Ventilación mecánica en pacientes tratados con membrana de oxigenación extracorpórea (ECMO) / Mechanical ventilation in patients subjected to extracorporeal membrane oxygenation (ECMO)

La ventilación mecánica (VM) es clave en el manejo del síndrome de distrés respiratorio del adulto (SDRA) ya que existe un alto nivel de evidencia de que la ventilación con volúmenes tidales de 6ml/kg (ventilación protectora) mejora la supervivencia. La oxigenación con membrana extracorpórea (ECMO) veno-venosa es una terapia de rescate en el tratamiento de la insuficiencia respiratoria refractaria que mejora la oxigenación, reduce el CO2 y facilita la aplicación de VM protectora, reduciendo potencialmente la lesión pulmonar asociada a VM. Aunque las estrategias ventilatorias en pacientes con SDRA han sido analizadas en numerosos estudios, no existe consenso respecto a cómo ventilar a pacientes con ECMO veno-venosa. El concepto de «lung rest», introducido hace años, carece aún de evidencias para recomendar su uso pero podría promover la recuperación pulmonar y facilitar el destete de la VM. El objetivo de esta revisión es describir las diferentes estrategias de ventilación en pacientes tratados con ECMO veno-venosa (AU)

Mechanical ventilation (MV) is a crucial element in the management of acute respiratory distress syndrome (ARDS), because there is high level evidence that a low tidal volume of 6ml/kg (protective ventilation) improves survival. In these patients with refractory respiratory insufficiency, venovenous extracorporeal membrane oxygenation (ECMO) can be used. This salvage technique improves oxygenation, promotes CO2 clearance, and facilitates protective and ultraprotective MV, potentially minimizing ventilation-induced lung injury. Although numerous trials have investigated different ventilation strategies in patients with ARDS, consensus is lacking on the optimal MV settings during venovenous ECMO. Although the concept of 'lung rest' was introduced years ago, there are no evidence-based guidelines on its use in application to MV in patients supported by ECMO. How MV in ECMO patients can promote lung recovery and weaning from ventilation is not clear. The purpose of this review is to describe the ventilation strategies used during venovenous ECMO in clinical practice (AU)

[Sanitary interest of carbonic, carbogaseous or acidulated waters]. / Interés sanitario de las aguas carbónicas, carbogaseosas o acídulas.

The intention of this Communication is to highlight the main characteristics of the carbonic, carbogaseoses or acidulated waters of the Spanish legislation, as therapeutics agent as well as bottled drinking waters. These waters stimulate the secretion and motility of the digestive apparatus and if they are given by oral way in a correct amount, they have diuretic effects. In balneation they also introduce a vasodilatation, effect due to the penetration of the gas carbonic into the skin and its contact with the vascular walls, but this practice is not common in Spain.

Traqueopatía osteoplástica: aportación de otro caso / Osteoplastic tracheopaty: a case report

Las causas productoras de estenosis traqueales son diversas, siendo las más frecuentes las iatrogénicas (períodos de intubación prolongados para apoyo ventilatorio). Menos frecuentes son las congénitas, las infecciosas, las tumorales, y las derivadas de otras patologías como la sarcoidosis, policondritis, etc. Más raro aún es la conocida como traqueopatía osteoplástica. Esta entidad, de etiología desconocida, provoca dificultad respiratoria progresiva. Su diagnóstico de sospecha es por imagen y el definitivo mediante el estudio histopatológico. Su tratamiento es con láser carbónico, generalmente con buena respuesta. Presentamos el caso de un paciente con disnea progresiva causada por una estenosis osteoplástica; exponemos su manejo diagnóstico y terapéutico y su evolución (AU)

[Health resort treatment of children with progressive muscular dystrophy]. / O lechenii detei s progressiruiushchimi myshechnymi distrofiiami na kurorte.

The results of a complex treatment at health resorts of 126 children with Duchenne myopathy and 84 children with spinal amyotrophies at the age of 5-15 years are given. The complexes included carbon-dioxide sulfurated hydrogen baths, mud application (with different localization depending on a form of the disease), fresh baths, oxygenotherapy and therapeutic physical training. The authors revealed good tolerance to procedures and the positive dynamics of the main clinical manifestations of the disease, confirmed by the electrophysiological and biochemical studies. As a result of the treatment it was possible to achieve progressiveness of the disease in all patients at different periods (from 1 month to 1 year). The authors give recommendations for the use of treatment at health resorts as a necessary link in the general chain of rehabilitative measures for children with various forms of progressive muscular dystrophies.

[Health resort treatment of preschool children with cerebral palsy]. / Kurortnoe lechenie detei doshkol'nogo vozrasta s tserebral'nymi paralichami.

In the Pyatigorsk resort, 226 children from 3-7 years of age with different forms of cerebral paralysis were studied. For therapeutic purposes, besides general health improvement measures, remedial gymnastic and massage, such resort factors as carbon dioxide and sulfurated hydrogen and radon baths of different concentrations and mud procedures were used. As a result of such studies, some indications for referrals of preschool children with cerebral paralysis to balneomud resorts were outlined. Differentiated complexes of resort treatment, depending upon the form and severity of clinical sings were elaborated, as well as the possibility of resort therapy in children with cerebral paralysis, complicated by the intracranial hypertensive syndrome.