Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial.

Importance: Daily spontaneous breathing trials (SBTs) are the best approach to determine whether patients are ready for disconnection from mechanical ventilation, but mode and duration of SBT remain controversial. Objective: To evaluate the effect of an SBT consisting of 30 minutes of pressure support ventilation (an approach that is less demanding for patients) vs an SBT consisting of 2 hours of T-piece ventilation (an approach that is more demanding for patients) on rates of successful extubation. Design, Setting, and Participants: Randomized clinical trial conducted from January 2016 to April 2017 among 1153 adults deemed ready for weaning after at least 24 hours of mechanical ventilation at 18 intensive care units in Spain. Follow-up ended in July 2017. Interventions: Patients were randomized to undergo a 2-hour T-piece SBT (n = 578) or a 30-minute SBT with 8-cm H2O pressure support ventilation (n = 557). Main Outcome and Measures: The primary outcome was successful extubation (remaining free of mechanical ventilation 72 hours after first SBT). Secondary outcomes were reintubation among patients extubated after SBT; intensive care unit and hospital lengths of stay; and hospital and 90-day mortality. Results: Among 1153 patients who were randomized (mean age, 62.2 [SD, 15.7] years; 428 [37.1%] women), 1018 (88.3%) completed the trial. Successful extubation occurred in 473 patients (82.3%) in the pressure support ventilation group and 428 patients (74.0%) in the T-piece group (difference, 8.2%; 95% CI, 3.4%-13.0%; P = .001). Among secondary outcomes, for the pressure support ventilation group vs the T-piece group, respectively, reintubation was 11.1% vs 11.9% (difference, -0.8%; 95% CI, -4.8% to 3.1%; P = .63), median intensive care unit length of stay was 9 days vs 10 days (mean difference, -0.3 days; 95% CI, -1.7 to 1.1 days; P = .69), median hospital length of stay was 24 days vs 24 days (mean difference, 1.3 days; 95% CI, -2.2 to 4.9 days; P = .45), hospital mortality was 10.4% vs 14.9% (difference, -4.4%; 95% CI, -8.3% to -0.6%; P = .02), and 90-day mortality was 13.2% vs 17.3% (difference, -4.1% [95% CI, -8.2% to 0.01%; P = .04]; hazard ratio, 0.74 [95% CI, 0.55-0.99]). Conclusions and Relevance: Among patients receiving mechanical ventilation, a spontaneous breathing trial consisting of 30 minutes of pressure support ventilation, compared with 2 hours of T-piece ventilation, led to significantly higher rates of successful extubation. These findings support the use of a shorter, less demanding ventilation strategy for spontaneous breathing trials. Trial Registration: ClinicalTrials.gov Identifier: NCT02620358.

Prevalencia de burnout a través de dos medidas y su relación con variables sociodeportivas / Burnout's Prevalence through two Measures and its Relation with Sociodemographic's Variables

Resumen Se estudia la prevalencia del síndrome de burnout en deportistas y su relación con variables sociodeportivas. Se aplicaron los dos instrumentos de medida disponibles en España que miden el constructo: IBD-R y versión española del ABQ, en una muestra de 646 deportistas. Los resultados obtenidos muestran una prevalencia del 4.2 % para el IBD-R y 3.3 % para el ABQ, así como diferencias estadísticamente significativas para sexo, presentando los varones una realización personal más reducida que las mujeres, y niveles competitivos más altos de prevalencia general y de la subescala agotamiento físico/emocional en el nivel nacional que en el local. Estos datos son similares a los hallados en investigaciones anteriores, tanto en prevalencia como en diferencias según variables sociodeportivas.

Abstract This study aims to investigate the prevalence of burnout syndrome in athletes and their relation with different social and sporting variables. They have implemented the two instruments available in Spain for measuring burnout in athletes: IBD-R and the Spanish version of ABQ in a sample of 646 athletes with an average age of 19.73 years. The results show a prevalence of 4.2% for IBD-R and 3.3% for the ABQ and statistically significant differences for sex, presenting the smaller male self-fulfillment than women; and competitive, presenting higher prevalence levels overall and subscale physical/emotional exhaustion at the national level as home. These data are similar to those found in previous investigations, both prevalence and differences according social and sporting variables.

Entrenamiento psicológico en tiro olímpico: Estudio de un caso / Psychological training in olympic shooting: a case study / Treino psicológico no tiro olímpico: estudo de caso

Este artículo presenta una intervención psicológica con una tiradora olímpica de la modalidad pistola aire comprimido que presenta elevados niveles de estrés, ansiedad, síndrome de burnout y deseos de retirada deportiva. El objetivo fue reducir la sintomatología ansiosa y mejorar su rendimiento deportivo. La intervención tuvo una duración de doce meses y un seguimiento de seis meses. El entrenamiento psicológico estuvo compuesto por técnicas de planteamiento de objetivos, restructuración cognitiva, entrenamiento en parada de pensamiento, autoinstrucciones y técnicas de relajación y visualización. Tras la intervención psicológica desaparece el síndrome de burnout y mejoran los indicadores de estrés y ansiedad, aumentando el rendimiento deportivo de la tiradora y desapareciendo los pensamientos de abandono deportivo. Con esta investigación se pone de manifiesto la importancia del entrenamiento psicológico en los deportistas

This article sets out a psychological intervention on an Olympic shooter. She competes in the air gun class and shows high levels of stress, anxiety, burnout syndrome and desires to retire from the sport. The main objective was to cut down the symptoms of anxiety and to enhance her sporting performance. The intervention lasted twelve months and was followed up for six months. The psychological training was composed of target-setting techniques, cognitive restructuring, thought stopping training, self-instruction and relaxation and visualisation techniques. After the psychological intervention, the burnout syndrome disappeared and stress and anxiety indicators improved which meant that the shooter’s sporting performance increased and her desire to retire started to disappear. This research underscores the importance of psychological training in sport

Este artigo apresenta uma intervenção psicológica com uma atiradora olímpica da modalidade de pistola de ar comprimido que apresentaelevados níveis de stress, ansiedade, síndrome de burnout e desejos de retirada desportiva. O objectivo foi reduzir a sintomatologia ansiosa e potenciaro seu rendimento desportivo. A intervenção teve a duração de doze meses e um período de monitorização de seis meses. O treino psicológico foi compostopor técnicas de formulação de objectivos, restruturação cognitiva, treino em paragem de pensamento, auto-instruções e técnicas de relaxamento evisualização. Após a intervenção psicológica o síndrome de burnout foi eliminado, bem como os pensamentos de abandono desportivo. Por seu turno,verificou-se uma melhoria nos indicadores de stress e ansiedade, tal como no rendimento desportivo da atiradora. Com esta investigação comprova-sea importância do treino psicológico nos desportistas