience with vulvar carcinomas. Also, we report some of our most recent findings regarding the clinical impact of PTEN in this type of tumor. METHODS: In total, 150 FFPE vulvar carcinoma samples in a tissue microarray were examined by IHC with regard to PTEN, PI3K, AKT, and mTOR. All evaluations were performed by slide digitalization and quantification using APERIO ImageScope software. All measurements were converted into HScore values for the statistical analysis. RESULTS: Sharp and specific PTEN expression was observed in the nuclei and cytoplasmic compartments. Its HScore values ranged from 3.5 to 226, with a median of 92.5. mTOR expression was robust in all cases (mean HScore=248.1). AKT and PI3K had median HScore values of 200.5 and 156.5, respectively. In addition, PTEN expression was associated with higher rates of patient survival. CONCLUSION: The preanalytical step is the first issue in the immunohistochemical evaluation of PTEN. With regard to the analytical procedure, the antigen retrieval step yielded better stains for protocols with high-pH buffers, and antibody clone 6H2.1 effected the most reliable results. PTEN is a good prognostic marker for vulvar cancer, correlating with higher rates of patient survival. Our data underscore the importance of technical standardization to ensure more reliable and reproducible evaluation of PTEN in clinical practice.

Triage in the defence medical services.

Triage of patients into categories according to their need for intervention is a core part of military medical practice. This article reviews how triage has evolved in the Defence Medical Services and how it might develop in the context of recent research. In particular, a simple model demonstrates that the ideal sensitivity and specificity of a triage system depends upon the availability of transport and the capacity of the receiving units. As a result, we may need to fundamentally change the way we approach triage in order to optimise outcomes-especially if casualty evacuation timelines become longer and smaller medical units more prevalent on future operations. Some pragmatic options for change are discussed. Finally, other areas of current research around triage are highlighted, perhaps showing where triage may go next.

Seguridad en el traslado intrahospitalario de pacientes críticos en pediatría / Safety of interhospital transfers of critical care patients in pediatrics

La unidad de cuidados intensivos (UCI) es el ámbito más seguro para la atención de pacientes críticamente enfermos. Sin embargo, hay situaciones en las que el paciente debe ser trasladado a algún otro lugar del hospital, pudiendo incrementar el riesgo para eventos adversos. El objetivo es describir la implementación de un programa de capacitación y realizar un relevamiento de los traslados de pacientes de UCI. Estudio descriptivo y prospectivo. Se incluyeron todos los pacientes trasladados desde las UCI 44-45-72 y 65 durante el periodo de Julio 2012 a Junio 2013. Se diseñó una lista de chequeo, con datos de cada paciente, material para el traslado y registro de efectos adversos. Se agruparon por gravedad en Grupo I: Sin requerimientos de inotrópicos y sin asistencia respiratoria mecánica (ARM) y Grupo II: Requerimientos de ARM y/o inotrópicos (A Estables, B Inestable). Se realizó capacitación del personal encargado de los traslados para completar las listas de chequeo y recomendaciones sobre traslado seguro. Se documentaron 104 traslados y se distribuyeron en Grupo IA 32%, 2A 61% y 2B 11%. Se pesquisó un total de 61 (58.65%) eventos adversos. Se registraron eventos adversos en 58.65% de los traslados y solo 47.11% de los traslados fueron realizados en condiciones adecuadas (AU)

The intensive care unit (ICU) is the safest environment for the care of critically ill patients. Nevertheless, in certain settings the patients have to be transferred to other sectors of the hospital, which may increase the risk of adverse events. With the aim to describe the implementation of a training program and to assess the transfer of ICU patients a descriptive and prospective study was conducted. All patients transferred from ICUs 44-45,72, and 65 over the period July 2012 to June 2013 were included. A checklist was developed with patient data, materials included in the transfer, and recording of adverse events. Patients were categorized according to severity into Group I: No need for inotropics and mechanical ventilation (MV) and Group II: Need for MV and/or inotropics (A Stable, B Unstable). Personnel in charge of the transfers were trained in the filling out of the checklists and recommendations for safe transfers. One hundred and four transfers were registered; 32% of the patients were in Group IA, 61% in Group 2A, and 11% in 2B. A total of 61 (58.65%) adverse events were observed. Adverse events were registered in 58.65% of the transfers and only 47.11% of the transfers were performed under adequate conditions (AU)

Estudio comparativo de dos modos de ventilación no invasiva para retirar la asistencia respiratoria mecánica en lactantes post-operatorios de cirugía cardiovascular / Comparative study of two modalities of non-invasive ventilation for the weaning from mechanical ventilation of post-cardiovascular surgery infants

La mejor estrategia en el post-quirúrgico de cardiopatías congénitas para promover la extubación precoz y destete de asistencia respiratoria mecánica (ARM) con ventilación no invasiva (VNI) todavía no ha sido establecida. El objetivo es comparar eficacia de la presión positiva continua en la vía aérea (CPAP) vs presión positiva con dos niveles en la vía aérea (BIPAP) en la extubación electiva de estos pacientes. Es un estudio prospectivo entre el 1 de junio de 2008 y 31 marzo de 2010. Se randomizaron los pacientes para extubación electiva: modo CPAP o BIPAP. Se registraron datos demográficos y del procedimiento quirúrgico, entre otros. El fracaso de VNI fue definido como reintubación dentro de las 72 hs posteriores a la extubación o más de un criterio de intubación. Durante el periodo de estudio 1438 pacientes fueron admitidos en UCI35. En el grupo BIPAP se randomizaron 53 pacientes, de los cuales se extubaron exitosamente 49 (92%), pero 4 se reintubaron debido a falla cardiaca. En el grupo CPAP se randomizaron 46 y fallaron en la extubación 18 (39%) debido a múltiples episodios de desaturación y apneas. De éstos, 11 requirieron reintubación endotraqueal y ARM. En 7 pacientes, se pasó a modo BIPAP y permanecieron extubados, aunque el cruzamiento no fue parte del diseño de este estudio. En el destete de ARM de los pacientes post-quirúrgicos de cardiopatías congénitas, el uso de BIPAP fue más efectivo que CPAP. En esta última modalidad se presentaron mayor número de fracasos de VNI (AU)

The best strategy for early extubation and weaning from mechanical respiration (MV) with non-invasive ventilation (NIV) in post-surgical congenital heart defect patients has not been established yet. The aim of this study was to compare the efficacy of continuous positive airway pressure CPAP) vs bi-level positive airway pressure (BIPAP) in the elective extubation of these patients. A prospective study was conducted between June 1, 2008 and March 31, 2010. Patients that were candidates for elective extubation were randomized to CPAP or BIPAP. Data on demographics and surgical procedure, among others, were recorded. Failure of NIV was defined as the need for reintubation within 72 hours after extubation or more than one criterion for intubation. Over the study period, 1438 patients were admitted to ICU 35. Fifty-three patients were randomized to BIPAP, of whom 49 (92%) were successfully extubated; however, four were reintubated due to heart failure. Forty-six patients were randomized to CPAP. Extubation failed in 18 (39%) due to multiple episodes of desaturation and apneas. Eleven of 18 required endotracheal reintubation and mechanical ventilation. Seven patients were switched to BIPAP and remained extubated, although the switch was not part of the study design. In the weaning of post-surgical congenital heart defect patients from MV, BIPAP was more effective than CPAP. In the latter modality, the incidence of NIV failure was higher (AU)