Strength characteristics in faster change of direction basketball players: A comparison across cutting angles.

Change of directions (COD) involves multidirectional and complex actions, with performance influenced by multiple factors. As lower limb strength is one of the most determinant of COD performance, the present study aimed to (a) explore the differences in strength outcomes across different lower limb muscle actions between faster and slower basketball players in COD actions at different angles and (b) analyse the relationship between isometric, concentric and eccentric strength outcomes and COD performance at different cutting angles. Twenty-five basketball players (44% female) completed a battery of tests, encompassing isokinetic and isometric squat strength assessments, along with COD tests at 45°, 90° and 180°. Players were categorised as 'low-performance' and 'high-performance' groups based on execution time in COD, facilitating a comparison between performance groups. Results indicated that concentric strength showed the greatest differences between performance groups at 45° COD (effect size ≥ 0.813; p ≤ 0.034). Isometric and eccentric strength demonstrated a moderate-to-large relationship with 90° COD performance (Rho ≥ 0.394; p ≤ 0.045), and all muscle actions exhibited a large relationship with 180° COD (Rho ≥ 0.445; p ≤ 0.030). Moreover, the fastest players showed higher levels of concentric strength relative to eccentric strength, regardless of the cutting angle. These findings hold practical applications, suggesting that basketball coaches should train a specific kind of muscle action depending on the individual players' COD demands, focusing on improving the rapid eccentric force application while striving to reduce the eccentric/concentric ratio.

Determination of change of direction deficit thresholds across a spectrum of angles in basketball players.

Change of direction deficit (CODD) offers valuable insights into a player's balance between linear and multidirectional speed. However, there are still no established reference values for CODD. The objectives of this study were to determine CODD thresholds for various change of direction angles in basketball players according to gender and analyse the relationships between CODD and execution time in speed tests. One hundred and thirty basketball players (46% female; age: 23.7 ± 5.29 years; height: 189.1 ± 11.1 cm; body mass: 84.3 ± 15.7 kg) undertook 10-m linear and change of direction speed test at 45º, 90º and 180º. A k-means cluster analysis was conducted to standardise CODD thresholds and a one-way analysis of variance to identify the differences between clusters. The results revealed angulation-specific CODD thresholds, ranging from 3% to 8%, 17% to 25% and 43% to 51% for 45º, 90º and 180º cutting angles, respectively for the pooled sample. Furthermore, differences inter-clusters (p < 0.05) were observed for execution time at all cutting angles for both genders. Therefore, strength and conditioning coaches are encouraged to assess CODD as a highly valid variable for evaluating change of direction performance and to use current CODD thresholds to tailor training programmes according to each athlete's needs.

The Influence of Functional Movement and Strength upon Linear and Change of Direction Speed in Male and Female Basketball Players.

The present study aimed to analyse the relationship between functional movement and strength variables upon linear speed (Ls) and change of direction (COD) based on gender. It also aimed to identify the determinants of performance of Ls and COD according to gender. Fifty basketball players (54% female) completed the assessment in which the weight-bearing dorsiflexion test, the Y-balance test, the unilateral countermovement jump, the unilateral drop jump, the unilateral triple hop test, Ls and CODs were performed. Speed variables were divided according to time execution into "low-performance" and "high-performance" to establish a comparison between performance groups. Strength variables significantly influenced speed tests' performance in both genders (p < 0.05). For males, the greater the Ls, the higher the change of direction deficit (p < 0.001). Multiple regression analysis revealed that a long and vertical stretch-shortening cycle (SSC) was the most influential physical ability for speed performance in females (45-65% variance explained; p < 0.001), while in males, a short and horizontal SSC played a significant role (30-61% variance explained; p < 0.022). These results suggest that gender should be considered in programming strength training to improve speed, as each gender will benefit most from the application of different force-orientations and different SSC. Also, the faster the male players were in Ls, the less efficient they were in the COD performance. This is why for men, it would be recommended to perform eccentric exercises along with deceleration and technique drills to improve COD speed.

Vertical Versus Horizontal Training for Improving the Change of Direction Speed in Adult Basketball Players: A Systematic Review and Meta-analysis.

ABSTRACT: Barrera-Domínguez, FJ, Martínez-García, D, Jerez-Mayorga, D, Chirosa-Ríos, LJ, Almagro, BJ, and Molina-López, J. Vertical versus horizontal training for improving the change of direction speed in adult basketball players: a systematic review and meta-analysis. J Strength Cond Res XX(X): 000-000, 2023-The ability to perform changes of direction (COD) is a complex skill that involves the application of multiple force-orientations, and its execution at maximum speed is crucial in basketball players. The present study aimed to synthesize findings from previous interventions classified according to force-orientation (vertical, horizontal, or mixed) and determine their magnitude of the effect on COD performance in basketball players. A systematic review of the literature was performed in several databases (Web of Science, Scopus, SPORTDiscus, and PubMed) following the PRISMA statement and reviewed the quality of the included papers according to the Cochrane Collaboration Guidelines Assessment. Sixteen articles with a total of 21 reports were included to analyze the role of force-orientations in COD performance. For the meta-analysis, the standardized mean differences with 95% confidence intervals (CIs) were calculated to determine the chronic changes induced by training and performed an effect size (ES) analysis with a random-effects model. The results showed that all force-orientations generated improvements in COD performance (ES = -0.47 [95% CI -0.57, -0.36], Z = 8.74 [p < 0.01]). It was a mixed force-orientation that produced the greatest changes (ES = -0.91 [95% CI -1.27, -0.55], Z = 4.96 [p < 0.01]), followed by vertical training (ES = -0.45 [95% CI -0.70, -0.20], Z = 3.51 [p < 0.01]). Horizontal training was the least studied and showed the smallest change (ES = -0.10 [95% CI -0.14, -0.07], Z = 5,71 [p < 0.01]). This meta-analysis demonstrates that mixed vertical and horizontally oriented training may be the most optimal because it offers a greater variety of multidirectional stimuli that better prepares the athlete to deal with complex COD in real-game situations.

Involvement and Autonomy of Minors in Medical Settings: Perceptions of Children Undergoing Surgery and Parents.

Informed consent presupposes competence and represents a formal decision by an informed person who has the legal capacity to accept medical action or participate in research. Our aim was to analyze the perceptions of minors and their parents about the age at which they consider that a minor is competent for making health decisions. A descriptive observational study was carried out in 302 minors between 12 and 17 years of age undergoing elective surgery, and 302 parents (range 30 to 62 years). Two semistructured questionnaires were designed, one for the minors and the other, for the parents. A total of 20.1% of minors and 31.1% of parents believe that patients should not make decisions related to their health until they are 18 years old. A total of 74.9% of the minors surveyed consider that from 16 years of age, the minor is empowered to make decisions. In parents, this percentage is 60%. In the pediatric setting, each case and situation must be examined individually to determine if the minor meets the condition of maturity to decide. The ideal is to promote the minor's participation in decision-making, giving them the opportunity to participate in the process in a manner appropriate to their capacity.

Effect of individualised strength and plyometric training on the physical performance of basketball players.

The aims of this study were to examine the effects of eight weeks of individualised force-velocity imbalance (F-Vimb) training on physical performance in basketball players and to analyse the differences in physical performance between two periods of time (four to eight weeks) with this training. Thirty male players (age, 22.8 ± 5.68 years; height, 1.87 ± 0.07 m; body mass, 86.3 ± 11.1 kg) were divided into an intervention group (INT, n = 15), who performed an individualised training based on individual F-Vimb; and a control group (CON, n = 15), who underwent a non-individualised training programme; both groups performed two days/week of intervention and the same pre-season basketball training. At baseline, at four weeks, and at eight weeks of intervention, an assessment was performed including countermovement-jumps, unilateral drop jumps, triple hop test, force-velocity profile, sprint and change of direction (COD). At four weeks, the INT showed improvements in sprint and vertical jumping actions (≥3.76%, ES ≥0.44, p ≤ 0.02). At eight weeks, the INT continued to improve vertical jumping actions (p < 0.05) and showed improvements in horizontal jumping (6.80%, ES = 0.45, p < 0.01) and COD (≥2.99%, ES ≥0.96, p < 0.01). A significant reduction in F-Vimb was observed for INT (ES = 0.77, p = 0.01). In contrast, none of these changes were observed in CON. Thus, an individualised F-Vimb training intervention improved physical performance after eight weeks, with changes in sprint and vertical jump after first four weeks. Basketball coaches should optimise the force-velocity profile and improve the performance in sport-related actions as jumping and changing direction.

An individualised F-Vimb training programme improved sport-specific actions after eight weeks in basketball athletes.Improvements were specific to the orientation worked on, with vertical jumping and sprint actions being the most sensitive to change after just four weeks of individualised F-Vimb intervention.In complex actions such as COD, it would be recommended to optimise the F-V profile, emphasising a vertical force-orientation for at least 8 weeks.

The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era.

OBJECTIVES: To establish the epidemiological characteristics, ventilator management, and outcomes in patients with acute hypoxemic respiratory failure (AHRF), with or without acute respiratory distress syndrome (ARDS), in the era of lung-protective mechanical ventilation (MV). DESIGN: A 6-month prospective, epidemiological, observational study. SETTING: A network of 22 multidisciplinary ICUs in Spain. PATIENTS: Consecutive mechanically ventilated patients with AHRF (defined as Pao2/Fio2 ≤ 300 mm Hg on positive end-expiratory pressure [PEEP] ≥ 5 cm H2O and Fio2 ≥ 0.3) and followed-up until hospital discharge. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were prevalence of AHRF and ICU mortality. Secondary outcomes included prevalence of ARDS, ventilatory management, and use of adjunctive therapies. During the study period, 9,803 patients were admitted: 4,456 (45.5%) received MV, 1,271 (13%) met AHRF criteria (1,241 were included into the study: 333 [26.8%] met Berlin ARDS criteria and 908 [73.2%] did not). At baseline, tidal volume was 6.9 ± 1.1 mL/kg predicted body weight, PEEP 8.4 ± 3.1 cm H2O, Fio2 0.63 ± 0.22, and plateau pressure 21.5 ± 5.4 cm H2O. ARDS patients received higher Fio2 and PEEP than non-ARDS (0.75 ± 0.22 vs 0.59 ± 0.20 cm H2O and 10.3 ± 3.4 vs 7.7 ± 2.6 cm H2O, respectively [p < 0.0001]). Adjunctive therapies were rarely used in non-ARDS patients. Patients without ARDS had higher ventilator-free days than ARDS (12.2 ± 11.6 vs 9.3 ± 9.7 d; p < 0.001). All-cause ICU mortality was similar in AHRF with or without ARDS (34.8% [95% CI, 29.7-40.2] vs 35.5% [95% CI, 32.3-38.7]; p = 0.837). CONCLUSIONS: AHRF without ARDS is a very common syndrome in the ICU with a high mortality that requires specific studies into its epidemiology and ventilatory management. We found that the prevalence of ARDS was much lower than reported in recent observational studies.

Stratification for Identification of Prognostic Categories In the Acute RESpiratory Distress Syndrome (SPIRES) Score.

OBJECTIVES: To develop a scoring model for stratifying patients with acute respiratory distress syndrome into risk categories (Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score) for early prediction of death in the ICU, independent of the underlying disease and cause of death. DESIGN: A development and validation study using clinical data from four prospective, multicenter, observational cohorts. SETTING: A network of multidisciplinary ICUs. PATIENTS: One-thousand three-hundred one patients with moderate-to-severe acute respiratory distress syndrome managed with lung-protective ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The study followed Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis guidelines for prediction models. We performed logistic regression analysis, bootstrapping, and internal-external validation of prediction models with variables collected within 24 hours of acute respiratory distress syndrome diagnosis in 1,000 patients for model development. Primary outcome was ICU death. The Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score was based on patient's age, number of extrapulmonary organ failures, values of end-inspiratory plateau pressure, and ratio of Pao2 to Fio2 assessed at 24 hours of acute respiratory distress syndrome diagnosis. The pooled area under the receiver operating characteristic curve across internal-external validations was 0.860 (95% CI, 0.831-0.890). External validation in a new cohort of 301 acute respiratory distress syndrome patients confirmed the accuracy and robustness of the scoring model (area under the receiver operating characteristic curve = 0.870; 95% CI, 0.829-0.911). The Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score stratified patients in three distinct prognostic classes and achieved better prediction of ICU death than ratio of Pao2 to Fio2 at acute respiratory distress syndrome onset or at 24 hours, Acute Physiology and Chronic Health Evaluation II score, or Sequential Organ Failure Assessment scale. CONCLUSIONS: The Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score represents a novel strategy for early stratification of acute respiratory distress syndrome patients into prognostic categories and for selecting patients for therapeutic trials.

Influence of Dynamic Balance on Jumping-Based Asymmetries in Team Sport: A between-Sports Comparison in Basketball and Handball Athletes.

The aims of the present study were to analyze mobility, dynamic balance and lower-limb strength and the prevalence of asymmetry according to the type of sport and assess the association between inter-limb asymmetry and sports performance. A total of 23 basketball and 25 handball players performed a test battery consisting of functional movements and a jump test. Inter-limb asymmetry was calculated using a standard percentage difference equation. A between-groups comparison analysis was carried out, and Pearson's correlation coefficients (r) were calculated to establish a relationship between asymmetries and physical performance. The results found athletes in different sports to exhibit different performance in functional movements and the jump test, but no bilateral asymmetries. The reactive strength index (RSI) and stiffness asymmetries were significantly associated with the anterior reach Y-balance test (YBT) (r = -0.412; p < 0.01 and r = -0.359; p < 0.05, respectively), and the unilateral triple hop test (THTU) was negatively correlated to anterior reach, posterior lateral reach YBT and YBT composite YBT (r = -0.341 to -0.377; p < 0.05). These findings suggest that the asymmetries exhibited important dispersion not dependent upon the type of sport but on each individual and the applied test. In addition, asymmetry in anterior direction YBT showed the strongest association to the rest of the sports performance variables.

Decisive Factors for a Greater Performance in the Change of Direction and Its Angulation in Male Basketball Players.

A study was made to initially evaluate whether the age category directly could influence anthropometric measurements, functional movement tests, linear sprint (30 m) and strength. Moreover, and as the main purpose, this study aimed to examine the relationship between the time execution and angles in different changes of direction (COD) test with the analyzed sport performance variables. A total sample of 23 basketball players (age: 17.5 ± 2.42 years; height: 184.6 ± 6.68 cm; body weight: 78.09 ± 11.9 kg). Between-groups' comparison explored the differences between basketball categories (Junior, n = 12; Senior, n = 11). The COD variables were divided by the time execution into low responders (LR) and high responders (HR) to establish comparisons between groups related to COD time execution. Pearson's correlation coefficient was used to establish correlations between different CODs and sport performance variables. The results showed a greater influence of age category upon COD performance, especially when the cutting angle was sharper (7.05% [Confidence limits (CL) 90%: 2.33; 11.99]; Quantitative chances (QC) 0/2/98), in which athletes need greater application of strength. Moreover, the sharper the angle or the larger the number of cuts made, the greater the relationship with the vertical force-velocity profile (-42.39 [CL 90%: -57.37; -22.16]; QC 100/0/0%). Thus, the usefulness of the f-v profile to implement training programs that optimize the f-v imbalance and the improvement of the COD performance in basketball players is suggested.

Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial.

BACKGROUND: There is no proven specific pharmacological treatment for patients with the acute respiratory distress syndrome (ARDS). The efficacy of corticosteroids in ARDS remains controversial. We aimed to assess the effects of dexamethasone in ARDS, which might change pulmonary and systemic inflammation and result in a decrease in duration of mechanical ventilation and mortality. METHODS: We did a multicentre, randomised controlled trial in a network of 17 intensive care units (ICUs) in teaching hospitals across Spain in patients with established moderate-to-severe ARDS (defined by a ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen of 200 mm Hg or less assessed with a positive end-expiratory pressure of 10 cm H2O or more and FiO2 of 0·5 or more at 24 h after ARDS onset). Patients with brain death, terminal-stage disease, or receiving corticosteroids or immunosuppressive drugs were excluded. Eligible patients were randomly assigned based on balanced treatment assignments with a computerised randomisation allocation sequence using blocks of 10 opaque, sealed envelopes to receive immediate treatment with dexamethasone or continued routine intensive care (control group). Patients in the dexamethasone group received an intravenous dose of 20 mg once daily from day 1 to day 5, which was reduced to 10 mg once daily from day 6 to day 10. Patients in both groups were ventilated with lung-protective mechanical ventilation. Allocation concealment was maintained at all sites during the trial. Primary outcome was the number of ventilator-free days at 28 days, defined as the number of days alive and free from mechanical ventilation from day of randomisation to day 28. Secondary outcome was all-cause mortality 60 days after randomisation. All analyses were done according to the intention-to-treat principle. This study is registered with ClinicalTrials.gov, NCT01731795. FINDINGS: Between March 28, 2013, and Dec 31, 2018, we enrolled 277 patients and randomly assigned 139 patients to the dexamethasone group and 138 to the control group. The trial was stopped by the data safety monitoring board due to low enrolment rate after enrolling more than 88% (277/314) of the planned sample size. The mean number of ventilator-free days was higher in the dexamethasone group than in the control group (between-group difference 4·8 days [95% CI 2·57 to 7·03]; p<0·0001). At 60 days, 29 (21%) patients in the dexamethasone group and 50 (36%) patients in the control group had died (between-group difference -15·3% [-25·9 to -4·9]; p=0·0047). The proportion of adverse events did not differ significantly between the dexamethasone group and control group. The most common adverse events were hyperglycaemia in the ICU (105 [76%] patients in the dexamethasone group vs 97 [70%] patients in the control group), new infections in the ICU (eg, pneumonia or sepsis; 33 [24%] vs 35 [25%]), and barotrauma (14 [10%] vs 10 [7%]). INTERPRETATION: Early administration of dexamethasone could reduce duration of mechanical ventilation and overall mortality in patients with established moderate-to-severe ARDS. FUNDING: Fundación Mutua Madrileña, Instituto de Salud Carlos III, The European Regional Development's Funds, Asociación Científica Pulmón y Ventilación Mecánica.

A Prognostic Enrichment Strategy for Selection of Patients With Acute Respiratory Distress Syndrome in Clinical Trials.

OBJECTIVES: Incomplete or ambiguous evidence for identifying high-risk patients with acute respiratory distress syndrome for enrollment into randomized controlled trials has come at the cost of an unreasonable number of negative trials. We examined a set of selected variables early in acute respiratory distress syndrome to determine accurate prognostic predictors for selecting high-risk patients for randomized controlled trials. DESIGN: A training and testing study using a secondary analysis of data from four prospective, multicenter, observational studies. SETTING: A network of multidisciplinary ICUs. PATIENTS: We studied 1,200 patients with moderate-to-severe acute respiratory distress syndrome managed with lung-protective ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We evaluated different thresholds for patient's age, PaO2/FIO2, plateau pressure, and number of extrapulmonary organ failures to predict ICU outcome at 24 hours of acute respiratory distress syndrome diagnosis. We generated 1,000 random scenarios as training (n = 900, 75% of population) and testing (n = 300, 25% of population) datasets and averaged the logistic coefficients for each scenario. Thresholds for age (< 50, 50-70, > 70 yr), PaO2/FIO2 (≤ 100, 101-150, > 150 mm Hg), plateau pressure (< 29, 29-30, > 30 cm H2O), and number of extrapulmonary organ failure (< 2, 2, > 2) stratified accurately acute respiratory distress syndrome patients into categories of risk. The model that included all four variables proved best to identify patients with the highest or lowest risk of death (area under the receiver operating characteristic curve, 0.86; 95% CI, 0.84-0.88). Decision tree analyses confirmed the accuracy and robustness of this enrichment model. CONCLUSIONS: Combined thresholds for patient's age, PaO2/FIO2, plateau pressure, and extrapulmonary organ failure provides prognostic enrichment accuracy for stratifying and selecting acute respiratory distress syndrome patients for randomized controlled trials.

A vascular endothelial growth factor receptor gene variant is associated with susceptibility to acute respiratory distress syndrome.

BACKGROUND: The acute respiratory distress syndrome (ARDS) is one of the main causes of mortality in adults admitted to intensive care units. Previous studies have demonstrated the existence of genetic variants involved in the susceptibility and outcomes of this syndrome. We aimed to identify novel genes implicated in sepsis-induced ARDS susceptibility. METHODS: We first performed a prioritization of candidate genes by integrating our own genomic data from a transcriptomic study in an animal model of ARDS and from the only published genome-wide association study of ARDS study in humans. Then, we selected single nucleotide polymorphisms (SNPs) from prioritized genes to conduct a case-control discovery association study in patients with sepsis-induced ARDS (n = 225) and population-based controls (n = 899). Finally, we validated our findings in an independent sample of 661 sepsis-induced ARDS cases and 234 at-risk controls. RESULTS: Three candidate genes were prioritized: dynein cytoplasmic-2 heavy chain-1, fms-related tyrosine kinase 1 (FLT1), and integrin alpha-1. Of those, a SNP from FLT1 gene (rs9513106) was associated with ARDS in the discovery study, with an odds ratio (OR) for the C allele of 0.76, 95% confidence interval (CI) 0.58-0.98 (p = 0.037). This result was replicated in an independent study (OR = 0.78, 95% CI = 0.62-0.98, p = 0.039), showing consistent direction of effects in a meta-analysis (OR = 0.77, 95% CI = 0.65-0.92, p = 0.003). CONCLUSIONS: We identified FLT1 as a novel ARDS susceptibility gene and demonstrated that integration of genomic data can be a valid procedure to identify novel susceptibility genes. These results contribute to previous firm associations and functional evidences implicating FLT1 gene in other complex traits that are mechanistically linked, through the key role of endothelium, to the pathophysiology of ARDS.

Polyserositis: a diagnostic challenge.

BACKGROUND: Polyserositis (PS) is the inflammation, with effusion, of different serous membranes. It has been associated with different aetiologies, but the aetiology of PS remains unknown in a high percentage of patients. AIMS: The general objective of this retrospective study was to analyse the aetiology of PS cases seen at Son Llàtzer Hospital in an 11-year period. Other objectives were to determine the epidemiological, clinical and analytical characteristics of these patients. METHODS: An observational, descriptive and retrospective study to analyse the aetiology of PS cases seen at Son Llàtzer Hospital. The inflammation of two or more serous membranes confirmed by an imaging test was required and at least one of the serous fluid should be an exudate. RESULTS: A total of 92 patients was included in the study. The most common diagnosis was neoplasm (nearly one-third of cases) followed by infectious and autoimmune diseases. PS aetiology was unknown in more than one-third. Pleura and pericardium were the most common sites of serosal involvement (83%). Antinuclear antibodies' positivity in serum and increased levels of adenosine deaminase in pleural effusion were significantly associated with a final diagnosis of autoimmune disease. Increased pleural lactate dehydrogenase levels were significantly associated with a final diagnosis of neoplasm. In 9 of 14 patients with a previous cancer, PS represented a recurrence of their cancer. Cases of unknown aetiology presented most frequently as pleural and pericardial involvement, and the majority resolved. In very few patients, an infectious aetiology could be proven. CONCLUSION: PS is a frequent clinical entity that is associated with different diseases and its diagnosis could be challenging, with a high rate of unknown aetiologies.

Evaluating the efficacy of dexamethasone in the treatment of patients with persistent acute respiratory distress syndrome: study protocol for a randomized controlled trial.

BACKGROUND: Although much has evolved in our understanding of the pathogenesis and factors affecting outcome of patients with acute respiratory distress syndrome (ARDS), still there is no specific pharmacologic treatment for ARDS. Several clinical trials have evaluated the utility of corticoids but none of them has demonstrated a definitive benefit due to small sample sizes, selection bias, patient heterogeneity, and time of initiation of treatment or duration of therapy. We postulated that adjunctive treatment of persistent ARDS with intravenous dexamethasone might change the pulmonary and systemic inflammatory response and thereby reduce morbidity, leading to a decrease in duration of mechanical ventilation and a decrease in mortality. METHODS/DESIGN: This is a prospective, multicenter, randomized, controlled trial in 314 patients with persistent moderate/severe ARDS. Persistent ARDS is defined as maintaining a PaO2/FiO2 ≤ 200 mmHg on PEEP ≥ 10 cmH2O and FiO2 ≥ 0.5 after 24 hours of routine intensive care. Eligible patients will be randomly allocated to two arms: (i) conventional treatment without dexamethasone, (ii) conventional treatment plus dexamethasone. Patients in the dexamethasone group will be treated with a daily dose of 20 mg iv from day 1 to day 5, and 10 mg iv from day 6 to day 10. Primary outcome is the number of ventilator-free days, defined as days alive and free from mechanical ventilation at day 28 after intubation. Secondary outcome is all-cause mortality at day 60 after enrollment. DISCUSSION: This study will be the largest randomized controlled clinical trial to assess the role of dexamethasone in patients with persistent ARDS. TRIAL REGISTRATION: Registered on 21 November 2012 as DEXA-ARDS at ClinicalTrials.gov website ( NCT01731795 ).

Age, PaO2/FIO2, and Plateau Pressure Score: A Proposal for a Simple Outcome Score in Patients With the Acute Respiratory Distress Syndrome.

OBJECTIVES: Although there is general agreement on the characteristic features of the acute respiratory distress syndrome, we lack a scoring system that predicts acute respiratory distress syndrome outcome with high probability. Our objective was to develop an outcome score that clinicians could easily calculate at the bedside to predict the risk of death of acute respiratory distress syndrome patients 24 hours after diagnosis. DESIGN: A prospective, multicenter, observational, descriptive, and validation study. SETTING: A network of multidisciplinary ICUs. PATIENTS: Six-hundred patients meeting Berlin criteria for moderate and severe acute respiratory distress syndrome enrolled in two independent cohorts treated with lung-protective ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using individual demographic, pulmonary, and systemic data at 24 hours after acute respiratory distress syndrome diagnosis, we derived our prediction score in 300 acute respiratory distress syndrome patients based on stratification of variable values into tertiles, and validated in an independent cohort of 300 acute respiratory distress syndrome patients. Primary outcome was in-hospital mortality. We found that a 9-point score based on patient's age, PaO2/FIO2 ratio, and plateau pressure at 24 hours after acute respiratory distress syndrome diagnosis was associated with death. Patients with a score greater than 7 had a mortality of 83.3% (relative risk, 5.7; 95% CI, 3.0-11.0), whereas patients with scores less than 5 had a mortality of 14.5% (p < 0.0000001). We confirmed the predictive validity of the score in a validation cohort. CONCLUSIONS: A simple 9-point score based on the values of age, PaO2/FIO2 ratio, and plateau pressure calculated at 24 hours on protective ventilation after acute respiratory distress syndrome diagnosis could be used in real time for rating prognosis of acute respiratory distress syndrome patients with high probability.

Assessment of PaO2/FiO2 for stratification of patients with moderate and severe acute respiratory distress syndrome.

OBJECTIVES: A recent update of the definition of acute respiratory distress syndrome (ARDS) proposed an empirical classification based on ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) at ARDS onset. Since the proposal did not mandate PaO2/FiO2 calculation under standardised ventilator settings (SVS), we hypothesised that a stratification based on baseline PaO2/FiOv would not provide accurate assessment of lung injury severity. DESIGN: A prospective, multicentre, observational study. SETTING: A network of teaching hospitals. PARTICIPANTS: 478 patients with eligible criteria for moderate (100300). PRIMARY AND SECONDARY OUTCOMES: Group severity and hospital mortality. RESULTS: At ARDS onset, 173 patients had a PaO2/FiO2≤100 but only 38.7% met criteria for severe ARDS at 24 h under SVS. When assessed under SVS, 61.3% of patients with severe ARDS were reclassified as moderate, mild and non-ARDS, while lung severity and hospital mortality changed markedly with every PaO2/FiO2 category (p<0.000001). Our model of risk stratification outperformed the stratification using baseline PaO2/FiO2 and non-standardised PaO2/FiO2 at 24 h, when analysed by the predictive receiver operating characteristic (ROC) curve: area under the ROC curve for stratification at baseline was 0.583 (95% CI 0.525 to 0.636), 0.605 (95% CI 0.552 to 0.658) at 24 h without SVS and 0.693 (95% CI 0.645 to 0.742) at 24 h under SVS (p<0.000001). CONCLUSIONS: Our findings support the need for patient assessment under SVS at 24 h after ARDS onset to assess disease severity, and have implications for the diagnosis and management of ARDS patients. TRIAL REGISTRATION NUMBERS: NCT00435110 and NCT00736892.

Demostración ecocardiográfica de la contracción mecánica auriculoventricular en el flutter auricular común / No disponible

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