Instalación del equipo para terapia con óxido nítrico inhalado en paciente con asistencia mecánica ventilatoria / Equipment installation for inhaled nitric oxide therapy in required mechanical ventilation patients", "_i": "

La instalación del equipo para terapia con óxido nítrico inhalado en paciente con asistencia mecánica ventilatoria es un conjunto de actividades que pretenden garantizar la administración segura y continua del óxido nítrico inhalado, con la finalidad de evitar o limitar los efectos secundarios derivados de esta terapia. Este procedimiento se encuentra dividido en tres etapas: la preparación del sistema de suministro del óxido nítrico, la conexión del sistema de inyección del gas y la instalación del monitoreo del suministro de gas; además es imprescindible tener presente las indicaciones, contraindicaciones, complicaciones y puntos importantes en todo el proceso de instalación del sistema.

Equipment installation for inhaled nitric oxide therapy in required mechanical ventilation patients is a set of activities that pretend to assure the safe and continual administration of inhaled nitric oxide in order to avoid or limit the secondary effects resulting from this therapy. This procedure is divided in three stages: the supply system preparation of the nitric oxide, the connection of the gas injection system and the monitoring gas supply installation; is essential, as well, keep in mind the indications, contraindications, complications and main points in all the system installation process

Protección ocular al paciente en estado crítico bajo efectos de sedación / Eye protection for the patient in critical condition under sedation effect", "_i": "

Considerando la tendencia mundial sobre la seguridad del paciente y la calidad del cuidado se hace indispensable diseñar, proponer e implementar procedimientos que lleven a satisfacer tales objetivos. El paciente en estado crítico requiere de cuidados especializados que garanticen la integridad física durante su estancia hospitalaria, a fin de prevenir y/o limitar las complicaciones que en la convalecencia resulten trascendentales para su rehabilitación y reintegración a su rol social. Por lo tanto se propone el procedimiento de protección ocular al paciente en estado crítico bajo efectos de sedación en cuatro etapas que pueden aplicarse de manera universal en toda instancia hospitalaria en la que se proporcione cuidado enfermero a pacientes con deficiencia en la oclusión natural de los ojos.

Considering the world-wide tendency on the security of the patient and the quality of the care it is made indispensable design, propose and implement procedures that take to satisfy such objectives. The patient in critical state requires of specialized cares that guarantee physical integrity during their hospital stay, in order to prevent and/or to limit the complications that in the rehabilitation are transcendental for their rehabilitation and reintegration to their social roll. Therefore the procedure of ocular protection to the patient in critical state under effects of sedation in four stages sets out that can be applied of universal way in all hospitable instance in which well-taken care of nurse to patients with deficiency in the natural occlusion of the eyes provides itself.

Transanal rectocele repair using linear stapler and bioabsorbable staple line reinforcement material: short-term results of a prospective study.

PURPOSE: This study was designed to determine the short-term results of transanal rectocele repair with use of a linear stapler and Bioabsorbable Seamguard. METHODS: Ten women (median age, 56.1 y) with obstructed defecation syndrome were enrolled in the study. The preoperative study consisted of a medical history, physical examination, anoscopy, endoanal ultrasound, and defecography. All patients completed a severity score and a visual analog scale for global quality of life, and provided the postoperative dates of complications. RESULTS: Overall, the treatment significantly improved the obstructed defecation: the severity score improved from a median of 19.8 +/- 4.2 at baseline to 6.10 +/- 8.2 at one month (P < .005), 5.9 +/- 8.3 at 6 months (P < .005), and 6 +/- 8.3 at one year after the operation (P < .005). A significant improvement was observed in the visual analog scale, which improved from a median of 1.8 +/- 1.4 at baseline to 6 +/- 1.6 at one month (P < .005), 6.6 +/- 2.1 at 6 months (P < .004), and 7 +/- 2.5 at one year (P < .004). A significant improvement was also observed in various symptoms. Only 2 patients manifested urgent defecation. CONCLUSIONS: The present study demonstrates that rectocele repair using a linear stapler and Seamguard is a safe, easy procedure, with a very low rate of complications and good immediate outcome.

Evaluation by three-dimensional anal endosonography of injectable silicone biomaterial (PTQ) implants to treat fecal incontinence: long-term localization and relation with the deterioration of the continence.

BACKGROUND: The purposes of the study were the long-term evaluation of silicone implants with three-dimensional (3D) anal endosonography and its correlation with anal incontinence. METHODS: Fifteen patients were injected with silicone because of anal incontinence and co-existing internal anal sphincter disruption (n = 8) or thinning (n = 7). The evaluation was performed with the Wexner score and 3D anal endosonographies. RESULTS: Forty-four implants were performed. The endosonography at 3 months detected that all the implants were properly located. At 24 months, it detected 37/44 implants of initially injected and 33/37 were properly located. Four of 37 implants had moved and 7/44 were neither in the anus nor in the rectum. A total of 8/15 patients had their implants correctly placed. Globally, silicone implants significantly improved fecal continence. CONCLUSIONS: The silicone implants might have moved or even be lost. The continence deterioration suffered by most patients after the first year of the injection has no relation with the localization and number of implants that the patients have.

Evaluation of the use of PTQ implants for the treatment of incontinent patients due to internal anal sphincter dysfunction.

OBJECTIVE: This study reports the results of injectable silicone PTQ implants for faecal incontinence due to internal anal sphincter (IAS) dysfunction. METHOD: Twenty patients (12 women) with partial faecal incontinence aged from 55 to 65 years were treated by a PTQ implant. All patients completed the Cleveland Clinic Continence and Quality of Life questionnaire. Endoluminal ultrasound and anorectal physiological testing were performed in each patient. All implants were inserted into the submucosal plane without ultrasound guidance. RESULTS: Faecal continence was significantly improved up to 1 year. The Wexner continence score fell from a median of 13.05 (range, 5-20) before treatment to 4.5 (range 2-7.7) at 1 month after (P < 0.005). This rose gradually to 6.2 (range, 0-16) at one year (P = 0.02) and 9.4 (range, 1-20) at 2 years (P = 0.127). There were no differences in resting or squeeze pressure before and at 3 months after treatment (P = 0.86 and P = 0.93). Fourteen (70%) patients experienced pruritus ani during the first few weeks after the procedure and one developed infection at the implant site. CONCLUSION: Silicone implantation is minimally invasive and technically simple. It is effective over 1 year in the treatment of faecal incontinence due to IAS dysfunction.

Nuevo método para el tratamiento local de las fístulas digestivas externas y sepsis grave de la herida / New methos for local treatment of outter digestive fistula oral acute sepsis in wounds

Se realiza estudio prospectivo de pacientes tratados en el Hospital General Docente “Dr. Agostinho Neto” de Guantánamo que presentan fístulas digestivas externas y sepsis grave de la herida, desde enero de 1988 a diciembre de 2002, y que usan para su tratamiento local dispositivo para lavado y succión en fístulas y heridas infectadas. De los 22 pacientes tratados, 18 fueron por fístulas digestivas externas y, 4, por sepsis grave de la herida. De las 18 fístulas tratadas, curaron 16 (88.88 por ciento de curación) y fallecieron 2 (9.2 por ciento). Las 4 sepsis graves de las heridas curaron para el 100 por ciento de curación. De los 22 pacientes tratados en total curaron, 20 para un 90.9 por ciento y fallecieron, 2 para un 9.1 por ciento (AU)

Bioabsorbable staple-line reinforcement to reduce staple-line bleeding in the transection of mesenteric vessels during laparoscopic colorectal resection: a pilot study.

BACKGROUND: Staple line hemorrhage and leak are the 2 most dreaded complications of laparoscopyassisted resection of colorectal cancer (LARCC). Recently, anastomotic staple lines have been reinforced with a range of absorbable and non-absorbable bioprosthetic reinforcement materials. This pilot prospective study used the bioabsorbable Seamguard (BSG; WL Gore & Associates, Flagstaff, AZ) for routine reinforcement of the mesenteric vascular staple transection to prevent mesenteric hemorrhage and to assess its safety and feasibility in a consecutive series of laparoscopic colonic resections. METHODS: Twenty-five patients consecutively scheduled to undergo LARCC were enrolled in the study. All operations were performed with a standard LARCC technique which included loading of the BSG sleeves onto the jaws of the cutter/stapler. RESULTS: There were 23 wholly LARCC cases and 2 open conversions. BSG was used in all 25 patients. No patient experienced staple-line bleeding or other complications during the surgical procedure. The mean number of staple-line reinforcement sleeves used was 2.6 (range, 2-4). The mean operative time was 118 minutes (range, 65-184 minutes). Additional measures to achieve hemostasis were not required in any case. The mean cost was US 475.20 dollars for the procedure. CONCLUSIONS: This small pilot study has shown the routine use of BSG mesenteric staple line reinforcement to be safe, quick and effective during LARCC.

Use of anorectal ultrasounds in perianal Crohn's disease: consistency with clinical data.

BACKGROUND: anorectal ultrasonography (ARU) is a simple technique, and its diagnostic value for anorectal diseases either in conventional subjects or in patients with Crohn s disease (CD) is insufficiently reported. The objective of this study is to evaluate the use of ARU, its consistency with clinical orientation, and its ability to provide relevant information for patients with bowel CD and perianal involvement. METHODS: thirty ARUs were performed for 24 patients (17 male, mean age 35,7 years; range 19-59 years) with diagnosed CD (bowel and anorectal involvement). The reason to perform an ARU was to evaluate an anal fistula (15 patients, 50%), potential abscesses (9 patients, 30%), and fecal incontinence (2 patients, 6,6%), and for post-treatment monitoring purposes (4 patients, 13,3%). RESULTS: diagnostic orientation coincided for 14 patients (46,6%). An abscess was found in eight patients (26,6%), and five patients were clinically suspicious. The abscess was postanal in 3 patients. Fistulas were found in 17 patients (56,6%), and 15 patients were clinically suspicious. Transsphincterian fistulas were observed in seven patients, and abscesses were associated with fistula in six patients. Transsphincteric defects were observed in 10 patients (four internal sphincters, one external sphincter, and five both) but only two patients suffered from incontinence. ARU provided data relevant to therapeutic approach in 19 patients (63,3%). CONCLUSIONS: ARU has provided very important data for the diagnosis and treatment of anorectal diseases. Based on this technique clinical decisions can be improved, which in some instances may prove critical.

Utilidad de la ecografía anorrectal en el Crohn perianal y su concordancia con la clínica / Use of anorectal ultrasounds in perianal Crohn's disease: consistency with clinical data

Introducción: la ecografía anorrectal (EAR) es una exploraciónsencilla y está altamente contrastado su utililización en la bibliografía.El propósito del estudio ha sido examinar la utilidad dela EAR, la coincidencia con la orientación clínica y la capacidadde aportación de datos de interés en aquellos pacientes con enfermedadde Crohn perianal (ECPA).Métodos: se realizaron 30 EAR en 24 pacientes (17 hombres,edad media 35,7) con enfermedad de Crohn diagnosticada ysospecha clínica de tener algún proceso anorrectal. El motivo másfrecuente de petición de EAR fue la valoración de fístula anal (15casos, 50%), sospecha abscesos (9 casos, 30%), incontinencia fecal(2 casos, 6,6%) y control evolutivo tras tratamiento (4 casos,13,3%).Resultados: la orientación diagnóstica coincidió en 14 pacientes(46,6%). Los abscesos fueron encontrados en 8 pacientes(26,6%), cinco de ellos sospechados clínicamente. La localizaciónmás frecuente fue postanal (3 pacientes). Se detectaron fístulas en17 pacientes (56,6%), en 15 de ellos sospechados; siendo la tranesfinterianala más frecuente (7 pacientes). En 6 pacientes las fístulastenían además abscesos asociados. Defectos esfinterianosfueron observados en 10 pacientes (cuatros del esfínter interno,uno del externo y cinco en ambos); sin embargo sólo 2 pacientespadecían incontinencia. Datos ultrasonográficos relevantes paraplantear un plan terapéutico fueron obtenidos en 19 pacientes(63,3%).Conclusiones: la EAR ha proporcionado importantes datosen el diagnóstico y para el tratamiento la enfermedad anorrectal.Basándonos en ella, podemos mejorar la decisión clínica, aportandoun cambio terapéutico que puede ser crítico en algunos casos

Background: anorectal ultrasonography (ARU) is a simpletechnique, and its diagnostic value for anorectal diseases either inconventional subjects or in patients with Crohn's disease (CD) isinsufficiently reported. The objective of this study is to evaluatethe use of ARU, its consistency with clinical orientation, and itsability to provide relevant information for patients with bowel CDand perianal involvement.Methods: thirty ARUs were performed for 24 patients (17male, mean age 35,7 years; range 19-59 years) with diagnosedCD (bowel and anorectal involvement). The reason to perform anARU was to evaluate an anal fistula (15 patients, 50%), potentialabscesses (9 patients, 30%), and fecal incontinence (2 patients,6,6%), and for post-treatment monitoring purposes (4 patients,13,3%).Results: diagnostic orientation coincided for 14 patients(46,6%). An abscess was found in eight patients (26,6%), andfive patients were clinically suspicious. The abscess was postanalin 3 patients. Fistulas were found in 17 patients (56,6%), and15 patients were clinically suspicious. Transsphincterian fistulaswere observed in seven patients, and abscesses were associatedwith fistula in six patients. Transsphincteric defects were observedin 10 patients (four internal sphincters, one externalsphincter, and five both) but only two patients suffered from incontinence.ARU provided data relevant to therapeutic approachin 19 patients (63,3%).Conclusions: ARU has provided very important data for thediagnosis and treatment of anorectal diseases. Based on this techniqueclinical decisions can be improved, which in some instancesmay prove critical

Prevalence and factors associated with headache in patients with systemic lupus erythematosus.

Headache is common in systemic lupus erythematosus with reported prevalence as high as 70%. The aims of this study were: to estimate the prevalence and types of headache in a sample of patients with systemic lupus erythematosus comparing it with rheumatoid arthritis, to determine clinical and serological associations. Eighty-one systemic lupus erythematosus and 29 rheumatoid arthritis consecutive patients seen in our outpatient clinic were interviewed. Headache was evaluated using the diagnostic criteria proposed by the International Headache Society. Additional evaluations were carried out in the 81 systemic lupus erythematosus patients including depression, disease activity, lupus damage, function disability, quality of life, and severity degree using a validated scales. We analysed the following autoantibodies: anti-double stranded DNA, anti-nucleosomes, anti-histones, anti-ribosomal P, anti-cardiolipin antibodies, anti-beta2-glycoprotein-I (GPI), and antinuclear antibodies. Forty-one per cent of systemic lupus erythematosus and 17% of rheumatoid arthritis patients suffered from headache (P = 0.02). No significant difference for any primary headache type between the two groups was found. Frequency of headache types in systemic lupus erythematosus patients was: migraine 24%, tensional-type headache 11%, and mixed headache 5%. In systemic lupus erythematosus patients the risk factors associated with headaches were Raynaud's phenomenon (OR 3.6; 95% CI 1.3-9.5; P = 0.009) and beta2GPI antibody positivity (OR 4.5; 95% CI 1.2-16.2; p = 0.016). We conclude that headache is more common in systemic lupus erythematosus than in rheumatoid arthritis patients and was independently associated with Raynaud's phenomenon and beta2GP-I antibodies.

Associated conditions in myasthenia gravis: response to thymectomy.

To compare the response of thymectomy in patients with associated conditions (PWAC) and without associated conditions (PWOAC). Comparative, retrospective. 198 patients with the established diagnosis of myasthenia gravis who had a thymectomy between 1987 and 2000, and who were folowed up for at least 3 years. We formed two groups, one with associated conditions and the second without associated conditions. The patients were divided into four groups: (i) patients in remission, (ii) patients with improvement, (iii) patients without changes, and (iv) patients whose condition worsened. Associated conditions (AC) were found in 49 patients (26%). The main associated conditions were hyperthyroidism in 16 patients (33%) hypothyroidism in seven (14%), rheumatoid arthritis in five (10%) and hypothyroidism and Sjogren syndrome in three (6%). Concerning the response of thymectomy, 13 patients WAC showed remission (27%), vs. 54 patients WOAC (39%). Twenty patients WAC showed improvement (41%) vs. 46 WOAC (33%). Thirteen patients WAC had no changes (27%) vs. 37 WOAC (26%). Finally, in three patients WAC their condition worsened (6%) vs. three WOAC (2%). The response to thymectomy was high (69%) in both groups. We did not identify significant differences.

Response of thymectomy: clinical and pathological characteristics among seronegative and seropositive myasthenia gravis patients.

OBJECTIVE: To identify the response to thymectomy in patients with seronegative and seropositive myasthenia gravis (SPMG). We analyzed the associated diseases, thymus histology, and the severity of symptoms between the two groups. MATERIAL AND METHODS - DESIGN: Descriptive, comparative. STUDY UNITS: Fourteen patients with seronegative myasthenia gravis (SNMG) and 57 patients with SPMG who had a thymectomy between 1987 and 1997, with at least 3 years of follow-up. The patients were divided into four groups; (1) Remission, (2) Improvement, (3) No change and (4) Deterioration. RESULTS: Fourteen patients (20%) were seronegative and 57 were seropositive (80%). In the group of patients with SNMG, three patients were in remission (21%), five with improvement (36%), five with no change (36%) and one with worsening (7%). In the group of patients with SPMG, 12 were in remission (21%), 17 with improvement (30%), 25 with no change (44%) and three (5%) with worsening. The patients with SNMG were older, with less associated diseases and with a lower frequency of thymomas. CONCLUSIONS: The response to thymectomy was similar between the two groups. It has been suggested that seronegative patients have a better prognosis, but our results show no differences.

Pruebas diagnósticas en miastenia gravis. Conformación de un estándar diagnóstico mediante un método de consenso / Diagnostic test in myasthenia gravis. Creation of a standard for diagnosis using a method of consensus

Introducción. En la actualidad la mejor prueba para el diagnóstico de miastenia gravis (MG) es la electromiografía de fibra única (EFU). Debido al coste de la prueba, pocos hospitales en el mundo la pueden tener para uso rutinario para confirmar el diagnóstico de MG. Objetivo. Identificar un estándar de oro aceptable para hospitales que no cuenten de manera habitual con EFU mediante la utilización de una metodología de consenso realizado en tres etapas. Sujetos y métodos. Las dos primeras etapas del estudio se realizaron mediante encuestas prolectivas y la tercera etapa mediante una metodología Delfos. En la primera etapa se aplicó un instrumento a 55 neurólogos generales donde se preguntaba cuál era la mejor combinación de pruebas y la mejor prueba aislada con las que habitualmente realizaban el diagnóstico de MG. En la segunda etapa se aplicó un segundo instrumento de recolección a 15 expertos de unidad motora (EUM), quienes analizaron cuatro situaciones clínicas frecuentes en la práctica (cuadro clínico clásico de MG generalizada, paciente con cuadro de miastenia ocular, cuadro de MG generalizada de mediana probabilidad y cuadro clínico de baja probabilidad), identificando la mejor prueba aislada y el mejor conjunto de pruebas para el diagnóstico de miastenia gravis con y sin el uso de EFU. Finalmente, se crearon cuatro flujogramas de las cuatro situaciones clínicas analizadas que fueron consensuados mediante una metodología Delfos con ocho neurólogos EUM. Resultados. Hemos identificado un estándar de oro aceptable para hospitales que no cuenten de manera general con EFU mediante una metodología de consenso. También hemos consensuado cuatro flujogramas diagnósticos de las situaciones clínicas más frecuentes a las que nos enfrentamos en la práctica clínica habitual. Conclusión. Hemos encontrado una serie de resultados con una utilidad importante para el diagnóstico de MG aplicables a médicos generales, médicos internistas y neurólogos que no cuenten con todas las pruebas disponibles para el diagnóstico de esta enfermedad (AU)

[Diagnostic tests in myasthenia gravis. Creation of a standard for diagnosis using a method of consensus]. / Pruebas diagnósticas en miastenia gravis. Conformación de un estándar diagnóstico mediante un método de consenso.

INTRODUCTION: Nowadays the best test for the diagnosis of myasthenia gravis (MG) is the single fiber electromyography (SFEMG). Due to the cost of the test it has not become routine in most part of the hospitals to confirm the diagnosis of MG. OBJECTIVE: To identify an acceptable gold standard for hospitals which do not have access to SFEMG, but have access to some other classical test through the use of a consensus methodology. SUBJECTS AND METHODS: The study was realized in three stages. The first two stages were done through a prolective survey and the third stage through a Delfos methodology. During the first stage 59 general neurologist were interviewed, applying an instrument in which they were asked which were the best test and the best group of tests to diagnose MG without using the SFEMG. During a second stage, a second collection instrument was applied to 15 experts in motoneuron diseases to identify the best isolated test and the best test scheme with and without using the SFEMG in four frequent clinical situations in clinical practice (typical clinical case of generalized MG, patient with ocular myasthenia, patient with generalized MG of medium and low probability). Finally four flowcharts were created of the four analyzed clinical situations and were approved through a Delfos methodology with 8 neurologist motoneuron disease. RESULTS: We identified an acceptable gold standard for hospitals which do not have access to SFEMG through the use of a consensus methodology. We have also completed four diagnostic flowcharts about the most frequent clinical situations that we have faced in the ordinary practice. CONCLUSIONS: We have found a series of important results for the diagnosis of MG available to general physicians, internists and neurologist that do not have all the test for the diagnosis of MG.

Laser surgery for retinopathy of prematurity.

Retinopathy of prematurity (ROP) is a common eye disorder occurring in preterm infants. Formally known as retrolental fibroplasia, ROP is defined as a vasoproliferative disorder that occurs in the developing retina of premature infants' eyes. Until recently, cryotherapy was the recommended treatment for infants diagnosed with advancing ROP. Now laser surgery is being used as an alternative treatment. This article reviews the pathophysiology, etiology, and classification of ROP, considers the pros and cons of laser surgery versus cryotherapy, and outlines the experience with laser surgery in our NICU.

Distintos comportamientos de la oxigenación sistémica e intestinal en el síndrome de distress respiratorio del adulto (ARDS) tratado con presión espiratoria positiva final (PEEP) / Different behaviors of the systemic and intestinal oxygenation in the adult respiratory distress syndrome treated with positive end-expiratory pressure

La relación entre disponibilidad y consumo de O2 (DO2 y VO2, respectivamente) ha sido extensamente estudiada en pacientes críticos. Sin embargo, existen pocos intentos de vincular éstas mediciones a la oxigenación tisular. Nosotros realizamos éste estudio en pacientes con ARDS tratados con PEEP con el propósito de demostrar que el pH intramucoso gástrico (pHi) podría contribuir al monitoreo de la oxigenación tisular y aportar información adicional sobre el significado de la relación VO2/DO2. Con éste objetivo, 11 pacientes con ARDS, sedados con diazepam, relajados con pancuronio y ventilados mecánicamente con una FiO2 de 1, fueron sometidos a incrementos secuenciales de PEEP a O, 10 y 15 cmH2O, con intervalos de 209 minutos. En cada caso se midieron pHi por tonometría, volumen minuto cardíaco por termodilución y contenidos arteriales y venosos mixtos de O2 (gases, Hb y saturación), calculándose DO2 y VO2. Se realizaron correlaciones entre DO2 y VO2 y DO2 y pHi por cuadrados mínimos. A través de un método de agrupamiento se distinguieron diferentes comportamientos. Adicionalmente, se incluyeron otros 2 pacientes para corroborar la metodología estadística. De ésta forma quedaron definidos 3 grupos. En el grupo I (6 pacientes), con las dismuinuciones de la DO2, el VO2 fue constante (r media 0,49 ñ 0,34), aunque el pHi se redujo (r media 0,90 ñ 0,09)...

Distintos comportamientos de la oxigenación sistémica e intestinal en el síndrome de distress respiratorio del adulto (ARDS) tratado con presión espiratoria positiva final (PEEP) / Different behaviors of the systemic and intestinal oxygenation in the adult respiratory distress syndrome treated with positive end-expiratory pressure

La relación entre disponibilidad y consumo de O2 (DO2 y VO2, respectivamente) ha sido extensamente estudiada en pacientes críticos. Sin embargo, existen pocos intentos de vincular éstas mediciones a la oxigenación tisular. Nosotros realizamos éste estudio en pacientes con ARDS tratados con PEEP con el propósito de demostrar que el pH intramucoso gástrico (pHi) podría contribuir al monitoreo de la oxigenación tisular y aportar información adicional sobre el significado de la relación VO2/DO2. Con éste objetivo, 11 pacientes con ARDS, sedados con diazepam, relajados con pancuronio y ventilados mecánicamente con una FiO2 de 1, fueron sometidos a incrementos secuenciales de PEEP a O, 10 y 15 cmH2O, con intervalos de 209 minutos. En cada caso se midieron pHi por tonometría, volumen minuto cardíaco por termodilución y contenidos arteriales y venosos mixtos de O2 (gases, Hb y saturación), calculándose DO2 y VO2. Se realizaron correlaciones entre DO2 y VO2 y DO2 y pHi por cuadrados mínimos. A través de un método de agrupamiento se distinguieron diferentes comportamientos. Adicionalmente, se incluyeron otros 2 pacientes para corroborar la metodología estadística. De ésta forma quedaron definidos 3 grupos. En el grupo I (6 pacientes), con las dismuinuciones de la DO2, el VO2 fue constante (r media 0,49 ñ 0,34), aunque el pHi se redujo (r media 0,90 ñ 0,09)...(AU)