Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) / Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE)

La ecocardiografía transesfofágica es una técnica semiinvasiva que permite una evaluación de la morfología y función cardiaca a tiempo real y que constituye, a día de hoy, un estándar de calidad en las intervenciones de cirugía cardiovascular. Se ha convertido en una herramienta fundamental tanto de monitorización como de diagnóstico en el perioperatorio que permite la correcta planificación quirúrgica y manejo farmacológico dirigido. El objetivo de este documento es dar respuesta de forma consensuada y avalada por la evidencia científica de cuándo y cómo debe hacerse la ecocardiografía transesfofágica intraoperatoria en cirugía cardiovascular, qué aplicaciones tiene en el intraoperatorio, quién debe realizarla y cómo debe transmitirse la información obtenida durante el estudio. Los autores han hecho una revisión sistemática de las guías internacionales, artículos de revisión y ensayos clínicos para dar respuesta a estas preguntas

Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions

Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE). / Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE).

Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.

Ventilación con presión de soporte y ventilación proporcional asistida durante la retirada de la ventilación mecánica / Pressure support ventilation and proportional assist ventilation during weaning from mechanical ventilation

OBJETIVOS: Comparar la tolerancia, la duración de la ventilación mecánica (VM) y los desenlaces clínicos durante la retirada de la VM en 2 modalidades ventilatorias: la ventilación con presión de soporte (PSV) frente a la ventilación proporcional asistida (VPA). DISEÑO: Estudio observacional y prospectivo. Ámbito: Servicio de Medicina Intensiva. PACIENTES: Inclusión consecutiva de 20 pacientes en PSV y 20 pacientes en VPA cuando cumplieron los criterios de inicio de retirada de VM y su médico responsable decidió iniciar este proceso. La modalidad ventilatoria escogida y los parámetros ventilatorios durante el estudio fueron realizados por su médico responsable. INTERVENCIONES: Ninguna. Variables de interés: Variables demográficas, de mecánica respiratoria, parámetros ventilatorios, duración de VM y desenlaces clínicos (reintubación, traqueostomía, mortalidad).RESULTADOS: Los 2 grupos fueron similares en sus características basales. No existieron diferenciasen la duración total de VM (10 [5-18] días en PSV frente a 9 [7-19] días en VPA; p = 0,85).Tampoco existieron diferencias en términos de reintubación (5 [31%] en PSV frente a 3 [19%] enVPA; p = 0,69) ni de mortalidad (4 [20%] en PSV frente a 5 [25%] en VPA; p = 1). Ocho pacientes (40%) en PSV y 6 en VPA (30%) (p = 0,74) presentaron deterioro clínico y requirieron regresar a la modalidad asistida controlada por volumen. CONCLUSIONES: La PSV y la VPA presentan similar tolerancia, duración de la VM y desenlaces clínicos durante la retirada de esta

OBJECTIVES: To compare tolerance, duration of mechanical ventilation (MV) and clinical outcomes during weaning from MV in patients subjected to either pressure support ventilation (PSV)or proportional assist ventilation (PAV).DESIGN: A prospective, observational study was carried out. SETTING: Intensive Care Unit. PATIENTS: A total of 40 consecutive subjects were allocated to either the PSV or the PAV groupuntil each group contained 20 patients. Patients were included in the study when they met the criteria to begin weaning and the attending physician decided to initiate the weaning process. The physician selected the modality and set the ventilatory parameters. INTERVENTIONS: None. Variables of interest: Demographic data, respiratory mechanics, ventilatory parameters, duration of MV, and clinical outcomes (reintubation, tracheostomy, mortality).RESULTS: Baseline characteristics were similar in both groups. No significant differences were RESULTS: Baseline characteristics were similar in both groups. No significant differences were observed between the PSV and PAV groups in terms of the total duration of MV (10 [5-18] vs. 9 [7-19] days; P = .85), reintubation (5 [31%] vs. 3 [19%]; P = .69), or mortality (4 [20%] vs. 5 [25%] deaths; P = 1). Eight patients (40%) in the PSV group and 6 patients (30%) in the PAV group (P = .74) required a return to volume assist-control ventilation due to clinical deterioration. CONCLUSIONS: Tolerance, duration of MV and clinical outcomes during weaning from mechanical ventilation were similar in PSV and PAV

[Pressure support ventilation and proportional assist ventilation during weaning from mechanical ventilation]. / Ventilación con presión de soporte y ventilación proporcional asistida durante la retirada de la ventilación mecánica.

OBJECTIVES: To compare tolerance, duration of mechanical ventilation (MV) and clinical outcomes during weaning from MV in patients subjected to either pressure support ventilation (PSV) or proportional assist ventilation (PAV). DESIGN: A prospective, observational study was carried out. SETTING: Intensive Care Unit. PATIENTS: A total of 40 consecutive subjects were allocated to either the PSV or the PAV group until each group contained 20 patients. Patients were included in the study when they met the criteria to begin weaning and the attending physician decided to initiate the weaning process. The physician selected the modality and set the ventilatory parameters. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographic data, respiratory mechanics, ventilatory parameters, duration of MV, and clinical outcomes (reintubation, tracheostomy, mortality). RESULTS: Baseline characteristics were similar in both groups. No significant differences were observed between the PSV and PAV groups in terms of the total duration of MV (10 [5-18] vs. 9 [7-19] days; P=.85), reintubation (5 [31%] vs. 3 [19%]; P=.69), or mortality (4 [20%] vs. 5 [25%] deaths; P=1). Eight patients (40%) in the PSV group and 6 patients (30%) in the PAV group (P=.74) required a return to volume assist-control ventilation due to clinical deterioration. CONCLUSIONS: Tolerance, duration of MV and clinical outcomes during weaning from mechanical ventilation were similar in PSV and PAV.